Biomedical subjects
Publications and source records attributed to H H Lien.
CT-scans of 12 patients with tumour-induced occlusion of the inferior vena cava were studied with regard to collateral veins. A comparison was performed with findings at phlebography in 10 patients and at autopsy in 2. The site and appearance of the main collateral pathways are presented. A close study of vascular structures renders useful information on collateral circulation in occlusion of the inferior vena cava.
Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development.
The width of the right and left thoracic paraspinal shadows were measured at all levels in 200 presumably normal individuals. The paraspinal shadow could be identified in nearly all cases on the left side and in approximately one-third on the right. The range of variation was greater on the left side than one the right. The left paraspinal shadow was wider at the upper levels and in individuals above 40 years of age.
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Computed tomography of the azygo--oesophageal recess was performed in 85 normal subjects. The recess was convex towards the left or had an approximately straight left wall. Convexity towards the right did not occur. Localized bulges caused by the azygos vein, oesophagus and aorta were frequent. The recess became gradually deeper caudally in patients below 50 years of age. Above that age a marked posterior extension of the heart and a prevertebral position of the aorta often caused a localized shallowing at the level of the inferior pulmonary veins or the ventricles.
In 20 patients with measurable metastatic renal cancer 4'-epi-doxorubicin (Adriamycin) administration (75 mg/m2, every 3 weeks) did not result in any tumor remission. Hematologic and gastrointestinal toxicity was generally mild to moderate. Anthracycline-induced cardiac side effects were not observed in any of the patients.
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The distance from the posterior border of the inferior vena cava to the anterior vertebral margin was measured in 100 presumably normal patients in the supine position. Seventeen of these were also examined in the right and left lateral positions and the changes in course of the vena cava compared with the supine position.
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Fifty patients with testicular tumor were subjected to computer tomography, lymphography, cavography, and retrograde phlebography of the left renal and testicular veins followed by urography. The yield of computer tomography in detecting metastases of the iliac, lumbar and thoracolumbar regions was compared with that of the other examinations, and was particularly high in the upper part of the retroperitoneal space.
Antegrade phlebography of a testicular vein in connection with orchidectomy was performed in 29 patients and funicular lymphography was successful in 26 of these. Eleven patients had retroperitoneal metastases and 18 were normal. The phlebographic and lymphographic findings in both groups are described and discussed as well as the collateral pathways in cases with stenosis of the testicular vein. Antegrade phlebography is recommended but funicular lymphography does not merit a place in the routine examinations of patients with testicular tumor.
The non-ionic water-soluble contrast medium metrizamide (Amipaque) was used for high-dose urography in 11 patients with apparently normal renal function. Films of good quality were obtained. Adverse reactions and the effect on pulse and blood pressure as well as a large number of blood and urine laboratory parameters were recorded. Only clinically insignificant effects occurred, and the medium is recommended for further use in urography.
Displacement of the inferior vena cava, impressions made by adjacent structures, or intraluminal filling defects mat indicate retroperitoneal tumor growth. However, similar changes may be caused by nonmalignant normal or pathological conditions. The authors illustrate several such cases seen among 1,428 examinations performed during a three-year period.
The value of lymphography from the foot, urography and phlebography of the inferior vena cava and the left renal and testicular veins in the search for retroperitoneal metastases was investigated in 120 patients with testicular tumors. Phlebography of the left renal and testicular veins was a valuable supplement to the other examinations, so that the combined use of all these methods is recommended in demonstrating metastases and in evaluating the extent of growth and effect of treatment.
The normal phlebographic appearances of the left renal and left testicular veins are described, based upon the findings in 100 patients admitted because of confirmed or possible testicular tumor. The patients had no metastases demonstrated at foot lymphography, urography and phlebography of the inferior vena cava.
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