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Biomedical subjects

I Tollefsen

Publications and source records attributed to I Tollefsen.

At least 19 recordsLinked to original sources

Thymic cyst: is a correct preoperative diagnosis possible? Report of a case and review of the literature.

UNLABELLED: A case of a giant cervico-mediastinal cyst of thymic origin in an 8-year-old child is presented. The cyst was asymptomatic except for deformity due to its size. In spite of several diagnostic approaches like ultrasonography, computed tomography, cyst puncture with biochemical analysis of cyst content and direct contrast injection and radiography after emptying of the cyst, the ultimate diagnosis as to the origin of the cyst was not disclosed until after operation and histopathological examination of the operative specimen. On a more general basis the diagnostic possibilities and pitfalls are discussed. CONCLUSION: a correct preoperative diagnosis of a thymus cyst is difficult and in many instances impossible even when all diagnostic measures at hand are utilized, including radiographic methods, computed tomography, magnetic resonance imaging, ultrasonography and biochemical examination of cyst aspirate and estimation of tumour markers in cyst fluid and serum.

Biopsy↗

Aortic dissection: natural course of disease? Report of two cases representing the extremes of the condition.

OBJECTIVE: In a time when diagnostic methods and above all, surgical as well as interventional radiological treatment for aortic aneurysms and aortic dissections have reached a point nobody could think of a few years back, the present authors feel that it is worth while to remind oneself of the natural course of disease in these conditions. Taking into consideration the high morbidity and mortality rate in surgically treated patients with aortic dissection, and the high complication rate per- and postoperatively, it also seems right to ask if a more expectative and conservative approach to the condition sometimes perhaps may be justified. METHODS AND MATERIAL: Two case reports are given. One was a 15-year-old boy with Stanford (Daily) type B dissection who statistically ought to have a good prognosis, but who died within 2 h after onset of symptoms. The other patient, a middle-aged woman with Stanford type A dissection, survived for 25 years without operation. CONCLUSION: These two cases, though not unique viewed separately, we consider to represent the extremes of the condition and also a natural course of disease, while none of them was operated on.

Adolescent↗

[Radiologic intervention in the biliary tract performed at a central hospital].

During the ten-year period 1987-96, 131 diagnostic percutaneous transhepatic cholangiographies (PTC) were performed in 103 patients due to obstructive jaundice. 54 cases of percutaneous transhepatic bile drainage (endoprosthesis) (PTBD) and 53 of percutaneous transhepatic external drainage (PTED) were also performed. In 89 patients (86%) the obstructive jaundice was caused by malignant disease. Puncture was done under fluoroscopic or ultrasonographic control. An 8 Fr. plastic endoprosthesis of 15 cm length was used for internal bile drainage, and a 7.6 Fr. 60 cm long catheter was used for external drainage. For combined external/internal drainage an 8.4 Fr. catheter of 60 cm length was used. 24 patients (23%) developed complications. Eight of these complications were serious, and three patients (2.5%) died as a result of the procedure. Three patients developed duodenal perforations. 11 out of 51 patients (20%) treated with endoprosthesis died within 30 days. Mean functioning time for endoprostheses was 128 days. Progress in radiologic intervention technique has changed the treatment of obstructive jaundice. In our view, endoscopic bile drainage should be the treatment of choice. Percutaneous transhepatic bile drainage is an alternative in cases where endoscopic therapy fails.

Adult↗

[Forestier syndrome. A rare cause of dysphagia and dyspnea].

Of the many diseases presenting some kind of dysphagia, Forestier's syndrome is perhaps one of the rarest. In American literature DISH, or diffuse idiopathic skeletal hyperostosis, is the most commonly used term. The authors present a case, a 57-year-old man from Eritrea, whose only complaints were dysphagia and some breathing problems. Lateral X-ray revealed radiologic changes in the cervical vertebral column, fairly typical for Forestier's syndrome, with large osteophytes and extensive ossification on the anterior border, reaching from the level of the second down to the seventh cervical vertebra. The radiographs also showed bulging of the pre-vertebral soft parts into the air column of the pharynx. Protruding osteophytes were surgically removed, with improvement of the patient's symptoms. A review of the clinical and radiological characteristics of the syndrome is also given and possible therapeutic measures are mentioned.

Deglutition Disorders↗

[Fluorosis. Experiences based on two cases].

Since 1961 sodium fluoride has been an alternative in the treatment of osteoporosis, although there is still some difference of opinion between endocrinologists regarding the effect on pain and occurrence of fracture of the vertebral column. Two cases are reported, both treated for postmenopausal osteoporosis with calcium, vitamin D and sodium fluoride for longer periods over many years, and with good effect on pain and tendency to lumbar vertebral body fracture. In both patients the diagnosis of skeletal fluorosis was delayed for several years, mainly because information about this treatment never reached the radiologist. When the diagnosis was eventually established after the radiologist himself had made inquiries to the referring physician, the patients had in the meanwhile undergone several unnecessary supplementary examinations because of suspected cancer metastasis.

Aged↗

[Herniography. A 3-year material from a central hospital].

Herniography is the roentgenographic demonstration of hernias in the pelvic region by positive contrast peritoneography. The main indication for herniography is obscure groin pain and the suspicion of a hernia not visible at clinical examination. In a review of the last 75 patients from 1991-93, 30 hernias and 18 other findings were demonstrated. 13 patients have been operated till now, and their results are presented. Only 5.6% of Norwegian hospitals perform ten or more herniographies a year. We find herniography to be a reliable and safe diagnostic method that should receive more attention.

Adolescent↗

Transvenous pacemaker implantation via a unilateral left superior vena cava.

A 72-year-old man with a unilateral left superior vena cava and anomalous drainage of the inferior vena cava required permanent pacing. The anomalies were verified by venography and cardiac catheterization. Difficulties in implantation of a temporary and permanent pacemaker are described. A transvenous endocardial lead was placed in a stable position in the right ventricle. The pacemaker system has now functioned normally for 32 months.

Aged↗