Biomedical subjects
Publications and source records attributed to K Tallroth.
Massive callus formation in a distal femoral metaphyseal fracture of a trisomy-2 patient is reported. The child was neurologically severely handicapped. The possible pathomechanics of the callus formation is discussed.
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Between 1972 and 1981, 59 wrists of 44 patients destroyed by rheumatoid arthritis were arthrodesed by internal fixation with a Rush pin. This study comprises 45 wrists of 38 surviving patients--nine men and 29 women, aged 20 to 72 years. The follow-up time ranged from 1 to 11 years with a mean of 3.9 years. The surgical technique used in this study is simple and safe, and a good position of the wrist in both frontal and lateral projections can easily be achieved. The Rush pin is passed down the third metacarpal and into the radius. It stabilizes the wrist adequately. All the wrists operated on obtained a strong bony fusion of the radiocarpal joint. The complication rate was low. Five of 45 Rush pins were removed because the subcutaneously located distal tip between the metacarpals irritated tendons and skin. In one male patient a thin Rush pin broke and a pseudoarthrosis of the intercarpal joints developed; there was, however, no need to remove the pin.
Round atelectasis is a little-known form of peripheral pulmonary collapse which may mimic a neoplastic tumor. Usually the atelectasis forms a well-demarcated round or oval intrapulmonary pleural-based mass at the basal, posterior or interlobar pleura. It is thought to be a sequela of a pleural effusion. If the radiographic features are characteristic, and fine-needle biopsy finding negative, the diagnosis of round atelectasis can be made with assurance, and unnecessary procedures such as thoracotomy and pulmonary resection can be avoided. In this paper experiences of 11 patients with this condition are presented. In 4 the diagnosis was established by surgery and in 7 a long-term follow-up confirmed the diagnosis of a nonmalignant intrapulmonary lesion. The pathogenesis, clinical and radiological features, and the diagnostic workup are discussed.
A 58-year-old patient with neutropenia due to SLE developed spondylitis of the lumbar region caused by Candida albicans. The spondylitis was probably superinfected with Staphylococcus aureus. The initial one month's intravenous combination therapy with amphotericin B and flucytosine was discontinued because of fever reactions to amphotericin B, suspected myelosuppressive effect of flucytosine and insufficient clinical response. This therapy was followed by four months of oral ketoconazole and clindamycin with good results and without any side-effects.
Silastic implants for a wide variety of medical purposes are in current and frequent use worldwide. Only recently there have been reports of the migration of silicone to the surrounding tissues via lymphatics. In the present material of nine cases with carpal implants followed for more than two years, bone cysts developed in the surrounding bones on five occasions. The only cysts so far investigated thoroughly contained foreign body reaction, and silicone could be detected by electron probe microanalysis. A long-term follow-up is suggested whenever these implants are used.
A case is presented in which intermittent swelling of the face, left upper limb and both lower limbs was associated with steatorrhea. The thoracic duct was found to be obstructed at the thoracic outlet. After surgery the symptoms disappeared promptly. The value of lymphography is discussed and compared to the other diagnostic methods.
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The lymphographic appearances of the retroperitoneal lymph nodes in 10 patients with multiple myeloma have been analyzed. None of the patients had any signs of extramedullary involvement of myelomatosis before lymphography. In 3 cases irregular filling defects suggestive of myelomatous involvement were found. In one case they were close to a myelomatous bone lesion, whereas in the others the lymphographic abnormality was totally unexpected. In all 3 patients other nodes showed reactive hyperplasia. Such nonspecific hyperplasia was also encountered in 3 other cases. In 2 cases the myelomatous involvement of lymph node was detected before the diagnosis was recognized which is contrary to the belief that multiple myeloma involve nodes late in the disease. In addition to diagnostic aid the lymphographic demonstration of the myelomatous spread into lymph nodes may influence on the selection of the therapeutic approach to the disease.
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Three patients with primary lymphomas of the brain are presented. The angiographic and computed tomographic (CT) appearances resembled the few cases reported previously. In all three cases angiography showed avascular tumours with little vessel displacement or involvement whereas the CT scans showed large strongly and homogeneously enhancing tumour masses. Neither method alone gives pathognomonic appearances, but taken together angiography and CT should suggest the diagnosis of this rare tumour.
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The case material was collected from 3 Institutions with a total of 441 patients: 217 with primary bone tumor and 224 with soft tissue sarcomas. In the majority of patients lymphography was performed during the initial diagnostic workup. The lymphograms were interpreted as negative or positive for metastases. In bone tumors, the incidence of metastases was 21%, ranging from 28% for osteosarcoma to 18% for Ewing's sarcoma and 13% for chondrosarcoma. In tumors of the soft tissue, the frequency was somewhat higher (28%), with special regard to rhabdomyosarcoma (53%), anaplastic sarcoma (67%), neurogenic sarcoma (42%) and synovial sarcoma (35%). In the group of bone sarcomas, primary hematogenous spread was 3 times more frequent than lymphogenous spread, while in soft tissue sarcomas, with a higher incidence of lymphatic spread, this finding was inverted. In the more consistent tumor groups, the occurrence of lymphatic metastases indicated a significant worsening of the prognosis. In 96 patients, lymph node biopsies were performed and the radiologic histologic correlation gave evidence of a 97.7% overall diagnostic accuracy.
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The diagnostic value of double contrast barium meal and endoscopy was assessed in a material of 100 patients with upper abdominal symptoms. Although endoscopy turned out to be more sensitive in revealing pathologic conditions of the stomach, barium meal is by no means obsolete, provided that due attention is paid to the examination technique.
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