Computed tomography of bone and soft tissue tumors.
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Biomedical subjects
Publications and source records attributed to L Ekelund.
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A review of the available clinical documentation on the use of iohexol in urography reveals good radiographic properties and patient tolerability with less adverse reactions than several of the conventional ionic contrast media under comparison. Iohexol has clearly been shown to be well suited for urography in adults and may be the contrast medium of choice in pediatric urography.
Tumour vascularity of a transplantable N-methyl-N-nitrosoguanidine induced adenocarcinoma of the colon in the liver was investigated by repeated hepatic arteriography and portography. The arterial vascularity was influenced by tumour size; a transient increase in vascularization was observed when tumour size increased. Portography revealed portal vessels concentrated to the peripheral parts but some portal vessels were also observed leading to the central part of the adenocarcinomas. The tumour volume of solitary adenocarcinoma in the liver could be estimated from measurements of the largest (a) and smallest (b) diameters on the angiogram according to the formula V = a x b2/2.
Six cases of suspected osteoid osteoma of tubular bones were evaluated by computed tomography (CT). In all cases a radiolucent nidus was clearly demonstrated. In two cases a radiodense center of the nidus was visualized. It is suggested that CT may replace conventional tomography in the evaluation of these lesions. Due to its ability to locate the lesion in the transverse plane, CT is superior for the exact planning of surgery to avoid unnecessary large or misdirected resections. Adequate window settings are essential in the evaluation of these lesions.
Computed tomography (CT) was performed in seven patients with intramuscular myxoma. All lesions were well demarcated, of homogeneous appearance and attenuation values ranging from 10 to 60 (HU). The tumor size, as estimated at CT, correlated well with the size of the surgical specimen, which is in contrast to the findings in some high grade malignant sarcomas.
Twenty-six patients with soft tissue lipoma and liposarcoma were evaluated by CT; 17 lipomas and 9 liposarcomas. All the lipomas except for one subcutaneous lesion were well-delineated. All but one partly calcified lipoma had homogeneous density with attenuation values in the range of the patients' own subcutaneous fat (-65 to -125 HU). The liposarcomas, on the other hand, were less well-delineated and less homogeneous with considerably higher attenuation values. Contrast enhancement may be seen as opposed to lipomas. The results indicate that it is quite possible by CT to differentiate between lipoma and liposarcoma, which is of great help in the preoperative planning.
An open surgical method for the creation of experimental renal artery stenosis by ligation with chromic catgut is described. Microscopic examinations at different intervals demonstrated the development of fibrosis throughout the arterial wall. These stenoses seem to provide a suitable model for the study of the effects of balloon catheter dilatation. Previously reported techniques for experimental artery stenosis induction are briefly reviewed.
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CT and angiography were performed in 21 patients with soft tissue tumors of the extremities (18 malignant and 3 benign) and the results were compared with the surgical and histopathologic findings. The tumor size was correctly evaluated at CT in 15 of 21 cases and at angiography in 17 of 21 cases. The main reason for overestimation of longitudinal tumor extent seems to be edema surrounding the poles of high grade malignant neoplasms. CT was superior to angiography in demonstrating the intra- or extramuscular tumor location. If only factors important for the surgical planning are considered, angiography yielded such information in 8 cases while CT was of critical value in the preoperative evaluation of 14 patients. It is concluded that CT should precede angiography in the examination of soft tissue tumors of the extremities. Angiography may be superior to CT in demonstrating vascular anatomy in relation to tumors of the medial thigh. With other tumor locations, angiography should be reserved for those lesions where vascular relationships are not adequately demonstrated at CT.
Stenotic renal artery anastomoses were produced in pigs in order to investigate the effects of transluminal angioplasty. Six weeks after surgery unilateral dilatation with a modern balloon catheter was performed in 8 pigs. These animals were reexamined with angiography and pressure gradient recording 8 to 10 weeks after dilatation and with post-mortem angiography 8 to 10 weeks later. Only 2 arteries had minimal residual stenoses, while in 6 arteries the stenoses were completely eliminated. Microscopic examination showed thinning of the fibrotic vessel wall, with defects in the internal elastic lamina.
Fibrous renal artery stenosis was induced by subtotal ligation with chromic catgut. Six weeks following unilateral ligation, transluminal balloon dilatation was performed in 8 pigs. Angiography was performed 8 to 10 weeks after dilatation, and at post-mortem 20 weeks after dilatation. Intra-arterial blood pressure and renal venous renin activity were measured before and at the repeat examination after dilatation and the morphologic changes in the arterial wall were evaluated at microscopy. Restenosis developed in 2 renal arteries, while successful dilatation was achieved in 6 cases.
Radiation doses to the skin, ovaries and testes were measured at urography and CT examinations of the kidneys and adrenals. The absorbed dose to the breasts and bone marrow at CT was estimated as well as the mean bone marrow dose at urography. The results were compared with previous measurements of absorbed doses and energy imparted at abdominal angiography including nephroangiography. CT of the kidneys involves a considerably lower risk for late biologic effects to the patient than urography and, in particular, angiography.
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Repeated, often severe, bleeding occurred from conduits constructed for urinary diversion in a young man. Ileum, sigmoid colon and part of the gastric antrum were successively utilized for diversion of urine. Histologic studies showed inflammatory changes within the conduit loops. The cause of this rare condition is unknown. Various measures to control the bleeding were unsuccessful.
Surface replacement of the hip was performed on nine patients (11 hips) with chronic arthritis. The results were evaluated twice clinically, as well as by radiography and roentgen stereophotogrammetry, an average of 15 and 23 months postoperatively. The early clinical results were promising. One or both of the components were loose in five hips and the acetabular socket had migrated in one hip, as revealed by the radiograms. Roentgen stereophotogrammetry revealed loosening in one hip and migration of one or both of the components in eight hips altogether. The radiograms gave the information needed in the daily routine but roentgen stereophotogrammetry gave more accurate information about early migration. At the third clinical follow-up, an average of 35 months postoperatively, two hips had been reoperated on and two had developed pain.
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