Biomedical subjects
Publications and source records attributed to L Ekelund.
Thirteen patients with renal carcinoma, primarily not operated upon, were re-evaluated 1 to 71 months after the first nephroangiography. Tumour progression could be demonstrated in 7 cases with a maximum linear diametric growth rate of 0.5 cm/2.5 months. The reasons for absence of growth in the remainder are not apparent, but probably related to the state of immunologic defense mechanism of the host.
Angiographic findings in 21 cases of renal pelvic carcinoma are presented. Important characteristics include neovascularity, visible capillary phase, vascular encasement, wide pelviureteric artery and absence of arteriovenous shunting. Angiography may also be of value for the differential diagnosis of ureteric obstruction as demonstrated in 5 of 6 patients with carcinoma of the ureter.
Liver angiography was performed in 13 patients with Crohn's disease and three with ulcerative colitis. Of these patients, 13 underwent liver biopsy, and findings were correlated with results of angiography and biochemical tests. Twelve liver biopsies were abnormal, primarily showing fatty infiltration and reactive hepatitis. Thirteen angiographies were abnormal, with widened and tortuous liver arteries being the most common finding. Liver function tests were within normal limits for all but three of the 16 patients, thus correlating poorly with findings of the other tests. These data show that angiography is useful in detecting hepatic abnormality, but evaluation with liver biopsy is necessary to determine the nature of the lesion.
Renal size (product of length and width) was measured at urography before and after nephrectomy performed for tumor in 33 patients aged 38-78 years (mean, 59). In 88% a statistically significant enlargement of the remaining kidney was found (P less than .001). Earlier reports stating that compensatory renal hypertrophy does not occur in older patients cannot be supported.
Amniotic fluid was obtained by transabdominal amniocentesis in 51 women in the 29th-36th week of pregnancy. The lecithin/sphingomyelin ratio was determined. In 28 patients,the ratio was less than 2.2. Beta-methasone was given for three days to 14 of them; the rest served as controls. On the fourth day, a second amniocentesis was performed on all patients. The lecithin/sphingomyelin ratio rose to a value greater than 2.2 in 4 of the patients in the betamethasone-treated group and in one of the controls. The percentage of palmitic acid in the lecithin increased concomitantly with increasing lecithin/sphingomyelin ratio. These results suggest that glucocorticoid induced acceleration of fetal pulmonary maturation may be reflected in the amniotic fluid as changes in its phospholipid composition. The lecithin/sphingomyelin ratio was found to be greater than 2.2 in 23 patients at the first amniocentesis. In such cases treatment with glucocorticoids can be avoided.
Percutaneous fine needle aspiration biopsy was performed at retrograde pyelography in order to differentiate between metastatic and scarry involvement of a strictured ureter in a patient earlier operated upon because of malignant teratoma. The method is recommended in patients with malignant diseases where the differential diagnosis is impossible to establish at retrograde pyelography or urography.
Fifteen physically healthy women who received permission for legal abortion on sociomedical grounds in the second trimester of pregnancy were given either cortisone acetate per os or adrenocorticotrophic hormone (ACTH) intramuscularyly for 3 days previous to hysterotomy. Eight other patients served as controls. The phospholipid composition of amniotic fluid, fetal lung washings, and lung tissue was analyzed. In the cortisone group there was a significant increase in the proportion of palmitic acid in the lung tissue lecithins linked to a corresponding decrease in the oleic acid. A similar tendency was observed in the ACTH group, but the changes were not significant. The investigation suggests that the human fetal lung already at this early stage of development is capable of responding to the action of cortisone by a relative increase in the synthesis of dipalmitoyllecithin.
Human fetal lung tissue obtained during the second trimester was cultured as organ culture with or without cortisol. The effect of cortisol on the phospholipid metabolism, as related to the appearance of osmiophilic lamellar bodies and the localisation of newly incorporated choline, was studied. In cortisol-treated explants, the concentration of saturated lecithins and the incorporation of (Me-3H)-choline into saturated lecithins increases significantly concomitantly with an increased number of osmiophilic lamellar bodies. The labelled choline is predominantly associated with these bodies. The obtained results indicate that cortisol accelerates the synthesis of pulmonary surfactant in the human fetal lung as early as in the second trimester.
Lungs obtained from human fetuses with a gestational age of 17, 19, and 24 weeks were cultured as organ culture for 6 days with or without cortisol. The total phospholipid content per milligram protein in the explants incubated with cortisol increased by 56-81 per cent compared with the controls. Lecithin accounted for 62-69 per cent of the phospholipid increment in the cortisol-treated explants, whereas only 44.2 per cent of the total phospholipids in the control incubations consisted of lecithin. Cortisol increased the incorporation of [Me-3H]choline into lecithin by 118-224 per cent. The investigation shows that the human fetal lung, quite early in gestation, is capable of responding to the action of glucocorticoids by accumulating phospholipids.
The angiographic findings in a relatively large number of expansile lesions of the spleen are presented. In cysts our findings correspond to those in earlier reports, the hallmark being stretching of intrasplenic arteries and veins around an avascular espansile lesion. As to neoplasms (primary as well as secondary), however, our findings suggest that the criteria of malignancy, that is, neovascularity, vascular encasement, and arteriovenous shunting, may be more frequent than is evident from earlier reports.
The angiographic findings in 13 patients with renal hemangiomas (one pararenal) are presented. The material suggests, contrary to earlier reports, a predominance for the female sex and the right kidney. Nine of the patients had macroscopic hematuria, of which five had renal colic. Obstruction was found at urography in seven cases. Renal angiography is the definitive diagnostic procedure and should be performed in all cases of unexplained macroscopic hematuria. Diagnosis may eventually be improved by pharmacoangiography or by hemodynamic studies using a dye dilution technique, as small arteriovenous shunts may remain undetected at angiography. Cardiac decompensation was not noted in our material, even though arteriovenous shunting within the hemangioma was seen in eight cases, suggesting that the shunt flow in renal hemangiomas usually does not reach levels high enough to impair the general circulation. Hypertension was present in only one patient, attributed to chronic pyelonephritis. Hematuria disappeared in all nine patients operated upon.
Phospholipids in embryonic lung tissue, pulmonary washings and amniotic fluid were measured to study the development of lyng surfactant in the horse. A significant increase in the concentration of total phospholipids in lung tissue and a concomitant rise in the amount of dipalmitoyl lecithin in amniotic fluid between 100 and 150 days of gestation indicated the initial formation of surfactant in the fetal lung during this period.
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