Biomedical subjects
Publications and source records attributed to W Mortensson.
Five cases with echogenic intraabdominal or retroperitoneal cystic structures are described. Some suggestions as to the differentiation of such findings from solid tumors are given.
Chest X-ray, pulmonary mechanics, clinical lung disease and growth were studied in 48 low birthweight infants surviving after ventilator treatment in the neonatal period. Bronchopulmonary dysplasia (BPD) was present in 14 infants shortly after weaning off ventilator. At 4 to 6 years of age most patients had normal chest radiographs but 13 still showed signs of pulmonary fibrosis and hyperinflation. Most patients had low dynamic compliance and high pulmonary resistance shortly after ventilator treatment. All but 8, however, had normal findings at 1 to 1 1/2 years of age. Pneumonias and bronchitis were common during the first two years but thereafter declined in frequency. Weight and length development were retarded for BPD patients during the first two years and for non-BPD patients for the first year. Both groups had a complete catch-up.
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In 59 normal infants attending well-baby clinics, food consumption was registered until 26 and growth until 52 weeks of age. They were either breast-fed or formula-fed with a cow's milk product or a soy protein product. The average consumption of breastmilk was 746, 796, 722 ans 689 g/day at 6, 14, 22 and 26 weeks respectively. Bottle-fed infants received larger volumes, and at 6 and 14 weeks were the calculated total energy intakes significantly higher than in breast-fed infants. No differences were seen between the feeding groups with respect to length and the sum of four skin folds. The soy formula-fed children, who happened to be 200 g heavier at birth, had lower weight gains during the first 6 weeks than the other two groups. Thereafter, the average weights of the soy formula group did not differ from the other groups. At 3 months, the soy formula-fed children displayed a slower mineralisation and maturation of bone, but the difference was no longer significant when re-examined at 6 months. Formulas based on soy protein isolates seem to be acceptable as substitutes for cow's milk formulas in feeding normal infants.
The value of glucagon to facilitate hydrostatic reduction of childhood ileo-colic intussusception was tested in a series of 188 consecutive cases. Sixty-nine patients selected at random received 0.05 mg glucagon/kg body weight intramuscularly before attempts at reduction were started. The rate of successfully accomplished reductions was 84 per cent in the test group and 76 per cent in the control group (not significant). The time for accomplished reduction was approximately equal in the two groups. After 3 unsuccessful attempts at hydrostatic reduction patients in the control group received glucagon. The subsequent attempt at reduction proved successful in slightly more than every second case. No complications occurred. In general, glucagon was not found to improve the rate of employed reductions nor on the time necessary for reduction to take place. The investigation indicated, however, that there may be a limited benefit of adjuvant medication of glucagon. After two unsuccessful barium enemas glucagon administration is therefore recommended before a third attempt at reduction is performed.
Two cases are reported of osteomyelitis in the proximal end of the femur and humerus, respectively, with subsequent reduction of the blood supply to the corresponding head. A hypothesis is presented to explain the genesis of the ischemia, and the implications on treatment of osteomyelitis of the hip and shoulder regions.
Tc-pertechnetate scintigraphy was performed in 81 infants and children, clinically suspected to have Meckel's diverticulum with ectopic gastric mucosa. The predominant symptom was rectal bleeding and anemia. Twenty-two patients underwent laparotomy and 12 had Meckel's diverticulum with ectopic gastric mucosa. In operated patients the sensitivity of scintigraphy in detecting ectopic gastric mucosa was 0.75, the specificity 1.0 and the diagnostic accuracy 0.86; the diagnostic accuracy was estimated to 0.96 for the whole material. Histologic examination of the diverticula showed a smaller area of the ectopic mucosa in cases with negative scintigraphic findings. In addition, prominent fibrosis seemed to be a more consistent finding in cases with negative as opposed to those with positive scintigraphic findings. Presence of anemia may provide a guideline as to whether or not scintigraphy is indicated.
Potentially pathogenic bacteria were isolated from the nasopharynx in 33/66 hospitalized infants and children with verified respiratory syncytial virus (RSV) infection. The value of chest roentgenograms and blood counts for the prediction of concomitant bacterial infection was evaluated. Abnormal chest roentgenograms were found in 89% whether pathogenic bacteria were present or not. The most common finding was general hyperinflation of the lungs, with or without infiltrates. This occurred more frequently in the group with isolated RSV infection. Fever, leucocytosis and an elevated ESR were found during the illness in more than half the cases. These findings were more frequent in children who harboured potential pathogenic bacteria, though the difference was not significant. For optimal evaluation of a case all available information about it should be taken into consideration.
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Serum alpha-fetoprotein (AFP) was analysed at 10-30 days of age in infants with positive TSH screening tests for congenital hypothyroidism. These levels were significantly higher in infants with true positive screening tests than in those with false positive tests; 27 of 43 infants with congenital hypothyroidism had serum AFP levels above the age-related reference range. The postnatal rate of elimination of AFP from serum did not differ in hypothyroid and euthyroid infants, indicating that the difference in serum AFP was due to more extensive synthesis in hypothyroid individuals. The level of serum AFP was inversely correlated with the roentgenological skeletal maturation index. It is postulated that increased serum AFP is caused by prenatal hypothyroidism and that analysis of serum AFP is a valuable tool to identify those infants with congenital hypothyroidism who are at risk of neuropsychological sequelae.
Villonodular synovitis in the hip joint of a girl aged 13 years diagnosed by means of arthrography is reported. The value of arthrography in examination of obscure hip joint complaints is emphasized.
Forty preterm infants treated with intermittent positive pressure ventilation were examined with chest radiography and tests of lung mechanics soon after ventilator treatment was completed and again 5 to 15 months later. The results of the two examination modalities were compared and related to occurrence of respiratory tract infection during the first years of life.
A prospective investigation is presented on the usefulness of lymphography, computed tomography, ultrasound, radionuclide examinations and fine-needle aspiration biopsy of the spleen and the liver in assessing subdiaphragmatic spread of Hodgkin's disease. Initial staging laparotomy is superior to all other diagnostic procedures. If laparotomy cannot be performed, CT and scintigraphy of the spleen are recommended. At restaging CT and lymphography provide equal diagnostic yield; CT is suggested, however, to be used in the first place.
The energy imparted and the radiation dose to the lungs, the breasts, the thyroid and to the bone marrow at chest radiography of infants and children were measured or calculated and the risk of inducing future malignant diseases was estimated. The radiation doses to the various organs corresponded to 5 to 30 per cent of the yearly background radiation. In infants of both sexes as well as for boys at a later age, radiation-induced leukemia and thyroid carcinoma constituted the greatest risk of future malignancies. After infancy, girls were more exposed to the risk of future breast carcinoma. On the whole, the risk of developing breast carcinoma constitutes a greater problem than does, for example, the risk of leukemia. Reversing the beam direction from postero-anterior to anteroposterior increases this risk while the risk of leukemia will remain unchanged.
Forty femoral neck fractures were followed for 5 years in a prospective clinical, roentgenographic and scintimetric investigation. Thirteen cases had uncomplicated healing, 22 necrosis and five non-union. The diagnostic value of radiographic changes was analysed with reference to development of necrosis of the femoral head or non-union. Sclerosis of the femoral head, and compression and displacement of the fracture were compatible with eventual healing and clinical recovery. Subchondral fracture and collapse of the load-bearing surface, diagnostic for necrosis, were observed in only 7 of 22 cases at 1 year and as late as 3-5 years in three cases. By contrast, four out of five non-union cases were established radiographically within 1 year. Patients needing an arthroplasty after fracture of the femoral neck should be identified on clinical grounds after early radionuclide scintimetry. Waiting for radiographic documentation of necrosis in cases with pain will increase the risk for physical and social impairment associated with poor function of the hip.
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In 40 patients with fracture of the femoral neck 85Sr scintimetry was performed at the time of nailing and 4 months postoperatively. The fractures were radiographed repeatedly for 5 years; thirteen fractures healed without complications, 22 developed necrosis of the femoral head, and 5 pseudarthrosis. The early isotope measurement did not distinguish between normal and necrosis cases even with detailed analysis. The 4 months activities were high in osteonecrosis and low pseudarthrosis. The latter observation is interpreted as evidence that non-union of a femoral neck fracture is due to severe permanent vascular damage.
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