Biomedical subjects
A Lunderquist
Publications and source records attributed to A Lunderquist.
[Rapid development within interventional radiology. Special training in new radiologic methods is needed].
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The YAG laser and Wallstent endoprosthesis for palliation of cancer in the esophagus or gastric cardia.
The need for frequent retreatment is a disadvantage of using endoscopic laser therapy (ELT) alone for palliative treatment of esophageal carcinoma. In this prospective study, therefore, we investigated the potential and feasibility of combining ELT with a self-expanding metallic stent (Wallstent). Twelve patients received ELT followed by stent placement (stent group) and were compared with 39 patients receiving ELT alone (ELT group). Swallowing ability was similar in the two groups. About one-third of the patients who had a short life expectancy, did not appear to benefit from stenting, whereas the interval between retreatments was prolonged by a factor of 2-4 in the remaining patients. Median survivals were 5.5 (range 1.0-23.5) months in patients with stents, and 4.5 (range 1.2-24.6) months in patients without stents. There were few complications related to stenting. In one patient, technical problems caused stent dislodgement into the stomach. Another stent patient died of hemorrhage from an untreated tumor in the stomach, but it was considered unlikely that the bleeding was caused by the stent. In conclusion, this preliminary trial suggests that a Wallstent endoprosthesis, used in combination with laser treatment, may become a valuable tool for prolonging the dysphagia-free interval in selected patients.
In vivo microscopy of hepatic metastases: dynamic observation of tumor cell invasion and interaction with Kupffer cells.
In vivo microscopy was used in the study of the biological behavior of tumor cells and of the activity of Kupffer cells in hepatic tumors in situ. Three tumor models, Friend erythroleukemia inoculated into Dilute Brown Aguti (DBA)/2 mice, murine colon adenocarcinoma (CT)-26 in Bagg Albino inbred albino (BALB)/c mice, and mammary cancer 13762 NF in Fischer rats, were investigated. Tumor cells showed a strong tendency to adhere to the sinusoidal endothelium, most frequently in the sinusoids near the tumors. Mechanical trapping of tumor cells in the narrow portion of hepatic sinusoids, a phenomenon suggested by previous investigators as a predominant pattern for tumor cells to arrest in the liver, was not confirmed. Our study documented that in tumor-bearing livers, as compared with normal control livers, the population size and the phagocytic capacity of Kupffer cells are increased in nontumorous areas but are significantly decreased inside the tumors. In vivo microscopic images showed that Kupffer cells are not only attracted to tumor cells in the hepatic circulation but also have the ability to phagocytose those tumor cells. In vivo microscopy has been shown to be a useful tool for dynamic studies in tumor biology, pathology, and pharmacology.
Hepatic in vivo video microscopic study for evaluating experimental and approved magnetic resonance contrast agents.
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Peribiliary plexa--important pathways for shunting of iodized oil and silicon rubber solution from the hepatic artery to the portal vein. An experimental study in rats.
OBJECTIVES: Iodized oil is commonly used in chemoembolization of hepatic tumors, and silicon rubber solution is used for casting studies of hepatic tumor vasculature. Understanding the distribution patterns of iodized oil and silicon rubber solution is of significance in the refinement of iodized oil techniques and proper interpretation of hepatic tumor vascular studies. In this study, the location for iodized oil and silicon rubber solution shunting from the hepatic artery to the portal vein was identified. METHODS: Iodized oil and silicone rubber solution were injected into the hepatic artery in rats. The porta hepatis and the liver periphery were examined using in vivo microscopy. RESULTS: Iodized oil and silicone rubber solution had identical distribution patterns in the hepatic circulation. Both were shunted in large quantities from the hepatic artery into the portal vein through the peribiliary plexa. Other potential shunting sites did not contribute to the shunting. CONCLUSIONS: Though of different chemical natures, iodized oil and silicon rubber solution share similar distribution patterns in the liver. Hepatic arterioportal shunting of these substances occurs via the peribiliary plexa.
Distribution and effect of iodized poppyseed oil in the liver after hepatic artery embolization: experimental study in several animal species.
To define the intrahepatic distribution of iodized poppyseed oil and its effect on the liver, hepatic artery embolization (HAE) was performed in five mice, 12 rats, four rabbits, and 21 pigs with the iodized oil alone or in combination with gelatin sponge powder (GSPow) in three rats or gelatin sponge particles (GSPs) in nine pigs. All mice, rats, and rabbits underwent radiography of the upper abdomen and in vivo microscopy of the hepatic periphery during and immediately after injection and 1, 4, and 24 hours later. All pigs underwent angiography before and after HAE as well as measurement of portal venous pressure before HAE and 15, 30, 45, and 60 minutes and 4 weeks after HAE. Follow-up radiographs were obtained in 18 pigs. HAE performed with the iodized oil only was well tolerated by the liver, even when high doses were used, likely because of continuous flushing of the sinusoids by high blood flow from peripheral arterioles. When HAE was performed with the iodized oil and GSPow, this blood flow ceased and necrosis developed. The degree of necrosis after HAE with the iodized oil in combination with GSPs was directly associated with the dose of iodized oil. HAE performed with GSPs only did not cause damage.
In vivo microscopy of hepatic tumors in animal models: a dynamic investigation of blood supply to hepatic metastases.
The dynamics of blood circulation in three experimental animal models of hepatic metastasis were investigated with in vivo microscopy. It was demonstrated that the tumor vasculature communicated with the portal venules and hepatic sinusoids that surrounded the tumors. The hepatic artery was not seen to connect to the tumors directly. However, it was demonstrated that arterial blood entered tumors through the portal venules and that the hepatic arterial flow entered the tumor without resistance, while blood from the portal vein met great resistance at the tumor border, with only small amounts entering the tumor. Interruption of either the hepatic artery or the portal vein did not result in cessation of the blood circulation in hepatic tumors. A reciprocal relationship between the hepatic arterial and portal venous supplies to hepatic tumors was suggested, and it was hypothesized that arterioportal communications play an important role in the arterial and portal venous supply of blood to hepatic tumors. A comprehensive understanding of the blood supply of hepatic tumors is important for improving clinical treatment of hepatic tumors.
Effect of biliary decompression on reticuloendothelial function in jaundiced rats.
The recovery of reticuloendothelial system (RES) function following decompression of obstructive jaundice was studied using a rat model with bile duct ligation and side-to-side choledochoduodenostomy. Histopathological changes in the liver were still present 5 weeks after relief of jaundice, while results of liver function tests had returned to normal. RES function evaluated by the blood clearance and organ uptake of radiolabelled Escherichia coli using a corrected phagocytic index gradually returned to normal following biliary decompression. The severely impaired RES activity noted 1 week after operation may explain the increased incidence of sepsis and renal insufficiency in the early period after biliary surgery in jaundiced patients.
[Endoprosthetic dilatation of the vena cava eliminates obstruction in superior vena cava syndrome].
A 62-year-old woman with superior vena cava obstruction (SVCO) secondary to small cell lung cancer was treated with expandable wire stents prior to chemotherapy and irradiation. The treatment resulted in immediate and complete remission of the SVCO symptoms.
Imaging in pancreatic pain.
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Interventional radiology of the biliary tract. Metallic stents.
Biliary metallic stents were placed in 18 patients with bile duct obstruction. Six patients received Gianturco stents and 14 Wall-stents. Results of these tests are discussed.
Angiography in lesions of the small bowel.
Following the introduction of endoscopy and newer imaging techniques, such as ultrasonography, computer tomography and magnetic resonance imaging, the indications for angiography have been reduced mainly to the diagnosis and treatment of unexplained gastrointestinal hemorrhage and ischemia. Radiologic signs of hemorrhage include extravasations of contrast medium, irregular vessels and aneurysms. Vascular stenoses and occlusions are the main radiologic signs of ischemia.
Balloon dilatation of the ampulla of Vater. An experimental study in the rabbit.
In order to evaluate possible local tissue injury following balloon dilatation of the ampulla of Vater, the ampullas of 10 rabbits were dilated. The ampullas and the common bile ducts were examined histologically two months afterwards. All the ampullas were found to be normal. In one case aggregations of lymphoid cells were found in the thin wall of the common bile duct. Cholangiography was performed in 8 of the animals two months after dilatation. This was done to evaluate gross signs of local injury, i.e. strictures. All these were normal.
Alcohol sclerotherapy of non-parasitic cysts of the liver.
Between 1980 and 1987, nine patients with non-parasitic cysts of the liver were treated with computed tomography-guided percutaneous puncture and evacuation of the cyst contents followed by injection of absolute alcohol as a sclerosing agent. During the same period only one patient was treated with surgery. The patients included seven women and two men with a mean age of 62 years. Three patients had a single cyst and six patients had multiple cysts. The size of the largest cysts varied between 5 and 20 cm (mean 10 cm). Patients with multiple liver cysts had repeated punctures and sclerosing procedures (up to eight times); 50-3100 ml of cyst fluid (mean 650 ml) was drained per procedure. One patient had symptoms of moderate alcohol intoxication; otherwise no complications were noted. Follow-up was performed with computed tomography or ultrasonography for 8-54 months (median 18 months). The results have been considered successful in eight out of nine patients who had cyst regression and reduced symptoms. Two patients, however, required additional surgical treatment due to residual and multiple cysts. Computed tomography-guided alcohol sclerotherapy of non-parasitic liver cysts appears to be a safe and effective initial therapy.
The radiology of jaundice.
Ultrasonography is the most useful technique for screening patients with suspected obstructive jaundice. Additional information may be gained with CT when US fails either because of disturbing gas-filled loops of bowel or because the patient is obese. A more specific diagnosis is usually obtained from the ERCP which can be combined with percutaneous biopsy and drainage of obstructed bile ducts. PTC and PTCD are left for those patients in whom ERCP has failed.
Gianturco expandable metallic biliary stents: results of a European clinical trial.
Eleven patients with benign strictures (after choledochojejunostomy, n = 10; chronic pancreatitis, n = 1) and 16 with malignant biliary strictures (cancer of the pancreas, n = 7; cholangiocarcinoma, n = 5) were treated with a self-expanding metallic biliary stent. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilation. All patients had immediate relief of jaundice and cholangitis. In a follow-up period of 6-21 months, nine of the 11 patients with benign disease had no difficulties with infection, pruritus, or recurrent jaundice. In patients with malignant strictures, the stent produced relief of biliary obstruction unless recurrent tumor invaded the bile ducts. With careful patient selection, this stent appears to be useful in the management of biliary obstruction, particularly in benign disease.
Enteral versus parenteral glucose as the sole nutritional support after colorectal resection. A prospective, randomized comparison.
Twenty consecutive patients undergoing resection for colorectal carcinoma were randomized to receive either a glucose polymer by nasojejunal tube or glucose by intravenous infusion as the sole postoperative nutritional support for 4 days. Identical amounts of glucose were given by the two routes. Brief infusions of insulin (10 mU kg-1) and glucose (25 g) were given before and 4 days after surgery for the purpose of metabolic evaluation. Blood glucose was consistently lower in the enteral than in the parenteral group (p less than 0.05). Glucose tolerance and the hypoglycemic response to insulin were impaired after surgery in the parenteral group (p less than 0.01 in both cases) but not in the enteral group. Clearance and release of insulin were similar before and after surgery and were similar in both groups. Patients receiving enteral glucose had less postoperative distress and required fewer doses of analgesic drug (p less than 0.05 in both cases). It is concluded that enteral infusion of glucose preserves insulin action and glucose tolerance after colorectal resection, whereas intravenous infusion of glucose does not. The favorable metabolic effects seen after enteral infusion are accompanied by a reduction of postoperative discomfort.