Biomedical subjects
Publications and source records attributed to B F Zachrisson.
In 22 patients with deep venous insufficiency thermography performed at rest and immediately after exercise was compared with conventional ascending phlebography. Thermography was found to have a high sensitivity in detecting incompetent perforating veins, while the specificity was low. The non-invasive thermography is an attractive technique for preoperative detection of perforating veins.
Thermography was performed before ascending phlebography in a series of 232 patients with suggested deep venous thrombosis. Thirty per cent of the patients were thermo-negative. The predictive value of a negative thermography was 88 per cent. Thermography is useful as a screening method, but it has low specificity and thus a relatively high incidence of false positives must be accepted.
Two new contrast media, Amipaque (metrizamide, Nyegaard & Co A/S, Oslo) and Hexabrix (ioxaglic acid, Laboratoire Guerbet, Paris) were compared in a double blind study in patients with arterial insufficiency in the legs. The incidence of subjective adverse effects (pain and sensation of heat) was low and similar with both contrast agents. Also the effects on heart rate and blood pressure were small and transient and similar with both contrast agents.
A 15-year-old girl was operated for gastric leiomyoblastoma (epithelioid leiomysocarcoma) with metastasis to a regional lymph node. She has subsequently been operated on twice: once for local recurrence and metastases 9 years after her initial operation and once for an intraabdominal lymph node metastasis. Now, 13 years after her first operation for gastric leiomyoblastoma she is free from symptoms and signs of disease. Preoperative angiography was helpful in diagnosing the recurrence and planning the second operation. Our observations speak in favor of surgical treatment of recurrent and metastasizing gastric leiomyoblastoma. This patient was also operated for multiple pulmonary chondro-hamartomas, primarily suspected to be metastases. Coincidence of gastric leiomyoblastoma and pulmonary chondro-hamartoma does not seem to be due to chance alone.
Early operation of patients with acute cholecystitis is nowadays accepted as the treatment of choice. One prerequisite for this policy is, however, the availability of diagnostic procedures that can rapidly secure or, even more important, exclude the diagnosis to avoid unnecessary operations. Infusion cholecystography was here shown to be an accurate method giving decisive information in patients with clinically suspected acute cholecystitis. The gallbladder was not visualized in 26 out of 45 patients with inconclusive clinical signs of acute cholecystitis. The diagnosis of acute cholecystitis was confirmed at operation or by a typical clinical course in these 26 patients. In the 19 patients with visualized gallbladder diagnosis other than acute cholecystitis were established by acute operation or by other means.
A case of water-clear cell hyperplasia of the parathyroid glands is reported. As far as we know this case is unique in respect of the following features. All the parathyroids were located in the superior mediastinum. One abnormal parathyroid gland was removed with the help of a mediastinoscope. The patient survived a massive parathyroid hemorrhage. This case draws attention to the facts that enlarged parathyroid glands can appear as mediastinal tumours and that massive bleeding can occur in abnormal parathyroid glands.
During recent years the total number of patients undergoing surgery for hyperparathyroidism has markedly increased, but the annual number of cases with substantial hypercalcemia has remained unchanged. Parathyroid carcinoma and water clear cell hyperplasia cause more severe hypercalcemia than other kinds of hyperparathyroidism. Grave hypercalcemia due to hyperparathyroidism is more common among the elderly, but can occur during pregnancy and also among children. Occasionally, a patient with hyperparathyroidism can also have another cause of the hypercalcemia and does not become normocalcemic until adequately treated for both. The suspicion of grave hypercalcemia should arise due to its clinical features. Determination of serum calcium and intact parathyroid hormone concentrations establishes the diagnosis. The basic treatment of grave hypercalcemia is to rehydrate the patient and to restore the sodium losses. To further lower the serum calcium value we have found bisphosphonates to be very effective. The definitive treatment of grave hypercalcemia due to hyperparathyroidism is surgery. As a last resort, frail patients with grave hyperparathyroidism can undergo surgery under local anesthesia. Repeat operations can improve the prognosis of patients with metastatic parathyroid carcinoma. Selective venous catheterization with blood sampling for determination of intact parathyroid hormone can be helpful in localizing recurrent disease.
In a double blind study of 100 consecutive patients routinely referred for urography, a conventional contrast medium (Isopaque cerebral) was compared at a dose of 180 mg I/kg body weight with a low osmolar contrast medium (Hexabrix 160) at a dose of 90 mg I/kg body weight. In spite of 50 per cent dose reduction, equally good diagnostic effect was achieved with Hexabrix as with the conventional contrast medium.
Three modern low osmolar contrast media (Iopamiro, Omnipaque and Hexabrix) were injected intravenously in 150 patients. They were all effective for urography in a concentration iso-osmolar to blood and with a dose of 90 mg I/kg body weight in patients with normal renal function. In patients with decreased renal function, this low dose is not sufficient and should be doubled. No significant diagnostic differences between the three media were found. The subjective and objective adverse effects were minimal and transient.
Eighty patients were examined with computed tomography (CT) of the kidney and the retroperitoneal space after percutaneous stone extraction. Most examinations were done within a week after the operation. The morphologic changes were usually small or none. In 7 patients minor renal or perirenal fluid collections were found. Their operations had been complicated by bleeding or leakage. In 66 patients CT was compared with conventional radiographs. Residual stones were more often detected by CT. They were usually small. Percutaneous renal stone extraction is considered a safe and efficient method.
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