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Biomedical subjects

B Stener

Publications and source records attributed to B Stener.

At least 37 records · Page 2Linked to original sources
PubMed1981

Transacetabular arthrotomy of the hip joint.

Removal of a loose body or some other lesion in the acetabular fossa by an ordinary arthrotomy of the hip joint can be extremely difficult and may necessitate dislocation of the femoral head with the ensuing risk of vascular disturbances. A method has been developed to overcome these difficulties. Essentially it implies that a hole is made centrally in the acetabular fossa from the intrapelvic side via an inferior midline abdominal incision and extraperitoneal dissection. After the hole has been made in the bone, the fat pad in the acetabular fossa (pulvinar acetabuli) is incised and the pathological lesion, e.g. a loose body, can easily be removed. Large areas of the femoral head can be inspected by movements of the joint in different directions. If indicated, the whole acetabular fossa can be removed leaving only the cartilage-covered part of the acetabulum (facies lunata) intact. The method has been successfully used in four hip joints in three patients.

Adult↗
PubMed1981

Function after anterolateral resection of the lower leg for extirpation of tumors. Extension and pronation of the foot restored by transfer of the tibialis posterior muscle.

A function preserving method for radical removal of tumors located anterolaterally in the lower leg is described. The loss caused by the inclusion of all extensors and pronators of the foot in the surgical specimen is compensated for, to a large extent, by transfer of the tendon of the tibialis posterior muscle to the conjoint tendons of the extensor digitorum longus and peroneus tertius. The function after such an operation has been studied in two patients using various methods including strength measurements and, in one of them, electromyography.

Adult↗
PubMed1981

Function after removal of various hip and thigh muscles for extirpation of tumors.

Forty-six patients who had undergone excision of one or more well defined hip and/or thigh muscles because of a soft-tissue tumor or a tumoriform lesion were investigated with respect to the function of the operated limb and the isometric and isokinetic strength of the affected motion or motions, relative to the non-operated side (percentage). Hip flexion: Loss of the iliopsoas caused slight impairment of function. The flexion strength decreased with increasing flexion of the hip joint. Loss of the rectus femoris reduced the isometric strength by 37 and the isokinetic strength by 17 per cent. Hip abduction: The strength reduction was only about 50 per cent and the impairment of function only slight or moderate even in patients with extensive loss of abductor muscles. Hip adduction: Removal of all three prime adductors (longus, brevis, magnus) caused a strength reduction of about 70 per cent but the impairment of function was only slight or moderate. Hip extension: Loss of the gluteus maximus caused only a small strength reduction and no impairment or only slight impairment of function. Significant strength reduction was only seen when all hamstrings had been removed. Knee extension: Loss of one, two, and three of the quadriceps muscles reduced the isometric strength by 22, 33, and 55 per cent, respectively. The isokinetic strength was reduced somewhat more. The strength reduction usually had to exceed 50 per cent to cause more than slight impairment of function. Knee flexion: Loss of the semitendinosus, the biceps femoris, and all the hamstrings reduced the isometric strength by 24, 28, and 67 per cent, respectively. The isokinetic strength was reduced somewhat less. Loss of one of the hamstrings usually caused no impairment of function whereas loss of all three resulted in moderate impairment of function.

Adolescent↗
PubMed1980

Primary leiomyosarcoma of bone: a study of five cases.

Five cases of leiomyosarcoma of bone are described. The patients, 3 men and 2 women, ranged in age from 24 to 74 years. Four of the five tumors were located in the distal half of the femur. Radiographically, all tumors presented as purely osteolytic lesions. Angiography, performed in 3 cases, revealed hypervascularity and the presence of irregular, tortuous vessels at the site of the lesion in 1, but not in 2 others. Histologically, the five tumors showed features characteristic of leiomyosarcomas. The most prominent features were blunt-ended, cigar-like, chromatin-rich nuclei in elongated acidophilic cells arranged in bundles which intersected each other at wide angles. The importance of trichrome stains, such as van Gieson stain, for th recognition of leiomyosarcomas is emphasized. Electron microscopic examination, performed in 3 cases, showed as the most prominent features spindle-shaped cells in parallel arrangement containing abundant myofilaments which elongated densities, pinocytotic vesicles, and basal lamina structures.

Adult↗
PubMed1979

Concomitant arteriovenous vascular malformation in skeletal muscle: a clinical, angiographic and histologic study.

A vascular malformation in skeletal muscle is described in 4 patients. Pathologically and anatomically, it consists of an abundance of concomitant arteries and veins and thick-walled capillaries. Angiography demonstrates the high vascularity of the lesion, and contrast medium appears early in draining veins indicating arteriovenous shunting. In the angiograms, the highly vascular region displays a certain striation which is due to the presence of muscle fiber bundles running between the pathologic vessels. This angiographic picture suggests benignity: an intramuscular malignant tumor rarely leaves intact muscle fiber bundles passing right through it.

Adult↗
PubMed1978

Hemangiopericytoma: a clinicopathologic, angiographic and microangiographic study.

A clinicopathologic study of 11 hemangiopericytomas is reported, and the results of clinical angiography in 4 patients and a correlated microangiographic-histologic study of 1 tumor are presented. Six of the tumors were collected and accepted as hemangiopericytomas in a review of 42 tumors registered as hemangiopericytoma in the Swedish Cancer Registry during the period 1958--1968. The other 5 tumors occurred in patients treated by us. The histologic examination and the follow-up information showed that it can be difficult to predict the prognosis on morphologic grounds, that borderline tumors exist and that a recurrence as well as a metastasis may dedifferentiate. The tumors studied by clinical angiography all proved to be highly vascular. Irregular vessels of varying caliber were filled with contrast medium and, in addition, a prominent diffuse opacification took place. Early filling of veins was not noted despite the high vascularity. The correlated microangiographic-histologic study suggests that the irregular vessels seen on clinical angiograms corresponded to wide, angulated, thin-walled vessels without muscle coat or elastic tissue, while the diffuse opacification was caused by a dense network of delicate, branching, slit-like capillary spaces.

Adult↗
PubMed1978

High amputation of the sacrum for extirpation of tumors. Principles and technique.

A detailed description is given of the principles and surgical technique for extensive resection of the sacrum, including an adjacent part of each ilium, for radical removal of tumor. Two levels of sacral amputation are discussed: between S1 and S2 (through the canals of the S1 nerves) and through S1 (above the canals of the S1 nerves), with or without inclusion of the rectum in the specimen. The former level permits the preservation of the S1 nerves; the latter does not. Important pathoanatomic facts are discussed. The effects of these operations on the urogenital and anorectal function and on the stability of the pelvic girdle are briefly reviewed. Five illustrative cases are reported with comments on the results.

Anal Canal↗
PubMed1977

Extirpation of tumors located near the thoracic cage. A method for increasing the margin of healthy tissue on the deep side of the tumor.

When an aggressive tumor develops in a flat muscle near the thoracic cage the question may arise as to how achieve an adequate margin on the deep side of the tumor. This is especially the case if the tumor has recurred after a previous non-radical operation. A method is described by which the external thoracic fascia, the external intercostal musculature, and the periosteum on the external surface of the ribs can be included in the specimen as a continuous wall of healthy tissue on the deep side of the tumor. This technique has been used in 11 patients, 9 of whom had undergone one or more inadequate operations earlier. Eight patients had a malignant tumor, three an extra-abdominal desmoid. In one of the latter patients, in whom a recurrent tumor was adherent to rib periosteum, the method was unsuitable. In the other patients the method appears to have been adequate for local control of the tumor.

Adult↗
PubMed1976

Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves.

The anorectal function in 3 patients with bilateral and 4 patients with unilateral well-defined loss of sacral nerves after radical tumour excision was studied by clinical examination and by simultaneous registration of the following variables: volume and pressure in the rectum, pressure in the internal anal sphincter area and myoelectrical activity in the external anal sphincter. The patients with bilateral loss of sacral nerves had serious impairment of function. Constipation was their only safeguard against incontinence. The preservation of the first and second sacral nerves bilaterally was not sufficient for discrimination between different qualities of rectal contents passing the anal canal. The sensation of rectal distension was also impaired. The reflex pattern of the internal anal sphincter was, however, intact. The external anal sphincter displayed a weak spontaneous myoelectrical activity in the patients who had at least one second sacral nerve intact, and a weak increase of the activity could be induced voluntarily. The normal transient increase of myoelectrical discharge from the external anal sphincter in response to rectal distension could not, however, be elicited. In patients with total unilateral loss of the sacral nerves no significant impairment of anorectal function was noted. Total one-sided denervation implied deficient sensibility of the anal canal unilaterally, but no disturbance of sphincter function as judged from the reflex response of the internal and external anal sphincters to rectal distension.

Adult↗
PubMed1976

Pelvic strength after major amputation of the sacrum. An exerimental study.

Major sacral resections up to the level of S 1 and even higher have been performed. This has raised the question of the degree to which such operations weaken the pelvic ring. Fifteen cadaver pelves, including the fifth lumbar vertebra, were loaded to failure, five unresected, five after resection of the sacrum between S 1 and S 2, and five after resection about 1 cm below the promontory. The weakening of the pelvic ring amounted to approximately 30 per cent with the former type of resection and 50 per cent with the latter. Taking into consideration the calculated normal load on L 5 in upright standing it seems safe from this study to allow patients to stand with full weight-bearing at an early stage postoperatively after submaximal resection of the sacrum.

Adult↗
PubMed1976

Old total rupture of the adductor longus muscle. A report of seven cases.

Seven cases of old total rupture of the adductor longus muscle are described. Five patients were referred with the suspicion of a soft tissue tumour. Six patients reported an adequate trauma when thoroughly questioned; four of them had sustained the injury while playing soccer; the seventh patient could not recall any trauma. The diagnosis of this lesion is discussed.

Adolescent↗
PubMed1976

Distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella. A case report and an experimental study.

A 12-year-old boy presented with a proximally retracted patella 5 months after an injury to the left knee. The clinical and radiographic features and the findings at operation led to the conclusion that the original lesion had been a distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella, produced by the medial and lateral longitudinal patellar retinacula. Loading experiments on amputation and cadaver specimens showed that these retinacula, apart from being tendons for the vastus medialis and the vastus lateralis, respectively, constitute a direct fibrous connection of considerable strength between the patella and the tibia and thus are capable of producing avulsion fractures.

Adult↗
PubMed1975

Neurourologic evaluation after resection of the sacrum.

Five patients with bilateral, and four patients with unilateral, well defined sacral nerve lesions after sacral resection for tumor were examined with a clinical evaluation, cystometry, and cystoscopy including a test of vesical and urethal sensibility with different stimuli. In patients with bilateral division of the sacral nerves below the S 2 level, no active detrusor contractions were registered, indicating that the second sacral segment alone cannot subserve the micturition reflex. In patients with unilateral division of sacral nerves 1 to 5 or 2 to 5, a normal micturition reflex was registered. There was a complete loss of bladder mucosal pain when sacral nerves 3 to 5 had been cut bilaterally, while the sensibility was normal when sacral nerves 4 to 5 had been cut bilaterally. In patients with unilateral division of all sacral nerves below L 5 or S 1, mucosal pain tested by means of electrcoagulation of the bladder and pin-pricking of the urethra could not be felt on the denervated side. Stretching of the detrusor wall with a ureteral catheter, however, could be felt on the denervated side, indicating that this sensation was not mediated in sacral nerves but probably in the hypogastric nerves. Thermesthesia of the mucosa was demonstrated on the intact side of the bladder but not on the denervated side when the patients with unilateral sacral nerve lesions were tested with jet streams of cold or hot saline against the bladder wall.

Adult↗