Biomedical subjects
Publications and source records attributed to C Strandberg.
We present a case of acute aortic occlusion, which was diagnosed immediately with CT. Since a prompt diagnosis is essential we recommend contrast enhanced CT as a quick procedure to confirm diagnosis and to exclude dissecting thoracic aneurysm and genuine abdominal aneurysm.
OBJECTIVE: To evaluate the effect of a vaginal ultrasound probe on bladder neck anatomy and mobility. PATIENTS AND METHODS: Twenty women, 15 with urinary incontinence and five with other urological complaints, were studied. Colpocysto-urethrography (CCU) during rest. Valsalva and withholding manoeuvres were compared with and without simultaneous vaginal endosonography. The CCU diagnoses and measurements of bladder neck position and mobility in relation to the symphysis pubis were compared with and without the probe inserted. A small, 7 MHz vaginal probe (Brüel and Kjaer, type 1846) was used with the scanning field 45 degrees to the long axis of the probe. RESULTS: The CCU diagnoses as well as the measurements of bladder neck position and mobility relative to the symphysis pubis were unaffected by the insertion of this probe. CONCLUSION: Vaginal ultrasonography is a minimally invasive technique; it is convenient for routine, firstline evaluation of bladder neck anatomy and mobility in incontinent women.
To compare the information of bladder neck suspension given by colpo-cysto-urethrography (CCU) and vaginal ultra-sonography (US), 44 women with various grades of incontinence were examined by both methods. The criteria for evaluation of incontinence for each method were applied on both procedures. CCU-diagnoses of type of bladder neck descent were compared as well as US-measurements of bladder neck position and mobility in relation to the symphysis pubis during rest, Valsalva and withholding. The interobserver agreement of diagnosis was 58%, which is comparable to interobserver agreement for CCU. The measurements of bladder neck suspension by bladder to symphysis (BS)-distance and rotation-angle in relation to the symphysis pubis, revealed almost identical results for the two procedures. The US-measurements had a better accuracy than the CCU measurements. Furthermore, hypermobility of the bladder neck was related to grade of incontinence and to diagnoses including anterior suspension defects. Presence of a cysto- or rectocele affected the size of the rotation angles. Patients with a cystocele had a 16 degrees larger rotation angle by both procedures. Presence of a rectocele increased the rotation angle, measured by US, but decreased the angles, measured by CCU. Furthermore, the ability to withhold was decreased, when the patient had a rectocele. Since the same information of bladder neck suspension is provided by the two methods, and since the US-criteria revealed a better accuracy and a good clinical reliability, ultrasonography is recommended for evaluation of bladder neck anatomy--also for practical and economical reasons.
To evaluate the reliability of diagnosing type of bladder suspension defect in incontinent women by means of voiding colpo-cysto-urethrography (CCU), 93 CCU-series with exposures at rest, coughing, withholding and voiding were diagnosed. Three senior and one junior radiologists, a gynecologist and a urologist diagnosed the CCU-series twice with 3-6 months interval. The main diagnostic possibilities were anterior bladder suspension defects, posterior defects and normal, which were in accordance with general practice of choosing an abdominal suspension operation for the anterior suspension defects and a vaginal operation for the posterior defects. The intra-observer agreement varied between 99% and 72%, i.e. 1/5 to 1/4 of the patients changed from one main diagnostic group to another at the two examinations. The inter-observer agreement varied between 43% and 60%. Information of clinical patient data, given to the two clinicians, did not change their CCU-diagnoses significantly. We concluded, that CCU should not be recommended as a routine for evaluation of type of suspension defect since the intra-inter-observer variation was around 25% and 50% respectively. CCU might still be useful preoperatively in selected cases, since it gives an excellent visualisation of bladder base anatomy.
At emergency laparotomy after a fall bleeding from injuries to the upper pole and from lacerations involving the hilum of the spleen were found in a 2 1/2-year-old girl. Partial splenectomy using a linear stapler allowed preservation of the lower pole with intact vessels. Observed peroperatively for 10 minutes, the splenic remnant retrained a macroscopically normal appearance. Blood transfusion was avoided and drainage postoperatively comprised no more than 25 ml serosanguineous fluid. Provided intact splenic capsule can be used for the line of resection, partial splenectomy using a linear stapler seems to be a safe method.
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Two radiologists independently assessed 100 leg vein phlebograms for the presence or absence of deep venous thrombosis. In a subsequent questionnaire, 66 physicians were asked to state the level of agreement they would require to use conventional phlebography in their diagnostic decisions, and whether they would reduce their requirements if the phlebographic technique were made less painful and less expensive. The responses indicated physicians' requirements for reproducibility of a well-known routine diagnostic method may be unrealistic, and that physicians do not consider the inconvenience of an examination to the patient or its cost in setting their requirements for diagnostic precision.
An automatable HPLC column switching technique was used for on-line sample clean-up of prostanoids from body fluids. 6-Keto-PGF1 alpha, TxB2, PGF2 alpha and PGE2 in urine, amniotic fluid and plasma were purified by precolumn extraction prior to RP-HPLC-separation. Several precolumn stationary phases were tested, as was the influence of precolumn length and sample acidification. Further, chromatographic behaviour of urine reference compounds was studied. Optimal purification of prostanoids from urine was achieved with microBondapak C18/Corasil as precolumn adsorbent in 1-cm cartridges. Overall recoveries were 64.6 +/- 4.5% for 6-Keto-PGF1 alpha, 72.3 +/- 3.5% for TxB2, 89.6 +/- 3.8% for PGF2 alpha, and 80.4 +/- 3.3% for PGE2. Preliminary results obtained with amniotic fluid and plasma confirmed that precolumn extraction of prostaglandins is also applicable to other body fluids. In discussion, precolumn extraction is compared with the off-line technique using disposable C 18 cartridges.
The effect of glucagon administered as a bolus (1 mg) followed by a continuous infusion (2 mg/h) for 8 h and a placebo was compared in 37 adults with urographically demonstrated ureteral calculi less than 6 mm. The bolus injection was given 20 min after start of intravenous urography, and the infusion was initiated immediately afterwards. No effect on pain relief or passage of calculi was found. Nausea and/or vomiting were recorded significantly more frequently in patients who had glucagon than in patients who had the placebo. It is concluded that glucagon is of no value in acute ureteral colic.
A questionnaire on micturating cystourethrography (MCU) was submitted to all 74 Danish radiology departments. It was answered by 85% of the departments and of these 73% performed about 1500 examinations in patients suspected of vesicoureteral reflux (VUR) during 1982. The technique of MCU varied considerably. Several factors of importance for the outcome of the examination were not regarded. Although the optimal technique has not yet been settled, some standardization is warranted for better detection of VUR and for comparison of results. Even when the most rational technique is followed there still will remain cases where a repeat study will turn out differently.
The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems.
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The inhibitory effect of glucagon-(1-21)-peptide on the motility of the stomach and duodenum during radiologic double contrast studies was examined. In a randomized trial of equimolar doses of glucagon and glucagon-(1-21)-peptide on 70 patients, glucagon-(1-21)-peptide showed to have a significantly weaker effect than glucagon. Glucagon caused significant increases in plasma-glucose and plasma-insulin, while glucagon-(1-21)-peptide had no such effects. In a subsequent randomized study on 75 patients glucagon-(1-21)-peptide in various doses was tested against placebo. The effect was insignificant from that of placebo at practically all dose levels. No side effects were registered. It is concluded, that glucagon-(1-21)-peptide probably has a certain relaxing effect on the smooth muscle of the stomach and duodenum, but that this effect is too small for practical clinical use.