Biomedical subjects
Publications and source records attributed to F Schweden.
Between 1987 and 1991 we performed a unilateral or bilateral frontoorbital advancement to correct trigono- or plagiocephaly in 10 children: Three-dimensional CT provides an exact basis for operation planning. Titanium miniplates allow an already primarily rather stable osteosynthesis. The best time for this intervention is the end of the third month of life.
Primary tumours of the pulmonary arteries are rare neoplasms seldom diagnosed during the patient's life time. We report on two cases of pulmonary artery sarcomas diagnosed during life time of the respective patients in intra-operative frozen sections by histopathological examination. Case 1 was of a 55-year-old man with a fibrosarcoma originating from the main pulmonary trunk. Case 2 was of a 43-year-old woman with a malignant fibrous histiocytoma originating from the right pulmonary artery. In both patients a radical tumour resection under cardiopulmonary bypass was attempted. Both patients, however, had a local tumour recurrence and died 18 months (patient 1) and 6 months (patient 2) after surgery. A review of pulmonary artery sarcomas is given.
During a period of six years 131 patients had CT for gastrointestinal tumours or inflammatory bowel disease; the results were analysed retrospectively according to standard criteria. The preoperative CT appearances were compared with the surgical and histological findings. Confirmation of the diagnosis was obtained at surgery and from pathological studies carried out within six weeks of the CT. There were 93 malignant and 8 benign tumours and 30 inflammatory lesions. The reliability of CT for determining tumour extent and the presence of metastases can be improved by standardising the method of examination. Altogether a sensitivity of 75-85%, a specificity of 89-96% and an accuracy of 83-86% was obtained, depending on the anatomical lesion. Correct findings of all three staging parameters T, N and M for carcinomas was, however, obtained in only 56%. Differentiation between malignant and benign tumours and from inflammatory lesions was possible in the presence of specific CT patterns.
In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superior to MRI, as lesions of the joint capsule were shown with greater certainty.
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Surgery continues to be the only treatment of proven efficiency for renal cell carcinoma. Chemo- and radiotherapy must be regarded as ineffective. Antagonists of the multiple drug-resistance gene, which is responsible for the chemoresistance of renal cell carcinoma as well as immunotherapy, are new experimental approaches in the treatment of renal cell carcinoma. The broad use of ultrasonography as a screening method has led to an increase in the diagnosis of small, asymptomatic renal tumors. At present, almost 65% of the renal tumors referred for surgery at our institution are asymptomatic. We found parenchyma-sparing surgery to be adequate treatment for many of these tumors. Advanced stages of renal cell carcinoma, on the other hand, can be cured by ultra-radical surgery (e.g., tumor thrombectomy or metastasectomy) in a considerable percentage of patients, as long as diffuse distant metastases are absent. Utilization of a broad range of imaging techniques is mandatory to rule out diffuse dissemination when considering such an operation.
The results of endosonography and computed tomography, using an optimized CT technique, have been compared in the preoperative detection of intrathoracic tumor spread of esophageal cancer. In 22/40 patients with esophageal tumors complete passage of the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stage of esophageal tumor (T1-2). Out of 9 tumors confined to the esophageal wall, 8 were classified correctly by endosonography and only 5 by computed tomography. The results in advanced T3 and T4 tumors (13 patients) were comparable following endosonography and computed tomography. Endosonography is an important means of selecting patients with early-stage cancers in whom a curative resection is still a possibility.
During the past decade new techniques such as computed tomography (CT) and ultrasonography have been reported to have changed the diagnostic investigation and treatment of renal abscess in adults. To evaluate whether similar changes have taken place in the pediatric age group, a retrospective study of all patients seen between 1979 and 1989 was performed. Seven patients, 0.8 to 14 (mean, 9) years old, with renal abscesses in eight kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tools, revealing the diagnosis by showing a hypoechoic or hypodense mass. All patients had an initial trial of intensive antibiotic treatment, which led to resolution of the abscesses in two of the eight kidneys. In all other cases the abscesses were additionally drained, which was done surgically in two and by ultrasonography- or CT-guided percutaneous drainage in four patients. Abscess cultures grew Staphylococcus aureus (three), Escherichia coli (one) and Salmonella Group B (one) and were sterile in one case. Drainage was unsuccessful in only one patient, who subsequently underwent nephrectomy for uncontrolled infection of a diffusely damaged kidney. We conclude that the diagnosis of renal abscesses is greatly facilitated by ultrasonography and CT and that most patients can be cured without operation by antibiotics and, if necessary, by additional percutaneous drainage.
The results of endosonography and computed tomography--using an optimized technique of CT--in preoperative staging of esophageal cancer are compared. In 22 of 40 patients with esophageal tumors a complete passage by the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stages of esophageal tumors (T1/T2). Out of nine tumors confined to the esophageal wall, eight were classified correctly by endosonography, only five by computed tomography. The results in T3- and T4-carcinomas (13 patients) were comparable for endosonography and computed tomography. Endosonography is of importance in the selection of patients with early stages of cancer, in whom a curative resectability is still possible.
Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologically enlarged. In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum including the subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9) of enlarged lymph nodes diagnosed by CT were detected by TEE. A pathological study in 9 patients demonstrated true positive findings in 2 vs 1, true negatives in 4 vs 5, false positives in 3 vs 2 and false negatives in 0 vs 1 comparing TEE with CT. From these preliminary data, we conclude that TEE, although still experimental, is equal or superior to CT in detecting enlarged nodes in the lower mediastinum, specifically in the aortopulmonary window but clearly inferior in the upper mediastinum and the hilar region. Additional information on central tumors and infiltration of the heart or great vessels can be clarified. In addition, data on hemodynamics and cardiac status can be obtained. TEE seems to be a promising tool in the preoperative staging of lung cancer.
Rectal carcinomas are amongst the most common malignant tumours. The aim of this work was to determine whether high resolution CT with thin sections (1 mm) can provide satisfactory delineation of perirectal tumour infiltration. Correct determination of local tumour spread was possible in four out of nine patients and distinction between those tumours confined to the rectal wall and those infiltrating the perirectal tissues was possible in four out of eight patients.
Two hundred and eighty-seven radiological and sonographic examinations in 142 patients with confirmed peritoneal carcinosis were evaluated retrospectively. The examinations included abdominal films (19), infusion urograms (20), contrast examinations of the intestine (26), small bowel enemas (2), double-contrast examinations of the colon (40), demonstrations with water-soluble contrast (6), sonographies (80) and CTs (96). CT and colonic double-contrast studies were complementary and valuable methods for diagnosing peritoneal carcinosis and should both be used.
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61 Patients with histologically proved primary mediastinal tumour were examined by computed tomography (CT) of the thorax prior to surgery. The retrospective analysis of the CT scans led to the correct diagnosis in 77% of cases. CT-values (HE), calcifications or form of tumour growth was found to be unreliable in the classification of tumour status.
The ductal adenocarcinoma is the most frequent tumour of the pancreas. So far, imaging methods did not enable early diagnosis of the tumour, since in most cases it cannot be detected before it has grown to a size of 2-3 cm diameter. CT findings of the carcinoma of the pancreas as well as problems connected with the diagnosis and with staging of the tumour are presented in a concise review.
Metaiodobenzylguanidine (MIBG) imaging is a well-established method for locating intra- and extraadrenal pheochromocytomas. We investigated whether preoperative injection of 123-I-MIBG might be useful for intraoperative staging of chromaffine tumor cells. This was performed in a 46-year-old patient in whom the diagnosis of a malignant pheochromocytoma had been established by 123-I-MIBG imaging and enhanced catecholamine secretion. The rationale for intraoperative staging in this patient was a discrepancy between computed tomography (CI) of the abdomen and the radionuclide imaging, because scintigraphy revealed a mass with MIBG uptake in the right lower abdomen that could not be visualized by CT. We thus applied a preoperative dose of 4 mCi 123-I-MIBG and determined tissue activity by direct organ measurement. A right abdominal mass was thus identified with an activity of 10 x 10(4) impulses/s as compared to normal tissue (15 x 10(2)). The left-sided tumor was found to be identified correctly by prior CT and MIBG imaging. We thus conclude that intraoperative application of this single probe measurement might help to identify chromaffine tumor cells that have not been located fully by CT.
The value of magnetic resonance tomography in the diagnosis of carcinoma of the cervix was studied in a prospective series of 20 patients. The results were compared with those of computed tomography and with the clinical findings. The diagnosis depended on the postoperative histology. Gynaecological examination proved superior to imaging methods in determining the extent of local tumour spread. Tumour involvement of the regional lymphatic system was better demonstrated by MRT than by CT. Exact staging proved inadequate with both these methods and the new imaging methods have not produced any changes in operative planning or technique.
The computer tomograms of 22 patients with renal oncocytomas were analysed retrospectively. Characteristic findings were: 1. solid round space-occupying lesions (22/22), 2. sharp demarcation from the kidney (20/22), 3. smooth margin (20/22), 4. hypodensity after intravenous contrast (20/20), 5. enhancement (19/19), 6. central hypodense nidus (16/22), 7. homogeneous beyond the nidus (11/22). In the presence of these criteria, the diagnosis of an oncocytoma may be suspected. Safe differentiation from a renal cell carcinoma may not always be possible.