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Biomedical subjects

I Morild

Publications and source records attributed to I Morild.

At least 19 recordsLinked to original sources

Venous and neural invasion as predictors of recurrence in rectal adenocarcinoma.

After radical surgery for rectal adenocarcinoma, the presence of venous and neural invasion of tumor cells was correlated with the pattern of treatment failure, local in the pelvis or distant. Of 128 operation specimens, venous and neural invasion was demonstrated in 22 percent and 32 percent, respectively. A significant decrease of the distant recurrence-free 5-year survival (Kaplan-Meier method) was seen when venous invasion was demonstrated (32.9 percent vs. 84.3 percent; P less than 0.0001), whereas more local failures were registered in patients with neural invasion. The local recurrence-free 5-year survival in patients with neural invasion was 64.3 percent, compared with 81.1 percent when neural invasion was not demonstrated (P = 0.03). Their prognostic value was then studied in a Cox regression model including stage and grade. Neural invasion had the strongest association with local recurrences, whereas venous invasion was found to be the third strongest independent predictor of metastasis, after lymph node status and extent of local tumor infiltration. We conclude that examining for the presence of venous and neural invasion gives reliable prediction of recurrences after radical resection of rectal cancer. Recording of tumor recurrence pattern may lead to a better selection of patients for adjuvant therapy after surgery.

Adenocarcinoma

Low-dose preoperative radiation postpones recurrences in operable rectal cancer. Results of a randomized multicenter trial in western Norway.

A randomized, multicenter clinical trial was conducted in Western Norway to study the effectiveness of preoperative radiation therapy in operable rectal cancer, given at a dosage of 3150 cGy in 18 fractions, 2 to 3 weeks before radical surgery. Three hundred nine patients were entered into the trial between May 1976 and December 1985. After radiation no tumor was seen in 4.5% of the patients. There was no increased morbidity or mortality at surgery. The 5-year survival for evaluable patients was 57.5% in the control group and 56.7% in the radiotherapy group. For patients operated on for cure the 5-year survival was 60.9% and 64.2% in the control group and radiotherapy group, respectively. Radiation significantly delayed both local and distant recurrences in patients in the radiation group who had curative resection from 13.3 months in controls to 27.1 months. The local recurrence rate in the corresponding groups was 21.1% and 13.7%, respectively. We conclude that higher preoperative radiation doses should be used in new trials as a higher dosage may transform the observed positive effects into a survival benefit.

Adult

The role of venous and neural invasion on survival in rectal adenocarcinoma.

A total of 254 rectal adenocarcinomas were examined for the presence of venous and neural invasion. Both the incidence of venous and neural invasion increased with Astler-Coller's stage, except for stage C1 related to neural invasion. Both prognostic factors predicted significantly reduced actuarial survival rates in patients with node-negative tumors. Thus, examination for the presence of venous and neural invasion can add information to conventional staging in node-negative tumors for assessing prognosis after radical surgery for rectal adenocarcinoma.

Actuarial Analysis

Tumour shrinkage and down staging after preoperative radiation of rectal adenocarcinomas.

In order to analyse the influence of low radiation doses on human rectal adenocarcinomas, gross and microscopical changes after preoperative radiation were compared to controls treated with immediate surgery in a randomised, prospective trial. The X-ray doses given were 31.5 Gy in 3.5 weeks, and the interval between radiation and operation was 2 to 3 weeks. A total of 138 patients having preoperative radiotherapy and 131 controls were analysed. The overall tumour size was reduced after radiation. Complete tumour regression was obtained in six (4.4%) patients. All of these tumours were exophytic and mobile at the initial examination and all were either well or moderately well differentiated. A significant downstaging was found after preoperative radiation. The incidence of positive lymph nodes was 27.5% in the resected specimens in controls and 18.4% after radiation (p less than 0.05). The total number of recurrences was reduced after radiation in stage C2 tumours, but not in the other stages. Preoperative radiation did not influence the histological grade of the tumours. There was no difference between the two randomised groups with respect to 5-year survival or disease-free survival in any histopathological stage.

Adenocarcinoma

Cocaine and fetal death.

Toxicologic screening for cocaine and its metabolites was performed on 103 cases of fetal death autopsied in the Office of Chief Medical Examiner, City of New York. In 64 cases cocaine or its metabolites were found in the blood or in the brain. Some malformations were also found. The study indicates that maternal use of cocaine may lead to abruptio placentae, abortion and fetal death. The importance of toxicologic examination in these deaths is emphasized.

Brain Chemistry

[Repetition of sudden infant death].

Sudden infant death syndrome is the most common cause of death in the age group one month - one year. The article reviews a ten-year survey from Western Norway. Among 131 cases, there were six where a previous sibling had had the same diagnosis. Nevertheless, risk of repetition of sudden infant death syndrome is considered to be low.

Humans

[Fatal self-poisoning in Western Norway in 1978-1987].

Self-administered poisoning is a common occurrence in a hospital medical department. Fatalities are few when treatment can be given. However, a certain number of deaths do occur outside hospitals--most of them in the patient's home. A forensic examination is usually performed in these cases. In the years 1978-87, 297 deaths from self-administered poisoning were investigated at the Grade Institute, Department of Forensic Medicine, University of Bergen. Alcohol was the most common cause of death. Amongst drug-induced poisonings, tricyclic antidepressants were the most frequent cause of death.

Adolescent

Transanal extirpation for early rectal cancer.

Transanal extirpation was performed in 38 patients with adenocarcinoma of the rectum. In 17 patients (group I) the tumor extended into the submucosa only, and in 14 patients (group II) tumors extended into, but not through, the muscularis propria. There was a significant difference in local recurrence between groups I and II. None of the patients in group I and six of the patients (42.6 percent) in group II developed local recurrences (P = 0.02). The 5-year actuarial survival probability was 100 and 82.6 percent, respectively. Transanal extirpation is an alternative to transsphincteric and abdominoperineal resection in the treatment of early well or moderately well-differentiated cancer of the rectum. The surgical procedure is simple and has few complications; however, only tumors extending no deeper than the submucosa are suitable for this treatment. The operation should be followed by frequent sigmoidoscopies and rectal palpation. The procedure should be defined as an excisional biopsy until results from the histologic examination are presented.

Adenocarcinoma

Sudden death from asthma.

Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, University of Bergen during the period 1977-1986 were recorded. There were 11 cases with information in the police report of the use of pressurised bronchodilating aerosols prior to death. Seven of the victims were found with the aerosol in the hand or close by the body. Overdosage due to excessive inhalation were suspected in several of the victims. The possibility of side effects due to overuse is discussed. Other mechanisms of death are also discussed.

Administration, Inhalation

Seafaring bodies.

Cases involving two bodies that had drifted for at least 500 km on the high seas are described.

Adult

The fjord murders.

The method used to locate the bodies of victims of a double murder and retrieve them from the bottom of the sea at a depth of 340 m is reviewed.

Craniocerebral Trauma

Peripolar cells in the avian kidney.

Four white leghorn chickens were injected with furosemide (20 mg per kg body weight) three times at 12 h intervals and the kidneys fixed by perfusion after 36 h. Five chickens were injected with DOCA (desoxycortone trimethylacetate, 75 mg per kg body weight) three times at 12 day intervals and the kidneys fixed by perfusion after 36 days. Serial sections from the kidneys of these two groups of birds were made and the number of peripolar cells recorded. These recordings were compared with the number of peripolar cells in four normal, untreated chickens. A significant increase in the number of peripolar cells was recorded in the furosemide treated group. No significant change was seen in the DOCA treated group. However, in the DOCA-group heavily granulated podocytes were found. No distinct morphological difference was found between the granules in the podocytes and the granules in the peripolar cells. A possible lysosomal nature of the peripolar cell granules is discussed.

Animals

Fetal strangulation following uterine rupture.

A woman who was 30 weeks pregnant was sitting with a three-point seat belt fastened in the front passenger seat of an automobile that was involved in a head-on collision. On admission to hospital, the fetus was found in a breech position with the fetal head situated just beneath the mother's liver. Laparotomy had to be performed 4 h later and the fetus was found to have been completely expelled from the uterine cavity through a rupture in the fundus uteri. The findings in the fetus suggest that the head was expelled first, and that the fetus was then strangled by uterine contractions. The significance of using seat belts during pregnancy is discussed briefly.

Accidents, Traffic

An explosive decompression accident.

Four divers in a compression chamber system were suddenly decompressed from 9 atm to 1 atm. One of the divers was about to close the door between the chamber system and the trunk when the accident happened. He was shot out through the door and severely mutilated. The three others died on the spot. The autopsy results are described. The most conspicuous finding was large amounts of fat in the large arteries and veins and in the cardiac chambers, as well as intravascular fat in the organs, especially the liver. This fat can hardly have been embolic, but must have "dropped out" of the blood in situ. It is suggested that the boiling of the blood denatured the lipoprotein complexes, rendering the lipids insoluble.

Accidents, Occupational

Non-caseating granulomas in patients with hematologic malignancies. A report of three cases.

Sarcoidosis or sarcoid-like lesions occurred in three patients with hematologic malignancies. In one patient, an overlap syndrome sarcoidosis/polycythemia vera was the most probable diagnosis. In the other two cases, the granulomas were probably secondary to myelofibrosis and Waldenström's disease, respectively. Recent epidemiological studies have failed to show a causal relationship between sarcoidosis and malignancy. The co-existence of sarcoidosis and malignancy is probably fortuitous, but non-caseating granulomas may occur secondary to malignant diseases.

Aged

Effect of volume depletion on the afferent arterioles in the avian kidney.

Nine white leghorn chickens were injected i.m. with furosemide (10 to 60 mg/kg body weight) twice daily for 18 days. The birds were then anesthetized with a combination of equithesin and diazepam and the kidneys perfused via the heart. Kidney tissue was sectioned serially and the granular epithelioid cells were counted in the juxtaglomerular apparatuses of the furosemide treated birds and in 3 normal chickens. Hyperplasia and hypergranulation of the epithelioid cells was found to occur in the juxtaglomerular apparatuses of both mammalian and reptilian type nephrons (with and without Henles loop) in the furosemide treated group. This finding was interpreted as an effect of hypovolaemia on the juxtaglomerular apparatuses. Furosemide caused an immediate stop in weight gain, an increase in the erythrocyte volume fraction and a sudden drop in blood pressure. The blood pressure later rose to subnormal levels. The heart rate was not altered. Plasma sodium and chloride fell significantly one day after furosemide administration and remained low throughout the experiment. Potassium fell during the second part of the experimental period. Captopril was injected after 18 days of furosemide treatment and lowered the blood pressure significantly. This was interpreted as indirect evidence for the presence of renin in the granular epithelioid cells and indicates the importance of the renin angiotensin system in maintaining the blood pressure in hypovolaemic conditions.

Animals

Tumor characteristics in colorectal cancer and their relationship to treatment and prognosis.

Two hundred sixty one patients with adenocarcinoma of the colon and rectum were studied with respect to histopathologic and macroscopic tumor characteristics. Nonmetastatic disease was associated significantly with well-differentiated tumors, tumors with pronounced inflammation, and polypoid adenocarcinomas. There was a higher proportion of poorly-differentiated tumors in the right colon. Inflammatory changes were uncommon in rectal lesions; these tumors were more often polypoid than in other locations. Survival was significantly influenced by tumor differentiation, degree of inflammation, macroscopic appearance, and tumor size. Well-differentiated adenocarcinomas, less than 2 cm in diameter, and well-differentiated polypoid adenocarcinomas, less than 4 cm in diameter, were all found in patients with Dukes' stage A tumors. Such patients may be candidates for local excision if the tumor is located in the distal part of the rectum.

Adenocarcinoma

Comparison of various anesthetic regimens in the domestic fowl.

Three anesthetic agents (equithesin, metomidate, and ketamine) combined with diazepam were tested in the domestic fowl. Laparotomy and thoractomy were possible with the equithesin/diazepam combination, but only laparotomy was possible with the metomidate/diazepam combination. The combination of ketamine/diazepam did not result in the depth of anesthesia required for surgical procedures. Repeated blood pressure and heart rate measurements were recorded by use of a modified noninvasive Doppler technique. Equithesin/diazepam was our combination of choice for long-duration surgical anesthesia. The depth of anesthesia could be modulated by increasing the dose of diazepam. Metomidate/diazepam was useful when short-term anesthesia was required. In contrast to equithesin/diazepam, the metomidate/diazepam combination provided unstable anesthesia of varying depth and duration. Adverse reactions with metomidate indicated caution when using this drug in chickens; the drug also caused marked bradycardia. Ketamine/diazepam combination cannot be recommended as an anesthetic agent for use in chickens. The combination may be useful for minor surgical procedures or treatment, but not for experimental procedures that involve major surgery. Diazepam alone had a slight tranquilizing effect.

Anesthesia, General