Biomedical subjects
Publications and source records attributed to J Göthlin.
The normal anatomy of the ascending lumbar veins and a catheterization technique used to demonstrate these veins at phlebography are reported. The use of this examination when dealing with malignant disease in the abdomen and retroperitoneal region is not warranted, on account of the wide range of anatomic and phlebographic variation.
The angiographic appearance of the end diastolic left ventricular cavity in 4 patients with obstructive idiopathic hypertrophic subaortic stenosis is characterized by a model in projective geometry. The muscular interventricular septum, catenoid-like (convex longitudinally and concave transversely towards the left ventricular cavity), has an oblique long axis of the catenoid relative to the apicomidaortic axis of the left ventricle. The cavity is shallow in its mid- and apical parts.
The renal blood flow and related variables were assessed with a dye dilution technique in conjunction with angiography of the enlarged kidney in 13 patients with unilateral disease, hypoplasia or aplasia of one kidney. The total renal blood flow, the width of the arteries, the kidney area, the vascular volume and the thickness of the cortex were all increased. The vascular resistance was decreased. The circulation time through the kidney was normal but the flow volume and most likely also the intrarenal flow velocity were increased.
After lymphography from the foot, with uncertain findings, fine-needle biopsy during fluoroscopy was performed in 107 patients. In 69 patients with possible metastases, involvement was demonstrated in 46, confirmed in 43 at operation. Lymph node involvement by general lymphatic disease was suggested in 38 patients, with biopsy confirmation in 12. In metastatic disease non-representative material was obtained in only 2 patients, in general lymphatic disease in 10. No significant complications occurred, and the side effects were small.
In ten patients, operated jejunoileostomy and ileocolostmy because of longstanding obesity resistant to conventional therapy, roentgenological examinations of the small bowel were performed before and after the operation. Seven patients were examined preoperatively, and all were investigated at least twice during a period from 1 to 38 months postoperatively. Preoperatively, the passage time pylorus-cecum was 80-270 min, and postoperatively, it varied between 1 and 30 min. There was no tendency to slowing of the gastrointestinal passage with time. Immediately postoperatively, the patients had 6 to 12 loose stools daily. At investigations performed 6-38 months after the operation, the stool frequency had diminished to 1-4 a day, and the patients had lost 21 to 98 kg in weight. Roentgenologically, an increased thickness of the mucosal folds of the small bowel could be demonstrated in 9 of the 10 patients. The results suggest that in patients with jejunoileostomy, the gastrointestinal passage time is decreased. The bowel function tends to normalize with time, but the passage time remains shorter than normal. Compensatory changes in the intestinal mucosa occur.
Angiotensin in a dose of 0.5 to 1.0 microgran injected into the renal artery of healthy kidneys initially decreased renal blood flow and increased the appearance time and mean transit time of dye and contrast medium as examined by a dye dilution technique and angiography. The initial phase is followed by a reactive hyperemia. The increased vascular resistance is probably localized peripherally on the arterial side of the vascular tree. Optimum dose is 0.5 to 1.0 microgram angiotensin in diagnosis of renal tumours. Optimum interval between drug administration and angiography is 10 to 60 s.
In 19 patients with renal carcinomas determination of the renal blood flow and related parameters were determined. In 10 of the kidneys the renal blood flow was higher than 1700 ml/min, in five kidneys the vascular volume was increased and in all kidneys the appearance time of dye in the renal vein was below normal. It is concluded that AV-shunting is present in all renal carcinomas even if they are hypovascularized or cystic. Underperfusion is supposed to be present in the normal renal parenchyma surrounding the carcinoma. The shunted amount of blood can be fairly large, in the present series up to 3 1/2 litre. The dye dilution technique is suitable for studies of the hemodynamics in renal carcinomas.
In 31 patients with renal carcinoma referred for angiography, rapid sequence angiography was performed in 25. In 18 of the patients determination of renal blood flow and related parameters was made in conjunction with the angiography. Carcinomas with high and medium-high differentiation comprised Group I, while those with medium and poor differentiation constituted Group II. In both groups a positive correlation was demonstrated between the renal blood flow and the tumour area. In group I, positive correlation (t greater than 2) was demonstrated between the vascular volume and the tumour area, between the vascular resistance and the emptying time of the tumour arteries and the normal renal arteries. There was some degree of shunting of blood in all tumours. Comparison of the arterial emptying time of the tumour arteries with the parenchymal arteries does not allow of staging of renal carcinomas. The degree of shunting may be an indication of the degree of malignancy and poor differentiation.
In 15 patients with large Cimino-Brescia fistulae, arm blood flow and cardiac output were determined by a dye-dilution technique. The mean blood flow through the arm with the shunt open was 1600 ml per min. On compression of the shunt the appearance time increased by 10 sec and there was a moderate decrease in cardiac output.
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Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.
Angiography findings in 18 patients with carcinoma of the gallbladder and 17 with cholecystitis indicate that similar abnormalities may appear in both lesions. Irregularities and obstruction of arteries were more common in malignant disease and somewhat more severe. Accumulation of contrast medium and prominent veins occurred in both groups. Displacement of adjacent vessels was more common in malignant disease. As chronic inflammatory lesions cannot with certainty be differentiated angiographically from malignant disease, cholecystectomy is recommended when the abnormalities described are demonstrated.
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Angiographic findings in 21 cases of renal pelvic carcinoma are presented. Important characteristics include neovascularity, visible capillary phase, vascular encasement, wide pelviureteric artery and absence of arteriovenous shunting. Angiography may also be of value for the differential diagnosis of ureteric obstruction as demonstrated in 5 of 6 patients with carcinoma of the ureter.
Using a dye dilution technique, blood flow was measured in the right and left renal veins in 12 patients with portal hypertension. There was evidence of spontaneous shunts to the left renal vein in all cases and at least in 4 cases to the right one. Spontaneous portal systemic shunts other than via esophageal varices is probably much higher than hitherto known.
Renal size (product of length and width) was measured at urography before and after nephrectomy performed for tumor in 33 patients aged 38-78 years (mean, 59). In 88% a statistically significant enlargement of the remaining kidney was found (P less than .001). Earlier reports stating that compensatory renal hypertrophy does not occur in older patients cannot be supported.
Severe haemorrhage after an uncomplicated pyelolithotomy in a young women was found to be caused by multiple, unilateral haemangiomas. The diagnosis was made at angiography prior to the subsequent nephrectomy.
Percutaneous fine needle aspiration biopsy was performed at retrograde pyelography in order to differentiate between metastatic and scarry involvement of a strictured ureter in a patient earlier operated upon because of malignant teratoma. The method is recommended in patients with malignant diseases where the differential diagnosis is impossible to establish at retrograde pyelography or urography.