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Biomedical subjects

L Blomqvist

Publications and source records attributed to L Blomqvist.

At least 19 recordsLinked to original sources
PubMed2003

Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer.

BACKGROUND: Despite radiotherapy and improved surgical techniques, local recurrence rates after treatment of rectal cancer still vary between 3 and 30 per cent. Tumour involvement of the circumferential resection margin (CRM) predicts a high risk of local recurrence. Magnetic resonance imaging (MRI) allows accurate description of the tumour and its spread within the mesorectum. The aim of this study was to assess the prognostic impact of an involved CRM identified at preoperative MRI in patients with rectal cancer. METHODS: Preoperative MRI was performed in 115 patients with rectal cancer between 1995 and 1999. The images were evaluated retrospectively. The shortest distance from the tumour to the CRM was measured, correlated with patient outcome and compared with histopathological findings. RESULTS: The risk of any recurrence in patients with or without a tumour-involved margin on MRI was nine of 29 and nine of 57 respectively (P = 0.036). Overall survival at 5 years was 43 and 77 per cent (P = 0.012) respectively. Twenty-four of 30 patients who had an involved CRM on histopathology were correctly identified by MRI. CONCLUSION: Patients with a potentially involved CRM identified by MRI had a significantly higher risk of recurrence and cancer-related death. Preoperative MRI may be of prognostic value in rectal cancer and may be used to select patients for neoadjuvant radiochemotherapy and/or more radical surgery.

Adult↗
PubMed2003

Preoperative staging of colorectal cancer--computed tomography and magnetic resonance imaging.

Cross-sectional imaging techniques are increasingly being used in the preoperative evaluation of patients with colorectal cancer. Both computed tomography (CT) and magnetic resonance (MR) imaging have been improved with significant advances of the technological hard- and software. This has contributed to high patient acceptance due to shorter examination times and more open configuration of the systems, consistent high quality images with better delineation of the normal abdomino-pelvic anatomy and pathology. New techniques such as CT-colonography have emerged from a research application to a clinical tool which can be used in different clinical settings. Phased-array receiver coils have significantly increased the usefulness of MR in the evaluation of rectal neoplasms due to the high resolution that can be obtained. New organ specific contrast agents for magnetic resonance imaging have facilitated the preoperative evaluation of liver metastases in favour of more invasive techniques with similar sensitivities. However, preoperative staging criteria for colorectal cancer using computed tomography and magnetic resonance imaging has to be updated and the results of new techniques have to be confirmed in large trials. In the future, further development of CT and MR may offer 'one-stop-shopping' protocols for both diagnosis, local and distant staging of colorectal cancer. Diffusion weighted MR-imaging, in vivo spectroscopy as well as further targeted imaging, such as with lymph node specific agents for MR may also prove to be helpful in the preoperative evaluation of patients with colorectal cancer.

Colonography, Computed Tomographic↗
PubMed2002

Non-Hodgkin's lymphoma in McKusick syndrome. A case report.

The McKusick syndrome in a female who developed highly malignant lymphoma at the age of 23, with multiple parenchymal lesions involving both kidneys, the lungs and the pancreas and also splenomegaly but without lymphadenopathy, is described together with diagnostic imaging findings. McKusick syndrome is associated with impaired cell-mediated immunity and might, like several other similar syndromes, harbor an increased risk of certain types of lymphoma. To our knowledge, there are no previous reports of non-Hodgkin's lymphoma in a patient with McKusick syndrome. The increased incidence of lymphoma in certain cases of congenital immunodeficiency raises the issue of a possible relationship between McKusick syndrome and lymphoma and could perhaps serve as one of the primary steps for a further characterization of this syndrome.

Adult↗
PubMed2001

Chest X-rays.

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Humans↗
PubMed2001

Dynamic 99Tcm-HIDA SPET: non-invasive measuring of intrahepatic bile flow. Description of the method and a study in primary sclerosing cholangitis.

In this study dynamic 99Tcm-HIDA single photon emission tomography (SPET) was performed in patients with primary sclerosing cholangitis and normal test subjects. The method offers the possibility of functional analysis of individual liver segments. After injection of 120 MBq of 99Tcm-HIDA, 12 consecutive SPET examinations were performed at 6-min intervals. The segmental borders of liver segments as seen on computed tomography or magnetic resonance examinations were superimposed on the scintigraphic images allowing placement of regions of interest (ROIs) in specific liver segments. Sampling from the same ROIs in consecutive SPET images enabled creation of time-activity curves for individual liver segments. A range of normal values was created by quantitative analysis of normal volunteer studies. Results of the studies in patients correlated well with cholangiographic extent of disease, liver function tests and histological stage. The technique may have particular value in diseases that affect the liver in a nonhomogenous or segmental fashion. Giving an indication of bile clearance from individual liver segments, it can quantify the functional importance of radiologically detected strictures. Percutaneous liver biopsy can be directed to the worst affected parts of the liver, making biopsy more representative. Sequential studies may allow monitoring of disease progression, aiding in selection and timing of therapeutic procedures.

Adult↗
PubMed2000

Local recurrence of rectal cancer: MR imaging before and after oral superparamagnetic particles vs contrast-enhanced computed tomography.

The aim of this study was to compare three imaging strategies for the diagnosis of local recurrence of rectal cancer: (a) MR imaging; (b) MR imaging after administration of enteral superparamagnetic particles (Ferristene); and (c) contrast-enhanced CT. Seventeen patients with previous surgery for rectal cancer were examined, 12 patients with local tumour recurrence in the pelvis and 5 patients with postoperative changes. Pelvic multi-coil MR imaging before and after oral administration of superparamagnetic contrast medium [Abdoscan (Ferristene USAN), Nycomed-Amersham, Lidingö, Sweden] as well as abdominal and pelvic CT was performed in all patients. The examinations were independently evaluated by three different radiologists. The general effect of the oral MR contrast medium, the delineation of normal and pathological structures as well as confidence in the diagnosis were registered on a visual analog scale (VAS). The diagnosis according to MR before and after oral contrast medium, and CT, was compared, in 16 patients, with the final diagnosis which was verified by biopsy (n = 3), surgery (n = 6), clinical follow-up (n = 4) and by follow-up with MR or CT (n = 3). No significant improvement in MR image quality was found after enteral contrast medium. The post-contrast MR diagnosis was not changed in any of the patients. The diagnosis on MR correlated with the final diagnosis in 12 of 16 patients (sensitivity 91%, accuracy 62%) and the diagnosis on CT in 11 of 16 patients (sensitivity 82 %, accuracy 56 %). The radiologists' "confidence" in the diagnosis and the degree of accordance with the final diagnosis did not score higher on MR after than before oral contrast administration; however, the accordance with the final diagnosis scored better on MR than on CT. No advantages of orally administered superparamagnetic contrast medium were observed in the examined patient group. Magnetic resonance is preferable to CT in diagnosing local tumour recurrence.

Administration, Oral↗
PubMed2000

Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography.

The aim of this study was to compare MR imaging and endoscopic ultrasonography (EUS) for the local staging of rectal tumours. Forty-nine patients were examined on a 1.5-T MR unit using either a pelvic phased-array coil (n = 37) alone or combined with an endorectal coil (n = 12). Sagittal and axial sequences with T2-weighted fast spin-echo and axial T1-weighted spin-echo techniques were employed. The EUS technique was performed using a flexible endosonoscope. The results were compared with findings at histopathological sectioning of the specimen. The T-stage on MR correlated with histopathology in 32 of 49 patients and on EUS in 29 of 49 patients. The N-stage on MR correlated with histopathology in 22 of 49 patients and on EUS in 26 of 49 patients. Tumour penetration of the rectal wall was predicted by MR with 86 % sensitivity and 65 % specificity, and by EUS with 89% sensitivity and 33% specificity. Preoperative radiotherapy was administered to 40 of the patients after the examinations which may explain some of the overstaging by MR and EUS. Three patients with surgically and histopathologically confirmed invasion of neighbouring organs in the pelvis were detected preoperatively on MR but none on EUS. Tumour penetration of the rectal wall and local lymph node metastases cannot accurately be predicted with MR or EUS. Magnetic resonance, however, seems to be more useful for preoperative identification of clinically occult advanced disease.

Aged↗
PubMed2000

Added value of CEA scintigraphy in the detection of recurrence of rectal carcinoma.

PURPOSE: To explore the diagnostic value of immunoscintigraphy compared to CT and/or MR imaging in the diagnosis of local recurrence (LR) of rectal cancer. MATERIAL AND METHODS: Forty-six patients suspected of having LR of rectal cancer were retrospectively studied. Carcinoembryonic antigen (CEA) scintigraphy findings were compared to CT and/or MR in all patients, and with data from surgery and morphology (31 patients), biopsy (7 cases) and follow-up (8 patients). RESULTS: CEA scintigraphy was not complementary to CT and/or MR in the detection of LR. Two false-positive and 14 false-negative diagnoses of LR occurred with CEA scintigraphy. Distant metastases including metastatic lymph nodes were found by this method in only 7 of 27 patients with proven metastases. CT/MR were able to demonstrate these metastases in 21 of 27 patients. CONCLUSION: Accuracy and sensitivity of CEA scintigraphy in the detection of LR and distant metastases is lower than that of CT and/or MR. However, CEA scintigraphy seems to have a high specificity and could therefore be used in patients with a strong clinical suspicion of LR but negative CT/MR investigations. Available diagnostic methods have limitations in differentiating between benign, post-treatment changes and LR of rectal cancer and in staging of malignant disease.

Adult↗
PubMed2000

The lateral thoracodorsal flap in breast reconstruction: a comparison between two plastic surgical centres.

In a retrospective study the results of breast reconstruction with 146 lateral thoracodorsal flaps operated on during the period 1991-94 at the Departments of Plastic Surgery at the Sahlgrenska University Hospital in Göteborg and the Stockholm Söder Hospital were evaluated. The median age of the 135 patients was 51 years (range 37-74). About two thirds of the patients were also operated on on the opposite side at the same time; and this was done more often in Stockholm, which partly explains the longer operating time in Stockholm. Perioperative bleeding (median 100 ml, range 25-400) was similar in both groups. Median postoperative bleeding, which was measured only in Stockholm, was 300 ml (range 30-1000). Seromas were seen only in Göteborg where postoperative drains were rarely used. The rate of early complications (infection and partial necrosis) were higher in Stockholm where more flaps were raised in irradiated tissue. We conclude that the results were similar in the two centres, and the thoracodorsal flap gives good results. The incidence of early morbidity could be reduced by excluding patients who had been irradiated, by inserting drains, and by giving antibiotic prophylaxis.

Adult↗
PubMed2000

Clinical follow up of the lateral thoracodorsal flap in breast reconstruction: comparative evaluation from two plastic surgical centres.

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.

Back↗
PubMed2000

A prospective and randomized study, "SVEA," comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result.

During the last 30 years, many methods for delayed breast reconstruction have been described. There is a lack of prospective randomized trials comparing reconstruction methods. The present study (SVEA), conducted 1995 to 1996, describes the impacts of three methods: the lateral thoracodorsal flap, the latissimus dorsi flap, and the pedicled transverse rectus abdominis muscle flap (TRAM), on important areas of life, patients' perception of cosmetic result, and quality of life. Questionnaires were completed before randomization and at 6 and 12 months postoperatively. The preoperative questionnaire concerned the impact of breast loss and expectations on reconstruction. Follow-up questionnaires dealt with satisfaction with cosmetic result and impact on important areas of life. A health-related quality-of-life questionnaire (SF-36) was completed at all points of assessment. A total of 75 of 87 randomized patients underwent breast reconstruction: 16 patients with the lateral thoracodorsal flap, 30 with the latissimus dorsi flap, and 29 with the TRAM flap. The majority were very satisfied with the cosmetic result. Most women reported improvements in important areas of life, and quality of life in terms of "social functioning" and "mental health" increased significantly after the reconstruction. The latissimus dorsi flap and TRAM flap scored significantly higher as compared with the lateral thoracodorsal flap for similarity with the contralateral breast and reduced problems in social situations. No differences between irradiated and nonirradiated patients were found. All methods were considered to produce good cosmetic results and improvements in patient-defined problem areas of life and quality of life. No negative effects were recorded. Thus, irrespective of method, breast reconstruction is a valuable tool for the mastectomized woman to cope with problems in everyday life.

Activities of Daily Living↗
PubMed2000

Reduction mammaplasty provides long-term improvement in health status and quality of life.

The objective of this study was to assess health status and quality of life in macromastia patients undergoing reduction mammaplasty. From January of 1997 to June of 1997, the Department of Reconstructive Plastic Surgery, at Stockholm Söder Hospital/Karolinska Hospital, conducted a prospective questionnaire study with preoperative and postoperative (6 and 12 months) assessments in 49 women who were 20 years or older. The questionnaire included four parts: Part I assessed pain (scale 1 to 10) in the neck, shoulders, back, breast, bra strap indention, and head. Part II assessed effects of breast size and weight on body posture, sleep, choice of clothing, sexual relations, and working capacity (scale 1 to 10). Part III assessed preoperative expectations for the operation in comparison with postoperative result (scale 1 to 6). Part TV included SF-36, an international health-related quality-of-life questionnaire, which has been standardized for Swedish women. As a result, reduction mammaplasty (mean resection weight, 1052 g) provided significant reduction of pain in all locations (p < 0.001). The improvements continued up to 12 months postoperatively. The patients' main subjective problems related to the size and weight of the breast were body posture and choice of clothing. The patients scored significant improvements of all subjective problems (p < 0.001), except sleep. The patients' expectations were met to a high extent. In some areas such as intimate situations, femininity, and social contacts, the results exceeded the preoperative expectations. Preoperatively, the mammaplasty patients scored significantly lower (p < 0.05 to p < 0.001, depending on area) in SF-36, i.e., the patients had lower quality of life compared with women in the same age group. Reduction mammaplasty resulted in significantly improved quality of life; furthermore, the results were similar after 6 and 12 months, indicating long-term improvement. In fact, after 1 year, there was no statistically significant difference between the patients who had been operated on and the age-matched women, i.e., the women were normalized in health-related quality of life as judged by the SF-36.

Adult↗
PubMed1999

A prospective randomised study (named SVEA) of three methods of delayed breast reconstruction. Study design, patients' preoperative problems and expectations.

A randomised study named SVEA to compare three methods for delayed breast reconstruction was initiated in 1994. The methods were: the lateral thoracodorsal flap, the latissimus dorsi flap, and the pedicled transverse rectus abdominis muscle flap. In the present paper we describe the study design, primary endpoints, and inclusion and exclusion criteria. Results from preoperative questionnaires about problems after mastectomy and expectations of the reconstruction are presented. The preoperative questionnaires, completed before randomisation, included a health related quality of life questionnaire, the SF-36, and a questionnaire concerning the impact of breast loss and expectations of the reconstruction. A total of 87 patients have been randomised in SVEA and 30 patients have been followed up outside the randomised study, comprising a reference group. The results from preoperative questionnaires, completed by 106 of the total 117 women, showed that they encountered many problems after mastectomy, primarily about feeling mutilated and being bothered socially. They held high expectations on the breast reconstruction in these areas. The women in the present study did not differ from Swedish women in general regarding health related quality of life, with two exceptions: the study sample scored lower on physical functioning and mental health.

Attitude to Health↗
PubMed1999

Clinical experience with the lateral thoracodorsal flap in breast reconstruction.

The lateral thoracodorsal flap is a local fasciocutaneous flap used for breast reconstruction. From 1986 to 1994 the authors used this flap in 157 breast reconstructions in 152 patients. The patients who had been treated with postmastectomy radiotherapy (N = 40) had significantly more (p < 0.01) early complications, such as necrosis and infection. Irradiated patients also required more operations due to secondary complications, such as capsular contracture (p < 0.05). A patient questionnaire (response rate, 91%) was sent to 121 patients and showed that, although a majority of patients felt the reconstructed breast was less sensitive to touch and harder than the contralateral breast, they still regarded the reconstructed breast as a natural part of themselves. More than 90% of patients did not regret the reconstruction and 80% would recommend it to a friend.

Adult↗
PubMed1999

Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen.

The aim of the present study was to investigate whether MRI could predict tumour involvement of the lateral resection margin on resected rectal cancer specimens. 26 specimens obtained after total mesorectal excision were examined in the sagittal and axial plane on a clinical 1.5 T MR system using phased-array surface coils. The shortest distance between the deepest point of tumour penetration and the lateral resection margin was measured. This distance is referred to as LRM. The results were correlated to measurements on digital images of giant histopathological sections. The total number of lymph nodes and lymph node metastases was also counted. LRM was less than or equal to 1 mm (a distance considered for non-radically excised tumours) in eight of the histopathological specimens. On MR images of the resected specimen, LRM was less than or equal to 1 mm in seven of these specimens. LRM was shorter in MR examinations than in histopathological giant sections in 11 specimens. The sensitivity, specificity, positive and negative predictive values for prediction of tumour involvement of the lateral resection margin (LRM < or = 1 mm) by MR of the resected specimen were 88%, 78%, 64% and 93%, respectively. Presence of lymph node metastases could not accurately be predicted by MR. However, it is concluded that the presence of a tumour free lateral resection margin can be predicted by MRI of resected rectal specimens when this exceeds 1 mm.

Adenocarcinoma↗
PubMed1998

The pelvis after surgery and radio-chemotherapy for rectal cancer studied with Gd-DTPA-enhanced fast dynamic MR imaging.

The aim of this work was to study the gadolinium-enhancement of malignant and benign pathology in the pelvis after surgery for rectal cancer. Thirty patients with either local recurrence (n = 17) or benign changes related to treatment for rectal cancer (n = 13) were studied with pelvic MR imaging. T2-weighted fast spin-echo as well as T1-weighted spin- or gradient-echo imaging before and after intravenous contrast was performed and referred to as contrast-enhanced MRI (CEMRI). In addition, between the pre- and postcontrast images, dynamic contrast-enhanced MRI (DCEMRI) was performed using a single-slice, multi-phase, contrast-enhanced T1-weighted fast spoiled gradient-echo sequence. The time between the start of contrast injection to the beginning of enhancement, the duration and rate of enhancement as well as enhancement amplitude were recorded. The data were compared with the clinical diagnosis according to biopsy in 8 patients and surgery in 6 patients. In the remaining 16 patients, the clinical diagnosis was obtained by clinical or radiological follow-up. DCEMRI did not improve the diagnostic information compared with CEMRI. None of the examined parameters were found to help discriminating malignant from benign changes. Characterisation of lesions in the pelvis after rectal cancer surgery was not improved by a dynamic gadolinium-enhanced sequence.

Adult↗