Biomedical subjects
Publications and source records attributed to S Lähde.
A method of positioning a patient with recent injury of the shoulder girdle for the axial glenohumeral view is described. No forced movement of the affected joint is needed and the patient may lie on his uninjured side.
An abdominal aortic aneurysm was detected in 77 patients among 16 488 abdominal ultrasonographies (US) performed in 1978-1983. In 62 cases the US finding was confirmed by operation, autopsy or other imaging method, and the US finding proved true in 60 cases. The length and diameter were accurately estimated and accompanying thrombosis reliably visualised. An error rate of 24% was observed in assessing the relation of the aneurysm to the renal arteries. US is recommended as the primary imaging mode in suspected abdominal aortic aneurysm. Screening of the abdominal aorta is recommended in elderly patients with abdominal pain and/or referred for abdominal US.
The suitability of CT for pelvimetry was studied. For accurate measurement of the true conjugate and interspinous diameter, a lateral topogram and an axial CT slice were taken. The radiation dose was reduced from 1 mGy (in conventional system) to 0.1-0.2 mGy.
Discitis is a rare complication of disc operation. During a 10-year-period 1100 patients were operated for lumbar disc herniation and only eight patients developed postoperative discitis. The symptoms began 3 weeks after the operation and the most prominent clinical feature was back pain with muscle spasm. The sedimentation rate was highly elevated but the body temperature was slightly elevated for only a few days. Typical radiographic findings were narrowing of the affected disc space and end-plate resorption 3-4 weeks after the initial symptoms. In the early phase, CT showed hypodense disc material in the affected disc space, which may be the first radiological sign of discitis.
Using 750 outpatients as our material, the effects of dimethicon , simethicon - pankreatin and lysin-vasopressin, of the position of the patient and of the filling of the stomach with soup on the success of pancreatic ultrasonography were studied. Dimethicon had no, simethicon - pankreatin an almost significant and lysin-vasopressin a highly significant positive effect. Lysin-vasopressin caused several mild adverse reactions. The filling of the stomach with soup combined with erect position was effective in about 3/4 of the cases. Prone position was not usefull.
A series of 226 patients with suspected pancreatic disease examined with ERCP, included 130 patients with normal ductal morphology (group I), 24 with 1-2 smooth narrowings of the main duct of the pancreas (group II), 20 with ectatic small branches (group III), 22 with an irregular main duct and ectatic small branches (group IV), and 30 patients with other findings in the pancreatogram. Pancreatic exocrine function was measured in 140 patients using the secretin test. The mean value of the maximal bicarbonate concentration was significantly (p less than 0.001) lower in the patients with severe ductal changes than in those with a normal pancreatogram. In addition, the number of patients with impaired exocrine function was significantly higher in group IV than in group I. The other groups did not differ significantly. A two-hour glucose tolerance test was done on 104 patients in addition to which 19 patients had overt diabetes. The number of patients with abnormal glucose tolerance was significantly higher in group IV (60%) than in group I (27.5%). The mean blood sugar value was also higher after one hour in group IV than in group I. The patients in the other groups did not differ significantly with regard to glucose metabolism. An almost significant negative correlation was found between the maximal bicarbonate concentrations and the one-hour blood glucose values (p less than 0.05).
Nine patients suspected of having parathyroid adenoma or hyperplasia on the basis of laboratory tests were examined by semiselective venous sampling for parathyroid hormone after unsuccessful neck explorations. Two pathologic parathyroid glands were found at re-operation. Only one was suspected preoperatively on the basis of venous sampling. Twenty patients suspected of having parathyroid adenoma or hyperplasia on the basis of the laboratory tests were examined by real-time sonography. Twelve adenomas and ten hyperplastic glands were found at operation. All the adenomas and hyperplastic parathyroid glands were preoperatively discovered with ultrasonography, but there were also three false-positive findings.
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The US and CT images of liver metastases in 42 patients were systematically compared. Based on the US image the lesions were classified as non-echogenic, slightly echogenic, and markedly echogenic lesions, target lesions and lesions with diffuse alteration of structure. There was often discrepancy between the appearance of the US and CT images. The discrepancy was increased after contrast enhancement in non-echogenic and in slightly echogenic metastases and in metastases with diffuse alteration of echo structure and diminished in target lesions. The possible reasons for these differences are discussed.
Twenty-four patients with steatotic liver underwent computerized tomography (CT) and ultrasound (US) examinations and liver biopsy, performed within a maximum interval of 6 weeks. The CT and US findings were compared with the fat and fibrous content of the biopsy specimens. A good linear inverse correlation between the CT findings and fat content was found. The ranges of CT values were 39-60 HU (mean, 52 HU) for mild fat content (less than or equal to 9.9%), 4-46 HU (mean, 27 HU) for moderate fat content (10.0-24.9%), and -6 to 19 HU (mean, 10 HU) for severe fat content (greater than or equal to 25.0%). With US it was possible to estimate roughly the fat and fibrous content of the liver. There was always the 'bright liver' finding in patients with 10.0% or more fat content, but it was impossible to estimate the content of fat more accurately. 'Bright liver' was also found in most patients with mildly and in all patients with severely increased fibrous content. It was impossible to differentiate the latter from each other or from the 'bright liver' caused by fatty degeneration.
A series of 214 patients with lower back and extremity pain syndromes underwent computed tomography (CT) after lumbar myelography. CT was in full agreement with the myelographic finding in 81%. In 12% CT gave more information but did not change the therapy. In 7% CT changed the diagnoses and was of significant benefit. Myelography was considered an appropriate primary method for evaluating lower back and extremity pain syndromes if the level of suspected lesion could not be predicted. CT is suitable not only as a method for checking unclear or confusing myelographic findings but also as a primary mode in selected cases.
Gray-scale ultrasound examinations were performed in 13 patients with 18 small asymptomatic haemangiomas of the liver and computed tomography in 10 of these patients. Different types of ultrasound images were found. One of them appeared as a well-demarcated area of increased echoes with an echo-free halo consisting of vessels, is probably characteristic for haemangioma. The other types of images are considered non-specific. The native CT scans demonstrated a well-demarcated spherical area with low attenuation in 8 cases and an area with attenuation similar to the liver in 4. After contrast medium injection, areas with lower attenuation were found in 7 cases, with irregular accumulation of contrast medium in the periphery in 4, and with distinct vessels in the periphery in one case, 2 haemangiomas had the same attenuation as the liver parenchyma.
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We analyzed separately from a urographic series 1 radiograph of the kidneys, ureters and bladder after releasing compression. The diagnosis was compared to that of the complete series in 230 consecutive urographic studies performed for recurrent urinary tract infections. The findings were in agreement in 88 per cent of the cases and no therapeutically significant change was overlooked owing to the decrease in the number of exposures. A urographic series with 2 films is described and recommended for the screening of recurrent urinary tract infections in young patients.
Esophageal double-contrast radiography was performed on 19 patients with endoscopically verified reflux esophagitis and on 12 patients with endoscopically normal esophagus. Using the findings at endoscopy as a reference, double-contrast radiography showed four false-negatives and one false-positive finding, its overall accuracy being 84%. In both double-contrast radiography and endoscopy, hiatal incompetence correlated poorly with the presence of any esophagitis. It was concluded that double-contrast radiography is the radiological method of choice in suspected reflux esophagitis, and that screening of the lower esophagus should be included in examinations of the upper gastrointestinal tract.
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