Biomedical subjects
Publications and source records attributed to S Laurin.
Angiography of benign bone tumors has previously only been performed in a limited number of cases. Twenty-five cases of 9 different types of benign bone lesion are reported. They were avascular or slightly hypervascular. Absence of soft tissue involvement serves to differentiate benign from malignant bone tumors.
Two patients with obstructive sleep apnea syndrome had polygraphic recordings demonstrated upper airway obstruction and sleep with extremely short sleep latency, severely disturbed nightsleep resulting in sleep deprivation, and excessive daytime sleepiness. Radiological investigation showed the upper airway obstruction to be caused by the tongue falling back occluding the pharynx. Nasopharyngeal intubation relieved the symptoms. The patients were trained to perform this treatment themselves every night, demonstrating that this treatment is an attractive alternative to the conventional tracheotomy.
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The authors compare the protein sparing effect of two diets, exclusively intravenous, including the same protein intake, but a different caloric intake, 21 calories/gm nitrogen for diet "A" (20 cases); 138 calories/gm nitrogen for diet "B" (20 cases). This has been observed during the six post-operative days of major visceral surgery: oesophagectomy, total gastrectomy, colic or rectocolic exeresis, sequestrectomy for acute pancreatitis, lots having been drawn for the diets. Daily nitrogen balances have been made and plasmatic and urinary levels of amino-acids have been measured before surgery and on the third and fifth post-operative days. Statistical exploitation is done by variance analysis (linear model of three factors) with a 99% confidence ratio: 1) Patient factor has no influence whatsoever on cumulative nitrogen balance. 2) Time factor arises only on the fourth post-operative day and only in the hypocaloric diet, leading to catabolism. 3) Metabolic condition is determinant. On no cancerous disease, superiority of hypercaloric diet is well demonstrated. On cancerous disease, nitrogen loss is only significantly different on 4th and 5th post-operative day: hypercaloric diet gives a better nitrogen balance.
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Late recurrence (more than five years) of benign giant-cell tumor of bone is uncommon. Two patients were evaluated by angiography, including injection of vasoactive drugs, because of osteolytic lesions developing six and seven years after primary operation for benign giant-cell tumor. Angiography established a probable recurrence in both cases. Angiography also permitted accurate evaluation of tumor extension, facilitating pre-operative planning. Giant-cell tumors are predominantly hypervascular lesions. Angiographic evaluation is therefore recommended when a recurrent lesion is suspected.
An eight year old girl with acute glomerulonephritis developed a massive hemothorax without previous trauma. Angiography demonstrated a bronchopulmonary sequestration with multiple arterial aneurysms. Surgical treatment was succussful. Pathologic-anatomic examination revealed arteritis of the type seen in the postcoarctectomy syndrome.
Micturition cystourethrography was performed with varying numbers of films exposed and the probability of missing a vesicoureteral reflux or underrating its severity was calculated for each series. It was concluded that a small number of exposures can give sufficiently accurate diagnosis.
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Angiography was performed in ten cases of myeloma (plasmacytoma), of which nine were solitary on admission. All lesions were hypervascular bone tumors with extension of neoplastic growth into adjacent soft tissue. Contrast uptake of the tumors occurred regularly and usually was non-homogeneous. In nearly all cases irregular tumor vessels and early venous drainage was evident with arteriovenous shunting in three. Pathologic-anatomic correlation demonstrated 'tumor vessels' to be newly formed vascular spaces lacking the normal constituents of vessel walls. The contrast uptake presumably was caused by passage of contrast into the newly formed, slit-like capillary vascular spaces. Angiography usually permitted separation of myeloma from benign, hypervascular bone lesions. The procedure proved to be of particular value in indicating definite malignancy, since myeloma was considered initially as the probable diagnosis in only one of the series. It was not possible, however, to differentiate myeloma from other malignant tumors by plain radiography or angiography. Irreversible renal failure occurred in one patient after angiography.
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The pharmacoangiographic effect of a vasoconstrictor (angiotensin) and a vasodilator (tolazoline) was compared in 18 patients with bone and soft-tissue tumors. Angiotensin was found to be the drug of choice in increasing diagnostic information on angiography. Ten to 15 mug of angiotensin seems to be a convenient dose in the axillary, iliac, and femoral arteries.
Angiography in 9 cases of giant cell tumors of bone is described. All cases had a greatly increased vascularity of the lesion, with concomitant increase in the diameter of the supplying arteries and draining veins. The arterial branching on the surface as well as within the tumor seemed specific of giant cell tumors. Arteriovenous shunting was marked. There was a marked, long-lasting, non-homogeneous tumor stain. Examination with angiotensin enhanced the pathologic findings. The angiographic appearance, often simulating malignancy, combined with the appearance of the skeletal films, make the diagnosis of giant cell tumor almost certain. Difficulties will be expereinced in differentiating giant cell tumors from metastatic deposits, especially in the spine.
Pelvic measurements in a group of 115 women delivering in breech presentation were compared with those in a group of 100 delivering in cephalic presentation. The average pelvic measurements were all a few mm larger in the breech cases and the average sum of the outlet diameters was significantly larger. Pelvic disproportion was not more common in breech presentation and no support was found for the theory that large pelvic measurements predispose to breech presentation. The small differences found are attributed to the moulding of the pelvis occurring during parturition.
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In a material of 89 patients with Hodgkin's disease, 98 combined examinations, including lymphangiography, cavography and urography, were performed. Lymphangiography disclosed signs of expansive lesion 33 times, cavography 21 times and urography 17 times. The diagnostic accuracy of lymphangiography was high. Routine cavography in Hodgkin's disease is not advocated; it may be restricted to cases with equivocal lymphographic findings.
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