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.

Six-year recurrence free survival after intraluminal iridium-192 therapy of human bilobar biliary papillomatosis. A case report.

BACKGROUND: Biliary papillomatosis is rare and often fatal. Liver resection or transplantation is recommended but may be impossible due to tumor or patient factors; furthermore, it appears to the authors of this study that no follow-up results after transplantation have been reported in previous studies. METHODS: Bilobar but limited biliary papillomatosis in a man age 54 years was mapped by cholangiopancreatography, cholecystectomy, and operative cholangioscopy. After cholangioscopic electrocoagulation, iridium-192 wires were temporarily inserted into the affected bile ducts, giving a dose of 60 grays at a 3-mm distance. Another percutaneous cholangioscopic electrocoagulation was performed 3 weeks later. RESULTS: The patient has been free of tumor and in good health for 80 months, but he has a long term stenting of a nonneoplastic stricture at the confluence of the bile ducts. CONCLUSIONS: Mechanical tumor reduction and intraluminal brachytherapy could possibly replace transplantation (which up to now has been suggested but not reported) when this life-threatening disease is bilobar, and also possibly replace liver resection for limited tumors in patients who are too frail for surgery.

MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence of rectal carcinoma.

PURPOSE: To compare advanced imaging techniques in the diagnosis of recurrent rectal cancer. MATERIAL AND METHODS: Twenty-five consecutive patients with either suspected or verified recurrence were examined by CT (n = 25), MR with phased-array capabilities (n = 24) and CEA scintigraphy (n = 16). Three experienced radiologists (who were blinded to results obtained at surgery and histopathology) independently evaluated the films, one observer for each modality. RESULTS: The MR radiologist arrived at a correct diagnosis in 87.5% of the examinations, the CT radiologist in 76% and the CEA radiologist in 75%. The MR radiologist's results correlated more often with reported pathology than did those of the CT radiologist with regard to the relation of recurrent tumor to surrounding structures in the pelvis. CONCLUSION: MR imaging is the most effective of the 3 modalities in the diagnosis of recurrent rectal cancer.

A modified technique for ethanol injection of liver tumors: preliminary results.

The technique for ethanol injection of liver tumors was modified in order to obtain less reflux with a better intratumoral distribution of ethanol, leading to more extensive necrosis and to a reduction of pain. The needle was stopped just before its entrance into the tumor and ethanol was injected while the needle was advanced a little beyond the distant border of the tumor. Pain and change in echogenicity during and immediately after each injection were evaluated in 11 patients with 38 malignant lesions who received 90 injections with the new or 46 with the conventional technique. Computed tomography and biopsies were used for later follow-up. With the new technique the injected tissue volume converted much more markedly to high echogenicity (p < 0.005), the pain was significantly reduced (p < 0.001), and posttreatment biopsies significantly less often contained viable cells (p < 0.05). These preliminary results suggest that the modified injections were more effective and less painful, and have enabled us to inject a larger volume of ethanol at each session to reduce the number of treatments.

The "ad hoc" estimation of outflow does not predict patency of infrainguinal reconstructions.

OBJECTIVES: This prospective study was performed to evaluate the clinical implication of the adhoc estimation (also called SVS score) of outflow on patency of infrainguinal in situ femoropopliteal or -distal bypasses. METHODS: The bypasses were followed with Duplex scanning at 1, 3, 6, and 12 months after surgery. Fifty-three bypasses were recruited for the study, 20 of which were performed in 17 diabetics. In 47% the adhoc scoring was < or = 4.5 and in 53% it was between 5 and 10 (1 corresponds to an excellent outflow and 10 to a blind segment). RESULTS: Within the first 30 days eight occlusions occurred, all of which were surgically corrected. The adhoc score for these bypasses was 4.2 vs. 4.9 (NS) for those who did not occlude. During follow-up, revisions were performed in 21 cases (40%) with 30 interventions. At the end of 1 year, 68% of the bypasses were patent (80% among diabetics and 64% among non-diabetics, NS). Patency at 1 year was not influenced by the adhoc classification. CONCLUSION: The estimation of outflow from angiography seems to be of no value in predicting graft patency in infrainguinal grafting.

Renal effects of local infusion of adenosine in man.

1. The effects of local intra-arterial infusion of adenosine on renal blood flow, glomerular filtration and renin release in eight healthy awake subjects have been examined. 2. Renal blood flow and glomerular filtration rate were measured as the clearances of p-aminohippurate and inulin, respectively. After basal samplings, adenosine was infused intra-arterially at successive rates of 2 and 10 micrograms min-1 kg-1 for 40 min at each rate. 3. Apart from a small increase in heart rate (65 +/- 4 to 71 +/- 4 beats/min), there were no signs of sympathetic activation (unchanged blood pressure and catecholamine levels) during the infusion. Clearance of p-aminohippurate tended to increase, but not significantly, during adenosine infusion (518 +/- 48 ml/min basal, 563 +/- 52 ml/min during the highest dose of adenosine). The arterial plasma concentration of p-aminohippurate decreased by 9 +/- 3% (P < 0.05), consistent with a small increase in renal blood flow in the infused kidney. Inulin clearance was reduced from 115 +/- 3 to 97 +/- 2 ml/min (P < 0.001). The extraction of inulin, reflecting the filtration fraction, was 18% in both kidneys in the basal state. During infusion of adenosine the extraction in the infused kidney decreased to 12 +/- 3% (P < 0.01 compared with the control kidney, 23 +/- 3%). 4. The total excretion of Na+ was unchanged, but there was a minor decrease in K+ clearance. Thus, the K+/Na+ excretion ratio decreased from a basal value of 13 +/- 2 to 10 +/- 2 (P < 0.01) at the highest dose of adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain.

Thirty-six 45-55-year-old men with healthy low backs were studied with respect to body composition, isokinetic and isometric trunk strength, trunk muscle endurance, and cross-sectional area and radiological density of mm erector spinae. Results were compared to those of men in the same age group with intermittent low back pain (LBP) (n = 91) and with chronic LBP (n = 21). The back healthy group was significantly stronger and had longer trunk muscle endurance times than men with chronic LBP. Men with intermittent LBP had strength and endurance values in between the back healthy and chronic groups. There were no significant differences between any of the groups with respect to body composition and cross-sectional area of mm erector spinae. Radiological density for mm erector spinae was significantly decreased in the chronic LBP group compared to the back healthy and intermittent LBP groups. The deconditioning syndrome and its relationship to intermittent and chronic LBP is discussed.

Percutaneous extraction of upper urinary calculi under fluoroscopic control--still a valuable complement to ESWL.

Percutaneous extraction of 372 renal and proximal ureteral calculi was performed under fluoroscopic control in 202 consecutive patients. In 193 kidneys (90%) removal of stones was performed under fluoroscopic control only and in 10% initial ultrasonic disintegration was used. A completely stone free kidney was achieved in 74%. If successful outcome is defined as no stones or residual fragments less than 5 mm, the success rate was 91%. With a mean size of 10.3 mm 259 intact stones were extracted under fluoroscopic control. Open surgery was performed in 13 of 202 patients, in 10 of these cases due to unsuccessful removal of an impacted ureteral stone. Complications occurred in 16%, none of them were serious. Open intervention became necessary in 2 patients. Bleeding which required blood transfusion occurred once. Percutaneous renal stone extraction under fluoroscopy is safe and useful in selected patients when ESWL can be expected to produce less favourable results. The ability to perform this technique should therefore be well maintained.

Anthropometry, spinal canal width, and flexibility of the spine and hamstring muscles in 45-55-year-old men with and without low back pain.

One hundred fifty 45-55-year-old men were divided into three groups: those with healthy backs, recurrent low back pain (LBP), and chronic LBP. These groups were studied with respect to anthropometry, spinal canal width, spinal sagittal configuration and flexibility, and the flexibility of the hamstrings musculature with straight leg raising (SLR). There were no differences between the groups with respect to anthropometry. The group with healthy backs had significantly greater lordosis and sagittal flexibility than the other groups. The width of the spinal canal was correlated to body height. The SLR test showed significantly higher values in the group with healthy backs and in the recurrent pain group than in the chronic pain group. The possible role of restoring normal range of motion to minimize the risk of LBP recurrence is discussed.

Cost effectiveness of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for medium-sized kidney stones. A randomised clinical trial.

To evaluate percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for their clinical effects, their cost effectiveness, their complication rates, and the patients' experiences, 55 consecutive patients were randomised to have one or other operation between October 1986 and October 1988. Six patients were excluded, 21 were treated with PNL and 28 with ESWL as primary treatment. Mean hospital stay and length of treatment were longer for PNL than for ESWL. Since 1 July 1987 all patients having ESWL have been treated without anaesthesia (n = 15), whereas epidural anaesthesia was used for all PNL. Slightly more of the ESWL patients experienced some pain during treatment. Minor complications or pain were more common after ESWL during the first 10 days after discharge from hospital. If patients with stone fragments of 4 mm or less were regarded as having a successful outcome, the success rates after one year were 94% for PNL and 77% for ESWL. The overall total cost was lower for ESWL than for PNL, the cost per successfully treated patient being 2172 pounds for PNL and 1810 pounds for ESWL. Medium sized kidney stones (6-30 mm, or 2-3 stones of 20 mm or less) can be efficiently and cheaply treated by both PNL and ESWL, though the cost of ESWL is lower. Even if effects other than cost (such as complications and patients' experience) are borne in mind, ESWL was superior to PNL for this group of patients.

Effects of lower limb unloading on skeletal muscle mass and function in humans.

A model to simulate effects of microgravity on skeletal muscle mass and function in humans has been developed. Unilateral lower limb unloading that allowed ankle, knee, and hip joint mobility was conducted in six healthy men by suspending one lower limb and having the subjects walk on crutches. They performed maximal unilateral concentric or eccentric quadriceps actions at different angular velocities before and after 4 wk of suspension and after 4 days and after 7 wk of uncontrolled recovery. Peak torque (PT) and angle-specific torque (AST) were measured. Muscle cross-sectional area (CSA) and radiological density (RD) of the thigh were assessed by means of computerized tomography. Concentric and eccentric PT and AST across speeds decreased (P less than 0.05) by 22 and 16%, respectively, in response to unloading. At 4 days of recovery PT (-11%) and AST (-7%) were still lower (P less than 0.05) than before. Muscle CSA and RD decreased (P less than 0.05) by 7 and 6%, respectively. After 7 wk of recovery PT, AST, CSA, and RD had returned to normal. The control limb showed no changes over the experimental period except for a 6% decrease (P less than 0.05) in RD. It is suggested that this human model of unloading could serve to simulate effects of microgravity on skeletal muscle mass and function because reductions in muscle mass and strength were of similar magnitude to those produced by bed rest.

Comparison of iopromide versus iohexol in aortobifemoral arteriography. A Swedish multi-center study of 446 patients.

A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. After premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.

Percutaneous nephrolithotomy--the birth of a new technique.

Extraction of renal calculi via a percutaneous track was for the first time practised at the Karolinska Hospital in 1973. After very strict indications in the beginning because of fear of uncontrollable bleeding, the method was found to be safe and the technique was spread all over the world. Now being to a large extent replaced by extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL) has still many applications e.g. alone in obstructed kidneys or together with ESWL in staghorn calculi.

3D-location of the L5-S1 fulcrum in relation to the hip.

The purpose of the present study was to measure the three-dimensional distance between the hips and L5-S1 joint in vivo so that this data could then be used in computer programs predicting the load at the lumbosacral joint from posture and anthropometric data. Twenty-one subjects were investigated with computed tomography; consecutive transverse slices were taken from the low-back to proximal thigh, and three-dimensional coordinates were recorded. The distance between the hips and the L5-S1 joint was 122 mm, corresponding to 6.9% and 7.5% of body height for men and women, respectively (P less than 0.05).

Moment arms of hip abductor and adductor muscles measured in vivo by computed tomography.

Anatomical data on the length of moment arms of hip muscles is required to evaluate the load on an endoprosthesis or a joint. We investigated 20 subjects and measured the moment arms of eight hip muscles with respect to their action in the coronal plane, i.e. in abduction or adduction. For this purpose computed tomography was used. Consecutive transverse scans were taken, three-dimensional coordinates recorded and moment arms calculated. The length of the moment arms was slightly longer in comparison with earlier data. It was also shown that several muscles produce moments in more than one plane, which probably contributes to joint stability. It is therefore concluded that one should consider contribution from muscles other than those traditionally classified as abductors, otherwise the forces at the hip will tend to be understimated.