Björn Nordenström

New Instruments for Biopsy

A new instrument has been designed to obtain cytologic material. It consists of a cannula, a thin screw needle and an instrument holder. The technique offers a more efficient sampling and better material than the simple needle aspiration technique.

A Method for Determination of Blood Flow with Use of Roentgen Contrast Medium

THE PUMPING capacity of the heart is in a high degree dependent upon the effectiveness of the valves. There is still, however, no practical method by which reliable quantitative data concerning this function can be obtained, although important contributions toward the solution of this problem have been made from several quarters (2, 32,46-48,50). The estimation of the insufficiency component in connection with aortic and mitral lesions has hitherto been made largely with physical diagnostic methods, but above all with the help of cardioangiography. Thus, with an injection of contrast medium in the ascending aorta it is possible to make a rough estimation of the insufficiency component in the aortic valves (4, 31, 43, 44, 50, 61). If at the same time the mitral valve is insufficient, it is sometimes possible to see a part of the contrast fluid regurgitate from the left ventricle to the left atrium. In cases of mitral insufficiency, however, it is as a rule easier to estimate this through injection of contr...

Coronary Angiography in 100 Cases of Ischemic Heart Disease

As late as the end of 1940 available contrast media for cardiovascular examinations were relatively toxic. Selective angiocardiography and thoracic aortography had therefore usually to be performed under general anesthesia. In order to avoid motion blur due to respiration, the lungs were inflated and kept in an inspiratory position during the film exposures. A striking improvement of the quality of the exposed films could be observed when the examination had been performed with a moderate inflation of the lungs. In 1955, Boerema and Blickman (2), in experiments on dogs, obtained better angiocardiographic films when the intrabronchial pressure was elevated. Due to the obstruction of inflow to the right side of the heart, a decreased flow of blood was induced, with a consequent reduction in dilution of the medium. Other effects in cardioangiography may also be obtained by elevation of the intrabronchial pressure, as demonstrated in animal and man by one of us (10). With sufficient deceleration of the blood ...

New Instruments for Biopsy1,2

A new instrument has been designed to obtain cytologic material. It consists of a cannula, a thin screw needle and an instrument holder. The technique offers a more efficient sampling and better material than the simple needle aspiration technique.

Percutaneous Catheterization of the Pericardium

Pathologically increased amounts of fluid in the pericardium can be removed after the introduction of a sharp needle into the pericardial cavity. This procedure has been adopted in connection with the occurrence of transudate, exudate or hemorrhage in the pericardium threatening to bring about cardiac tamponade. The possibilities of introducing a catheter into the pericardium have been tried and seem to imply certain advantages compared to the conventional technique with a needle.

Percutaneous Balloon-Occlusion of the Aorta

The possibilities at ordinary thoracic aortography, with free flow in the aorta, of obtaining satisfactory filling of small vessels arising from the aorta are restricted. Injections above an occlusion of the aorta were made in experiments in animals and reported by the present writer in 1954 and in man 1955 in order to improve the examination conditions. The risk of damage to the spinal cord, apparent in the experiments in animals with the contrast media then available, contra-indicated any further investigations of this type in man. A systematic series of investigations of the toxicity of new contrast media made it possible to continue the examinations in human subjects later, with injection above the occlusion. Parallel with these investigations, the catheterization technique was being further developed. In the first examinations with balloon occlusion of the aorta, a double-lumen catheter provided with a balloon was introduced into the descending aorta after exposure of the radial artery. The balloon was filled through one lumen and the contrast medium injection was made through the other. Certain difficulties were however encountered in introducing the relatively large catheter with the balloon into the radial artery.

Possibilities of angiography during temporary occlusion of the aorta in man.

One of the present writers (NORDENSTROM 1954) described the appearances of small vascular vessels, such as the intercostal and bronchial arteries following the injection of contrast medium above an occlusion of the thoracic aorta in the dog. The very small bronchopulmonary arterial vessels that are considered of importance for, inter alia, the blood supply to malignant tumours might possibly also be examined by this method in human subjects. Occlusion of the aorta in man has earlier been performed without complications in connection with operations (CRAFOORD 1945) although damage to the spinal cord has also been recorded. Such damage has occurred in operations upon coarctation of the aorta, despite the fact that the collaterals are thought to afford possibilities for a more protracted occlusion than when the aorta is normal (BING et call. 1948). Occlusion of the aorta distal to the origin of the left subclavian artery has also been possible without complications for up to 45 minutes in operations upon aortic aneurysms (BAHNSON 1953, LAM et colI. 1951, COOLEY & DE BAKEY 1955). One subject, however, is reported to have

The Thebesian Circulation in Coronary Angiography

* Director, Department of Roentgenology, Thoraxkliniken, Karolinska Sjukhuset, Stockholm, Sweden. By the Thebesian circulation is meant that part of the circulation in the myocardium at which the blood is evacuated to the heart cavities. This circulation has a rather complicated morphological basis and cannot be referred solely to the presence of the veins described by Thebesius15 in 1716. The Thebesian veins proper are small branch veins in the myocardium which empty their blood direct into the heart cavities. Besides these there are vessels presenting histologically the appearance of veins, which from branch arteries evacuate arterial blood to the heart cavities. These latter connections, which were discovered rather late (Wearn16-18), have also been referred to as arte-

Electric Potentials in Pulmonary Lesions

Cytologic. and bacteriologic examinations of pulmonary tissues obtained by transthoracic needle biopsies have proved of considerable diagnostic value. Cytologic examinations permit differentiations to be made between benign and malignant tumours as well as between the types. Low-differentiated cell forms indicate as a rule the presence of highly malignant growths and imply a poor prognosis. In spite of this, the roentgendiagnostic and cytologic determinations of a neoplasm are not always well correlated to the degree of clinical malignancy and the methods available for morphologic studies should therefore be used only with certain reservations in the prognosis. A further development of diagnostic means seems desirable and should perhaps not be restricted to morphologic studies; further diagnostic possibilities in morphology may well lie within the cytochemical and cytophysiologic fields. Certain attempts have therefore been made to combine morphologic methods used in connection with transthoracic needle biopsy with microchemical and microphysiologic studies. Thus, the DNA of cell samples obtained at transthoracic needle biopsy has to some extent been studied in our department and the oxygen tension in different parts of malignant tumours in situ is now under investigation.

Selective catheterization and angiography of bronchial arteries in dog.

The difficulty in obtaining satisfactory filling of the bronchial arteries in thoracic aortography is probably largely due to the dilution of the contrast medium in the aorta and to the physical differences between it and the blood. Small vessels arising from the aorta, such as the intercostal and bronchial arteries, are from their caliber and direction ideally adapted to the flow conditions of the blood. When a contrast medium that is heavy in relation to the blood is introduced into the aorta, it cannot, however, be expected to behave in the same way as the blood. Contrast medium that has obtained a greater dynamic energy than the blood when it reaches the point of origin of a small artery will not readily diverge from the general blood stream. This situation may indicate one of the important mechanisms that tend to inhibit contrast filling of the small aortic branches in thoracic aortography. Contrast medium was injected above a temporary occlusion of the thoracic aorta with balloon catheters in earlier experiments in order to master some of the difficulties in contrast filling of the bronchial vessels via the aorta (NORDENSTROM 1954). Quite small bronchial arteries could then be outlined, although