Curt Lagergren

Generalized Arterial Calcification Associated with Hydramnios in Two Stillborn Infants

Histologic, microradiographic and X‐ray crystallographic findings are recorded in two stillborn infants with idiopathic generalized arterial calcification, in one of which there was also nephrocalcinosis. The mineral salt deposits consisted solely of hydroxyapatite and was regarded as metastatic. In both cases there was hydramnios. Since 5 out of 7 known cases of neonatal idiopathic arterial calcification had hydramnios the possibility of a causal connection cannot be ruled out.

Angiography of Peripheral Tumors

Tumors vary widely in vascularity, most of them containing fewer but some, more blood vessels than the corresponding normal tissue. Some fifty years ago German pathologists found that the malignant mesenchymal tumors, or sarcomas, in particular, are highly vascular and the higher the malignancy the greater the vascularity. At the end of the 1920s the first radiologic examination of blood vessels involving injection ot contrast medium was performed in Portugal, and this technic was found to be a useful aid in study of the vascular supply of tumors. Dos Santos (9) proposed certain angiographic criteria of malignancy, notably the presence of numerous irregular vessels at the periphery of the tumor and a rapid transit of the contrast medium from the arteries to the veins. Material and Methods Angiography of peripheral tumors has been performed in our department since 1941, and the frequency of such examinations has increased in recent years. The material of tumor and/or tumor suspects submitted for angiograp...

Renal Function Studies in Medullary Sponge Kidney

Twenty-one patients with medullary sponge kidney but no clinical signs of renal infection underwent studies of renal function and repeated roentgenologic examinations. All but one of the patients had impaired tubular reabsorption of sodium, indicating damage to the tubules. As a result, the concentration capacity was greatly reduced. Measurements of pH and titrable acid in the urine after administration of ammonium chloride showed impaired capacity of the kidneys to equilibrate a metabolic acidosis. The extraction of PAH was diminished in 18 of 35 studied kidneys, suggesting that proximal tubules also are affected by the disease. No correlation was found between the severity of the roentgenologic changes and the renal function.

Can historical controls be used in current clinical trials in osteosarcoma?. Metastases and survival in a historical and a concurrent group.

Abstract A historical group consisting of 35 patients with osteosarcoma (preceding paper) was compared to a concurrent group of 23 patients. The treatment for the primary tumors differed only slightly in the two groups. Neither of the groups received adjuvant therapy. A more active approach was adopted for treatment of pulmonary metastases in the concurrent group. All the patients were followed for at least 2.5 years. The percentage of patients not developing metastases and the survival rate in the historical group were approximately one half those for the concurrent group. An analysis of prognostic factors disclosed differences between the two groups as regards the size and histological type of the tumor. The results of the study cast doubt on the suitability of historical controls in current clinical trials conducted to ascertain the effectiveness of adjuvant therapy for osteosarcoma. The importance of analysing prognostic factors is emphasized, especially where the patient groups are small and the follow-up is short.

Can historical controls be used in current clinical trials in osteosarcoma? Analysis of prognostic factors

Abstract A comparison with respect to possible prognostic factors has been made between a contemporary group of 44 patients with osteosarcoma in Sweden, who received treatment since 1971, and a historical group of 35 such patients treated prior to 1972. Only patients with no evidence of metastases on admission were included in the material. The case histories were reviewed by a team of pathologists and clinicians with experience of bone tumors, each case history was analyzed in detail and re-evaluated. The female/male ratio was lower, but not significantly so, for the contemporary group, 1:2.4, than for the historical group, 1:1.7. The mean age was similar in the two groups (18 and 17 years, resp.) Pain was the most common symptom in both groups, it was recorded in 86 and 100% in the contemporary and historical groups, respectively. Although the patients of the historical group generally presented more symptoms, the durations were similar in the two groups (3 months). The site patterns differed slightly, although not significantly so, in the two groups, there was a higher ratio of frequency of femoral and lower leg tumors for the historical group (54 and 32%, resp.) than for the contemporary group (36 and 45 %, resp.). The variability in tumor size was greater for the historical group, as was the tumor diameter (13 and 9 cm, resp.). The historical group had a greater proportion of osteoblastic tumors (83 and 63%, resp.) and these tended to be more malignant (Grade IV:80 and 68%, resp.). The study disclosed differences between the contemporary and the historical groups in respect to various factors that previous studies indicated might have a bearing on the prognosis in osteosarcoma. On the whole the prognosis would be expected to be less favorable for the historical group and there would seem to be a definite risk in using this group as a control group to the adjuvant interferon treated patients. Similar reviews of other non-randomized current clinical series would be a valuable aid in determining the efficacy of adjuvant therapy.

The Vasculature of the Developing and Mature Human Adrenal Gland

As was shown by Kolliker in 1854 [6], the adrenal gland in man is supplied by arteries that divide outside the capsule into a number of branches which pass through the capsule and ramify centripetally in the cortex and medulla. The complexity of the vascular supply of the adrenal glands [lo] is manifested in the difficulty of diagnosing pathologic conditions in the glands by angiography. From an article by Lever [8] i t is evident that the vascular pattern of the fully developed gland is similar in most mammals. No study seems to have been made, however, of the development of the vascular architecture during the preand postnatal growth of the adrenals. In the course of a study of the neoplastic changes in the adrenal glands the need for comparison with the normal microangiographic vascular pattern was recognized [3]. The investigation was accordingly extended to cover the development of the adrenal glands.

Radiography in the Differential Diagnosis Between Carcinoma of the Kidney and of the Renal Pelvis

The microscopic vascular patterns of renal adenocarcinomas and carcinomas of the renal pelvis were compared and the influence of these patterns on the angiographic pictures was estimated. It was concluded that in most instances the differential diagnosis between the two forms of tumour can be established by renal angiography due to differences in their vascular anatomy, and to differences in the reactions of the vascular patterns to the injection of adrenalin.

Evaluation of tumour extension by whole body scanner

SummaryFifteen patients with urinary bladder carcinoma were examined by computerised tomography parallel with conventional urography before, during and after radiation therapy. Computer tomography gave better diagnostic information in the cases in which the tumour had encroached upon, or was growing outside the bladder wall, and was equally as valuable as urography when it was located wholly within the bladder. The scans were of great value as a guide in the planning of computer-aided radiation therapy.

The vasculature of the adrenal gland in neoplasia and hyperplasia

Eine Serie von 28 Nebennieren mit Rinden-oder Marktumoren, Hyperplasie und Metastasen wurde mikroangiographisch und histologisch untersucht. In einigen Fällen war ein Vergleich mit klinischen Angiogrammen möglich. Das Gefäßmuster zeigte alle Übergänge vom normalen Verhalten, über Hyperplasie, Adenom, Phäochromocytom, Neuroblastom bis zum Krebs. Es ist unmöglich, in einer Grenzzone zwischen den einzelnen Formen allein auf Basis des Gefäßmusters zu unterscheiden. Micro-angiographic and histologic examinations were performed on a series of 28 adrenal glands with cortical or medullary tumors, and with hyperplasia and metastases; in some instances the results were compared with clinical angiograms. The vascular patterns varied by transitions from the normal adrenal glandvia hyperplasia, adenoma, pheochromocytoma, neuroblastoma to cancer. In the border zones it was impossible to differentiate between the forms solely from the vascular pattern. Further clinical details are available in the Department of Pediatric Pathology.