Nils Lindvall

Early Diagnosis and Treatment of Acute Ruptures of the Anterior Cruciate Ligament: A Clinical And Arthrographic Study Of Forty-eight Cases

Forty-eight patients with suspected acute rupture of the anterior cruciate ligament were examined under anesthesia and by arthrography. Thirty-five had complete and thirteen had Partial ruptures of the cruciate ligament. Thirty-three patients with complete rupture were treated by suture and the rest by conservative measures. Arthrography performed by a special technique was found to be a very good method of diagnosing acute ruptures of the cruciate ligaments. If the arthrogram suggests a cruciate-ligament rupture, the injured joined should always be examined under anesthesia. The results of operative treatment to date have been excellent.

Urolithiasis. A study of its frequency.

Considering the general impression of an increased number of patients with acute renal colic, the frequencies of roentgenologically verified ureteral and kidney calculi in a Swedish urban district have been studied for the periods 1953-55 and 1968-70. In a material of 986 outpatients (793 men and 193 women) we have proved an increase in incidence for upper urinary tract calculi in men from 2.2 to 3.3 0/00 (p less than 0.001) and in women from 0.5 to 0.8 0/00 (0.01 less than p less than 0.05). For the material as a whole, we have found a 50% increase (from 1.3 to 2.0 0/00; p less than 0.001) of acute urolithiasis between the periods studied. Some implications of the results in connection with primary hyperparathyroidism are discussed.

Reoperation for primary hyperparathyroidism

Abstract The reasons for failure of the initial exploration and the results of reoperation were analyzed in 53 patients with a diagnosis of primary hyperparathyroidism, 29 of whom were referred after initial operations elsewhere. Seventy-nine reoperations were performed. Sternotomy was used in 15 patients, and in retrospect was necessary in only 5. There was no operative mortality. The reasons for initial failure were incorrect diagnosis in 6 patients, true recurrence in 4 and persistent disease in 43. Persistence was caused by surgical failure in two thirds and pathology failure in one third. Of 47 patients reoperated on for hyperparathyroidism, 39 (83 percent) were cured, a rate warranting this type of surgery. Analysis of a long-term series of initial operations demonstrates a persistence rate of 5 percent (24 of 461) and a recurrence rate of 1 percent (4 of 461) in this disease. The need for reoperation was less than 1 percent over the recent 5 year period.

Detection of Sacro-Iliitis: A Comparison between Profile Scanning with the Use of 99mTc Pertechnetate and Scintigraphy with 99mTc Diphosphonate

Comparative evaluation of the sensitivity of 99mTc pertechnetate scanning and of 99mTc diphosphonate scintigraphy in detecting sacroiliac arthritis (S.I.) was performed in 32 patients with definite S.I., 14 with probable S.I., and 6 with inactive S.I.; 14 patients without any evidence of S.I. served as controls. Greater diagnostic accuracy was obtained by 99mTc pertechnetate scanning than with 99mTc diphosphonate scintigraphy in patients with active S.I. in the early stages before radiological changes had become evident and in patients 22 years old and younger. In patients with inactive S.I. a close correlation was found between clinical, radiological, and scintigraphical results with 99mTc diphosphonate scintigraphy. An index obtained by adding the uptake values measured by both methods in each subject yielded valuable information in patients with S.I. that is clinically difficult to differentiate.

Pheochromocytoma of the Bladder: A Case Report

A 39-year-old male patient with attacks of headache and tachycardia immediately after micturition is described. Systolic blood pressure of 250 mmHg was measured after voiding. Plasma noradrenaline was increased 10 to 20 times above the normal value during the attacks. Cystoscopy, arteriography, catheterization of the caval vein with sampling for plasma catecholamines and computerized tomography all supported the diagnosis of a bladder tumour. A beneficial effect of alpha-receptor blockade preoperatively was demonstrated. The tumour was operatively removed from the bladder. The postoperative course was uneventful.