Olle Olsson

Angiography in Renal Trauma

Renal rupture represents a fairly high percentage of abdominal Injuries. WILLIAMS & ZOLLINGER (1959) in a survey of 273 abdominal injuries in the period 1947-1958 found that 76 were in the urinary tract and that the kidney was involved in 58. Of62 cases of renal injury seen at our department, 27 were caused by traffic accidents (NILSSON & SANDBERG 1962). Examination by conventional roentgenography followed by urography are usually considered the methods of choice in the examination of cases of probable renal rupture. The predominant roentgenologic signs suggesting renal rupture are the loss of part or whole of the outline of the kidney, the failure to identify the lateral border of the psoas muscles, and the presence of a soft tissue mass. Urography may demonstrate a deformed renal pelvis, due to its rupture or compression by an intrarenal haematoma, and compression of the kidney or pelvis by an extrarenal haematoma. Deformation may also be caused by a blood clot or by two or more of these factors in combination. The demonstration of extravasation of contrast medium from the renal pelvis into the parenchyma or outside the kidney provides a conclusive sign of rupture. Such unequivocal evidence is seldom obtainable because the methods usually necessary to demonstrate these changes cannot be used. Pyelography is contraindicated, and the application of ureteric compression in association with

Frequency of Backflow in Acute Renal Colic

Backflow or reflux are terms used for extravasation of urine from the renal pelvis through a rupture at the fornical margin of one or several calyces. OLSSON (1948) in a monograph on backflow in urography described 6 patients with acute renal colic; another 7 patients were included in a paper of 1953. Many authors have since reported similar observations; these have all corroborated that backflow of this type usually occurs with severe renal colic, mostly of only a few hours duration and that the signs of urinary stasis in terms of delay of excretion on the side with backflow and dilatation of the kidney pelvis are usually only slight or moderate. Backflow as demonstrated by escape of urine outside the renal pelvis disappears fairly rapidly. Only exceptionally will backflow be demonstrable at control examinations; such exceptions have been described by OLSSON (1953), HARROW (1966), SCHWARTZ et colI. (1966), BONK et colI. (1966) . The frequency of backflow in acute renal colic is controversial and important. The importance is based on the fact that backflow may produce clinically noticeable changes in connection with the actual attack and may also form the basis for late lesions with reactive tissue proliferation in the sinus of and outside the kidney (FAJERS & IDBOHRN 1957), perinephritis (HARROW 1966) and eventually retroperitoneal fibrosis. This phenomenon was encountered in 5 patients in

Angiography in the Diagnosis of Duodenal Lesions: I. Differentiation between Primary Duodenal Carcinoma and Carcinoma of the Head of the Pancreas Involving the Duodenum

The necessity of a correct differential diagnosis between a lesion reqUlnng surgical approach and one suggesting conservative treatment is obvious. This holds also for conditions in which operation is indicated and those in which it may be contemplated. Lesions requiring surgery, for example primary carcinoma of the duodenum and carcinoma of the pancreas encroaching upon the duodenum, are obviously better approached surgically if correctly diagnosed. The author has examined a series of patients with lesions in different parts of the duodenum. The changes in barium meal examinations have often been the same in quite different pathologic conditions, for instance carcinoma, benign ulceration, inflammation, and vascular lesions. The changes have often also been of a type making it impossible to decide whether a tumour has arisen primarily in the duodenum or pancreas. Research on angiography in the diagnosis of carcinoma of the pancreas (LUNDERQUIST 1965, OLSSON 1965, 1970) and primary carcinoma of the

Angiography in Duodenal Carcinoma

Carcinoma of the duodenum is a fairly rare condition although its true frequency is difficult to estimate from the literature. EGER (1933) gave the frequency as 0.3 per cent of all gastro-intestinal neoplasms, whereas BOCKUS (1963) raised the figure by a factor of 10 giving an incidence of 3 per cent. Statistical summaries from the literature were presented by SERANO & MCPEAK (1966) and by CRAIG (1969). MATEER & HARTMAN (1932) classified duodenal carcinomas as superampullary, periampullary and infra-ampullary and stated that the second group was the most common. BOSSE & NEELEY (1969), however, considered that most primary duodenal tumours are infra-ampullary. Difficulties in diagnosis are pointed out in the literature on the roentgen examination of carcinoma of the duodenum. BERGENDAL (1939), inter alios, stressed the fact that it is often impossible to differentiate between primary carcinoma of the duodenum and primary pancreatic carcinoma involving the duodenum. The many diagnostic differentials include ulceration of unusual location and benign tumours of the duodenum as well as inflammatory and vascular lesions. SERANO & MCPEAK (1966) reported that under a third of the cases in a material of

Plasma exudation in the skin measured by external detection of conversion electrons

A novel technique for measurement of plasma exudation in the skin is described. Transferrin labelled in vivo with indium-113m is used as a plasma tracer. The conversion electrons from113mIn are detected with a polystyrene crystal mounted on a photomultiplier tube. Owing to the short range of the electrons in tissue, background radiation from tracer circulating in underlying tissue will be very small, allowing plasma exudation in the skin to be detected with a high signal to noise ratio. The characteristics of the detector system are described in model experiments using sheets of mylar to simulate soft tissue. The acute inflammatory response to histamine provocation was studied in guinea pig skin. A dose-related increase in count rate representing vasodilatation and plasma exudation was detected over the skin after histamine provocation. The electron radiation system appears suitable for detection of low levels of superficial radioactivity and for pathophysiological studies of the skin.

Angiography in the diagnosis of duodenal lesions. II. Benign tumours, ulceration and inflammatory and vascular lesions.

A common differential diagnostic difficulty presented by primary carcinoma of the duodenum and carcinoma of the head of the pancreas in certain ulcerative, infiltrative or stenotic lesions of the duodenum has been considered in previous papers (OLSSON 1968, 1971). Many other conditions must however also be included. SALIK (1961), for example, discussed various abnormalities simulating duodenal changes in carcinoma of the head of the pancreas and BOSSE & NEELY (1969) dealt with the matter on a wider basis. The authors agreed on the difficulty in many instances of arriving at a definite diagnosis both as to the primary site of a tumour and its malignancy. Further progress in differential diagnosis is obviously needed. Previous papers on the angiographic features of primary duodenal carcinoma (OLSSON 1968, 1971) and carcinoma of the pancreas affecting the duodenum (OLSSON 1971) suggested that the differential diagnosis was obtainable by angiography. It was anticipated that this would be a useful tool in the diagnosis of lesions in or involving the duodenum, such as malignant and benign tumours, ulceration, inflammation or vascular changes.

Multiple expanding renal lesions.

Unilateral or bilateral multiplicity of expanding lesions in the kidneys is not too unusual and different types of lesions may be combined. This stresses the need for detailed angiography of both kidneys in order to establish an exact diagnosis.

Book Review: The Reduction of Patient Dose by Diagnostic Radiologic InstrumentationThe Reduction of Patient Dose by Diagnostic Radiologic Instrumentation. Edited by MoseleyR. D.Jr & RustJ. H.. Charles C. Thomas, Springfield, Illinois1964. Price 12.50 dollars.

These articles on the roentgenologic examinations of the spinal cord and its surroundings cover myelography with positive and negative contrast media, angiography of spinal cord angiomas and vertebral phlebography. Viewpoints on new contrast media are also considered. The greater as well as the most interesting part of the book deals with technical problems in myelography. The two dominant methods of performing myelography, i.e. with positive and negative contrast media, are compared and evaluated in the introduction as well as the conclusion. JIROUT, in dealing with the pneumographic demonstration of normal and abnormal spinal arachnoidal structures, as well as writers who consider normal and abnormal findings in the cervical region, malformations in the sacral region, and disk protrusions in the lumbar region, all prefer gas myelography. It is evident that this offers a better chance than positive contrast myelography of revealing pathologic conditions of the spinal canal. It is difficult to go into all the details of the various articles, some of which are in French and some in English; suffice it to say that many are of great value in giving new aspects on different diagnostic problems. The book is excellently illustrated. The appearance of this volume is a sign of an increasing interest in roentgenologic procedures in the examination of the spinal cord and its surroundings. In contrast to the opinion of the publishers of the volume the reviewer has always considered gas myelography superior to myelography with a positive contrast medium, a view that has been further confirmed by reading this book. Bengt Liliequist