Sven Dahlgren

EFFECTS OF LOCALLY DEPOSITED COLLOIDAL THORIUM DIOXIDE.

During the years 1930-1945, in Sweden, there were performed a little more than 1,000 cerebral angiographies using contrast media containing thorium &OXide. An undetermined number of these patients had a leakage of contrast media out into the extravascular tissues (FIGURE 1 ) . Blomberg et al. found, in their study of 1963, 35 patients with extravascularly deposited thorium dioxide, and they estimated that in a minimum of 3% of the injections there had been extravascular leakage. In 1960 Novik reported the first case in Sweden of complications at the site of injection after cerebral angiography with thorium dioxide. In Sweden, to date, 13 patients with alterations of the subcutaneous tissues of the neck region have been observed after extravascular injection of thorium dioxide (TABLE 1 ) . Ten of these patients demonstrated the local formation of fibrous tissue as in the so-called thorotrastoma (FIGURE 2). Two of the patients demonstrated malignant tumors at the injection site, namely neurofibrosarcomas (FIGURE 3). Three of the patients developed necrotic ulcerations of the pharynx. These three patients particularly, but even several of the others, had troubles in swallowing, pain, and pressure sensations in the neck region. In two cases the clinical symptoms were dominated by paresis resulting from damage to the nerves in the affected region. The nerve damage probably resulted from mechanical interference and destruction by the fibrotic tissue. In one of the patients with a neurofibrosarcoma there are also developed a malignant mesothelioma of the cervical pleura distinct from the neurofibrosarcoma but adjacent to the thorium dioxide particles. The range of the patients’ ages at the time of diagnosis was 30 to 59 years. No difference was noted as to sex. The latent period from the time of thorium dioxide injection to the time of development of a thorotrastoma or a sarcoma has been estimated for each patient in TABLE 1 . As the changes developed slowly over a long period it was impossible to determine the exact latent period. The average latent period for all of these patients, however, is about 20 years. It has been difficult to determine the amount of extravascularly deposited thorium dioxide. Only an approximation has been obtained, partly with the help of radiation measurements and partly with the performance of roentgen examinations. In a smaller number of cases, in Sweden, contrast media containing thorium dioxide have been used in performing urethrography. The exact number of such examinations performed in Sweden is at the present time undetermined. Two patients who underwent such an examination were noted to have had a leakage of contrast media from the urethra into the surrounding tissues. These two patients have since developed carcinoma of the urethra (TABLE 2). These two cases were very similar. The two patients were diagnosed at the ages of 59 and 60 years respectively. Both patients developed widespread squamous cell carcinoma in direct association with the deposition of thorium dioxide (FIGURE 4). The latent periods, from the thorium dioxide injection to diagnosis

Aspiration biopsy diagnosis of neurogenous mediastinal tumours.

RINGERTZ & LIDHOLM (1956) reported that neurogenous tumours constituted nearly a third of the mediastinal tumours in a material of 155 of their own and 251 previously reported cases. Thymomas and teratomas are predominant in the anterior mediastinum with intrathoracic goitres, bronchogenic cysts and lymphomas in the superior and middle parts, and neurogenous tumours usually in the posterior mediastinum (SCHLUMBERGER 1951, OBERMAN & ABELL 1960). It is difficult to specify the exact incidence of the various types of tumours. The number of cases reported in the early literature is remarkably low, and SCHLUMBERGER (1951) considered the increase to be due to improvements in thoracic surgery. RINGERTZ & LIDHOLM (1956) demonstrated the close relationship between the number of mass chest roentgen examinations carried out and the number of cases of mediastinal tumours diagnosed. Improved techniques in the roentgen examination of the thorax have doubtless provided better means of establishing the nature of mediastinal masses. Neurogenous mediastinal tumours appear as well-defined, rounded, and often globular, masses without calcification and become readily apparent when they bulge into the air-filled lung. The typical localization is paravertebrally in the

Fibroma in the Interventricular Septum of the Heart: Successful Removal in a 13-month-old Infant

An account is given of the discovery of an intraseptal fibroma of the heart in a 13-month-old infant and the successful removal of the tumour.

Delayed Lung Lesions After Six Hours' Unilateral Pulmonary Artery Occlusion in Dogs

The perfusion to one pulmonary artery was occluded with a balloon catheter for 6 hours in anaesthetized dogs. One dog sacrificed immediately after the occlusion period, displayed no macro- or microscopic lung lesions. Seven dogs were observed for 2–7 days, during which time general condition and lung roentgen were normal. At autopsy, after exsanguination, 6 of them showed foci of haemorrhage, oedema and hyaline membranes in the previously occluded lung. None of the 8 animals demonstrated any pathological lesions in the non-occluded lung. The lesions were similar to those found in the post-perfusion lung syndrome, though less pronounced.This investigation was supported by a grant from Swedish National Association against Heart and Chest Diseases.

Chronic Idiopathic Jaundice (Dubin‐Johnson's syndrome) in Three Sisters

Three sisters, aged 18, 16 and 11 years, were suffering from familial jaundice with elevated direct bilirubin. Two of them had a brown pigmentation of the liver cells and had slight, diffuse gastrointestinal symptoms. They meet the criteria for Dubin‐Johnsons syndrome. The third, suffering from a very mild form of familial jaundice, had very little pigment in the liver cells. This case is difficult to classify, being either a Dubin‐Johnsons syndrome, a Rotors syndrome, or a condition intermediate between these two. Attempts to characterize the hepatic pigment with histochemical methods were made and seem to indicate that the pigment belongs to the lipofuscins.