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BACKGROUND: Photodynamic therapy (PDT) in combination with stent have shown promising results in the treatment of biliary tract cancer (BTC) in patients not suitable for surgery. Chemotherapy has been shown to improve survival in patients with local advanced and metastatic BTC. MATERIAL AND METHODS: In the current randomized trial the combination of chemotherapy and stent with and without temoporfin (Foscan) photodynamic therapy (PDT), with a primary endpoint on feasibility and safety, has been performed. Ten patients in each group. RESULTS: No serious, acute procedure-related complication related to PDT or the treatment combination was seen. The number of patients with cholangitis was equal in both groups. In the PDT group--arm A--two patients had cutaneous erythema after sun exposition, one of them with a localized blister. No neutropenic infection was seen. Quality of Life (QoL) was similar in both treatment groups. Progression free survival was numerically longer in the PDT group. CONCLUSION: The treatment combination was feasible. There was no serious complication related to PDT or the treatment combination. Number of cholangitis was equal in both groups, two abscesses were observed in the PDT group. Progression free survival was numerically longer in the PDT group.

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In 234 consecutive CT examinations of the lumbar spine, gas collection was observed in 4 cases with disk herniation, and in 6 cases of disk protrusion. In 3 cases free gas was found in the epidural space, and one patient presented an intraspinal gas-filled "bleb". Gas collection in intervertebral disk spaces and facet joints was found in a total of 60 patients. The CT findings and surgical results were compared to determine whether gas collection contributes to clinical symptoms. In most cases the presence of gas was not clinically important, but in one patient it presented as a spinal mass, causing pain and radiculopathy.

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Giant hydronephrosis and hydroureteronephrosis are rare conditions, but must be kept in mind in especially children and in young-to-middle-aged adults with long-standing, often symptomless, enlargement of the abdomen. A case of bilateral giant hydroureteronephrosis due to calculi in the ureters is reported. Despite renal insufficiency the patient denied any treatment, but survived 42 months after the primary diagnosis. For diagnostic purposes intravenous pyelography, ultrasonography and computerized tomography are preferable. Supplementary ante- and retrograde pyelography is valuable in locating stenosis or calculi.

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A recently proposed standard exercise procedure for the assessment of peripheral arterial disease has been tested in patients with unilateral intermittent claudication. The immediate post-exercise fall in systolic ankle pressure after a 1 minute walk at 4 km/h on a 10% slope has been compared with the results from the contralateral and control limbs. The test was acceptable to the patients and easy to perform but has not in this study proven sensitive enough, as described, to detect asymptomatic (but angiographically verified) arterial lesions. The test is found valuable, however, especially in patients with inconclusive resting pressure recordings i.e. with an ankle to brachial pressure index close to 0.9. A pressure drop of 30% or more in this group of patients seems to indicate functionally important arterial disease.

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A 99Tc-tin-colloid scintigraphy showed no uptake of the radiopharmaceutical in the liver of a patient with jaundice. The diagnosis was later established as primary sclerosing cholangitis.

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In order to investigate endothelial cells of lymphatic vessels for factor VIII-related antigen (FVIIIR:Ag), lymphatics from lo patients with malignant lymphoma or testicular carcinoma undergoing lymph-angiography were examined. After the lymphangiography was terminated, a part of the cannulated lymphatic vessel was removed and prepared for immunohistochemical examination for FVIIIR:Ag. All the lymphatic vessels showed positive cytoplasmatic staining for FVIIIR:Ag in the endothelial cells, the reaction being weak and patchy when compared with blood vessels. Electron microscopy was done on five lymphatic vessels and showed these to be lined with endothelial cells without a basal lamina.

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Iohexol 300 mg I/ml, Conray meglumine 282 mg I/ml and Amipaque 300 mg I/ml have been compared in a randomized double-blind cross over study in which one injection of Iohexol 300 mg I/ml and Conray meglumine 282 mg I/ml was made in the same artery (common and internal carotid artery) of the same patient, and one injection of Iohexol 300 mg I/ml and Amipaque 300 mg I/ml was made in another artery (external carotid artery and vertebral artery). All together 63 cerebral artery branches were examined in 27 patients, who served as their own controls. The effect of the contrast injections on the intra-arterial blood pressure, pulse rate, ECG, circulatory rate and the patients' reactions were recorded under standardized conditions. The quality of the film was also evaluated. No significant difference was found in the cardiovascular effects after the injection of Iohexol or Conray meglumine into the common carotid or internal carotid. There was significantly less pain and sensation of warmth after the injection of Iohexol than after Conray meglumine 282. In the vertebral and the external carotid arteries, where a comparison between Iohexol and Amipaque was carried out, it was found that no significant difference in the cardiovascular effects occurred. There was less sensation of warmth after the injection of Amipaque into the vertebral artery than was caused by Iohexol. The degree of discomfort in form of pain reaction was the same for the two media, when these reactions occurred. No serious side effects were observed.

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