Hungarian Radiology

[15th St. Agata Mammologist Day - Budapest, February 7, 2009]

PETRI Klára

JULY 15, 2009

Hungarian Radiology - 2009;83(02)

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Hungarian Radiology

[Beginning of a new section: Pathology without borders - Integrative medical papers]

LOMBAY Béla

Hungarian Radiology

[Can magnetic resonance imaging play a role in planning the method of delivery after Caesarean section?]

GERGELY István, CSÉCSEI Károly, DORFFNER Roland, BARANYAI Tibor

[INTRODUCTION - The number of Caesarean sections has been dramatically increasing worldwide, and also in Hungary in the last decade. In case of pregnancy following a preliminary Caesarean section it is always questioned if repeated Caesarean section or vaginal birth is required. The authors try to draw a conclusion from the thickness and the structure of the uterinal scar. The aim of the current study is to assess the additional role of uterinal MR examination undertaken between two births. PATIENTS AND METHODS - During our retrospective preliminary study T2 weighted sagittal images of uterinal MR examinations of 13 female patients were analysed. The presence of scar line was evaluated for thickness (millimetres, mm). This measurement was compared with the surgical report following consequent Caesarean section. Thus, a correlation was made between the surgical scar found at the repeated Caesarean section and the structure of the uterine scar seen by MR examination (between two births) which could play a role in the indication of the next birth. RESULTS - Three of our 13 patients gave birth via vagina (VBAC), and 10 via repeated Caesarean sections. According to the descriptions of the surgical scar the scars thinned out in six cases, whereas they made thickness in four. According to the appearance of the place of incision the scar was homogeneous and hypointens in nine cases, and inhomogeneous but basically hypointense in one case. According to the description of surgery in the MR examination the thinned out scar was thinner than 6 mm in 4 cases, and thicker than 6 mm in two cases. According to the description of surgery in the MR examination the nonthinned out scar was thinner than 6 mm in three cases, and thicker than 6 mm in one case. In two patients of three who gave birth via vagina the scar was thicker than 6 mm in the MR examination, and thinner than 6 mm in one case, the MR appearance of the scar was homogeneous and hypointens in two cases and complied with the original zonal anatomy in one case. CONCLUSION - In case repeated Caesarean section is not necessary from the aspect of the foetus or the mother, uterinal MR examination is of an additional significance in the complex indication of birth following a previous Caesarean section. The thickness, structure and signal intensity of the uterinal scar may provide a useful additional information.]

Hungarian Radiology

[Balloon dilatation and metallic stent placement in inferior vena cava stenosis complicating liver transplantation]

DOROS Attila, NÉMETH Andrea, HARTMANN Erika, DEÁK Pál Ákos, FEHÉRVÁRI Imre, TÓTH Szabolcs, NEMES Balázs, KÓBORI László

[INTRODUCTION - The only successful therapy for end stage liver cirrhosis is liver transplantation. The anastomotic stenosis of the inferior vena cava is rare but serious complication. In these cases surgery is a high risk procedure; therefore interventional radiological methods are recommended. PATIENTS AND METHODS - Eleven patients developed 12 caval stenosis from 365 liver transplant recipients in Budapest. One of the patients had caval stenosis again after retransplantation. Dilatation was performed with 10- 25 mm large balloon catheters in 6 cases and 6 metallic stents (12-24 mm in diameter) were implanted. All the procedures were performed via the common femoral vein. RESULTS - The success of the intervention was measured by the morphological results, clinical signs and by the changes of superior-inferior vena cava pressure gradients. Before the intervention 14 Hgmm mean pressure gradient was measured, which decreased to 8 Hgmm post intervention. Eleven patients developed renal insufficiency before treatment; this was reversible in 6 cases. One patient had impaired renal function before treatment, and later on again, after retransplantation. Three of 4 patients with renal insufficiency died in the post operative period. One stent migration was noticed prompting surgical fixation of the stent. CONCLUSION - Inferior vena cava stenosis represents a serious complication after liver transplantation, causing ascites, hydrothorax and venous congestion in the kidneys and the liver. In the critical post operative period surgery is not recommended, risking the viability of the liver and the life of the patient. Interventional radiology with balloon dilatation and stent implantation is the method of choice in these cases, primary stenting with large self expanding metallic stents is necessary in elastic stenosis caused by torsion of the anastomosis.]

Hungarian Radiology

[Mediastinal hamartoma in childhood]

KISS Regina Judit, VERES Lukács

[INTRODUCTION - Mediastinal hamartoma is a rare entity in children. Exact diagnosis can be given virtually only after surgical exploration, which is also the ultimate choice of treatment due to its benign nature. CASE REPORT - A 4-year-old boy with recurrent upper respiratory tract infections and pneumonias, had a huge tumour mass in his left upper lung lobe, which infiltrated the mediastinum. After a negative bronchoscopy and an unsuccessful CT-guided biopsy, surgery was performed. The final histological result revealed the mass to be mediastinal hamartoma. CONCLUSION - Mediastinal masses are relatively common in childhood, but mediastinal hamartoma is rare, and its preoperative diagnosis appears to be difficult.]

Hungarian Radiology

[Monteggia fracture]

SHAIKH Shoaib, LOMBAY Béla, KISS Ákos

[The Monteggia fracture is a very challenging injury, not only for the treating surgeon but also for the radiologist. The correct and timely identification of the injury is vital for a favourable outcome. Following is an overview of the Monteggia fracture.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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