Hungarian Radiology

[23RD CONGRESS OF THE SOCIETY OF HUNGARIAN RADIOLOGISTS, ABSTRACTS]

OCTOBER 20, 2006

Hungarian Radiology - 2006;80(05-06)

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Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS 2006]

Hungarian Radiology

[Statement of the board of the Society of Hungarian Radiologists]

LOMBAY Béla, PALKÓ András

Hungarian Radiology

[The value of multislice computed tomography in the diagnosis of pulmonary embolism and in differential diagnostics]

BODROGI Nándor, BARANYAI Tibor

[INTRODUCTION - The multislice CT (MSCT) pulmonary angiography has been used increasingly in the diagnosis of pulmonary embolism with worldwide application and nowadays it can be considered as a gold standard technique. At the author's department a single slice CT has been used from 1993 and a 10 slice CT system with 24 detector-lines was installed in 2004. The authors summarize the advantages of MSCT in the diagnosis and differential diagnosis of pulmonary embolism and its role in the follow-up of cases and the significant increase of the diagnostic safety. PATIENTS AND METHODS - 2576 chest MSCT examinations were performed between 16 February 2004 and 20 June 2005. In 261 cases pulmonary MSCT angiography was made due to suspected pulmonary embolism. In 7 cases the indication of the CT was different, but due to the findings (pulmonary embolism) this group of patients is discussed in this paper. 268 cases were evaluated retrospectively. In 12 patients, CT could not be performed due to contrast agent allergy or because of seriously impaired renal function. In 2 cases it was not possible to establish a venous access. The therapeutical result was monitored upon the request of the clinicians. The pulmonary MSCT angiography was performed in accordance with a detailed acquisition and reconstruction protocol. In the reprocessing stage the 2D (MPR) reconstruction in different directions was an important step. In addition, three-dimensional MIP was used and VRT reconstruction was also made, if needed. Bolus tracking was applied in order to achieve a good contrast phase. RESULTS - In 116 out of 268 cases pulmonary embolism was detected by pulmonary MSCT angiography. In 7 patients pulmonary embolism was not the primary diagnosis. Pathological changes could not be detected in 55 cases (20.5%) and embolism was not proven later in these patients. No false negative study was recognized. In one case, after the death of the patient the autopsy failed to prove the presence of pulmonary embolism, this represents one false positive diagnosis. In 97 patients pulmonary embolism was not detected, however other findings were found relating to the complains of the patients and thus proper therapy could be introduced. CONCLUSION - Pulmonary MSCT angiography proved to be a highly accurate method for the diagnosis and for exclusion of pulmonary embolism and also in the evaluation of its extent. MSCT can be used in monitoring the result of the therapy. In addition, MSCT gives an opportunity to detect other acute pathological conditions of the chest, thus value of the study is significant in the differential diagnosis.]

Hungarian Radiology

[Virtual reality in medicine]

SZÁNTÓ Dezső

Hungarian Radiology

[Successful radiological diagnostics in Bouveret’s syndrome]

KISS Katalin, FARKAS Szabolcs, LUKOVICH Péter, MAGYAR Péter, MESTER Ádám, MAKÓ Ernő†

[INTRODUCTION - Bouveret’s syndrome I is a rare clinical entity, a special form of gallstone ileus. Based on a case study the authors describe the clinical presentation, the complications and diagnostic work up of the Bouveret’s syndrome I. CASE REPORT - A 75-year-old female patient with repeated vomiting and haematemesis was examined. Known gallstones and obstructive jaundice was noted in the case history. Urgent gastroscopy was performed at admission, which proved haemorrhagic esophagitis as the cause of the haematemesis. A gallstone was found by endoscopy distal to the pyloric region obstructing the bowel lumen. Radiological examinations proved the presence of the stone exactly at the localization that was given. Surgery confirmed the diagnosis. CONCLUSION - Bouveret’s syndrome I should be considered in patients with repeated and long lasting vomiting and bile stone in the case history. Conventional X-ray may be sufficient to establish the diagnosis, however further imaging studies are needed to clarify exact anatomical situation and potential complications of the disease.]

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Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

LAM KID

[The impact of vitamin D in infertility and the role in pregnancy and in nursing period]

SPEER Gábor

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine, the target vitamin D level is 20 ng/ml, whereas the Endocrine Society recommends 30 ng/m as the minimum target value. These differences show that the two Society have different views on the risk of adverse effects. Screening, however, is not recommended by either society. In this review I summarize the role of the vitamin D supplementation in the prevention of infertility. Also, I suggest the protective effect of the vitamin D during the pregnancy. In my opinion screening program against D hypovitaminosis should be performed in case of infertility and in pregnancy, because data show a protective role of vitamin D against many disease of newborn. ]

Hypertension and nephrology

[Report on the 50th Jubilee Congress of the European Renal Association – European Dialysis and Transplant Association]

BÁNKI N. Fanni