Hungarian Radiology

[A Deliberate Violation of Symmetry My Entry for the Ig Nobel Prize]


DECEMBER 15, 2008

Hungarian Radiology - 2008;82(07-08)



Further articles in this publication

Hungarian Radiology

[Radiology of pancreas: review from the last year - Gastro Update 2007]


[PURPOSE - To demonstrate the recent results in radiological diagnostics of pancreas, and the actual place of the imaging and interventional methods. METHOD - Systematic review of the most recent articles from the last year in the following subjects: acute, chronic and autoimmune pancreatitis, pancreatic cancer and other tumors, PET and special imaging problems in pancreas transplantation. RESULTS - Annually, experience in pancreatic diagnostical methods are accumulating rapidly. Therefore, there is a continuous change in the examination algorithm with new diagnostic and therapeutic modalities making their way into the daily routine. Some of the algorithms become obsolete within a few years and their further application is considered mismanagement. Some other methods become obligatory steps in the diagnostics. These are the reasons why up-to-date knowledge of the literature is mandatory.]

Hungarian Radiology

[Role of contrast enhanced ultrasound in clinical practice]


[Ultrasound contrast agents consist of micro bubbles which can be visualized during their short intravascular and parenchymal transit time. An US system with special software, a small amount of intravenous contrast agent and a skilled operator is necessary to produce a successful study. This method can also be introduced into the clinical practice in our country. Careful indications and well performed studies can reduce the number of unnecessary CT and MR studies and biopsies. Contrast enhanced US has special clinical significance in the detection and characterization of focal liver masses, monitoring drug and local treatment effects of different abdominal tumors and in the case of injury of abdominal parenchymal organs.]

Hungarian Radiology

[Evaluation of cystic renal masses with MDCT]


[Modern CT and MRI scanners can give an exact and rapid diagnosis in the case of most cystic renal masses. Dilemma in their diagnosis is whether or not the changes need surgical intervention. The question of follow-up is decided with the use of the Bosniak classification. To characterize the cystic changes excellent quality, multiphasic MDCT examination is necessary with the following parameters: 80-120 mls. of non-ionic iodinated intravenous contrast material given with an injector at 3 ml/sec flow-rate with saline flush technique, unenhanced and post-contrast scans obtained at 35 and 70 seconds, with more scans at 120-300 seconds, as deemed necessary. A collimation of 16x1.5 mm with an overlap of 50% should be aimed for. Through the primary data we perform a reconstruction of 2 mm, with an option to create volume-rendered image sin the post-processing phase, as necessary. With the help of this CT protocol we can measure the different criterions of Bosniak classification in the cystic masses like minimal, smooth or irregular wall thickening, with or without enhancement. We can recognize hairline thin or thickened septa, fine or irregular (thick or nodular) calcifications, solid component with or without contrast enhancement. Using these criteria each cystic mass can be assigned to a Bosniak cystic category (I, II, IIF, III and IV)]

Hungarian Radiology

[High resolution sonography for the examination of peripheral nerves]


[High-frequency sonography is an important method for the imaging of the peripheral nerves, even though it is rarely used. For the examination of superficially located nerves, currently available transducers with frequencies between 12-17 MHz offer a better axial resolution than even MRI. Sonography is superior to MRI especially for the examination of nerves of the upper extremity. Main indications for the sonography of the nerves are entrapment syndromes, traumatic injuries of the nerves, tumors, polyneuropathies and sonographically-guided interventions. The sensitivity of sonography and electrophysiology in the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome are comparable. The combination of ultrasonography with electrophysiological studies increases the diagnostic yield in carpal and cubital tunnel syndromes. Sonography provides information for planning of peripheral nerve surgery and is helpful in evaluating postoperative complications. In selected cases, sonography can detect nerve lesions that require operative therapy earlier than electrophysiology. With technical enhancements, highfrequency ultrasonography is gaining increasing importance in the routine diagnostics of peripheral nerves lesions.]

Hungarian Radiology

[Standard Negative Findings of Imaging Diagnostic Procedures Recommendation by the Radiology Professional College, 2008]

FORRAI Gábor, KISS Ildikó, LAKI András, LOMBAY Béla, MORVAY Zita, NAGY Endre, NAGY Gyöngyi, ORMÁNDI Katalin, PALKÓ András, VÖRÖS Erika

All articles in the issue

Related contents

Lege Artis Medicinae

[Mechanism of mucosal defence and options to reduce virus invasion during the COVID pandemic]


[The portal of entry for coronavirus is the mucous membrane of the respiratory tract. Severity, organ manifestations and out­come of COVID-19 are determined by the viral load, burdening the attacked organism. Condition of the respiratory tract and gastrointestinal mucosa and the capacity of their defence system are crucial for virus penetration, fusion with epithelial cells and replication. Direct neural spread, penet­ra­tion into the deeper airways and spread through the lymph nodes depend on these functions. Virus binding and engulfment is an active process. The virus penetrates the endosomes of the epithelial cell, by enzymatic transfer where it is recognised by natural defence agents and triggers the first defence responses. These alarm the entire immune system and trigger a whole chain of inflammatory and enzymatic defence processes (cytokine and bradykinin storm) proportional to the viral load. The severity endpoint of COVID-19 pathology is alveolitis, cerebral vasculitis and intestinal da­mage, often with fatal outcome. The airway mucosa defends itself by secreting surface factors and recruiting and activating cells of the adaptive immune system. An important element of the latter is the early ap­pearance of secretory IgA in the mucosa. The viral invasion can be prevented by application of a nasal spray containing carrageenan, which engages the virus and prevents its attachment by the gel-forming property of carrageenan. This effect has worked in previous virus epidemics and the first COVID-19 experiences confirm its pro­tec­tive role. ]

Clinical Neuroscience

[Experience with natalizumab-treatment at Semmelweis University]

GOMBOS Barbara, ILJICSOV Anna, BARSI Péter, HEGEDÛS Katalin, SIMÓ Magdolna

[Multiple sclerosis is an autoimmune demyelinating disorder of the central nervous system. During the last two decades, numerous disease modifying drugs have been introduced for the treatment of the relapsing-remitting form of the disease. Since 2010, natalizumab (NTZ) treatment has been used as a second-line therapy for patients with breakthrough disease. In comparison to conventional immunomodulant drugs, NTZ has a more specific effect in that it prevents the entry of immune cells into the central nervous system without interfering with systemic immune response. The efficacy and the safety of NTZ have been confirmed by several studies. The most severe side-effect of NTZ is progressive multifocal leukoencephalopathy, which has been associated with an increased incidence in patients with anti-JCV antibody positivity, and in those who have been undergoing NTZ treatment for over two years and who have received prior immunosuppressive therapy. In the present study, our experience with natalizumab treatment of 37 patients at the Department of Neurology of Semmelweis University during the last 6 years is presented. We have observed a significant decrease of disease activity in our patients; in many cases the disease has become inactive both clinically (36/37) and radiologically (34/37). The patients’ quality of life has improved significantly during the treatment. In accordance with the literature, we confirm that NTZ is a highly effective treatment in a carefully selected patient group, and can be administered without significant inconvenience to the patient. ]

Lege Artis Medicinae

[Lipid lowering therapy during COVID-19 pandemic]

MÁRK László

[The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.]

Hypertension and nephrology

[Data on blood pressure over two years in resistant hypertensive patients with lett brain stem microvascular decompression]


[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]

Hypertension and nephrology

[Risk of drug-drug interactions in hemodialyzed patien]

SZABÓ Alexandra, HARIS Ágnes

[Hemodialysis patients usually need large number of medications fór treatment of their multiple comorbidities. Because of the polypharmacy we have to count on several drug-drug interactions, which might necessitate modification of types and dosages of drugs, based on the patient's actual condition and current treatment. The use of anticoagulants causes everyday problems, because these drugs have high pharmacokinetics potency, and on the other hand their administration is indispensable. In our investigation we aimed to analyze the drug therapy of chronic hemodialysis patients in the Szent Margit Hospital Taraba István Dialysis Unit, and present the clinical pharmacist's role in the hospital team.]