Hungarian Radiology


OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)



Further articles in this publication

Hungarian Radiology

[Tarsal coalitions in our adult patients]


[INTRODUCTION - Tarsal coalition is an abnormal bony, cartilaginous or fibrous union between two or three bones of the mid and hindfoot. It occurs mostly (90%) in the calcaneonavicular and talocalcaneal joints. Coalitions are usually detected in the second decade of life, but several cases are noted in children and in later adulthood. Estimated incidence is 1-2% of the total population. CASE REPORTS - Cases of unilateral tarsal coalitions (five calcaneonavicular, three talocalcaneal) in four male and three female patients are presented. The average age of the patients is 30 years. The radiologic diagnosis was based on the secondary signs seen on the lateral plain films of the feet. These signs are parallel with clinical symptoms, in contrary to the primary radiologic signs. The two types of the anomaly coexisted in a female patient. CONCLUSION - Routine lateral not-magnified pedal radiographs are valuable screening tool for tarsal coalitions.]

Hungarian Radiology

[Professor Mózes Péter was awarded professor emeritus title]


Hungarian Radiology

[MRI-guided prostate brachytherapy: First Hungarian experiences based on a canine study]


[INTRODUCTION - Modern radical radiotherapy can be an effective alternative of radical prostatectomy in low risk patients with prostate tumor. Our objective was to demonstrate the feasibility of transperineal MR-guided prostate interventions in an open MR unit and to present our early clinical experiences on canines. METHODS AND MATERIALS - The procedures were performed on 5 canines in an open-configuration 0.35T MR scanner. For interventions an MR compatible custom-made device was used. The canines were placed in the right lateral decubitus position. Template reconstruction, trajectory planning, target and OAR delineation were based on T2 FSE images. For image guidance and target confirmation, fast spoiled gradient-echo (FSPGR) sequence was used. MR compatible coaxial needles were inserted through the perineum to the base of the prostate. After satisfactory position was confirmed, brachytherapy catheters were placed through the coaxial needles, which were then removed. RESULTS - Mean and standard deviation of the needle displacements was 2.2 mm±1.2 mm, with a median of 2 mm. 96% of the errors were less than 4.0 mm. Implantation induced prostate motion was measured with a mean of 10.3 and 2.3 mm in cranio-caudal and transverse directions. Significant movement was only observed during the first 4 needle insertions. The average time needed for each step was: anesthesia 15 minutes, setup and positioning 15 minutes, initial imaging 15 minutes, template registration and projection 15 minutes, contouring, trajectory planning, insertion of 10 needles 60 minutes. CONCLUSION - Based on our canine model experiences our method seems to be a promising approach for performing feasible, accurate, reliable and high-quality prostate MR guidance within a reasonable time span. We plan to introduce MR-guided biopsy and brachytherapy in human patients in the near future.]

Hungarian Radiology

[More attention!]


Hungarian Radiology

[XV. Symposium and Postgradual Training of the Pediatric Radiologists]


All articles in the issue

Related contents

Clinical Neuroscience

[A prospective study evaluating the clinical characteristics of cluster headache]


[Introduction - Although cluster headache (CH) is one of the most severe human pain syndromes, its symptoms and therapeutic possibilities may be suboptimally recognised in current medical practice in Hungary. Aim - To present the clinical characteristics of CH based on a prospective study of patients attending the Headache Service of the Department of Neurology, Semmelweis University. Methods - We collected information about the symptoms, diagnosis and previous treatment of CH patients by filling in a 108-item questionnaire during outpatient visits. Results - In the 5-year period between 2004 and 2008 we obtained data from 78 CH patients (57 males and 21 females; mean age: 44.6±14.6 years). The male:female ratio did not change in subgroups based on disease onset (calendar years). Ninety-three percent considered CH the most severe pain state of their life. The pain was strictly unilateral, affecting the territory of the 1st trigeminal division in all patients. The attacks were accompanied by signs of ipsilateral cranial parasympathetic activation (lactimation 83%, conjunctival injection 67%, rhinorrhea 56%, nasal congestion 43%); less frequently, signs of sympathetic dysfunction (ptosis 48%, miosis 7%) were also present. Two patients had attacks showing the typical localisation, severity and time course of CH attacks, but not accompanied by autonomic phenomena. A considerable part of the patients also observed symptoms that are usually ascribed to migraine (nausea 41%, vomiting 18%, photophobia 68%, phonophobia 58%). This may have been instrumental in the fact that, regardless of the characteristic clinical symptoms, the diagnosis of CH took 10 years on average. At the time of their examination 63% of patients were not using adequate abortive medications and 59% did not have an adequate prophylactic measure. Discussion - Cluster headache is characterised by attacks of devastating pain that warrant an early diagnosis and adequate treatment. Our study underlines that information about the diagnosis and therapy of CH should be emphasized on occasions of neurology specialty training and continuing medical education.]

Hypertension and nephrology

[The interpretation of metabolic syndrome]

KÉKES Ede, KISS István

[The significant increase of the splanchnic ectopic fat, the disturbance of carbohidrate metabolism, atherogenic dyslipidemia and high blood pressure creates the syndrome so called deadly quartet. These components promote the early appearance of cardiovascular diseases (ischemic heart disease, stroke, peripheral artery disease, etc.) as well as the enormous growth of type 2 diabetes mellitus. It was thought, that the ectopic fat is the only background of the syndrome and the insulin resistance with hyperinsulinemia as well as the disruption of associated endocrine regulatory balance system and elevated sympathetic drive explain jointly the clinical events. We now know that cytokines released by ectopic fat issue (CRP, TNF-α, IL-6 etc.) launch processes in our organism, which contribute to the development of vascular remodelling, endothelial dysfunction and in the end to that of atherothrombotic processes. The diagnostic criteria of the syndrome were changed continuously parallel growing theoretical knowledge till 2009, when on the Harmony Conference the important components of the syndrome were accepted, but some laboratory and other parameters do not enter into everyday praxis.]

Clinical Neuroscience

Unilateral thalamic infarction causing downward gaze palsy in a patient with uncorrected tetralogy of fallot: a case report


Introduction - Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Adults with surgically uncorrected forms of this condition are extremely rare, since operation is recommended in childhood to prevent cyanosis. Cyanotic CHD increases the risk of thromboembolic events. An endothelial dysfunction caused by chronic hypoxia and shear stress due to rheological alterations with a platelet dysfunction appear to be the explanation behind this finding. Paramedian thalamic infarction causing vertical gaze palsy without midbrain involvement is an infrequent finding. We report here a rare case of a patient with untreated TOF, who suffered a left-sided unilateral thalamic infarction presenting as downward gaze palsy and diplopia. Case presentation - A 44-year-old women complained of sudden onset diplopia and vertigo. Neurological examination revealed a downward gaze palsy with other symptoms related to a vertebrobasilar territory circulatory disturbance. The MRI scan revealed an acute infarction, 8 mm in diameter in the left medial thalamic region without midbrain involvement. Discussion - Adults with uncorrected forms of TOF are extremely uncommon, and descriptions of stroke in these patients are therefore rarities. We set out to give a concise survey of the literature regarding TOF patients with stroke. Conclusion - We present a rare case of unilateral thalamic infarction causing downward gaze palsy in an adult patient with uncorrected TOF. Cyanotic CHD is regarded as one of the risk factors of stroke. Besides other pathologic conditions, ischaemic stroke at an early age should raise the suspicion of a cardioembolic origin and, in rare cases, might result from cyanotic CHD.

Hungarian Radiology


Lege Artis Medicinae


PAPP Előd, TÓTH Kálmán

[Angiotensin converting enzyme inhibitors have long been basic drugs in the treatment of heart failure. In the preventive treatment of ischaemic heart disease, however, their mortality-reducing effect has only been proved recently. The HOPE was the first trial that showed a beneficial effect of the angiotensin converting enzyme inhibitor ramipril in patients at high risk for cardiovascular diseases. The EUROPA trial showed a positive role of perindopril in the reduction of hard clinical endpoints in relatively low risk patients with known coronary artery disease. The PEACE trial was designed to show a possible group effect of angiotensin converting enzyme inhibitors, but it failed to demonstrate a beneficial effect of trandolapril in patients with coronary artery disease. The latest data from the EUROPA trial and results from three new prevention trials with perindopril or amlodipine plus perindopril combination and with quinapril have been presented recently. Perindopril was administered in patients over 65 years with previous myocardial infarction and with good left ventricle function in the PREAMI study. By the end of the study period, the combined end point and remodelling had decreased significantly. The ASCOT-BPLA trial (amlodipine plus perindopril versus beta-blocker plus diuretic) showed a reduction in all coronary events, in the risk of stroke and in the prevalence of new-onset diabetes mellitus. Quinapril was used in the IMAGINE trial in patients after coronary bypass surgery; the results did not support the hypothesis that early treatment with angiotensin converting enzyme inhibitors improves clinical outcome. Based on these new results, the indication of perindopril has been extended to the reduction of cardiovascular risk in patients with stable coronary artery disease after myocardial infarction or revascularization.]