Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2008]

JUNE 22, 2008

Hungarian Radiology - 2008;82(03-04)

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Hungarian Radiology

[Not ‘rounded-off’ birthday - Professor László Horváth, 71 years old]

LOMBAY Béla

Hungarian Radiology

[Oral presentations]

Hungarian Radiology

[Complications after subtotal extirpation of the esophagus and the radiological aspects of their treatment]

VÁGÓ Andrea, LUKOVICH Péter, FARKAS Szabolcs, KISS Katalin, KUPCSULIK Péter

[INTRODUCTION - Complications after subtotal esophageal extirpation (for eg.: insufficiency of anastomosis, stricture, etc.) and their treatment have special radiological considerations. Surgical departments and their radiologists meet early complications. But, all other radiological departments can face late complications, so the knowledge of these is important for all radiologists. PATIENT AND METHODS - 58 subtotal esophageal extirpations were performed in the last 5 years in the 1st Department of Surgery, Semmelweis University, Budapest. All postoperative radiological examinations were undertaken by the Department of Diagnostic Radiology and Oncotherapy. Most plain chest X-rays and swallowing examinations were made per-os with non ionic water soluble, low osmolarity contrast media on the 7th postoperative day. Further examinations were performed only if needed clinically. RESULTS - The complications were categorized as early and late. Early complications were aspiration, anastomosis insufficiency (31% of cases). Nine cases had self-dilating stents placed because of suture insufficiency. Further complications were noted following stenting (eg.: occlusion, dislocation of stent, closure of stent because of granulation tissues). Amongst late complications, stomach dilatation caused by pylorus-spasm (1 case), stricture of anastomosis (14 cases) and ’too-long’ esophageal stump (3 cases) were seen. CONCLUSION - Conventional radiology has a major role in diagnostics and treatment of complications of esophageal extirpation. Dynamic radiological examination and team work are required between the radiologist and surgeon. Also, it is crucial to cultivate good cooperation in cases of stent implantation, as contrary to the published literature, we find it better to have stents placed under flouroscopy rather than endoscopically.]

Hungarian Radiology

[16th French-Hungarian Radiological Symposium - Budapest, 16th-18th April, 2008]

– H. E. –

Hungarian Radiology

[Complex licence examination on breast diagnostics]

PALKÓ András, ORMÁNDI Katalin, FORRAI Gábor, PÉNTEK Zoltán

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Clinical Neuroscience

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

Clinical Neuroscience

Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Hungarian Radiology

[The quality control of radiological equipments in Hungary]

PELLET Sándor, PORUBSZKY Tamás, BALLAY László, GICZI Ferenc, MOTOC Anna Mária, VÁRADI Csaba, TURÁK Olivér, GÁSPÁRDY Géza

Lege Artis Medicinae

[Clinical trials for evaluating cardiovascular safety of SGLT-2- inhibitor drugs in patients with type 2 diabetes]

JERMENDY György

[SGLT-2-inihibitors are considered as a new class among oral antidiabetic drugs. The first derivatives of this class became available in the last couple of years in Hungary. According to the requirements from regulatory bodies, randomized, controlled clinical trials have been initiated in order to evaluate the cardiovascular safety of nearly all new antidiabetic drugs in patients with type 2 diabetes. Among SGLT-2-inhibitors, only one trial with empagliflozine has been completed so far. Based on the endpoints of the EMPA-REG OUTCOME trial a significant decrease in different cardiovascular events and total mortality was observed in type 2 diabetic patients with elevated cardiovascular risk. The exact pathomechanism of this beneficial effect has not been clearly understood. Currently, the position statements and scientific guidelines clearly describe the place of SGLT-2-inhibitor drugs in the treatment algorithm; the beneficial effect of empagliflozine on cardiovascular events should seriously be considered when making therapeutic decision. Together with the results of ongoing studies with SGLT-2-inhibitors (dapagliflozine: DECLARE, canagliflozine: CANVAS), these data will provide a more robust evidence about the cardiovascular safety of this new class of oral antidiabetic drugs. ]

Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2005]