Hungarian Radiology

[CALENDAR OF THE SOCIETY OF HUNGARIAN RADIOLOGISTS, 2010 PRECURSORY]

DECEMBER 21, 2009

Hungarian Radiology - 2009;83(04)

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Hungarian Radiology

[Board Meeting of the Society of Hungarian Radiologists - Sopron, October 9th, 2009.]

MORVAY Zita

Hungarian Radiology

[The effect of endovascular intervention in the presence of rare celiac trunk developmental anomalies]

VÁGÓ Andrea, SZENTPÉTERY László, FORRAI Gábor

[INTRODUCTION - The congenital absence of celiac trunk and it’s subtotal stenosis are rare abnormalities and often recognised only during digital substraction angiography (DSA). This anomaly is significant when there is a need to perform local intraarterial chemoperfusion or chemoembolisation of malignant hepatic tumours. In these cases the liver is supplied with arterial blood through the superior mesenteric artery and the gastroduodenal arch. The direction of blood flow in the common hepatic artery is changed ensuring the flow to the splenic and left gastric artery. In such circumstances it is not possible to obtain local chemotherapy. CASE REPORT - Two male patients (61 and 75 years old) are reported. Both patients were candidates for chemotherapy due to hepatocellular carcinoma (HCC). In these two cases the planned therapy was impossible because of a stenosis of the celiac trunk in one, and atresia of the celiac trunk in the other. CONCLUSION - The recognition of vascular anomaly prior to endovascular intervention significantly affects the planning of the therapy.]

Hungarian Radiology

[18th Congress and Postgradual Training of the Hungarian Society of Neuroradiologists - Siófok, November 5-7th, 2009.]

OSZTIE Éva

Hungarian Radiology

[Diagnosis of ovarian torsion through the ultrasound and in the operating theatre - An audit and review of the current diagnostic modalities]

SHOAIB Shaikh, NYÁRI Edit, KONCZ Júlia, LAKATOS Andrea, LOMBAY Béla

[INTRODUCTION - This audit was carried out to assess the usefulness of ultrasound in the diagnosis of adnexal torsion in pediatric and adolescent patients, and to demonstrate any ultrasound characteristics which are predictive of ovarian torsion in this population. PATIENTS AND METHODS - Retrospective review of ultrasound reports, operative reports, and medical records for 17 pediatric patients treated at BAZ-County University Hospital, Miskolc, was performed. The patients had presented to the pediatric surgery with complaints of abdominal pain between August 2000 and August 2008, and underwent an abdominal/pelvic ultrasound prior to going to the operating room for surgical management. All ultrasounds were categorized regarding the presence or absence of adnexal torsion. Other sonographic parameters included were: the mass size, description, and the presence of signs associated with adnexal torsion (presence and arrangement of ovarian follicles, presence of free fluid in the pelvis, and the presence or absence of arterial or venous flow by color Doppler to the ovaries). Surgical and pathological findings were also studied. RESULTS - All 17 patients in this review were surgically confirmed cases of torsion. 14 (82%) of the torsions occurred on the right side, 3 (18%) on the left side. Ultrasound described 8 adnexal masses with torsion as cystic (n=8, 47%). Pelvic fluid was present in nine patients (53%). Of 10 patients in which follicles were noted, follicles were observed to be peripherally displaced in seven (41%). Only two patients (12%) underwent laparoscopic surgery, remaining received open surgery. On evidence of torsion in the operating room, detorsion was performed in all cases. Finally, tubal cystectomy was performed in 2 (12%), ovarian cystectomy in four (24%), oophorectomy in two (29%), salpingooophorectomy in 6 cases (35%), and oophoropexy was performed in three cases (2%). The majority of pathology in those with confirmed torsion were hemorrhagic cysts in 10 cases (59%), paratubal cysts in three cases (18%), and teratomas in one cases (6%). No histologies were sent for three patients who received oopheropexy. 13 patients (76%) with torsion had adnexal masses greater 5 cm. The duration of complaints prior to treatment was also an important factor: Generally patients with more than one day long complaints underwent oophorectomy, exception to this was a case with intrauterine torsion. CONCLUSIONS - In our audit, patients with adnexal masses greater than 5 cms were more likely to have torsion than those patients with masses less than 5 cms.]

Hungarian Radiology

[Residents here and over the rainbow]

LOMBAY Béla

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[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.]

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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.

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[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. ]

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[Anti-NMDA-receptor encephalitis: description of the syndrome in line with presentation of the first Hungarian patient]

HOLLÓDY Katalin, CSÁBI Györgyi, LÁNG Anikó, RÓZSAI Barnabás, KOMÁROMY Hedvig, BORS László, ILLÉS Zsolt

[In the majority of cases, anti-NMDA (N-methyl-D-aspartate) receptor encephalitis is a severe, but treatable disorder, therefore early diagnosis and adequate therapy are very important. It should be suspected in children and young women, who develop acute psychiatric symptoms and seizures. During the course of the disease severe encephalopathy, agitation, hallucinations, orofacial dyskinesias, prolonged cognitive disturbance, autonomic symptoms can be observed and akinetic mutism develops. EEG shows diffuse slowing. Brain MRI is normal or unspecific. Elevated protein, pleiocytosis and oligoclonal bands can be present in the CSF. Detection of NMDA-receptor antibodies in sera or CSF confirms diagnosis. We present the case of a 15-year old girl, who fully recovered within two months after steroid treatment and repeated plasma exchange. Ovarian teratoma has not been detected.]

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[Meeting of the Hungarian Epilepsy League]

SZUPERA Zoltán