Hungarian Radiology

[Calendar of the Society of Hungarian Radiologists, 2011]

DECEMBER 27, 2010

Hungarian Radiology - 2010;84(04)

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Hungarian Radiology

[The effect of the orientation of the distal femur on the correction of axis after closing-wedge high tibial osteotomy - Short-medium term radiological assessment]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[Introduction - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The clinical result is affected by the correction of the varus malalignment. The degree of correction appears to be dependent not only on correction performed on tibia but also on the orientation of the distal femur. The valgus orientation of the distal femur can be associated with postoperative over-correction and varus orientation of the distal femur with postoperative under-correction. Patients and methods - We performed radiological assessment of 82 knees preoperatively and after closing wedge high tibial osteotomy (CWO) in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (23-54 months) on a standing weight-bearing anteroposterior radiograph. Pre- and postoperatively we measured the orientation of the distal femur, described as the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FC-FS). We subdivided the knees into 3 groups based on the orientation of the distal femur. In group A the FC-FS was 83-85° (normal orientation of the distal femur), in group B the FC-FS was £82° (valgus orientation of the distal femur) in group C the FC-FS was ³86° (varus orientation of the distal femur). Pre- and postoperatively we measured the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP) in all groups. We determined the anatomical femorotibial angle (FTA) as a sum of FC-FS, TP-TS and FC-TP. Results - In the first ten postoperative weeks - with significant osseous correction happened in the three groups - the articular component also decreased significantly in groups A and B, but did not change in group C. Between the postoperative 10th and the final follow-up examinations we did not notice significant osseous correction loss in any groups. In groups A and B the articular correction loss was not significant, at the same time in group C we noted significant articular correction loss. Conclusion - At valgus orientation of the distal femur the CWO results in greater correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This additional correction equals the (preoperatively unpredictable) amount of the articular correction. At varus orientation of the distal femur the CWO results in less correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This difference equals the (preoperatively unpredictable) loss of articular correc- tion.]

Hungarian Radiology

[Education of Hungarian radiologists]

LUZSA György

Hungarian Radiology

[7th Paraclinical radiological forum Measurements via the radiological equipments: in the interest of safety and quality - Budapest, October 12th, 2010]

GÁSPÁRDY Géza

Hungarian Radiology

[Surgical treatment of scoliosis: pre- and postoperative follow-up with whole-body EOS radiography]

LÉVAI Andrea, VÁRADY Edit, SZUKITS Sándor, WENINGER Csaba, BATTYÁNY István, ILLÉS Tamás

[Currently, Cotrel-Dubousset spondylodesis is the treatment of choice in orthopaedics. It allows for correction of deformity in three-dimensions allowing for stable fixation. EOS (Extended Orthopedic System) is an ultra low dose X-ray imaging system, simultaneously acquiring images of the whole body in two planes. Examinations with the EOS system is not only indicated in cases related to orthopaedics but in multiple other conditions owing to its low level of emitted radiation with rapid and cost-effective imaging. The importance of EOS examination is emphasized in systemic skeletal disorders, thus allowing itt o be used in various other clinical fields.]

Hungarian Radiology

[From the Jesuit secondary school of Pécs to the Department of Radiology at the Pediatric Clinic - János Weisenbach is 75 year-old]

LOMBAY Béla

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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.

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]

Hypertension and nephrology

[The Comprehensive Hungarian Screening Program for Health Protection 2010-2020]

KISS István, DANKOVICS Gergely