Hungarian Radiology

[Correlation of clinical parameters with myocardial perfusion grades in acute myocardial infarct patients]

UNGI Tamás, JÓNÁS Zsuzsanna, UNGI Imre, SASI Viktor, ZIMMERMAN Zsolt, PALKÓ András

JUNE 20, 2007

Hungarian Radiology - 2007;81(03-04)

[INTRODUCTION - The prognosis after opening the obstructed infarct-related coronary artery is influenced by several factors. In routine clinical practice revascularization is considered to be successful when the restoration of epicardial blood flow is complete. However, functional impairment in the myocardium can occur even with open epicardial arteries. There are two angiographic parameters closely related to myocardial viability: myocardial blush grade (MBG) that describes the quantity of contrast material in the myocardium, and TIMI myocardial perfusion grade (TMP) that describes its outflow dynamics. Our goal was to assess the prognostic value of these two parameters in the framework of a prospective clinical study. PATIENTS AND METHODS - We compared the two parameters based on visual estimation (MBG and TMP) with those characterizing myocardial impairment, such as ejection fraction (EF), wall motion score index (WMSI), creatine-kinase release and chest pain score in 22 patients with acute myocardial infarction and successful revascularization. Our results were obtained by Spearman's rank correlation and χ2-tests at a confidence interval of 95%. RESULTS - Close correlation with TMP was found in case of both parameters measured by echocardiography (EF: r=0.59, p=0.02; WMSI: r=-0.51, p=0.046). These results were supported by the correlation with creatinekinase release (r=-0.54, P=0.01). By the present number of patients, MBG does not show significant correlation with the measured clinical parameters. Presence of chest pain is associated neither with TMP nor with MBG. CONCLUSIONS - Assessing myocardial perfusion by visual evaluation provides useful prognostic information. The extent of chest pain does not indicate myocardial dysfunction. The clearence of the dye (used in TMP definition) is more characteristic to myocardial viability than maximal contrast density (used in MBG definition).]

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[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

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[Multisegmental tuberculous spondylodiscitis in a patient with Helicobacter pylori infection]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - Prospective randomized examination has been verified association between asymptomatic chronic Helicobacter pylori infection and systemic vascular inflammation and endothelial dysfunction in certain cases. CASE REPORT - A case of a 71 year-old female patient is described with proven coexisting primary tuberculous bronchoadenitis, secondary tuberculous spondylodiscitis and Helicobacter pylori infection as a cause of uncertain abdominal disorder. The patient's height decreased by 9 cm during 6 months, since the onset of the symptoms. The diagnosis was based on respiratory function test, positive rapid ureal test, bronchoscopy, cytologic and microbiological examinations. On dorsolumbal spinal plain films showed wedge, biconcave crus and mass deformities of nine vertebras. High serum level of CRP and C3 complement was suggestive of acute reactive inflammation. Before the introduction of drug therapy an MR examination was planned, however the patient died of an acute myocardial infarct on the 8th day after admission The postmortem findings proved the presence of pulmonary and vertebral tuberculosis, there was no evindence of aortocoronal and spinal vasculitis. The epispinal tissues were not involved. CONCLUSION - The patient’s case history, autopsy findings and the literature data are suggestive of the role chronic Helicobacter pylori infection in the development of spondylodiscitis and the deterioration of the disease.]

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[Sonographic appearance of the cytostatic therapyrelated hepatic injury]

JÓKÚTI László, VARGA Edit, KARÁDI Zoltán, KOVÁCS GÁBOR

[INTRODUCTION - The correlation between biochemical parameters and sonographic appearance of the liver in children and young adults receiving cytostatic therapy was investigated. PATIENTS AND METHODS - 104 (54 male, 50 female) patients at the hemato-oncologic unit of 2nd Department of Pediatrics, Semmelweis University Budapest were enrolled into this prospective, single-blind, uncontrolled study: patients’ ages were between 2.0 and 32.7 years (mean 12.2 yrs, ± SD 5.7). 69 patients received chemotherapy for acute lymphoblastic leukemia (ALL), 35 patiens for osteogenic osteosarcoma (OSC). The time interval between the initiation of the cytostatic therapy and the examination was between 1 month and 16 years (mean 3.9 yrs). Ultrasonography was performed after 5-8 hours of fasting, without sedation. Echogenicity, distal attenuation of liver parenchyma and Doppler waveforms of the hepatic vein branches were evaluated. Alanine-aminotransferase (ALT) and gamma-glutamyltransferase (GGT) activity were measured in peripheric blood samples. Statistical correlation was analysed between sonographic appearance and biochemical parameters of the liver. RESULTS - 35 patients had at least one sonographic abnormality: of these, 9 had elevated enzyme activity. Among the 69 patients with normal ultrasound findings, only 2 had increased enzyme activity (Chi square test, p=0.001). When tested against enzyme activity, echogenicity and attenuation showed significant (p=0.002 and p=0.01, respectively), Doppler waveform in the hepatic vein branches showed marginally significant correlation (p=0.05). All three ultrasound parameters had low sensitivity regarding the elevation of enzyme levels, however attenuation and hepatic vein waveform proved to be specific (both 94%) for enzyme level elevation and all three showed high negative predictive values (96%, 93% and 92%, respectively). When combining all three sonographic parameters in a single variable, correlation was even higher (p=0.001), sensitivity became acceptable (82%) and negative predictive value increased further to 97%. CONCLUSIONS - The authors conclude that a correlation exists between three simple sonographic indicators (echogenecity, distal attenuation, Doppler waveforms of the HVs) and liver injury detected by biochemical parameters. Due to the low sensitivity of the ultrasound parameters to confirm of the presence of diffuse liver injury is not possible. However, the combined use of the ultrasound and biochemical parameters a good negative predictive power can be achieved and therefore this is a useful tool in the follow-up for hepatic status.]

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Clinical Neuroscience

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

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