Hungarian Radiology

[Crossing Europe with Science and by Bike A Birthday Portrait of Professor Gábor Vadon]

LOMBAY Béla

DECEMBER 15, 2008

Hungarian Radiology - 2008;82(07-08)

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Hungarian Radiology

[A Deliberate Violation of Symmetry My Entry for the Ig Nobel Prize]

LOMBAY Béla

Hungarian Radiology

[Radiology of pancreas: review from the last year - Gastro Update 2007]

FORRAI Gábor

[PURPOSE - To demonstrate the recent results in radiological diagnostics of pancreas, and the actual place of the imaging and interventional methods. METHOD - Systematic review of the most recent articles from the last year in the following subjects: acute, chronic and autoimmune pancreatitis, pancreatic cancer and other tumors, PET and special imaging problems in pancreas transplantation. RESULTS - Annually, experience in pancreatic diagnostical methods are accumulating rapidly. Therefore, there is a continuous change in the examination algorithm with new diagnostic and therapeutic modalities making their way into the daily routine. Some of the algorithms become obsolete within a few years and their further application is considered mismanagement. Some other methods become obligatory steps in the diagnostics. These are the reasons why up-to-date knowledge of the literature is mandatory.]

Hungarian Radiology

[Role of contrast enhanced ultrasound in clinical practice]

HARKÁNYI Zoltán

[Ultrasound contrast agents consist of micro bubbles which can be visualized during their short intravascular and parenchymal transit time. An US system with special software, a small amount of intravenous contrast agent and a skilled operator is necessary to produce a successful study. This method can also be introduced into the clinical practice in our country. Careful indications and well performed studies can reduce the number of unnecessary CT and MR studies and biopsies. Contrast enhanced US has special clinical significance in the detection and characterization of focal liver masses, monitoring drug and local treatment effects of different abdominal tumors and in the case of injury of abdominal parenchymal organs.]

Hungarian Radiology

[Evaluation of cystic renal masses with MDCT]

BATA Pál, MIKUSI Regina, KARLINGER Kinga, BÉRCZI Viktor, SZENDRŐI Attila, ROMICS Imre

[Modern CT and MRI scanners can give an exact and rapid diagnosis in the case of most cystic renal masses. Dilemma in their diagnosis is whether or not the changes need surgical intervention. The question of follow-up is decided with the use of the Bosniak classification. To characterize the cystic changes excellent quality, multiphasic MDCT examination is necessary with the following parameters: 80-120 mls. of non-ionic iodinated intravenous contrast material given with an injector at 3 ml/sec flow-rate with saline flush technique, unenhanced and post-contrast scans obtained at 35 and 70 seconds, with more scans at 120-300 seconds, as deemed necessary. A collimation of 16x1.5 mm with an overlap of 50% should be aimed for. Through the primary data we perform a reconstruction of 2 mm, with an option to create volume-rendered image sin the post-processing phase, as necessary. With the help of this CT protocol we can measure the different criterions of Bosniak classification in the cystic masses like minimal, smooth or irregular wall thickening, with or without enhancement. We can recognize hairline thin or thickened septa, fine or irregular (thick or nodular) calcifications, solid component with or without contrast enhancement. Using these criteria each cystic mass can be assigned to a Bosniak cystic category (I, II, IIF, III and IV)]

Hungarian Radiology

[High resolution sonography for the examination of peripheral nerves]

JOSEF Böhm

[High-frequency sonography is an important method for the imaging of the peripheral nerves, even though it is rarely used. For the examination of superficially located nerves, currently available transducers with frequencies between 12-17 MHz offer a better axial resolution than even MRI. Sonography is superior to MRI especially for the examination of nerves of the upper extremity. Main indications for the sonography of the nerves are entrapment syndromes, traumatic injuries of the nerves, tumors, polyneuropathies and sonographically-guided interventions. The sensitivity of sonography and electrophysiology in the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome are comparable. The combination of ultrasonography with electrophysiological studies increases the diagnostic yield in carpal and cubital tunnel syndromes. Sonography provides information for planning of peripheral nerve surgery and is helpful in evaluating postoperative complications. In selected cases, sonography can detect nerve lesions that require operative therapy earlier than electrophysiology. With technical enhancements, highfrequency ultrasonography is gaining increasing importance in the routine diagnostics of peripheral nerves lesions.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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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Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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