Hungarian Radiology

[Doping in Athens and in Hungary - Thoughts on the next two years of our Society]

LOMBAY Béla

OCTOBER 20, 2004

Hungarian Radiology - 2004;78(05)

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Hungarian Radiology

[In vitro optimization of sequences applicable for the MR examination of the gastrointestinal tract with respect to certain contrast materials]

BABOS Magor, PALKÓ András, KARDOS Lilla, CSERNAY László

[PURPOSE - Optimization of gradient-echo and spin-echo sequences in order to visualize oral contrast media for magnetic resonance imaging (MRI) of the small bowel using a 1-T unit. MATERIAL AND METHODS - Authors investigated the optimal appearance of four different potential oral contrast media (rosehip syrup, blackcurrant extract, iron(III)-desferrioxamine, cocoa) with different spin-echo and gradientecho sequences using a simple plastic model. They were searching the optimal solution by changing the parameters of the chosen sequences keeping an eye in every case on the signal-to-noise ratio, the contrast, the resolution, the artifacts and the signal intensity of the contrast materials. RESULTS - The gradient-echo sequences are suitable for imaging of the small bowel. Too short echo time should be avoided because of the increased formation of artifacts. A lot of artifacts can be eliminated using fat saturation. T2*- weighted gradient-echo sequences provide good appearance for the cocoa drink, as well as the three-dimensional gradient-echo sequence. The use of sequential gradientecho acquisition methods is advisable only in non-cooperating patients, because of their low signal-to-noise ratio. The iron(III)-desferrioxamine solution, the rosehip syrup and the blackcurrant extract are potential positive contrast agents on T1-weighted sequences. On the single-shot fast spin-echo (SSFSE) sequence the rosehip syrup and the blackcurrant extract appear as negative contrast materials. CONCLUSIONS - Authors could select and optimize the sequences suitable for each contrast material and effective in small bowel MRI. The substances used in their experimental model are not harmful for humans when administered orally, so determination of additives is the only problem remained before their use in the clinical practice.]

Hungarian Radiology

[Pelvic computed tomography in staging of prostate cancer before surgery]

BERCZI Csaba, TÓTH György, VARGA Attila, FLASKÓ Tibor, KOLLÁR József, TÓTH Csaba

[PURPOSE - The aim of the study was to measure the sensitivity and specificity of computed tomography for local staging in patients underwent radical perineal prostatectomy. PATIENTS AND METHODS - 160 patients were involved in the study. Rectal digital examination, measurement of prostate specific antigen, prostate biopsy, CT, ultrasound, chest X-ray examination and bone scintigraphy were performed in every case before radical prostatectomy. RESULTS - The average preoperative prostate specific antigen concentration was 15.8 ng/ml before surgery. The average Gleason score of biopsies was 3.19. CT showed extraprostatic infiltration in 14 patients (pericapsular invasion n: 6, seminal vesicula n: 3, bladder infiltration n: 5, lymph node metastasis n: 2). The histological examination proved extraprostatic invasion of the tumour in 35 cases (pericapsular invasion n: 35, seminal vesicula n: 25, bladder infiltration n: 5). The cancer was localized in the prostate in 125 patients. Sensitivity and specificity of CT for pericapsular invasion were 14% and 98%, for infiltration of seminal vesicula 12% and 100%, and for bladder infiltration 20% and 97%. There was not a significant difference between the prostate specific antigen values (p=0.94) in cases when the tumour was confined to the prostate and when the cancer showed extraprostatic infiltration. There was significant difference between the Gleason score values between the two groups (p=0.008). CONCLUSION - The sensitivity of CT for local spread of prostate cancer is very low, thus CT is not a suitable method for the local staging before surgery.]

Hungarian Radiology

[PACS-seeing in Nancy - Study-tour, September, 2004]

FORRAI Gábor, BARTA Miklós

Hungarian Radiology

[Radiation protection belongs to patient’s right]

SZÁNTÓ Dezső

Hungarian Radiology

[Breast cancer screening in Hold street started twenty five years ago]

GÖBLYÖS Péter, TANKA Ida, GRÉGER Judit

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Clinical Neuroscience

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.

Clinical Neuroscience

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.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[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?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

[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.]