Hungarian Radiology

[Entertainment ultrasound]

HARKÁNYI Zoltán

JUNE 10, 2005

Hungarian Radiology - 2005;79(03)

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Hungarian Radiology

[Past, present and future of Department of Radiology of Pécs]

BATTYÁNY István

Hungarian Radiology

[Prevention of thrombotic complications in vascular interventional procedures]

HORVÁTH László, BATTYÁNY István, ROSTÁS Tamás, HARMAT Zoltán, BODROGI Gabriella, RADICS Éva

[Procedures of vascular interventional radiology is linked inevitably a certain amount of risk of thrombotic complications, like intimal and vascular wall injuries, increased thrombotic risk caused by the catheter itself, etc. The first approach of thrombotic prevention was achieved by acetyl salicylic acid in case of peripheral arteries, this treatment was later replaced by long-term anticoagulation. Opportunities were provided by the recognition of risky blood characteristics in relation to thrombotic complications. Consequently, a well performed preparation and premedication of the patients could reasonably decrease the risk. The most important steps are the cessation of smoking, normalization of hemoconcentration and antithrombotic premedication. Better understanding of the nature of atherosclerotic progression led to the introduction of long-term fibrinolytic inhibition therapy. In the past decades beside patients with vascular stenosis, the oncology patients are also treated by different radiological interventions, like intraarterial chemotherapy and chemoembolization. The use of several-day-long infusion represent a new challenge, the treated vessels, the lumen and the surface of the catheter must be prevented of thrombosis. For this purpose a few suitable drugs can be applied with mild anticoagulant and fibrinolytic stimulating effect. We use the sodium pentosan polysulphate.]

Hungarian Radiology

[Comparison of the results of lung helical CT and lung scintigraphy in pulmonary embolism]

WENINGER Csaba, BODROGI Gabriella, BOROS Szilvia, SCHMIDT Erzsébet, UDVAROS Eszter, ZÁMBÓ Katalin

[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

Hungarian Radiology

[The possibilities of invasive radiological therapy of deep venous thrombosis and in vitro experimental examination of therapeutic factors affecting the treatment]

HARMAT Zoltán, JÁRAY Ákos, BATTYÁNY István

[INTRODUCTION - The first part of this paper is an overview on the possibilities of invasive radiology treatment of deep venous thrombosis. In the next part an in vitro experiment is described demonstrating the basics of mechanical and pharmaco-mechanical catheters applied in deep venous thrombosis. MATERIALS AND METHODS - The in vitro haemodinamic model of the iliocaval veins contained a thermostat and an engine responsable for pulsing circulation according to the venous system. We tested the chance of driftage of thrombus in different age according to the state of the collateral system. Thrombectomy was made by mechanical (Simpson-catheter) and pharmaco-mechanical (Pulsespray catheter) ways. The weight of the non-drifted thrombi was measured. RESULTS - All the 16 thrombus were flown while collateral system was closed and none of them were flown while the collateral system was open but the rate of their solubility was different. The efficacy of the thrombus-removal by Simpson catheter was better than by Pulse-spray catheter and fresh thrombus-fragments were more soluble than older ones. CONCLUSION - By this in vitro experiment we opened the way for using mechanical and pharmaco-mechanical catheters in deep venous thrombosis.]

Hungarian Radiology

[Interventional radiology of multiple biliary stenoses]

ROSTÁS Tamás, BATTYÁNY István, HADJIEV Janaki

[INTRODUCTION - In palliative treatment of malignant bile duct obstruction the endoscopic and the percutaneous methods are the possible options. In multiple lesions the percutaneous method must be preferable. Decrease of the bilirubin level to normal gives an opportunity for further treatment of the oncology patients. CASE REPORT - Authors report three patients’ case history, when following an unsuccessful endoscopic retrograde cholangiopancreatography, percutaneous cholangiography revealed multiple biliary stenoses. In all cases successful stent implantations were performed (three stents in one patient, two stents in two patients). The bilirubin levels decreased rapidly and the quality of life improved in all cases. Following the stent implantation selective cytostatic treatment (one patient) and systemic cytostatic treatment (one patient) were performed. The mean survival time was 300 days. CONCLUSION - In the case of multiple biliary stenoses the percutaneous stent implantation is an acceptable palliative method, which permit the possibilities of further interventional radiological or oncological treatments.]

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Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Transthyretin familial amyloid polyneuropathy - three Hungarian cases with rare mutations (His88Arg and Phe33Leu)]

CSILLIK Anita, POZSONYI Zoltán, SOÓS Krisztina, BALOGH István, BODÓ Imre, ARÁNYI Zsuzsanna

[Introduction - Transthyretin familial amyloid polyneuropathy is a rare autosomal dominant progressive systemic disesase of adults caused by endoneural amyloid deposition due to point mutations of the transthyretin gene. It is the most severe form among hereditary polyneuropathies, being fatal within 10 years if left untreated. The disease is underdiagnosed, the late onset forms (above the age of 50) being probably more widespread than previously thought. Early diagnosis is essential as the early introduction of causal therapy (tafamidis) slows progression and prolongs survival. Patients - We report here three non-related Hungarian cases of transthyretin familial amyloid polyneuropathy with non- Val30Met mutations (His88Arg in two cases, Phe33Leu in one case). They were all characterized by late-onset, progressive, length-dependent, axonal, sensorimotor polyneuropathy and the simultaneous presentation of severe restrictive cardiomyopathy. In all three cases, clinical and electrophysiological signs of myopathy were also present, suggesting the involvement of skeletal muscles as well. In two cases, high resolution ultrasound of the peripheral nerves was also performed, which showed segmental structural alterations (change or loss of fascicular structure) and some increase of echogenicity of the interfascicular epineurium, without substantial enlargement of the nerves. Conclusion - In Hungary, mainly the rare, non-Val30Met mutation forms of transthyretin familial amyloid polyneuropathy are encountered, as in our cases. As opposed to the Val30Met forms, these mutations are characterized by late onset and simultaneous presentation of severe cardiomyopathy. Our report highlights the importance of considering transthyretin familial amyloid polyneuropathy in the differential diagnosis of late-onset, progressive, axonal polyneuropathies of unknown etiology, particularly if associated with cardiac disease.]

Clinical Neuroscience

[Perinatal stroke - from symptoms to follow-up]

VOJCEK Eszter, CSÉCSEI Márta, FLACH Edina, RUDAS Gábor, GRÁF Rózsa, PRINCZKEL Erzsébet

[Background and purpose - We aimed to analyze patient characteristics of term neonates with the diagnosis of stroke between 2006 and 2017 at the 3rd level Neonatal Intensive Care Unit of the Szent János Hospital. Method - We conducted a retrospective and prospective analysis including 18 newborns with stroke. Presentation, imaging methods, etiology and clinical context were discussed. All patients had a follow-up at 2 years of age or later. Subject of the study - In the past 10 years 17 term born and one premature neonate born at 36 weeks of age were diagnosed with stroke in our unit. All patients were born at good condition generally with high Apgar scores (9±1). Cesarean section was performed in 4 cases. Results - With an estimated incidence of one in 1600-4000 births, the incidence of perinatal stroke in our unit was found to be the same as mentioned in the international databeses. Regarding imaging method, cranial ultrasound scan do not visualise arterial ischaemic stroke therefore head MRI is recommended. Neurological symptoms of the patients presented in the first two days of life. Etiology included thrombophilia (4/18), infection (4/18), vascular malformation (2/18), moderate asphyxia (2/18) and pre-eclampsia (2/18). Middle cerebral artery was involved in 50% while the anterior cerebral artery was affected in 33%. The stroke occured in the left hemisphaerium in 44%, in the right side in 39% and was bilateral in 17%. In two cases the stroke was diagnosed in utero. Early childhood developmental support resulted in average or above average gross and fine motor development and cognitive outcome. Conclusion - Presenting neurological symptoms tipically occur in the first few days after birth when perinatal stroke need to be considered among the broad spectrum of neonatal illnesses. Normal developmental outcome can be achieved even in cases of extensive brain damage with early childhood developmental support. Severely impaired development was observed in the cases of in utero stroke. Inherited prothrombotic disorders may have implications for subsequent pregnancies of the mother. ]

Lege Artis Medicinae

[The history of acute stroke care in Hungary ]

BERECZKI Dániel

[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

Lege Artis Medicinae

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]