Hungarian Radiology

[Functional disorders of the pharynx associated with gastroesophageal reflux disease]


MAY 15, 2010

Hungarian Radiology - 2010;84(01)

[The reduced tone of the lower esophageal sphincter, hypomotility of esophagus and dilatory evacuation of stomach are causes of gastroesophageal reflux disease (GERD). Primary damages of esophageal motility lead to regurgitation of gastric content. The evolution of various disorders of esophagus, pharyngoesophageal junction and hypopharynx depend on regurgitant volume gastric and bile acids. The barium swallow well detects mucosal abnormalities and uncordinated contractions of pharyngeal constrictor and levator muscles moreover dyskinesia of upper and lower esophageal sphincters. According to the database of evidence-based medicine (Cochrane Library), sensitivity of barium pharyngo-esophagograms is in mild grade cases 72-74%, in moderate and in severe ones 88-93% and 100%, respectively. Till now laryngeal stasis, penetration and aspiration, dysmyotonia of lateral wall, cricopharyngeal bar, waterfall, vallecular balloon, besides double anterior wall signs of pharyngeal malfunctions were reviewed. We have to also consieder respiratory, cardiovascular and neurological manifestations.]



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[Systematic review of the recent articles of the years 2008/2009 about breast tumours’ radiological diagnostics and guided therapy, the actual place of the imaging and interventional methods are presented.]

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[Dual energy computed tomography - dual-source CT]


[The authors describe fundamentals of computed tomography (CT) examination performed by dual-source, dual energy CT scanner. The special applications of dual energy acquisition are demonstrated, e. g. examination of pulmonary perfusion in case of embolism, bone subtraction during CT angiography, differentiation of various stones and calcifications. The dual energy acquisition can improve the accuracy and sensitivity of the radiological diagnosis.]

Hungarian Radiology

[Radiological assessment of the combined high tibial osteotomy in the frontal plane]

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 main principle of HTO is to achieve a transfer of loading from diseased, arthritic areas of the joint to areas with relatively intact, healthly cartilage. This stress reduction can be achieved with correction of the loading axis. A stress reduction occurs in the medial compartment of the knee when the loading axis is transferred from the medial compartment to just lateral to the center of the joint. PATIENTS AND METHODS - We performed radiological assessment of 52 knees preoperatively and after combined high tibial osteotomy (CO) in the 10th postoperative week, in the 12th postoperative month and in the 5th postoperative year on a standing weight-bearing anteroposterior radiograph. CO involved performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge was transferred to the gap on the medial side. Pre- and postoperatively we measured the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FCFS), 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). We determined the FTA as a sum of FC-FS, TP-TS and FC-TP. RESULTS - The FC-TP, the TP-TS and the FTA decreased significantly after CO according to data measured in the 10th postoperative week. We achieved the planned correction (FTA 171-169°) in 77% of cases. Undercorrection (FTA ≥172°) was detected in 7, overcorrection (FTA ≤168°) was noted in 5 cases. We detected significant loss of correction between the 10th postoperative week and the 12th postoperative month (the FTA increased significantly, the loss of correction was 1° in 26 cases, 2° in 7 cases). The valgus alignment did not increase in any case. The articular component did not change in 36 cases. We did not note significant loss of correction and the valus alignment did not increase in any case between the 12th postoperative month and 5th postoperative year. We noted the recurrence of varus deformity in 1 case. We detected loss of correction due to increasing articular component in further 4 cases. The FC-FS did not change during the first 5 postoperative years. CONCLUSION - If we achieved the planned correction (FTA 171-169°) according to data measured in the 10th postoperative week on a standing weight-bearing anterposterior radiographs, we did not detect recurrence of varus deformity in any case during the first 5 postoperative years. If the articular component (FC-TP) did not change between the 12th postoperativ month and the 5th postoperative year (in 61.5% of cases), in our opinion we achieved the optimal correction.]

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Clinical Neuroscience

[A rare paroxysmal movement disorder: Mixed type of paroxysmal dyskinesia]

AYSU Sen, DILEK Atakli, BAHAR Guresci, BAKI Arpaci

[Paroxysmal dyskinesias are rare, heterogeneous group of disorders characterised by recurrent attacks of involuntary movements. The four classic categories of paroxysmal dyskinesias are kinesigenic, nonkinesigenic, exercise-induced and hypnogenic. There are some patients that do not fit in these four groups of paroxysmal dyskinesia and are termed as “mixed type”. We describe a 13-year-old girl who had features of both paroxysmal kinesigenic dyskinesia and paroxysmal nonkinesigenic dyskinesia that was misdiagnosed as refractory epilepsy. She improved substantially with a combination of carbamazepine and clonazepame. It is important to recognize the clinical presentation of paroxysmal dyskinesias and distinguish these movement disorders from other disorders, such as psychogenic disorders and epilepsia, for deciding the treatment and prognosis of the patients. This case highlights the importance of the recognition of a rare paroxysmal movement disorders.]

Clinical Neuroscience

[Validation of the Hungarian Unified Dyskinesia Rating Scale]

HORVÁTH Krisztina, ASCHERMANN Zsuzsanna, ÁCS Péter, BOSNYÁK Edit, DELI Gabriella, PÁL Endre, KÉSMÁRKI Ildikó, HORVÁTH Réka, TAKÁCS Katalin, BALÁZS Éva, KOMOLY Sámuel, BOKOR Magdolna, RIGÓ Eszter, LAJTOS Júl

[Background - The Unified Dyskinesia Rating Scale (UDysRS) was published in 2008. It was designed to be simultaneous valid, reliable and sensitive to therapeutic changes. The Movement Disorder Society organizing team developed guidelines for the development of official non- English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new UDysRS and its validation process into Hungarian. Methods - After the translation of UDysRS into Hungarian and back-translated into English, it was reviewed by the UDysRS translation administration team. Subsequent cognitive pretesting was conducted with ten patients. For the large field testing phase, the Hungarian official working draft version of UDysRS was tested with 256 patients with Parkinson’s disease having dyskinesia. Confirmatory factor analyses (CFA) determined whether the factor structure for the valid Spanish UDysRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥0.90 compared to the Spanish-language version. Results - For the Hungarian UDysRS the CFI was 0.98. Conclusion - The overall factor structure of the Hungarian version was consistent with that of the Spanish version based on the high CFIs for the UDysRS in the CFA; therefore, this version was designated as the Official Hungarian Version Of The UDysRS.]

Hungarian Radiology

[Esophageal perforation in pneumectomized patient]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - In 58 per cent of cases the fistulas and perforations are developing in middle third part of the esophagus. CASE REPORT - A 58 year old male patient's left lung was surgically removed due to drug-resistant actinomycosis. The pneumectomy has induced mediastinal dislocation and fibrothorax. Six years later the patient complained of odyno-dysphagia and of swallowing cough. On chest plain film we observed left-sided hydrothorax and barium swallows showed perforation of esophagus at the ipsilateral side. Esophageal adenocarcinoma and exudative pleuritis were confirmed by endoscopy and by histology following thoracocentesis. CONCLUSION - In case of pneumectomized patient with swallowing cough, dysphagy and recently development of pleural fluid collection the diagnosis of esophageal perforation is likely. The pleural pain is usually missing due to postoperative indurative pleurisy.]

Hungarian Radiology

[Esophageal diverticula in mixed connective tissue disease]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The functional and morphological changes of oesophagus occur in two third of mixed connective tissue disease patients according to the literature. CASE REPORT - We report three cases of 27, 39 and 48 year old women suffering of lateral pharyngoesophageal, epibronchial and epiphrenic diverticula associated with connective tissue disease. Diverticula had an average diameter of 3.8 cm (maximal diameters: 7.2-8 cm). The esophageal pouches produced dysphagia, dystonia, motility disorders, food stagnation and vomiting, retrosternal burning sensation and tachyarrythmia after 5-16 month's latency period. In one patient pneumoesophagus also evolved. The high serum enzyme levels and proximal electromyogram proved the presence of polymyositis. CONCLUSION - The localization, number and the size of esophageal diverticula are determined by the interstitial myopathy.]

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TAKÁTS Annamária

[The greatest challenge in the treatment of Parkinson's disease is to delay or stop dyskinesias and motor fluctuations. The development of the so-called late levodopa failure is supposed to be due to the pulsatile dopaminergic stimulation. Growing evidence suggests that continuous stimulation that approaches the physiologic state decreases dyskinesias and prevents motor fluctuations. Continuous striatal stimulation can be achieved in several ways, including COMT inhibition, the use of prolonged release dopamine agonists, a new delivery system in patch form, intrajejunal levodopa infusion and deep brain stimulation.]