Hungarian Radiology

[Future planning of radiology before joining the EU]

BARANYAI Tibor

FEBRUARY 20, 2004

Hungarian Radiology - 2004;78(01)

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Further articles in this publication

Hungarian Radiology

[Conference of the Senior and Junior Club of the Society of Hungarian Radiologists]

MAKULA Éva

Hungarian Radiology

[Cornell Seminar]

VÁRKONYI Ildikó

Hungarian Radiology

[Recovery of multiple brain abscesses caused by Serratia marcescens in newborn age]

FEJES Melinda, BORBÁS Éva, PAPP Attila, SZÉKHELYI Zsuzsanna, SZŰTS Ágnes

[INTRODUCTION - Multiple brain abscesses caused by Serratia marcescens is a rare disease in newborn infants. The paper describes the development, case history and treatment of the disease. Radiological features of Gram negative bacterial meningitis and brain abscesses are also discussed. PATIENT AND METHODS - A newborn baby boy presented polycythaemia and fever was admitted to the hospital in the first days of his life. On the 11th day after admission convulsions occured and because of suspected intracranial abnormality or meningitis cranial CT was performed. On CT scans multiple abscesses were revealed and surgical therapy including drainage and ventricle shunt was done. During the treatment he had epileptic seisures frequently, but he became symptome free after the introduction of complex antiepileptic therapy. Now the two year old boy is in a good physical condition but he has mild motoromental deficience. CONCLUSION - Radiological imaging plays an important role in the diagnosis and the follow up of brain abscesses and also in the evaluation of its complications.]

Hungarian Radiology

[Theoretical basis of tumor staging The significance of imaging in oncological diseases]

GŐDÉNY Mária

[The general goal for staging patients with any cancer is to determine the overal extent of disease prior to choice of therapy. It has been well documented that biological behavior of any cancer and, therefore, the prognosis of the patient is strongly linked to the extent of the tumor, the presence or absence of lymphatic dissemination as well as systemic metastases. The staging systems have undergone a number of modifications. Classifications of TNM system identifies the depth of tumor invasion (T), the status of regional lymph nodes (N) and the distant metastases. These three parameters are then incorporated into the final clinical stage. There are further modifications which influence the patient survival, e.g. biological, genetical, hystological factors, tumor grade. All cancer cells show dysregulation of cell cycle controll. As the cancer proliferates and the tumor reaches approximately 1-2 mm in diameter further growth recquires the development of new blood vessels (neo-angiogenesis). Intensity of tumor growth has a prognostic influence to the patient's life and depends on the tumor doubling time, which classifies tumors into slow, intermadiate and rapid growing types. The diagnostic impact of imaging is based on the ability of a technique to detect and evaluate the cancer accurately. The very high accuracy and reproducibility of cross-sectional imaging, paticularly computed tomography (CT) and magnetic resonance imaging (MRI) make these methods extremely important in the detection, staging and in the evaluation of the tumors. The revolutionary advances in detection and treatment of malignant disease have led to an increasing role of the radiologist as a member of the multidisciplinary cancer team.]

Hungarian Radiology

[Passed away dr. Imre Szatai]

TÓTH Erzsébet

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[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

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[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

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A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

HORVÁTH Bence, PERÉNYI Ádám, MOLNÁR Fiona Anna, CSANÁDY Miklós, KISS József Géza, ROVÓ László

Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

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[Benefits of SGLT-2 inhibitors: beyond glycemic control]

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[In the recent years, according to international and Hungarian guidelines, in addition to lifestyle modification, metformin is the preferred initial glucose-lowering drug for most people with type 2 diabetes, if not contraindicated. Sodium glucose co­transporter-2 inhibitors have been shown to reduce progression of chronic kidney disease, or kidney failure, as well as the risk of hospitalizations for congestive heart failure and (mainly in secondary prevention) cardiovascular death in patients with type 2 diabetes. For major adverse cardiovascular events and for the renoprotection, there seems to be no class effect. On the other hand, a class effect of sodium glucose co­transporter-2 inhibitors is evident for hospitalization for heart failure. In this review the authors summarize novel data about sodium glucose cotransporter-2 inhibitors, and about their new perspectives in the near future.]