Hungarian Radiology

[Gas collection in the superior mesenteric and in the portal veins]

LUDVIG Zsuzsanna, PAP Tímea, SZILÁGYI Adrienn, KOSTYÁL László, BARTA Szabolcs, BOTOS Ákos

DECEMBER 20, 2006

Hungarian Radiology - 2006;80(07-08)

[INTRODUCTION - Intrahepatic gas is frequently seen during abdominal ultrasound studies which is generally of biliary origin due to biliary interventional procedures e.g. endoscopic sphincterotomy. In our case, large amount of intrahepatic gas was present originated from the superior mesenteric and portal veins. CASE REPORT - A 94-year-old male patient with vomiting, shivering and heavy abdominal pain was admitted in bad condition to the department of surgery. Billroth II gastric resection was noted in the case history. Chest, plain abdominal X-ray and abdominal ultrasound examination was performed. Ultrasonography showed a large amount gas collection in the region of the left liver lobe (no prior history of endoscopic sphincterotomy). It was difficult to perform abdominal ultrasound due to the intrahepatic gas collection and abdominal bowel gas. Computer tomographic examination confirmed the presence of intrahepatic gas which is localized in the portal venous system. Large amount of gas collection was seen in the abdominal cavity, in the mesenterium and in the retroperitoneum. In addition a gallstone of 2 cm in size was found in the duodenum. CONCLUSION - CT scans confirmed the perforation of gall bladder due to subsequent cholecystic- duodenal fistula. As a consequence of perforation, inflammation of the mesentery and retroperitoneum developed causing mesenteric vein thrombosis and bowel wall necrosis. Bacteria in the necrotic bowel wall produced gas which entered into the veins and reached the portal system.]

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Hungarian Radiology

[Pneumoportogram without intestinal pneumatosis]

HERBERT Zsuzsanna, LAKATOS Levente, RADNAI Béla, SEMJÉN Dávid, BOROS Szilvia

[INTRODUCTION - Classical radiological signs of ischemic bowel wall necrosis are the presence of gas in the affected bowel wall and intrahepatic gas in the portal venous system. CASE REPORT - A 76-year-old male patient was admitted to the hospital with the suspicion of ileus and perforation. Plain abdominal X-ray showed presence of gas in the portal venous system in addition to small bowel and colonic ileus. Pneumoportogram was present without intestinal pneumatosis. Abdominal laparotomy revealed extensive bowel wall necrosis and no surgical solution was possible. After surgery the patient died. CONCLUSION - Reviewing our case and the medical literature, the significance of plain abdominal X-ray in addition to abdominal CT and ultrasound examination should be emphasized. This case report helps to differentiate the origin of intrahepatic gas in order to select proper therapeutical approach.]

Hungarian Radiology

[Commemoration on the 30-year-old Pediatric Radiology Department and 20-year-old Institute of Radiology in Miskolc]

BORBÁS Éva

Hungarian Radiology

[Development of CT - Is there a limit? Conversation with professor Mathias Prokop]

HARKÁNYI Zoltán

Hungarian Radiology

[23rd Congress of the Society of Hungarian Radiologists, 1st Hungarian-Austrian Congress of Radiology]

HARKÁNYI Zoltán

Hungarian Radiology

[The role of static MR-urography in diagnostics of urinary obstruction]

KIS Zsuzsanna, FAZEKAS Péter, KULCSÁR Dániel, KÖTELES Márta, KOVÁCS Annamária, MAGYAR Klára

[INTRODUCTION - The idea and methodology of MRurography has just crystallized recently due to the development of technology. The traditional MRU technology means the strongly T2 weighted sequence, suitable for depicting stationary liquid spaces. Its use is independent of the functional status of the kidneys thus it is suitable for depicting dilatated ureters in case of nonfunctioning kidneys, too. Authors's aim was to define the role of sMRU in the diagnostics of obstructive urinary diseases. PATIENTS AND METHODS - 60 sMRU examinations were performed on 59 patients using a 1.5 T Siemens Symphony MR scanner in the CT-MR Laboratory of the Markhot Ferenc County Hospital between May 1, 2003 and October 31, 2005. The sMRU was performed with 2D T2 TSE sequence with angiographic character. In each case, the examinations were completed with conventional sequences in multiple planes. The role of gadolinium enhanced T1-weighted MR urography in the same diseases was not studied. In 7 cases, low-dose thin slice CT examination was performed to reveal the precise cause of obstruction. The examinations were preceded by abdominal ultrasound or intravenous urography (IVU). RESULTS - Out of the 60 sMRU examinations uretery dilatation were observed in 50 cases. In the background of obstruction, stone could be detected in 13 patients, dilatation was observed in 4 patients and MR did not indicate stone. In 7 cases with known neoplastic disease, associated urinary obstruction could be detected. In the background of obstruction primary neoplasm was found in 10 patients unknown prior the MR examination. Other benign obstruction occurred in 13 cases. Obstruction was not proved in 10 patients. In these cases the examination was justified by uncertain ultrasound findings together with abnormal renal function parameters. Follow up sMRU was performed in one patient. False diagnosis was established in two patients, the cause of dilatation was not found in one patient. CONCLUSIONS - The sMRU examination can provide more precise detection of the causes of severe urinary obstructions. It helps to define the level of obstruction in case of known malignant tumors. The grade of urinary dilatation could be also evaluated. The sMRU examination in conjunction with conventional sequences in multiple planes made possible to set up a correct therapy plan.]

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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.

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.

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.]