Hungarian Radiology

[Interventional radiology of multiple biliary stenoses]

ROSTÁS Tamás, BATTYÁNY István, HADJIEV Janaki

JUNE 10, 2005

Hungarian Radiology - 2005;79(03)

[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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Hungarian Radiology

[13th French-Hungarian Radiologic Symposium and 5th Eastern-Central European Francophone Congress of Radiology]

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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

[Medal of commemoration Mihály Erdélyi 2005]

BOHÁR László

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

[CALENDAR OF RADIOLOGICAL EVENTS, 2005]

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[EVEN VISITING SCIENTISTS COULD MAKE DISCOVERIES IN MONTREAL]

LÁZÁR György

[This publication summarizes the scientific adventure with Professor Selye, and focuses on the specific effect of rare metal salts on reticuloendothelial functions. Rare earth metal ions markedly affect the functions of cells involved in inflammatory and immunological phenomena. The Kupffer cell blockade induced by GdCl3 is a generally accepted method for investigation of the physiological and pathophysiological roles of Kupffer cells. Potential beneficial effects of macrophage blockade have been demonstrated in different shock states, liver injury and obstructive jaundice.]

Clinical Neuroscience

Isolated hypoglossal nerve palsy due to a jugular foramen schwannoma

ÖZTOP-CAKMAK Özgür, VANLI-YAVUZ Ebru, AYGÜN Serhat, BASTAN Birgül, EGEMEN Emrah, SOLAROGLU Ihsan, GURSOY-OZDEMIR Yesemin

Introduction – Although the involvement of the hypoglossal nerve together with other cranial nerves is common in several pathological conditions of the brain, particularly the brainstem, isolated hypoglossal nerve palsy is a rare condition and a diagnostic challenge. Case presentation – The presented patient arrived to the hospital with a history of slurred speech and an uncomfortable sensation on his tongue. Neurological examination showed left-sided hemiatrophy of the tongue with fasciculations and deviation towards the left side during protrusion. Based on the clinical and MRI findings, a diagnosis of hypoglossal nerve schwannoma was made. Discussion – Hypoglossal nerve palsy may arise from multiple causes such as trauma, infections, neoplasms, and endocrine, autoimmune and vascular pathologies. In our case, the isolated involvement of the hypoglossal nerve was at the skull base segment, where the damage to the hypoglossal nerve may occur mostly due to metastasis, nasopharyngeal carcinomas, nerve sheath tumors and glomus tumors. Conclusion – Because of the complexity of the region’s anatomy, the patient diagnosed with hypoglossal nerve schwannoma was referred for gamma knife radiosurgery.

Clinical Neuroscience

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

EEG-based connectivity in patients with partial seizures with and without generalization

DÖMÖTÖR Johanna, CLEMENS Béla, EMRI Miklós, PUSKÁS Szilvia, FEKETE István

Objective - to investigate the neurophysiological basis of secondary generalization of partial epileptic seizures. Patients and methods - inter-ictal, resting-state EEG functional connectivity (EEGfC) was evaluated and compared: patients with exclusively simple partial seizures (sp group) were compared to patients with simple partial and secondary generalized seizures (spsg group); patients with exclusively complex partial seizures (cp group) were compared to patients with cp and secondary generalized seizures (cpsg group); the collapsed sp+cp group (spcp) was compared to those who had exclusively secondary generalized seizures (sg group). EEGfC was computed from 21-channel waking EEG. 3 minutes of waking EEG background activity was analyzed by the LORETA Source Correlation (LSC) software. Current source density time series were computed for 23 pre-defined cortical regions (ROI) in each hemisphere, for the 1-25 Hz very narrow bands (1 Hz bandwidth). Thereafter Pearson correlation coefficients were calculated between all pairs of ROI time series in the same hemisphere. Z-scored correlation coefficients were compared at the group level (t-tests and correction for multiple comparisons by local false discovery rate, FDR). Results - Statistically significant (corrected p<0.05) EEGfC differences emerged at specific frequencies (spsg > sg; cpsg > cp), and at many frequencies (sg > spcp). The findings indicated increased coupling between motor cortices and several non-motor areas in patients with partial and sg seizures as compared to patients with partial seizures and no sg seizures. Further findings suggested increased coupling between medial parietal-occipital areas (structural core of the cortex) and lateral hemispheric areas. Conclusion - increased inter-ictal EEGfC is associated with habitual occurrence of secondary generalized seizures.