Hungarian Radiology

[Investigation of colon-transit in children with chronic idiopathic constipation]

KÓCSÁK Elvira, GOMBOS János, POREMBA Beáta

DECEMBER 27, 2010

Hungarian Radiology - 2010;84(04)

[Constipation is a very common problem in childhood with diverse etiology. Most of the cases can be attributed to functional constipation. The types of chronic idiopathic constipation (CIC) are as follows: slow colonic transit, functional fecal retention, combination of the two and constipation which is predominant in irritable bowel syndrome. The first step in diagnosing/treating the condition should involve the exclusion of primary organic causes, as well as metabolic, neurological and iatrogenic ones. Then special anorectal physiological investigations are needed. In our laboratory, the aim of radionuclide study is to demonstrate the two types of CIC, the slow colon transit (SCT) and the functional fecal retention (FFR). Such evaluation makes it easier for the clinician to plan appropriate treatment. The radionuclide study is conducted as follows: after adequate pretreatment, Tc-99m Fyton is administered orally, and images are collected at 2, 6, 12, 24, 30 and 48 hours following administration. After the evaluation of the specific studies, exploration of the causes and exact diagnosis are established. Appropriate treatment is always planned individually. We would like to demonstrate this by presenting 3 cases.]

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Hungarian Radiology

[The end of an era, and at the horizons of a new one]

LOMBAY Béla

Hungarian Radiology

[Lesions resembling radial scar of the breast - Is preoperative biopsy of the radial scar needed?]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, TÓTH Dezső, BÁGYI Péter

[INTRODUCTION - The radial sclerosing lesion is one of the most common benign breast lesions. It can mimic malignant tumours on mammogram in many cases. In one third of the cases invasive tumour or in situ carcinoma occur in radial sclerosing lesion, therefore surgical excision is mandatory. The aim of our work is to diagnose the malignant cases with preoperative biopsy (FNAB, core biopsy) when radial scar morphology lesion is detected in order to avoid two-step surgical procedure. PATIENTS AND METHODS - Forty-five patients were examined with the same method. In all cases of radial sclerosing morphology lesions a mammography, complementary radiograms, ultrasonography (US) and synchronous US guided FNAB and core biopsy were performed. Postoperative pathological findings were compared to the results of preoperative biopsies. RESULTS - In 6 of 45 cases (13%) malignant tumours mimicked radial scar in morphology. All of them were diagnosed preoperatively with core biopsy (B5). The FNAB was nondiagnostic (C1) in 2 patients, suspicious for malignancy (C4) in 2 patients and was positive in 2 cases (C5). Radial scars or complex sclerosing lesions were diagnosed in 39 patients preoperatively. In 28 cases (72%), malignancy was not detected with postoperative pathological examination. In 8 cases (20%) DCIS and, in 3 cases (8%), malignant tumours were found associated to radial scar. Neither FNAB nor core biopsy gave false positive results in the non-malignant group. In the patients with DCIS associated to radial scar, core biopsy proved malignancy in 5 cases and FNAB in only 1 case. In 3 cases of invasive malignant tumour associated with radial scar core biopsy was positive in 1 patient, while FNAB was negative or non-diagnostic in all of them. CONCLUSION - According to the latest publications vacuum- assisted large-core needle biopsy (VLNB) performed with 11G needle (12) is the safest procedure to justify or exclude malignancy in the radial scar. Observation would be enough in the non-malignant cases and this procedure has therapeutic potential as well. In case where these methods are not available, as in Hungary, all radial scar cases require surgical excision. Therefore, preoperative core biopsy is recommended in order to avoid a two-step surgical procedure.]

Hungarian Radiology

[The effect of the orientation of the distal femur on the correction of axis after closing-wedge high tibial osteotomy - Short-medium term radiological assessment]

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 clinical result is affected by the correction of the varus malalignment. The degree of correction appears to be dependent not only on correction performed on tibia but also on the orientation of the distal femur. The valgus orientation of the distal femur can be associated with postoperative over-correction and varus orientation of the distal femur with postoperative under-correction. Patients and methods - We performed radiological assessment of 82 knees preoperatively and after closing wedge high tibial osteotomy (CWO) in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (23-54 months) on a standing weight-bearing anteroposterior radiograph. Pre- and postoperatively we measured the orientation of the distal femur, described as the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FC-FS). We subdivided the knees into 3 groups based on the orientation of the distal femur. In group A the FC-FS was 83-85° (normal orientation of the distal femur), in group B the FC-FS was £82° (valgus orientation of the distal femur) in group C the FC-FS was ³86° (varus orientation of the distal femur). Pre- and postoperatively we measured 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) in all groups. We determined the anatomical femorotibial angle (FTA) as a sum of FC-FS, TP-TS and FC-TP. Results - In the first ten postoperative weeks - with significant osseous correction happened in the three groups - the articular component also decreased significantly in groups A and B, but did not change in group C. Between the postoperative 10th and the final follow-up examinations we did not notice significant osseous correction loss in any groups. In groups A and B the articular correction loss was not significant, at the same time in group C we noted significant articular correction loss. Conclusion - At valgus orientation of the distal femur the CWO results in greater correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This additional correction equals the (preoperatively unpredictable) amount of the articular correction. At varus orientation of the distal femur the CWO results in less correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This difference equals the (preoperatively unpredictable) loss of articular correc- tion.]

Hungarian Radiology

[Necrotizing enterocolitis in neonatology: comparing the role of X-ray and ultrasonographic examinations]

JENEI Mónika, VÁRKONYI Ildikó, NYITRAI Anna, SZABÓ Miklós, BOKODI Géza, KIS Éva

[INTRODUCTION - The authors’ purpose was to analyse the role of abdominal ultrasonography (US) in the diagnosis of necrotizing enterocolitis (NEC). They have compared the sensitivity of the current standard diagnostic modalities for this clinical entity: plain abdominal radiography and abdominal US. For a more objective comparison, they created an US scale along with utilising the score system based on abdominal radiography which was published recently. PATIENTS AND METHODS - 46 out of 76 neonates having both clinical and radiological diagnosis of NEC had comparable radiographic and sonographic examinations between June 2006 and October 2009. The authors created a 10-grade US score system, in which sonographic signs of NEC are listed in order of severity, corresponding, where possible with the radiographic scale that was available. The findings were scored individually, then the distribution of scores and their relationship to each other were analysed. For further analysis four groups of severity based on the scores were created with the following categories: mild, moderate, severe and very severe. After graphical representation of the groups, the relationship of the groups created on the basis of scoring the findings by the two diagnostic methods were examined. RESULTS - According to this analysis both abdominal radiographs and sonographs are suitable for diagnosing NEC, which has been justified with statistical data. When analysing the severity groups the authors proved that the two methods diverge in judging groups 3 and 4, thus severe and very severe. The distributions of severity groups formed by the two imaging modalities are different, (P<0,01); and the proportion of group 3 and group 4 is different in case of US and radiographic examinations (P=0.003). CONCLUSIONS - Abdominal sonography and radiography are equally suitable diagnostic methods for diagnosing NEC, and the two methods match each other very well. In cases of mild state, the severity of the disease was found to be the same with both methods, but US allows more sensitive differentiation of serious cases. It is very sensitive in detecting perforations, so it could play a role in determining the indication of surgery.]

Hungarian Radiology

[Surgical treatment of scoliosis: pre- and postoperative follow-up with whole-body EOS radiography]

LÉVAI Andrea, VÁRADY Edit, SZUKITS Sándor, WENINGER Csaba, BATTYÁNY István, ILLÉS Tamás

[Currently, Cotrel-Dubousset spondylodesis is the treatment of choice in orthopaedics. It allows for correction of deformity in three-dimensions allowing for stable fixation. EOS (Extended Orthopedic System) is an ultra low dose X-ray imaging system, simultaneously acquiring images of the whole body in two planes. Examinations with the EOS system is not only indicated in cases related to orthopaedics but in multiple other conditions owing to its low level of emitted radiation with rapid and cost-effective imaging. The importance of EOS examination is emphasized in systemic skeletal disorders, thus allowing itt o be used in various other clinical fields.]

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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.]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, ERDEN Simsek Nazan, YULUG Burak

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.