Hungarian Radiology

[József Fülöp, Péter Réti G.: The radiodiagnostics of the rheumatic diseases of the hip joint]

KAPOSI N. Pál

JUNE 20, 2006

Hungarian Radiology - 2006;80(03-04)

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Hungarian Radiology

[Atypical breast cyst: problems of differential diagnosis]

PAPP László, KOVÁCS Zsolt, SZABÓ Éva, MINIK Károly, ANTALFI Bálint, BENDE Sándor

[INTRODUCTION - Cystic breast masses detected by ultrasound can be devided into several groups upon their morphology. One of them is the group of progressive atypical cysts. CASE REPORT - A young female patient presented multiple palpable nodules in the central part and in the upper-medial quadrant of the left breast. Ultrasound examination showed cystic lesions of middle size and with smooth walls. The cytological results of two consecutive punctures of the cyst was C2, consistent with acute inflammatory hemorrhagic cystic content. The patient was followed up by ultrasound, which 4-6 months later demonstrated considerable progression in size and morphological changes of the cysts. The presence of intracystic nodules and the pericystic solid lesions made the use of MRI examination justified but it couldn’t exclude the possibility of multicentric malignancy. The breast team decided the excision of the cystic lesions, at first. The biopsy revealed multiple intraductal and intracystic papilloma surrounded by normal breast tissue. CONCLUSION - Considering the problems of differential diagnosis which raised the suspicion of similar morphological histological entities (intracystic papillar carcinoma, adenoid cystic carcinoma, DCIS) surgery was justified. According to the authors’s suggestion, despite of the frightening morphological, radiological and clinical status, the less radical surgery should be performed.]

Hungarian Radiology

[Quality insurance in radiology]

FEHÉR Lászlóné

Hungarian Radiology

[Geophagy]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The causes of geophagism are psychotic sociopathies, popular customs, religious rites, natural disasters, crimes besides alcohol and drug abuses. CASE REPORT - A 50-year-old midly drunken man ate ten tablespoonful wet sands up. Barium swallows showed the dense material to pass slowly into the stomach and duodenum resulting a cast sign two hours later. The dirt was washed out from the stomach, the bowels became spontaneously empty. There was no complications. CONCLUSION - The geophagy can be easily diagnosed based on gastroduodenal cast phenomenon and lingering passage.]

Hungarian Radiology

[The history of the National Institute of Radiology and Radiation Physics]

GÁSPÁRDY Géza

Hungarian Radiology

[Renal cystic lesions The importance of CT in diagnosis and management in correlation with Bosniak classification]

MOHAMMED Al-Absi, ABDULMALIK Qais, IBRAHIM Al-Nono, ABDULILAH Ghilan, MOHAMMED Abdul Gafour

[OBJECTIVE - The purpose of this study was to assess the importance of CT in differentiating renal cystic masses of surgical causes from those of non-surgical masses. PATIENTS AND METHODS - The patients included in this study were collected from a private diagnostic center and university hospital prospectively, yielding a total of 55 analyzable renal cystic lesions. A careful helical CT abdomen focusing on the kidneys with intravenous contrast was obtained from all patients. The lesions were categorized into surgical and medical renal cystic masses using the Bosniak classification system supported by histology reports and follow up protocols for medical cases. RESULTS - Of 55 cases, 35 were classified as surgical (13 lesions as category IV and 22 as III) and 20 as medical cases (15 as category II and 5 as III). Out of 22 resected category III lesions 15 were found to be malignant and all categorized as type IV were malignant. No malignancies have been identified in the prospectively monitored group of patients. CONCLUSION - Our series results are comparable with other teaching institution series, and support the usefulness of the Bosniak classification system in separating renal cystic lesion into surgical and non-surgical lesions but with diagnostic categorization difficulty of complicated multilocular hydatid cysts versus neoplastic (category III) cystic masses.]

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

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[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

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

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NAGY Ildikó, FABÓ Dániel

[Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient’s condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology. ]

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[LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders]

SOÓS Zsuzsanna, SALAMON Mónika, ERDEI Katalin, KASZÁS Nóra, FOLYOVICH András, SZŰCS Anna, BARCS Gábor, ARÁNYI Zsuzsanna, SKALICZKI József, VADASDI Károly, WINKLER Gábor

[Celiac disease - in its typical form - is a chronic immunemediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment.]