Hungarian Radiology

[Neuroradiological Division in the European Union]

BARSI Péter

SEPTEMBER 20, 2008

Hungarian Radiology - 2008;82(05-06)

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Hungarian Radiology

[Sixty years, fourty years - milestones in ultrasound diagnostics]

HARKÁNYI Zoltán

Hungarian Radiology

[Radiological diagnostics in bone metastases]

GŐDÉNY Mária, BODOKY György

[Imaging plays a crucial role in defining bone metastases, and thus, therapy planning. We are responsible for accurate data collection, pre-treatment evaluation, evaluation of therapy response and post-treatment evaluation. Precision highly depends on the expertise and experience of the evaluating radiologist, and therefore, being familiar with the latest literature is essential. The bone status can be detected well by bone scan, analysed by conventional X-ray examination and by the cross sectional digital imaging modalities. The whole body PET/CT functional imaging is becoming increasingly popular in the metastatic workup of patients and for monitoring response to therapy. MRI has been found to be the most accurate method for bone metastasis in most comparative evaluations in the literature. This article is a review of the latest papers focusing on the clinical significance of the imaging results in bone metastasis diagnostics.]

Hungarian Radiology

[Rheumatoid arthritis: significance and methodology of cervical spine X-rays in everyday practice]

NÉMETH Ildikó, BUDAY Ilona, MOLNÁR Éva, NYITRAI Márta, SAÁRY Krisztina, TARKOVÁCS Andrea, VARSÁNYI Nóra, FARBAKY Zsófia

[Cervical spine joint destruction in rheumatoid arthritis may lead to progressive vertebral instability. It is a severe risk factor for cord compression, which may even lead to sudden death. Many patients with atlantoaxial subluxation may have no symptoms referable to the neck. True degree of subluxation may occur during anaesthesia when the neck muscles are relaxed and protective spasm is absent. The cervical deformities can be visualised on conventional, transoral and functional lateral view in the flexion and extension positions of the neck. The aim of our study is to demonstrate the usefulness of cervical dynamic X-ray for patients suffering from rheumatoid arthritis. This is the first classical radiological imaging method in the diagnosis and in radiographic follow-up. It is a very important method in the preoperative evaluation to prevent definitive neurologic injury. We describe the method for screening, measuring and grading cervical subluxations and instability in our everyday routine.]

Hungarian Radiology

[Role of radiofrequency ablation in the treatment of malignant liver tumors - Possibilities and limitations]

BÁNSÁGHI Zoltán

[Radiofrequency tumour therapy is a minimally invasive procedure. It has been used in several specialities independently of the type and location of the tumour, and has shown its worth. In primary hepatic malignancies, radiofrequency ablation (RFA) is a curative procedure. Recent publications reveal that hepatocellular carcinomas which were of cirrhotic origin and not larger than 5 cm have shown similar responses to both RFA and surgery. In cases of metastatic hepatic tumours, RFA showed slightly poorer results as compared to surgery. But, in tumour foci less than 3 cm or in patients in whom the perioperative risks were high (and they presented with tumor foci less than 3 cm and 3 foci), RFA proved to be a better alternative to surgery. RFA, when used percutaneously, is a cheaper procedure as compared to surgical resection. It can be performed on an out-patient basis with a maximum of 24 hours of observation. Local anesthetic or slight sedation may be employed. Greatest advantage of RFA is its ability to cause tumour degradation. Its results are not well known in our country. Under the existing financial system, RFA is not feasible.]

Hungarian Radiology

[Use of plain and intravenous contrast material multidetector CT examinations in acute abdomen]

TÓTH László, TÓTH Géza, TURUPOLI Emőke, LOMBAY Béla, PAVLIKOVICS Gábor

[Through most of Europe, multidetector computed tomography is used as the first-line modalitiy for examining the acute abdomen. Acute abdominal pain, symptoms referring to abnormal bowel movements, gastrointestinal bleeding, worsening general state, and other typical clinical signs require quick and precise diagnosis since these conditions are frequently life-threatening. The sensitivity and specificity of CT examinations have significantly improved due to the development of the machinary. Thus, the scope of indications are also expanding. Almost all acute abdominal disorders, that may lead to an acute surgical procedure, can be diagnosed with the help of multidetector CT. Unnecessary surgical procedures, the risk to the patients and also the cost of hospitalization can be reduced using multidetector CT examination.]

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Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Clinical Neuroscience

[Health status and costs of ambulatory patients with multiple sclerosis in Hungary]

PÉNTEK Márta, GULÁCSI László, RÓZSA Csilla, SIMÓ Magdolna, ILJICSOV Anna, KOMOLY Sámuel, BRODSZKY Valentin

[Background and purpose - Data on disease burden of multiple sclerosis from Eastern-Central Europe are very limited. Our aim was to explore the quality of life, resource utilisation and costs of ambulating patients with multiple sclerosis in Hungary. Methods - Cross-sectional questionnaire survey was performed in two outpatient neurology centres in 2009. Clinical history, health care utilisation in the past 12 months were surveyed, the Expanded Disability Status Scale and the EQ-5D questionnaires were applied. Cost calculation was conducted from the societal perspective. Results - Sixty-eight patients (female 70.6%) aged 38.0 (SD 9.1) with disease duration of 7.8 (SD 6.7) years were involved. Fifty-five (80.9%) had relapsing-remitting form and 52 (76.5%) were taking immunomodulatory drug. The average scores were: Expanded Disability Status Scale 1.9 (SD 1.7), EQ-5D 0.67 (SD 0.28). Mean total cost amounted to 10 902 Euros/patient/year (direct medical 67%, direct nonmedical 13%, indirect costs 20%). Drugs, disability pension and informal care were the highest cost items. Costs of mild (Expanded Disability Status Scale 0-3.5) and moderate (Expanded Disability Status Scale 4.0-6.5) disease were 9 218 and 17 634 Euros/patient/year respectively (p<0.01), that is lower than results from Western European countries. Conclusion - Our study provides current inputs for policy making and contributes to understanding variation of costof- illness of multiple sclerosis in Europe.]

Clinical Neuroscience

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Clinical Neuroscience

[Dopamine agonists in Parkinson’s disease therapy - 15 years of experience of the Neurological Clinics from Tîrgu Mureș. A cross-sectional study ]

SZÁSZ József Attila, CONSTANTIN Viorelia, MIHÁLY István, BIRÓ István, PÉTER Csongor, ORBÁN-KIS Károly, SZATMÁRI Szabolcs

[Background and purpose - There is relatively few data regarding the usage of dopaminagonists for the treatment of Parkinson’s disease; furthermore, there are no publications regarding Central- and Eastern-European countries. The aim of the study was to evaluate the use of dopamine agonists as a therapeutic option amongst Parkinson’s disease patients admitted to the Neurological Clinics of Tîrgu Mures during the last 15 years. Methods - In our study we investigated the data of all Parkinson’s patients treated at our clinics between the 1st of January 2003 and the 31st of December 2017. We analyzed the particularities of dopamine agonists’ usage based on the therapeutic recommendations from the final report of these patients. Regarding time since the diagnosis, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. Results - During the studied period a total of 2379 patients with Parkinson’s disease were treated at the Clinics. From the 1237 patients with disease duration under 5 years 665 received dopamine agonists: 120 as monotherapy, 83 together with monoamine oxidase inhibitors and in 234 cases associated with levodopa. The remaining 228 patients were treated with a triple combination of levodopa, dopamine agonists and monoamine oxidase inhibitors. In patients suffering from Parkinson’s disease for more than 5 years, in 364 cases out of 653 a dopamine agonist was part of the therapy. Conclusion - The usage of dopamine agonists was similar to the data presented in other studies. We consider that clinicians treating the disease should, with the necessary prudence, use the available and recommended dopamine agonist with the utmost courage to their maximum therapeutic potential.]

Lege Artis Medicinae

[INCIDENCE RATES OF CHILDHOOD TYPE 1 DIABETES WITHIN EUROPE AND HUNGARY BASED ON EURODIAB DATA]

GYÜRÜS Éva, SOLTÉSZ Gyula

[Type 1 diabetes is generally believed to be be the result of an immune destruction of pancreatic ßcells in genetically susceptible individuals exposed to environmental risk factors. To study the epidemiology of childhood-onset type 1 diabetes mellitus in Europe, the EURODIAB collaborative group established in 1988 prospective geographicallydefined registers of new cases diagnosed under 15 years of age. The 10-year-old study shows a greater than 10-fold range in incidence rate of childhood diabetes in Europe. The standardised average annual incidence rate during the period 1989-1998 ranged from 3,6 cases per 100 000 per year in Macedonia to 43,9 cases per 100 000 per year in Finland. Combined data from all centres indicates that the annual rate of increase in incidence was 3,2% but in some central and eastern European countries it was higher. The age-group-specific rates of increase were 5% for children aged 0-4 years, 3,7% for 5-9 years, and 2,1% for 10-14 years, which shows that the highest rates of increase occurred in the youngest age group. The Hungarian Childhood Diabetes Registry has collected the data of all newly diagnosed children with type 1 diabetes aged 0-14 years since 1st January 1978. The standardised incidence rate during the period 1978-2002 was 8,6 cases per 100000 per year, the lowest in the youngest (0-4 yr), highest in the10-14-year-old-children. There was a linear increasing trend in incidence with the average rate of annual increase of 5,1%. Comparing our incidence rate with other European countries Hungary belongs to the medium-risk countries with similar age- and sex-specific incidence rates. The results of the EURODIAB study confirm a very wide range of incidence rates of childhood type 1 diabetes within Europe and show that the increase in incidence varies from country to country. Such variation seems to be unlikely to be explained by genetic differences, since Europeans (except some small populations) are more homogeneous compared with other populations of other continents. The rapid increase in incidence may be explained by changes in environmental factors.]