Hungarian Radiology

[Once again about the membership fees]

MORVAY Zita

DECEMBER 21, 2009

Hungarian Radiology - 2009;83(04)

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Hungarian Radiology

[Residents here and over the rainbow]

LOMBAY Béla

Hungarian Radiology

[Cervical space occupying lesions: diagnosis at sonoelastography]

UJLAKI Mátyás, MAGYAR Péter, KARLINGER Kinga

[Among cervical (neck) region tumours, the thyroid lesions and the metastatic lymph nodes are the most detectable with conventional B-mode ultrasonography (US). The use of MRI and CT scans are limited because of the cost, and in case of CT, the radiation. With the introduction and constant development of sonoelastography, we have in our hands a new imaging procedure which is cheap, fast and harmless, yet giving more information to the examiner than conventional US. The elastographic examination of thyroid lesions is a more explored area than the elastographic visualisation of cervical lymph nodes. The ‘off-line’ elastography showed the highest accuracy allowing to calculate and analyse the strain index of cervical lymph nodes - strain index > 1.5 (85% sensitivity, 98% specificity) - but the ‘off-line’ processing of US elastograms is still too time consuming to be used in busy clinical settings. During the examinations of the thyroid gland both real-time and off-line processed strain imaging were used. An Italian team made a great leap forward as they standardized the degree of distorsion under the application of the external force. Then using the Ueno and Itoh elasticity score they achieved remarkable accuracy with real-time sonoelastography (P <0.0001). On the other hand only those organs are suitable for the US elastography characterization which can be slightly compressed, consequently the examination of a lesion with calcified shell cannot give useful information. Near to the pulsating arteries substantial amounts of decorrelation noise may appear and the examiner has to pay attention what structures are in the ROI box since the sonoelastography method assumes computations relative to the average strain inside the box. To detect a follicular carcinoma in the thyroid gland remains a big challenge. Despite of the limitations most researchers agree on the fact that sonoelastography is a perfect tool to use in addition to the conventional US examination. B-mode US combined with sonoelastography raised the accuracy in differentiation in all cases. With this modality it is also possible to deduce the number of cases when healthy lymph nodes or tissue peaces are taken for biopsy during FNAB.]

Hungarian Radiology

[Clinical significance of nuclear scans in assessing function of thyroid nodules]

NAGY Dezső, BORBÉLY Katalin

[Functional and anatomical imaging plays an important role in the diagnosis and treatment of thyroid nodules presenting with continuously increasing number. In the first part of the paper the usefulness and recent trends of the classical nuclear medicine is discussed. The second part presents the interpretation of incidental thyroid lesions detected by PET-CT and the usefulness of PET in the evaluation of thyroid carcinoma.]

Hungarian Radiology

[Digital volume tomography - The use of cone beam CT in dentistry, oral and maxillofacial surgery]

PLACHTOVICS Márk

[Oral and maxillofacial radiology is a subspecialty with its own field of indication. The goal is to achieve proper diagnostic image quality with the minimal amount of harmful radiation. The most common acquisition techniques are the intraoral radiograph and the panoramic radiograph which result in an overview picture of the whole dental status of the patient or the full mouth survey with the higher doses of radiation indicated for periodontological treatment. The next level is the supplementary radiograph such as occlusal radiograph, transversal tomography (some panoramic radiographs have this option), lateral cephalometric projection, submentovertex view or Waters projection, etc. More over cone beam CT acquisition or digital volume tomography as is called. In case of some described special indications CT, MRI or sometimes US acquisition can be made. In the field of three dimensional radio-diagnostics, the CT has a superior place with well-known advantages for everybody, and the usage has been limited only by the high radiation dose. The main point of the acquisition is the image quality. The load of radiation only makes the field of indication narrow. In every day practice - because of the higher radiation load of each high quality CT - the pictures passing to the doctor are preferred to take with lower resolution and wider slices although the diagnostic value of this never reaches the wanted level. This is why this new acquisition system also mentioned in the title would be better known. This system works with reasonable low radiation coupling with the possibilities of the high fidelity 3D imaging focusing on the bony structures of the head and neck region. The purpose of this article is to give a comprehensive introduction to this method in use for more than a decade. From 2006 in Hungary we also have the option to use the technology.]

Hungarian Radiology

[Voiding sonocystography with ultrasound contrast material for the diagnosis of vesicoureteral reflux]

KIS Éva

[Voiding sonocystography with intravesical administration of ultrasound contrast agent is a sensitive method to detect vesicoureteral reflux without irradiation. Depicting microbubbles in the ureters and collecting system is feasible even with very small amounts of a second-generation ultrasound contrast agent, Sonovue. The reflux is graded (I-V) in a similar manner to the system used in voiding cystourethrography. In this article a detailed description is presented.]

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NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Matrix metalloproteinases and their tissue inhibitors in relapsing remitting multiple sclerosis: Possible markers and treatment agents

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Matrix metalloproteinases (MMPs), which are synthesized by many cell groups and responsible for the destruction of matrix proteins, and endogen tissue inhibitors of MMPs (TIMPs) have a role in the pathogenesis of Multiple Sclerosis (MS) by affecting the blood-brain barrier. We aimed to investigate the role of MMPs and TIMPs in the immunopathogenesis and in the course of multiple sclerosis (MS). We enrolled 25 relapsing remitting MS patients, who had a definite MS diagnosis according to McDonald criteria and 25 healthy subjects similar for age and gender as control group. MMP-9- and TIMP-1 levels were measured twice in patient group (one time during an attack and one in remission) and once in healthy subjects. MMP-9- and TIMP-levels of patients during attack and remission period and MMP-9/TIMP-1 ratio were found significantly higher than in the control subjects. In patient group MMP-9 and TIMP-1 levels and MMP-9/TIMP-1 ratio during attacks were not significantly different than during remission period. However, when subdivided according to their number of attacks, patients with 2 attacks had significantly higher levels during attack period comparing to remission period (p<0.05); in case of patients with more than 2 attacks did not have a statistically significant difference in attack and remission periods. Matrix metalloproteinases are important actors in MS immunopathogenesis, particularly in the early period and inhibitor agents for these enzymes can be used as a treatment option.

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[The link between creativity, as the highest expression form of human achievement, and bipolar disorder came into focus of scientific investigations and research. Accomplished writers, composers and visual artists show a substantially higher rate of affective disorders, prodominantly bipolar mood disorders, comparing to the general population. Then again, patients afflicted with bipolar II subtype (hypomania and depression), as well as persons presenting the mildest form of bipolar mood swings (cyclothymia) possess higher creative skills. It evokes therefore that certain forms and mood states of bipolar disorder, notably hypomania might convey cognitive, emotional/affective, and motivational benefits to creativity. The aim of this paper is to display expression forms of creativity (writing, visual art, scientific work) as well as productivity (literary and scientific work output, number of artworks and exhibitions, awards) in the light of clinically diagnosed mood states at an eminent creative individual, treated for bipolar II disorder. Analysing the affective states, we found a striking relation between hypomanic episodes and visual artistic creativity and achievement, as well as scientific performance, whereas mild-moderate depressed mood promoted literary work. Severe depression and mixed states were not associated with creative activities, and intriguingly, long-term stabilised euthymic mood, exempted from marked affective lability, is disadvantageous regarding creativity. It seems, thereby, that mood functions as a sluice of creativity. Nevertheless, it is likely that there is a complex interaction between bipolar mood disorder spectrum and psychological factors promoting creativity, influenced also by individual variability due to medication, comorbid conditions, and course of disorder.]

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[Telephone based supporting program to quit tobacco smoking in Hungary]

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[The National Korányi Institute of Pulmonology, Methodology Centre for Tobacco Smoking Cessation Support has been operating a free quitline since 2013. The aim of the program is to provide professional advice on how to quit smoking, to spread information about supporting services and to refer interested smokers to specialized health care providers. Proactive calls following a specific protocol are available once a week for a six week period. This study presents the activities of our service in the last six years. Data of our retrospective longitudinal study were analysed by descrip­tive statistical methods. Between 2015 and 2020, there were received 24 286 messages received on the answering machine of the quit-line service. We were able to initiate conversation with approximately 55% of the interested callers. The free of charge quit-line is used predominantly by lower educated and indigent people. Program participants had a serious nicotine addiction. The program is particularly useful for smokers who are otherwise less likely to receive expert support. Between 2015 and 2020, the average abstinence rate of program participants was 16% after their proactive calls. The initial abstinence rate was 19% in 2015, which dropped to 6% in 2020. In this period the average quit rate was 13% at the six-month and 9% at the one-year follow-up. One possible reason for the low cessation rate is that the telephone counselling program can focus only on changing the patients’ behaviour without the in-person help of pharmacological support. Thus healthcare workers play a key role in encouraging of quit smoking and managing the nicotine withdrawal.]