Hungarian Radiology

[Prenatal detection of campomelic dysplasia by sonography]

NAGY Gábor, VRECZENÁR László

OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)

[INTRODUCTION - The campomelic dysplasia is a disorder characterized by short and bowed lower limbs resulting in dwarfism. CASE REPORT - In the case of a 21-year-old primipara woman the second screening ultrasonography raised the suspicion of short and bowed lower limbs of the fetus, at the 19th week of the pregnancy. Repeated examinations proved the presence of short and bowed femurs and tibias and abnormal echogenecity of the bones. The upper limbs were almost normal in length. During the 19th week of pregnancy, after a genetic analysis in agreement of the parents the pregnancy was interrupted without any complication. Photography and Xray of the fetus confirmed the diagnosis. CONCLUSION - Fetal ultrasonography should include exact size measurement and observation of the shape of the long bones, making possible the early detection of limb anomalies. The anomaly being proven by positive genetic analysis the pregnancy can be interrupted at the parents' request.]

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Hungarian Radiology

[Computed tomography brain perfusion in the management of acute stroke]

BAGI Róbert, SZABÓ Tünde, MONOKI Erzsébet

[INTRODUCTION - The multidetector CT-technology made the application of perfusion CT-examination in the diagnosis of vascular brain damages possible in recently. The purpose of this study was to introduce the method and to assess the importance of computed tomography brain perfusion in emergency patient care and early diagnosis of brain ischemia. PATIENTS AND METHODS - We perform brain perfusion examinations with a 2 slice multidetector computer tomography (General Electric Highspeed NX/i, 2004) in our hospital. We examined the results of native and perfusion CT of 27 patients who underwent CT brain perfusion examination during emergency patient care in our department between 2004 January and 2006 December. We also examined if the patients got systemic thrombolysation and the patients’ condition after therapy. RESULTS - The perfusion software can make quantitative colour maps of parameters (CBF, CBV, MTT) and can visualize mean value and percentil decrease of measuring parameters. There were 18 positive and 8 negative CTbrain perfusion examinations in the examined period. One examination was technically unvaluable. CONCLUSION - By measuring blood flow's decrease the CT-brain perfusion examination can separate the reversible and irreversible damage of brain parenchyma. The examination protocol of brain vascular damages are native CT-scan, postcontrast perfusion CT-examination and CTangiography by the recommendation of international literature. Despite the multidetector CT-s and CT-perfusion technic is available for years, the CT-brain perfusion examination is not a routine process in the emergency patient care in our country.]

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Hungarian Radiology

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Hungarian Radiology

[Pancreas transplantation: Indication, surgery, complications, diagnostic imaging and outcome]

NÉMETH Andrea, DOROS Attila, HARTMANN Erika, WESZELITS Viola, DABASI Gabriella, LANGER Róbert, MÁTHÉ Zoltán, JÁRAY Jenő

[Diabetes mellitus is often leading to chronic microvascular and macrovascular complications. At present time, wholepancreas transplantation is the only option to achieve long-term insulin independence. Therefore, simultaneous kidney-pancreas transplantation has become the preferred treatment option for selected patients with type I diabetes mellitus and renal failure. In this review authors describe the indications and main types of pancreas transplantation: simultaneous pancreaskidney transplantation, renal transplantation first then pancreas transplantation, pancreas transplantation alone, islet-cell transplantation, and deal with surgical technical aspects. The immunological, metabolic, inflammatory, technical and late complications are also datailed as well as the outcome of the operations. The importance of the various imaging techniques is emphasized. The rate of mortality and complications are significantly higher after simultaneous kidney-pancreas transplantation than those after kidney transplantation alone. The role of the radiologist is to promote a successful outcome by early detection of the complications.]

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[Technical aspects of MR urography based on two cases]

HORVÁTH László, BOGNER Péter, NAGY Gyöngyi, BAJZIK Gábor, VANDULEK Csaba, REPA Imre

[Intravenous urography has been the gold standard in diagnostic radiology studying the urogeintal system. However, ultrasound and other cross-sectional imaging methods have brought major change in this area. Beside modern (multislice) CT examinations the methods of MR urography are more frequently applied making possible both static and dynamic examinations beyond the wellknown advantages of MR imaging. The authors describe two complemetary methods of MR urography which provide a complete evaluation of the urinary system. The first method is aimed to image stationary fluid by using heavily T2 weighted turbo spin echo pulse sequences. This measurement well depicts the dilations of the excretory system even with little or no excretion of urine. The second method is analogous with the traditional IVU, as the excretion of a less nephrotoxic gadolinium based contrast medium followed by a T1 weighted gradient echo pulse sequence (possibly dynamic) helps to visualise the renal cavities and the urinary pathways. Normal renal function is a prerequisite when using this technique in order to visualise normal and obstructed urinary pathway disorders. The use of MR urography together with traditional MR methods may significantly reduce the number of invasive examinations and methods based on X-ray radiation exposure. MR urography may be exceptionally important in the uroradiological study of distensions of renal cavities in pediatric cases, pregnant women and renal transplant patients or in case of contrast material allergy.]

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[Estimation of serum uric acid in the Hungarian population]

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[The clinical significance of serum uric acid markedly increased in the last years, especially in the civilized countries, but the abnormal serum uric acid level shows a significantly strong increasing tendency worldwide. The high level of uric acid is an integral part of metabolic syndrome. Today we recognized the important role of xanthine oxidase in the clinical practice for developing of oxidative stress in some tissues and organs. In 2011 during the Hungarian Health Care Screening Program we analyzed the prevalence of metabolic factors in 18 886 subjects. In the present publication we have dealt with uric acid and calculated the occurrence of abnormal values in percentage of the observed population. We found abnormal values in 12.3% of women (over 350 µmol/l) and 16.5% of men (over 400 µmol/l). The average values were higher in hypertensive subjects against normotensive ones in both gender. There was a close correlation among the metabolic components and the elevated uric acid level. The screening had given a possibility for detecting hidden gout and some other diseases, where the elevated uric acid level is specific of the clinical entity.]

Lege Artis Medicinae

[POSSIBILITES AND DIFFICULTIES OF COLORECTAL CANCER SCREENING IN HUNGARY]

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[The frequency of colorectal cancer is increasing all over the world. It is the second most frequent oncological disease leading to death in both sexes in Hungary. The main part of colorectal cancer develope after the age of 50. In case of patients having higher risk we have to calculate with the earlier appearance of the tumour and detectable molecular genetic disorders. The development of colorectal cancer needs a long time. Before the appearance of the cancer, precancerous processes (adenomas, polyps) can be detected in the large intestine. The development of colorectal cancer can be prevented by the removal of the adenomas (polypectomy). There are many different and efficient methods to detect the precancerous and early disorders. For increasing the compliance to screening programs the common efforts of the society, the National Health Care Services and medical doctors are necessary. The education of the population and the medical services would also be helpful. The colorectal cancer screening programs are costeffective and supported by the different health services independently from the type of the insurance. Screening the patients having higher risk is one of most important task. In these cases the use of colonoscopy is the most frequent method for the screening and follow up as well.]

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[Frequency and diagnosis of pediatric air gun injuries]

MAKRA József, LOMBAY Béla, RIVASZ-TÓTH Gyula

[INTRODUCTION - Air guns are frequently given to children as toys. Air guns have a pellet caliber of 0.17 or 0.22 and are propelled by compressed gas. Though they have little penetrating effect, they may cause life threatening injuries. Our purpose was to evaluate the frequency and the development of the diagnostic opportunities in children with air gun injuries during the last 30 years (1971-2000). PATIENTS AND METHODS - 52 patients (39 boys and 13 girls) were admitted to our pediatric surgery department due to of air gun injuries. The average age was 9 years (range 2 to 14 years). During the first fourteen years conventional X-ray (plain film and fluoroscopy), since 1984 ultrasonography and later (1986) CT has also been used for the diagnosis. RESULTS - In the first ten years 12 patients, in the second decade 18 patients and in the third ten years 22 patients were admitted and treated with air gun injuries. The sites of injury included upper, lower extremities (n=23), head (n=10), neck (n=5), chest (n=9) and the abdomen (n=5). The majority of patients had superficial injury and Xray plain films in different views were obtained, only. Major complication occured in 10 cases: bone fracture (n=1), soft tissue abscess (n=4) pneumothorax and hemothorax (n=4), bowel perforation (n=1). In these cases ultrasonography and/or CT was performed and they were helpful to establish the correct diagnosis. CONCLUSION - The general conception that air guns are toys, is basically wrong. The practice of placing air guns in the hands of children by their parents is very dangerous. On the basis of our results, the frequency of air gun injuries in children increased significantly in the last decade and the injuries were more serious than before (due to thew technologic modification of air gun). Ultrasonography and CT have important role in the diagnosis, but conventional X-ray remains the basic method in most of cases.]

Lege Artis Medicinae

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[According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 percent in general practice. As un­treated depression is the most important risk factor for suicide, early detection and effective management of depression (especially depression which predisposes sui-cide) are critical in prevention. According to international and national studies the re-cognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we present two short questionnaires used for re-cognising depression and acute suicide risk and we describe their use in family/ general practice. We aim to raise awareness of the need of a systematic, nationwide sui-cide prevention programme which is supported on government level as well. ]

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[Early mental test - developing a screening test for mild cognitive impairment]

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[Background and purpose - Mild cognitive impairment (MCI) is a heterogenous syndrome considered as a prodromal state of dementia with clinical importance in the early detection of Alzheimer’s Disease. We are currently developing an MCI screening instrument, the Early Mental Test (EMT) suitable to the needs of primary care physicians. The present study describes the validation process of the 6.2 version of the test. Methods - Only subjects (n=132, female 95, male 37) over the age of 55 (mean age 69.2 years (SD=6.59)) scoring at least 20 points on Mini-Mental State Examination (MMSE), mean education 11.17 years (SD=3.86) were included in the study. The psychometric evaluation consisted of Alzheimer’s Disease Assessment Scale Cognitive subscale (ADAS-Cog) and the 6.2 version of EMT. The statistical analyses were carried out using the 17.00 version of SPSS statistical package. Results - The optimalised cut-off point was found to be 3.45 points with corresponding 69% sensitivity, 69% specificity and 69% accuracy measures. The Cronbach-α, that describes the internal consistence of the test was 0.667, which is higher as compared with the same category in the case of the ADASCog (0.446). A weak negative rank correlation was found between the total score of EMT 6.2 and the age of probands (rs=-0.25, p=0.003). Similarly, only a weak correlation was found between the education levels and the total score of EMT 6.2 (rs=0.31, p<0.001). Two of the subtests, the repeated delayed short-time memory and the letter fluency test with a motorical distraction task had significantly better power to separate MCI and control groups than the other subtests of the EMT. Conclusion - The 6.2 version of EMT is a fast and simple detector of MCI with a similar sensitivity-specificity profile to the MMSE, but this version of the test definitely needs further development.]