Hungarian Radiology

[Radiologists - Pécs, 27th June 2008]

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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Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[The examination of burnout among healthcare workers]

FEJES Éva, MÁK Kornél, POHL Marietta, BANK Gyula, FEHÉR Gergely, TIBOLD Antal

[Health reforms in recent decades have been largely based on economic considerations and have led to a significant problem in the sector today, with the issue of human resources being pushed back, which is exacerbated by burnout syndrome. The aim of this questionnaire-based study was to examine the complex background of burnout among health care workers in the cities of Komló, Pécs and Kecskemét. Baseline demographic data were recorded. Burnout was assessed by the Maslach Burnout Inventory (MBI), and the intensity of dysfunctional attitudes were also studied. Depression was detected by the Beck Scale and social supports, and effort-reward dysbalance were also examined. Overall 411 employees participated in our study. Age group distribution was middle aged access, vast majority of the workers was between 36 and 55 years. Mean burnout scale was 58.6 (SD = 16.3), 63 workers had mild (14.2%), 356 had moderate (80.7%) and 22 had severe (5.1%) burnout. In a multivariate analysis the type of work (OR = 1.018), age (OR = 2.514), marital status (OR = 1.148), job type (OR = 1.246) the lack of social support (OR = 1.189) and allowance (OR = 9.719) were independently associated with burnout (p < 0.05 in all cases). There was a significant association among burnout, depression and dysfunctional attitudes. The vast majority of our social workers suffered from moderate and a small, but significant proportion suffered from severe burnout. Our work draws attention to the modifiable and unmodifiable risk factors of burnout in this population, which may help in the development of preventive strategies.]

Clinical Neuroscience

Comparison TachoComb with SurgiWrap, Surgicel and Lyodura in epidural fibrosis: An experimental rat model

HUSEYIN Karasu, IŞIL Güzel

Objectives - We designed this study to evaluate the effect of TachoComb and to compare it with SurgiWrap, Surgicel, and Lyodura in an experimental rat model for epidural fibrosis (EF). Methods - This prospective and experimental rat model study was performed at Dicle University, School of Medicine, Department of Neurosurgery, in Diyarbakır, Turkey, between January 2005 and June 2005, using 50 Sprague Dawley rats (30 female and 20 male) with a mean weight of 290 g. The rats were divided into five groups: TachoComb, Surgicel, SurgiWrap, Lyodura, and control. Results - Eight weeks after laminectomy, the rats were killed and EF was evaluated. EF was statistically different between the groups. The lowest EF score was in the TachoComb group (F=6.915, p<0.001). Conclusions - According to this study, TachoComb was found to be a more effective agent in decreasing EF than Surgicel, SurgiWrap, or Lyodura.

Clinical Neuroscience

Different work schedules of nurses in Hungary and their effects on health

FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]