Hungarian Radiology

[Scientific meeting on radiofrequency tumor ablation - Interdisciplinary Forum of the MOTESZ]

ENGLONER László

AUGUST 10, 2005

Hungarian Radiology - 2005;79(04)

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Hungarian Radiology

[Development of Coronary Disease After Irradiation of Gastric Ulcer]

GYENES György

Hungarian Radiology

[Ethiopathogenesis of polycystic ovarian syndrome and imaging diagnostics of polycystic ovary]

JAKAB Attila, MOLNÁR Zsuzsanna, TÓTH Zoltán

[Polycystic ovarian syndrome is a heterogenous syndrome with a wide variety of endocrine and metabolic abnormalities and clinical symptoms. It is considered as the most frequent endocrine disorder in women in reproductive age and the most common cause of anovulatory infertility. Key features include menstrual cycle disturbance, hyperandrogenism and obesity. There are many extraovarian aspects to the pathophysiology of polycystic ovarian syndrome, but ovarian dysfunction is central. The underlying unique feature of the ovarian morphology gives the significance of the ultrasound examination. At a recent consensus meeting, a refined definition of the polycystic ovarian syndrome was agreed, encompassing a description of the morphology of the polycystic ovary. The subjective appearance of polycystic ovary should not be substituted for the definition. Further, a woman having polycystic ovary in the absence of menstrual disorder or hyperandrogenism (asymptomatic polycystic ovary) should not be considered as having polycystic ovarian syndrome, until more is known about the situation. Since ultrasound description of polycystic ovary morphology has central role in the diagnosis, and untreated polycystic ovarian syndrome carries long term health risks, the increasing attention to ovarian morphology may offer an effective tool to decrease women`s morbidity. This review outlines the background and feature of ovarian morphology in polycystic ovarian syndrome, and details the current ultrasound definition of polycystic ovary.]

Hungarian Radiology

[Thoughts relating to PET and CT]

LOMBAY Béla

Hungarian Radiology

[Breast core needle biopsies yielding uncertain results - Experience at the complex mammographic screening unit in Kecskemét]

AMBRÓZAY Éva, BORI Rita, LŐRINCZ Margit, LÓRÁND Katalin, CSERNI Gábor

[INTRODUCTION - On occasion core biopsies yield an inconclusive (B3 or B4) result in the triple diagnostics of breast lesions. These cases may turn to be malignant in the operation specimen. This study evaluates the value of B3 and B4 diagnoses and the consequences of these diagnoses. MATERIALS AND METHODS - Core needle biopsies were generally taken under imaging guidance with an automatic gun using G14 gauge needles. They were evaluated using internationally and nationally accepted categories from B1 to B5. The analysis was based on data collected between 2000 and March 2005. RESULTS - Of the 663 core needle biopsy specimens 31 (4.7%) were classified as B3 and 22 (3.3%) as B4. Specimens were more often fragmented in the latter category (a rate of 0.64 as compared with a rate of 0.26). Patients with a B3 diagnosis were operated on in 23 cases, eight of which turned to be malignant (0.35). B4 diagnoses were followed by operations in 21 cases and were found to be malignant on 19 occasions (0.9). Whenever a B4 diagnosis was associated with radiological findings of malignancy (category 5 on mammography and/or ultrasound) the cases unanimously proved to be malignant. The same association with B3 diagnoses yielded malignancy in a rate of only 0.67. CONCLUSION - Both B3 and B4 diagnoses represent an indication for operation. Our experience suggests that B4 diagnoses when coupled with a radiological opinion of malignancy can be candidates for definitive (therapeutic breast conserving) surgery whereas B3 diagnoses require diagnostic excisions.]

Hungarian Radiology

[Installation, functioning and financing of the PET-CT and radiotherapy simulatory CT machines - Recommendations of the Hungarian College of Radiologists]

PALKÓ András

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Related contents

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Hypertension and nephrology

[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

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

[CONSCIOUSNESS AND ALTERED CONSCIOUSNESS]

SZIRMAI Imre, KAMONDI Anita

[The notion of consciousness in the English scientific literature denotes a global ability to consciously perform elementary and intellectual tasks, to reason, plan, judge and retrieve information as well as the awareness of these functions belonging to the self, that is, being self-aware. consciouness can also be defined as continuous awareness of the external and internal environment, of the past and the present. The meaning of consciouness is different in various languages, but it invariably includes, the conscious person is capable to learn, retrieve and use information. Disturbance or loss of consciouness in the Hungarian medical language indicates decreased alertness or arousability rather than the impairment of the complex mental ability. Awareness denotes the spiritual process of perception and analysis of stimuli from the inner and external world. Alertness is a prerequisite of awareness. Clinical observations suggest that the lesions of specific structures of the brain may lead to specific malfunction of consciouness, therefore, consciouness must be the product of neural activity. “Higher functions” of human mental ability have been ascribed to the prefrontal and parietal association cortices. The paleocerebrum, limbic system and their connections have been considered to be the center of emotions, feelings, attention, motivation and autonomic functions. Recent evidence indicates that these phylogenetically ancient structures play an important role in the processes of acquiring, storing and retrieving information. The hippocampus has a key role in regulating memory, learning, emotion and motivation. Impaired consciouness in the neurological practice is classified based on tests for conscious behavior and by analyzing the following responses: 1. elementary reactions to sensory stimuli - these are impaired in hypnoid unconsciousness, 2. intellectual reactions to cognitive stimuli - these indicate the impairment of cognitive contents in nonhypnoid unconsciousness. Obviously, disturbance of elementary reactions related to alertness and disturbance of intellectual performance overlap. In conditions with reduced ability to react to or to perceive external stimuli the cognitive disturbance of consciouness cannot fully be explored.]