Hungarian Radiology

[Where are the Hungarian men with breast cancer?]

GÖBLYÖS Péter

DECEMBER 10, 2005

Hungarian Radiology - 2005;79(06)

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Hungarian Radiology

[Autumn thoughts in winter]

LOMBAY Béla

Hungarian Radiology

[Ultrasound of the acute pediatric scrotum]

COLEY D. Brian

[Proper evaluation of the acute scrotum, like any condition, starts with a history and physical examination by an experienced clinician. Often this is all that is needed to arrive at an accurate diagnosis, which then allows prompt and appropriate treatment. However, the true nature of the underlying disease producing scrotal pain is not always clear, and the consequences of error (testicular loss) are undesirable. Ultrasound is the single most useful imaging tool for imaging the scrotum. While nuclear medicine studies can help assess blood flow, the combination of anatomic detail provided by modern ultrasound equipment and the ability to assess blood flow and perfusion with color Doppler makes ultrasound invaluable. Properly performed and interpreted, ultrasound provides very high sensitivity and specificity for acute scrotal conditions. Understanding of the conditions that produce acute scrotal pain in children will improve one’s diagnostic abilities. The most important diagnosis to consider is testicular torsion, since untreated this will result in testicular death. While testicular torsion can occur at any age, it is most common in the perinatal and peripubertal age groups. Torsion of a testicular appendage is a frequent cause of scrotal pain in prepubertal males. The sonographic findings can mimic epididymitis, but diligent and focused sonographic examination can make the diagnosis. Epididymitis typically affects postpubertal males, but can be seen in younger patients with functional or anatomic urinary tract anomalies. Sonographic evaluation of the post-traumatic painful scrotum can help to differentiate injuries that can be managed conservatively and those that require surgery. Less common causes of scrotal pain include hernias and hydroceles, vasculitis, and idiopathic edema. Understanding the characteristic sonographic features of these conditions allows the examining physician to make more accurate and confident diagnoses. It is hoped that this review article will help to promote this understanding.]

Hungarian Radiology

[Male breast cancer]

GÖBLYÖS Péter

[Male breast cancer does not get a sufficient attention which would be appropriate due to its special features. Diagnostical and therapeutical protocols are not existing, a national center and international collaboration would be necessary. Incidence of male breast cancer is one percent of the female breast cancers, and 5 percent of all male cancers. The absolute number of the cases increased in the past years. The mutation of gene BRCA2 plays the main role in the male breast cancer. The breast cancer of the men is a "late disease", because often neither the doctor nor the patient considers this opportunity. The diagnosis is often established at an advanced stage. Cancer can occur on both sides, but the right breast is more often affected. Staging is the same as in female patients. Prognosis is poorer than in females, the tumor-receptor rate is better, HER2 in men does not plays any role. Basic principles of diagnostics and therapy are same as in females, mainly because there is no consensus about the treatment of the male breast cancer. The same proved protocols are used in men which are applied in women. The ground-method is surgery, reduced radicality and mastectomy is usually applied. Males react on hormone therapy better, than women, mainly chemotherapy is suggested. Follow up of the patients and the psychological support is extremely important. A multidisciplinary collaboration is necessary in the treatment of the male patient, and education is of great importance.]

Hungarian Radiology

[Isolated gallbladder rupture following blunt abdominal trauma]

PÉTER Lívia

[INTRODUCTION - Gallbladder injuries following blunt abdominal trauma occur rarely and are usually associated with damage to other abdominal organs. Isolated rupture of the gallbladder is extremely rare. CASE REPORT - A 42-year old intoxicated male patient suffered a blunt abdominal trauma 4 days before the admission. The physical examination was of normal and no specific laboratory values were found. Ultrasound examination demonstrated the gallbladder with hyperechoic thickened wall and inhomogenous content. Beside of the gallbladder fluid collection was detected with irregular margins. To prove the diagnosis of gallbladder injury computed tomography was carried out. Break of the gallbladder wall and hight density lumen content, corresponding to blood was detected. Around the gallbladder an irregular fluid collection was seen, which reached the level of the transverse section of the mesocolon. Computed tomography excluded traumatic lesion of other parenchimal abdominal organs. Surgery confirmed the radiological diagnosis. CONCLUSION - The patient with isolated gallbladder injury had a multiphasic clinical course. Sometimes the diagnosis has to be established at a relatively asymptomatic stage. The basic methods of the diagnostics are the ultrasound examination and computed tomography.]

Hungarian Radiology

[X-ray examination of paintings]

SZABÓ Éva, SZENTKIRÁLYI Miklós

[INTRODUCTION - After the discovery of X-ray it was not only used for medical purposes, but also to study the internal structure of various objects. The X-ray examination can be applied not only to examine paintings, but other works of art. METHODS AND RESULTS - The rontgenograms are made by industrial film without any screen in the museum. In case of paintings soft-beam examination technique was used. The basic principle of the X-ray examination of different paintings is based on the presence of different atomic number in different paints. Authors after the examination of four paintings achieved a significant finding. In these paintings the stylistic and structural features of the pictures, injuries, originality, changes in the composition during the work of the artist can be studied. CONCLUSIONS - Recordings made by an industrial radiological equipment in the Museum of Fine Arts (Budapest) are helpful in the restorer work.]

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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

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

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