Hungarian Radiology

[Winners of the ESGAR Competition]

PALKÓ András

APRIL 20, 2003

Hungarian Radiology - 2003;77(02)

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Hungarian Radiology

[The role of the mechanical lithotripsy for the treatment of ”difficult” common bile duct stones]

OROSZ Péter, NAGY György, SÜMEGI János, JUHÁSZ László

[INTRODUCTION - Present work aimed to identify some predictors of success or failure (gender, age, number and size of stones, presence of periampullary diverticula and jaundice) in mechanical lithotripsy. PATIENTS AND METHODS - 7998 endoscopic retrograde cholangio-pancreatographies, 2430 endoscopic sphincterotomies and 1205 bile duct stone extractions were performed between 1981 and 2000 years. In 159 patients - because of failure of standard techniques - mechanical lithotripsy was attempted for crushing of large bile duct stones. There were 39 men (mean age 70.5 years) and 120 women (mean age 67.7 years). 65 patients had single stone, 31 had 2 stones and 63 had multiple stones. 80 patients had larger stones than 20 mm in diameter. 23 patients had periampullary diverticula and 98 were jaundiced. Mechanical lithotripsy was accomplished with Olympus BML 2Q and BML 4Q intraendoscopic systems. When the first attempt failed, repeated treatment was performed or a Wilson-Cook extraendoscopic system was used. Data of predictors were processed using univariate analysis, Chi-square test and Fischer’s exact test. P<0.05 was regarded as statistically significant. RESULTS - Clearance of common bile duct was obtained in 130 patients (81.8%). Procedure related cholangitis occured in 16 patients. 8 pancreatitis developed, 7 of them subsided with conservative therapy, 1 of them required surgical treatment. On univariate analysis, the stone size was the only variable to differentiate the success from failure of procedure (p<0.05). Other variables had not any role in determining the outcome. CONCLUSION - Mechanical lithotripsy is a useful method with a high success rate and with an acceptable complication rate for treatment of ”difficult” bile duct stones. Stone size is the single outcome predictor.]

Hungarian Radiology

[The ECR 2003 Image Solving Meeting]

PALKÓ András

Hungarian Radiology

[Locoregional Treatment of Infants with Neuroblastoma: the Role of Radiation Therapy and Late Consequences of Radiation Effects]

GYENES György

Hungarian Radiology

[The Swiss Syndrome]

SZÁNTÓ Dezső

Hungarian Radiology

[Metal objects in the MR]

VÁRALLYAY György

[During magnetic resonance imaging the patient is exposed to three different types of electromagnetic radiation: static magnetic field, gradient or time varying magnetic fields and radiofrequency electromagnetic fields. The potential risks associated with performing MRI in patients with ferromagnetic implants, materials, or devices are related to the possibility of movement or dislodgement, to the induction of electrical currents and to the heating. The majority of metallic implants are considered to be safe for MRI, but patients with cardiac pacemakers, ferromagnetic aneurysm clips, cochlear implants, implantable drug infusion pumps should not be examined by MRI.]

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[Neurophobia is the fear of neurological diseases. Its main symptom is that medical students and young doctors are not able to utilize their basic neurological knowledge at the bedside. According to statistics, every second student suffers from neurophobia. This attitude could explain why in the last two decades less and less young doctors wanted to become neurologist. Medical students complain that they receive no instructions, and are afraid of loosing their interest and of facing the failure of their competency. The hardship of neurology was explained by the insufficient knowledge of anatomy and the infrequent encounter with patients. Even general practitioners have anxiety about neurological patients. The loss of interest in neurosciences seems to associate with insensitivity of human-centered culture and corruption of empathic thinking. The burnout syndrome of medical doctors and students can be explained by stress, loss of respect, permanent competition, independency that interferes with responsibility, stiff hierarchy of medical society, fear of diagnostic failures and of economical difficulties. The scores of depression in female students were higher than in male. The idea of the “good neurologist” has been changed. The business oriented care, the shortage of time, and the financial restrictions corroded the conventional practice and ceased the vocational idealism. At present, personal teaching is going to transform into impersonal multimedia learning. Because of the drastic change of values, the age of inner-oriented professionals has terminated also in the medicine. Medical doctors follow even less the traditional troll of professional behavior, but according the social demands, they choose their specialization for subsistence. The highly esteemed social status of neurologists and psychiatrists is going to sink in Europe. To reduce neurophobia it would be desirable 1. to introduce neurology training in the early years of medical school; 2. to teach neurology in all semesters, 3. to assure the effective teaching of neuro-anatomy and physiology, 4. to organize more one-to-one teacher-student communication. In the United States, residents participate in teaching during their residency training. To master neurology dedicated teachers are necessary whom neurology residents ought to meet personally with optimal frequency. However, these requirements seem to fail because of the chiefly technical characters of the actual reforms.]

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