Journal of Nursing Theory and Practice

[Intracystic brachytherapy of cystic brain tumors by image fusion method- intracavital beta irradiation of 90-Yttrium solution]


APRIL 30, 2015

Journal of Nursing Theory and Practice - 2015;28(02)

[Aim of the research: The authors aimed to gain acceptance, effectiveness testing and the timetable of the shrinking of the cysts for the treatment procedure of patients with cystic craniopharyngeoma. The procedure utilizes intracavitary beta irradiation by 90Y colloidal solution. Image fusion was used for the first time for the guidance and control of the intra cystic irradiation of brain tumors. The authors also examined the use of the image fusion for brachytherapy of brain tumors before, during, and months or even years after surgery and to patient follow up. Research and sampling methods: 130 craniopharyngeoma cyst was irradiated with the Yttrium-90 colloidal solution in 84 patients. The internal wall of the cyst were getting a load of 180-300 Gy. The volumes of the cysts were followed almost over 30 years by the control of CT-MRI image fusion. For the planning of the irradiation the authors developed their own software and BrainLab was used for the CT-MRI-PET image fusion. For the mathematical and statistical calculation Matlab and MedCalc soft wares were utilized. Results: The results were from 130, 90Y β stereotactic intracavitary irradiation of cystic craniopharyngiomas. As per cystic CRF volume the volume reduction exceeded 80 %. The mean survival rate following 90-Y irradiation was 7.5 years. Large-scale shrinkage of craniopharyngioma cysts were observed significantly, following 6 months. Conclusions: According to long term clinical experience the intracavitary 90 Yttrium brachytherapy is a relatively non-invasive and effective mode for the recurrent cystic craniopharyngeoma therapy. Procedures where isotope get implanted, qualify in all aspects of a minimally invasive therapy.]


  1. Semmelweis Egyetem Egészségtudományi Kar
  2. Szent János Kórház és Észak-Budai Egyesített Kórházak, Idegsebészeti Osztály



Further articles in this publication

Journal of Nursing Theory and Practice

[The international practice and acceptation concept on Hungary of the Advanced Practice Nurse (APN) training on the MSc level]

OLÁH András, MÁTÉ Orsolya, BETLEHEM József, FULLÉR Noémi

[In Hungary it was a niche and a reasonable developement according to the international trends to start the BSc nursing programme in 1989 - then the MSc nursing programme in 2000 -. However the structure of the nursing specialities’ education was not reviewed with the increase of the level of nursing education, so all of the nursing specialities’ education happens under BSc level. Also did not happened the determination of the nursing competencies on each educational level. These causes just contribute to have decreased number of nursing students within the BSc programmes and the numbers of nurses who intent to leave the profession are also increased. Migration of nurses, increased costs of the health care system, aging society, lack of physicians and the special knowledge of nurses to use for diagnostical and therapeutical equipements are challanges too beside these problems regarding the nurses. However, international literature says that with the employment of well-educated BSc, MSc nurses with expanded competencies the the problem of the lack of the physicians, waiting times, costs of the care, patients’ mortality may be decreased, patient’s satisfaction increases and because of the expanded nursing competencies the migration and nurses intent to leave are decreased. That is why it is reasonable to create BSc/MSc nursing specialities and expand nursing competencies in Hungary as well according to the international trends. Authors of this paper draw up a possible recommendation for the Hungarian implementation.]

Journal of Nursing Theory and Practice

[The effect of work uncertainty on burnout and health of nurses]


[Aim of the research: To measure how work uncertainty effects on burnout, psychosomatic symptoms and subjective health conditious. Research and sampling methods: In this cross-sectional study the authors have conducted a group of nurses (N=29) at Mátra Health Institute in 2013-2014. The survey was designed by the authors. Results: The burnout becomes higher as the uncertainty at the workplace rises (p=0,038; r=0,387). The degree of the burnout correlates with the subjective negative health status (p<0,001; r=-0,650) and with the appearance of psychosomatic symptoms (p=0,003; r=0,530). The most common psychosomatic symptoms are the backache and dorsal pain, weakness, weariness, headache and sleeping problems. Conclusions: The uncertainty influences only the degree of the burnout, and it had no any effect on other variables) ]

Journal of Nursing Theory and Practice

[An in-depth look at chest pain, for ambulance nurses]

MOSKOLA Vladimír, HORNYÁK István

[Ambulance nurses often deal with complaints of chest pain, both when working independently and when on call in an emergency ambulance or quick response vehicle. It is essential that they know as much as possible about any life-threatening symptoms, and are as up-to-date with the latest skills when attending patients. This also helps teamwork and efforts to ensure an improvement and the proper treatment of the patient’s condition (in the context of an ambulance nurse’s duties). This all requires a knowledge of differential diagnosis, which gives a broad outline of the diseases that could potentially underlie the chest pains suffered by a patient who calls an ambulance. The more in-depth theoretical knowledge also promotes an understanding of the importance of intervention by ambulance crew/doctors in the case of certain diseases, the importance of the time factor, and the reason for urgency even if the patient’s condition does not appear serious at first glance. In the light of these factors the authors have undertaken to provide readers with new, evidence-based knowledge.]

Journal of Nursing Theory and Practice

[The role of self-help groups in the treatment of alcoholism]


[Alcoholism is one of the best-known addictions. The results of both international and national surveys illustrate the health consequences of the excessive consumption of alcoholic beverages, and its link with alcoholic disease and the associated dangers, but we still find a high proportion of people who show unrestrained consumption. Is there a genuine desire to recover, is there motivation, and where should one look for help? Such assistance could take the form of a self-help group, where addicts who want to quit, those in the various stages of recovery, or those who have already recovered, can meet up. The aim is to achieve and maintain abstinence, and prevent a relapse. The author presents the process and benefits of self-help, from the perspective of addiction. Her study proves that the treatment of alcoholism requires a complex approach, and one in which we can ascribe a key role to self-help groups.]

Journal of Nursing Theory and Practice

[Hungarian Cancer Society - Nursing Section]

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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.

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Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.