Lege Artis Medicinae



JUNE 20, 2005

Lege Artis Medicinae - 2005;15(06)

[Digital cross-sectional imaging techniques, especially computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in the diagnosis of pathologic conditions affecting the head and neck. MRI, because of its superb soft tissue contrast resolution and multiplanar imaging ability gives the most information regarding the origin and the extent of a laesion, intracranial extension, perineural-, as well as bone marrow involvement and play key role in the management of different diseases. Careful observation of the characteristic radiological features usually leads to correct diagnosis, however, some of the lesions are not typical, looking very similar and can be difficult to differentiate from each other. The purpose of the present article is to provide an overview of the most common pathologic conditions examined with MRI.]



Further articles in this publication

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ACZÉL Klára, DEÁK György, FARKAS Róbert, MAJOROS Gábor

[INTRODUCTION - Nematode infection of the eye occur only sporadically in the continental area. The pathogenic parasite in these cases is usually a Dirofilaria species, mostly D. repens. CASE REPORT - A case of human subconjunctival dirofilariosis is reported, where acquisition from abroad or animal contact in the background of the infection were excluded. The surgical removal of the entire living worm resulted in the complete cure of the patient. CONCLUSION - Knowing the occurrence of Dirofilaria infection of dogs and the increasing spread of the vector mosquitoes during the summer (in towns, too), the increasing occurrence of human dirofilariosis affecting the eye and orbital area in 10-20% of the cases must be taken into account.]

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ALTORJAY Áron, VARGA István, SÁRKÁNY Ágnes, TÓTH Sándor, MUCS Mihály, HAMVAS Balázs, PAÁL Balázs, THAN Zoltán

[INTRODUCTION - The leading role of laparoscopy in the surgical treatment of functional diseases of the gastro-esophageal junction has become indisputable. But has the time of the “classic”, open surgical interventions really gone for good? PATIENTS AND METHODS - Between January 1., 2000 and December 31., 2004 we performed hiatal reconstruction and antireflux plastics for 186 patients. 83.3% (155/186) of the operations was performed laparoscopically, while 16.7% (31/186) with the traditional approach. The average age of patients was 46.9 years, 7% of the operations was performed on children. In case of recurrent paraoesophageal hernias the surgical plan was drawn up based on the result of the barium swallow X-ray performed after endoscopic clipping of the Z-line. In case of a brachy-esophagus, we formed the neo-esophagus by performing the Collis-Nissen operation modified by us (Neodinium magnet + plastic sliding scale) from the traditional abdominal exposure. RESULTS - The indication for hiatal reconstruction and antireflux operation was sliding hernia in 68.2%, paraesophageal hernia in 17.8% and reflux disease in 14%. We observed signs of panmural esophagitis in 22%, while latent or true brachy-esophagus in 10.7%. Antireflux procedures were grouped as Nissen type operation in 82.7%, Toupet type in 9.67%, Narbona in 2.1%, Belsey-Mark IV in 1.61%, and resection type operation in 3.76%. To narrow the diaphragmatic openings, two sutures were needed in most cases (57.1%). Conversion to laparotomy was necessary in 3.2%. We observed recurrences in 3.3% after laparoscopic interventions. In case of open operations we experienced no recurrences in the studied period. The barium swallow X-ray examination performed after endoscopic clipping of the Z-line could reveal brachy-esophagus before the operation. CONCLUSION - Open surgical interventions can not fall into oblivion even in the age of laparoscopic hiatal reconstructions and antireflux plastics. Open surgical procedures are justified even in the new milennium in cases when the patient's medical history contains upper abdominal operations - due to an increased risk of injury because of adhesions -,in cases of primarily recurrent paraesophageal hernias after an unsuccessful open and/or laparoscopic reconstruction, as well as in cases of reflux with complications.]

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[Late effects on renal glomerular and tubular function in childhood cancer survivors]


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[Life’s deep-frozen libraries - Stone’s throw from the new generation of biobanks]

PÓS Zoltán

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[Poliomyelitis - Success and problems in eradication]

BUDAI József

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LI Hua, KÉRI Szabolcs

Evidence suggests that pathogen-associated pattern recognition receptors (Toll-like receptors, TLRs) are implicated in the pathophysiology of schizophrenia. TLRs are important in both peripheral immune responses and neuronal plasticity. However, the relationship between peripheral TLR expression and regional brain volumes is unknown in schizophrenia. We therefore assessed 30 drug-naïve, first-episode patients with schizophrenia. TLR4+/TLR1+ monocytes were measured using flow-cytometry. High resolution magnetic resonance images (T1 MRI) were obtained and analyzed with FreeSurfer. Results revealed significant negative correlations between the percentage of TLR4+ monocytes, mean fluorescent intensities, and brain volumes in frontal and anterior cingulate regions. The measures of TLR1+ monocytes did not show significant relationships with regional brain volumes. These results raise the possibility that abnormal TLR-activation is associated with decreased brain volumes in schizophrenia.

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[Minimally invasive and O-arm assisted en bloc spinal tumor resections ]

SZABÓ Viktor, LAKOSI Ferenc, NAGY Máté, DÓCZI Tamás, BÜKI András, SCHWARCZ Attila

[The en bloc resection of spinal tumors is required in primary spine tumors and in selected cases of secondary spine tumors, where the primary disease is under control and long survival time is expected. Three cases are presented, applying O-arm assisted navigation or minimally invasive anterior approaches for en bloc tumor removal. O-arm navigation assisted osteotomies were carried out to remove a Th.V. breast tumor metastasis en bloc, intact bony part of the Th.V. vertebra was spared. Vertebral corpectomies of a patient with L.IV. chordoma and of a patient with L.V. carcinoid were also performed using minimally invasive, microscope assisted, anterior approaches to the lumbar spine. No morbidity or local recurrence were detected in the patient with breast cancer 1 year after the operation. Nevertheless, new spinal metastasis were revealed 1 year after surgery despite the appropriate oncological treatment. The patient with L.IV. chordoma is still tumor free (last follow-up: 18 month after surgery), but post operatively detected lower limb paresis and gait disturbances are persisted. The posterior healthy bony parts of the spinal column remained intact, since only anterior approaches were used for en bloc L.IV. corpectomy. No morbidity or recurrence was detected in patient with L.V. carcinoid tumor on 1 year follow-up. Both the O-arm navigation assisted surgery and the minimally invasive anterior approaches to the spine can help to reduce surgical morbidity and to spare healthy bony structures of the spine. The later could play important role to provide long term spine stability. The presented new surgical technologies can be accepted only, if they produce at least the same oncological results on longer follow-ups as conventional surgical approaches.]

Clinical Neuroscience

Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study


Objective - Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. Inflammation is a hypothetic etiological factor in BPPV. The aim of this study was to evaluate inflammatory biomarker levels in BPPV patients and compare these with the healthy subjects. Materials and methods - This prospective case-control study was conducted with 114 newly diagnosed BPPV patients and age- and sex- matched 83 healthy subjects. The laboratory investigations included serum hemogram, full biochemistry profiles, vitamin levels, thyroid hormone profiles, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte to HDL-cholesterol ratio (MHR) values were calculated and compared between the patients and healthy subjects. Results - The mean age was 39.1 ± 12.4 years for patients, and 37.0 ± 11.9 for controls. Vitamin B12, hematocrit (Hct), creatinine, urea, and fT4 values, lymphocyte, total bilirubin, direct bilirubin and indirect bilirubin levels were significantly lower in BPPV patients (p ˂ 0.05), while HDL, SGOT, and ESR values were significantly higher. In the BPPV patients the mean NLR, PLR, and mean platelet volume (MPV) values were significantly higher than in the control subjects. Neutrophil, platelet, monocyte, MHR, and CRP values were similar in both groups (p ˃ 0.05). Conclusion - Our result suggests that NLR, PLR, MPV, ESR, and bilirubin levels should be taken into account as potential biomarkers of BPPV. As they are inexpensive parameters and widely available, they can be used in clinical practice for prediction of BPPV. However, further large-scale studies are required to confirm this relationship.

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[Frequency and risk factors of “de novo” tumors after kidney transplantation ]


[After kidney transplantation, the administration of immunosuppressive therapy not only renders the patient susceptible to infections, but it may also damage the function of tumor cell recognition and elimination. Our study was performed at the Department of Surgery, University of Szeged. After establishing the inclusion criteria, 570 patients were involved in the study. We examined the age, sex, immunosuppressive therapy of the patients, and searched for the rela­tionship between the different immunosuppressive agents and the type of the tumor. In 81 cases, de novo cancer was diagnosed. Among patients treated with cyclosporin and tacrolimus there was no significant difference in the mean age (p = 0.734) and body mass index (p = 0.543). There was no significant difference in graft function between the two groups of patients (Tac vs Cyc; 44 vs 20). Related to the time passed since the trans­plantation to diagnosing the tumors the earliest were prostate and cervix cancers however without significant difference. Skin cancers are the most frequent followed by post-transplant lym­pho­prolife­ra­tive diseases. The increasing risk of developing tumors is mainly due to immunosuppressive therapy. ]

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[Somatostatinoma of the duodenum]

JUNG János

[A malignant endocrine tumor of the middle part of the duodenum is reported in a 58-year old male patient. The tumor was examined with immunohistochemistry and was found to contain predominantly somatostatin-immunoreactive cells with rare cells showing glucagon and HCG immunoreactivity. Microscopically, the tumor had mixed architecture, with a trabeculo-glandular pattern. The first (frozen section) examination suggested a moderately differentiated adenocarcinoma. ]