Lege Artis Medicinae

[MAGNETIC RESONANCE IMAGING IN NEUROLOGY. PART I. - IMAGING OF THE BRAIN]

VÖRÖS Erika

DECEMBER 20, 2004

Lege Artis Medicinae - 2004;14(12)

[Magnetic resonance imaging has become a basic imaging method in neurological diagnosis in the past decade. It provides excellent anatomical, morphological and in special indications, functional information on the central nervous system. In this issue, the role of magnetic resonance imaging in the diagnosis of brain diseases is outlined in connection with relevant clinical courses and the cardinal neurological signs.]

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Lege Artis Medicinae

[LETHAL SEPTIC INFECTION IN RHEUMATOID ARTHRITIS]

BÉLY Miklós, APÁTHY Ágnes

[INTRODUCTION - The lethal septic infection was studied in a randomized (non-selected) autopsy population of 234 in-patients with rheumatoid arthritis. The patients died at the National Institute of Rheumatology between 1970 and 1999. PATIENTS AND METHOD - The aims of this study were to determine the prevalence of lethal septic infection with or without purulent arthritis in rheumatoid arthritis; the relationship between purulent arthritis and lethal septic infection; the clinically missed diagnosis of lethal septic infection and purulent arthritis; the influence of the main complications and associated diseases on lethal septic infection with and without purulent arthritis; the pathogens in lethal septic infection; and the clinico-laboratory parameters associated with lethal septic infection in rheumatoid arthritis. RESULTS - Lethal septic infection was found in 31 (13.24%) of 234 rheumatoid arthritis patients. Purulent arthritis complicated lethal septic infection in 15 (6.4%) of 31 patients. There was a significant association between lethal septic infection and purulent arthritis. Sepsis was detected clinically in 17 of 31 lethal cases and purulent arthritis was detected 9 of 15 septic infection complicated with suppurative articular processes. The coexistent complications (systemic vasculitis, AA amyloidosis), and associated diseases (tuberculosis with or without miliary dissemination, malignant tumors, diabetes mellitus) did not influence the prevalence of septic infection. The most frequent pathogenic agents were: Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella species, Streptococcus species. The patients with septic infection had significantly lower levels of beta-globulin, and higher values of Waaler-Rose or latex fixation test in comparison to patients without septic infection or without complications. CONCLUSION - Lethal septic infection may exist in rheumatoid arthritis without the classical clinical symptoms of sepsis, and clinically latent suppurative processes may be found at autopsy. The missed clinical diagnosis of a fatal complication is explained by the weak immune response and atypical clinical symptoms of elderly patients mainly treated with steroids and immunosuppressive drugs.]

Lege Artis Medicinae

[A new medical field is born - The first world congress of immuno-genomics, Budapest]

PÓS Zoltán, WIENER Zoltán

Lege Artis Medicinae

[THE RELATIONSHIP BETWEEN THE DEPRESSIVE MOOD OF PARENTS AND THE BEHAVIOURAL PROBLEMS OF THE CHILD]

HAJNAL Ágnes, SUSÁNSZKY Éva, SZÁNTÓ Zsuzsa, CSOBOTH Csilla

[INTRODUCTION - In this article we analyze the relationships between behavior problems of adolescents and depressed mood of their parents based on literature review and on our own questionnaire surveys. METHODS - We present the data from two surveys conducted among Hungarian adolescents. The first survey was conducted among 1604 young women students, aged of 15-19 years. The second survey included 502 high school students in Budapest. Both surveys were aimed at the lifestyle, health behavior, risk behavior, and emotional state, as well as the social-economic status and family background of the adolescents. Data of both surveys were analyzed using the SPSS 8.0 statistical program package. The association between the mood category of mothers and fathers and the risk factors and emotional state indicators of their children were tested with χ2 tests, as well as the indicators of students whose parents were not treated for depression. RESULTS - Data from both surveys suggest that there are close relationships between the negative mood states of the parents and the behavior problems of their children, especially between the mood of mothers and the behavioral and emotional state of daughters. CONCLUSIONS - Our research data call attention to the phenomenon that girls react explicitly and quite sensitively to the mood state of their mothers while the boys’ behavioral and emotional states are less responsive to their parents’ mood. On the other hand, boys react more intensively to the emotional instability of their fathers than to the instability of their mothers.]

Lege Artis Medicinae

[THE PRACTICE AND PROBLEMS OF EVIDENCED BASED DRUG TREATMENT]

KERPEL-FRONIUS Sándor

[The organization, the budget and the practical delivery of modern healthcare are all based upon the sum of available evidences. However, in the individualized drug therapeutic decisions beside the external evidences the personal experience of the treating physician as well as the preferences and expectations of the patients must be represented with equal emphasis. Without the interaction of these three modern, patient oriented medicine is not conceivable. Evidenced based drug application is primarily based upon the results of prospective, randomized, controlled clinical trials. The individual experiences and the systematic observations represent the lowest level of the evidence hierarchy. The results of the clinical studies are expressed as the absolute difference of the results of the treated and control groups and as relative values relating the outcome of the experimental group to the control, respectively. In practice the easily interpretable term "number needed to treat" is widely used. It shows how many patients have to be treated relative to the control group in order to observe the expected therapeutic outcome in one case. The wealth of evidences cannot be efficiently used without systematization in the daily practice. Therefore, the data collected from the independent publications containing the primary evidences are subjected to a joint statistical evaluation. Thereafter, the results are combined in systematic reviews by independent experts following thorough weighting without prejudice. Then short summaries, more easily and rapidly digested by practicing physicians are made according to the same principle. They are restricted to the presentation of the problem, the tabulation of the summarized data and the conclusion. It is expected that in the future systems combining the electronically stored patient's data with external evidences making possible the patient oriented presentation of the sum and hierarchy of evidences will be extensively used.]

Lege Artis Medicinae

[BOUVERET’S SYNDROME]

KESZTHELYI László, FÓGEL Kristóf, VADINSZKY Péter, SÁVOLT Ákos, PŐCZE Balázs, BALOGH István

[INTRODUCTION - Gallstone ileus is a rare disorder among elderly population. The gallstone coming through a bilioenteral fistula into the gastrointestinal tract is stuck into the duodenal lumen causing ileus in approximately 0,5% of all cases. The syndrome is named after Bouveret, the first describer. CASE REPORT - Author present the case of 72 year old female patient with known cholelithiasis. Investigations proved existing cholelithiasis causing the patient abdominal pain one year before admission but she gave no consent to surgical intervention. An emergency admission to our department occurred after four days of abdominal pain and vomiting. The clinical status of the patient and abdominal X-ray examination suggested stomach evacuation disturbance. Double contrast barium swallow test and gastroscopy proved bowel obstruction caused by a gallstone. During surgery gastrotomy and the removal of gallstone was carried out. There were no postoperative complications and the patient was discharged home. CONCLUSION - Cholelithiasis should be resolved at any chosen time well before complications may occur. The simultaneous appearance of stomach evacuation problems and cholelithiasis should draw attention to this rare disease.]

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[MR imaging of acute disseminated encephalomyelitis and multiple sclerosis in children. A review (in English language)]

PATAY Zoltán

[Inflammatory diseases of the central nervous system (CNS) are relatively rare in children, but their relevance to public health is considerable due to frequent and significant long term morbidity and even mortality. As in adults, acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) and their variants are the most common entities in this group of pathologies in the pediatric patient population. Recent efforts have focused on establishing standardized diagnostic criteria schemes to facilitate the diagnosis and differential diagnosis of these diseases, however especially with multiple sclerosis those have not been fully validated yet for disease occurring in children. In recent decades the role of MRI has been constantly increasing in the diagnostic work-up of suspected inflammatory diseases of the CNS as well as in the follow-up of patients with confirmed disease. Currently, MRI is the first-line diagnostic imaging modality in ADEM and MS and is fully integrated in the most widely used diagnostic criteria schemes, but it has a key role in clinical therapeutic research trials as well. This paper provides an update on the current concepts and strategies of MRI in inflammatory diseases of the CNS, as well as a review of the imaging semiology of the various disease entities and variants with emphasis on clinical and imaging particularities relevant to the pediatric patient population.]

Clinical Neuroscience

Marchiafava-Bignami disease: Report of three cases

GUNAY Gul, MESUDE Özerden, ZEYNEP Ozdemir, CAHIT Keskinkiliç, HAKAN Selçuk, BATUHAN Kara, AYSUN Soysal

Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder characterized by demyelination and necrosis of the corpus callosum. We report three patients who had history of chronic alcoholism, different clinical presentation and MRI findings consistent with the diagnosis of Marchiafava-Bignami disease.

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

Lege Artis Medicinae

[MAGNETIC RESONANCE IMAGING IN ABDOMINAL DIAGNOSTICS]

PALKÓ András

[Magnetic resonance imaging (MRI) plays more and more important role in the abdominal imaging diagnostics since fast measurement sequences have become available making it possible to avoid movement artifacts and resulting in better quality and more informative images of the abdominal parenchymal organs and most segments of the gastrointestinal tract. The greatest advantage of MRI is that it is able to create images of adequate geometric resolution and excellent tissue characterization capacity without the use of ionizing radiation and iodinated contrast media. Today MRI is applied mostly in those cases when previous data suggest that computed tomography will not be informative or the results of recent imaging examinations (x-ray, ultrasound, computed tomography) do not provide sufficient diagnosis. Presumably MRI will be used with increasing frequency as the first or single best method of choice in the near future. Beased on these facts in abdominal diagnostics, MRI may be considered as a problem-solving modality which plays an outstanding role in the detection, differential diagnosis, staging and follow-up of many neoplastic and inflammatory lesions.]

Hungarian Radiology

[Xanthogranulomatous cholecystitis]

BERÉNYI Zsolt, MORVAY Zita, PALKÓ András

[INTRODUCTION - The xanthogranulomatous cholecystitis is a rare and benign form of lesions associated with diffuse thickening of the gall bladder wall. It is important to recognize it radiologically because it can be mistaken easily for gall bladder carcinoma. The characteristic US, CT and MR findings, however, may be helpful in the differential diagnosis. CASE REPORT - We present the cases of two middleaged female patients suffering from right upper quadrant, radiating abdominal pain for several weeks without occurrence of fever. In both patients, the ultrasound examination revealed marked thickening of the gall bladder wall containing hypoechoic nodules. Further, non-specific sign such as cholecystolithiasis and fine infiltration of the adipose tissue surrounding the gall bladder and dilatation of extrahepatic or intrahepatic bile ducts were visible. On the post contrast CT images, rim enhancement was detectable. MR/MRCP examination showed a sharp delineation of the gall bladder from the liver parenchyma. Both patients underwent cholecystectomy. The pathological examination excluded malignancy and confirmed the diagnosis of xanthogranulomatous cholecystitis. CONCLUSION - The characteristic features of xanthogranulomatous cholecystitis (hypoechoic xanthogranulomas in the markedly thickened gall bladder wall and the presence of calculi) can be detected by ultrasound examination. CT or MRI may play an important role in confirmation of the diagnosis of an inflammatory process and provide useful information in exclusion of gall bladder carcinoma.]