Lege Artis Medicinae

[The role of computed tomography in tumor staging of bronchogenic carcinoma]

HEILER Zoltán1, PÁLFFY Gyula1, KOSTIC Szilárd1, MONOSTORI Zsuzsanna2, REPA Imre2

MAY 26, 1993

Lege Artis Medicinae - 1993;3(05)

[Operability of lung cancer is based on the size and local extension of the tumor as well as the presence of lymph node and distant metastases. Agreement and disagreement between CT and surgical tumor staging was investigated for 197 cancer patients after surgery. Sensitivity and specificity of CT prediction ranged 57–93% and 71–100% ac cording to tumor stadium. CT diagnosis has been relatively unreliable in describing tumor propagation along the pulmonary veins (less frequently arteries) towards the atrium and in recognizing a discrete tumor invasion of the mediastinum. Local thickening of the parietal pericardium, and small pericardial effusion have been considered as indirect signs of pericardial tumor infiltration. MR examination have been found to be a supplemental technique for assessing tumor spread to the great vessels of the mediastinum. The authors believe on the results that new techniques, such as MR angiography and indirect CT signs will help in making a more accurate preoperative diagnosis of lung cancer.]

AFFILIATIONS

  1. Országos Korányi Tbc és Pulmonológiai Intézet Orvostovábbképző Egyetem Mellkasi Sebészeti Tanszék
  2. Semmelweis Orvostudományi Egyetem Központi Radiológiai Diagnosztika Budapest

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Further articles in this publication

Lege Artis Medicinae

[The prerequisite of T cell recognition: antigen processing and presentation]

RAJNAVÖLGYI Éva

[Multiple regulatory mechnanisms are activated wit hin the immune system to maintain the homeostasis of the organism. A key element of these processes is the specific recognition of antigens mediated by T and B lymphocytes. This is the basis of clonal selection and antigen specific activation of the immune system (LAM 1991. 1(18):1308–1314.) which results in the most efficient elimination of the antigen. T cells play a predominant role in the discrimination of self and non-self structures. Antigen specific activation of T cells results in the expression of cell surface molecules and in the production of different lymphokines of high biological activity, which define the possibilities for cell to cell interactions and influence the function of different cell types affecting the outcome of the immune response. The appropriate activity of functionally distinct T cells enables the most efficient mobilization of effector mechanisms leading to the elimination of the antigen without destroying self components. In order to exert their regulatory and effector functions they require a well regulated collaboration with antigen presenting cells. This review summarizes our present knowledge on the intracellular degradation and transportation pathways occuring on in antigen presenting cells determining the antigen specific functions of T cells. It is well established that these events influence the efficacy or protection against pathogens and have a basic influence on the normal or pathological outcome of autoimmunity.]

Lege Artis Medicinae

[Thoughts on radical hysterectomy]

BŐSZE Péter

[Radical hysterectomy and pelvic lymphade nectomy have been used for the treatment of carcinoma of the uterine cervix in most Western countries for decades. These surgical procedures, however, have rarely been advocated in Hungary. Advantages and disadvantages of radical hysterectomy with pelvic and paraaortic lymph node dissection are discussed. Emphasis is placed on patient selection. It is the author's view that radical surgery does have a place in the management of cervical cancer. The patient should be informed about the possible treatment modalities available such as radical surgery, radical radiation therapy or a combination of surgery and irradiation, and she should be involved in the decision making process. Radical hysterectomy with pelvic lympha denectomy is a major operation with potentially significant intraoperative and postoperative complications. A dequate surgical skill and sufficient experience are required and this procedure should be regularly practiced. For these reasons, it is probably best performed in cancer centres.]

Lege Artis Medicinae

[The Social Security Health Insurance Fund's Mental Hygiene Board of Trustees]

[The Board of Trustees of the Social Insurance Health Insurance Fund for Mental Hygiene invites applications for the implementation of mental health promotion and mental hygiene programmes from the fund allocated by Parliament from the 1993 social insurance budget, pursuant to Act LXXXIV of 1992. ]

Lege Artis Medicinae

[Report on gastroenterological endoscopic activity in Hungary in 1992]

NAGY György, JUHÁSZ László

[At the request and on behalf of the Endoscopic Section of the Hungarian Gastroenterological Society, we have compiled the main data of the Hungarian endoscopic activity in 1992. We received responses to our questionnaire from 117 endoscopic laboratories and one private endoscopic practice. The responses received were summarised in a table.]

Lege Artis Medicinae

[Heparin-Aspirin Reperfusion Trial]

MATOS Lajos

[Treatment efficacy was first assessed 7-24 hours after the start of rt-PA infusion: at this time, the coronary artery leading to the infarct was patency in 82% of patients also receiving heparin therapy, compared to 52% of patients receiving aspirin supplementation (p<0.0001). Vessels that were patency-free at the first test remained open in 80% of those also treated with heparin after one week, the same was 95% in those treated with aspirin (non-significant). Bleeding was observed in 18 patients in the heparin group and 15 in the aspirin group. Ischaemic events were observed in eight cases in the former group and in two cases in the latter group - these were not statistically significantly different. The mortality rate was 1.9% in the heparin group and 4.0% in the aspirin group. ]

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[A prospective study evaluating the clinical characteristics of cluster headache]

ERTSEY Csaba, VESZA Zsófia, BANGÓ Márta, VARGA Tímea, NAGYIDEI Diána, MANHALTER Nóra, BOZSIK György

[Introduction - Although cluster headache (CH) is one of the most severe human pain syndromes, its symptoms and therapeutic possibilities may be suboptimally recognised in current medical practice in Hungary. Aim - To present the clinical characteristics of CH based on a prospective study of patients attending the Headache Service of the Department of Neurology, Semmelweis University. Methods - We collected information about the symptoms, diagnosis and previous treatment of CH patients by filling in a 108-item questionnaire during outpatient visits. Results - In the 5-year period between 2004 and 2008 we obtained data from 78 CH patients (57 males and 21 females; mean age: 44.6±14.6 years). The male:female ratio did not change in subgroups based on disease onset (calendar years). Ninety-three percent considered CH the most severe pain state of their life. The pain was strictly unilateral, affecting the territory of the 1st trigeminal division in all patients. The attacks were accompanied by signs of ipsilateral cranial parasympathetic activation (lactimation 83%, conjunctival injection 67%, rhinorrhea 56%, nasal congestion 43%); less frequently, signs of sympathetic dysfunction (ptosis 48%, miosis 7%) were also present. Two patients had attacks showing the typical localisation, severity and time course of CH attacks, but not accompanied by autonomic phenomena. A considerable part of the patients also observed symptoms that are usually ascribed to migraine (nausea 41%, vomiting 18%, photophobia 68%, phonophobia 58%). This may have been instrumental in the fact that, regardless of the characteristic clinical symptoms, the diagnosis of CH took 10 years on average. At the time of their examination 63% of patients were not using adequate abortive medications and 59% did not have an adequate prophylactic measure. Discussion - Cluster headache is characterised by attacks of devastating pain that warrant an early diagnosis and adequate treatment. Our study underlines that information about the diagnosis and therapy of CH should be emphasized on occasions of neurology specialty training and continuing medical education.]

Lege Artis Medicinae

[The role of MRI in the diagnosis of tumours]

GŐDÉNY Mária

[Imaging is important in the evaluation of tumour detection, staging to determine the response to therapy, to follow the patient to find an early recurrent tumour. The ability to assess cancer spread has been revolutionized by advances of digital imaging modalities, such as digital ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI is the method of choice for detecting and evaluating brain, spine, head and neck and musculoskeletal tumours, but it is complementary in the investigation of the thorax. US and CT remains the primary test for imaging the abdomen, while MRI plays a subsidiary role as a problem solving technique. In the evaluation of focal liver disease numerous prior reports have documented a superior performance of MRI compared to CT and US in the detection of primary and metastatic liver tumours. MRI is gaining more and more importance in imaging of the pelvis. Breast MRI is increasingly used as an adjunct to conventional imaging modalities. Several recent developments in MRI have altered the role of this imaging, and it is often the preferred choice among diagnostic tools for the detection and characterization of tumour cases.]

Clinical Neuroscience

[Post-traumatic ischemic stroke in childhood]

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[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

Clinical Neuroscience

[Neurological and psychiatrical prospects of apathy]

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[During his long practice as head physician of a neurological and psychiatrical department with over 100 beds performed the examination and department of more than a hundred thousand patients. Based on the acquired experience and the data of the most recent literature he treats every aspect of the apathy syndrome. He emphasizes the multidisciplinary approach during both establishing the causes and the examination and treatment of patients. In order to clarify the diagnosis consultations with other disciplines must be used as well as the the knowledge provided by the now essential CT, MRI, PET, SPECT. The author discusses the international therapeutical possibilities and practice after the recently alredy possible exact diagnosis.]

Clinical Neuroscience

First experiences with MR-compatible implants in the management of Aneurysmal subarachnoid haemorrhage

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Aneurysm clips made of titanium alloy were considered to be useful for clinical application due to the expected reduction in artifact formation on postoperative CT and MR. First, the behaviour of the new titanium clip (Aesculap) was investigated in phantom experiments in CT and MR scanners. After the in vitro tests had proved the applicability of the new implants, a series of operations was performed employing the new clip in 21 patients and the traditional phynox clip in 17 patients. All patients with a titanium implant had postoperative 11, T2 and proton-weighted MR scans. In 12 cases pre- and postoperative; in 9 cases only postoperative MR angiographies were carried out. In 4 patients both control MR- and catheter angiographies were performed. Clinical results as analysed at least 6 months following the operation were not different from those of 1992 and 1993 of the same team and were comparable to recently published data in the literature. The study has shown that ability to effectively diagnose clip-adjacent brain structures can be improved considerably by employing clips of titanium alloys. Concerning the value of postoperative MR angiography either with or without contrast material to control the effectiveness of aneurysm occlusion, the following conclusion was drawn: while the postoperative potency of the parent artery was clearly visualized in every case, it was impossible to define whether occlusion of the aneurysm had been complete.