Lege Artis Medicinae

[The role of ultrasound in the diagnosis of septic hip prosthesis loosening]

FÖLDES Károly1, BÁLINT Péter1, GAÁL Marianna1, KISS Csaba1, BÁLINT Géza1

SEPTEMBER 30, 1992

Lege Artis Medicinae - 1992;2(09)

[The aim of the authors is the application of non-invasive ultrasound examination to the detection of complications after hip joint arthroplasty. Their recent work has been a trial to explore the kind of diagnostic assistance of ultrasound in case of suspected endoprosthetic infection. 39 patiens have been examined after hip joint arthroplasty. Out of this sample there was a suspected clinical infection in 20 cases. The rest 19 patients had no complaints and made the control group. Out of the patients with complaints effusion was detected around the neck of the prosthesis by means of US in 7 cases. Out of these in 10 cases reoperation in 6 cases US guided joint aspiration verified our US results. The authors made conclusion that as to patients having complaints of pain after hip joint arthroplasty very useful assistance in avoiding infection may be given by quided ultra sound aspiration.]


  1. Országos Reumatológiai és Fizioterápiás Intézet



Further articles in this publication

Lege Artis Medicinae

[Echocardiography in the management of acute myocardial infarction]


[The author presents a detailed review of the role of echocardiography (echo) in the management of acute myocardial infarction (AMI). The echo diagnosis of AMI is based on segmental wall thinning and akinesia with a 90% accuracy. Echo has made a major impact on the immediate diagnosis of mechanical complications in the hemodynamically compromised patient with AMI. These mechanical complications which include myocardial rupture of the free wall or the septum or the papillary muscle, may be successfully treated by prompt surgical intervention. Echo diagnosis has an important role in the management of other complications of the acute, subacute and chronic phases of infarction as well, such as pericardial effusion, left ventricular thrombus, left ventricular aneurysm and pseudoaneurysm. Therapeutic strategies are thoroughly affected by systolic and diastolic function assessed by echo. Echo has a basic role in the algorithm of postinfarction anticoagulant treatment. Besides rest echo, early stress echo has a definite prognostic value in predicting multivessel disease and identifying viable myocardium which requires revascularisation procedures. The indications for echo in the acute phase and before discharge are summarized according to recent American recommendations. ]

Lege Artis Medicinae

[Clinical and immunological aspects of polymyositis and dermatomyositis]

DANKÓ Katalin, ZILAHI Zsolt, SZEGEDI Gyula

[Polymyositis and dermatomyositis are autoimmune diseases characterized by muscle weakness, tenderness, occasionally pain, and ultimately atrophy and fibrosis of the muscles. The extraskeletal manifestations, particularly the cardiopulmonary, oropharyngeal, gastrointestinal involvement, are described. Studies of autoantibodies and cellular immune function support a central role for disordered immunity in the pathogenesis. The myositis-specific autoantibodies, expecially those directed at certain enzymes important in protein synthesis are found in a clinically distinct subset of patients. ]

Lege Artis Medicinae

[Right ventricular infarction]

KISS Gabriella

[Right ventricular infarction (RVI) may occure as isolated or, more often, associated with left ventricular – inferior or occasionally anterior - infarction. The diagnosis of RVI is based first of all on the characteristic clinical symptoms, on the ECG pattern and on the results of 2D-echo-cardiography. The exact localisation of the infarction has vital significance in the therapy of the acute phase. The mortality can be substantially decreased with adequate therapeutic measures even in severe cases. The prospective prognosis of RVI is more favourable than that of left ventricular infarcti on. The author presents the most important diagnostic and therapeutic features related to RVI. ]

Lege Artis Medicinae

[Role of platelet function in the pathogenesis of alzheimer's disease]

HASITZ Mária, LIPCSEY Attila, RÁCZ Zoltán

[Dementias, especially those of Alzheimer type represent very serious types of disease in the elderly. Amounting evidence suggests that Alzheimer's disease is reflected in the platelets of the patients. Our results and the data of scientific literature have been summarized. In vitro parameters of platelet shape and aggregation were compared. Platelet shape, characterized by aggregometer oscillation amplitude, and the initial rate of 50 uM ADP-induced aggregation have been recommended for supporting the diagnosis of Alzheimer's disease or Alzheimer-type senile dementia. Our results and those of others revealed that the function of the Alzheimer platelet is influenced by two effects: the plasma medium and the genetic background resulting in the change of the platelets. The results suggest that both effects are involved in the vitro functions detected.]

Lege Artis Medicinae

[Endoscopic "limited" resection of early gastric cancer theorethical approach and the first steps of clinical practice in hungary]

SIMON László, DOMJÁN Lajos, BALOGH István, DEÁK György, FEHÉR István

[Recently – based upon Japanese experiences - a new method was applied in the surgical strategy of early gastric carcinoma resection: endoscopic („limited”) resection of the lesion optionally in selected cases. Methods of endoscopic interventions are outlined, „mucosal strip biopsy" in details. The first Hungarian application of this method was successfully performed in case of II.a type early gastric cancer developed in an old patient of high operational risk. Two cases of early gastric carcinoma are analysed, summarizing the indications and contraindications of the operative endoscopical intervention, criteria of the selection of suitable cases, and the needs of the oncological-histological evaluation.]

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Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

Chronic cerebrospinal venous insufficiency - disease or misdiagnosis?

PÁNCZÉL Gyula, SZIKORA István, BERENTEI Zsolt, GUBUCZ István, MAROSFŐI Miklós, KOVÁCS Krisztina, RÓZSA Anikó, RÓZSA Csilla

Background and purpose - Former studies reported internal jugular vein stenosis in patients with multiple sclerosis. We aimed to evaluate if these venous stenoses were real and cerebral venous outflow of patients with multiple sclerosis differed from that of normal controls. Methods - 20 controls were prospectively investigated by angiography and duplex ultrasound. Seven patients with multiple sclerosis underwent angiography in other centers; we reviewed these registrations and performed venous ultrasound examinations. Results - Angiography displayed >50% stenosis of internal jugular vein in 19 controls (69±17% on the right and 73±13% on the left side) and <50% stenosis in 1 control (43.5% and 44.6%). All 7 patients had at least one-sided stenosis. The mean degree of stenosis was 63±16% on the right and 67±13% on the left side. There was no significant difference in the degree of stenosis between patients and controls. However, these “stenoses” disappeared if the contrast agent was injected at a catheter position below the orifice of the subclavian vein during venography. The venous flow volume was also similar between groups: 479.7±214.1 and 509.8±212.0 ml/min (right and left side) in the patients and 461.3±224.3 and 513.6±352.2 ml/min in the control group; p=0.85 and 0.98 (right and left). Color and power duplex imaging also revealed normal blood flow of the internal jugular vein in all patients and controls. Conclusion - The cerebral venous status of patients with multiple sclerosis and controls were similar. The angiographic “stenoses” were virtual, caused by the contrast dilution effect of the non-contrast blood stream of the subclavian vein.

Hungarian Radiology

[Ultrasound of the acute pediatric scrotum]

COLEY D. Brian

[Proper evaluation of the acute scrotum, like any condition, starts with a history and physical examination by an experienced clinician. Often this is all that is needed to arrive at an accurate diagnosis, which then allows prompt and appropriate treatment. However, the true nature of the underlying disease producing scrotal pain is not always clear, and the consequences of error (testicular loss) are undesirable. Ultrasound is the single most useful imaging tool for imaging the scrotum. While nuclear medicine studies can help assess blood flow, the combination of anatomic detail provided by modern ultrasound equipment and the ability to assess blood flow and perfusion with color Doppler makes ultrasound invaluable. Properly performed and interpreted, ultrasound provides very high sensitivity and specificity for acute scrotal conditions. Understanding of the conditions that produce acute scrotal pain in children will improve one’s diagnostic abilities. The most important diagnosis to consider is testicular torsion, since untreated this will result in testicular death. While testicular torsion can occur at any age, it is most common in the perinatal and peripubertal age groups. Torsion of a testicular appendage is a frequent cause of scrotal pain in prepubertal males. The sonographic findings can mimic epididymitis, but diligent and focused sonographic examination can make the diagnosis. Epididymitis typically affects postpubertal males, but can be seen in younger patients with functional or anatomic urinary tract anomalies. Sonographic evaluation of the post-traumatic painful scrotum can help to differentiate injuries that can be managed conservatively and those that require surgery. Less common causes of scrotal pain include hernias and hydroceles, vasculitis, and idiopathic edema. Understanding the characteristic sonographic features of these conditions allows the examining physician to make more accurate and confident diagnoses. It is hoped that this review article will help to promote this understanding.]

Lege Artis Medicinae

[The role of MRI in the diagnosis of tumours]


[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.]

Lege Artis Medicinae

[Hip joint involvement in rheumatoid arthritis: pathological features and orthopaedic treatment]


[The authors review the orthopaedic surgical treatment possibilities of the hip joint affected by rheumatoid arthritis. In the first part, they draw the attention to the characteristic features of the disease. They describe a possible pathological interpretation of rheumatoid arthritis and emphasize the specific features of the rheumatoid hip joint. Different surgical interventions and treatment possibilities are analyzed. Because of the multiple joint involvement in these patients, the possibility of sequential operations has to be considered. The importance of close cooperation between rheumatologists and orthopaedic surgeons is emphasized. According to the authors, one of the most effective long term treatment possibility of the rheumatoid hip is the total hip arthroplasty.]