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Hungarian Radiology

JULY 15, 2009

[Can magnetic resonance imaging play a role in planning the method of delivery after Caesarean section?]

GERGELY István, CSÉCSEI Károly, DORFFNER Roland, BARANYAI Tibor

[INTRODUCTION - The number of Caesarean sections has been dramatically increasing worldwide, and also in Hungary in the last decade. In case of pregnancy following a preliminary Caesarean section it is always questioned if repeated Caesarean section or vaginal birth is required. The authors try to draw a conclusion from the thickness and the structure of the uterinal scar. The aim of the current study is to assess the additional role of uterinal MR examination undertaken between two births. PATIENTS AND METHODS - During our retrospective preliminary study T2 weighted sagittal images of uterinal MR examinations of 13 female patients were analysed. The presence of scar line was evaluated for thickness (millimetres, mm). This measurement was compared with the surgical report following consequent Caesarean section. Thus, a correlation was made between the surgical scar found at the repeated Caesarean section and the structure of the uterine scar seen by MR examination (between two births) which could play a role in the indication of the next birth. RESULTS - Three of our 13 patients gave birth via vagina (VBAC), and 10 via repeated Caesarean sections. According to the descriptions of the surgical scar the scars thinned out in six cases, whereas they made thickness in four. According to the appearance of the place of incision the scar was homogeneous and hypointens in nine cases, and inhomogeneous but basically hypointense in one case. According to the description of surgery in the MR examination the thinned out scar was thinner than 6 mm in 4 cases, and thicker than 6 mm in two cases. According to the description of surgery in the MR examination the nonthinned out scar was thinner than 6 mm in three cases, and thicker than 6 mm in one case. In two patients of three who gave birth via vagina the scar was thicker than 6 mm in the MR examination, and thinner than 6 mm in one case, the MR appearance of the scar was homogeneous and hypointens in two cases and complied with the original zonal anatomy in one case. CONCLUSION - In case repeated Caesarean section is not necessary from the aspect of the foetus or the mother, uterinal MR examination is of an additional significance in the complex indication of birth following a previous Caesarean section. The thickness, structure and signal intensity of the uterinal scar may provide a useful additional information.]

Lege Artis Medicinae

NOVEMBER 19, 2006

[INSULIN ASPART IN THE CLINICAL PRACTICE]

JERMENDY György

[Insulin aspart (B28 Asp-insulin), which is produced by recombinant DNA technology, is a fast-acting insulin analogue. Due to the aspartate for proline substitution at position 28 of the Bchain, the insulin molecule's tendency for selfassociation is diminished, therefore, insulin aspart rapidly dissociates into dimeric and monomeric forms and absorbs quickly and easily after subcutaneous administration. Compared to human regular insulin, insulin aspart has a faster onset of activity, a higher plasma peak and a shorter duration of action. Overall, the pharmacokinetic profile of insulin aspart better mimics the physiological postprandial insulin secretion. Therefore, insulin aspart can be used for prandial insulin substitution in order to decrease postprandial blood glucose excursion. It should be administered immediately before meals, but some observations suggest that it can also be used after finishing meal. This allows a more flexible lifestyle for patients. Insulin aspart can be used in both type 1 and type 2 diabetes. Compared to regular human insulin, a moderate decrease in the HbA1c values and fewer nocturnal hypoglycaemic events are expected from insulin aspart use. Insulin aspart is appropriate for pump treatment as well. It has recently been approved for use in pregnancy, whereas for children and adolescents the expected benefits should be weighed against the more modest clinical experience available. Similarly to other insulin analogues, results of long-term clinical investigations with insulin aspart with regard to the development of complications are not yet available.]

Hungarian Radiology

DECEMBER 20, 2003

[Intrauterine MR studies of the fetus]

SHAIKH Shoaib, LOMBAY Béla

[Ultrasound plays the primary role in the diagnostic examination to identify prenatal congenital abnormalities. In certain cases when the ultrasound is equivocal, fetal MRI can be performed in order to provide additional information to US. Based on the results of MRI, decision can be made to continue or to terminate the pregnancy. MR can be performed without premedication. No evidence of fetal risk has been reported. The new MR systems decreased the artifacts due to fetal movements, good quality studies can be done from the second trimester.]

Lege Artis Medicinae

JANUARY 20, 2011

[Osteonercosis of the femoral head during pregnancy]

KISS-POLAUF Marianna, TAKÁCS János, TASI Róbert, RÁKÓCZI István

[Osteonecrosis of the femoral head associated with pregnancy is a rare condition. Approximately 40-50 cases have been reported, the first one by Pfeifer in 1957. Avascular osteonecrosis is usually caused by factors that impair the bone’s blood supply (intraosseous arterious or venous occlusion, venous stasis, hypertension in the bone marrow). Owing to the cautious use of radiological imaging techniques during pregnancy and the limited experience with this condition, the correct diagnosis is usually made only retrospectively. Thus, total hip replacement is required in most cases. In the third trimester, MRI examination is safe to perform, and in some cases a simple X-ray should be also considered, as timely avoidance of weight-bearing and other therapeutic interventions might help to prevent the arthroplasty. Here, we would like to present a case observed and treated by us, and to overview the options that could facilitate making the correct diagnosis and finding the appropriate therapeutic program.]

Lege Artis Medicinae

MARCH 20, 2005

[Pregnancy in women with systemic lupus erythematosus]

KISS Emese, BHATTOA P. Harjit, BETTEMBUK Péter, BALOGH Ádám, SZEGEDI Gyula

Lege Artis Medicinae

JANUARY 20, 2010

[Special problems of hypertension in women]

KAPOCSI Judit, DEÁK György

[Menopause and pregnancy are especially vulnerable periods of women’s life regarding hypertension. The “Guidelines for the Management of Arterial Hypertension”, issued by the European Society of Hypertension and the European Society of Cardiology, dedicates a separate chapter to hypertension in women. The renewed guidelines of the Hungarian Society of Hypertension also pays a special attention to hypertension detected during pregnancy. In this article, the euthors review the topics of hypertension detected during menopause and pregnancy, discussing pathomechanism and therapy.]

Lege Artis Medicinae

JULY 20, 2006

[POSSIBLE TERATOGENICITY OF VAGINAL METRONIDAZOLE TREATMENT AND ITS EFFECT ON GESTATIONAL AGE AND PREVALENCE OF PRETERM BIRTH - CASE-CONTROL STUDY]

KAZY Zoltán, PUHÓ Erzsébet, CZEIZEL Endre

[INTRODUCTION - The primary aim of the study was to investigate the possibility of a teratogenic effect of vaginal metronidazole treatment during pregnancy. MATERIALS AND METHODS - Various congenital abnormalities and all (1-3) their matched controls were analysed in the population-based database of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. The study group comprised 38 151 pregnant women who had newborns without any congenital abnormalities (control group) and 22 843 pregnant women who had newborns or fetuses with congenital abnormalities. Main outcome measures were analysed in 22 congenital abnormalities groups. The use of metronidazole during the second and third trimesters being common, the secondary objective of the study was to analyse the effect of vaginal metronidazole treatment (500 mg of Klion) on gestational age and birth weight in the control group without congenital abnormalities. RESULTS - The prevalence of vaginal metronidazole treatment during pregnancy was 1.7% in the case group (n=388) and 1.5% in the control group (n=570) (odds ratio (OR), 1.1, 95% confidence interval (CI): 1.0-1.3). Comparisons of cases and their matched controls showed an association between vaginal metronidazole treatment during the second and third months of gestation and congenital hydrocephaly (adjusted OR with 95% CI, 10.7, 1.1-104.5), but this was only based on five cases. The analysis of metronidazole treatment reported by the physicians did not confirm this association. After metronidazole use the mean gestational age was slightly shorter (by 0.1 week) and the mean birth weight was also slightly lower (by 40g) in the treated group. CONCLUSION - This finding should only be regarded as an indication for a possible association between vaginal treatment with metronidazole during pregnancy and congenital hydrocephalus. The results showed that vaginal metronidazole treatment alone was not able to prevent a possible vaginal infection that is associated with preterm birth, and that the prevalence of low birth weight was higher among treated women. The protective effect of metronidazole on preterm birth and low birth weight was not confirmed.]

Clinical Neuroscience

JANUARY 20, 2009

[Genetically determined neuromuscular disorders of some roma families living in Hungary (in English language)]

LÁSZLÓ Aranka, MAYER Péter, KÓBOR Jenõ, RÁCZ Katalin, TÁLOSI Gyula, ENDREFFY Emőke, HERCZEGFALVI Ágnes, HORTOBÁGYI Tibor, TISZLAVICZ László, BEREG Edit, KATONA Márta, SZABÓ János, KARCAGI Veronika

[The authors discuss the clinical and molecular genetic aspects of genetically determined neuromuscular disorders of some Roma families living in Hungary. Among the autosomal recessively inherited spinal muscular atrophic (SMA) group, 8 Caucasian children had the typical 7-8 exonal deletions of the SMA gene, but only 2 patients belonged to the Roma population. There was no difference in the molecular genetic findings among the Caucasian and the Roma SMA patients. All of them had 7- 8 exonal deletions of the SMA gene. We wanted to call attention to the founder mutation of the Roma population in 7 patients suffering from congenital myasthenia (CMS) from 3 Roma families. The 1267G deletion for CMS was detected by molecular genetic method. Clinical onset was pubertal and relatively slow progression of specific and phenotypic features for this founder mutation of acetyl-cholin receptor epsylon gene. In 2 patients (sister and brother) the sarcoglycanopathy 2C type C283Q mutation was proven in one Roma family suffering from limb-girdle muscular dystrophy (LGMD). Two out of the three facioscapular-humeral dystrophy (FSHD) Roma families carried 21.8 kb and 18.5 kb alleles in FSHD A1 gene (D4S139). In one family together with prenatal diagnosis founder mutation in FSHD A1 gene was detected, according to the autosomal dominant (AD) inheritence. In (F2) prenatal diagnosis was carried out, 18.5 kb/18.5 kb homozygosity was proven in the fetus, so the pregnancy was interrupted. In the CMS, LGMD and FSHD Roma patients ancient typical Roma founder mutations were found.]

Lege Artis Medicinae

FEBRUARY 20, 2011

[Influenza vaccination of pregnant women and the experiences related to the pandemic influenza A-virus H1N1 infection in Hungary 2009]

CZEIZEL Endre

[During the influenza A-H1N1 pandemic, only about 16% of pregnant women were vaccinated against the virus, despite their higher expected mortality risk. According to the official data, five pregnant women died. In addition, the high fever that occurs in influenza increases the risk of some congenital abnormalities. The vaccine used in Hungary is not associated with severe complications in pregnant women and their fetuses, therefore, it can be administered during any stage of pregnancy. The author discusses the causes that deterred pregnant women from being vaccinated. The main problem seems to be that some physicians were under-informed and were reluctant to take responsibility.]

Clinical Neuroscience

SEPTEMBER 30, 2008

[Antiepileptic drugs as mood stabilizers: what did we learn from the epileptology?]

RAJNA Péter

[Author summarizes the practical aspects of psychiatric application of mood stabilizing antiepileptic drugs. He observes how to transfer experiences taken from the “epileptological” practice into the psychiatric care of bipolar patients. He shortly demonstrates the relevant information on the mechanisms of action, controversies and possible clinical effects influenced by the seizure inhibiting effect of the concerning molecules. By the opinion of the author the clinical importance of pharmacokinetic parameters are underestimated in the psychiatric practice. Therefore - as an original approach in the literature - he summarizes the detailed clinical indications of serum level measurements of antiepileptic drugs applied in psychiatry as mood stabilizers. The therapeutic experiences in epilepsy added a lot of practices for the most effective dosing, building, tapering and exchange of the mood stabilizer antiepileptics. Drug interactions (appear among the psychotropic drugs or with the commonly used medicines). As in any chronic therapies the main condition of patient's compliance is the lacking or very mild presence of the applied therapy. The paper discusses the most frequently occurring and drug-specific side effects in table forms. Using the term of “relative therapeutic potential” the need of balance between the efficacy (influenced by the choice and dosing) and the tolerance are pointed. Rules of application can change significantly in special populations like in pregnancy, obesity, chronic diseases or in chronic comorbide states and in case of polytherapy. As for the special therapeutic effects, the experiences are not completed even in group of antiepileptics: we have larger and more favorable knowledge on the traditional drugs (carbamazepine and valproates) and on lamotrigine (from the newer generation) but promising but not enough information exists on the newest antiepileptic molecules. Further targeted studies are needed for the identification and positioning of antiepileptic drugs in the palette of mood stabilizing pharmacotherapy and for the definition of evidence based, individually tailored and lifelong applied highly effective combinations of the mood stabilizing pharmacotherapy containing antiepileptic agents.]