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Hungarian Radiology

JANUARY 20, 2003

[Ultrasonographic twin peak sign]

JAKOBOVITS Ákos

[INTRODUCTION - Author describes ultrasonographic twin peak sign in order to differentiate dichorial-diamniotic from monochronic-diamnotic pregnancy in early gestation. In case of dichorial pregnancy the chorial tissue is forming a triangle shape. In case of monochorial twins the two amnion layers are forming a ”T” shape. CASE REPORT - The first case represents a dichorionic pregnancy, while the second case is an example of monochorionic placental formation. CONCLUSION - The twin peak sign has clinical significance, because dichorionic pregnancies carry less risk of gestational and labor complications.]

Lege Artis Medicinae

DECEMBER 10, 2009

[Insulin analogues and pregnancy]

TAMÁS GYULA, KERÉNYI ZSUZSA

[Near-normoglycaemic metabolic control in pregnant women with diabetes - started before conception in pregestational diabetes - decreases the frequency of maternal and foetal complications. Such control can be achieved by using optimalised systems of insulin therapy. A number of (ultra)rapid and long-acting insulin analogues became available during the last decade, which - on the basis of theoretical considerations - might be used to maintain normoglycaemia. Summarising the data available today, the use of rapid insulin analogues (lispro, aspart) seem to be effective and safe during pregnancy. Some questions arise, however, about their modes of application. The use of long-acting insulin analogues in pregnancy is currently not indicated. Further trials are needed to prove their efficacy and safety in diabetic pregnancy.]

Hungarian Radiology

OCTOBER 20, 2007

[Prenatal detection of campomelic dysplasia by sonography]

NAGY Gábor, VRECZENÁR László

[INTRODUCTION - The campomelic dysplasia is a disorder characterized by short and bowed lower limbs resulting in dwarfism. CASE REPORT - In the case of a 21-year-old primipara woman the second screening ultrasonography raised the suspicion of short and bowed lower limbs of the fetus, at the 19th week of the pregnancy. Repeated examinations proved the presence of short and bowed femurs and tibias and abnormal echogenecity of the bones. The upper limbs were almost normal in length. During the 19th week of pregnancy, after a genetic analysis in agreement of the parents the pregnancy was interrupted without any complication. Photography and Xray of the fetus confirmed the diagnosis. CONCLUSION - Fetal ultrasonography should include exact size measurement and observation of the shape of the long bones, making possible the early detection of limb anomalies. The anomaly being proven by positive genetic analysis the pregnancy can be interrupted at the parents' request.]

Lege Artis Medicinae

MAY 16, 2007

[MANAGEMENT OF GASTROINTESTINAL DISEASES DURING PREGNANCY]

NOVÁK János, TAKÁCS Tamás, ÚJSZÁSZY László, BENE László, OLÁH Attila, RÁCZ István

[Medical treatment of gastrointestinal diseases has developed dramatically in the past 10 years. However, management of gastrointestinal disorders in pregnancy is still a serious challenge and requires special expertise. This paper provides recommendations on the indications of gastrointestinal endoscopy and treatment options based on the best available evidence, primarily from large retrospective studies and case reports. Currently there are no generally applicable, widely accepted, evidence-based guidelines available on the treatment of pregnant women. The risks of the gastrointestinal disease versus those of the medications used to treat it should be considered with regard to the health of both the mother and the foetus in each individual case. The risks and benefits of treatment and the consequences of withholding treatment should be discussed with the patient, the obstetrician and any other clinicians involved, and should be carefully documented.]

Hungarian Radiology

JANUARY 20, 2003

[Heterotopic pregnancy]

SARLÓS Géza, VARGA Tamás, HEGEDŰS Géza

[INTRODUCTION - Simultaneous presence of intrauterine and extrauterine gestations is very rare. CASE REPORT - A 26 year old multiparous woman known to be 10 weeks pregnant presented with severe abdominal pain. Transabdominal sonography revealed a concomitant ectopic pregnancy with large amount of intraperitoneal fluid. Cardiac activities of both the intrauterine and the ectopic fetuses were clearly visible on abdominal ultrasound. Emergency laparoscopy confirmed intraabdominal hemorrhage and rupture of the left fallopian tube. The laparoscopic salpingectomy did not affect the ongoing intrauterine pregnancy. The woman subsequently delivered a healthy infant. CONCLUSION - Though heterotopic pregnancy especially without previous ovarian hyperstimulation is extremely rare. The confirmation of an intrauterine pregnancy does not exclude a co-existing ectopic pregnancy as well as in case of extrauterine pregnancy the simultaneous presence of an intrauterine pregnancy must be considered.]

Lege Artis Medicinae

AUGUST 20, 2010

[A chance to concretize the teratogenic risk: healthy babies born to mother with isotretinoin treatment during pregnancy]

TIMMERMANN Gábor, KONDÉR Béla, GIDAI János, CZEIZEL Endre

[The teratogenic risk means the probability of the occurrence of congenital abnormalities in fetuses after the exposure of teratogenic agents, mainly drugs during pregnancy. The recent highresolution ultrasound scanning may help us to concretize this teratogenic risk. The Genetic, Teratogenic and Family Planning Counseling Clinic of the authors in Budapest were visited by 10,557 couples or client between 1998 and 2007. Ten pregnant women visited this Clinic due to the isotretinoin (Roaccutan) treatment during pregnancy during the 10 years study period. At present Roaccutan is the most teratogenic drug among the medicinal products in Hungary because its teratogenic risk is 25% for a characteristic pattern of congenital abnormality syndrome including a/microtia, ventriculomegaly and contruncal cardiovascular malformation. These fetal defects are detectable by the high-resolution ultrasound scanning between 18th and 20th gestational week of pregnant women. Thus this examination was recommended for the 10 pregnant women with unintended use of isotretinoin (Roaccutan ) in early pregnancy. Six pregnant women followed our advice and the repeated ultrasound scanning was not able to detect the above-mentioned characteristic defects and all the 6 newborns were healthy after birth. In conclusion the recent highresolution ultrasound examination provides a chance for the diagnosis of certain fetal defect between 18th and 20th gestational week of pregnant women. The Hungarian law allows these pregnant women to decide the termination of pregnancy until 20th (24th) gestational week after the diagnosis of severe fetal defects. However, this approach can protect the life of the major part of fetuses in pregnant women at high risk.]

Lege Artis Medicinae

MARCH 20, 2005

[THE EFFECT OF SEXUAL HORMON ALTERATIONS ON THE FREQUENCY OF OEDEMATOUS ATTACKS IN PATIENTS WITH HEREDITARY ANGIONEUROTIC EDEMA]

FELVINCI Réka, VISY Beáta, NÉMETH Éva, VARGA Lilian, JAKAB László, FARKAS Henriette

[INTRODUCTION - Changes in the body's hormonal equilibrium may alter the frequency of angioedema attacks in patients with hereditary angioneurotic edema. We assessed the relations between the angioedema attacks and puberty, menstruation, anticoncipient pill taking, pregnancy, delivery and menopausa. We also studied the possible impact of an embryo with hereditary angioneurotic edema on the frequency of attacks during pregnancy. PATIENTS, METHODS AND RESULTS - 53 female patients were included in the study. Data was surveyed by a questionnaire and detailed gynecological examination. We pointed out that the frequency of the attacks increased in 34% of the patients during puberty, in 58% of the patients at the time of menstruation and in 63% of the contraceptive pill users. In 36% of the women the frequency decreased in the postmenopausal state. In case the pregnancy affected the disease, the embryo with hereditary angioneurotic edema increased the number of attacks during pregnancy. CONCLUSION - Our analysis shows that conditions with sexual hormon alterations have an effect on the number of edematous attacks, therefore patients with hereditary angioneurotic edema need more attention both in nursing and therapy when they are in a life-period of hormonal change. Our results offer the oppurtunity of a better prediction of edematous attacks thus the oppurtunity of better therapy and better quality of life.]

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.]