Effect of bisphosphonate treatment in patients with Paget's disease of the skull.

OBJECTIVES: Hearing loss has long been known to be a complication of Paget's disease of bone. The aim of this study was to investigate Paget's disease of the temporal bone with special attention to hearing loss. METHODS: Twenty-five patients with skull involvement were treated with either pamidronate or tiludronate. Imaging included radiography, quantitative bone scintigraphy (QBS), single photon emission computed tomography (SPECT) and high-resolution computed tomographic (HRCT) scanning. Audiometric assessment was also performed. RESULTS: Twenty-three of the 25 patients with skull involvement suffered from hearing loss. Bisphosphonate treatment resulted in a decreased serum total alkaline phosphatase (serum tAP) level and QBS ratio, and also seemed to improve the complaints of the patients. HRCT demonstrated involvement of the middle ear ossicles (n = 7), involvement of the petrous pyramids (n = 14), demineralization of the otic capsule (n = 10), porosis pericochlearis (n = 8), narrowing of the external auditory meatus (n = 12), mastoid process thickening (n = 5) and stapedial footplate thickening (n = 4). The audiometric examination did not show any significant changes 1 yr after bisphosphonate treatment. CONCLUSIONS: HRCT imaging is a well suited tool for demonstrating the complication of Paget's disease. QBS and measurement of serum tAP level may also be regarded as useful techniques for monitoring treatment. However, hearing may remain impaired in spite of the improved scintigraphy and laboratory parameters, therefore, audiometric assessment is also important in pagetic patients with skull involvement.

[Risk of embolism in diagnostic and therapeutic intravascular procedures--in vitro model]. / Embolia veszélye terápiás és diagnosztikus intravascularis beavatkozásoknál--in vitro modell.

The purpose of the study was to evaluate the risk of distal embolisation in a silicon model during different endovascular diagnostic and therapeutic procedures. Endovascular technics, such as guidewire and catheter advancement, metal stent placement, balloon angioplasty and thrombectomy device were compared. Clots were produced from human blood sample. The transparent silicon model was filled with saline, flow was generated by an hydraulic pump. Stenosis was created by mechanical compression. The size of the circulating particles were measured with a mesh of nylon filters. No loose particles were detected using guidewire, pigtail and straight catheters. Balloon inflation induced embolisation of particles ranging from 100 microns-12 mm in length. Deployment of self expandable metallic stents did not result in particle migration but secondary angioplasty inside the stent detached particles (ranging from 400 microns to 12 mm in length). Use of thrombectomy device resulted in significant particle migration (ranging from 400 microns to 1500 microns in length).

The role of STIR MRI sequence in the evaluation of the breast following conservative surgery and radiotherapy.

The purpose of the study was to define the value of fat suppressed STIR sequence in the MRI of the conserved breast. To our knowledge, this study is the first clinical evaluation of STIR sequence in post-therapy conditions. Forty patients with early (T1-2, N0-1) invasive breast cancer underwent conservative surgery and postoperative radiotherapy. Routine follow-up examinations, including physical examination and mammography were supplemented with breast MRI in all cases 6-166 months (mean 27.6) after initial treatments. Three patients had bilateral cancer. Including follow-up (9 patients) MRI examinations, altogether 53 MRIs were available for analysis. An 0.5 T MRI (Elscint, Haifa, Israel) was used with double breast coil. Axial T1 and T2 weighted spin echo, STIR and 3D gradient echo dynamic sequences were performed. Pre- and postcontrast slices underwent serial subtraction. Twenty-eight circumscribed lesions were identified. All were well visualised on STIR sequence, regardless of histologic nature of lesions. One low grade DCIS was not detected by any sequence. Differential diagnosis between benign and malignant lesions was not possible by STIR sequence alone. STIR sequence was found to be more sensitive in the detection of treatment related breast edema and fluid collection, than T2 SE (spin-echo) sequence. Even the patients who were not good candidates for subtracted contrast enhanced dynamic studies - because of motion artefacts - could have been examined with satisfactory results. STIR is a very sensitive sequence for depicting circumscribed lesions and post-therapy complications, but not suitable for differentiation. It is a useful tool in the follow-up of patients with conserved breast subjected to radiotherapy.

In vitro evaluation of the embolic risk of diagnostic and therapeutic intravascular procedures.

BACKGROUND: The purpose of the study was to evaluate the risk of distal embolisation in a silicon model during different endovascular diagnostic and therapeutic procedures. MATERIAL AND METHODS: Endovascular technics, such as guidewire and catheter advancement, metal stent placement and balloon angioplasty were compared. Clots were produced from human blood sample. The transparent silicon model was filled with saline, flow was generated by an hydraulic pump. Stenosis was created by mechanical compression. The size of the circulating particles were measured with a mesh of nylon filters. RESULTS: No loose particles were detected using guidewire, pigtail and straight catheters. Balloon inflation induced embolisation of particles ranging from 100 microns to 10 mm in length. Deployment of self expandable metallic stents did not result in particle migration but secondary angioplasty inside the stent detached particles (ranging from 400 microns to 12 mm in length). Deployment of balloon expandable stent yielded in the stretching of the clot, which became sometimes longer than the stent, resulting in the detachment of the non covered portion. CONCLUSION: The risk of distal embolisation during guide-wires and catheters manipulation is not significant. Balloon catheters and secondary angioplasty after deployment of self-expanding stents caused large particles detachment.

In vitro evaluation of a new rotational thrombectomy device: the Straub Rotarex catheter.

PURPOSE: To evaluate the efficacy of a new rotational thrombectomy device, and the procedure-related risk of particle embolization. METHODS: The experiments were performed in transparent silicone tubes. The conditions of flow were as close as possible to physiological parameters. Distal embolization was detected by a mesh of nylon filters. RESULTS: The Straub Rotarex catheter was able to remove all clots. The mean number of migrating particles larger than 1000 microm was 0.17 (+/- 0.38), the mean number of 400-1000 microm migrating particles was 1.08 (+/- 1.04). The mean intervention time was 67 (+/- 37) sec. The mean volume of collected liquid was 96.6 (+/- 24.7) ml. CONCLUSION: The in vitro results suggest that the Straub Rotarex catheter is able to remove large volumes of thrombus with a limited risk of embolization. The main limitation of our model is the absence of adhesion of the clot to the tube.

Pseudosarcoma in Paget's disease.

The authors describe the case of a male patient who had had Paget's disease since 1973 which led to the diffuse swelling of the proximal femur in 1993. The elevated alkaline phosphatase level and the destructive lytic lesions on the X-ray of the femur raised the possibility of malignancy. The bone scan showed increased accumulation in the proximal part of the left femur. On the MR the low T1 and the elevated T2 signal intensity suggested malignity despite that in some regions signals typical of adipose tissue could also be seen, which is usually interpreted as a sign of benignity. In the histological specimens no signs of malignant tumour cells were identified. The patient received bisphosphonate treatment which decreased his pain and swelling and also the alkaline phosphatase level. The patient died because of a rapidly progressing retroperitoneal fibrosarcoma and lung metastasis in 1996. The autopsy did not prove any malignant transformation of Paget's disease of bone in the proximal femur.

[Radiologic follow-up after breast-conserving surgery: value of MRI examination of the breast]. / Posztoperatív sugárkezelés okozta mellékhatások radiológiai követése emlömegtartó mütét után: az emlö MR-vizsgálatának értéke.

The aim of the study was to establish an objective method for evaluation the extent, topography and quantity of skin and soft tissue side effects after tele- and/or brachyradiotherapy of the conserved breast and to compare the sequales of different radiation methods. 26 patients operated on for T1-2 N0-1 breast cancer underwent the following kinds of postoperative radiotherapy: 1. 46-50 Gy whole breast teletherapy + 10-16 Gy electron boost (5 patients), 2. 46-50 Gy teletherapy + 10-15 Gy HDR brachytherapy boost (12 patients), 3. 46-50 Gy teletherapy (6 patients), 4. 36,4 Gy sole HDR brachytherapy of the tumour bed (5 patients). The postirradiation side effects were examined by MRI, mammogram, US and physical examination, as well. MRI was performed on a 0.5 T, double breast coil, with SE-T1, SE-T2 and 3D-GE sequences. The findings of MRI and mammography were compared to physically detectable side effects using the RTOG/EORTC late radiation morbidity scoring scheme. US is useful in the measurement of skin thickening and in the diagnosis of fat necrosis. Mammography and physical examination are very subjective and low specificity methods to evaluate postirradiation side effects. MRI is a suitable and more objective method to detect the real extent and quantity of skin thickening and fibrosis. The incidence of > or = G2 side effects of skin and breast parenchyma were 64.5 and 32.2%, respectively. The differences between the side effects of whole breast irradiation and sole brachytherapy of the tumour bed are also clearly demonstrated. Brachytherapy alone is feasible without compromising cosmetic results. The authors established the MRI criteria for categorization the extent and grade of skin thickening and fibrosis (focal vs diffuse, grade 1-4). Breast MRI is an objective tool for assisting to the evaluation of the side effects of postoperative radiotherapy.

Isotope diagnostics, CT and MR in urinary tract diseases of infants and children.

Ninety-nine isotope, 4 CT and 10 MR examinations were carried out in 1990 to test urogenital disorders in infants and children. The procedures are described with sidelights on indication, difficulties of technical nature and comparison with internationally published reports. An examination strategy is devised, with estimation of its effectiveness in the follow-up and after-care.

Correlation between oesophageal dysmotility and cardiovascular autonomic dysfunction in diabetic patients without gastrointestinal symptoms of autonomic neuropathy.

The vagal function was assessed by oesophageal scintigraphy and cardiovascular autonomic function tests in 65 diabetic patients without gastrointestinal symptoms of autonomic neuropathy and in 20 control subjects. Oesophageal radioisotope transit time was abnormal in 32% of diabetics. Values of cardiovascular function tests were normal in 34% of diabetics while definitive and early signs of cardiac autonomic neuropathy were found in 34% and 32% of diabetics, respectively. The results of oesophageal scintigraphy and cardiovascular function tests were concordant only in 54% of diabetics. Simultaneous impairment of oesophageal motility and cardiovascular (vagal) reflexes could be frequently but not uniformly observed in diabetics. Thus, vagal innervation of different organs (oesophagus and heart) might be affected to different degrees in diabetic patients.

[The diagnostic value of so-called "post-cholecystectomy bile duct dilatation"]. / Uber den diagnostischen Wert der sog. "postcholecystektomischen Gallengangserweiterung".

In 1706 gallstone operations the diameter of the common bile ducts was determined in 990 cases during telecholangiography using a so-called functional cholangiodiametry. The data of 213 postoperative determinations of the common bile duct diameters performed during the follow-up period did not support the existence of a postcholecystectomic compensatoric dilation of the common bile duct. Ultrasound and ERCP failed to find postoperative bile duct dilation in patients without complaints following cholecystectomy and in persons with complaints of extrabiliary origin. In conclusion we found that biliopancreatic and organic reasons (residual calculi, papillary stenosis, bile duct stenosis, chronic pancreatitis) can always be detected as the underlying cause of a significant bile duct dilation.

A new examination method for detecting renovascular hypertension: functional DTPA renal scintigraphy sensitized by captopril.

DTPA functional renal camera scintigraphy (DTPA-FS) was performed in 220 patients with moderately severe and severe hypertension after an initial 7-14-day Captopril + thiazide-type diuretic treatment. If, comparing it with the DTPA-FS prior to treatment, appearance or increase of a side difference were observed and it was also indicated by the clinical picture, nephroangiography was performed. Using this method, 15 cases of unilateral, 3 bilateral renal arterial stenoses were recognized, and in one case restenosis was diagnosed, in all cases of positive DTPA-FS with Captopril. In negative case of DTPA-FS sensitized with Captopril, there was no positive angiographic finding. The method of DTPA-FS performed under Captopril effect is considered to be a simple, harmless, specific out-patient examination for screening genuine renovascular hypertension. To perform several angiographies likely to be negative can be avoided by this method. The hypotensive effect of Captopril may, at the same time, be a useful guide in differentiating patients with renovascular hypertension being suitable most of all for surgical intervention or angioplasty.

Screening the familial accumulation of kidney malposition and malrotation.

Sacral dystopic kidneys have been found in a couple of brothers and sisters. By screening all the first-grade relatives in one generation, 5 brothers and sisters showed kidney malposition and malrotation. This is the first report in the literature about family screening for this developmental anomaly. Based on the results an autosomal recessive character of the clinical pattern was suggested; it is pointed out that the final clearing of the hereditary process requires further family screenings.

Myasthenia gravis: 75seleno-methionine scanning of thymus gland.

The 75Se-seleno-methionine isotope thymus scanning was examined in a series of patients with myasthenia gravis. The method proved useful and informative in the diagnostics of myasthenia. Prior to thymectomy, the thymic tumour or a large gland could be observed and some hints could be gained concerning the biological activity of the gland. After the operation, the success of thymectomy could be checked and later a possible recidive could be shown or excluded. In non-operative cases the change in thymic activity could be followed which is an important sign of a malignant or tumorous growth of the thymus.