Malignant degeneration of chronic suppurative bone diseases]

Out of 1189 patients with osteomyelitis of the Hungarian Institute of Medical Rehabilitation malignant degeneration in the region of purulent bone process has been observed in 6 cases by the authors. Out of them 5 cases were carcinoma planocellulare and 1 case was sarcoma gigantocellulare. During the detailed analyses of the cases it is pointed out by the authors that on the basis of the standpoint established regarding the rehabilitation in locomotor diseases the indication of the amputation in patients with osteomyelitis is not absolutely limited to the cases undoubtedly malignized. Rehabilitation and resocialization of the patients is better promoted with the performed amputation and the up-to-date manufactured prosthesis than by a series of unsuccessful and hazardous therapeutical experiments.     

The effectiveness of cognitive behavioural therapy for social anxiety disorder in routine clinical practice

Numerous randomized controlled trials have shown cognitive behaviour therapy (CBT) to be effective in treating social anxiety disorder (SAD). Yet, less is known about the effectiveness of CBT for SAD conducted by psychotherapists in training in routine clinical practice. In this study, 231 patients with SAD were treated with CBT under routine conditions and were examined at pre- and post-treatment as well as at 6 and 12 months follow-up. We applied self-reports to assess symptoms of SAD (defined as primary outcome), depression and psychological distress (defined as secondary outcome). We conducted both completer and intent-to-treat analyses and also assessed the reliability of change with the reliable change index. Results revealed significant reductions in symptoms of SAD between pre- and post-assessments, with effect sizes ranging from d = 0.9 to 1.2. Depending on the SAD specific questionnaire applied, 47.8% to 73.5% of the sample showed a reliable positive change, whereas 1.9% to 3.8% showed a reliable negative change. Depressive symptoms and psychological distress also decreased significantly from pre- to post-assessment, with large effect sizes. Significant treatment gains regarding both primary and secondary outcomes were further observed at 6 and 12 months follow-up. The current findings based on a large sample of patients suggest that psychotherapists in CBT training working under routine conditions can effectively treat symptoms of SAD, depression and psychological distress.     

123I-Labelled metaiodobenzylguanidine for the evaluation of cardiac sympathetic denervation in early stage amyloidosis

Purpose

Cardiac amyloidosis is a rare disorder, but it may lead to potentially life-threatening restrictive cardiomyopathy. Cardiac manifestations frequently occur in primary amyloidosis (AL) and familial amyloidosis (ATTR), but are uncommon in secondary amyloidosis (AA). Echocardiography is the method of choice for assessing cardiac amyloidosis. Amyloid deposits impair the function of sympathetic nerve endings. Disturbance of myocardial sympathetic innervations may play an important role in the remodelling process. ¹²³I-MIBG can detect these innervation changes.

Methods

Patients with biopsy-proven amyloidosis underwent general work-up, echocardiography and ¹²³I-MIBG scintigraphy. Left ventricular internal dimensions and wall thickness were measured, and highly refractile cardiac echoes (sparkling) were analysed. Early (15?min) and late (4?h) heart-to-mediastinum ratio (HMR) and wash-out rate were determined after administration of MIBG.

Results

Included in the study were 61 patients (30 women and 31 men; mean age 62?years; 39 AL, 11 AA, 11 ATTR). Echocardiographic parameters were not significantly different between the groups. Sparkling was present in 72?% of ATTR patients, in 54?% of AL patients and in 45?% of AA patients. Mean late HMR in all patients was 2.3?±?0.75, and the mean wash-out rate was 8.6?±?14?% (the latter not significantly different between the patient groups). Late HMR was significantly lower in patients with echocardiographic signs of amyloidosis than in patients without (2.0?±?0.70 versus 2.8?±?0.58, p?<?0.001). Wash-out rates were significantly higher in these patients (?3.3?±?9.9?% vs. 17?±?10?%, p?<?0.001). In ATTR patients without echocardiographic signs of amyloidosis, HMR was lower than in patients with the other types (2.0?±?0.59 vs. 2.9?±?0.50, p?=?0.007).

Conclusion

MIBG HMR is lower and wash-out rate is higher in patients with echocardiographic signs of amyloidosis. Also, ¹²³I-MIBG scintigraphy can detect cardiac denervation in ATTR patients before signs of amyloidosis are evident on echocardiography.     

PET and MRI for the evaluation of regional myocardial perfusion and wall thickening after myocardial infarction

Background

Deterioration of left ventricular (LV) function after myocardial infarction (MI) is a major cause of heart failure. Myocardial perfusion performance may play an important role in deterioration or improvement in LV function after MI. The aim of this study was to evaluate the myocardial perfusion reserve (MPR) and stress perfusion in deteriorating and non-deteriorating LV segments in patients after MI by PET and MRI, respectively.

Methods

Regional wall thickening of 352 segments in 22 patients was assessed at 4 and 24?months after MI by cardiac MRI. PET was performed to evaluate MPR and adenosine stress ¹³N-ammonia perfusion 24?months after MI. Segments were divided into four groups according to deterioration or improvement in wall thickening.

Results

Normal functional segments at 4?months after MI that remained stable had a significantly higher mean MPR and mean stress perfusion PET value than deteriorated segments (p?p?Conclusion This study demonstrated the additional value of myocardial perfusion assessment in relation to the functional integrity of the injured myocardium. Segmental functional LV improvement after MI was associated with better regional myocardial perfusion characteristics. Furthermore, the amount of wall thickening reduction was associated with regional myocardial perfusion abnormalities in patients after MI.     

Necessity of a more standardized microbiological characterization of rodents for aging studies

The establishement of germ-free, gnotobiotic, and SPF animal colonies is a major component of any effort to develop suitable animal models for aging research. Epidemic and endemic disease in laboratory animals can lead to unacceptable losses, contamination of research results, and exposure of staff and investigators to unnecessary health risks. Monitoring the health status and microbiological burden of the animals is particularly important. These issues are discussed, with accompanying guidelines and protocols in pragmatic, tabular form.     

The role of proximal osteomy of the tibia in the treatment of arthrosis of the knee joint]

The results of heigh tibia osteotomy performed between 1970 and 1975 in 20 cases in the material of the Orthopaedic Department of the "Semmelweis" University Medical School, Budapest, are reported. In 13 cases good--in 6 cases satisfactory results have been obtained. In 1 case the surgical intervention was of no effect. With regard to the explicit pain-relieving effect the operation is recommended by the authors in the treatment of knee arthrosis.     

The Caudate Lobe: The Blind Spot in Radioembolization or an Overlooked Opportunity?

Purpose

The caudate lobe (CL) is impartial to the functional left and right hemi-liver and has outspoken inter-individual differences in arterial vascularization. Unfortunately, this complexity is not specifically taken into account during radioembolization treatment (RE), potentially resulting in under- or overtreatment of the CL. The objective of this study was to evaluate the CL coverage in RE and determine the detection rate of the CL arteries on CT angiography during work-up.

Methods

In all consecutive patients who underwent RE treatment between May 2012–January 2015, ^99mTc-MAA SPECT/CT and posttreatment scans (⁹⁰Y-bremsstrahlung SPECT/CT, ⁹⁰Y-PET/CT, or ¹⁶⁶Ho-SPECT/CT) were reviewed for activity in the CL. Pretreatment CT angiographies were reviewed for the visibility of the CL arteries.

Results

Eighty-two patients were treated. In 32/82 (39 %) the CL was involved. In 6/32 (19 %) patients, no activity was seen on the posttreatment scan in the CL, whereas in 40/50 (80 %) patients without CL tumor involvement, the CL was treated. ^99mTc-MAA SPECT/CT and final posttreatment scans were discordant in 16/78 (21 %). ^99mTc-MAA SPECT/CT had a positive and negative predictive value of 94 % and 46 %, respectively, for activity in the CL after RE. In untreated CLs, significant hypertrophy was observed with a median volume increase of 33 % (p = 0.02). CL arteries were seldom visible on the pretreatment CT; the identification rate was 12–17 %.

Conclusion

Currently in RE treatments, targeting or sparing of the CL is highly erratic and independent of tumor involvement. Intentional treatment or bypassing of the CL seems worthwhile to either improve tumor coverage or enhance the functional liver remnant.

     

Inhibitory effects of different galanin compounds and fragments on osmotically and histamine-induced enhanced vasopressin secretion in rats

The effects of rat, porcine and human galanin, and the human 1-16 and human 16-30 terminal galanin fragments on vasopressin secretion were studied in rat. The plasma vasopressin level was determined by radioimmunoassay (RIA). There were no changes in the basal vasopressin secretion after galanin administration. A significant increase in vasopressin concentration was detected following 2.5% NaCl or histamine administration. I.c.v. injected rat, porcine or human galanin or the 1-16 N-terminal galanin fragment prevented the plasma vasopressin level enhancement. Following the i.v. administration of rat galanin or the i.c.v. injected 16-30 C-terminal galanin fragment, the vasopressin concentration did not return to the normal level. Administration of the galanin antagonist galantid (M15) i.c.v. before the rat galanin i.c.v. injection prevented the inhibitory effect on the increased plasma vasopressin level following 2.5% NaCl solution or histamine administration. The results indicate that there is no significant difference in the inhibitory effect of rat, porcine or human galanin or the 1-16 galanin fragment on the enhanced plasma vasopressin secretion induced by hyperosmosis or histamine administration.Our findings suggest that galanin, as a peptide modulator, is physiologically involved in the regulation of vasopressin release following different forms of stimulation: an osmotic response or histamine administration.