Long-term clinical results from 10 years follow-up after radiosynoviorthesis: a prospective observational study.

BACKGROUND: The aim of this study was to assess the long-term anti-inflammatory effect and safety of 90-Yttrium and 166-Holmium radiosynoviorthesis (RSO) for treating chronic knee synovitis of various origins. METHODS: A total of 820 patients were included in this study and were followed up to 10 years after the procedure for objective and subjective changes in signs and symptoms of inflammation. RESULTS: Five years after RSO, excellent and good results were seen in 71% (95% CI 67-74%) of patients. Six, seven, eight and nine years following RSO, efficacy did not decrease significantly. Ten years after RSO, the effectiveness of the therapy fell to 65% (95% CI 59-71%). Overall, 64% of patients did not need another joint puncture ten years after RSO. We achieved excellent to good results at 5 years in 79% of patients with rheumatoid arthritis, 59% with ankylosing spondylitis, and 62% with osteoarthritis. Efficacy was mainly affected by the local X-ray stage of the knee joint. A significant association was also found between the diagnosis of the underlying disease and the success of radiosynoviorthesis. Efficacy, however, was not substantially affected by any of the following factors: the duration of synovitis, the number of punctures before radiosynoviorthesis, the number of intraarticular steroid injections before the procedure, or the number of interventions before radiosynoviorthesis (radiotherapy, surgery). CONCLUSIONS: Radiosynoviorthesis is an effective long-term method of treating chronic synovitis. The treatment showed the most favorable effects in patients with rheumatoid arthritis and those with mild to moderate degenerative osseous changes.

[The significance of high-resolution ultrasonography in the diagnosis of peripheral nerve disorders]. / A nagy felbontású ideg-ultrahangvizsgálatok jelentosége a periférias idegek betegségeinek diagnosztikájában.

High resolution ultrasonography is an emerging technique for the investigation of peripheral nerves and is increasingly used worldwide in the diagnosis of peripheral nerve disorders, however, until now it is not widespread in Hungary. According to the literature this method is especially useful in entrapment neuropathies, traumatic peripheral nerve injuries, tumors of the peripheral nerves and sonographically guided interventions. Ultrasonography allows precise morphological analysis and quantitative measurements of the nerves providing useful complementary information to electrodiagnostic data. In entrapment neuropathies ultrasound shows nerve swelling mainly proximal to the sites of compression and a focal change of echotexture. On longitudinal scan, an abrupt caliber change and spindle-like swelling of the compressed nerve segment can be seen. Evaluation of the anatomical background and visualisation of the postoperative and posttraumatic changes provide useful information for planning of the therapy. Ultrasound may be of significant help in localizing the pathological nerve segment when it is at an electrophysiologically inaccessible site or when substantial secondary axonal loss precludes precise electrophysiological localization and it might even show pathological changes when nerve conduction studies are normal. Contrary to electrophysiological investigation ultrasonography might discover neurotmesis in the akute phase of traumatic nerve injuries indicating the necessity of surgical intervention. We provide a summary of the main indications and further application areas of this method.

Ultrasonography of ulnar neuropathy at the elbow: axonal involvement leads to greater nerve swelling than demyelinating nerve lesion.

OBJECTIVE: To evaluate nerve size parameters measured by ultrasound in patients with ulnar neuropathy at the elbow (UNE) and to correlate them with the type of nerve lesion. METHODS: The largest cross sectional area (CSA(max)) of the ulnar nerve around the elbow and the cubital-to-humeral nerve area ratio (CHR) were measured in 50 elbows with UNE and in 87 elbows of 50 healthy subjects. CSA(max) and CHR were compared between controls and patients with predominantly demyelinative and axonal nerve involvement. Subgroups of patients with pure sensory and mixed sensorimotor axonal lesion were also compared. RESULTS: In patients with axonal nerve involvement, a significantly larger CSA(max) and CHR were found when compared to those with predominantly demyelinating nerve lesion; both groups differed significantly from healthy controls. CSA(max) values in patients with sensorimotor axonal lesion were significantly higher than in those with pure sensory axonal involvement. CONCLUSION: CSA(max) and CHR highly correlate with the type of nerve pathology in UNE, with a significantly larger nerve swelling seen in axonal lesions, as compared to demyelinating lesions. SIGNIFICANCE: In addition to helping in the localization of nerve lesion, ultrasonography may also reflect the type and degree of nerve lesion as assessed by electrophysiological means.

[Transient left ventricular dysfunction: special form of stress cardiomyopathy]. / Reverzibilis, stressz indukálta cardiomyopathiak.

INTRODUCTION: The phenomenon of stress induced left ventricular dysfunction has been long recognised. A special reversible form of it, characterized by left ventricular apical dilatation, is the so-called "tako-tsubo" or ampoule cardiomyopathy, based on its first description by Sato et al. in 1990. The tako-tsubo cardiomyopathy and stress cardiomyopathy are considered almost equivalent in the referring publications. METHODS: Retrospective analysis of patient data between 2002 and 2007: these patients suffered from transient left ventricular dysfunction and coronary artery disease and myocarditis were disclosed. RESULTS: 6 female patients between 55 and 80 years. In 5 of 6 cases the different forms of stress could be found before the patients were admitted to our department. CONCLUSIONS: The presented cases shed light to the fact that the apical dilatation of the left ventricle is only one of the possible presentations of stress induced cardiomyopathy. The main feature of this entity is not the tako-tsubo-like left ventricular dilatation, which is not always present, but the almost universal QT prolongation and negative T waves. These ECG features come a few days after the appearance of the reversible left ventricular dysfunction.