Gadolinium deposition in the paediatric brain: T1-weighted hyperintensity within the dentate nucleus following repeated gadolinium-based contrast agent administration.

AIM: To determine whether repeated gadolinium-based contrast agent administration (GBCA) in children is associated with the development of increased T1-weighted signal intensity within the cerebellar dentate nucleus. MATERIALS AND METHODS: With institutional review board approval for this The Health Insurance Portability and Accountability Act-compliant retrospective study, a cohort of 41 patients under the age of 18 years who underwent at least four contrast-enhanced magnetic resonance imaging (MR) examinations of the brain from 2005 to 2015 were identified. For each examination, both dentate nuclei were manually contoured, and the mean dentate nucleus-to-pons signal intensity (DN-P SI) ratio was calculated. The DN-P SI ratios from the last to first MRI examination were compared, and the correlation between DN-P SI ratio and cumulative gadolinium dose was calculated using a linear mixed effect model to control for potentially confounding variables. RESULTS: For the 41 patients in the cohort, there was a significant increase in the mean DN-P SI ratio from the first MRI to the last MRI examination (1.05 versus 1.11, p=0.004). After controlling for patient diagnosis, history of chemotherapy or radiation, sex, and age, there was a significant positive association between DN-P SI ratio and cumulative gadolinium dose (coefficient=0.401, p=0.032). CONCLUSION: Repeated GBCA administration in children is associated with increased T1-weighted signal intensity within the dentate nucleus.

[Epidemiologic aspects of ischemic heart diseases in diabetic women]. / A diabetes mellitusban szenvedö nök ischaemiás szívbetegségének epidemiológiai jellemzöi.

The author discusses the relation of female gender, diabetes mellitus and cardiovascular disease relying upon the "WHO/Europe Health For All" statistical database, data of MEDLINE and the results of Framingham Heart Study. Cardiovascular disease is multifactorial in origin, and it is in connection with increasing prevalence and incidence of diabetes mellitus and hypertension. The mortality caused by ischaemic heart disease is 3-5 times higher if the patients suffer from diabetes mellitus as well. Diabetes mellitus alters the existing difference between males and females in the epidemiological characteristics of ischaemic heart disease. Pathomechanismus (such as metabolic disorders of lipids, hemostasis, endothelial function) are in connection with the changes of estrogen/progesteron balance, have a great role in this change. Diabetes mellitus still has been of significant epidemiological importance from the point of view of cardiovascular's incidence. The prevention of micro-, and macroangiopathy caused by diabetes mellitus beside the genetic factors is one of the most important parts of the epidemiological strategy.

[Lipid, apoprotein and fibrinogen levels in the blood of male patients following myocardial infarct and the effect of diet on these parameters in ischemic heart disease]. / Vérlipid-, apoprotein- és fibrinogénszintek szívinfarctuson átesett férfiakban, valamint diéta hatása e paraméterekre ischaemiás szívbetegekben.

The authors have found significantly higher the levels of two not routinely examined risk factors, fibrinogen and lipoprotein (a) in 28 male patients after myocardial infarction than the corresponding data of the PROCAM-study and in the case of fibrinogen than in 23 healthy blood donors. A positive correlation was observed between the LDL-cholesterol and total cholesterol, the LDL-cholesterol and the main apoprotein of LDL, the Apo B level, and between the HDL-cholesterol and the main apoprotein of HDL, the Apo AI. During a 3 week long treatment in the Cardiac Rehabilitation Department the effect of low cholesterol, high unsaturated fatty acid content diet on the lipid, apolipoprotein and fibrinogen levels of male patients suffering from coronary heart disease with cholesterol level higher than 5.2 mmol/l was studied. Significantly decreased the total cholesterol (from 6.21 +/- 0.96 mmol/l to 5.87 +/- 0.98 mmol/l, -5.5%), the LDL-cholesterol (from 3.87 +/- 1.02 mmol/l to 3.61 +/- 0.96 mmol/l, -6.7%), the HDL-cholesterol (from 1.16 +/- 0.39 mmol/l to 1.04 +/- 0.28 mmol/l, -10.3%), the main apoprotein of HDL, the Apo AI (from 1.47 +/- 0.23 g/l to 1.33 +/- 0.29 g/l, -9.5%) and the main apoprotein of LDL, the Apo B level (from 1.59 +/- 0.43 g/l to 1.46 +/- 0.50 g/l, -8.1%). The change of fibrinogen lipoprotein (a) level was not significant. According to the earlier observation of the authors and the data of the literature, the effect of low cholesterol diet on the change of HDL cholesterol was not favourable. The investigation of apolipoprotein levels failed to get closer to the understanding of its mechanism.

[Changes in the serum lipid levels in males with ischemic heart disease under the effect of diets with various cholesterol and fat contents]. / Ischaemiás szívbetegségben szenvedö férfiak szérum lipidszintjeinek változása különbözö koleszterin- és zsírtartalmú diéták hatására.

In the treatment of hyperlipoproteinaemia the diet still has a primary importance. The authors have investigated the effect of different fat, cholesterol and unsaturated/saturated fatty acid content diets on the lipid levels of men suffering from coronary heart disease during 3 weeks long hospital treatment in the Cardiac Rehabilitation Department. On a diet containing daily 65 g fat, 230 mg cholesterol with a 1.23 unsaturated/saturated fatty acid ratio the total cholesterol level of 66 patients showed a 5.8% decrease (P < 0.05). The 1% decrease of triglyceride, the 3.9% decrease of HDL-cholesterol, the 7.3% decrease of LDL-cholesterol levels were not significant. There was a positive correlation between the cholesterol level at the beginning and the degree of its change (0.7043): the patients with 6.5 mmol/l or less cholesterol level at the entry in the study showed a 2.8% decrease in serum cholesterol level, the patients with more than 6.5 mmol/l 8.1%. On a diet containing daily 105 g fat, 420 mg cholesterol, with a 0.7 unsaturated/saturated fatty acid ratio the triglyceride level showed a 20.6%, the total cholesterol 0.5% increase, at the same hand the HDL-cholesterol 1.1%, the LDL-cholesterol 5.1% decrease (only the change of triglyceride level was significant). The results emphasise the strong relation between diet and level of serum lipids.

[Experience in the management of patients with artificial heart valves (analysis of the material of the Békés County Cardiology Clinic)]. / A mülbillentyüs betegek gondozásával szerzett tapasztalatok (A Békés megyei Kardiológiai Szakrendelés anyagának elemzése).

Authors report of 152 patients, 146 of whom underwent single mitral (n = 70), single aortic (n = 64), double aortimitral (n = 17) and aortic-mitral-tricuspid (n = 1) valve replacement with mechanical prostheses. 6 patients received bioprostheses. The mean age was 55 years. Follow-up ranged from 1 to 23 years (mean 5.1 years). The methodology of follow-up consisted patients examination in our office (at least twice a year) and questionnaire. Valve related complications were defined as paravalvular leak (6 cases), valve thrombosis (3 cases), thromboembolism (13 cases), anticoagulant-related hemorrhage (21 cases), infectious endocarditis (6 cases). During care 14 patients died. The most common causes of death were left-ventricle insufficiency (n = 6), infectious endocarditis (n = 3), prosthetic valve thrombosis (n = 1), cerebral hemorrhage (n = 2) and sudden death (n = 2). 138 patients (56 percent) are retired or invalid. Authors emphasize the importance of regular control and the significance of anticoagulant policy (in the target international normalized ratio to 2.5-3.5 and the provision of the antibiotic prophylaxis to avoid the late complications.

[Routine roentgen examination of the skull in head injuries]. / A fejsérültek rutinszerü koponya röntgenvizsgálatáról.

Authors in their present report are studying the routine skull X-ray examination of head injured patients. They discuss the disadvantages of the routine up to the present. They introduce the classifications found in the literature. With the help of these classifications the injured who do not need skull X-ray examination can be separated. In case of hospitalisation they consider the anamnesis and clinical examination to be primary in contradiction to the X-ray result. They introduce the retrospective results their head injured patients treated between 1977-1986 in their department.