Continuous selective intra-arterial application of nimodipine in refractory cerebral vasospasm due to aneurysmal subarachnoid hemorrhage.

BACKGROUND: Cerebral vasospasm is one of the leading courses for disability in aneurysmal subarachnoid hemorrhage. Effective treatment of vasospasm is therefore one of the main priorities for these patients. We report about a case series of continuous intra-arterial infusion of the calcium channel antagonist nimodipine for 1-5 days on the intensive care unit. METHODS: In thirty patients with aneurysmal subarachnoid hemorrhage and refractory vasospasm continuous infusion of nimodipine was started on the neurosurgical intensive care unit. The effect of nimodipine on brain perfusion, cerebral blood flow, brain tissue oxygenation, and blood flow velocity in cerebral arteries was monitored. RESULTS: Based on Hunt & Hess grades on admission, 83% survived in a good clinical condition and 23% recovered without an apparent neurological deficit. Persistent ischemic areas were seen in 100% of patients with GOS 1-3 and in 69% of GOS 4-5 patients. Regional cerebral blood flow and computed tomography perfusion scanning showed adequate correlation with nimodipine application and angiographic vasospasm. Transcranial Doppler turned out to be unreliable with interexaminer variance and failure of detecting vasospasm or missing the improvement. CONCLUSION: Local continuous intra-arterial nimodipine treatment for refractory cerebral vasospasm after aSAH can be recommended as a low-risk treatment in addition to established endovascular therapies.

[The diagnosis of herpes encephalitis--a case-based update]. / A herpesencephalitis diagnosztikájáról egy esetismertetés kapcsán.

Herpes simplex virus encephalitis (HSVE) is a rare and life-threatening infection. The clinical signs are diverse and often misleading regarding the aetiology. However, focal seizure with fever and typical CT/MRI finding should always raise the possibility of HSVE as early diagnosis and antiviral therapy is crucial. Before the advent of molecular techniques and high-tech imaging histological examination from multiple brain biopsies were often necessary. Although nowadays PCR and other molecular methods may provide an aetiological diagnosis some cases need neuropathological verification. Due to the high IgG seropositivity rate in the population the plasma IgG titer is not diagnostic and elevation of its plasma level requires several weeks. We report the case of a 25-years old male patient who initially presented with epileptic seizures. There was no final diagnosis and no causal treatment in the district general hospital. The patient was admitted to our institution in comatose state on day 9; the initiated diagnostic tests and therapy could not save the patient who died next day. The autopsy and subsequent neuropathological examination revealed HSVE. We present a flowchart on diagnostic work-up and special techniques to aid diagnosis in suspected viral encephalitis.

[Treatment of wide necked intracranial aneursyms in a two-step procedure with stent implantation and coils]. / Széles nyakú intracranialis aneurysmák ellátása két ülésben stentbeültetéssel és spirálokkal.

Since the introduction of electrolytically detachable coils the endovascular treatment of intracranial aneurysms is dynamically developing. The good results with this technique led to a progressive expansion of the indications. For the treatment of complex, wide-necked and fusiform aneurysms several new devices and techniques were developed. The introduction of a new device is possible after a feasibility study. In these studies the number of cases is low. Some risk factors or possible complications occur only after the introduction of a new device to the market.

[Potentials of interventional radiology: percutaneous radiofrequency ablation]. / Az intervenciós radiológia lehetóségei: percutan radiofrekvenciás ablatió.

The efficacy of the treatment of hepatic malignancies has improved, mostly due to the physical procedures which affect the tumors locally. The authors performed 210 radio-frequency ablations in 1.38 patients. They recommend this procedure based on their experiences. RF treatment is performed together with other therapeutical procedures done by cooperation of oncology clinic. The main indication for the treatment of tumors is, lesions less than 4 cm in diameter and the number of masses is less than 4. The treatment can be performed by CT guidance and is documented well. The applied RF generator is made by Radionics, electrodes are cooled. In 68% of the tumors they achieved complete necrosis using this procedure. After the intervention patients experienced no serious complications. The only side effects were abdominal pain and discomfort. RF tumor ablation is an important and effective procedure in the treatment of hepatic tumors.

[Treatment of malignant liver tumors with radio-frequency ablation (RFA)]. / A máj rosszindulatú daganatainak kezelése rádiófrekvenciás tumorablatióval (RFA).

INTRODUCTION: A lot of different methods exist for the treatment of liver primary and secondary tumours. Nowadays surgery is the method of choice. If operation is not possible and other conditions are available, local tumour ablation is applicable. One of these methods is the radio-frequency (RF) thermal ablation. AIMS: This method is effective on the base of literature, albeit the indications are not uniform. Authors by the own experience wanted to get dates to define the indication and to study the effectivity of this method in the therapy of liver tumour. PATIENTS/METHODS: Between the 1 January 2000 and 31 January 2002, 86 tumors of 40 patients were treated with RF thermal tumour ablation. This method was applied first in Hungary by our workgroup. RF ablation was performed with generator Cosman CC-1, Radionics, Burlington and cooled-tip single or cluster electrodes. RESULTS: Complete response was achieved in 56 percent. Results of primary tumour necrosis was better when the diameter of the tumour was 3.5-4 cm or less or the treatment was achieved by cluster electrode. 20 patients became tumour free (5 have breast cancer). Tumour spread came into existence in the spite of therapy in ten patients, 8 patients died. The average observation time was one year. In conclusion, the results of this study show that RF ablation with a cooled-tip electrode needle is a safe and effective technique for local treatment of hepatic lesions 4 cm or less in diameter and if the number of lesion less than 4-5. CONCLUSIONS: Authors suggest to use widely the RF technique with other methods in the treatment of hepatic tumours.

[Results of mammographic screening at the Mammary Center of Debrecen in 1999 and 2000]. / A mammográfiás emlórákszúrés eredménye a debreceni Emlócentrumban 1999-ben és 2000-ben.

INTRODUCTION: The screening mammography decreases the mortality of female breast cancer. METHODS: A complex, independent centre of screening mammography has been operating in Debrecen since 1999. RESULTS: The number of the examinations were 10,399 in 1999 and 13,800 in 2000. The number of explored breast cancer cases were 43 (0.41%) in 1999 and 62 (0.45%) in 2000. CONCLUSION: Although the mortality reduction can be exactly measured after several years, we are convinced that the chances for a better life of these 107 women operated on with breast cancer in early state increased thanks to our project. The results of the breast cancer screening program in Debrecen fulfilled the professional requirements of mammographic service-screening.

Pseudoaneurysm and ilio-caval fistula caused by malignant fibrous histiocytoma of the aorta--CT diagnosis and angiographic confirmation.

We report a case of a malignant fibrous histiocytoma (MFH) of the aortic bifurcation, which manifested as a pseudoaneurysm with the formation of an ilio-caval fistula, a complication about which, to our knowledge, nothing has been published previously. Spiral CT, catheter arteriography and venography were complementary in the diagnostic procedure.