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Sira L, Zsíros N, Bidiga L, Barna S, Kanyári Z, Nagy EB, Guillaume N, Wild D, Rázsó K, Andó S, Balogh I, Nagy EV, Balogh Z. Case report: Metastatic pancreatic neuroendocrine tumour associated with portal vein thrombosis; successful management with subsequent pregnancies. Front Endocrinol (Lausanne) 2023; 14:1095815. [PMID: 36923225 PMCID: PMC10008953 DOI: 10.3389/fendo.2023.1095815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Splanchnic vein thrombosis due to co-existing metastatic pancreatic neuroendocrine tumour (pNET) and JAK2V617F mutation is a rare condition. CASE REPORT Here we present a case of a young woman with complete remission of a non-functioning grade 2 pNET with unresectable liver metastases, coexisting with JAK2V617F mutation. Splenectomy and distal pancreatectomy were performed. Neither surgical removal, nor radiofrequency ablation of the liver metastases was possible. Therefore, somatostatin analogue (SSA) and enoxaparine were started. Peptide receptor radionuclide therapy (PRRT) was given in 3 cycles 6-8 weeks apart. Genetic testing revealed no multiple endocrine neoplasia type 1 (MEN-1) gene mutations. After shared decision making with the patient, she gave birth to two healthy children, currently 2 and 4 years old. On pregnancy confirmation, SSA treatment was interrupted and resumed after each delivery. Ten years after the diagnosis of pNET, no tumour is detectable by MRI or somatostatin receptor scintigraphy. PRRT followed by continuous SSA therapy, interrupted only during pregnancies, resulted in complete remission and enabled the patient to complete two successful pregnancies.
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Affiliation(s)
- Lívia Sira
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Noémi Zsíros
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Bidiga
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Barna
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Kanyári
- Department of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edit B. Nagy
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nicolas Guillaume
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Katalin Rázsó
- Division of Haematology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Andó
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Balogh
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre V. Nagy
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: Endre V. Nagy,
| | - Zoltán Balogh
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Dunne H, Rizan C, Jones A, Bhutta MF, Taylor T, Barna S, Taylor CJ, Okorie M. Effectiveness of an online module: climate-change and sustainability in clinical practice. BMC Med Educ 2022; 22:682. [PMID: 36115977 PMCID: PMC9482263 DOI: 10.1186/s12909-022-03734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Climate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes. METHODS A multi-media, online module was developed, and 3rd and 4th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed. RESULTS Forty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 - 21% students to between 91 - 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting. CONCLUSION This is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery. TRIAL REGISTRATION Study registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.
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Affiliation(s)
- H Dunne
- Cambridge University Hospital, Cambridge, UK.
| | - C Rizan
- University Hospitals Sussex NHS Foundation Trust & Brighton and Sussex Medical School, Brighton, UK
| | - A Jones
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - M F Bhutta
- Brighton and Sussex Medical School & University Hospitals Sussex NHS Foundation Trust GB, Brighton, UK
| | - T Taylor
- University Hospitals Southampton, Southampton, SO16 6YD, UK
| | - S Barna
- Centre for Sustainable Healthcare, 291, Cranbrook house, 287 Bambury Rd, Summertown, Oxford, OX2 7JQ, England
| | - C J Taylor
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - M Okorie
- Brighton and Sussex Medical School & University Hospitals Sussex NHS Foundation Trust GB, Brighton, UK
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Barna S, Meouchi C, Magrin G, Conte V, Stock M, Resch A, Georg D, Palmans H. PD-0815 Microdosimetry with tissue-equivalent proportional counters at an ion beam therapy facility. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Képes Z, Kukuts K, Oszlánszki A, Mihovk I, Krizsán Á, Barna S, Robinson A, Deidda D, Mester J, Varga J, Garai I, Forgács A. Initial clinical experience with dedicated multi-pinhole (MPH) collimator for 99mTc-HMPAO brain perfusion SPECT. Hell J Nucl Med 2022; 25:143-147. [PMID: 35913861 DOI: 10.1967/s002449912474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Dedicated multi-pinhole (MPH) collimators have been successfully tested in selected clinical investigations. The aim of our work was to report initial experiences with an MPH collimator set designed for brain perfusion single photon emission tomography (SPECT). SUBJECTS AND METHODS Ten patients underwent sequential technetium-99m-hexamethylpropyleneamineoxime (99mTc-HMPAO) SPECT with a dual-head SPECT camera equipped with conventional low-energy parallel hole collimators (LEHR), and with a triple-head system equipped with MPH collimators. Low-energy parallel hole collimators data were reconstructed by filtered back projection (FBP), ordered subset expectation maximization (OSEM), software for tomographic image reconstruction (STIR). In addition, both the parallel hole data and MPH data were reconstructed by Tera-TomoTM 3D iterative reconstruction denoted LEHR_TT3D and MPH_TT3D, respectively. Five medical experts visually compared the reconstructed images of the five data sets and defined a ranking sequence from the lowest (1) to the highest (5) image quality. Results were compared using the Friedman test. P values below 0.05 were considered significant. RESULTS Low-energy parallel hole collimators acquisition resulted in 5 million, while MPH acquisition in 13 million total counts with 30 and 34 minutes of acquisition time, respectively. Mean rank coefficients of the reconstruction methods were 1.96±0.52, 2.66±0.46, 2.86±0.60, 3.62±0.55, 3.9±0.68 for FBP, STIR, LEHR_TT3D, LEHR_OSEM, MPH_TT3D respectively. The differences between MPH_TT3D-FBP (P<0.01); MPH_TT3D-STIR (P<0.05); LEHR_OSEM-FBP (P<0.01) were significant. CONCLUSION Image quality provided by MPH collimator is comparable to that provided by conventional LEHR imaging. Higher sensitivity has the potential to shorten acquisition time or to reduce the amount of administered activity.
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Affiliation(s)
- Zita Képes
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdeikrt. 98, 4032 Debrecen, Hungary. ,
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Csernátony Z, Győrfi G, Barna S, Manó S, Szabó J, Zhang L. The roof step cut: A novel technique for bony reconstruction of acetabular roof deficiency during total hip replacement. Jt Dis Relat Surg 2022; 33:9-16. [PMID: 35361075 PMCID: PMC9057543 DOI: 10.52312/jdrs.2022.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
This study aims to present a new technique, the roof step cut (RSC), for acetabular augmentation of hip dysplasia. Patients and methods
Between December 2008 and March 2020, we applied the RSC technique in a total of 48 hips of 41 patients (2 males, 39 females; mean age: 50.1±9.5 years; range, 30 to 75 years) with Hartofilakidis type A, B, C hip dysplasia. The RSC technique uses a L-shaped graft cut from the femoral head. The graft is partially inside the acetabulum and partially on the lateral aspect of the ilium. It is fixed with two screws at a 45° angle allowing simultaneous distalization and lateral covering of the cementless cup. Follow-up was done at six weeks, three months, and annually thereafter using standard pelvis anteroposterior X-ray and function scores. The 99mTc bone scintigraphy examination was also performed at around two weeks, six months, and 12 months postoperatively to evaluate the healing process of the graft. Results
The mean follow-up time was 59.6±25.6 (range, 12 to 109) months. No significant center-edge angle changes and no contiguous radiolucent zones at the boneprosthesis interface were observed at the final follow-up. The single-photon emission tomography (SPECT) showed the activity of the bone graft gradually increased after surgery and became almost the same as the reference area after 12 months. Functional evaluation showed a significant improvement after the operation. No complication directly related to the technique was observed. Conclusion
In the short-term follow-up, the RSC technique is a reliable procedure for acetabular augmentation of hip dysplasia, providing enough coverage for the cementless cup and assuring proper stability.
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Affiliation(s)
| | | | | | | | | | - Lei Zhang
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
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Képes Z, Mikó M, Kukuts K, Esze R, Barna S, Somodi S, Káplár M, Varga J, Garai I. Imaging with [ 99mTc]HMPAO - a novel perspective: investigation of [ 99mTc]HMPAO leg muscle uptake in metabolic diseases. Acta Radiol 2021; 64:187-194. [PMID: 34894745 DOI: 10.1177/02841851211063601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sensitive imaging modalities in the diagnosis of microcircular complications of the lower extremities induced by metabolic diseases are becoming a focus of interest. PURPOSE To investigate the [99mTc]HMPAO uptake of the legs in type 2 diabetes mellitus (T2DM) and obesity, and to search for associations with clinical parameters and nerve conducting studies. MATERIAL AND METHODS A total of 57 patients with controlled T2DM and 46 obese participants without DM were enrolled in the study. [99mTc]HMPAO SPECT/CT examinations were performed to evaluate the radiopharmaceutical accumulation of the legs. For the quantitative assessment of tracer uptake, standardized uptake value (SUVpeak) was measured in fixed spheric volumes of interest placed on both sural muscles on the attenuation-corrected images. Measurement of current perception threshold applying Neurometer (NM-01/CPT) was used to evaluate peripheral nerve dysfunction. Laboratory parameters assessing the glucose homeostasis of the study participants were also measured. RESULTS In the diabetic group, significantly lower leg SUV values were detected compared to the non-DM obese group (median: 0.517 vs. 0.607; P < 0.001). Body mass index (BMI) (P < 0.0001), age (P = 0.0283), HbA1c (P = 0.0068), and glucose level (P = 0.0044) proved to be significant predictors of muscle tracer uptake. Neurometer studies showed positive correlation with HbA1c levels in the T2DM group (P = 0.0002). CONCLUSION We assume that [99mTc]HMPAO uptake of leg muscles is associated with microcirculation, so quantitative [99mTc]HMPAO SPECT/CT might be a sensitive method for evaluating lower limb microvascular alterations. BMI, age, HbA1c, and glucose level may be significant predictors of peripheral vascular abnormalities triggered by metabolic disturbances.
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Affiliation(s)
- Zita Képes
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Márton Mikó
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kornél Kukuts
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
| | - Regina Esze
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Barna
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
| | - Sándor Somodi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Káplár
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - József Varga
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Garai
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
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Barna S, Resch A, Puchalska M, Georg D, Palmans H. PH-0321 Determination of the effective point of measurement of a ionization chamber in light-ion beams. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simon Z, Virga B, Pinczés L, Méhes G, Miltényi Z, Barna S, Szabó R, Illés Á. Transition Between Diffuse Large B-Cell Lymphoma and Classical Hodgkin Lymphoma- Our Histopathological and Clinical Experience With Patients With Intermediate Lymphoma. Pathol Oncol Res 2021; 27:625529. [PMID: 34257590 PMCID: PMC8262174 DOI: 10.3389/pore.2021.625529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Even though information about the pathophysiology and clinical features of grey-zone lymphoma, an entity intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma, is growing, there are still a number of unanswered questions. The disease has no easily reproducible diagnostic criteria, which makes identification challenging. Uncommon, mixed histological picture and unusual clinical presentation should raise suspicion for grey-zone lymphoma. In this retrospective analysis we present 9 gray zone lymphoma patients, who were diagnosed in our institute between 2008 and 2018. The histological diagnoses was oftentime challenging, we asked for a revision in three cases due to the unusual clinical behavior and in other three cases only the relapse of the disease proved to be grey-zone lymphoma. Based on the initial histopathological diagnoses we applied adriablastine-bleomycine-vinblastine and procarbasine or cyclophosphamide-vincristine-adriablastine and prednisolon as first line chemotherapy regime with additional rituximab in six cases and brentuximab-vedotine in one patient. In six of the nine patients due to the primary refractory disease we used rituximab plus cisplatine, cytosine-arabinoside, prednisolone salvage treatment and five of these patients responded well enough to become eligible for autologous stem cell transplantation. One young male patient was refractory for various treatments and died due to the progression of his lymphoma. As a rare disease grey-zone lymphoma has no existing diagnostic criteria or guiedlines for its standard of care, which makes the everyday practice rather challenging for the clinicians, and emphasize the importance of unique decision making in every case and the repeated consultation between the pathologist and hematologist.
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Affiliation(s)
| | | | | | - Gábor Méhes
- Institutes of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Képes Z, Nagy F, Budai Á, Barna S, Esze R, Somodi S, Káplár M, Garai I, Varga J. Age, BMI and diabetes as independent predictors of brain hypoperfusion. Nucl Med Rev 2021; 24:11-15. [DOI: 10.5603/nmr.2021.0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
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Barna S, Garai I, Nagy G. [Single photon emitting radiopharmaceuticals in oncology]. Magy Onkol 2020; 64:98-103. [PMID: 32520002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
In this review the isotopes and radiopharmaceuticals used for single-photon techniques will be discussed, covering their current use and possible future trends. SPECT technics have a wide range of diagnostic isotopes and therapeutic isotopes whose diagnostic imaging is possible thanks to new technologies. In the field of nuclear medicine nowadays the parallel use of diagnostic and therapeutic radiopharmaceuticals is becoming more and more important, causing an important role for theranostics.
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Affiliation(s)
- Sándor Barna
- Scanomed Orvosi, Diagnosztikai, Kutató és Oktató Kft., Debrecen, Hungary.
| | - Ildikó Garai
- Scanomed Orvosi, Diagnosztikai, Kutató és Oktató Kft., Debrecen, Hungary.
| | - Gábor Nagy
- Scanomed Orvosi, Diagnosztikai, Kutató és Oktató Kft., Debrecen, Hungary.
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11
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Kovács Á, Légrádi G, Wirth A, Nagy F, Forgács A, Barna S, Garai I, Bükki T. [The value of artificial and human intelligence - the example of bone scintigraphy]. Magy Onkol 2020; 64:153-158. [PMID: 32520009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
We present a possible method of Artificial Intelligence (AI) based applications that can effectively filter noise-sensitive bone scintigraphy images. The use of special AI, based on preliminary examinations, allows us to significantly reduce study time or activity administered to the patient, thus reducing the patient, assistant, and physician radiation. We present the features of the AI filtering application, its teaching process, which is important to understand, so that the physician can safely take the processed image of the AI as a "secondary reliable opinion" to help them make a more accurate diagnosis. We also examine the robustness of the algorithm, the specificities and challenges of complex clinical control.
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Affiliation(s)
- Ákos Kovács
- Mediso Medical Imaging Systems Kft., Budapest, Hungary.
| | - Gábor Légrádi
- Mediso Medical Imaging Systems Kft., Budapest, Hungary.
| | - András Wirth
- Mediso Medical Imaging Systems Kft., Budapest, Hungary.
| | - Ferenc Nagy
- ScanoMed, Orvosi, Diagnosztikai, Oktató és Kutató Kft., Debrecen, Hungary
| | - Attila Forgács
- ScanoMed, Orvosi, Diagnosztikai, Oktató és Kutató Kft., Debrecen, Hungary
| | - Sándor Barna
- ScanoMed, Orvosi, Diagnosztikai, Oktató és Kutató Kft., Debrecen, Hungary
| | - Ildikó Garai
- ScanoMed, Orvosi, Diagnosztikai, Oktató és Kutató Kft., Debrecen, Hungary
| | - Tamás Bükki
- Mediso Medical Imaging Systems Kft., Budapest, Hungary.
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Hircsu I, Gazdag A, Bodor M, Berta E, Andrási M, Kanyári Z, Győry F, Barna S, Bhattoa HP, Nagy B, Nagy VE, Erdei A. [Multiple endocrine neoplasia type 2A in a family]. Orv Hetil 2020; 161:75-79. [PMID: 31902232 DOI: 10.1556/650.2020.31595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors present the case of a multiplex endocrine neoplasia type 2A (MEN2A). The 55-year-old woman underwent detailed examinations for abdominal complaints. Bilateral adrenal masses and thyroid nodular goiter were found. Based on metanephrine excretion and MIBG imaging, bilateral phaeochromocytomas were diagnosed. The thyroid nodules were confirmed by thyroidectomy as bilateral medullary thyroid carcinoma. Asymptomatic primary hyperparathyroidism was also detected. Laparoscopic adrenalectomy and parathyroid adenoma removal were performed. Based on family history and the characteristic clinical presentation, MEN2A syndrome was confirmed by genetic testing. During genetic screening of first-degree relatives, the patient's 25-year-old daughter was shown to be a gene carrier. Preventive thyroidectomy was performed and histology proved multifocal medullary thyroid cancer. In addition to the importance of genetic testing, the authors emphasize the guideline-based, but individualized approach to patients with suspected MEN2A syndrome. Orv Hetil. 2020; 161(2): 75-79.
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Affiliation(s)
- Ildikó Hircsu
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Annamária Gazdag
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Miklós Bodor
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Eszter Berta
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Mónika Andrási
- Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Zsolt Kanyári
- Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Ferenc Győry
- Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Sándor Barna
- Nukleáris Medicina Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Harjit Pal Bhattoa
- Laboratóriumi Medicina Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Béla Nagy
- Laboratóriumi Medicina Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - V Endre Nagy
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Annamária Erdei
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
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Kovács DÁ, Fedor R, Asztalos L, Andrási M, Szabó RP, Kanyári Z, Barna S, Nemes B, Győry F. Surgical Treatment of Hyperparathyroidism After Kidney Transplant. Transplant Proc 2019; 51:1244-1247. [PMID: 31101206 DOI: 10.1016/j.transproceed.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic renal impairment is often associated with complex bone disorders. Improvement of secondary hyperparathyroidism (HPT) is expected after kidney transplant (KT) if the glomerular filtration rate is normalized. PATIENTS AND METHODS There were 888 KTs performed between 1996 and 2017 at our department. A total of 558 general patients have been operated on for HPT during the same period. The 2 populations had a common part: out of the 558, a total of 69 (12.4%) were in end-stage renal failure when operated on because of secondary HPT. That also means that 7.8% of all KTs were associated with HPT. Retrospective, single-center analysis was performed using the patients' medical records. The aim of our study was to analyze the results of parathyroidectomies after KT. RESULTS Parathyroid surgery was performed on 19 patients (2.14%) because of HPT after KT. The applied surgical technique was total parathyroidectomy with autotransplant in 6 cases, subtotal parathyroidectomy in 3 cases, and selective parathyroidectomy in 10 cases. In all cases, histology revealed benign disease. Complications were observed in 10 cases (52%); there were 6 cases of postoperative hypocalcaemia (31.58%), 1 case of transient laryngeal recurrent nerve paresis (5.26%), and 6 cases of recurrent HPT (31.58%). SUMMARY The first step of HPT management is calcimimetic drug treatment. It is essential to prevent possible complications with regular laboratory monitoring. If the proper conservative therapy is refractory or severe in complications, surgery should be chosen. If the patient is already waiting for a KT, it is worth performing the parathyroid surgery before KT. Close collaboration with endocrinologists and nephrologists is needed to achieve successful therapy.
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Affiliation(s)
- D Á Kovács
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - R Fedor
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - L Asztalos
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - M Andrási
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R P Szabó
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zs Kanyári
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - S Barna
- University of Debrecen Scanomed Ltd, Debrecen, Hungary
| | - B Nemes
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Győry
- Division of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Pinczés L, Magyari F, Reményi G, Pfliegler G, Barna S, Bedekovics J, Illés Á. Intravascular Occlusion by Leukemic Blast Cells Causing Multiplex Hand Necrosis in a Patient with Acute Myeloid Leukemia. Pathol Oncol Res 2019; 26:1349-1351. [PMID: 30875032 DOI: 10.1007/s12253-019-00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- László Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Ferenc Magyari
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Reményi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Pfliegler
- Division of Rare Diseases, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Judit Bedekovics
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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15
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Gyory F, Kovács D, Roland F, Andrási M, Barna S, Nagy V E, Tóth L, Damjanovich L. Oncological concernings in patients with graves’ disease. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Kovács D, Gyory F, Roland F, Andrási M, Barna S, Tóth L, Nagy V E, Damjanovich L. Rare endocrine disorder: parathyroid carcinoma. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Kracskó B, Barna S, Sántha O, Kiss A, Varga J, Forgács A, Garai I. Effect of patient positioning on the evaluation of myocardial perfusion SPECT. J Nucl Cardiol 2018; 25:1645-1654. [PMID: 28361477 DOI: 10.1007/s12350-017-0865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND ECG-gated SPECT myocardial perfusion imaging is usually acquired in supine position. However, some patients are not comfortable in this position for a variety of personal or medical reasons. Our aim was to investigate the effect of patient positioning on quantitative SPECT imaging results using normal supine database. METHODS 55 patients (mean age 58.5 ± 8.3 years) were enrolled in this prospective study. Each patient had a pair of ECG-gated stress SPECT myocardial perfusion images acquired on two gamma cameras: one in supine position and the other in upright sitting position. Left ventricular (LV) ejection fraction (EF), end-diastolic (ED), and end-systolic (ES) left ventricular volumes (V), LV mass, summed stress perfusion defect score (SSS), and total severity score (TSS) were calculated automatically relative to a supine normal reference database. RESULTS There were no significant differences in LVEF using the two cameras (0.65 ± 0.08 vs. 0.66 ± 0.10; P > 0.1). However, EDV, ESV, and LV mass were significantly smaller in sitting position than in supine position (89 vs. 80 ml; 33 vs. 29 ml and 115 vs. 109 ml, respectively, all P < 0.0001). On the other hand, SSS and TSS were significantly higher in sitting position than in supine position (5.16 vs. 8.73 and 166.82 vs. 288.27, both P < 0.0001). Overall, more studies in sitting position were interpreted as abnormal than in supine position (P < 0.05). CONCLUSION Patient positioning has a significant impact on quantitative gated SPECT imaging results. Using a supine normal reference database, SSS and TSS were larger in sitting position than in supine position. Thus, for imaging in sitting position, separate normal limits are required.
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Affiliation(s)
- Bertalan Kracskó
- Institute of Cardiology, University of Debrecen, Móricz Zs. krt. 22., Debrecen, 4032, Hungary.
| | | | | | | | - József Varga
- Department of Nuclear Medicine, University of Debrecen, Debrecen, Hungary
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Magyari F, Barna S, Husi K, Simon Z, Miltényi Z, Váróczy L, Udvardy M, Illés Á. Alternative salvage regimens for relapsed/refractory classical Hodgkin's lymphoma. ACTA ACUST UNITED AC 2016; 21:404-10. [PMID: 26907830 DOI: 10.1080/10245332.2015.1115192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE AND IMPORTANCE Hodgkin's lymphoma (HL) is a well-curable disease. The treatment usually includes combined multiagent conventional chemotherapy and radiotherapy. One-fifth of the patients need repeated treatments because of relapse or primary progressive disease. Those HL patients, who cannot be cured at least with salvage therapy (including autologous haemopoietic stem cell transplantation (auto-HSCT)), have really unfavourable prognosis. INTERVENTION For this heavily pretreated subset of HL patients, novel but less toxic treatment strategies should be considered. Brentuximab-vedotin (BV) is a novel targeted treatment option, which was administered after the failure of two different regimens in patients, who were ineligible for auto-HSCT or after the failure of auto-HSCT. Moreover, there are favourable data with chemotherapeutical regimens supplemented with rituximab not only in relapsed but also in newly diagnosed classical HL patients. Bendamustine, an almost forgotten 50-year-old drug, lives its renaissance in the twenty-first century, which can be administered in refractory HL as well. Combination of the 'new' and 'old' drugs might be also helpful. CONCLUSION Our data suggest that rituximab plus bendamustine (supplemented with or without BV) could be a suitable alternative bridging salvage therapy for heavily pretreated HL patients.
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Affiliation(s)
- Ferenc Magyari
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | | | - Kata Husi
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Zsófia Simon
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Zsófia Miltényi
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - László Váróczy
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Miklós Udvardy
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Árpád Illés
- a Department of Hematology , Institute for Internal Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
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Erdei A, Steiber Z, Gazdag A, Bodor M, Berta E, Szász R, Szántó A, Ujhelyi B, Barna S, Berényi E, Nagy VE. [Differential diagnosis of Graves' orbitopathy. Case report]. Orv Hetil 2016; 157:310-5. [PMID: 26876268 DOI: 10.1556/650.2016.30381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.
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Affiliation(s)
- Annamária Erdei
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
| | - Zita Steiber
- Szemészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Annamária Gazdag
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
| | - Miklós Bodor
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012.,Klinikai Farmakológiai Tanszék, Debreceni Egyetem, Gyógyszertudományi Kar Debrecen
| | - Eszter Berta
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012.,Klinikai Farmakológiai Tanszék, Debreceni Egyetem, Gyógyszertudományi Kar Debrecen
| | - Róbert Szász
- Belgyógyászati Intézet, Hematológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Antónia Szántó
- Belgyógyászati Intézet, Immunológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Bernadett Ujhelyi
- Szemészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Sándor Barna
- Nukleáris Medicina Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Ervin Berényi
- Radiológiai Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - V Endre Nagy
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
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Palágyi P, Barna S, Csábi P, Lorencz P, László I, Molnár Z. Recent Advances of Mucosal Capnometry and the Perspectives of Gastrointestinal Monitoring in the Critically Ill. A Pilot Study. J Crit Care Med (Targu Mures) 2016; 2:30-37. [PMID: 29967834 DOI: 10.1515/jccm-2016-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/05/2015] [Indexed: 11/15/2022] Open
Abstract
Mucosal capnometry involves the monitoring of partial pressure of carbon dioxide (PCO2) in mucous membranes. Different techniques have been developed and applied for this purpose, including sublingual or buccal sensors, or special gastrointestinal tonometric devices. The primary use of these procedures is to detect compensated shock in critically ill patients or patients undergoing major surgery. Compensatory mechanisms, in the early phases of shock, lead to the redistribution of blood flow towards the vital organs, within ostensibly typical macro-haemodynamic parameters. Unfortunately, this may result in microcirculatory disturbances, which can play a pivotal role in the development of organ failure. In such circumstances mucosal capnometry monitoring, at different gastrointestinal sites, can provide a sensitive method for the early diagnosis of shock. The special PCO2 monitoring methods assess the severity of ischaemia and help to define the necessary therapeutic interventions and testing of these monitors have justified their prognostic value. Gastrointestinal mucosal capnometry monitoring also helps in determining the severity of ischaemia and is a useful adjunctive in the diagnosis of occlusive splanchnic arterial diseases. The supplementary functional information increases the diagnostic accuracy of radiological techniques, assists in creating individualized treatment plans, and helps in follow-up the results of interventions. The results of a pilot study focusing on the interrelation of splanchnic perfusion and gastrointestinal function are given and discussed concerning recent advances in mucosal capnometry.
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Affiliation(s)
- Péter Palágyi
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Sándor Barna
- Department of Anaesthesiology and Intensive Therapy, Bács-Kiskun County Hospital, Teaching Hospital of the University of Szeged, Szeged, Hungary
| | - Péter Csábi
- Department of Anaesthesia and Intensive Care, Wexham Park Hospital, Wexham Park, United Kingdom
| | - Péter Lorencz
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Ildikó László
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
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Kracskó B, Garai I, Barna S, Szabó GT, Rácz I, Kolozsvári R, Tar B, Jenei C, Varga J, Kõszegi Z. Relationship between reversibility score on corresponding left ventricular segments and fractional flow reserve in coronary artery disease. Anatol J Cardiol 2015; 15:469-74. [PMID: 25430413 PMCID: PMC5779139 DOI: 10.5152/akd.2014.5500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of this study was to find the correlation between the severity of perfusion abnormality detected by scintigraphy and the FFR value, as well as the localization of a particular coronary lesion. On the basis of FFR values and the corresponding left ventricular segments, we proposed a combined index to aim for better correlation with myocardial ischemia than the FFR parameter alone. Methods: Twenty-eight patients (male: 22, female: 6, age 62±7.62) having FFR measurements and myocardial perfusion SPECT studies were enrolled in our retrospective analysis. FFR measurements on 36 vessels (20 LAD, 6 LCx, 10 RCA) with intermediate stenosis (40%-60%) were compared to the Tc-99m SestaMIBI myocardial perfusion SPECT studies. SPECT studies were performed before the invasive procedure in all cases. We introduced a new ischemic index, the left ventricular ischemic index (LVIi), by combining FFR values with the number of corresponding myocardial segments (N) [LVIi=N x (1-FFR)]. This index correlated with the regional myocardial perfusion defects identified on the scintigrams. A perfusion reversibility score of 2 or above was considered indicative of active ischemia (regional difference score: rDSc). For the statistical analysis, we used linear regression analysis and receiver operating characteristic (ROC) curve analysis to compare the different parameters. Results: A close linear relationship was found between the LVIi and rDSc values (p<0.001) with linear regression analysis. When analyzing all FFR values independently of the localization of the lesions, they also correlated significantly to the rDSc, but this relation was not as close. LVIi predicted active ischemia (≥2 rDSc) on myocardial scintigraphy with 78% sensitivity and 94% specificity when the cutoff value was set to 0.96. FFR alone predicted ischemia on scintigraphy with 72% sensitivity and 94% specificity at the best 0.8 cut-off value. The area under the ROC curve was significantly higher for LVIi than FFR (0.94 vs. 0.87; p<0.05). Conclusion: The scintigraphic data indicate that an LVIi >0.96 implies a clinically relevant stenotic lesion. In our opinion, FFR values, weighted with the corresponding left ventricular segments, should be taken into consideration for the best clinical decision-making.
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Affiliation(s)
- Bertalan Kracskó
- Institute of Cardiology, University of Debrecen Clinical Center; Debrecen-Hungary.
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Miltenyi Z, Barna S, Garai I, Simon Z, Jona A, Magyari F, Gergely M, Nagy Z, Keresztes K, Pettendi P, Illes A. Prognostic value of interim and restaging PET/CT in Hodgkin lymphoma. Results of the CHEAP (Chemotherapy Effectiveness Assessment by PET/CT) study - long term observation. Neoplasma 2015; 62:627-34. [PMID: 25997970 DOI: 10.4149/neo_2015_075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Very few studies have determined the prognostic value of interim and restaging PET/CT in patients with Hodgkin lymphoma using current standard of care therapy outside clinical trials. We analyzed the effect of the results of interim and restaging PET/CT on the survival (overall- and relapse-free) in patients who received standard first-line treatment based on the stage of disease and risk factors. We investigated the differences between the relapse and non-relapse groups based on the clinical pathological characteristics of patients who had positive interim PET/CT results.Between January 1, 2007 and December 31, 2011, the staging, interim and restaging PET/CT scans of patients with Hodgkin lymphoma were analyzed. The Deauville criteria were used for the evaluation of interim PET/CT scans. One hundred and thirteen Hodgkin lymphoma patients underwent staging, interim and restaging PET/CT scans. None of the therapy was modified based on the interim PET/CT results. The median follow-up time was 43.5 months. A total of 62 early stage patients and 51 advanced stage patients were identified. The five-year overall survival rates were 93.4% in the interim PET negative group and 58% in the interim PET positive group (p<0.001). The five-year relapse-free survival rates for the negative and positive groups were 92.7% and 40.8%, respectively (p<0.001). The negative predictive value was 100% in the early stage group and 82.35% in the advanced stage group. By comparison, the positive predictive values were 53.8% and 58.8%, respectively, in these two groups. In the interim PET positive group, patients over 40 years of age had a significantly higher probability of relapse (p=0.057).The routine clinical use of interim PET/CT is highly recommended based on our investigation. However, patients with positive interim PET/CT results required frequent additional evaluations.
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Páll A, Becs G, Erdei A, Sira L, Czifra A, Barna S, Kovács P, Páll D, Pfliegler G, Paragh G, Szabó Z. Pseudopheochromocytoma induced by anxiolytic withdrawal. Eur J Med Res 2014; 19:53. [PMID: 25288254 PMCID: PMC4196012 DOI: 10.1186/s40001-014-0053-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022] Open
Abstract
Background Symptomatic paroxysmal hypertension without significantly elevated catecholamine concentrations and with no evidence of an underlying adrenal tumor is known as pseudopheochromocytoma. Methods We describe the case of a female patient with paroxysmal hypertensive crises accompanied by headache, vertigo, tachycardia, nausea and altered mental status. Previously, she was treated for a longer period with alprazolam due to panic disorder. Causes of secondary hypertension were excluded. Neurological triggers (intracranial tumor, cerebral vascular lesions, hemorrhage, and epilepsy) could not be detected. Results Setting of the diagnosis of pseudopheochromocytoma treatment was initiated with alpha- and beta-blockers resulting in reduced frequency of symptoms. Alprazolam was restarted at a daily dose of 1 mg. The patient’s clinical condition improved rapidly and the dosage of alpha- and beta-blockers could be decreased. Conclusions We conclude that the withdrawal of an anxiolytic therapeutic regimen may generate sympathetic overdrive resulting in life-threatening paroxysmal malignant hypertension and secondary encephalopathy. We emphasize that pseudopheochromocytoma can be diagnosed only after exclusion of the secondary causes of hypertension. We highlight the importance of a psychopharmacological approach to this clinical entity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Zoltán Szabó
- Division of Emergency Medicine, Institute of Internal Medicine, University of Debrecen Medical Center, Nagyerdei krt, 98, Debrecen, 4032, Hungary.
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Erdei A, Gazdag A, Bodor M, Berta E, Katkó M, Ujhelyi B, Steiber Z, Győry F, Urbancsek H, Barna S, Galuska L, Nagy VE. [Novel treatment opportunities in Graves' orbitopathy]. Orv Hetil 2014; 155:1295-300. [PMID: 25109914 DOI: 10.1556/oh.2014.29963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves' orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves' orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted.
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Affiliation(s)
- Annamária Erdei
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012
| | - Annamária Gazdag
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012
| | - Miklós Bodor
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012 Debreceni Egyetem, Gyógyszerésztudományi Kar Klinikai Farmakológiai Tanszék Debrecen
| | - Eszter Berta
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012 Debreceni Egyetem, Gyógyszerésztudományi Kar Klinikai Farmakológiai Tanszék Debrecen
| | - Mónika Katkó
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012
| | - Bernadett Ujhelyi
- Debreceni Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Debrecen
| | - Zita Steiber
- Debreceni Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Debrecen
| | - Ferenc Győry
- Debreceni Egyetem, Általános Orvostudományi Kar Sebészeti Intézet, Pajzsmirigy Centrum Debrecen
| | - Hilda Urbancsek
- Debreceni Egyetem, Általános Orvostudományi Kar Sugárterápiás Tanszék Debrecen
| | - Sándor Barna
- Debreceni Egyetem, Általános Orvostudományi Kar Nukleáris Medicina Tanszék Debrecen
| | - László Galuska
- Debreceni Egyetem, Általános Orvostudományi Kar Nukleáris Medicina Tanszék Debrecen
| | - V Endre Nagy
- Debreceni Egyetem, Általános Orvostudományi Kar Belgyógyászati Intézet, Endokrinológia Tanszék Debrecen Nagyerdei krt. 98. 4012
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Garai I, Borbély K, Barna S, Szûcs B, Hascsi Z, Tóth Z, Illés A. [18F-FDG PET/CT in lymphomas: assessment difficulties due to illness characteristics, and comparison with literature data]. Magy Onkol 2011; 55:178-186. [PMID: 21918743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 06/20/2011] [Indexed: 05/31/2023]
Abstract
Fluor-18-deoxy-glucose (18F-FDG or FDG) positron emission tomography - computer tomography (PET/CT) has recently become integrated into the clinical routine of patients with lymphoma in Hungary. The basic condition of risk-adapted treatment of these patients is the exact staging and early objective evaluation of the effectiveness of therapy. Between 1 May 2007 and 31 October 2010, 1862 18F-FDG PET/CT examinations were conducted for lymphoma patients at the PET/CT Center in Debrecen. This is more than 15% of the total examined patient population, and this rate shows a slight increase with each year. Based on the experience obtained from lymphoma patients by routine metabolic PET/CT scans we analyzed the difficulties of the evaluation in different time frames of patients' management. It is well known that FDG uptake of lymphomas depends on multiple factors. Although most histological subtypes are associated with uptake of FDG, the intensity of the tracer uptake is different. Different intensity of FDG uptake of the same type of lymphoma following therapeutic procedures might cause difficulties in the evaluation of the scans ensuring that primary staging by PET/CT is highly required for precise measurement and reliable comparison of data. Extranodal involvement was detected in ~40% of the patients with variable rate of prevalence. Extranodal involvement is associated with great diversity and in most cases it is not characteristic of the illness and might appear in different forms and in any organs. Additionally, because accompanying disease may produce false positive results, detailed clinical data and precise case history is highly required.
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Affiliation(s)
- Ildikó Garai
- ScanoMed Orvosi Diagnosztikai Oktató és Kutató Kft., Debrecen, Hungary.
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Nash D, Ruotoistenmäki J, Argentieri A, Barna S, Behbehani J, Berthold P, Catalanotto F, Chidzonga M, Goldblatt L, Jaafar N, Kikwilu E, Konoo T, Kouzmina E, Lindh C, Mathu-Muju K, Mumghamba E, Nik Hussein N, Phantumvanit P, Runnel R, Shaw H, Forna N, Orliaguet T, Honkala E. Profile of the oral healthcare team in countries with emerging economies. Eur J Dent Educ 2008; 12 Suppl 1:111-119. [PMID: 18289274 DOI: 10.1111/j.1600-0579.2007.00493.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.
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Affiliation(s)
- D Nash
- College of Dentistry, University of Kentucky, Lexington, KY, USA.
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López-Zetina J, Ford W, Weber M, Barna S, Woerhle T, Kerndt P, Monterroso E. Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County, 1994-6. Sex Transm Infect 2000; 76:462-9. [PMID: 11221130 PMCID: PMC1744247 DOI: 10.1136/sti.76.6.462] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe HIV prevalence and the association between syphilis incidence and sexual and drug injection risk behaviours in a cohort of street recruited injecting drug users (IDUs) in Los Angeles County, between 1994 and 1996. METHODS During the study period, 513 street recruited African-American and Latino IDUs were screened for syphilis and antibodies to HIV. Subjects were administered a risk behaviour survey at baseline and followed up at 6 month intervals for 18 months with repeated interviews and serological screening. Rate ratios were used to examine associations between syphilis incidence and demographic characteristics and risk behaviours. A proportional hazard model was used to identify predictors of syphilis incidence independent of demographic characteristics. RESULTS 74% of the sample were male, 70% African-American, 30% Latino; and the median age was 43 years. Overall baseline serological prevalence of HIV was 2.5% and of syphilis 5.7%. None of the participants were co-infected for HIV and syphilis at baseline or at any of the 6 month follow ups. Among 390 eligible IDUs retained for analysis of incidence data, the overall syphilis incidence was 26.0 per 1000 person years. Higher syphilis incidence was found for women compared with men (RR = 2.70; 95% CI 1.60, 4.55), and for those 44 years of age or younger compared with those 45 years of age and older (RR = 2.26; 95% CI 1.25, 4.08). African-Americans were more likely to be syphilis incident cases when compared with Latinos, although the difference did not reach statistical significance (RR = 1.27; 95% CI 0.72, 2.23). In bivariate analysis, risk behaviours significantly associated with higher syphilis incidence included injection of cocaine, "speedball" and heroin, "crack" smoking, recency of first injection event, backloading of syringes, injecting with others, exchanging drugs or money for sex, multiple sex partners, and non-heterosexual sexual preference. Variables that significantly predicted syphilis infection at follow up in the multivariate analysis included multiple sex partners (RR = 7.8; 95% CI 2.4, 25.0), exchanging money for sex (RR = 3.0; 95% CI 0.9, 9.6), and recent initiation to injection drug use (RR = 4.6; 95% CI 1.1, 18.8). CONCLUSION Syphilis transmission among IDUs in Los Angeles County remains a serious public health concern, particularly among IDUs who engage in trading of sex for money or drugs. Although low, the prevalence of HIV observed in this study constitutes a serious concern because of the potential for expanded HIV transmission in this susceptible population of IDUs with high syphilis incidence. Enhanced case finding screening efforts and prevention of transmission of sexually transmitted infections should specifically target hard to reach IDUs and their sexual partners.
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Affiliation(s)
- J López-Zetina
- Los Angeles County, Department of Health Services, HIV Epidemiology Program, Los Angeles, California, USA.
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Abstract
A survey of dental schools in the European Union was carried out for two main reasons. Firstly to promote the exchange of information in respect of curriculum objectives in the different countries and secondly to ascertain the differences in the interpretation of the 1978 EU sectoral directives for dental education and training. Out of 127 schools, only 30 responded, yet the information provided is of considerable importance. It demonstrates wide divergence in the interpretation of the 1978 Directives and methods of assessment of clinical competence. There is a considerable difference throughout Europe in hours devoted to the various subjects included in the Dental Directives. There is little evidence of convergence in methods of assessment or quality assurance. The survey demonstrates the difference in resources, levels of staff, availability of clinical training places, output in research and patient treatments throughout the European Union. The results question the effectiveness of the 1978 Dental Directives in promoting convergence of standards. As there is free movement of dentists throughout the European Union, it is concluded that a different approach may be necessary to ensure that all European Union dental graduates achieve comparable standards in their education and training.
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Affiliation(s)
- D B Shanley
- School of Dental Science, Trinity College, Dublin, Ireland
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Datcu G, Datcu MD, Barna S, Cioară O. [The value of prazosin treatment in arterial hypertension]. Rev Med Chir Soc Med Nat Iasi 1988; 92:751-4. [PMID: 3253928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Marcu C, Barna S, Bostaca I, Negoiţă CI. [Phonomechanocardiographic aspects during effort in patients with angina pectoris]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1988; 40:167-75. [PMID: 2908078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Negoiţă CI, Ivan A, Barna S, Marcu C, Duda R, Datcu G, Datcu MD, Groll M, Mitroi I, Bostaca I. [Clinico-epidemiological research on arterial hypertension and ischemic cardiopathy]. Rev Med Chir Soc Med Nat Iasi 1986; 90:227-32. [PMID: 3764188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Barna S. [Borderline arterial hypertension]. Rev Med Chir Soc Med Nat Iasi 1982; 86:688-90. [PMID: 7170529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Marcu C, Georgescu G, Barna S, Stamate T. [Value of the right endoatrial electrocardiogram in the diagnosis of cardiac rhythm disorders]. Rev Med Chir Soc Med Nat Iasi 1982; 86:403-10. [PMID: 7170482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Negoiţă CI, Marcu C, Barna S, Ardeleanu M. [Investigations of the left ventricular dynamics in stable-angina pectoris (AP)]. Rev Med Chir Soc Med Nat Iasi 1982; 86:243-248. [PMID: 25588243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The investigations were carried out in 78 patients with stable AP without myocardiaI infarction in their case history and in 30 controls all distributed in three series: I = 37 patients with AP and marked alterations of ventricular repolarization (ST depression ≥ 52 mm and T negative waves ≥ 2 mm); II = 41 patients with AP and normal ECG and III = 30 controls, clinically and ECG normal, of similar age with the patients in the I and II series. The investigations of the left ventricular systole periods also rendered evident in the patients with AP important alterations of ventricular repolarization (Ist series): prolonged preejection period (PEP) due to the izovolumetric contraction time (IVCT), shortening of the ejection time (LVET) and decrease of PEP/LVET ratio as well as the significant increase of S(IV)/S(I) ratio. Although slightly shortened in this series, the electromechanic systole (QS(II)) does not present statistically significant alterations, the prolonged PEP being partially counter-balaced by the shortened LVET. The most sensitive index seems to be the PEP/LVET ratio. The alterations' of the left ventricular systole periods become evident late in the course of the disease, when significant ischemic lesions are present this the method has no value in determining an early diagnosis. On the other hand this type of investigation is an useful quantitative method for estimating the functional state of the cardiac muscle in the patients with the diagnosis of AP (stage diagnosis of AP) and subsequent evolution (repeated records).
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Affiliation(s)
- C I Negoiţă
- Institutul de medicină şi farmacie Iaşi, Clinica I medicală
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Barna S. [Ultrasonic studies in diseases of the salivary glands]. Fogorv Sz 1981; 74:289-93. [PMID: 6946933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
The present study compared the rates of development of a group of 35 pre-school children in a home-training scheme. The children entered the service at different ages and suffered from different disabilities. The families received weekly visiting from a home advisor, who was specially trained to develop skills in the parents to help their children. Those who developed most rapidly were the group of environmentally deprived children. The non-specific developmentally delayed and Down's syndrome children progressed well during the study period. The children who suffered from cerebral palsy and those with visual handicaps developed at a very slow rate, despite the training that they were receiving. This finding may reflect the severity of their handicaps but also it suggests that the needs of these particular groups should be further examined. The age of entry to the scheme did not seem to be an important variable. The individual variability within each specified group was wide.
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Domnişoru L, Barna S, Trăistaru E, Patrichi C. [Incidence of hepatitis B surface antigen in some extrahepatic diseases]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1979; 31:355-60. [PMID: 43572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Negoiţă CI, Marcu C, Barna S, Damăceanu G. [Left ventricular dynamics in arterial hypertension]. Rev Med Chir Soc Med Nat Iasi 1979; 83:213-20. [PMID: 545596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Negoiţă CI, Barna S, Marcu C. [The P wave in arterial hypertension]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1976; 28:37-40. [PMID: 7813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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40
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Burdea M, Brătianu A, Polac N, Răuţu I, Barna S. [Immunological dynamics in the course of acute leukemia in children]. Rev Med Chir Soc Med Nat Iasi 1972; 76:39-42. [PMID: 4502097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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41
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Barna S. [The use of tisercinetta tablets in the preparation of patients for dental treatment]. Fogorv Sz 1971; 64:325-7. [PMID: 5286247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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