Méhen belül felszívódó magzati mellékvesevérzés ultrahang-diagnózisa = Ultrasound diagnosis of fetal adrenal hemorrhage

Absztrakt: Az újszülöttkorban igazolt mellékvesevérzések előfordulási gyakorisága az ultrahang-diagnosztika fejlődésével emelkedett az elmúlt években. A méhen belül kialakuló esetek ritkán kerülnek felismerésre. A mellékvese cysticus elváltozásainak differenciáldiagnózisa sokszor csak a megszületés után lehetséges. Esettanulmányunkban a 33. terhességi héten a magzati felhas bal oldalán kialakult és ultrahangvizsgálattal észlelt 4 × 3 cm-es cysticus elváltozás nyomon követését mutatjuk be. A terhesség alatt elvégzett képalkotó vizsgálatok (ultrahang, illetve mágneses rezonancia) mellékvesevérzést igazoltak. A 37. terhességi hétre a vérzés nyom nélkül felszívódott. Három héttel később, a 4150 grammos magzat tervezett császármetszés útján, jó állapotban jött világra. A megszületés után végzett endokrinológiai és ellenőrző ultrahangvizsgálatok eltérést nem találtak. Ez a tanulmány az első publikált eset a szakirodalomban, mely igazolja, hogy magzati mellékvesevérzés kialakulhat a méhen belül, és rövid idő alatt spontán felszívódhat. Esetünk felhívja a figyelmet arra, hogy a mellékvesevérzés a szülési traumától függetlenül is előfordulhat az újszülöttnél. Feltételezhető az is, hogy a várandósság alatti mellékvesevérzés előfordulási gyakorisága nagyobb az eddig az újszülöttkorban leírt esetekből következtetettnél. Orv Hetil. 2019; 160(52): 2073–2078. | Abstract: The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073–2078

Diffusion weighted magnetic resonance imaging demonstrates tumor response following palliative embolization of a recurrent shoulder plasmacytoma

We report the palliative embolization and functional imaging follow-up of a recurrent shoulder plasmacytoma. The multiple myeloma patient complained of severe pain and discomfort, while he could not tolerate further chemotherapy. The left shoulder lesion had earlier received a high dose of irradiation. Thus, the well-vascularized lesion was embolized via feeding arteries branching off from the left subclavian artery in two sessions. The patient's symptoms rapidly improved post-embolization and the serum free light chain ratio stabilized at a lower level. The follow-up magnetic resonance image showed increased diffusivity in previously restricted tumor foci. This has negatively correlated with the decreased fludeoxyglucose uptake on PET, suggesting post-embolization necrosis

Az izolált septum pellucidum hiány praenatalis diagnosztikája ultrahang- és mágneses rezonancia képalkotó vizsgálattal

Összefoglaló. A septoopticus dysplasia, vagy más néven De Morsier-szindróma egy ritka, az agy középvonali képleteit érintő rendellenesség, mely a septum pellucidum hiányával, hypophysis-diszfunkcióval, látóideg-hypoplasiával és mentális visszamaradottsággal jár együtt. A septum pellucidum hiánya önmagában is előfordulhat izolált formában, de ennek septoopticus dysplasiától való praenatalis elkülönítése jelentős diagnosztikai kihívást jelent. Az izolált septum pellucidum hiány a kevés, rendelkezésünkre álló irodalmi adat alapján ártalmatlan anatómiai variáció. Esetbemutatásunkban a magas mágneses térerővel végzett magzati mágneses rezonancia (MR) képalkotó vizsgálat segítette az izolált septum pellucidum hiány septoopticus dysplasiától való elkülönítését azáltal, hogy lehetővé tette a látóidegek és a chiasma pontosabb megítélését, valamint az esetleges egyéb agyi rendellenességek kizárását. A szülés utáni kétéves követési periódus alatt a gyermek normális szomatomentális fejlődést mutatott mindennemű hormonális és vizuális eltérés nélkül. Esetbemutatásunk megerősíti, hogy a septum pellucidum izolált hiánya önmagában lehet egy tünetmentes anatómiai variáció, melynek praenatalis diagnosztikai algoritmusában a vizuális traktus és az agyszerkezet pontosabb megítélése kapcsán a magas mágneses térerővel végzett magzati MR-vizsgálat kulcsfontosságú szerepet játszik, és lehetőséget biztosíthat a septoopticus dysplasia praenatalis kizárására. Orv Hetil. 2020; 161(52): 2195-2200. Summary. Septo-optic dysplasia is characterized as a midline anomaly with agenesis of the septum pellucidum, optic nerve hypoplasia and pituitary dysfunction. The septal agenesis can occur in isolated form, but its prenatal differentiation from septo-optic dysplasia can be challenging. The isolated agenesis of septum pellucidum is an asymptomatic anatomical variation, based on the few literature data available. We report a case where prenatally performed high magnetic field magnetic resonance imaging helped the differential diagnosis by visualizing and assessing thickness of the optic nerves and chiasma. The development of the infant was followed for 24 months and showed no abnormalities. Our case report confirms that isolated agenesis of the septum pellucidum is probably an asymptomatic variation and the visualization of the optic nerves with high magnetic field fetal MRI could be a crucial point of the differential diagnosis and provide possibility to exclude septo-optic dysplasia in utero. Orv Hetil. 2020; 161(52): 2195-2200

Identification of risks in the application of surgical robotics

The continuously growing pace of robot development implies that by 2020, there is going to be on average one robot per household in the world. The aim of robot deployment in larger numbers is to help to extend human capabilities, and to eliminate to disadvantages of the human embodiment. As a consequence, besides industrial robots, service and surgical applications appear in growing numbers. While in the field of industrial production, the adherence to sophisticated safety standards grants a low level of risk of injury, but there are numerous risks in the case of robots operating in a divided workspace. Service robots will inevitably interact physically with an operator and the served people. The complex systems of surgical robots requires risk analysis of every component, and also adequate measures to reduce the hazards. To apply these, the probable risks and their consequences have to be identified first, while making sure the robot fulfills its function

Impaired mixed emotion processing in the right ventrolateral prefrontal cortex in schizophrenia: an fMRI study

Background: Schizophrenia has a negative effect on the activity of the temporal and prefrontal cortices in the processing of emotional facial expressions. However no previous research focused on the evaluation of mixed emotions in schizophrenia, albeit they are frequently expressed in everyday situations and negative emotions are frequently expressed by mixed facial expressions. Methods: Altogether 37 subjects, 19 patients with schizophrenia and 18 healthy control subjects were enrolled in the study. The two study groups did not differ in age and education. The stimulus set consisted of 10 fearful (100%), 10 happy (100%), 10 mixed fear (70% fear and 30% happy) and 10 mixed happy facial expressions. During the fMRI acquisition pictures were presented in a randomized order and subjects had to categorize expressions by button press. Results: A decreased activation was found in the patient group during fear, mixed fear and mixed happy processing in the right ventrolateral prefrontal cortex (VLPFC) and the right anterior insula (RAI) at voxel and cluster level after familywise error correction. No difference was found between study groups in activations to happy facial condition. Patients with schizophrenia did not show a differential activation between mixed happy and happy facial expression similar to controls in the right dorsolateral prefrontal cortex (DLPFC). Conclusions: Patients with schizophrenia showed decreased functioning in right prefrontal regions responsible for salience signaling and valence evaluation during emotion recognition. Our results indicate that fear and mixed happy/fear processing are impaired in schizophrenia, while happy facial expression processing is relatively intact

Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

BACKGROUND: Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic–ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown. METHODS: One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0–14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1–3/4–6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome. RESULTS: N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group. CONCLUSIONS: In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0–14. GA only affected metabolite levels in the good outcome group. IMPACT: Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0–14 in newborns with hypoxic–ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14. Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome. However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared. Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic–ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan

Factors affecting postural instability after more than one-year bilateral subthalamic stimulation in Parkinson's disease: A cross-sectional study

Balance impairment in Parkinson's disease is multifactorial and its changes due to subthalamic stimulation vary in different studies.We aimed to analyze the combination of predictive clinical factors of balance impairment in patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least one year.We recruited 24 patients with Parkinson's disease treated with bilateral subthalamic stimulation and 24 healthy controls. They wore an Opal monitor (APDM Inc.) consisting of three-dimensional gyroscopes and accelerometers in the lumbar region. We investigated four stimulation conditions (bilateral stimulation OFF, bilateral stimulation ON, and unilateral right- and left-sided stimulation ON) with four tests: stance on a plain ground with eyes open and closed, stance on a foam platform with eyes open and closed. Age, disease duration, the time elapsed after implantation, levodopa, and stimulation responsiveness were analyzed. The distance of stimulation location from the subthalamic motor center was calculated individually in each plane of the three dimensions. We analyzed the sway values in the four stimulation conditions in the patient group and compared them with the control values. We explored factor combinations (with age as confounder) in the patient group predictive for imbalance with cluster analysis and a machine-learning-based multiple regression method.Sway combined from the four tasks did not differ in the patients and controls on a group level. The combination of the disease duration, the preoperative levodopa responsiveness, and the stimulation responsiveness predicted individual stimulation-induced static imbalance. The more affected patients had more severe motor symptoms; primarily, the proprioceptive followed by visual sensory feedback loss provoked imbalance in them when switching on the stimulation.The duration of the disease, the severity of motor symptoms, the levodopa responsiveness, and additional sensory deficits should be carefully considered during preoperative evaluation to predict subthalamic stimulation-induced imbalance in Parkinson's disease

Identification of Hazards in Invasive/Surgical Robotics

Service robotics receives more and more attention in the developed world beside industrial applications. While industrial robotics conquered the factories, it was important that researches develop a number of principles and guidelines to help minimizing the risk of human accidents. Today’s safety standards of industrial robotics almost completely exclude the possibility of physical interaction between the human operator and the robotic device. Just recently, a new paradigm, the divided workspace has prevailed, and as a consequence, a number of new and critical safety issues have emerged. Service robots have become even more complicated, as we cannot erect a fence around domestic robots, and in the case of medical robotics, the human–machine interaction is inevitable. The goal of this research was to explore and quantify human–machine interactions, and classify them based on their hazard level. The focus is on surgical robotic devices and their current applications, as this situation presents one of the most complex form of interaction. It is necessary to make service robots complying with safety standards, based on a unified and generally accepted methodology