The calcaneo-stop procedure is a simple and reliable method for the correction of severe flexible paediatric flatfoot. Our prospective, short-term results following the anterograde screw implantation into the talus correlate well with the results of similar or different arthroereisis methods. Further investigations are required to evaluate the long-term outcome of the screw calcaneo-stop method, including the conditions following implant removal.

Célkitûzés-Bár a szédülés a leggyakrabban elôforduló panaszok egyike, a vestibularis perifériák hirtelen kialakult tónusaszimmetriája hátterében mégis ritkán találunk perifériás eredetû betegséget utánzó malignus koponyaûri tumorokat. Dolgozatunk egy heveny vestibularis szindróma klinikai képében jelentkezô, késôi, temporalis csontot is beszûrô, disszeminált, generalizált mikrometa sztá zi sokkal járó meningitis carcinomatosa esetet mutat be, ami egy primer pecsétgyûrûsejtes gyomorcarcinoma fel ébredését követôen jelent meg. Kérdésfelvetés-Célul tûztük ki, hogy azonosítjuk azon patofiziológiai folyamatokat, melyek magyarázatul szolgálhatnak a daganat felébredésére, disszeminációjára. A vestibularis tónusaszimmetria lehetséges okait szintén vizsgáltuk. A vizsgálat alanya és módszerei-Ötvenhat éves férfi betegünk interdiszciplináris orvosi adatait retrospektíven elemeztük. Összegyûjtöttük és részletesen újraértékeltük az eredeti klinikai és patológiai vizsgálatok leleteit, majd új szövettani festésekkel és immunhisztokémiai módszerekkel egészítettük ki a diagnosztikus eljárásokat. Background-Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multiorgan micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose-Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. Methods-A 56-year-old male patient's interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. Results-During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone

Periprosthetic femoral fractures are rare but significant events following total hip replacement. Metaphyseal short stems have recently been popularized as a bone preserving alternative to conventional uncemented total hip replacement. We present two periprosthetic femur fractures which occurred around two different metaphyseal uncemented stem designs. Successful conservative treatment was possible in both cases achieving bony union and excellent clinical results.

The aim of the study was to check the validity of computed tomographic (CT) doses exhibited by SPECT/CT and PET/CT hybrid devices. Dose measurements were taken from four SPECT/CT and four PET/CT cameras commercially available from different manufacturers. A calibrated ionization chamber was placed in whole-body or head phantoms for the acquisition of CT images with clinically used parameters. Computed tomography dose index (CTDIvol) values were calculated according to the IEC 60601-2-44:1999 formula. The measured CTDIvol doses were compared with those preprogrammed by the manufacturer. In the case of the whole-body phantom, the differences between the measured and displayed values varied between -31 and +24% [European document RP162 (2012) sets up the limit for acceptance criterion as ±20%]. The head phantom data showed either an agreement between -10 and +24%, or an underestimation by two-fold. The latter seemed to be because, while preprogramming the doses, the manufacturer had used the whole-body phantom instead of a proper head phantom. The results of the work demonstrate the need for individual dosimetric calibration of every single X-ray tube. Dosimetric checks should be included in the regular quality control programmes of the SPECT/CT and PET/CT devices. Special attention should be paid to head-and-neck and paediatric protocols, in which the use of a head phantom is recommended for dose calibration.

Pulmonary vein isolation is associated with silent cerebral ischemic lesions detected by diffusion-weighted magnetic resonance imaging (MRI), with an incidence between 1% and 40%. Recent studies have shown that these cerebral lesions can occur after radiofrequency ablation for left ventricular extrasystole.  Risk of these lesions in conventional ablation has not been evaluated. Aim of this study was to investigate silent cerebral ischemic lesions following left-sided conventional ablation. In a prospective study 296 consecutive patients scheduled for paroxysmal supraventricular tachycardia (PSVT) ablation were screened, and 26 patients meeting study criteria were enrolled. Patients were excluded for age under 18 years or over 80 years, clinically significant neurovascular or valvular disease, proven left atrial thrombus, thrombophilia, previous pacemaker or ICD implantation, documented paroxysmal atrial fibrillation, or any contraindication to MRI. Participants underwent cerebral MRI 24 hours prior and after the ablation, in case of new ischemic lesions a repeated MRI was planned within 3-6 months. Two sequences were used, a 3D T2-weighted fluid-attenuated inversion recovery (FLAIR) and an axial diffusion-weighted (DW) sequence. By definition acute lesions appear as hyperintensities on the postprocedural diffusion-weighted images which correlate with the hypointense signals on the apparent diffusion map and can not be detected on the preprocedural images. Patients were planned to be divided into three groups patients with and without silent cerebral ischemic lesions who underwent left-sided ablation, and a control group undergoing only right-sided ablation. Groups were compared based on clinical and procedural characteristics. The mean age was 43.9 ± 17.3 years, 42% (n = 11) were men, 35% (n = 9) had a history of hypertension. In all groups radiofrequency energy was used and the ablation was performed with a 4 mm tip non-irrigated  catheter. In case of a left-sided procedure left atrium was approached by transseptal puncture controlled by intracardiac echocardiography. Before the transseptal puncture intravenous heparin was administered. Activated clotting time was aimed to be 200-300 seconds. None of the postprocedural MRI in the left-sided or the right-sided group revealed any evidence of new cerebral ischemic lesions. Mean procedural time of left-sided ablations was 176.9 ± 74.7 minutes which was significantly longer (p = 0.0077) compared to the right-sided procedures with 132 ± 72.2 minutes total time. Mean left atrial procedural time was 69.1 ± 7.8 minutes, average ACT was 265 ± 28.2 seconds. No silent ischemic cerebral lesions were detected by MRI after catheter ablation of left-sided PSVT substrate in comparison with the historical population undergoing ablation for atrial fibrillation or ventricular extrasystole. Presumably, cerebral lesions occur at a lower rate or might not appear at all after these less complex procedures.