Clinical Neuroscience

[Age-related lesions of the choroid plexus]

HORÁNYI Béla1, SZENDRŐI Mária1

NOVEMBER 01, 1968

Clinical Neuroscience - 1968;21(11)

[Authors studied 30 cases of age-related lesions of epithelial cells and stroma of the choroid plexus. In all cases, they found plexus sclerosis of variable intensity. In 21 cases, Biondi's lesions were detected in the epithelial cells of the plexus, detectable by silver impregnation. The morphological characteristics of these formations are discussed. In their material, they have compared the choroid plexus abnormalities with the occurrence of other age-related brain lesions, i.e. senile plaques and Alzheimer's fibrillum lesions. ]

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  1. Budapesti Orvostudományi Egyetem I. sz. Neurológiai és Psychiatriai Klinika

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Clinical Neuroscience

[Factors affecting the offsetting ability psychopathic reactions ]

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[To summarise what has been said, I would like to present my views on psychopathy below. 1. The abnormal personality structure is not a disease and thus does not in itself affect the integrity of the capacity to reason. 2. The abnormal personality structure may facilitate the commission of a particular act, but its assessment as a mitigating circumstance is a matter for the judge. It is rarely necessary to draw the attention of the mental health professional to this fact, and in particular in the case of recidivists, prison as a "forced treatment" should be acknowledged and approved. 3. The involvement of the capacity to reason comes to the fore in manifest psychopathic states, i.e. in cases of psychic decompensation reaching pathological levels, or when a psychotic reaction occurs at the base of a pathological personality structure. In these cases, the most crucial question is to determine the relationship between the pathological state that has developed and the sinful act; in Nyírő's definition, the disease is criminal or the conscious self. 4 I have not discussed the structural aspects of military justice and pathological personality, but I will merely mention that the issue here is complicated by special military problems, including the question of military fitness and the occurrence of special military crimes. More common is the disqualification or incapacity to report if the offender was or has become unfit for military service. The assessment of special military offences is different and the shaping influence of the military environment changes the assessment. These issues have been mentioned for the sake of completeness, as they would exhaust the scope of a paper, but they are also a specific problem affecting a narrower range of people. The title of my topic promised a description of psychopathic reactions affecting the ability to report and this is apparently not what I gave. However, I believe that without a negative assessment of the abnormal personality structure, which is still a controversial issue in both psychiatry and forensic psychiatry and which does not generally affect the integrity of sanity, the issue cannot be discussed. Practical experience has shown that in the vast majority of cases, the psychoanalytical assessment of pathological conditions arising from pathological personality structures is less of a problem than the correct interpretation of the pathological personality structure itself, psychopathy, and its impact on the integrity of the mental capacity. ]

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[The author reports observations from 40 stereotaxic surgeries in 35 Parkinson's patients. He has developed a new stereotaxic method which, as far as possible, is maximally adapted to ventricular and structura variations and, accordingly, allows not only accurate targeting but also in vivo localization, documentation and interpretation of surgical events. Using his new method of laesio analysis, he detected compression of tremor- and tonus-responsive laesios at the boundaries of V.o. 1 p. and V. im. and V. o. a. in the thalamus, and at the boundaries of Z. i. and Ra. prl., I, in the subthalamus. At the target point corresponding to the site of subthalamic compression, he observed a persistent tremor arrest during EMG-traced electrode insertion, and a single small lesion (40 mm) at this site proved to have a very good effect on both tonus and tremor. Evaluating the surgical results according to the site of laesio placement, he found that combined laesio of the VL nucleus and subthalamus gave better results than pallidum laesio, but the best results were observed after subthalamus, Z. i., Ra. prl. laesio. Undesirable psychic side effects were most often observed with VL nucleus and subthalamus laesio combination. Positive development of the psychic picture and the least side effects were observed after subthalamic laesio. He considered the improvement of psychomotor function as an important factor in the somatomotor improvement or its preservation.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

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Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]