Clinical Neuroscience

[Analysis of violent sexual offences with special reference to psycho-cultural aspects]

SZABÓ Miklós1, BURIS László1

MARCH 01, 1969

Clinical Neuroscience - 1969;22(03)

[The authors have processed data from the Institute of Forensic Medicine of the University of Debrecen Medical School on medical expert opinions on violent sexual offences for the years 1955-1965. The perpetrators of these offences are most frequently among the 21-30 year olds. 55.89% of offenders had some form of mental defect. Factors that may be a motive for committing sex offences are significantly present in the indicators without such a discrepancy. The vast majority of the victims of these crimes were juveniles, 37.29% of whom were mentally ill. In all cases of sexual offences, authors consider it important to conduct a detailed mental health assessment of both the offenders and the victims of the offence. ]

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  1. Debreceni Orvostudományi Egyetem Igazságügyi Orvostani Intézete

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[A pseudopapillitis fluorescein angiográfiás diagnosztikája ]

WEINSTEIN Pál, BROOSER Gábor

[Fluorescein angiography is very useful for differentiating between congestive papillitis and pseudopapillitis. In congestive papillitis the papilla is fluorescent, in pseudopapillitis this fluorescence is not detectable on the papilla.]

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[Effect of cervical lymphatic dysfunction on EEG after tonsillectomy]

OBÁL Ferenc, SZABON József, BÖRCSÖK Edit, FÖLDI Mihály

[Tonsillectomy shifts the EEG in the direction of slowing down, because this operation leads to a transient disturbance of cervical lymph flow and thus to a transient subclinical lymphostatic encephalopathy. ]

Clinical Neuroscience

[Reversible internuclearis of traumatic origin ophthalmoplegia]

TEMESVÁRI Péter

[An 18-year-old young man developed internuclear ophthalmoplegia with rapid regression after trauma, among other microsymptoms. After reviewing the hypothesized pathomechanism, the author points out that in seemingly trivial traumas that do not involve the skull or spine, certain predisposing factors may lead to brainstem lesions with asymptomatic or only suggestive clinical signs, which may be of importance in subsequent differential diagnosis or specialist opinion. ]

Clinical Neuroscience

[Wegener's granulomatosis involving the nervous system ]

HALMAY Zsuzsa, VATHY István

[The authors describe a case of Wegener's granulomatosis in which, in addition to the tympanic pathological lesions, extensive vasculitis and granulomatous inflammation of the meninges and brain matter, as well as granulomatous perineuritis, were observed. The neurological manifestations of Wegener's granulomatosis involvement of the nervous system. ]

Clinical Neuroscience

[Comments on childhood ammentiform psychosis mechanisms of child psychosis]

ZSADÁNYI Ottó, KLEININGER Ottó, GŐDÉNY Sára

[An 11-year-old child with an aetiologically unclear clinical presentation classified as amentiform psychosis is analysed. Results of EEG, PEG, Psychological-testing series are compared with clinical findings over a follow-up of nearly 2 years. In their opinion, neither bacteriological-virological nor psychogenic stress effects can be demonstrated due to currently available technical conditions, so that perhaps pubertal hormone disruption resulted in an anatomical functional transient harmony disturbance that was expressed in clinical psychosis, anatomical-electrical in relation to bihemispheric asynchrony. It is hypothesized that interhemispherially transmitted informatio asynchrony, which also seems to be associated with hormonal disturbances during puberty, may result in a disturbance of realistic perception of the external world and may cause transient psychiatric disturbances. This seems to be confirmed by the return to equilibrium of anatomical, electrical (PEG, EEG.) activity and recovery without residual symptoms.]

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Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

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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.]

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]