Clinical Neuroscience

[Data for the biography of Ferenc Schwartzer]

VARGA Lajos

MARCH 01, 1960

Clinical Neuroscience - 1960;13(03)

[The author presents a detailed description of Ferenc Schwartzer, found in the Hungarian National Archives, written by Adolf Hollán, the counsellor of the Interior Ministry, in his own handwritten submission for the award of the medal on 27 October 1871.]

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Clinical Neuroscience

[LSD studies in schizophrenic patients treated with electroshock ]

IRÁNYI Jenőné

[1. Based on a comparison of the symptoms of eight schizophrenic patients with ES block before and after treatment with 50- 125 gamma LSD, the change in response after treatment was analysed from a pathophysiological and localisation point of view. 2. ES block treatment did not completely prevent the development of LSD intoxication symptoms, but the reactio was strikingly poor. No activating effect was observed. 3. Symptoms partially corresponded to specific LSD symptoms. No cortex localisable intoxication symptoms developed. 4. Subcortical and midbrain symptoms were present. Brainstem movement disturbances and neurovegetative changes were suggestive of diencephalic dysregulation.]

Clinical Neuroscience

[Intravascular use of Novocaine in epilepsy]

BŐHM Tivadar

[Based on his observation of 30 epileptic patients, the author found intravascular N. given in combination with standard antiepileptic drugs to be therapeutically effective in the majority of cases in the treatment of affective and mood disorders, and in the elimination of foggy states of consciousness. The anticonvulsant action of N. was pronounced in the resolution of both sporadic and status seizures. The improvement was confirmed by EEG studies along with clinical symptoms. Based on the literature on the pathomechanism of epileptic disease symptoms and his own clinical and EEG observations, he attempts to explain the complex effect of N. He considers its use to be justified mainly in cases where conventional treatments have not led to satisfactory results. ]

Clinical Neuroscience

[Effect of strophanthin on blood flow to the brain, potassium and sodium balance, and cerebral venous pressure]

SOLTI Ferenc, PÉTER Ágnes, SIMONYI Gusztáv, ISKUM Miklós, RÉFI Zoltán, DUBSKY Mária, RANDL János

[The effects of strophanthin on cerebral circulation and brain potassium and sodium balance were studied in circulatory healthy people. The blood flow through the brain increases with acute strophanthin, while the resistance of cerebral blood vessels decreases. Cerebral venous pressure is also markedly reduced. The brain releases potassium in response to Strophanthin. It is considered likely that strophanthin has a significant brain attack point. Alteration of the brain's potassium balance is a major cause of the central effect of strophanthin.]

Clinical Neuroscience

[Effect of Andaxin ( meprobamate) on skeletal muscle phosphorylase activity]

KOCSÁR László, VERESS Olivia, KAJTOR Ferenc

[1. The effect of Andaxin (meprobamate) on skeletal muscle phosphorylase activity of dogs, rats, rabbits and guinea pigs after 4-6 days of enteral meprobamate administration was investigated. 2. Our results show that after Andaxin treatment, the phosphorylase activity of dog muscle decreased by 25-73% (45% on average) and that of rat muscle by 19-56% (40%). 3. Rabbit muscle phosphorylase activity increased by -9.3 -( +170.0)% (43%) and guinea pig by 114% after Andaxin administration. 4. The phosphorylase activity of skeletal muscle of dog, rat, rabbit, guinea pig was not affected by Andaxin in vitro.]

Clinical Neuroscience

[Comment on the article "The problem of remuneration for occupationally mentally ill people"]

GOLDSCHMIDT Dénes, VÁRHELYI Gyula

[The development of specific operating rules for institutions for the treatment of the mentally ill, different from those for hospitals, in line with their specific situation, and taking into account the following aspects: 1. in the case of rehabilitation institutions, economic profitability, with appropriate deductions for the remuneration of patients. 2. in the case of a therapeutic establishment, the therapeutic aspect, with the possibility of rewarding the patient in various ways for psychotherapeutic purposes and, at the same time, with appropriate social care. 3. formation of a joint committee of appropriate financial and mental health professionals to clarify various financial issues.]

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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 multi-organ 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. 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. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]