Clinical Neuroscience

[Enhancing insulin sensitivity with ganglion paralysers in insulin shock treatment II.]

MEZEI Béla1, PÖSTYÉNYI Katalin1, VÁRKONYI Péter1

APRIL 01, 1963

Clinical Neuroscience - 1963;16(04)

[1. Using Synapleg in IS treatment, the coma dose was reduced by 70.6% to 54%. 2. Coma with Synapleg was generally shorter than with hexamethasone. 3. There were no complications with the Synaplegic combination. ]

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  1. Székesfehérvári Városi és Megyei Kórház Ideg-Elmeosztálya

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Clinical Neuroscience

Über die Problematik der Neurosen im Kindesalter

GÖLLNITZ Gerhard

Es wird vor der allzu starken Ausweitung des Begriffes ,,Neurose im Kindesalter“ gewarnt. Kinderfehler, phasenbedingte kindliche Fehlhaltungen, psychogene Reaktionen, psychogene Entwicklungen und auch einfache abnorme Erlebnisreaktionen sind nicht mit Neurosen gleichzusetzen. Für diese Diagnose ist eine abnorme psychogene Entwicklung zu fordern, die zu somatischen und psychischen Störungen führt, die das Kind nicht mehr kompensieren kann und die vom Kind selbst als fremdartig und störend empfunden werden. Näher eingegangen wird auf die besondere Umweltanfälligkeit und damit auch Neuroseanfälligkeit encephalopathischer Kinder, bei denen die Fähigkeit des Abstandnehmens und bestimmte Erlebnisse zum Abschluss zu bringen sowie die Hemmung und Eingrenzung intrapsychischer Reaktionen behindert sind. Es sind Kinder mit einem schwankenden Biotonus. Grundsätzliche Bedenken werden gegen die Verwendung des Begriffes „Psychopathie für das Kindesalter ventiliert, umso mehr, als damit die keineswegs bewiesene These von der Vererbung psychischer Eigenschaften allzu leicht dazu verführt, sich in seinem therapeutischen Handeln beeinflussen und lähmen zu lassen.

Clinical Neuroscience

[Enhancing insulin sensitivity with ganglion paralysers in insulin shock treatment ]

MEZEI Béla, PÖSTYÉNYI Katalin, VÁRKONYI Péter

[1. With hexamethasone in IS treatment, the coma dose was reduced by 75-25% in 28 of our patients. 2. With this association, coma usually occurs sooner and the accompanying vegetative symptoms are milder. 3. Hexamethon combination has no complications. ]

Clinical Neuroscience

[Some problems in clinical pharmacopsychology from an experiential perspective]

SIMKÓ Alfréd

[The practical relevance of pharmacopsychology as a clinical science is determined by its relationship to structural phenomenology and psychopathology. Only in this way is it able to approach the experiences that can be correlated with the dynamics of action of a psychotropic drug in question. (Psychopathological concepts that work with definitions that are abstracted from static mappings - with logical value - have not proved sufficient for this methodology.) After stressing the principle of target symptoms (Freyhan, Hippius) and syndromatics (M. Müller), which are important for the indications of pharmacopsychiatric treatments, the prophenomenal concept of "actual sensitivity" was elucidated, the latter being understood as the experiential dimension of the vital dispositions that can be influenced by medication. Following Friesewinkel's conception, we projected the effects of psychotropic drugs into the dimensions of "Aktualbefindlichkeit" changes. The basic law of pharmacopsychology was recognized in our experience that any pathological experience can only be influenced by medication to the extent that it is still mobile in relation to the variable intensional dynamics and the "Aktualbefindlichkeit". After presenting Hackstein's critical understanding of the issue of clinically relevant effect-disassociations (H. W. Janz), we addressed the issue and illustrated its essence with an example from our own case. We followed Ziolko in listing the most important subjective factors modifying the perception of impact. We have pointed out the phenomena of 'subjective intolerance', which we have mostly evaluated as oppositional. ]

Clinical Neuroscience

[Clinical use of Melipramine (Imipramine) ]

NAGY A Tibor, PERTORINI Rezső

[The authors analyze the clinical data of 45 patients treated with melipramine, describe the dosage, the course of the cure, the side effects, the other somatic treatments and psychotherapy applied during the cure. ]

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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.

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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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.

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Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

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In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

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[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]