Clinical Neuroscience

[Epidermoid tumours (cholesteatomas) in the central nervous system]

BARADNAY Gyula1, SZANDTNER György1, HOFFMANN János1

FEBRUARY 01, 1966

Clinical Neuroscience - 1966;12(02)

[Authors report 3 operated and 2 autopsy cases of central nervous system epidermoid tumours. Two of their operated patients were lost, the third one is symptom and complaint free since surgery - 2 years ago. They also describe the views on the aetiology of epidermoid tumours, the macro- and micromorphology of these tumours, their clinical symptoms and the surgical treatment options. ]

AFFILIATIONS

  1. Szegedi Orvostudományi Egyetem Kórbonctani és Kór szövettani Intézete és II. sz. Sebészeti Klinikája

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Curative experiments on depression patients with Elysione]

NYÍRŐ Gyula, IRÁNYI Jenőné

[Authors conducted therapy trials with low doses of Elysione in 50 depressed male patients. They observed a reaction to Elysione in nearly 500 cases. 3 mg induced well-appreciated euphoria, 4-10 mg induced psychotomimetic, neurological and vegetative symptoms. Cure courses (one injection per day for 7, 10 and 14 days) in depressed patients proved to be of therapeutic value. Before its practical use, a large number of trials should be carried out and side effects should be eliminated by modifying the chemical structure, and it should be possible to use it per os.]

Clinical Neuroscience

[Measurement of muscle action potential propagation velocity in clinical patient material]

HASZNOS Tivadar, FENYŐ Egon

[The authors investigated the propagation velocity of muscle action potentials in 53 normal individuals, 18 neurogenic lesions, 15 patients with myopathy and 2 patients with myasthenia. The muscle conduction velocity was assessed in the m. deltoideus, m. biceps brachii, m. flexor digiti V., m. tibialis anterior and m. quadriceps. Stimulation was performed with two needle electrodes in bipolar mode and recording with a concentric bipolar electrode. The muscle conduction velocity was 4.48 + 0.09 m/sec in the normal control group, 3.28 + 0.21 m/sec in neurogenic lesion and 3.07 + 0.18 m/sec in myopathy patients. The difference was highly significant in both groups (P < 0.001). The muscle conduction velocity within the neurogenic group was found to be the same in peripheral nerve lesion (3.29 = 0.33 m/sec) and anterior horn lesion (3.25 + 0.26 m/sec). In the neurogenic cases, we found a conduction velocity value below 3.5 m/sec in 68% of the clinically affected muscles. A conduction velocity below 3.5 m/sec was observed in 66.6% of myopathic patients. Conduction velocity values found in Duchenne-type dystrophia musculorum progressiva, dystrophya myotonic, thyrotoxic myopathy, myopathia tarda and polymyositis were significantly different from normal controls. In dystrophia musculorum progressiva in facioscapulo humeralis and limb girdle, the deviation from normal control was not significant. In myasthenia cases, muscle conduction velocity was normal (4.57 I 0.21 m/sec). The authors discuss the factors that may lead to a decrease in muscle conduction velocity in neurogenic and myogenic laesio. ]

Clinical Neuroscience

[Changes in serum arginine levels in patients with epilepsy]

SZILÁGYI Á. Katalin, PATAKY István

[Authors investigating serum arginine levels in a mixed neuropsychiatric patient population found that the epileptic patient group had significantly lower levels compared to both normal controls and all other patients. No correlation was found between clinical presentation or pathogenetic factors and the development of arginine levels. A correlation between the nature of brain electrical activity and arginine levels, not statistically verifiable, seems to be observed. ]

Clinical Neuroscience

[The role of Ospolot in the treatment of childhood epilepsy]

KISZELY Katalin

[Based on our observation of 20 patients treated with Ospolot, we found that Ospolot is suitable for the treatment of psychomotor epilepsy. Because of its relatively frequent side effects, it should only be introduced in cases resistant to other therapies, initially in combination with other anticonvulsant drugs, under hospital observation. It should be tried in psychomotor seizures in which the EEG also indicates temporal focus. If focal convulsive activity on EEG is reduced or eliminated in response to medication, the clinical picture usually improves. ]

Clinical Neuroscience

[Report from four months study trip in the Netherlands (Wassenaari)]

LEEL-ŐSSY Lóránt

[The author reports on his four-month study trip to the Netherlands.]

All articles in the issue

Related contents

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

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.

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

Clinical Neuroscience

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

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[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.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]