Clinical Neuroscience

[Experience of Frenolone-Melipramine Combination Treatment in Chronic Schizophrenics ]

ADORJÁNI Csaba1, GÁLFI Béla1, SCHENKER László1

NOVEMBER 01, 1963

Clinical Neuroscience - 1963;16(11)

[It can be concluded that our trials with Frenolone + Melipramine combination have shown positive results both in terms of beneficial effects on pathological symptoms and insignificant side effects. Although we cannot draw any firm conclusions due to the small number of cases, we consider that further studies are warranted on the basis of appropriate indications. ]

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  1. Egészségügyi Minisztérium Munkatherápiás Intézete

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Clinical Neuroscience

[Guillain-Barré syndrome gallbladder carcinoma]

SZŐKE Tamás, HAFFNER Zsolt, KOMÁR József

[The authors describe a case of gallbladder carcinoma with an initial clinical presentation of Guillain-Barré syndrome, the underlying disease only becoming clear at autopsy. They add to the evidence for the effect of metastases in causing polyneuropathy. They support a polyaetiological view of the pathomechanism of carcinomatous polyneuropathy. Guillain-Barré syndrome caused by gallbladder carcinoma has not been found in the literature, as Dodgson and Hoffmann reported only polyneuropathy caused by bronchus carcinoma, except in an esophageal carcinoma. ]

Clinical Neuroscience

[Data on intracranial space narrowing in the elderly diagnosis and differential diagnosis of intracranial intracranial processes]

GÁTAI György

[1. Intracranial space-occupying processes in the elderly differ from the average in both localization and specificity in younger age. The difference is so pronounced that diagnostic conclusions can be drawn on the basis of age as to the location and nature of the process. 2. Multiple tumours are much more common in older age. This fact should be taken into account in the diagnosis of multiple nodal syndromes in old age. 3. Solitary intracranial space-occupying processes in elderly patients are mainly supratentorial. If extraparenchymal, they are mostly not true tumours, are benign and can be successfully treated by surgery; if intraparenchymal, they are predominantly deep-seated, malignant tumours that cannot be surgically manipulated. An exception to the latter are spontaneous intra cerebral haematomas. 4. Axial constrictive processes, especially in the brainstem and cerebellum, are very rare in older age. Such localisations are probably not due to a single tumour. 5. Infratentorial space-occluding processes are significantly less frequent than the average, primarily primary (non-metastatic) small tumours. The majority of infratentorial tumours are pontocerebellar, benign. 6. Intracranial space-occluding processes in the elderly are polarising in terms of specificity: in addition to malignant, incurable tumours, vascular space-occluding processes of surgical origin are becoming more frequent, while the more "benign" tumours, which account for the majority of younger cases, are becoming rare. 7. The vast majority (4/5) of brain tumours with symptomatic onset over 60 years are malignant. Involutional age predisposes to malignant brain tumour development; benign tumours detected in old age usually start to develop before rather than at involutional age. ]

Clinical Neuroscience

[Some aspects of psychotherapy for alcoholists]

NAGY A. Tibor, KLEININGER Ottó

[The authors aim to contribute to the efforts of the new phase in the fight against alcoholism in the country by drawing on a decade of experience. In grouping their patient material, they identify the development of an awareness of the disease as a primary task, which also determines the direction of psychotherapy. They see the more effective work of the social services as a prerequisite for the content of medical intervention, the avoidance of false results and, last but not least, the elimination of factors that prevent regression, through appropriate preparation. They touch on the link between alcoholism and psychopathy, and attribute the causes of alcoholism, particularly in rural areas, to the underlying motives behind unmet needs. In addition to awakening an awareness of the disease, which is a genuine voluntary activity, the creation of more optimal cultural opportunities is also seen as a key task, in order to develop a greater sense of community. In the case of those subject to enforced withdrawal, it would be preferable to establish appropriate work camps under medical supervision, rather than a purely medical form of treatment. Measures to eradicate alcoholism can only be effective if medical and social action are more closely linked.]

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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.

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.

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.

Clinical Neuroscience

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

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

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.

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[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.]