Clinical Neuroscience

[Histophysiology of antidiuretic centres]

BARA Dénes1

JUNE 01, 1967

Clinical Neuroscience - 1967;20(06)

[The regulatory role of the supraopticoneurohypophyseal system in water balance has been known for decades. Initially, ADH was thought to be secreted by the pituitary glands of the nerve lobe and their activity was regulated by the supraoptic nerve.]

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  1. Szegedi Orvostudományi Egyetem Kórbonctani és Kórszövettani Intézet

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Clinical Neuroscience

[In the temporal lobe space-constricting processes psychiatric disorders]

RÓTH György

[The author analyses the psychiatric disorders observed in 58 cases of temporal lobe spatial constriction. These disorders occurred in 67% of the cases. On the basis of his own observations and recent research on the temporal lobe, he concludes that psychiatric disorders in temporal lobe constrictions are the result of damage to the structures located in this lobe, mainly those of the limbic system. He attributes only a secondary role to the general increase in intracranial pressure through diffuse damage to brain functions. It is noteworthy that the highest percentage of such symptoms was observed in the case of constrictive processes in the temporal lobe of the non-dominant hemisphere. ]

Clinical Neuroscience

Nachweis und Identifizierung von Autoimmunfaktoren bei der Multiplen Sklerose

SCHUMACHER K., ROSS J.

Elektrophoretische Untersuchungen zeigen durchweg einen Anstieg der Gammaglobulinfraktionen im Liquor während des akuten Stadiums der Krankheit. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Die Gamma-Globulinfraktionen steigen an. Immunelektrophoretische und chromatographische Untersuchungen bestätigen dies. Wenn das Gammaglobulin ansteigt, werden im Liquor Plasmazellen nachgewiesen. Diese Daten legen nahe, dass immunologische Prozesse an der Multiplen Sklerose beteiligt sind. Der Nachweis von Antikörpern gegen das ZNS-Antigen im Patientenserum scheint effektiv zu sein, denn Ross kann sie bei 40 % der Patienten ohne Selektion nachweisen. Seine Ergebnisse wurden von anderen bestätigt. Die Autoren versuchen, diese Antikörper zu identifizieren. Durch säulenchromatographische Trennung und Immunelektrophorese wurden die gesuchten Antikörper als 19 S-Gamma-Globulin oder IgM-Antikörper identifiziert. Die saure Hydrolyse und die elektrophoretische Analyse von Antikörper-Antigen-Komplexen aus Multiple-Sklerose-Serum und -Gehirnextrakten ergaben das gleiche Ergebnis. Kontrollstudien mit anderen 19 S-Gamma-Globulinen beim Menschen zeigen, dass die Spezifität nicht in Frage steht. Lamoureux und Borduas konnten während einer akuten Krankheitsepisode neben der Anhäufung von Gamma-Globulin auch eine Anhäufung von Gamma-M und Gamma-A-Globulin im Liquor nachweisen. Sie entdeckten eine zytotoxische Substanz aus den Gammaglobulinfraktionen, die Nerven- und Gliazellen in Gewebekulturen schädigte. Über die Art des Antigens ist wenig bekannt. Die Autoren gehen von mindestens zwei Arten von Antigenen aus, einem Lipid und einem Protein. Es ist noch nicht bekannt, ob der Serumantikörper ein autoaggressiver oder ein sekundärer Faktor ist.

Clinical Neuroscience

[Motorcycle Jackson seizures associated with compulsive naming ]

BENKE Bálint

[The author describes the case of a patient with epilepsy who developed Jackson seizures with forced feeding after a herniactomy. Based on the literature, he raises the problematic nature of the case and tries to find an explanation for this rare symptom association. ]

Clinical Neuroscience

Au sujet des phenomenes convulsifs au cours de la degenerescence hepato-lenticulaeires

GEORGIEV I.

Chez 7 patients atteints de dégénérescence hépato-lenticulaire, des phénomènes convulsifs ont été observés. Elle a été observée dès l'époque de Strümpell et a depuis été rapportée par des auteurs avec une incidence de 8-20%. Le diagnostic a été établi par des tests cliniques et biochimiques. L'hérédité a été détectée chez deux d'entre eux. Trois patients de sexe masculin et quatre de sexe féminin ont eu un suivi de 2 à 10 ans. Début de la maladie à l'âge de 9 à 14 ans. Type de crise : 4 GM, dont 1 a également présenté des crises jacksoniennes, 1 psychomotrice et 2 PM, Les crises surviennent à différents stades de la pathologie. Le mécanisme n'est pas entièrement compris. Ces patients représentent la variante épileptique du syndrome. Les lésions précoces du tronc cérébral frontal sont mises en évidence à la fois par la pathologie et l'EEG. Outre la dégénérescence hépato-lenticulaire, qui provoque principalement des atteintes fronto-pariétales, lenticulaires et cérébelleuses, on peut envisager un autre analogue de la maladie, qui est une maladie du système fronto-ponto-cérébelleux, avec une épilepsie fréquente et un tableau clinique similaire à celui de la dégénérescence hépato-lenticulaire : l'encéphalite hyperkinétique progressive. Cela fait de Dawson, van Bogaert et Pette une unité nosologique. Encéphalite de Döring. Les troubles micro-structurels et biochimiques restent à analyser.

Clinical Neuroscience

[The relationship between limited responsibility and the nature of new offences]

BODA Lívia, BAKONYI Ferenc, SZABÓ Árpád

[We have raised the possibility of criminal-mental-iatrogenization and the need for criminal-mental-praeventio. We suggested that, in order to avoid the former and to achieve the latter: (a) the mental health expert's opinion, if he or she finds limited competence, should include a prognosis in addition to the diagnosis; or (b) introduce a new concept to identify those persons for whom, for example, limited sanity arises because of insanity, but who, because of the individual's mental capacity, in the medical judgment, cannot be expected to obtain the necessary result from a limited sentence. Our assumptions and recommendations are supported by statistical data from our Office's files and by quotations from the ETT's Judicial Committee's decisions of principle. ]

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[Neuropsychological rehabilitation following acquired brain injury]

TAMÁS Viktória, KOVÁCS Noémi, TASNÁDI Emese

[Neuropsychological rehabilitation or rehabilitation neuropsychology is a field within applied neuropsychology. It originally diverges from applied clinical and functional neuropsychology, although it could not be entirely differed from them. The unique nature of this area over the complexity is given by its process-controlled and system-approach aspects. In Hungary the number of neurorehabilitation centres and departments requiring neurocognitive rehabilitation has been continually increasing. Nevertheless, the number is still low; accordingly in our country this field is relatively young and isn’t well known. Authors of this review would like to draw attention to the importance of rehabilitation of patients with acquired brain injury and improvement of their quality of life with the theoretical and practical knowledge, as well as the necessity of future alterations and challenges emphasizing the need of a significant change of this narrow domain. ]

Clinical Neuroscience

Utilization of acute vascular imaging and neurointervention for acute ischaemic stroke patients in 20 Hungarian stroke centers

POZSEGOVITS Krisztián, SZABÓ Géza, SZUPERA Zoltán, NAGY Péter, NÉMETH László, KONDÁKOR István, TUSA Csaba, BERENTE László, SALACZ Pál, VÉCSEI László, SAS Katalin, SEMJÉN Judit, NIKL János, SZAPÁRY László, KAKUK Anikó, RÓZSA Csilla, HORVÁTH Melinda, IMRE Piroska, KÖVES Ágnes, BALOGH István, MOLNÁR Sándor, FOLYOVICH András, AL-MUHANNA Nadim, BÉRES-MOLNÁR Katalin Anna, HAHN Katalin, KRISTÓF Piroska, SZÁSZ Attila Sándor, SZŰCS Anna, BERECZKI Dániel

Background - Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Subjects and methods - We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centres before 31st August 2016. Results - Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion - Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro­intervention capacity needing improvement.

Clinical Neuroscience

[Health status and costs of ambulatory patients with multiple sclerosis in Hungary]

PÉNTEK Márta, GULÁCSI László, RÓZSA Csilla, SIMÓ Magdolna, ILJICSOV Anna, KOMOLY Sámuel, BRODSZKY Valentin

[Background and purpose - Data on disease burden of multiple sclerosis from Eastern-Central Europe are very limited. Our aim was to explore the quality of life, resource utilisation and costs of ambulating patients with multiple sclerosis in Hungary. Methods - Cross-sectional questionnaire survey was performed in two outpatient neurology centres in 2009. Clinical history, health care utilisation in the past 12 months were surveyed, the Expanded Disability Status Scale and the EQ-5D questionnaires were applied. Cost calculation was conducted from the societal perspective. Results - Sixty-eight patients (female 70.6%) aged 38.0 (SD 9.1) with disease duration of 7.8 (SD 6.7) years were involved. Fifty-five (80.9%) had relapsing-remitting form and 52 (76.5%) were taking immunomodulatory drug. The average scores were: Expanded Disability Status Scale 1.9 (SD 1.7), EQ-5D 0.67 (SD 0.28). Mean total cost amounted to 10 902 Euros/patient/year (direct medical 67%, direct nonmedical 13%, indirect costs 20%). Drugs, disability pension and informal care were the highest cost items. Costs of mild (Expanded Disability Status Scale 0-3.5) and moderate (Expanded Disability Status Scale 4.0-6.5) disease were 9 218 and 17 634 Euros/patient/year respectively (p<0.01), that is lower than results from Western European countries. Conclusion - Our study provides current inputs for policy making and contributes to understanding variation of costof- illness of multiple sclerosis in Europe.]

Clinical Neuroscience

[Assessment of health related quality of life among epileptic patients in the context of coping strategies and subjective disease perception]

KOVÁTS Daniella, CSÁSZÁR-NAGY Noémi, JUHOS Vera, SALLAY Viola, BÉKÉS Judit, FABÓ Dániel, KELEMEN Anna, KURIMAY Tamás

[Purpose – Psychosocial condition and life quality of epileptic patients are greatly determined by the existence of the disease-related comorbid disorders, like depression, anxiety, and the subjective disease perception, as well as the neuropsychological consequences of the seizures. (Whitehead et al. 2015; Goldstein et al. 2005). It has been examined in patients living with epilepsy how subjective disease perception and coping strategies influence life quality, comorbid depression and the condition of anxiety. Methods – Study patients were asked to fill in a self-completion questionnaire, which examined their psychosocial condition (HADS, Beck Depression Scale), life quality (Qolie-31), coping strategies (FKV-LIS), and subjective disease perception (IPQ-R), as well as sociodemographic and disease variables. The subjects of the study: the data of epileptic patients between the age of 18 to 70 was recorded. Patients were selected from the adult outpatients of a national centre, a regional hospital and two private health care centres located in Budapest. Results – Based on the multiple regression analysis. Beck’s depression (b coefficient=-0.351, t=-4.703, p<0.001**). Depressive coping strategy (FKV Dep) (b coefficient = -0.235, t=-3.123, p=0.002**). Subjective health perception (b coefficient =0.232. t=3.643, p<0.001**). Sex (women; b coefficient =-0.162, t=-3.008, p=0.003**). IPQ consequences (b coefficient =-0.161, t=-2.572, p=0.012*). Active coping strategy (FKV Act; b coefficient =0.146, t=2.572, p=0.012*). Type of seizure (b coefficient =-0.138, t=-2.527, p=0.013*), and Sleep quality (b coefficient =-0.125, t=-1.995, p=0.049) explain some 75.6% of the variance of life quality’s total score (model3: F=33.333, p<0.001**. adjusted R2=0.733). Conclusions – Among the factors of the subjective disease perception (IPQ-R), the physical, mental and social consequences play the most important role. Similarly, the impact of negative emotional representation, as well as the erratic nature of the seizures are decisive. Emotional representation, cyclicity and disease coherence have an important role in coping with disease-related negative emotions. ]

Journal of Nursing Theory and Practice

[Healthcare and social aspects of nursing in relation to the rare Pompe disease]

TÓTH Mónika, VÁRDI Katalin Borbála

[Aim of the study: Pompe disease is a rare mitochondrial disease, which is treated with enzyme replacement therapy. The authors examined the lifestyles of patients diagnosed with Pompe disease, and their knowledge regarding the illness. They compared this with the results of the regular checkups performed during the care process, in order to assess the patients’ compliance. Sample and methods: The research was conducted among patients suffering from Pompe disease, treated at the Rehabilitation Department of the Törökbálint Institute of Pulmonary Medicine (N=14). The survey of the patients’ knowledge took place in the form of personal interviews. The findings related to the regular enzyme replacement therapy were recorded and collated in the course of interviews conducted by telephone with the nurses of the centres administering the treatment. The data was processed using Microsoft Excel software. Results: In 2012 in Hungary the number of patients diagnosed with Pompe disease was 14 (12 adults, 2 children). The time elapsed from emergence of the first symptoms to the precise diagnosis in the case of all known patients (except in the case of one screened child) was an average of 13.4 years. Ten of the patients were receiving enzyme replacement therapy. The survey revealed that the conditions of the patients receiving the enzyme replacement therapy did not deteriorate. In the case of the female child, the decrease in CK levels was accompanied by growth and movement consistent with her age, and an improvement in vocalisation. Conclusions: For patients diagnosed with the once fatal Pompe disease, enzyme replacement therapy now offers the opportunity of a full life; and complementary treatments not only boost the effectiveness of the enzyme replacement, but also improve the patients’ subjective quality of life.]