Clinical Neuroscience

[Micro-tumour mimicking symptoms of cervical disc herniation in the coccygeal fossa (Problems of clinical and histopathological diagnosis)]

GALLYAS Ferenc1, GEDEON László2, MAJERSZKI Klára2, MÉREI F. Tibor1

APRIL 01, 1985

Clinical Neuroscience - 1985;38(04)

[The clinical and pathological issues of the C6 root mycrotum of the b.o. mimicking the symptoms of a herniated disc are analysed. literature on the histopathology of neurinomas and neurofibromas is summarised. ]

AFFILIATIONS

  1. Pécsi Orvostudományi Egyetem Idegsebészeti Klinika
  2. Országos Ideg- és Elmegyógyászati Intézet III. Neuro-Psychiatriai Osztálya

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[On model theories of endogenous psychoses]

SIMKÓ Alfréd

[The author presents variations in the interpretation of so-called "endogenous" psychoses, from the vague notion of "heredodegeneration" to the nosological and axial-syndromic principle and methodologies based on the progression picture, pointing to the increasing importance of the dominant role of biological, psychopathological and social perspectives. In the models, the author sees relatively valid hypothesis constructs intended to bring together the larger body of knowledge on a topic. Their disadvantage is that their categorical validity is determined solely by their own systematising principle: therefore, models that are too closed are in danger of becoming rigid and dogmatic. Without claiming to be exhaustive, the author only sketches out the brain topological, constitutive and character typological, descriptive-phenomenological, form-phenomenological, psychoanalytic, existential-anthropological, genetic, cybernetic, and broader biological and sociogenetic models of endogenous psychoses. It highlights the importance of their flexibility, resolvability and synthesizability, without which their clinical usefulness, especially in the context of endogenous psychoses, becomes questionable. ]

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[Indications for transoral neurosurgery]

PÁSZTOR Emil, VAJDA János, PIFFKÓ Pál, GÁDOR Ildikó

[The microscopic surgical technique has made it possible to operate relatively safely on pathological lesions located in the ventral part of the craniocervical transition, often causing severe bulbar symptoms. The indications for this operation are discussed based on the experience of 11 patients operated on with transoral surgery. ]

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[Differential diagnostic approach to paranoid syndromes and schizophrenia paranoid from the clinician's perspective]

BOHÁCS Elemér

[The author discusses the differential diagnostic problems of schizophrenia paranoids and paranoid syndromes from the clinician's perspective and provides a diagnostic workup of a 5-year discharge from the hospital. ]

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[The pathogenetic role of the "stump" of the occluded internal carotid artery - the external carotid artery in the context of surgery for stenosis]

BODOSI Mihály, MÉREI Tibor

[After occlusion of the internal carotid artery, focal ischemic symptoms persist in a quarter of patients. This may be due to an ulcerated surface of the stump of the internal carotid artery or to clots filling the inlet of the occluded artery, and emboli from this may enter the intracranial vessels via the internal carotid artery anastomoses. Further evidence for this hypothesis is provided by presenting the material of 10 patients in whom endarterectomy was justified in preparation for extra-intracranial anastomosis surgery to narrow the external carotid artery inlet. In this way, the carotid fork can be studied. The findings emphasize the pathogenetic role of the carotid stump and suggest its excision when endarterectomy of the external carotid artery is warranted anyway. However, it is also considered to be an option when the ulcerated entrance of the carotid stump is at risk of further embolization. Surgical management is described. ]

Clinical Neuroscience

[Cerebral tumor detection by brain scintigraphy ]

TÓTH Gábor, SZÉPLAKI Zoltán, ANTÓNY Miklós

[The authors report on brain scintigraphy of 71 patients with brain tumors. They analyze their results according to localization and histological type. They highlight that hemangiomas, meningiomas, and supra tentorial gliomas are well visualized, cerebral metastases to a lesser extent. ]

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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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Cases of inborn errors of metabolism diagnosed in children with autism

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Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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