Clinical Neuroscience

[On surgical indications for metastases of spinal carcinoma]

PÁSZTOR Emil1, NAGY Vilmos1

DECEMBER 01, 1961

Clinical Neuroscience - 1961;14(12)

[Based on our experience with 40 patients with spinal metastases, we do not refrain from operating on single nodal spinal metastases and paraplegia alone is not a contraindication. The indication for surgery and the expected results depend mainly on the histological and biological characteristics of the primary tumour, the course of the disease and the general physical condition of the patient. Based on the catamnestic evaluation of operated and non-operated patients, surgery can be recommended. Since the severity of compression or paresis is significant in the postoperative outcome, early surgery is desirable. ]


  1. Országos Idegsebészeti Tudományos Intézet



Further articles in this publication

Clinical Neuroscience

Entwicklung – Reaktion — Prozess

NIKOLA Schipkowensky

In dieser Begriffsbestimmung wird die Untrennbarkeit des somatischen und psy chischen Lebens in den Vordergrund gestellt, was allerdings nicht besagen will, sie seien identisch. Schon dadurch ist aber unterstrichen, dass die Materie das Primäre ist, der Geist — das Sekundäre ; denn Form ohne Inhalt ist undenkbar. Das Bewusstsein, als höchste Form menschlichen Daseins, darf man nicht als ein blosses Epiphänomen seines Organs hinstellen. Die psychische Tätigkeit wird zwar vom Grosshirn geleistet, sie ist aber in ihren Inhalten und in ihrer logischen Gliederung von der objektiven Wirklichkeit deter miniert, deren subjektive Abbildung sie darstellt. Die Definition verweist ferner auf den biologischen Ursprung der menschlichen Persönlichkeit, deren weitere Entwicklung auf der Verbindung von unbedingten Reflexen mit der Er arbeitung kompliziertester dynamischer Stereotypen zeitlicher Verknüpfungen beruht. Schliesslich setzt diese Definition auch die Untrennbarkeit von Psychi atrie und Neurologie voraus : Sie sind einheitliche Glieder der einen medizi nischen Wissenschaft.

Clinical Neuroscience

[Multiple sclerosis and generalised reticulosarcoma combined case]

PAPP Mátyás, KIRÁLY Ferenc

[A 63-year-old patient had multiple sclerosis for about 20 years, which progressed in relapses. 8 months before his death, he developed generalized lymph node enlargement. Autopsy and histopathological examination showed generalized reticulosarcoma throughout the body and diffuse soft tissue and perivascular tumour proliferation in the central nervous system. With minor exceptions, the pia-glia membrane inhibited spread into the neural tissue everywhere except in the corpus pinealea, which may be attributed to the specific biological behaviour of the corpus pinealea in the face of pathological processes. In the central nervous system, in addition to the tumoral proliferation occupying the perivascular spaces, we found multinodular marrow neoplasms, which correspond in their location and histological features to old multiple sclerosis foci. On the basis of the histological picture and the clinical course, the described case must be considered as an accidental encounter of two separate diseases. ]

Clinical Neuroscience

[Rare symptom of cervical vertebral chordoma]


[A 60-year-old man with a cervical chordoma, the clinical picture of which was fluctuant and the diagnosis of which could only be clarified by histopathological examination. Contrary to previous literature, reactive marginal sclerosis was detected in vertebra C III, with the chordoma as the primary cause. This case confirms the phenomenon that the clinical picture of vertebral chordoma is atypical and thus difficult to diagnose clinically. ]

Clinical Neuroscience

[Spiractin electroencephalography tests]


[Studies with Spiractin have shown that: 1. in addition to its effect on the respiratory center, it has an excitatory effect on the diffuse activating system of the brainstem. 2. it can be used as a provoking agent in electroencephalography of patients with epilepsy (especially in children). 3. It may also occasionally cause generalized seizures, which should be kept in mind in cases of epilepsy.]

Clinical Neuroscience

[Report on the EEG training course in Marseille ]

WALSO Róbert

[The author reports on the EEG course in Marseille, organized by the International Federation of Societies for EEG and Clin. Neurophysiology" in Marseille from 28 August to 2 September 1961.]

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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.

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.

Journal of Nursing Theory and Practice

[Operational Efficiency Investigation from APN Perioperative Perspective]


[In the healthcare system operating theatres have to put great emphasis on quality work, patient safety and efficiency as well, and to achieve this, optimal utilization of theatres is extremely important. The results of researches in this topic in Hungarian and international literature draw attention to a lot of aspects. The study of perioperative periods, and the evaluation of the analysed processes show that theatres could be operated more effectively. As a result of this, more operations could be carried out and waiting time would also reduce. In order to increase the efficiency of the processes, APNs can play a prominent role at several points. According to the experience, the number of people using health care and the number of people waiting for surgery is increasing, which is further increased by the development of the ongoing SARS-CoV-2 (COVID-19) epidemic. Thereby, patients are not satisfied with the service. The work of APNs would also help increasing the contentment of patients during the operation procedures. Taking advantage of the multifunctional role of the nurse due to her knowledge and training, she actively participates in the operation, in the smooth running of the scheduled daily surgical program and contributes to the reduction of the number of missed, planned surgeries.]

Journal of Nursing Theory and Practice

[Assessing Nurses’ Knowledge of Surgical Wound Care, Complications and Knowledge of Bandages]


[Aim of our research was to assess the knowledge of nurses working in surgical departments about surgical wound treatment, phases of wound healing, its complications, and intelligent bandages. Our quantitative, cross-sectional, descriptive examination was carried out in a hospital in Transdanubia with non-random, expert sampling and a self-made questionnaire. Our target group was nurses working in the surgical departments of the hospital (N=85). During the data analysis, the descriptive statistical methods of MS Office Excel 2016 software were calculated: mean, standard deviation, frequency. A χ2-test was used to examine the relationship between variables (p <0.05). Knowledge of bandages was not affected by educational attainment (p>0.05). Those who perform wound care in their daily work have more knowledge about the wound treatment sequence of the wounds that are primarily healing, as well as about intelligent dressings (p<0.1). For the classes, there was a significance for the recognition of complicated wounds, knowledge of the benefit of the absorbable suture and the use of analgesic procedures (p<0.001). In the interests of patient safety, nurses’ knowledge of wound treatment needs to be continuously improved. It is necessary to provide an accessible source of information and further training.]