Clinical Neuroscience

[Personal comments]

JANSZKY József, RÁSONYI György, BÉKÉS Judit, HOLLÓ András, HALÁSZ Péter

FEBRUARY 20, 2002

Clinical Neuroscience - 2002;55(01-02)

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Clinical Neuroscience

[Chemotherapy of recurrent supratentorial malignant gliomas (Phase II study)]

ÁFRA Dénes, SIPOS László, VITANOVICS Dusan

[At the Hungarian National Institute of Neurosurgery 73 recurrent supratentorial malignant tumours were treated by chemotherapy during the last ten years. Chemotherapy was applied after postoperative radiotherapy but in some cases following reoperation only. All cases were clinically and by CT or MRI verified recurrences. Forty-three patients received BCNU-DBD (dibromodulcitol) treatment (23 anaplastic astrocytoma - AA, and 20 glioblastoma multiforme - GM): day 1. BCNU 150 mg/sq.m. in iv. infusion, day 2. dibromdulcitol 1000 mg/sq orally was given. This course was repeated every six weeks, altogether 2-8 times. Sixteen patients with AA responded with complete or partial regression but only 6 did with GM. Median survival was 14 and 7 months, the difference proved to be significant, p=0.0091. PCV combination (procarbazine, CCNU, vincristine) was applied to 16 patients with AA and 14 cases with recurrent oligodendroglioma (O). Treatment started with vincristine 1.5 mg/sq. m. iv. (2.0 mg maximum), the next day CCNU 100 mg/sq.m. was given, followed by procarbazine 60 mg/sq.m. on days 8-22. and finished by the same dose of vincristine on day 30. The course was repeated after one month, mostly six times. Six patients with AA did not respond; in cases of oligodendroglioma all but one responded with complete or partial improvement. It is remarkable that no significant difference was found between the survivals of BCNU-DBD or PCV treated AA patients. Chemotherapy of supratentorial malignant glioma recurrences with nitroso-ureas and their combination proved to be efficacious. It also seems, that in recurrent cases lower grade gliomas show better response rate than glioblastomas.]

Clinical Neuroscience

[Treatment of migraine in hypertension and ischemic heart disease]

FICZERE Andrea, CSIBA László

[Migraine is a common disorder with a prevalence of 9-10% in Hungary. Migraine can be accompanied by hypertension and/or ischemic heart disease sometimes in younger patients, but more frequently in the elderly, which is important for therapeutical considerations. The article reviews the literature with special focus on hypertension and coronary heart disease. In the second part, the authors summarize their experiences on headache patients.]

Clinical Neuroscience

[Neurology in the internet era]

LENGYEL András

Clinical Neuroscience

[Pregnancy and psychiatric disturbances]

SZÁSZ Anna, KOVÁCS Zsuzsanna

Clinical Neuroscience

[CONGRESS CALENDAR]

[Congress calendar 2002;55(01-02)]

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Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

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.

Clinical Neuroscience

[A case of destructive cervical spondylarthropathy related to chronic dialysis]

BERTA Balázs, KOMÁROMY Hedvig, SCHWARCZ Attila, KAJTÁR Béla, BÜKI András, KUNCZ Ádám

[A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.]

Clinical Neuroscience

[High prevalence of burnout and depression may increase the incidence of comorbidities among Hungarian nurses]

ÁDÁM Szilvia, CSERHÁTI Zoltán, MÉSZÁROS Veronika

[Background and purpose - Poor mental health among health care professionals may have a significant impact on public health. There is limited information about the prevalence and potential consequences of burnout and depression among nurses in Hungary. The objective of this study is to explore the relationship between burnout as well as depression and somatic symptoms as well as comorbidities among nurses in Hungary. Methods - Cross-sectional study with self-administered questionnaires among 1,713 nurses. Burnout and depression were assessed by the Maslach Burnout Inventory (MBIHSS) and the Shortened Beck Depression Questionnaire, respectively. Somatisation was measured by the Patient Health Questionnaire (PHQ-15). Correlates of burnout and depression were assessed by logistic and linear regression analyses. Results - The prevalence of depressive symptom and clinical depression was 35% and 13%, respectively. The prevalence of moderate and high level emotional exhaustion, depersonalisation, and decreased personal accomplishment was 44%, 36% and 74%, respectively. We identified burnout and depression as a predictor of high prevalence of subjective somatisation. Whilst burnout showed a strong association with increased prevalence of hypertension, depression predicted almost all examined diseases, in particular, cardiac and cerebrovascular diseases, as well as neoplasms. Conclusion - We found high prevalence of burnout and depression among nurses in Hungary. As depression has been shown to be associated with higher prevalence of comorbidities than burnout, its consequences may be more significant. Appropriate prevention, diagnosis, and adequate treatment of burnout and depression may decrease the prevalence of ensuing comorbidities.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Hypertension and nephrology

[Dialysis service in coronavirus pandemic]

SZEGEDI János, HORN Péter, GERGELY László, TÖLGYESI Katalin, MOLNÁR Gergely

[The coronavirus pandemic started at December 2019 from Wuhan. The rate of spread of the coronavirus epidemic has shocked the entire world, and the WHO declared it as a pandemic in March 2020. The first case in Hungary was confirmed in March 2020. The infection primarily damages the lungs but can also infect other organs. The relationship between coronavirus infection and the kidney is bidirectional. On the one hand, the infection can cause acute renal damage, and on the other hand, chronic kidney patients and patients receiving renal replacement therapy are at increased risk of infection due to their immune compromised status. Chronic kidney patients are three times more likely to have a severe Covid-19 infection than the general population. Among patients with severe Covid-19, the incidence of acute renal failure may exceed. Patients treated with the HD program have a higher risk of infection due to transportation and treatment in the common area. The mortality rate of Covid-19 infected patients receiving renal replacement therapy is 20-35% according to international data. Infections occured in all the dialysis centers of the B.Braun Avitum Dialysis Network during both the 2nd and 3rd wave of the epidemic. Epidemiological data confirm that preventive measures are of paramount importance in the field of prevention of infections and in the care of the pandemic. Effective prevention and patient care can only be ensured on the basis of correct epidemiological data. The management of the B.Braun Avitum Dialysis Network decided at the time of the outbreak in Hungary to establish an Operational Staff to perform tasks related to the epidemic. The tasks of the Operational Staff are the following: to ensure an effective, up-to-date connection with the dialysis centers, to update the epidemiological data, and to develop and operate an effective prevention program and action plan. To address the epidemic situation, complex measures were introduced in the Network regulated in a pandemic plan which was periodically reviewed. This document includes detailed hygiene regulations regarding patient transport, screening of dialysis center entrants, proper use of mask and personal protective equipment, hand hygiene, contact and respiratory isolation, rules of behavior, ordering a visitation ban, and regulation of cooperation with the hospital. ]