Clinical Neuroscience

[Some data on ischemic penumbra]

NAGY Zoltán

SEPTEMBER 20, 1993

Clinical Neuroscience - 1993;46(09-10)

[Answer to the question of dr. István Széll]

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Clinical Neuroscience

[Pharmaco-EEG investigation on sedative effect of antiallergic drugs. Setastin is a non-sedative antihistamina]

RAJNA Péter, VERES Judit

[Effect of setastine on pharmaco-EEG was investigated in a double blind placebo controlled study in ten healthy volunteers. Changes caused by setastine were compared with those of two referent antihistamine drugs (chloropyramine and hismanal) having great differences in their sedative side effect. The themporo-occipital alpha per theta ratio was the most sensitive EEG marker in differentiating the two referent drugs. The EEG effect showed by setastine was very similar to that to hismanal and opposite to that of chloropyramine. In addition an increase of the total power and the power of beta was also measured. The latter changes might refer to an inherent EEG effect of setastine. EEG changes of setastine cannot be evaluated as signs of hypovigilance and the similarity of EEG effect of hismanal and setastine also supports the non-sedative nature of setastine estabilished by clinical studies. The pharmaco-EEG method utilized gives possibility for an objective investigation of psychotropic side effects of the particular drugs. ]

Clinical Neuroscience

[Efficacy of cinolazepam on insomnia generated under shift-work conditions]

KÖVES Péter

[The efficacy of cinolazepam (a benzodiazepine with middle half life time and light pharmacological potential) on insomnia generated under shift-work conditions was investigated, and shown to be an efficent hypnotic. Cinolazepam (daytime dose 20 mg, night dose 40 mg) improved significantly both sleep and awakening quality: there were no hangover effects, drug provoked intrasleep or early morning insomnia. During the time cinolazepam was administered drug tolerance was not observed. The structure of cinolazepam-induced sleep could be characterised by shortened sleep latency, increase of deep slow wave sleep, improvment of sleep continuity and unchange of REM sleep parameters both during night- and daytime.]

Clinical Neuroscience

[Observation of embolic events during carotis constructive surgery]

RÓZSA András, ENZT László, JÁRÁNYI Zsuzsa

[The changes of middle cerebral artery circulation during carotid artery surgery in 65 patients were monitored, and the observed embolic events are discussed. Of the 65 patients, 37 were operated with shunt protection (group A) and 28 without (group B). In 31 of all cases 55 embolic events were noted. In 22 of the group A patients 37 embolic events were observed, one of them occured during the declamping of the external caruiid circulation. Eighteen emboli were observed in 9 of the Group B cases. There were embolic events in 5 cases due to external declamping. All the above mentioned embolic events occured without postoperative clinical sings.]

Clinical Neuroscience

[Experiences with carotid-doppler examinations on patients with arterial bypass operation on the lower extremities]

OLÁH László, FÜLESDI Béla, VALIKOVICS Atilla, CSIBA László, OLVASZTÓ Sándor, BÁNFI Csaba, KOZLOVSZKI Bertalan

[Carotis-Doppler examinations were performed on 83 patients with severe, obliterative disease of the arteries of the lower extremities and on 96 age-matched controls without signs and symptoms. In the group with obliterative arterial disease, severe or moderate stenosis of the carotid arteries was found in 20 and 40% of the patients, respectively, whereas in the control group the proportion of moderate carotid-stenosis was 2% and no case of severe stenosis was found. The role of risk factors was also studied. Based on their results the authors suggest, that because patients with obliterative disease on the arteries of the lower extremities have higher risk for stenosis, ultrasound investigations and regular follow up of the carotid arteries are needed.]

Clinical Neuroscience

[Brachioradial syndrome: superficial radial neuropathy]

KISS Gábor

[Damage of the superficial branch of the radial nerve represents a rare, and rarely recognized, mononeuropathy. The first three cases in the Hungarian literature are presented. The essential role of electrodiagnosis in detecting of the disease is stressed. Special attention should be paid to avoid any lesion which might result from improper patient-care.]

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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

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.

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]