[The u. n. treatment of acute fatal catatonia electrospasm]
VARGHA Miklós1, KOVÁCS Béla1
NOVEMBER 20, 1953
Clinical Neuroscience - 1953;6(04)
VARGHA Miklós1, KOVÁCS Béla1
NOVEMBER 20, 1953
Clinical Neuroscience - 1953;6(04)
[Attempts have been made to deconstruct the nosolgical entity of schizophrenia from several angles. A detailed differentiation on the basis of psychopathology may be useful in order to find a closer link between the diverse biochemical, pathophysiological, morphological sub-scores and the psychopathological picture. Morphological lesions (Miskolczy, Hechst (Horányi), Josephy, Fünfgeld), as Miskolczy emphasises, only provide a consistent picture in certain forms of schizophrenia. The relative intactness of the cerebral areas (Stief, Hechst (Horányi)) is in contrast to some of the clinical symptoms, so that we can say that morphological lesions, whether of the brain or liver (Gaupp), etc., have not been able to prove the unity of schizophrenia or to clarify the affiliation of the different forms. Biochemical and pathophysiological research is at the stage of data collection, as Riebelling, in his most recent summary paper, has pointed out.]
[1. Acute life-threatening insanity can be cured by early and cumulative electroshock treatment. 2. The syndrome can be understood as a cluster of symptoms of cortico-cerebrospinal-pituitary-adrenal dysfunction, which may be triggered by psychic, somatic and toxic effects. 3. Instead of the various names used in the literature - delirium acutum, amentia, catatonia perniciosa, azotaemic insanity, acute toxic psychosis, etc. - a more comprehensive name seems justified.]
[A case of a lateral ventricular diverticulum herniating into the cisterna ambiens and a case of multiple intracerebral ventricular diverticulosis were described. Cisterna ambiens diverticulum may form in adulthood on rigid hydrocephalus cerebrum, although it has also been described in children. It is essentially an infratentorial herniation of the retrosplenial gyrus in a slowly developing brain pressure gradient. A large differential between supratentorial and infratentorial pressures is a favourable condition for its development. It can be diagnosed in vivo only by ventriculography. It is to be distinguished from arachnoid cysts of the cisterna ambiens, which do not converge with the ventricular system and have no parenchyma or ependyma in their walls. Intracerebral diverticula may originate anywhere in the ventricular system of the juvenile hydrocephalus brain. The pathomechanism of their origin is due to the readiness of the severely oedematous parenchyma to infiltrate and secondary collapse into the ventricular system. (Weber and da Rugna: dissezierende intracerebrale Divertikel) The involvement of the dilated third ventricle in the cisternae is not a true diverticulum, but is notoriously common in hydrocephalus. The clinical significance of diverticulum formation is that it is a self-healing activity that eliminates obstruction to cerebrospinal fluid circulation and provides a route for the surgical resolution of occlusive hydrocephalus.]
[After presenting the clinical and histopathological findings of two quite acute (2 days and 7-8 days) fatal "ascending polyradiculoneuritis", the author deals with pathological issues, which, given the severity of the cases, the histopathology provides a good starting point. The focus of the tissue process falls on the area between the root nerve and the intervertebral duct. However, inflammatory infiltrates are initially very sparse, consist of lymphocytes throughout, and do not extend beyond the area of parenchymal destruction; that is, they do not correspond to real but to "reparative inflammation." Morphologically verifiable parenchymal injury is also initially disproportionate to severe clinical relapses and is only approx. It unfolds in 1 week. All this is against the generally accepted origin of the virus; confirmation of the allergic origin raised by Pette may not be by histological but by clinical-laboratory tests.]
[A summary of the articles published in the issue in Russian and German]
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.
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.
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.
Hypertension and nephrology
[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]
Lege Artis Medicinae
[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrepresented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]
Clinical NeuroscienceCases of inborn errors of metabolism diagnosed in children with autism
Clinical NeuroscienceEvaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations
Clinical NeuroscienceElectrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study
Lege Artis Medicinae[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]
Lege Artis Medicinae[Dear Reader! Greetings to the 30th anniversary of founding the LAM]