[REVIEW OF THE LITERATURE]
MARCH 20, 2006
Hungarian Radiology - 2006;80(01-02)
MARCH 20, 2006
Hungarian Radiology - 2006;80(01-02)
[There is a spectacular development in diagnostic radiology in the last one and a half decades. State-of-the-art US, CT and MR appliances and the dynamic software developments has improved diagnostic safety by order of magnitude, which resulted in the reduction of possible errors and misinterpretations. The advent of MSCT resulted in shorter scanning times, the submillimeter collimation and the subsecond scan time improves the spatial resolution of the image, the motion artifacts are reduced and the evaluation of the parenchymal organs improves. However, the new technology of MSCT raises new questions. Due to faster data collection the acquisition time decreases, that is why the tracing of the contrast material must be accurately timed. The high contrast material density that appears suddenly in pulsing vessels makes a disturbing effect on its environment, thus making way to erroneous interpretation. The performance of a secondary reconstruction (2D and 3D reconstructions) may diminish the possibility of diagnostic pitfalls and artifacts. Reconstruction increments made from appropriately overlapping thin slices are required for good image quality and spatial resolution, otherwise the image quality is deteriorating, some vessels might “disappear”, they are not depicted. We are struggling with several problems using MIP CTangiography. The proper elimination of the bones, the improper selection of VOI (volume of interest) might lead to false positive result, and the assessment of small vessels might become impossible. The differentiation of soft plaque and vessel thrombus can also be a problem, and the hard plaque may imitate a constriction. The knowledge of breath and pulsating motion artifacts, beam-hardening artifacts and flow-related artifacts is essential. Differentiating difficulties during virtual endoscopy, the partial volumen effect, the interpretation of various post-operative conditions, the disturbing effects of implants may cause diagnostic and differential diagnostic problems. The author gives a summary of possible errors, misinterpretations and artifacts that may occur with the application of MSCT even if examination protocols are followed.]
Lege Artis Medicinae
[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.]
Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.
We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey between 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.
Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.
Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still unclear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of generalised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.
Clinical NeuroscienceLate carcinomatous meningitis as vertigo
Clinical NeuroscienceAlexithymia is associated with cognitive impairment in patients with Parkinson’s disease
Lege Artis Medicinae[COVID-19-cardiology at spring, 2020]
Journal of Nursing Theory and Practice[Examination of the Strength of Core- and Perineal Muscles in Case of Different Movements]
Journal of Nursing Theory and Practice[Examination of Parental Treatment among Outgoing Ambulance Workers]
Journal of Nursing Theory and Practice[BLS Quality Assessment – The Effectiveness of Telephone Cardiopulmonary Resuscitation Instruction]
Journal of Nursing Theory and Practice[The History of the Founding of the first State School of Nursing ]
Journal of Nursing Theory and Practice[Remembering Judit Mészáros]