Lege Artis Medicinae

[Arthrosis - An epidemic of the 21st century]

BÁLINT Géza

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

COMMENTS

0 comments

Related contents

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

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.

Clinical Neuroscience

[New opportunities in neuro-rehabilitation: Robot mediated therapy in conditons post central nervous system impairments]

FAZEKAS Gábor, TAVASZI Ibolya, TÓTH András

[Decreasing the often-seen multiple disabilities as a consequence of central nervous system impairments requires broadening of the tools of rehabilitation. A promising opportunity for this purpose is the application of physiotherapy robots. The development of such devices goes back a quarter of century. Nowadays several robots are commercially available both for supporting upper and lower limb therapy. The aim is never to replace the therapists, but rather to support and supplement their work. It is worthwhile applying these devices for goal-oriented exercises in high repetition, which one physically fatiguing for the therapist or for the correction of functional movement by various strategies. Robot mediated therapy is also useful for motivation of the patient and making the rehabilitation programme more versatile. Robots can be used for assessment of the neuromotor status as well. Several clinical studies have been executed in this field, all over the world. Meta-analyses based on randomized, controlled trials show that supplementing the traditional physiotherapy with a robot-mediated component presents advantage for the patients. Further studies are necessary to clarify which modality and intensity of the exercises, in which group of patients, in which stage lead to the expected outcome.]

Clinical Neuroscience

[Conductive education for children with neurological diseases]

BALOGH Erzsébet, KOZMA Ildikó

[Conductive education, developed by the 40-s last century, spread out in the world in spite the lack of hard scientific evidences for its benefit. There are sorts of cerebral palsies (athetosis, ataxia) in which conductive education might have the unique role to help. In cerebral palsies of other sorts it is much helpful if the disturbance of body scheme and degree of somatomotor neglect are superior to the palsy. Short term results of conductive education are to see in the better movement coordination whilst the long term outcome is the increased activities of daily living.]

Lege Artis Medicinae

[ALDOSTERONE AT THE BEGINNING OF THE 21ST CENTURY]

GLÁZ Edit, SZŰCS Nikolett, VARGA Ibolya

[The discovery of aldosterone as the principal mineralocorticoid hormone led to a new era in the study of the regulation and the pathological/clinical relevance of the fluid-salt homeostasis and blood pressure. Here, we discuss briefly the history of the discovery of aldosterone, its biosynthesis, the mechanism of action, regulation and the diseases which are associated with its pathologically increased production and hypertension: primary and secondary hyperaldosteronisms. Considering their clinical significance, we focus on primary hyperaldosteronisms as they represent a considerable portion of secondary hypertensions that can be definitively cured. Differential diagnosis issues related to other forms of hypertension of different origins are discussed in detail. Recent findings of the past fifteen years indicate that besides its classical genomical actions aldosterone has much more diverse non-genomic actions as well including proinflammatory and profibrotic effects even in physiological concentrations. Based on these observations, aldosterone can be regarded as a risk hormone in the aetiology of cardiomyopathies, vasculopathies and neuropathies and therapeutical consequences are also discussed.]

Hypertension and nephrology

[The beginnings and difficulties of peritoneal dialysis at the end of the last century. Part II. Hungarian experiences]

KARÁTSON András

[In Part I, I summarised the beginnings, the theoretical background and the international experiences of peritoneal dialysis. Hungarian publications related to peritoneal dialysis in the 1950s were focusing on the role of the method in the treatment of chronic renal disorders. The first dialysis centres were established in the medical universities of Hungary (Szeged in 1955, Budapest in 1960, Pécs in 1964, Debrecen in 1970) and in Miskolc in 1968. Despite the restricted hemodialysis capacities the intermittent technique of peritoneal dialysis did not spread in accordance with the demand. A survey conducted at the beginning of the 1970’s in the territory of the five counties with 1.5 million inhabitants revealed that considering the numbers of patients with renal diseases requiring dialysis, developing of a network of care and increasing the dialysis capacities is necessary and so is the development of a system of szatellite peritoneal dialysis, which was implemented with our support in 10 units of the county hospitals. A devoted and enthusiastic organiser of the nation-wide system of peritoneal dialysis was professor Taraba, who, due to his untimely death, was deprived of seeing the nation-wide spread of CAPD. At the beginning of the 1980’s the first reports on the favourable effects of CAPD appeared in Hungary. Solutions prepared in pharmacies and the lack of up-to-date equipment resulted in the frequent occurrence of peritonitis. In addition, the unfavourable memories of dialysis performed with bottled solutions (long treatment times, frequently peritonitis) were still vivid among patients and colleagues supervising the treatment. As a consequence, our survey conducted in 1991 revealed that the spread of CAPD all over the world in Hungary resulted in a significant increase of those treated with the intermittent method (more than 10% of the dialysis patients), while those treated with CAPD remained under 2%. Several reports on CAPD and the consequences that followed from them as well as the further training organised in the Szent Margit Hospital, Budapest and in Gánt, and also the guidelines issued by the Society of Hungarian Nephrologists the number of those treated with dialysis has exceeded 6000 in the past decade. 10% of them received CAPD/APD treatment.]