Lege Artis Medicinae

[Artwork of the Month Together I-II.]

SZURCSIK József

NOVEMBER 20, 2005

Lege Artis Medicinae - 2005;15(11)

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Lege Artis Medicinae

[Effects of tiotropium on lung hyperinflation, dyspnoe and exercise tolerance in COPD]

NAGY László Béla

Lege Artis Medicinae

[MANAGEMENT OF LIFE-THREATENING ENDOSCOPIC THERAPY-RESISTENT OESOPHAGUS VARICEAL BLEEDING]

ERŐSS Bálint Mihály, SZÉKELY György, SIKET Ferenc, LÁZÁR István

[INTRODUCTION - Liver cirrhosis has two serious consequences: hepatic failure and portal hypertension. Portal hypertension has two important clinical appearances: variceal bleeding and therapy resistant ascites. Variceal bleeding can be recurrent and resistant to endoscopic treatment. These complications can be prevented by implantation of Transjugular Intrahepatic Portosystemic Shunt (TIPS). CLINICAL CASE - A 59 year old male with cirrhosis due to hepatitis C, was hospitalized in our department in April 2004 with variceal bleeding. We tried to control the bleeding twice by band ligation, once by sclerotherapy and with the use of Sengstaken-Blakemore tube, but bleeding continued for three weeks despite the endoscopic treatment. The patient needed intensive care therapy and was treated with more than forty units of packed red cells and plasma. At that point we decided to implant a TIPS, which was carried out succesfully. After TIPS implantation no rebleeding occured and the shunt had good patency. Moderate hepatic encephalopathy was observed, which is a well known phenomenon, but it could be treated with pharmacologic therapy. CONCLUSIONS - In case of portal hypertension TIPS implantation can prevent from variceal rebleedings and may caus significant improvement in the quality of life.]

Lege Artis Medicinae

[SCREENING OF PSYCHIATRIC SIDE EFFECT OF INTERFERON THERAPY WITH QUESTIONNAIRE]

GAZDAG Gábor, SZABÓ Zsuzsa

[INTRODUCTION - Interferon therapy is an effective treatment of several oncological, hematological and viral diseases but it can precipitate serious side effects too. Among others the most frequent are the psychiatric symptoms. These symptoms are also the most frequent reasons of non-compliance and early cessation of treatment which can be avoided with rapid recognition and adequate treatment. Therefore, the early recognition of the psychiatric symptoms is of high importance. METHODS AND RESULTS - Authors report a self-administered questionnaire developed to screen the most frequent psychiatric symptoms precipitated by interferon treatment. They also present the evaluation method for the questionnaire, which makes the evaluation of the data easier for non-psychiatrist doctors as well. Between September 2004 and July 2005 all interferon treated patients who also had psychiatric consultation filled in the questionnaire. The number of patients was 26. Authors set up a decision-making algorhythm for the evaluation, so the non-psychiatrist doctors were able to judge whether a psychiatric consultation was needed as well as its urgency. With the data of 26 interferon treated patients who all went through a psychiatric consultation during a 10 months period, authors discuss their first experience, going into details in the three false positive and the two false negative cases. CONCLUSION - Authors founded the questionnaire helpful in the clinical practice and recommended the use for doctors working in general practice. They also suggest to carry it further research with more patients to strengthen the results.]

Lege Artis Medicinae

[Peptic ulcer disease - facts and questions]

WERLING Klára

Lege Artis Medicinae

[MEDICAL TREATMENT OF LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA - RISK FACTORS AND SIDE-EFFECTS]

KARSZA Attila

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

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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.

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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.

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A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

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Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.