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.

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Obstructive sleep apnea syndrome (OSAS) may cause daytime sleepiness, mood changes and dysfunction in various cognitive areas due to recurrent arousals and / or chronic intermittent hypoxia. Different possibilities have been proposed regarding the most affected cognitive areas and mechanisms of OSAS. However, it is difficult to compare findings of the different studies due to the fact that individuals with different disease severities were included in the study groups. In the current study, we aimed to determine the relationship between severity of OSAS and cognitive functions, to investigate the effect of continuous positive airway pressure (CPAP) titration treatment on cognitive functions and the relationship between these changes and electrophysiological potential. 

The study included 4 groups of patients with simple snoring and mild, mo­de­rate and severe OSAS. In the pre-treatment evaluations, verbal fluency, visuospatial me­mory, attention, executive functions, lan­guage abilities and electrophysiological tests for event-related potential were performed. The same procedure was reapplied after 4 months of CPAP-therapy. 

Long-term recall scores and total word fluency scores were found to be low in the groups with moderate and severe disease compared to the patients with simple snoring (p: 0.04, p: 0.03, respectively). The information processing time was higher in patients with severe disease compared to patients with simple snoring (p: 0.02). The P200 and N100 latencies related to event related potentials (ERP) were significantly different between the groups (p: 0.004, p: 0.008, respectively). After CPAP treatment, significant differences were found in N100 amplitude and latencies and all cognitive areas except abstraction. In addition, N100 amplitude and latency change rate as well as change in attention and memory abilities were correlated (r: 0.72, p: 0.02; r: 0.57, p: 0.03, respectively). 

In the current research, disease severity was found to negatively affect long-term logical memory, sustained attention and verbal fluency. Moreover, significant improvement was detected in all cognitive areas with CPAP treatment. The findings of our study support that changes in N100 potential have the potential to be used as a biomarker that can be used to monitor cognitive function recovery after treatment.

Immune-checkpoint inhibitors (ICI) are effective drugs in cancer treatment that block immune checkpoints and stimulate an attack on cancer cells. However, various side effects were reported with ICIs. Peripheral nervous system (PNS) side effects are three times more frequent than those in the central nervous system. A 63-year-old male patient was admitted to our department with a 10-day history of dyspnea, diplopia, and generalized weakness.

Ciprofloxacin (CIP) is a broad-spectrum antibiotic widely used in clinical practice to treat musculoskeletal infections. Fluoroquinolone-induced neurotoxic adverse events have been reported in a few case reports, all the preclinical studies on its neuropsychiatric side effects involved only healthy animals. This study firstly investigated the behavioral effects of CIP in an osteoarthritis rat model with joint destruction and pain.