Lege Artis Medicinae

[From Graffiti to Public Space Art ]

HÁRDI István

JANUARY 20, 2018

Lege Artis Medicinae - 2018;28(01-02)

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Further articles in this publication

Lege Artis Medicinae

[The Experience of Illness and Recovery – Patient Representation in the European Medicines Agency ]

CZIGLÉNYI Boglárka

Lege Artis Medicinae

[Classical methods in modern approach. Training for the recognition of emotions using bibliotherapy-techniques]

SZABÓ József, SIPOS Mária

[BACKGROUND - Nowadays it is an understood fact, that theory of mind has a great psychological significance. Deficits of theory of mind skills are observed in schizophrenia such as depression, dementia, autism and some personality disorders as well. Conceptions of theory of mind and emotion recognition ability have been coming in front at the expanse of the older empathy also in the present-day research in connection with helper connections and their effects. It is probably due to popular approach of cognitive neuroscience exact methods. METHODS - We intended to demonstrate, that the ability of emotion recognition can be developed, or partially restored, even in case of patients suffering from schizophrenia. We compiled an 8-seat training. Our method was a bibliotherapy training, each of chosen novels expressed one of basic emotions (by Ekman). After a common reading we projected validated portraits expressing also those emotions. Participants had to choose reflecting the emotional state of the characters photos. Then they shared stories from their own lives experiencing similar emotions. We measured the effectiveness of our method by the Reading the Mind in the Eyes measured (RMET) test. RESULTS - Comparing data before and after the training in t-test we detected significant difference (p=0.000608 <0.05). Verifying that the observed changes are not only the common effects of the other types of treatment, the same tests were performed on a similar in-patient treated control group. There was no significant difference between the RMET first time and two weeks later values of the control group (p=0.467). The rate of changes in the test and control group (RMET) was compared in a paired-sample t-test, and we also found a significant difference: p=0.000786 <0.005. CONCLUSIONS - The deficit of theory of mind in schizophrenia can be reduced, which indirectly can improve our patients' communication and adaptation skills, or worse, their deterioration can be reduced.]

Lege Artis Medicinae

[Dear Reader!]

KAPÓCS Gábor

Lege Artis Medicinae

[The role of gut microbiota in mental health]

FRECSKA Ede, MÓRÉ Csaba

[During the last decade, the Human Mic­robiom Project resulted in several important discoveries regarding the role of the microbiota communities - with the central role of the gut flora - in maintaining physiological homeostasis. The increasing knowledgebase carries important consequences for mental health. From a psychiatrist’s perspective, the current publication summarizes the most important results which may help to understand the etiopa-thology of neuropsychiatric illnesses, facilitate development of effective therapeutic interventions, and provide cues for disease prevention and a healthier lifestyle. ]

Lege Artis Medicinae

[Faces of dementia]

FULLAJTÁR Máté, HIDASI Zoltán

[Dementia is defined as a combination of symptoms or as a syndrome. In different types of dementia syndromes cognitive, behavioural and psychological symptoms can be distinguished according to clinical aspects. The prevalence of dementia increases continuously with age, causing significant challenges for the health care system of developed countries. Early diagnosis and early intervention by progression slowing therapy can be defined as goals in treating dementia. At the same time, the education and psy­chological support of the patients, their relatives and health care providers are also essential. A more accurate knowledge of the pathomechanisms behind the symptoms is ne­cessary in order to develop more effective therapies in the future. The authors review the most important types of mild cognitive impairment and dementia syndromes, their clinical and diagnostical criteria and therapeutic possibilities, focusing on early diagnosis and prevention.]

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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

Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Clinical Neuroscience

Extraskeletal, intradural, non-metastatic Ewing’s sarcoma. Case report

OTTÓFFY Gábor, KOMÁROMY Hedvig

Intracranial localization of Ewing’s sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing’s sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re­gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima­ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.

Hypertension and nephrology

[Non-pharmacological treatment of hypertension and reducing cardiovascular risk in general practitioners’ clusters]

MOHOS András, KOZMA Anna, MARKÓ-KUCSERA Mária, MESTER Lajos

[Hypertension and cardiovascular diseases are major public health issues. In their treatment non-pharmacological methods have a role in every case either alone or as a complement. Patient adherence is a key factor. The role of primary care is very important in the management and with general practitioners’ cluster model and with the involvement of new primary care professionals (for example: dietetitian, physiotherapist) the opportunities are expanding. In the A GP Cluster and in the Marosmenti GP Cluster the analysis of the patients’ results who participated in an individual health status examination, in dietetic and in physiotherapy services. Assessing the professionals’ attitudes towards GP cluster model. In the A GP Cluster 2409 people, in the Marosmenti GP Cluster 1826 people participated in an individual health status examination. 14.6% and 19.9% of the participants were under the age of 18. 58.9% and 60.7% of the participants over the age of 18 were female. 1083 and 232 patients used physiotherapy services, 147 and 187 people used dietetic services. The age distribution of the individual health status examinations is correspond to the Hungarian age pyramid. In addition to the preventive approach came into view the community based local health care services. The GP cluster model was welcomed by the patients, the physiotherapy was more popular than dietetic among them. All professionals of the GP clusters had a positive opinion of the professional work done in the project. Conclusion: There is a demand both from the patients and the healthcare professionals for the GP cluster concept. The establishing of an appropriate monitoring system and creating long-term, sustainable operating conditions are essential for achieving lasting social health gains. ]

Lege Artis Medicinae

[Autopsy by Pencil – When Anatomy and Art Meet ]

CZIGLÉNYI Boglárka