Lege Artis Medicinae

[Monitoring the immunophenotype of mononuclear cells in the cerebrospinal fluid acute lymphoid leukemia patients]

BABOSA Mária1

APRIL 29, 1992

Lege Artis Medicinae - 1992;2(04)

[Cerebrospinal fluid and blood samples were drawn at scheduled intervals from recently diagnosed or recurrent acut lymphoid leukaemia patients undergoing combined cytostatic therapy. The immunophenotype of mononuclear cells, separated from the samples, was determined and compared. It was found that the number of non-pathological mononuclear cells increased from time to time during the intense treatment period of ALL patients with high malignancy or recur rence and that their phenotype was similar to the actual surface markers of peripheral lymphocytes. According to findings in the literature based on monitoring other parameters, this phenomenon may be due to the increased permeability of the blood brain barrier, injured by intense chemotherapy and radiotherapy, or to reactive cell proliferation. ]

AFFILIATIONS

  1. Heim Pál Gyermekkórház Haematológiai Osztály Budapest

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Lege Artis Medicinae

[Malnutrition syndrome in childhood part I.]

BAKSAI László, PHILIP W. H. Eskes

[Malnutrition is a chrocic nutritional disorder resulting from insufficient intake of caloric energy and/or some the fundamental nutrients. Since it is the most common public health problem in the world it has a great impact on pediatric morbidity and mortality. The etiology is extremely complex. When one considers the less severe symptoms and signs caused by vitamin-, mineral-, and trace element deficiencies, it is apparent that not only children living in underprivileged countries are affected. In the course of making the diagnosis an assessment of the nutritional status should also be made, especially considering the above-mentioned marginal nutritional deficiencies. The most common manifestation of nutritional disorders is anemia, which is mostly caused by lack of iron, vitamin B12, folic acid and can be complicated by infections. Nutritional requirements can be affected by several drugs. That is why this medication-nutrition interaction has to be kept in mind during treatment. The interaction of malnutrition and infection is very important, primarily for three reasons: mechanisms by which infection complicates the metabolic and nutritional status of the host; importance of suboptimal nutritional status on susceptibility and severity of intercurrent infections; clinical and therapeutic implication of these interactions. ]

Lege Artis Medicinae

[The bleeding time]

BODA Zoltán

[The bleeding time is considered to be the best screening test for the detection of disorders of primary haemostasis. Despite a large number of bleeding time tests, the exact pathophysiological background of the prolonged bleeding time is unknown. The significance of the cellular (platelet) von Willebrand protein is emphasized. A sensitive method (Ivy) and standardized devices (Simplate) are suggested. Examination of the bleeding time in cases of von Willebrand disease and congenital or acquired thrombocytopathy is essential. Specific recommendations regarding the rational use of the bleeding time (diagnostic algorythm) are presented. ]

Lege Artis Medicinae

[Clinical importance of pharmacogenetic investigation]

VAS Ádám, RÓNA Kálmán, GACHÁLYI Béla , SZABÓ Ildikó

[This is a brief review on the most important monogenically determined metabolic polymorphisms, their biochemical background and clinical significance. Relevant data from literature are also featured. The authors review data on possible connections between metabolic polymorphism and the risk of certain diseases.]

Lege Artis Medicinae

[Correspondence]

SZOMBATI István, MANNINGER Jenő, KAZÁR György, HARMAT Pál, MÁRTON Éva, KRASZNAI Géza

[Includes the following letters : Little Hungarian point system; ...and the injured?; Abuse of psychosomatics the organic dimension of psychiatry; Psychogenic horsekick; ]

Lege Artis Medicinae

[P300 wave evoked by visual and acustic stimuli in parkinsonian patients with or without dementia]

MOGYORÓS Ilona, SZOMBATHELYI Éva

[Authors analysed the relationship between cognitive function disturbance observed in patients with Parkinson's disease and clinical features of the disease. Relationship between the latency prolongation of the P 300 wave and the duration of substitution therapy, clinical form and severity of the disease (the Hoehn-Yahr stage) was examined. 75 randomly selected young patients with Parkinson's disease were divided in to two groups: one with and the other without dementia as determined by the Wechsler. Hunt and Mini Mental State tests. The latency of the P 300 wave using visual and acoustic stimuli was determinated. Significant prolongation of the latency of P 300 wave evoked both by visual and acoustic target stimuli was found in parkinsonian patients with dementia. Patients with dementia have longer duration of disease and substitution therapy. The akinetic-rigid form of the disease was more frequent in this group as well. A significant part of younger patients are chacarterised not only with motor but with cognitive function disturbance, too. Determination of the latency of P 300 wave helps to select these patients and to choose the adequat therapy. ]

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Additional value of tau protein measurement in the diagnosis of Creutzfeldt-Jakob disease

CSEH Katalin Edina, VERES Gábor, DANICS Krisztina, SZALÁRDY Levente, NÁNÁSI Nikolett, KLIVÉNYI Péter, VÉCSEI László, ZÁDORI Dénes

Since the definite diagnosis of Creutzfeldt-Jakob disease (CJD) can currently only be provided by autopsy, there is a special need for fine diagnostic tools in live patients to achieve accurate diagnosis as early as possible. The aim of this study was to perform a preliminary retrospective analysis on the utility of the measurement of total Tau (tTau) and some other biomarkers from the cerebrospinal fluid (CSF) of patients with rapidly progressive dementia in the diagnostic work up of CJD. Beside the assessment of relevant clinical data and the findings of electroencephalography and brain magnetic resonance imaging, the presence of 14-3-3 protein and the levels of tTau were determined by Western blot technique and enzyme-linked immunosorbent assay from the CSF of 19 patients diagnosed with rapidly progressive dementia between the period of 2004-2017 at the Department of Neurology, University of Szeged. This preliminary study provided 100% sensitivity for 14-3-3, and interestingly, only 40% specificity to support the clinical diagnosis of CJD. Regarding tTau, the sensitivity values were calculated to be 100% or 83%, whereas the specificity values were 71% or 86%, depending on the applied cut-off levels. The poor specificity of 14-3-3 is not in line with literature data and may be the result of the small number of patients in the cohort with non-prion disease, predominantly consisting of disorders with considerable tissue damage, whereas tTau presented good sensitivity and specificity values. The combined application of these and novel chemical biomarkers may increase both sensitivity and specificity to a desired level.

Lege Artis Medicinae

[Recurrent meningitis caused by spontaneous liquorrhoea]

TÓTH Géza, FŰTŐ László, SASHALMI Sándor, KISSÍK Imre, HOMONNAI Andrea, KIS Zsuzsanna, KORDÁS Marianna, CZIRJÁK Sándor

[INTRODUCTION - The most common and most important cause of recurrent meningitis is bacterial infection. In the majority of cases, recurrent episodes of bacterial meningitis are associated with certain anatomical abnormalities that enable bacteria to penetrate subarachnoideal space. Nasal liquorrhoea can arise via traumatic or non-traumatic way. Non-traumatic nasal liquorrhoea with normal pressure is either of congenital origin or "idiopathic" and is frequently called spontaneous liquorrhoea. Spontaneous liquorrhoea is a rare entity making up 3-4 % of nasal liquorrhoea. CASE REPORT - The patient presented in this study was initially treated with purulent meningitis. A diagnosis of Streptococcus pneumoniae infection was established by bacterial culture tests. After being discharged, the patient was free from complaints for a considerable period of time. Her recurrent symptoms of a running nose were diagnosed later as allergic rhinitis at an ambulatory examination. A year later the patient was readmitted to hospital with bacterial meningitis. Due to the noticeable rhinorrhea on admission, the initially suspected liquorrhoea was confirmed by an otorhinolaryngological examination. A CT scan of the cranium verified external and internal pneumocephalus. Through a nuclear medicine examination a liquor fistula communicating with the sphenoidal sinus was diagnosed. After recovering from the meningitis caused by ascending bacterial infection the patient successfully underwent a neurosurgical operation for a reconstruction of the cerebral base via frontal craniotomy. CONCLUSION - With this case presentation we wish to bring attention to the rare disorder of spontaneous cerebrospinal fluid rhinorrhea when treating recurrent meningitis.]

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.