Lege Artis Medicinae

[Piano music to fight insomnia]

SZEBENYI Béla

AUGUST 31, 1994

Lege Artis Medicinae - 1994;4(08)

[More than 250 years ago, in 1742, the fourth piece in J. S. Bach's Klavierübung series, the "Aria mit verschiedenen Veraenderungen vors Clavicimbal mit 2 Manualen" (1), was published. This monumental work, which contains 30 variations, is a direct and symbolically rich work. indirect medical implications, so it is perhaps worthwhile to briefly examine the circumstances of its creation, its artistic value and the way it is performed.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]

MORVAY Zita, MAROFKA Ferenc, CSAJBÓK Ernő, SZENOHRADSZKY Pál

[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]

Lege Artis Medicinae

[Catheter ablation of supraventricular tachycardias]

KEMPLER Pál, LITTMANN László, TÓTH K. Zoltán

[Medical therapy for supraventricular arrhythmias is often ineffective. Arrhythmia surgery is limited by its considerable morbidity and cost. A better understanding of the exact anatomic-electrophysiologic correlations that govern supraventricular arrhythmogenesis and the advances in catheter ablative techniques have led to a new, effectual and costeffective therapy. Catheter ablation techniques result in a high rate of success rates and a low rate of complications. Radiofrequency ablation has become an accepted form of treatment for a variety of supraventricular arrhythmias. This review summarizes current data on catheter ablation of supraventricular arrhythmias.]

Lege Artis Medicinae

[The role of langerhans' cells in the development of cervical cancer]

PETE Imre, SÁPI Sándor, GONDA Gábor

[While the number of deaths from cervical cancer of women over the age of 45, has fallen in the recent years the mortality in women under the age of 35 has increased. The reason for this change is not clear. A large number of analytical studies tried to identify the risk factors for cervical cancer (age, marital status, time of first intercourse, number of sexual partners, coital frequencies, circumcision of partners, menstrual patterns, gravidity, type of contraception, smoking, viral infection, socioeconomic circumstances) but the real con nection between the disease and the varions risk factors remained unclear. The results of these studies suggest that, the 'one hit one tumor' hypothesis can't be proven, and it seems more appropriate to cousider a complex effect of these etiologic factors acting on the altered immunologic status of the cervix uteri. We tried to concentrate on one out of these factors from the literature which may play a cardinal role in the development of CIN or invasive cervix cancer. It is evident from the literature that the macrophages present in the cervix tissue in CIN, or infiltrating the tumor tissue in invasive cancer, could influence either the development of cervical cancer or the prognosis of the disease. It has long been known that in the cervical tissue there are a specific type of dentric cells taking part in the antigen presentation process. The examination of behavior, distribution and activity of these so – called Langerhans cells due to the exogen effect in the cervical tissue may be a which contributes to the understanding of the process leading to the development of CIN. ]

Lege Artis Medicinae

[Morbidity of ischemic heart disease in early breast cancer patients 15-20 years after adjuvant radiotherapy]

GYENES Gábor

[Our aim was to assess the frequency of cardiac side effects, primarily ischemic heart disease, in symptom-free patients with early breast cancer previously treated with radio therapy. Thirty-seven survivors of a previous randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left-sided disease (study group patients) were compared with 17 controls who were either treated for right-sided disease, or were non-irradiated patients. Radiotherapy was randomized in the original study; either tangential field Co-, or electron-therapy was delivered. A bicycle ergometry stress test with 99m Tc Sesta MIBI myocardial perfusion scintigraphy was carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), and none of the 17 controls exhibited some kind of significant defect on scintigraphy, indicating ischemic heart disease (p <0,05). Radiotherapy for left-sided breast cancer with the above-mentioned treatment technique may be an independent risk factor in the long-term development of ischemic heart disease. The need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer, is emphasized. ]

Lege Artis Medicinae

[Recovery from persistent vegetative state of four months or more]

KEITH Andrews

[A retrospective study was carried out on 43 patients admitted to a ward specifically designed for the rehabilitation of patients with persistent vegetative states after another. Of these, 11 regained consciousness four months or more after brain injury. It was reported that the patients' first reaction to being able to follow with their eyes was between the 4th month and the 3rd year of the condition, while the first reaction to being instructed was between the 4th and the 12th month. Only one patient was unable to communicate, six used non-verbal means to express at least yes and no, four could speak. Six patients required full care, while two became independent in their daily activities. Four patients were able to eat independently, three needed assistance, and four patients required maintenance of gastric tube feeding.]

All articles in the issue

Related contents

Clinical Neuroscience

[Sleep habits among preschool- and schoolchildren]

FUSZ Katalin, RITECZ Bernadett, BALOGH Brigitta, TAKÁCS Krisztina, SOMLAI Eszter, RAPOSA L. Bence, OLÁH András

[Objective - Our aim is to evaluate sleep habits, sleep quality and influencing factors among preschool- and schoolchildren. Method - Two questionnaires were recorded. Questionnaire 1 dealt with sleeping habits, breastfeeding and health behavior of preschool children and infant, and it contained the abbreviated version of the Children’s Sleep Habits Questionnaire. Questionnaire 2 dealt with health behavior and the application of sleep hygiene rules, as well as it contained the Athens Insomnia Scale. Subjects - We assessed a total of 1063 questionnaires: 516 kindergarten children participated in our online survey across the country; 547 primary and secondary school students participated in the 2nd questionnaire survey in Szolnok. Results - Parents’ observation shows that the average nighttime sleeping time of kindergarten children is 10 hours 20 minutes on weekdays and 10 hours 36 minutes on weekends. The most popular sleeping habits in kindergarten age: teal reading (65.1%) and co-sleeping (42.8%). Parents of infants used breastfeeding (50.4%) and rocking (43.2%) most frequently before sleep. Co-sleeping has a positive influence on the length of lactation. Among the preschool sleeping habits we have proved a number of positive effects of teal reading, while watching television have negative effects. The sleep quality of school-age children according to the Athens Insomnia Scale is 6.11 points (SD: 4.11), 19% of the children are insomniac. Their sleep time is 7 hours 31 minutes on weekdays and 9 hours 30 minutes on weekends. The usage of good health behavior and sleep hygiene rules positively influence sleep quality and sleep duration. Conclusions - With our results, we would like to draw the attention of children and parents to the importance of sleeping and using sleep hygiene rules.]

Clinical Neuroscience

[Tracing trace elements in mental functions]

JANKA Zoltán

[Trace elements are found in the living organism in small (trace) amounts and are mainly essential for living functions. Essential trace elements are in humans the chromium (Cr), cobalt (Co), copper (Cu), fluorine (F), iodine (I), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), and questionably the boron (B) and vanadium (V). According to the biopsychosocial concept, mental functions have biological underpinnings, therefore the impairment of certain neurochemical processes due to shortage of trace elements may have mental consequences. Scientific investigations indicate the putative role of trace element deficiency in psychiatric disorders such in depression (Zn, Cr, Se, Fe, Co, I), premenstrual dysphoria (Cr), schizophrenia (Zn, Se), cognitive deterioration/de­mentia (B, Zn, Fe, Mn, Co, V), mental retardation (I, Mo, Cu), binge-eating (Cr), autism (Zn, Mn, Cu, Co) and attention deficit hyperactivity disorder (Fe). At the same time, the excess quantity (chronic exposure, genetic error) of certain trace elements (Cu, Mn, Co, Cr, Fe, V) can also lead to mental disturbances (depression, anxiety, psychosis, cognitive dysfunction, insomnia). Lithium (Li), being efficacious in the treatment of bipolar mood disorder, is not declared officially as a trace element. Due to nutrition (drinking water, food) the serum Li level is about a thousand times less than that used in therapy. However, Li level in the red cells is lower as the membrane sodium-Li countertransport results in a Li efflux. Nevertheless, the possibility that Li is a trace element has emerged as studies indicate its potential efficacy in such a low concentration, since certain geographic regions show an inverse correlation between the Li level of drinking water and the suicide rate in that area. ]

Lege Artis Medicinae

[Epilepsy in coronavirus pandemic]

SZŰCS Anna, HALÁSZ Péter, NARULA Lalit

[We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply; each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro­nic patients. Those methods favour bes­­ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma­de telemedicine an essential tool of pa­tient care, education and better computer supply for those in need is crucial. ]

Clinical Neuroscience

A case report of Morvan syndrome

AYTAC Emrah, ACAR Türkan

Morvan syndrome is a rare disease characterized by peripheral nerve hyperexcitability, encephalopathy, dys­autonomia and significant insomnia. The patient, who was included in the present study, was followed-up at our clinics for confusion, myokymia, hyperhidrosis, epileptic seizures, tachycardia, agitation, hypokalemia, and hyponatremia. The cranial MRI of the patient demonstrated hyperintensities at the T2 and FLAIR sections of the medial temporal lobe and insular lobes. Electromyography and neurotransmission examination results were concordant with peripheral nerve hyperreactivity. Contactin-associated protein-like 2 antibodies and leucine-rich glioma inactivated protein 1 antibodies were detected as positive. The patient was diagnosed with Morvan syndrome; intravenous immunoglobulin and corticosteroid treatment was started. Almost full remission was achieved. This very rare syndrome implies challenges in diagnosis and treatment; however, remission can be achieved during the follow-up. In addition, caution is needed in the long-term follow-up of these patients regarding the development of malignancies.

Clinical Neuroscience

[Pharmacological and nonpharmacological treatment of insomnias with regard to sleep medicine]

FALUDI Béla, ROZGONYI Renáta

[Insomnia - one of the most prevalent sleep complain - has a great impact on the everyday life. Basically two different form of insomnia can be defined: the insomnia disorder and the co-morbid insomnias. To treat adequately determination of background pathology is essential, which is based on the help of Sleep Medicine Centers. According to the newest guidelines, the treatment of insomnia disorder is based on cognitive behavioural therapies followed by pharmaceutical intervention. In this review we provide the short description of cognitive behavioural therapies and basic principles of hypnotic drugs. Despite the availability of insomnia guidelines the huge variation of the insomnia medication can be seen in the daily practice. Due to the above mentioned reasons we summarize the good clinical practice of hypnotic drug administration for insomnia patients.]