Lege Artis Medicinae

[The diagnosis and clinical impact of foramen ovale - The diagnostic criteria of paradoxical embolism]

LENGYEL Mária

FEBRUARY 20, 2002

Lege Artis Medicinae - 2002;12(02)

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Lege Artis Medicinae

[Data on health-behaviour in samples from counties with high and low suicide rates]

ZONDA Tamás, PAKSI Borbála

[Authors conducted a comparative sociological, social-psychiatric survey in the summer of 2000 on a representative sample (1000- 1000 people) from counties with high and low suicide rates (Bács-Kiskun and Vas). They also studied the so-called "health-behaviour" of subjects since it was supposed that negation or refusal of medical help are forms of latent auto-agressivity, probably of common origin with "direct" self-harm (alcohol abuse, smoking, suicide), from deeper behavioural roots. The rates of morbidity and mortality of the two counties do not differ each other significantly with the exception of alcoholism. In spite of this facts, people living in the Great Hungarian Plain (Alföld) regard themselves in worse health condition than people in western countryside, presenting as patients in the health care system more frequently in the Alföld. Authors did not find any connection between the quality of health behaviour and the sharply divergent suicide rates of the two territories. Studying the two sample as a whole, they found marked problems in the field of health behaviour in both counties. They also stress that suicide and alcoholism in Hungary are very closely connected entities. Authors suggest that tasks for the public health service in this matter are significant.]

Lege Artis Medicinae

[Tumour therapy with the tools of interventional radiology]

ENGLONER László

[The author reviews the interventional radiological methods applicable in tumour therapy. The therapy of non-resectable primary and secondary liver tumours is discussed based on literature data and own experience. The possibilities of percutaneous tumour ablation are limited by the size and number of the tumours. Intra-arterial chemotherapy, chemoembolisation and feeding artery occlusion can be successful resulting in longer life and better quality of life in cases with advanced tumours. The results are better if these methods are combined with systemic chemotherapy.]

Lege Artis Medicinae

[Comparison of piperacilline-tazobactam monotherapy with amikacine combined therapy in neutropenic patients with fever]

SZÉKELY Éva

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

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.]

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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.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]