Lege Artis Medicinae

[The First Mindfulness Conference in Hungary ]

BRYS Zoltán, KIS János Tibor, SIMONCSICS Eszter

SEPTEMBER 20, 2018

Lege Artis Medicinae - 2018;28(08-09)

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Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project ]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project INTRODUCTION - After introducing adequate complementary food to the diet of breastfed/formula-fed babies, the frequency and amount of semisolid/solid food is increasing, the breastmilk/formula intake is decreasing and finally the weaning process is completed. During this process the developing feeding skills of the infant enables them to self-feed. The self-feeding infant and toddler should participate in family meals. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Issues concerning the development of self-feeding skills were analyzed. RESULTS - With advancing age the proportion of infants/toddlers, reported to be able to (partially) self-feed, has increased. The age, at which the majority of toddlers (83.1%) were reported to self-feed, was at 13-15 months. By the age over 2 years 57.2% of the toddlers were fully self-feeding, 39.3% were self-feeding with some assistance, and 3.5% were still completely fed by their mother/caregiver. While self-feeding became more prevalent, the proportion of toddlers with feeding problems and insufficient weight gain has increased. With more prevalent complementary feeding more parents assessed their feeding style rather scheduled than on demand. In the whole sample the proportion of infants/toddlers, who ate with the family, was 43.8%. CONCLUSIONS - In our sample, as previously described in the scientific literature, the developmental readiness to self-feed has developed in the majority of infants by the age of 13-15 months. During progres­sion of weaning an increasing proportion of parents thought, that feeding was rather scheduled than on demand. This finding points at the importance of educating parents about the importance of responsive feeding during and after weaning. For self-feeding toddlers, responsive feeding means, that the mother/caregiver offers a choice of healthy and adequate amount of food, at a proper place, at proper times, responds to the hunger and satiety cues of the child and the toddler decides, whether to eat, what and how much to eat.]

Lege Artis Medicinae

[Saviours, Judases, Philosophists and Physicians The Spinoza Resolution]

KAZAI Anita

Lege Artis Medicinae

[The liaison between internal medicine and psychiatry can be life-saving in the treatment of severe anorexia nervosa]

SZÉNYEI Gábor, BENE László, TÚRY Ferenc

[INTRODUCTION - In the severe forms of anorexia nervosa hospitalization may be required, and the somatic treatment is provided in a department of internal medicine. In such cases, collaboration between internist and psychiatrist is essential. Psycho­logical support is necessary even in the period of nutritional rehabilitation. This can be applied in the framework of consultation-liaison psychiatry. After the initial weight gain providing psychotherapy in an outpatient setting is fundamental. In the case of anorexic patients who maintain a close relationship with the family, family therapy is the most effective treatment. CASE REPORT - A 26-year old female patient with anorexia was hospitalized in a department of internal medicine after an extreme emaciation, her body mass index was 11.6. During this period there was a psychiatric consultation involving the fa-ther of the patient as well. Her body weight increased, and outpatient family therapy was initiated. Fifteen family sessions were conducted in nine months, with special focus on the separation-individuation process. At the end of the therapy a full remission could be observed, with a normal body weight, and her periods returned. After a four-month follow-up her state was stable, and she got married. CONCLUSION - Interdisciplinary collaboration can be cardinal when somatic and psychological disorders are interwoven. The role of family therapy is crucial in those cases where emotional separation from the family of origin is difficult, even if the patient does not live with the parents any longer. ]

Lege Artis Medicinae

[Farewell to a Special Physician who Loved Literature – Remembering István Kiss MD]

MOLNÁR-TAGA Márta, VASAS Lívia

Lege Artis Medicinae

[Jan Veth and his Portraits of Notable Peers ]

NÉMETH István

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Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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Coexistence of cervical vertebral scalloping, pedicle deficiencies and dural ectasia in type I neurofibromatosis

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Neurofibromatosis type 1 (NF-1; also known as Von Recklinghausen’s disease) is a common autosomal dominant disease that occurs in the general population at the rate of 1 in 3000. Many NF-1 patients present with spinal malformations. A 54-year-old female patient was admitted to the Outpatient Clinic of Dermatology with gradually increasing swelling and spots on the body that had been present for a long period of time. Cervical vertebral scalloping, pedicle deficiencies and dural ectasia (DE) were also detected. She was diagnosed with NF-1. NF-1 is routinely seen in dermatology practice. Coexistence of NF-1 with vertebral scalloping, pedicle deficiencies and DE rarely occurs. Our case is the second reported instance in the literature of NF-1 with a spinal anomaly in the cervical region, and the first reported instance of the coexistence of NF-1 with cervical vertebral scalloping, pedicle deficiencies and DE.

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Evidence suggests that pathogen-associated pattern recognition receptors (Toll-like receptors, TLRs) are implicated in the pathophysiology of schizophrenia. TLRs are important in both peripheral immune responses and neuronal plasticity. However, the relationship between peripheral TLR expression and regional brain volumes is unknown in schizophrenia. We therefore assessed 30 drug-naïve, first-episode patients with schizophrenia. TLR4+/TLR1+ monocytes were measured using flow-cytometry. High resolution magnetic resonance images (T1 MRI) were obtained and analyzed with FreeSurfer. Results revealed significant negative correlations between the percentage of TLR4+ monocytes, mean fluorescent intensities, and brain volumes in frontal and anterior cingulate regions. The measures of TLR1+ monocytes did not show significant relationships with regional brain volumes. These results raise the possibility that abnormal TLR-activation is associated with decreased brain volumes in schizophrenia.

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[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

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[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]