Lege Artis Medicinae

[The Sides of the Coin]

ZSUZSA Gábor

FEBRUARY 22, 2007

Lege Artis Medicinae - 2007;17(02)

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Lege Artis Medicinae

[Altering cannabinoid signaling during development disrupts neuronal activity]

Lege Artis Medicinae

[57th Annual Meeting of the American Association for the Study of Liver Diseases]

PÉTER Zoltán

Lege Artis Medicinae

[THE DIFFERENTIATION OF CHRONIC PANCREATITIS FROM PANCREATIC CANCER]

CZAKÓ László

[The poor prognosis of pancreatic cancer is mainly due to late diagnosis. The differentiation between pancreatic cancer and chronic pancreatitis is difficult, because the two diseases cause similar clinical symptoms and morphological alterations. Furthermore, chronic pancreatitis is associated with an increased risk of malignant transformation, thus the two diseases may be present simultaneously. The recent developments in molecular genetic tests and in imaging techniques, such as multidetector computed tomography, magnetic resonance cholangio- pancreatography, endoscopic ultrasoundguided fine needle aspiration and positron emission tomography/computed tomography, have fundamentally transformed the differentiation of the two disorders. This paper provides a systematic review of the recent evidence-based results concerning the differentiation of pancreatic cancer and chronic pancreatitis.]

Lege Artis Medicinae

[Zoonoses in focus]

LAKOS András

Lege Artis Medicinae

[EFFECT OF END-OF-LIFE EDUCATION ON MEDICAL STUDENTS’ AND HEALTH CARE WORKERS’ DEATH ATTITUDE]

HEGEDÛS Katalin, ZANA Ágnes, SZABÓ Gábor

[INTRODUCTION - The aim of our research was to evaluate the effect of courses for health care workers and medical students that deal with death, dying and bereavement and that of courses on hospice care of dying patients. The goal of the courses is to make communication on death more open by exploring critical issues related to fear of death to reduce inner anxiety and to improve attitude to dying patients. PARTICIPANTS AND METHOD - Participants (n=168) completed Neimeyer and Moore's Multi-dimensional Fear of Death Scale (MFODS) and Shortened Beck Depression Questionnaire (BDI) on the first and last day of the courses. In case of health care workers a follow-up survey was also performed 2 to 3 months after the course (n=32). RESULTS - The most significant factors of fear of death are: fear for significant others, fear of the dying process and fear of premature death. Overall fear of death scores are reduced as an effect of the courses, the alteration of the components of fear of death depends on the participants’ gender, age and profession as well. Improvement was observed in both groups in attitudes that can be related to the increase of knowledge on the quality care of dying patients like fear from the process of dying and fear from conscious experience of death. CONCLUSION - Besides education containing training as well it is important to strengthen the support function of workplaces in caring for the mental health of the health care staff. Furthermore it is important during gradual education that students participate in courses that aim to achieve opened communication in the most anxiety-evoking issues.]

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Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Clinical Neuroscience

[Mentalizing deficit among patients with traumatic brain injury ]

TAMÁS Viktória, BÜKI András, HEROLD Róbert

[Mentalization or theory of mind as an aspect of our social cognition, is our ability to infer mental states of others (intentions, desires, thoughts, emotions) and to predict their behavior accordingly. This function significantly affects our participation and orientation in the social world and plays an important role in conversational situations, social interactions, social integ­ration and adaptation. The brain regions that serve as the basis for mind-reading function can be damaged as a consequence of traumatic brain injury, which frequently occurs among the younger population. Traumatic brain injury can cause focal or diffuse cerebral injuries, often leading to theory of mind deficit. In this topic such publications were researched that compared theory of mind ability between traumatic brain injury patients and control subjects (comparative case-control studies). We searched for the studies in the following internet based/online databases: PubMed, Web of Science, ScienceDirect, Google Scholar, APA PsycNET (PsycARTICLES) and EBSCO Host. The search was performed using the following key word combinations: theory of mind or mentalizing or social cognition AND traumatic brain injury or head/brain injury or diffuse axonal injury. Based on the results of the included and processed studies (21 pc), traumatic brain injury often leads to mentalization deficit with different severity. With this present review we aim to draw attention to the fact that the appearance and severity of mind reading dysfunction can considerably affect the outcome of the disease, the length of rehabilitation time and the prognosis of traumatic brain injury patients. Besides this, with this review, we aim to take sides in whether theory of mind ability is domain-specific or domian-general based on studies including traumatic brain injury patients.]

Clinical Neuroscience

[Acoustic CR®-neuromodulation - first experiencies in Hungary with novel patented method in therapy of chronic subjectiv tinnitus]

BENCSIK Beáta, GÁBORJÁN Anita, HARNOS Andrea, LÁSZLÓ Klára, VÉGSŐ Péter, TAMÁS László

[Objective - Acoustic CR®-neuromodulation is a novel patented method for the therapy of chronic subjective tinnitus and has been tested in Hungary, as one of the first European countries introducing this procedure. It can be used for the treatment of monaural or binaural tonal tinnitus. Suitability of patients for this therapy was assessed by the help of an appropriate set of criteria. Aim of our study was to analyze 6-month therapy and related measurement data of patients first treated with this method in Hungary and evaluate the results. Method - 27 outpatients (20 males, seven females) with a minimum of 6-month long history of subjective tinnitus were assessed (four detected on the right side, six on the left side, 17 on both sides) who were treated for six months by Acoustic CR®-neuromodulation. On 44 treated ears (21 right, 23 left), changes of tinnitus frequency and loudness were measured and analysed, using Visual Analogue Scale (VAS) loudness/annoyance/pitch scores and Tinnitus Handicap Inventory tests, which were performed at defined intervals during the treatment period. Results - During this 6-month treatment period, significant decrease was detected in tinnitus frequency and loudness by tinnitometry (irrespective of the affected side), and an improvement in VAS annoyance/pitch scores and THI test results. VAS loudness did not show any significant changes. Conclusion - Acoustic CR®-neuromodulation therapy may be a useful treatment of subjective chronic tinnitus, but its efficacy should be proved in controlled clinical trials.]

Hungarian Radiology

[Male breast cancer]

GÖBLYÖS Péter

[Male breast cancer does not get a sufficient attention which would be appropriate due to its special features. Diagnostical and therapeutical protocols are not existing, a national center and international collaboration would be necessary. Incidence of male breast cancer is one percent of the female breast cancers, and 5 percent of all male cancers. The absolute number of the cases increased in the past years. The mutation of gene BRCA2 plays the main role in the male breast cancer. The breast cancer of the men is a "late disease", because often neither the doctor nor the patient considers this opportunity. The diagnosis is often established at an advanced stage. Cancer can occur on both sides, but the right breast is more often affected. Staging is the same as in female patients. Prognosis is poorer than in females, the tumor-receptor rate is better, HER2 in men does not plays any role. Basic principles of diagnostics and therapy are same as in females, mainly because there is no consensus about the treatment of the male breast cancer. The same proved protocols are used in men which are applied in women. The ground-method is surgery, reduced radicality and mastectomy is usually applied. Males react on hormone therapy better, than women, mainly chemotherapy is suggested. Follow up of the patients and the psychological support is extremely important. A multidisciplinary collaboration is necessary in the treatment of the male patient, and education is of great importance.]

Clinical Neuroscience

[MOVEMENT-RELATED BETA RESPONSES IN ESSENTIAL TREMOR AND PARKINSON’S DISEASE]

GERTRÚD Tamás, PÁLVÖLGYI László, TAKÁTS Annamária, SZIRMAI Imre, KAMONDI Anita

[Objective - To investigate the pathomechanism of essential (ET) and parkinsonian tremor (PT) by studying the correlation between tremor severity and movement-related beta rhythm changes of the human electroencephalogram. Patients and methods - We recorded the electroencephalogram of 10 patients with essential tremor, 10 with Parkinsonian tremor and 10 controls. In a preliminary session we determined the side with lower and higher tremor intensity (T+, T++ respectively), using accelerometry. Subjects pressed an on-off switch in a self-paced manner with left and right thumb. After digitalization of the EEG from Cz, C3, C4 electrodes, the movement reactive beta frequency (MRBF), its minimum/maximum peak power values and their latencies triggered to movement offset were determined. Results - The time course and amplitude of movement related beta desynchronization (ERD) were similar in each group regardless of tremor intensity. In ET tremor severity did not influence post-movement beta synchronization (PMBS) amplitude (PMBSET+=100.98±48.874%, PMBSET++=135.1±92.87%; p=0.231), however it was significantly delayed after the movement of the more tremulous hand (latPMBSET+=1.26±0.566 s, latPMBSET++= 1.57±0.565 s, p=0.003). In the PT group on the side of pronounced tremor the amplitude of PMBS decreased but it was not delayed, compared to the less affected hand (PMBSPT+=115.19±72.131%, PMBSPT++= 77.84±53.101%, p=0.0028; latPMBSPT+=1.4±0.74 s, latPMBSPT++=1.25±0.797 s, p=0.191). In controls the power and latency of PMBS was similar on both sides. Conclusions - The results suggest that neuronal mechanisms underlying PMBS generation are differently affected by ET and PT. Investigation of PMBS might be used for the differential diagnosis of essential tremor and Parkinson's disease.]