Lege Artis Medicinae

[The use of antihypertensive agents for the prevention of cardiovascular diseases]

PÁLL Dénes

MAY 20, 2010

Lege Artis Medicinae - 2010;20(05)

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Lege Artis Medicinae

[A prosthetic valve thrombosis causing coronary occlusion]

VARGA Ádám, VÁGÓ Tibor, NAGY András, CSERNI Gábor

Lege Artis Medicinae

[Psychoendocrine aspects of chronic stress, depression and eating disorders]

MOLNÁR Ildikó, MOLNÁR Gábor

[The brain is not only a central organ, but also a target of stress-related events. During chronic stress, many somatic and psychiatric disorders could be initiated by the decreased allostatic or adaptive abilities of the individual. The brain is involved in the regulation of stress-related events via hormones, neuropeptides, monoamines and cytokines. A number of endocrine diseases or hormonal changes are associated with behavioural, vegetative and emotional alterations, which occasionally lead to psychological disturbances, for example depression. The endocrine background is also reflected by the medical treatment of psychiatric patients, as demonstrated by the use of selective serotonin-reuptake inhibitors, and estrogen or levothyroxine substitution therapies. The psychiatric disorders presented here, such as the various forms of depression and eating disorders (anorexia and bulimia nervosa) are highlighted because of their frequencies and lifethreatening nature. By describing these disorders, we wish to aid their early diagnosis and treatment and to help incorporate them into everyday clinical practice.]

Lege Artis Medicinae

[Successful chest-wall reconstruction after the resection of a chondrosarcoma using muscle-flap and polytetrafluorethylene mesh repair]

AGÓCS László, KOCSIS Ákos, TAMÁS Róbert, LÉVAY Bernadett, CSEKEŐ Attila

[INTRODUCTION - Approximately 30% of malignant, primary bone tumours are chondrosarcomas, which most frequently develop on the anterior chest wall. Patients who are treated with adequate surgical intervention recover, 10-year survival rate is 97%. Besides the aesthetic outcome, preservation of breathing functions is crucial. CASE REPORT - The 36-years-old patient presented with a large chondrosarcoma, which infiltrated the left chest wall (4-6th ribs, the parietal pleura and the underlying muscles). Surgical resection was performed by opening the left thoracic cavity, sparing the skin and the subcutaneous layer. Reconstruction of the chest wall’s stability was carried out with a 20×25cm, polytetrafluoroethylene alloplastic Dualmesh, and an extensive myocutaneous dorsal flap (including the latissimus dorsi and serratus anterior muscles) that was pedicled on the left thoracodorsal vessels. After a normal postoperative period, the patient was released with sufficiently expanded lungs. No tumour remission was detected on the follow-up CT examination at 6 months after surgery. CONCLUSION - This case demonstrates that radical resection of chest-wall tumours and the above described reconstruction method allows the avoidance of paradoxial respiratory movements and provides excellent functional and aesthetic outcomes.]

Lege Artis Medicinae

[Significance of the metabolically neutral antihypertensive treatment in daily clinical practice]

FI Zsolt, DÉZSI Csaba András

Lege Artis Medicinae

[Painting and Eternity – Time in Margitte’s Art]

TÚRY Ferenc

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Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

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CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.