Lege Artis Medicinae

[Understanding Naturopathy]

SARKADI Ádám, VARGA Orsolya

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

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Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

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.

Lege Artis Medicinae

[Changes in infectology over the past two decades]

SZALKA András

[Infectious diseases and various infections are the major causes of morbidity and mortality in developing as well as in industrialised countries. Despite the advances in the past decades in our understanding of microbes, efficient treatment of diseases and preventive approaches, more than 13 million people die every year due to infectious diseases. In the past two decades, more and more new pathogens and infections diseases have been emerging and old diseases that were almost forgotten have re-emerged. There are many new diseases for which we do not have or have hardly any efficient antimicrobial drugs and no efficient vaccines. Despite an increasing frequency of multi- and panresistant microbes, the development of new antibiotics to be used against these infections is unlikely to occur in the near future. The big pharmaceutical companies have stopped the research of antibiotics. In this situation, the only option we have is to use antibiotics rationally and to take prevention and control of infections seriously, both in the outpatient system and in hospitals. Preserving the effectiveness of currently used antibiotics is in everyone’s interest and is everyone’s responsibility.]

Hypertension and nephrology

[Diabetology in dialysis]

MÁCSAI Emília, HALMAI Richárd, NEMERE Éva, BRASNYÓ Pál, KISS István

[According to epidemiological data, the number of diabetic patients requiring dialysis is increasing. Burnt-out diabetes, new onset diabetes during chronic dialysis treatment and new onset diabetes after transplantation diabetes are new types of diabetes compared to the traditional division forms. It is utmost important to evaluate education ability and acceptance the core values of lifestyle changes. Clear guidelines for oral anti-diabetic and insulin therapy have not yet been developed since this group of patients did not participate in previous major surveys. In order to formulate individualized therapeutic recommendations, it is imperative to perform regular glucose self-monitoring, which is also the cornerstone of solving unexpected situations. Both in hemodialysis and peritoneal dialysis, special considerations should be applied to the diabetic patient group, this review focuses on the current understanding of available relevant knowledge and summarizes presumably extrarenal diabetic complications as well.]

Clinical Neuroscience

[Deep brain stimulation for treatment refractory obsessive-compulsive disorder - a case report]

CSIGÓ Katalin, DÖME László, HARSÁNYI András, DEMETER Gyula, RACSMÁNY Mihály

[In the last 30 years it has been a great development in the understanding and therapy of obsessive-compulsive disorder. Adequate pharmaco- and cognitive-behavior therapies reduce the symptoms in 40-60% of patients, so a remarkable portion of patients still remains refractory to conventional treatment. Neurosurgery - with it’s reversible and irreversible techniques - brought a breakthrough in the therapy of treatment refractory patients. In the present case, we represent a 3 months follow-up of an obsessive-compulsive patient treated by deep brain stimulation. In our case, the stimulation target was the anterior limb of internal capsule. The clinical symptoms were measured by Y-BOCS. In addition various neuropsychological tests were used to monitor patient’s executive functions before and 3 months after the deep brain stimulation. We found that obsessive-compulsive symptoms improved after three months of the stimulation. The neuropsychological tests showed improvement in some executive functions (e.g. fluency, set-shifting, decision making). On the other hand our results revealed severe neurocognitive - mainly attention skill - deficits in a treatment refractory obsessive-compulsive patient.]

Lege Artis Medicinae

[Relationship between adipokinome and lipid parameters in Hungarian obese patients]

LŐRINCZ Hajnalka

[Since the prevalence of obesity has been dramatically increasing worldwide, a better understanding of obesity-related comorbidities leading to carbohydrate and lipid metabolism disorders has become essential. As an active endocrine organ, white adipose tissue secretes adipokines with diverse biological functions. We have found strong correlations between serum chemerin level and atherogenic lipoprotein sub-fractions in obese non-diabetic patients. To better characterize obese patients with and without manifest insulin resistance, we plan to determine serum levels of novel adipokines (omentin-1, vaspin, visfatin, lipocalin-2 and plasminogen activator inhibitor-1) and various oxidative stress markers including paraoxonase-1 activity, tumor necrosis factor-alfa and interleukin-6 levels, as well as low- and high-density lipoprotein subfractions in them and compare their data with lean individuals. We plan to determine correlations between the levels of novel adipokines and oxidative stress markers and lipoprotein subfractions. Furthermore, based upon our previous observations, we plan to study the potential alterations in the adipokine profile and the ratios of lipoprotein subfractions during a 5-year follow-up in obese patients. Our expected results may help to characterize the involvement of the adipokine profile in the regulation of lipoprotein metabolism. Early screening and treatment of lipid abnormalities may help to reduce the risk of cardiovascular events in obesity. ]