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Clinical Neuroscience

JANUARY 30, 2016

[The propagation and semiology of focal epileptic seizures. case presentations to the insula. theoretical considerations]

BALOGH Attila, BALOGH Attila ifj.

[Study objectives – The developing of diagnostical examinations in epileptology provides new challenges in seizure semiology. On the analysis of seizures it is important to examine the mechanisms of their propagation. The brain connectivity (based on the neuroimaging), the shadowing of the movement of excessive neuronal activity (based on computerized EEG and MEG methods), the cognition of the physiological and pathological brain networks are the foot- stone of the epileptic seizure propagation. The investigators prove, by means of case demonstrations of the role of the network nodes and the role of the epileptic hubs in the seizure symptomatology. Methods – The preoperative, intra and postoperative data are analised of three insular and one parietal epileptic patients in point of view of their seizure symptomes. Complex neuroimaging, noninvasive and invasive electrophysiology, intensive long-term video-EEG monitoring, computerized EEG analysis, fuctional mapping, intraoperative corticography were used. The etiology were confirmed with hystology. Results – It is observed that on seizure semiology our patients plays the insula a double role. In some cases, it is the focus of insular seizures with their symptoms difficult to identify. However, in the majority of cases and as a consequence of its rich neural connections, the insula has a peculiar property in the evolution of the symptomatogenic features of seizures. This observations are developing new relationships between the mechanism of seizure propagation and its semiological consequences. Conclusions – On epileptological point of view there are brain structures which has peculiar role in the „designe” of propagation of the epileptic excitement. The numerous new methods in neuroimaging and neurophysiology allowed the connectomical examination of the epileptic networks. The role of the epileptic diathesis is approachable with the metholdology of the brain connectivity. Theoretically the node of the epileptic network consist of the potential pathes where the localised excessive excitement can propagete. The route where the actual seizure can go adhead is determined by the actual edpileptic propensity of the above mentioned potential pathes.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2014

[Nursing Aspects of Communication with Conscious Patients Receiving Mechanical Ventilation]


[Aim of the study: The authors aimed to represent the verbal and non-verbal communication of intensive care unit nurses and reveal the difficulties they face when communicating with conscious patients receiving mechanical ventilation. Sample and methods: The study was conducted with the participation of nurses working in three intensive care units of Semmelweis University, with the use of a questionnaire that was filled in by 59 nurses. Results: There was a significant difference in the quality of communication between the day shift and the night shift (p<0.001). The workload of nurses has an impact on the effectiveness of their communication. The number of patients in the day shift (p=0.016) is also crucial and having a part-time job is determinant in the night shift (p=0,026). In both shifts, burnout of nurses had considerable effect on their communication with conscious patients who receive mechanical ventilation (day shift p=0.007; night shift=0.030), while their empathy did not. Conclusions: The environmental factors influenced the effectiveness of communication. Establishing contact with patients receiving mechanical ventilation can be improved by appropriate education of nurses, thus, the authors put forward a proposal for trainings on the subjects of communication and counselling.]

Clinical Neuroscience

FEBRUARY 20, 2003

[The role of electrical neuromodulation in the therapy for chronic lower urinary tract dysfunction]


[The electrostimulation techniques may be used as a supplement or an alternative to standard therapy. Electrical therapy for chronic lower tract dysfunction comprises of noninvasive pudendal nerve neuromodulation and invasive sacral nerve stimulation. Short-term functional electrical stimulation seems favourable in selected patients with detrusor hyperreflexia. Sacral nerve stimulation may be a successful treatment option for patients with refractory detrusor overactivity and some forms of urinary retention.]

Clinical Neuroscience

MARCH 30, 2008

[Prevalence of stroke/cardiovascular risk factors in rural Hungary - A cross-sectional descriptive study (in English language)]

BODO Michael, THURÓCZY György, PÁNCZÉL Gyula, SIPOS Kornél, ILIÁS Lajos, SZÕNYI Péter, BADÓ Mike Jr, NEBELLA Tamás, BÁNYÁSZ Attila, NAGY Zoltán

[A multi-faceted survey was conducted in 1992-94 to ascertain the somatic, mental and socio-economic conditions of the residents of a village in eastern Hungary. Here we report data on prevalence of somatic disorders from the survey. Objectives - a) To collect and compare prevalence of known cardiovascular disease, including stroke risk factors, in a specific population (a Hungarian village); b) to test a computer-based mass screening device ("Cerberus") designed to identify individuals in the test population at high risk for stroke; c) to compare results obtained with Cerberus with known stroke risk/cardiovascular disease factors and traditional medical records. Methods - A cross-sectional survey (546 subjects) was conducted in Csengersima in the early 1990s, using the Cerberus screening system, which includes: 1. a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2. amplifiers to record the pulse waves of cerebral (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; they were also screened for blood cholesterol, glucose, and triglyceride levels. Findings - Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries by rheoencephalogram, 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality of electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. Conclusion - The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. The simple, noninvasive test uses the bioimpedance method of measurement. This method offers a standardizable, costeffective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease. In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and the first steps of turning it into an expert system also tested.]

Lege Artis Medicinae

NOVEMBER 20, 2009

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

Lege Artis Medicinae

SEPTEMBER 20, 2002

[QT dispersion - the surface ECG marker of arrhythmic risk]

KUN Csaba, CZURIGA István, LŐRINCZ István

[During the past decade numerous publications have reported the pathophysiological and clinical value of QT dispersion. Increased QT dispersion was observed to be associated with proarrhythmic drug effects, prediction of mortality in heart failure and risk assessment after acute myocardial infarction. Based on the results of the repolarization process research and other significant clinical studies, the meaning and the usefulness of QT dispersion seems to be challenged. The original concept of portraying QT dispersion as a direct measure of regional heterogeneity of myocardial refractoriness is seriously flawed. At the same time, disproving this concept is not a good reason for stating that QT dispersion does not exist. The measurement of QT dispersion seems to be an approximate expression of repolarization abnormalities and should not be taken as a gold standard for a noninvasive estimate of repolarization abnormalities. However, we presently have no decent and widely available alternative to address repolarization abnormalities in standard 12-lead ECG. The authors present the pathophysiological meaning of QT dispersion, the controversies of automatic and manual methodology and the possible clinical relevances based on the most recent studies.]

Lege Artis Medicinae

JULY 20, 2006



[Over the past decade, the use of noninvasive ventilation in the setting of acute exacerbations of chronic obstructive pulmonary disease (COPD) has gained popularity, and is recommended by evidence-based guidelines. The evidence that it should be effective in chronic COPD is much weaker, and large, prospective, randomised, controlled studies that would also provide a guide for the selection of the best candidates, are still lacking. It has bee established, however, that home mechanical ventilation is certainly beneficial for a well-defined subgroup of patients. This includes the so called “blue bloater” patients (with hypercapnia and polyglobulia), other cases with increased hypercapnia, and patients with "overlapping" syndrome (COPD accompanied by sleep apnoe). Also, for patients with acute respiratory failure who refuse intratracheal intubation noninvasive mechanical ventilation remains the only choice. The past years have unequivocally proved the superiority of the positive pressure ventilation mode for either short term or long term use.]

Lege Artis Medicinae

JUNE 20, 2011

[The role and significance of vascular aging in the risk stratification of cardiovascular prevention]


[The structure and function of arteries change throughout one’s lifetime. The most important changes include lumenal dilation, diffuse intimal and medial thickening, increased stiffness, reduced compliance of central arteries and endothelial dysfunction. Arterial stiffness, an increased pulse wave velocity (PWV) and an increased carotid intima-media thickness (IMT) are independent predictors of cardiovascular events. The early vascular aging (EVA) could help clinicians to determine the increased cardiovascular risk. EVA can be be determined by noninvasive methods, as arterial stiffness and carotid IMT. EVA can be suitable for the early detection of cardiovascular diseases.]

Hungarian Radiology

JUNE 20, 2002

[MR-guided ultrasound surgery]

JÓLESZ Ferenc A., BÉRCZI Viktor, HÜTTL Kálmán, REPA Imre, HYNYNEN Kullervo

[The powerful union of focused ultrasound surgery and magnetic resonance imaging has created a new approach to noninvasive surgery. Using this integrated therapy delivery system the physician can achieve correct localisation of tumors, optimal targeting of acoustic energy, real time monitoring of energy deposition, and the means to accurately control the deposited thermal dose within the entire tumor volume. The advantages of MRI over ultrasound guidance in controlling focused ultrasound surgery lie in the more sensitive detection of tumor target, the real time detection of tissue temperature, and the confirmation of thermally-induced tissue changes - powerful features that eventually can replace the traditional surgical approach. Applying software that connects the therapy and imaging system, the physician can generate an entire plan from quantifying temperature changes to positioning the therapy transducer. The non-invasive debulking of tumors without disturbing adjacent, functionally intact structures is thereby accomplished. Ongoing clinical trials involving the treatment of breast fibroadenoma, localized breast cancers, and uterine fibroids have been most encouraging. But nowhere has the application of MRI-guided focused ultrasound surgery been more compelling than in brain, where not only tumor treatment is possible but also the focal, transient, reversible breakdown of the blood-brain-barrier. The implications of this mechanism for targeted intra-cerebral tumor therapy or other non-oncologic applications are clearly enormous. In addition to tumor treatment, MRI-guided focused ultrasound surgery has other potential clinical applications such as vascular occlusion, targeted drug delivery, and targeted gene therapy. FUS is not a new idea but the emergence of MRI based guidance has accelerated the progres of focused ultrasound surgery technology, certain weaknesses remain including excessively long treatment times, body and organ motion, and difficulties in finding acoustic windows at certain anatomic locations. Nevertheless, the successful clinical implementations of this method is already in progress.]

Clinical Neuroscience

NOVEMBER 30, 2006


CSAPÓ Krisztina, BAJKÓ Zoltán, MOLNÁR Sándor, MAGYAR Tünde, CSIBA László

[The vascular diseases (myocardial infarct, stroke, peripheral occlusive disease) have a common pathophysiological background, the arteriosclerosis, that impairs the autoregulation of cerebral vessels, decreases the endothel mediated flow in the peripheral vessels. Therefore the assessment of the vascular damage or the follow-up of therapy need a complex and simultaneous approach. Currently the morphological and functional changes in the vascular system can be investigated with separated measuring systems, focusing either to cardiac or cerebral parameters (intermittent blood pressure measurement, ECG, cerebral blood flow by transcranial Doppler e.g.). Our purpose is to establish a complex non-invasive system for the simultaneous measurement and comparison of cardiac/cerebral/periheral hemodynamics. The hemodynamic parameters in hypertensive patients are examined with transcranial Doppler and cardiac monitoring during tilt-table test. Intima-media thickness, flow-mediated dilatation in brachial artery, augmentation index and pulse wave velocity are also measured. The measurement will be repeated after 6 and 12 months follow-up. Our preliminary results are similar to those found in the literature, that proves the reliability of our complex noninvasive hemodynamic system. It is assumed, that 12 months antihypertensive therapies with ACE inhibitors, calciumantagonist etc. might result in different effects on different vascular parameters. Our system enables the individualization of antihypertensive therapy.]