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Clinical Neuroscience

MARCH 30, 2019

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Clinical Neuroscience

JANUARY 30, 2020

[Correction of the physiological artefacts at pre-surgical clinical functional MR]

KISS Máté, GÁL Andor Viktor, KOZÁK Lajos Rudolf, MARTOS János, NAGY Zoltán

[Introduction/aim of the study - Pre-surgical functional MRI (fMRI) is an important modality of examinations before brain surgery. There are several artefacts (e.g. motion, susceptibility) which may hinder the evaluation of fMRI data. Physiological artefacts (breathing, pulsation) also affect the sensitivity and specificity of anatomical localization. The aim of this study is to demonstrate the efficiency of physiological artefact identification and removal methods for presurgical evaluation. Materials and methods - Siemens Magnetom Verio 3T MRI scanner was used to collect data. The physiological parameters (breathing, pulse) were recorded with the MRI system’s built-in devices. Data from fourteen patients - with primary brain tumour - were evaluated with SPM12 utilizing the RETROICOR/RVHR tool to detect and decrease the effect of physiological artefacts. We compared the statistical maps obtained with and without the physiological correction using the Jaccard similarity coefficient, and ROI analyses. Results - Significant differences were found in the mean ROI values (p<0.0016) and the extensions of eloquent activations (p<0.0013), when using the physiological correction (RETORICOR/RVHR) based on convolution method. On the other hand, no significant differences were found between the ROIs’ standard deviations (F=0.28). The RETROICOR/ RVHR method helps to define the precise localisation of eloquent areas (p<0.009). The number of irrelevant (non-significant) voxels were increased (p<0.001). Conclusions - Minimising of physiological artefacts in fMRI data calculations, the (RETROICOR/RVHR) method based on convolution has been successfully adapted. This algorithm could be helpful before neurosurgical intervention. The activity pattern became more reliable. ]

Lege Artis Medicinae

OCTOBER 01, 2000

[The role of MR angiography in the examination of intracranial aneurysms: A comparative study]

P. Nagy Zoltán, BAJZIK Gábor , BOGNER Péter, BERÉNYI Ervin, SZÁSZ Krisztina, KOPA János, REPA Imre

[MR imaging has recently emerged for visual representation of blood vessel structures as well. With MR angiography (MRA), appropriate diagnosis can be established for a number of pathologies involving the arteries and veins. In this report, authors analyse the significance of MR and MRA examinations in the diagnostics of intracranial aneurysms of 87 cases, comparing these procedures with results obtained by digital subtraction angiography (DSA), which is regarded as the gold standard method. In 52 patients where surgical intervention was performed, intraoperative findings were used as control. MR - MR angiographic examination was very sensitive in detecting aneurysms larger than 3 mm (98%), the rate of depicting smaller aneurysms proved to be lower (56%), the overall sensitivity was 79%. MRA is an excellent non invasive diagnostic tool in the examination of intracranial aneurysms. The method can not replace catheter angiography completely but its application is justified and useful in many cases. Occasionally, aneurysms not seen on DSA can be depicted with MR angiography. ]

Clinical Neuroscience

NOVEMBER 20, 1996

[Cluster headache and its treatment]

JELENCSIK Ilona

[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

Clinical Neuroscience

SEPTEMBER 30, 2019

Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid

KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[Focus on quality of life: Reconstruction in Vascular Surgery ]

AGÓCS Gábor, VÁRADYNÉ HORVÁTH Ágnes, SZEBENI-KOVÁCS Gyula, ROZMANN Nóra, PAKAI Annamária

[The aims of the study: The aim of our research was to gain deeper insight into the quality of life of patients after reconstructive vascular surgery of the lower limb. Material and method: The Vascuqol questionnaire survey was performed at the PTE KK Vascular Surgery Clinic on the day before the surgery and 3-6 weeks after surgery (N=54). Statistical analysis was carried out with Microsoft Office Excel 2013. Results: In summary it can be stated that following surgical intervention the quality of life of patients significantly improved, this finding ephasises the importance of invasise therapy. As the extent of pain decreased after surgery, patients’ ability to walk started to improve, as well as their overall physical state and ability to carry out certain household activities. There was also an improvement in their social life, more time was spent with family and friends. Conclusions: Although the VascuQoL-25 questionaire is senstivie device to measure quality of life, it is difficult to apply in clinical practice beacause of its length.]

Lege Artis Medicinae

DECEMBER 21, 2020

[30 year history of surgery and the surgeon’s future ]

KUPCSULIK Péter

[During the past 3 decades, laparoscopic surgery has launched a revolution in operative medicine. The German gynaecologist Kurt Semm transformed the diagnostic laparoscopy for therapeutic procedure, as he performed the first laparoscopic ap­pen­dectomy. The surgeon Erich Mühe contributed with laparoscopic cholecystectomy to the set of surgical instruments. All over the world, a wide spectrum of laparoscopic procedures has been app­lied. Several laparoscopic procedures are now preferred over open approaches. Morbid obesity is associated with significant comorbidity and mortality. In­suffi­ciency of dietary measures lead to development of surgical interventions that resulted in unexpected excellent outcomes. “Metabolic surgery” was born. New methods and rising market of socio-medical requirements inspired progress in plastic surgery. Thanks to innovations in technology, reconstructive breast surgery has opened new ways. In the 1990s the prototype of “mas­ter–slave” robot controlled by a surgeon was constructed. Future of robotic surgery depends on cost reduc­tion, development of new technologies and creating the best applications. Coo­pe­ra­tion with partner medical specialities is essential for further development in surgery. Despite of obvious impact of new technologies the surgeon's way of thinking, personal qualities decision-making and professional knowledge remain cru­cial for further evolution. ]

Clinical Neuroscience

SEPTEMBER 30, 2018

A multidisciplinary clinical approach to facioscapulohumeral muscular dystrophy

CAKMAK Öztop Özgür, EREN Ilker, ASLANGER Ayca, GÜNERBÜYÜK Caner, KAYSERILI Hülya, OFLAZER Piraye, SAR Cüneyt, DEMIRHAN Mehmet, ÖZDEMIR Gürsoy Yasemin

Background - Impaired shoulder function is the most disabling problem for daily life of Fascioscapulohumeral muscular dystrophy (FSHD) patients. Scapulothoracic arthrodesis can give a high impact to the functionality of patients. Here we report our experience with scapulothoracic arthrodesis and spinal stenosis surgery in FSHD patients. Patients and methods - 32 FSHD patients were collected between 2015-2016. Demographical and clinical features were documented. All the patients were neurologically examined. The Medical Research Council (MRC) and the FSHD evaluation scale was used to assess muscle involvement1. Scapulothoracic arthrodesis and spinal stenosis surgeries were performed in eligible patients. Results - There were 16 male and 16 female (mean age 34.4 years; range 12-73) patients. 6 shoulders of 4 patients aged between 2132 years underwent scapulothoracic arthrodesis (two bilateral, one left and one right sided). Only one 63 years old female patient with severe hyperlordosis had spinal fusion surgery. All of the patients undergoing these corrective surgeries have better functionality in daily life, as well as superior shoulder elevation. Conclusion - Until the emergence and clinical use of novel therapeutics, surgical interventions are indicated in carefully selected patients with FSHD to improve arm movements, the posture and the quality of life of patients in general. Scapulothorosic arthrodesis is a management with good clinical results and patient satisfaction. In selected cases other corrective orthopedic surgeries like spinal fusion may also be considered.

Clinical Neuroscience

MARCH 30, 2019

[Prognostic factors of surgically treated spinal meningeomas and long-term surgical outcomes ]

CZIGLÉCZKI Gábor, NÉMETH Fanni, BERÉNYI György, BANCZEROWSKI Péter

[Introduction, the aim of article - The spinal meningeomas are one of the most common types of spinal tumors. In the treatment of spinal meningeomas, the surgical removal is the gold standard method. There are many factors that have impacts on surgical outcomes such as age, preoperative neurological condition, the extent of resection and histological grade. The aim of our article is to analyze surgical experiences, prognostic features and long-term surgical outcomes of spinal meningeomas. Patients and methods - Retrospective database of surgically treated patients with spinal meningeomas between 2008 and 2016 was made in the National Institute of Clinical Neuroscience, Budapest, Hungary. Demographic data, preoperative neurological symptoms, radiological discrepancies, pathological results (histology, grade), types of treatments and postoperative results were examined. All of our patients were followed clinically and radiologically in the postoperative courses. Results - All of the 153 patients were surgically treated. We have examined 112 women and 41 men. The average age of the patients was 65.5 years. In 98.7% of the cases, the postoperative control examinations (postoperative 6th week) showed a significant improvement in sensorial and motorial functions. The neurological improvements were evident right after the surgeries. In 2 cases (1.30%), no changes were observed in the preoperative symptoms. Recurrence was noticed in 4 cases (2.61%). Conclusion - According to our results, the spinal meningeomas can be sufficiently treated with early diagnosis and total surgical removal. Most of the patients become asymptomatic and the rate of recurrence is quite low.]

Lege Artis Medicinae

MARCH 01, 2000

[Historica Medica; Data from the history of domestic urology]

KAPRONCZAY Károly

[Until the first third of the 19th century, the science and practice of surgery encompassed all interventions that formed “external” diseases on the body surface, resulted from injuries, and rarely underwent abdominal interventions. True, the unresolved issue of pain relief, the risk of wound infection, has set a limit in this regard. Ophthalmology, for example, was practiced within surgery, and separate ophthalmology departments and clinics were separated from surgical departments only from the 1810s, although they remained in a long-dependent relationship with general surgical clinics. From these years onwards, the sectors covering a narrower range of surgical disciplines became increasingly different from surgery. Among the now large number of independent surgical professions, urological surgery can still show great results.]