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Lege Artis Medicinae

DECEMBER 10, 2018

[Experimental investigation of the complex energy balance]

GARAMI András

[The complex energy balance includes maintenance of both normal body mass and body temperature. In the homeostasis regulation it is important that the activities of several physiologic processes are balanced with each other, for example, the balance between food intake and energy expenditure is crucial to maintain normal body mass, while the balance between heat production and heat loss is vital in determining body temperature. Obesity and loss of body weight, as well as fever and hypothermia are consequences of the dysregulation in energy balance. In our research, we studied receptorial and neurohumoral mechanisms involved in the maintenance and in the impairment of energy balance. This paper gives an overview of our most important findings, which served as the basis of the application submitted to and awarded with 3rd prize by the Prof. Dr. Laszlo Romics Memorial Foundation. We review the physiologic role of transient receptor potential channels, mostly of vanilloid-1 (formerly: capsaicin receptor) in the regulation of body temperature and body mass. Among the neuropeptides which take part in the maintenance of energy balance, we present the thermoregulatory effects of alpha-melanocyte stimulating hormone and pituitary adenylate cyclase-activating polypeptide. Last, among the molecular mechanisms of systemic inflammation, which is characterized by thermoregulation disorders (e.g., fever, hypothermia), we recap the role of the vanilloid-1 and neurokinin-1 receptor, and bilirubin.]

Clinical Neuroscience

NOVEMBER 30, 2018

[Effects of neural therapy on quality of live in patients with inoperable lower extremity artery disease ]

MOLNÁR István, DEÁK Botond Zsolt, HEGYI Gabriella, KOVÁCS Zoltán, KAPÓCS Gábor, SZŐKE Henrik

[Objectives - Our aim was to evaluate the effects of percutaneous neurolysis of lumbal sympathetic ganglions on pain and the resulting changes in quality of life with validated objective and subjective methods. To follow the adverse effects and complications of the procedure. Materials and methods - A prospective, non-randomized, interventional, clinical cohort study under real life conditons was conducted. The time of the observation was 6 months. Palliative neural therapy was performed to reduce the ischemic pain of the affected leg of the patients involved in the study. Prior to treatment and after 35 days, Visual Analogue Scale (VAS) was used to measure the intensity of lower limb pain. The related changes in the quality of life were followed by a general 36-Item Short-Form Health Survey (SF-36) questionnaire. We measured the changes of the patients’ skin temperature and ankle/arm index. The post-treatment results were compared to the pre-treatment results. We compared the results of objective and subjective measures. We followed the side effects and complications of the pain therapy. Each of the examined subjects had obliterative (Fontaine II/b stage) arterial disease of the lower limbs, in which no revascularization intervention was feasible and their ischemic pain was of VAS≥7. Results - Data of 124 patients (69 male, 55 female) could be evaluated. The decrease in intensity of limb pain in the post-treatment period was significant (p=0.001). Quality of life also indicated a significant improvement (p=0.004). Changes in skin temperature and ankle/arm index demonstrated significant improvement (p≤0.005): skin temperature increased from 27.6°C to 31.2°C, the ankle/arm index inceased from 0.67 to 0.83 on average. Changes in objective and subjective measures correlated with each other. No worthening of symptoms, serious adverse events or complications were observed. Conclusion - The chemical denervation of the lumbar sympathetic ganglions with percutaneous application is a minimally invasive intervention, useful in outpatient care, which can be well tolerated by the patient without any significant side effect or complication. Its hyperaemic effect and the pain reduction of the leg can improve the quality of life of the patients.]

Clinical Neuroscience

MAY 25, 2014

[Temperature sensitivity of some nerve conduction parameters in diabetic polyneuropathy]

HIDASI Eszter, DIÓSZEGHY Péter, KÁPLÁR Miklós, MECHLER Ferenc, BERECZKI Dániel

[Background - We tested whether in diabetic polyneuropathy the temperature dependence of the median nerve conduction parameters reflects the severity of neuropathy. Methods - We validated an electrophysiological score against clinical signs of polyneuropathy. Electroneurography was performed at temperatures from 20-40 °C in diabetic patients with mild, moderate and severe neuropathy and controls. Results - The electrophysiological score reflected the clinical severity of polyneuropathy. At room temperature there were significant differences among groups in almost all parameters. In thermal sensitivity studies were significant differences in distal and proximal motor and sensory areas and in sensory conduction velocities. These four parameters normalized to 1 °C change in temperature also significantly differed among the four groups and were largest in controls and smallest in severe polyneuropathy. Conclusions - The use of an integral parameter - areas are essentially amplitudes integrated over time - increases the probability of detecting decreased thermal sensitivity of peripheral nerves in diabetes.]

Hungarian Radiology

OCTOBER 10, 2005

[Calcification of the tentorium cerebelli]

BILONKA Viola, BENDE Mariann

[A 16-year-old female patient with high temperature and headache was hospitalized because of suspicion of meningitis. Cranial CT showed a mild hydrocephalus, massive falx calcification and calcification in the projection of the tentorium. Excluding several well known reasons of the calcification the findings was thought to be a physiological variation. The child recovered after some days and left the hospital. The authors based on prior publications on tentorium calcification consider this finding a physiological-phylogenetic origin.]

Clinical Neuroscience

DECEMBER 10, 2005

[BASIC NEUROGRAPHY AND ITS DIAGNOSTIC IMPORTANCE]

KISS Gábor

[Nerve conduction studies are fundamental elements of the neurophysiological investigation of neuromuscular diseases. They provide information on peripheral nerve function. Knowledge of the biological and technical basis of the method is essential for the clinician to understand the place of nerve conduction testing in the diagnostic process. A characteristic feature of the nerve fibers is their ability to conduct electrical potentials. This conductivity changes in pathologic circumstances; therefore, the patient's nerve conduction data may be important if a neuromuscular disorder is suspected. The electrical activity spreading along the nerve fibres can be detected with special techniques and instruments. To perform an examination, a stimulator, a high quality amplifier and a computer with various accessories are necessary. The examination is usually carried out by surface stimulation and recording electrodes and requires some cooperation. By supramaximal stimuli all nerve fibers in the peripheral nerve are activated, and their summated activity is recorded bipolarly. For technical reasons the procedures for the motor and the sensory nerve conduction measurements are somewhat different, but their principles are similar. A number of parameters, such as the latency, the amplitude, the area and the shape of the evoked potentials are analyzed. These parameters are influenced by many biological (age, gender, body height, etc.), physical (such as limb temperature) and technical factors. The results are compared with the reference data. Nerve conduction studies may help distinguish between normal and diseased nerve function. The latter has two main categories; axonal lesion and demyelinisation. Axonal lesion is characterized by relatively normal conduction velocity and lower than normal amplitude of the potentials. Demyelinisation is almost the opposite with long latencies, slow conduction velocity and relatively spared potential amplitudes. Nerve conduction studies help differentiate between these two forms. Abnormalities found by nerve conducion measurement may reflect the severity of the disease. Repeated studies are suitable for quantitative follow-up. The anatomical, physiological, pathophysiological and technical details are discussed below. The characteristic neurographic findings of various diseases are also summarized.]

Lege Artis Medicinae

DECEMBER 20, 2003

[EXERCISE-INDUCED BRONCHOCONSTRICTION]

VIZI Éva, CSOMA Zsuzsanna, HUSZÁR Éva

[Exercise-induced bronchoconstriction describes the transient narrowing of the airways occurring during and most often after vigorous exercise. The mechanism of exercise-induced bronchoconstriction remains elusive, although airway drying and cooling plays a prominent role. The severity of this reaction depends on the temperature and the water content of the inspired air, the type and concentration of air pollutants inspired and the intensity of the exercise. Diagnosis of exercise-induced bronchoconstriction should include baseline spirometry followed by an exercise challenge test. The exercise can be a free-running test or a laboratory based test using a cycle-ergometer or a treadmill. Pre- and post-exercise pulmonary function should be compared, 10%-15% postexercise fall in forced expiratory volume in 1 second (FEV1) is used as a diagnostic criteria (10% in laboratory test, 15% in free-running test). Heat loss, water loss, post exertional airway rewarming and the role of several mediators have been proposed as possible mechanisms responsible for the airway obstruction induced by exercise. Exercise-induced bronchoconstriction can be easily diagnosed and treated in the majority of patients. When properly treated, asthmatic individuals should be able to participate or compete in the majority of sports.]

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.]

Lege Artis Medicinae

JULY 27, 2009

[Melatonin, sleep and the circadian rhythm: theoretical considerations and their chronopharmacological applications ]

BÓDIZS Róbert

[The predictive homeostasis of living organisms is an anticipatory adaptation to rhythmical environmental changes. A good example for this is the circadian rhythm preparing the organism for the alternation of day and night. The circadian rhythm of melatonin production anticipates the timing and duration of nocturnal sleep of human subjects. It also induces a sleep-like stimulusprocessing mode of the brain and - in case of adequate environmental circumstances - a soporific and in part, a sleep-inducing effect. Specificities of melatonin effects on sleep are the reduction of slow-wave EEG activity, as well as the increase in seep EEG spindling and REM sleep time. Like other substances with hypnotic properties, melatonin decreases core body temperature, but has also a strong chronobiotic effect that is expressed as rapid and strong phase shifts of the circadian rhythm, depending on the time of day of melatonin administration. Because light acutely suppresses melatonin production, adequately timed light exposition, containing also low wavelength components, together with exogenous melatonin, could be useful in treating jet-lag syndrome and other circadian rhythm disorders.]

Lege Artis Medicinae

FEBRUARY 20, 2005

[THE TREATMENT OF ACUTE ISCHEMIC STROKE BASED ON CURRENT GUIDELINES]

SZEGEDI Norbert, MAY Zsolt, ÓVÁRY Csaba

[Cerebrovascular diseases are third among the most frequent causes of mortality in developed countries and represent the most common cause of disability in adulthood. 80% of all acute stroke cases are of ischemic origin. The proven significant efficacy of intravenous thrombolysis with rt-PA in the NINDS rt-PA Stroke Trial was the cornerstone of the treatment of acute ischemic stroke, followed by several recommendations. From this time on, the attention shifted to early and appropriate recognition of symptoms and to organizing a quickly reacting emergency medical system in order to maximize the number of those patients transported immediately to the nearest stroke center to have the opportunity to be treated within three hours after their symptom onset. Specialized stroke facilities have documented benefit over other forms of stroke management concerning survival rates, but they need coordinated continuous multidisciplinary care for the patients, availability of CT scanner, laboratory examinations including tests of hemostasis, intensive care unit and well-trained stroke neurologists on 24-hours-a-day basis. Thrombolysis in these stroke centers with intravenous 0,9 mg/kg rt-PA improves the outcome of acute stroke with 30%. Although new guidelines strongly recommend the thrombolysis of selected ischemic stroke patients, the only evidence-based treatment of this condition has not yet become a part of the routine stroke management in Hungary. Regarding other specific antithrombotic therapeutic approaches, anticoagulation has the most contradictory status: in spite of well-defined theoretic considerations there are no evidence-based data in favour of routine anticoagulation in acute ischemic stroke, neither with heparin nor with low molecular weight heparins or heparinoids, while aspirin given within 24-48 hours after stroke onset was shown to have a significant but modest benefit. No data support the treatment with hemodilution or the administration of neuroprotective drugs. Evidence accumulating continuously determine the principles of general care including the methods and the targets in the acute phase of ischemic stroke regarding respiratory and cardiac care, management of blood pressure and blood glucose levels and body temperature.]

AUGUST 15, 2011

The Paracetamol (Acetaminophen) In Stroke?

Original abstract:High body temperature in the first 12-24 h after stroke onset is associated with poor functional outcome. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial aimed to assess whether early treatment with paracetamol improves functional outcome in patients with acute stroke by reducing body temperature and preventing fever. METHODS: In a multicentre, randomised, double-blind, placebo-controlled trial, patients with ischaemic stroke or intracerebral haemorrhage and body temperature between 36 degrees C and 39 degrees C were randomly assigned treatment with paracetamol (6 g daily) or placebo within 12 h from symptom onset. Treatment allocation was based on a computer-generated list of random numbers with varying block size. The primary outcome was improvement beyond expectation on the modified Rankin scale at 3 months, according to the sliding dichotomy approach. This trial is registered, number ISRCTN74418480. FINDINGS: Between March, 2003, and May, 2008, 1400 patients were randomly allocated treatment. 260 (37%) of 697 patients receiving paracetamol and 232 (33%) of 703 receiving placebo improved beyond expectation (adjusted odds ratio [OR] 1.20, 95% CI 0.96-1.50). In a post-hoc analysis of patients with baseline body temperature 37-39 degrees C, treatment with paracetamol was associated with improved outcome (1.43, 1.02-1.97). There were 55 serious adverse events in the paracetamol group (8%) and 70 in the placebo group (10%). INTERPRETATION: These results do not support routine use of high-dose paracetamol in patients with acute stroke. Paracetamol might have a beneficial effect on functional outcome in patients admitted with a body temperature 37-39 degrees C, but this post-hoc finding needs further study. FUNDING: Netherlands Heart Foundation.