Engineering geologic evaluation of overcompacted claystone, new metro line, Budapest

Abstract The Oligocene clay units in the Budapest area along the new metro (subway) line show different properties than most others. They are denser and of greater strength than most of the unconsolidated ones. This paper provides an overview of their engineering geologic properties using nearly 4700 physical parameter data. These data were obtained from cores representing sampling intervals of the Kiscell Clay, on the Buda side of the Danube River. Seventeen engineering geologic parameters were used in the description of the clay. The parameter analyses show that the clay behaves as a soft rock rather than a soil

Clinical parameters predict the effect of bilateral subthalamic stimulation on dynamic balance parameters during gait in Parkinson's disease

We investigated the effect of deep brain stimulation on dynamic balance during gait in Parkinson's disease with motion sensor measurements and predicted their values from disease-related factors. We recruited twenty patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least 12 months and 24 healthy controls. Six monitors with three-dimensional gyroscopes and accelerometers were placed on the chest, the lumbar region, the two wrists, and the shins. Patients performed the instrumented Timed Up and Go test in stimulation OFF, stimulation ON, and right- and left-sided stimulation ON conditions. Gait parameters and dynamic balance parameters such as double support, peak turn velocity, and the trunk's range of motion and velocity in three dimensions were analyzed. Age, disease duration, the time elapsed after implantation, the Hoehn-Yahr stage before and after the operation, the levodopa, and stimulation responsiveness were reported. We individually calculated the distance values of stimulation locations from the subthalamic motor center in three dimensions. Sway values of static balance were collected. We compared the gait parameters in the OFF and stimulation ON states and controls. With cluster analysis and a machine-learning-based multiple regression method, we explored the predictive clinical factors for each dynamic balance parameter (with age as a confounder). The arm movements improved the most among gait parameters due to stimulation and the horizontal and sagittal trunk movements. Double support did not change after switching on the stimulation on the group level and did not differ from control values. Individual changes in double support and horizontal range of trunk motion due to stimulation could be predicted from the most disease-related factors and the severity of the disease; the latter also from the stimulation-related changes in the static balance parameters. Physiotherapy should focus on double support and horizontal trunk movements when treating patients with subthalamic deep brain stimulation

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement and torsion.

Objective: To characterize the ultrasonographic findings on nerves in neuralgic amyotrophy. Methods: Fourteen patients with neuralgic amyotrophy were examined using high resolution ultrasound. Results: Four types of abnormalities were found: 1. Focal or diffuse nerve / fascicle enlargement (57%), 2. incomplete nerve constriction (36%), 3. complete nerve constriction with torsion (50%) (hourglass-like appearance), and 4. fascicular entwinement (28%). Torsions were confirmed intraoperatively and occurred on the radial nerve in 85% of the patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction / torsion / fascicular entwinement (p=0.007). Conclusion: Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment moving from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that the development of nerve torsion is facilitated by rotational movements of limbs. This article is protected by copyright. All rights reserved

A nyaki ütőerek dissectiója – 19 eset retrospektív elemzése

Absztrakt: A cervicalis agyi erek dissectiója az ischaemiás stroke-betegség gyakori oka a fiatal felnőttek körében. Kialakulhat erőteljes nyaki trauma, de minor erőbehatás következtében is. Gyakori a spontán esetek előfordulása, melyek genetikai, anatómiai és környezeti tényezőkkel is összefüggésbe hozhatók. A kórkép klinikai megjelenése változatos, a tünetek lehetnek kizárólag helyi jellegűek, illetve az érintett arteriás területre jellemzőek. Korai felismerése kiemelkedően fontos, ugyanis az idejében megkezdett kezeléssel kimenetele számottevően javítható. A végleges diagnózis felállításához a képalkotó eljárások elengedhetetlenek. A közlemény célja a cervicalis agyi erek dissectiójának (carotis és vertebralis arteria dissectio) összefogló leírása 19 eset bemutatása kapcsán. A vizsgálat során három év alatt a Neurológiai Klinikán extracranialis arteria dissectio miatt kezelt betegek klinikai jellemzőit, rizikófaktorait, diagnosztikai eredményeit és terápiáját elemeztük. A kórkép prognózisa változatos, betegeink 42%-a tünetmentessé vált. Orv Hetil. 2019; 160(22): 861–868. | Abstract: Cervical artery dissection is a common cause of stroke in young adults. It might occur shortly after a forceful neck trauma or a minor injury. However, spontaneous dissection is also common, which is associated with genetic, anatomical or environmental risk factors. Cervical artery dissection can produce a broad spectrum of clinical presentation varying from local symptoms to focal neurological deficits determined by the arterial territory involved. Early recognition is important since immediate initiation of treatment can significantly improve patient outcomes. While clinical features may raise suspicion for dissection, the diagnosis has to be confirmed by neuroimaging findings. The purpose of this paper is to give an overview on cervical (carotid and vertebral) artery dissections while presenting 19 cases. During three years, we evaluated the clinical features, risk factors, diagnostic and therapeutic procedures of these patients admitted with extracranial artery dissection. The prognosis of the disease can vary, 42% of our patients became asymptomatic. Orv Hetil. 2019; 160(22): 861–868

A Dravet-szindróma klinikai és genetikai diagnosztikájáról húsz esetünk kapcsán = Clinical and genetic diagnosis of Dravet syndrome: report of 20 cases

OBJECTIVE AND BACKGROUND: Severe myoclonic epilepsy in infancy (SMEI; Dravet's syndrome) is a malignant epilepsy syndrome characterized by prolonged febrile hemiconvulsions or generalized seizures starting in the first year of life. Later on myoclonic, atypical absence, and complex partial seizures appear. When one of these seizure forms is lacking the syndrome of borderline SMEI (SMEB) is defined. Psychomotor delay resulting in mental retardation is observed during the second year of life. In most patients a de novo sodium channel alpha-1 subunit (SCN1A) mutation can be identified. By reviewing the clinical, laboratory, and neuroimaging data of our SMEI patients diagnosed between 2000 and 2008, we would like to share our experiences in this rare but challenging syndrome. Our results will facilitate the earlier and better diagnosis of Hungarian children with SMEI. PATIENTS AND METHODS: Clinical, EEG, MRI and DNA mutation data of 20 SMEI patients treated in the Bethesda Children's Hospital (Budapest) were reviewed. RESULTS: The first seizure appeared at age 6.3+/-3.0 months. At least one of the first two seizures were complex febrile seizures in 19/20 and unilateral seizures in 12/20 children. All children except for one showed hemiconvulsions at least once; all children had seizures lasting longer than 15 minutes. Eight of twenty patients had SMEB. DNA diagnostics identified an SCN1A mutation in 17 patients (6 missense, 4 nonsense, 4 frameshift, 2 splice site, 1 deletion) while 3 children had no mutation. CONCLUSION: Early diagnosis of SMEI is important for the avoiding unnecessary examinations and false therapies as well as for genetic counselling. Typical symptoms of SMEI are early and prolonged febrile hemiconvulsions with neurological symptoms, mental retardation and secondary seizure types later on. The presence of an SCN1A mutation supports the diagnosis. We propose the availability of molecular diagnostics and stiripentol therapy for SMEI children in Hungar