38 research outputs found
Do the asymmetry and the size of the structures of the temporal lobe persist in early stages of schizophrenia?
A total of 14 patients of various ages diagnosed with schizophrenia and, as an
age-matched control group, 12 healthy subjects were examined using the MRI
method of neuro-imaging. The volume of the following structures was evaluated
in the right and left hemispheres: the superior temporal gyrus, the basolateral
temporal area (the region including the middle temporal gyrus, inferior temporal
gyrus and fusiform gyrus), the parahippocampal gyrus, the hippocampal
head, the amygdaloid body and the inferior horn of the lateral ventricle.
In schizophrenia a significant increase in the volume of the amygdaloid body on
both the left and right sides was observed. In the patients, as in the control
group, we noticed significant asymmetry between the left and right sides in the
volume of the structures studied. The left amygdaloid body was significantly
larger than the right, whereas the left hippocampal head and the temporal horn
of the lateral ventricle were smaller than the right.
Our findings suggest that in the early stages of schizophrenia, despite the increased
volume of the amygdaloid body, the asymmetry between the structures
of the temporal lobe is still present. However, the changes observed in the temporal
lobe could be related to the functional disturbances observed in this disease
A magnetic resonance volumetric study of the temporal lobe structures in depression
Depression is one of the most common psychiatric disorders and is associated
with considerable morbidity. In recent years structural-imaging technology has
provided an opportunity to examine the brain anatomy in patients with the
psychiatric illness. 10 patients of various ages and, as the control group,
16 healthy subjects were examined using the MRI method of neuroimaging.
The volumes of the following structures were evaluated in the right and left
hemispheres: the superior temporal gyrus, the basolateral temporal area (the
region including middle temporal gyrus, inferior temporal gyrus and fusiform
gyrus), the parahippocampal gyrus, the hippocampal head, the amygdaloid body
and the lateral ventricle. The significant difference between the control group
and the group with depression concerned the volume of the temporal horn of
the lateral ventricle of both hemispheres. In depressed patients the left temporal
horn was 49.8% and the right 38.4% larger in comparison with the control
group. In the control group there were significant differences between the left
and right hemispheres in the volume of all the structures studied, whereas in the
group with depression these difference in volume between the hemispheres
concerned only the amygdaloid body and the lateral ventricle
Sikeres extracorporalis membránoxigenizációs (ECMO-) kezelés Legionella-pneumoniában = Successful extracorporeal membrane oxygenation (ECMO) treatment in Legionella pneumonia
Absztrakt:
A súlyos akut légzési elégtelenség (ARDS) mortalitása elérheti a 60%-ot. A
lélegeztetéssel összefüggő további tüdőkárosodás mértéke csökkenthető alacsony
légúti nyomások és térfogatok alkalmazásával. A korszerű lélegeztetés ellenére
fennálló hypoxaemia esetében felmerül az extracorporalis membránoxigenizáció
lehetősége. A respirációs indikációval végzett kezelések száma világszerte nő,
bár hatékonyságuk még nem egyértelműen bizonyított. Beszámolunk az Intézetünkben
végzett sikeres, első venovenosus ECMO (VV ECMO-) kezeléssel ellátott ARDS-ről.
Hatvanhét éves férfi közösségben szerzett tüdőgyulladásának hátterében
Legionellát igazoltak. Empirikus, majd célzott
antibiotikumterápia ellenére súlyos ARDS, szepszis alakult ki. Respiráltatással
nem sikerült kielégítő oxigenizációt elérni, a hasra fordítás is csak átmeneti
javulást hozott. A beteget áthelyezték Intézetünkbe potenciális extracorporalis
’life support’ (ECLS-) terápia céljából. A felvételi vérgáz súlyos hypoxaemiát,
enyhe hypercapniát mutatott, PaO2/FiO2: 60,
PaCO2: 53 Hgmm, PEEP: 14 Hgmm, PIP: 45 Hgmm respirációs
paraméterek mellett. A mellkasröntgenen kétoldali gócos infiltrátumot, a
szívultrahangon csökkent balkamra-funkciót (45%), tágabb jobb kamrát láttunk,
emelkedett pulmonalis artériás nyomást mértünk (mPAP: 41 Hgmm). Femorojugularis
venovenosus ECMO-kezelést indítottunk. Tüdőprotektív (FiO2: 0,5, TV:
3–4 ml/ttkg) lélegeztetés mellett a vérgázértékek az alkalmazott VV
ECMO-technika elvárásainak megfelelően alakultak. 8 nap VV ECMO-kezelés után,
további 5 nap alatt leszoktattuk a beteget a lélegeztetőgépről. Összességében 21
nap intenzív terápiát követően visszahelyeztük a küldő intézetbe, ahonnan
rehabilitációt követően otthonába távozott. A fenti eset ismertetésével
szeretnénk felhívni a figyelmet a respirációs indikációjú ECMO-kezelések
jelentőségére, hogy ezek a kezelések a külföldi gyakorlathoz hasonlóan nagyobb
teret nyerhessenek a hazai intenzív terápiás gyakorlatban. Orv Hetil. 2019;
160(6): 235–240.
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Abstract:
The mortality of severe ARDS is almost 60%. Ventilation-associated lung-injury
can be avoided by low-pressure, low-volume ventilation. Potential use of ECMO in
case of refractory hypoxemia beside modern ventilatory therapy can be
considered. Increasing numbers of respiratory ECMO runs are seen worldwide,
though the efficacy remains controversial. The authors present the first
successful venovenous-ECMO treatment in severe ARDS in our Institute. We report
the case of a 67-year-old male who was admitted with community-acquired
pneumonia caused by Legionella. Despite empirical and later
targeted antibiotic therapy, severe ARDS with sepsis evolved. Neither
ventilation nor prone position resulted in permanent improvement in oxygenation.
The patient was referred to our Institute for extracorporeal life support (ECLS)
therapy. On admission, blood gas showed severe hypoxemia with mild hypercapnia
(PaO2/FiO2: 60, pCO2: 53 mmHg at PEEP: 14
mmHg, PIP: 45 mmHg). X-ray showed bilateral patchy infiltrates while cardiac
impairment (EF: 45%) and dilated right ventricle were seen on echocardiography.
Elevated pulmonary artery pressure (mPAP: 41 mmHg) was measured. After
implantation of femoral-jugular VV ECMO, oxygen saturation was appropriate with
lung protective ventilation (FiO2: 0.5, TV: 3–4 ml/kg). Improving
lung function enabled us to stop ECMO after 8 days and further 5 days later the
patient was weaned off ventilation. After 21 days of intensive care we
discharged him to the referral hospital. By reporting this case we emphasise the
potential role of respiratory ECMO. Consideration should be given to increase
the contingent of this modality in the Hungarian intensive care in accordance
with international practice. Orv Hetil. 2019; 160(6): 235–240
Volume Assessment in Mechanically Ventilated Critical Care Patients Using Bioimpedance Vectorial Analysis, Brain Natriuretic Peptide, and Central Venous Pressure
Purpose. Strategies for volume assessment of critically ill patients are limited, yet early goal-directed therapy improves outcomes. Central venous pressure (CVP), Bioimpedance Vectorial Analysis (BIVA), and brain natriuretic peptide (BNP) are potentially useful tools. We studied the utility of these measures, alone and in combination, to predict changing oxygenation. Methods. Thirty-four mechanically ventilated patients, 26 of whom had data beyond the first study day, were studied. Relationships were assessed between CVP, BIVA, BNP, and oxygenation index (O2I) in a cross-sectional (baseline) and longitudinal fashion using both univariate and multivariable modeling. Results. At baseline, CVP and O2I were positively correlated (R = 0.39; P = .021), while CVP and BIVA were weakly correlated (R = −0.38; P = .025). The association between slopes of variables over time was negligible, with the exception of BNP, whose slope was correlated with O2I (R = 0.40; P = .044). Comparing tertiles of CVP, BIVA, and BNP slopes with the slope of O2I revealed only modest agreement between BNP and O2I (kappa = 0.25; P = .067). In a regression model, only BNP was significantly associated with O2I; however, this was strengthened by including CVP in the model. Conclusions. BNP seems to be a valuable noninvasive measure of volume status in critical care and should be assessed in a prospective manner
A Streptococcus pneumoniae (pneumococcus) -infekciók ezer arca
Absztrakt
A Streptococcus pneumoniae (pneumococcus) által okozott
infekciók világszerte, így Magyarországon is, tartósan magas morbiditási és
mortalitási mutatókkal rendelkeznek a gyermek- és felnőttpopulációban egyaránt.
A felnőttkori, hospitalizációt igénylő, otthon szerzett tüdőgyulladások
35–40%-ában a pneumococcus kóroki szerepe igazolható, az S.
pneumoniae-pneumoniák 25–30%-a bacteraemiával jár. Az összes
fertőzés 5–7%-a fatális kimenetelű, idősek és rizikóbetegek körében az arány
meredeken növekedik. A súlyos, invazív formában zajló infekciók esetében a
mortalitás elérheti a 20%-ot, a szövődményráta adekvát antibiotikus terápia
mellett is jelentős. A szerzők összefoglalják a pneumococcalis betegségek
epidemiológiáját, a noninvazív és invazív fertőzések patogenezisét, valamint
prezentálják a legfontosabb klinikai aspektusokat esetbemutatásokon keresztül. A
betegek rizikóstratifikációja, a hemokultúrák vétele és a korai
antibiotikum-kezelés mellett az aktív immunizáció széles körű alkalmazása
segíthet csökkenteni az invazív fertőzések mortalitását. A pneumococcus elleni
vakcináció javasolt minden 50 év feletti felnőttnek, illetve minden 18 év
feletti krónikus betegnek, aki alapbetegsége miatt fogékony a pneumococcalis
infekcióra. Orv. Hetil., 2015, 156(44), 1769–1777
B-Type Natriuretic Peptide in the Critically Ill with Acute Kidney Injury
Introduction. Acute kidney injury (AKI) is common in the intensive care unit (ICU) and associated with poor outcome. Plasma B-type natriuretic peptide (BNP) is a biomarker related to myocardial overload, and is elevated in some ICU patients. There is a high prevalence of both cardiac and renal dysfunction in ICU patients. Aims. To investigate whether plasma BNP levels in the first 48 hours were associated with AKI in ICU patients. Methods. We studied a cohort of 34 consecutive ICU patients. Primary outcome was presence of AKI on presentation, or during ICU stay. Results. For patients with AKI on presentation, BNP was statistically higher at 24 and 48 hours than No-AKI patients (865 versus 148 pg/mL; 1380 versus 131 pg/mL). For patients developing AKI during 48 hours, BNP was statistically higher at 0, 24 and 48 hours than No-AKI patients (510 versus 197 pg/mL; 552 versus 124 pg/mL; 949 versus 104 pg/mL). Conclusion. Critically ill patients with AKI on presentation or during ICU stay have higher levels of the cardiac biomarker BNP relative to No-AKI patients. Elevated levels of plasma BNP may help identify patients with elevated risk of AKI in the ICU setting. The mechanism for this cardiorenal connection requires further investigation
Az első két sikeres, convalescens friss fagyasztott plazmával történő terápia hazai alkalmazása intenzív osztályon kezelt, kritikus állapotú, COVID–19-fertőzésben szenvedő betegekben (A COVID–19-pandémia orvosszakmai kérdései)
Introduction: At present, neither specific curative treatment nor vaccines for novel coronavirus 2019 (COVID-19) are available. There is an urgent need to look for alternative strategies for COVID-19 treatment especially in the case of severe and/or critically ill patients with cytokine release syndrome (CRS).Aim: Convalescent plasma proved to increase survival rates in other severe viral infections. Therefore, convalescent plasma could be a promising treatment option for severe COVID-19 patients.Method: In our article, we present the first two critically ill Hungarian patients with COVID-19 infection treated with convalescent fresh frozen plasma.Results: At the time of plasma therapy both patients were on mechanical ventilation and received antiviral agents and a full scale of supportive care. Each patient received 3 x 200 mL of convalescent plasma of recently recovered donors with sufficient novel anti-coronavirus IgG titers. Subsequent to convalescent plasma infusion, oxygenization improved and inflammatory markers decreased in both individuals. As compared to pretransfusion, lymphocyte counts increased and interleukin-6 level lessened. Both patients were weaned from mechanical ventilation within 2 weeks of treatment. No severe adverse effects were observed.Conclusions: Our experience indicates that convalescent plasma therapy is well tolerated and could potentially improve clinical outcomes. Optimal dose and timing as well as precise assessment of clinical benefit of convalescent plasma therapy will need further investigation in larger, well-controlled trials. This is the first report of the successful use of convalescent plasma in the treatment of critically ill patients with COVID-19 infection in Hungary
Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery
Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery