Spinnen aus Süd-Neu-Guinea : erster Teil

Die im nachfolgenden aufgeführten Spinnen wurden im Jahre 1907 gesammelt durch die Expedition, die unter Leitung von Dr. H. A. LORENTNZ Niederländisch Südwest-Neu-Guinea besuchte und namentlich an dem Lorentz-(,Noord"-)Nuss arbeitete. Diese Sammlung erfuhr einen erfreulichen Zuwachs durch Material, das Dr. J. W. R. KOCH als Mitglied der von der Kön. Niederländischen Geographischen Gesellschaft im Jahre 1904/1905 nach Niederländisch Neu-Guinea gesandten Expedition an der Südküste, in Merauke, an der Südwestküste arn Digul-Fluss und an der Etna-Bucht sammelte. Die Fortsetzung der Bearbeitung des vorliegenden Materiales wird in einem zweiten Teil geschehen. Das Material endlich, das durch die zweite Expedition von Dr. H. A. LORENTZ in 1909/10 in demselben Gebiete wie seine erste Expedition von 1907 gesammelt wurde, ging mir erst nach Abschluss vorliegender Arbeit zu und soll späterhin bearbeitet werden

Analysis of two cases of myasthenic crisis

Introduction: Myasthenia gravis is an autoimmune disease of the postsynaptic part of the neuromuscular junction. The disease is chronic, manifesting itself in the fatigue of various muscle groups, and the first manifestation of the disease often affects the muscles that move the eyeball and eyelid, although MG can lead to weakness of any muscle group. In turn, myasthenic crisis is a severe worsening of muscle weakness that often results in the urgent need of mechanical ventilation of the patient, due to the respiratory failure. Case reports: The first patient, 64 years old, female was admitted to the Neurology Department due to breathing difficulties and weakness of the limbs, which suddenly worsened within a dozen of hours before admission. During the stay, steroid therapy was used, as well as six times plasma exchange took place at the Nephrology Department with good treatment tolerance. The dosage of pyridostigmine was also modified, with no adverse effects. During the stay, the patient's condition improved - respiratory disorders resolved, ptosis was significantly withdrawn, and limb muscle tension increased globally. The second patient, aged 67, also female, with a history of myasthenia gravis as well, was admitted to the Neurology Department due to increased fatigue, ptosis, dysphagia, and difficulties in speaking and breathing. Steroid therapy was used, but due to high blood glucose, the steroid dose was reduced and a 2-day cladribine treatment was initiated, with good tolerance. Discussion: Myasthenic crisis is often a life-threatening condition that requires immediate treatment. Steroid therapy, pyridostigmine, IVIG and plasma exchange are standard approaches in myasthenic crisis. Cladribine is not an ordinary approach, but can be beneficial in some patients

Spinnen aus Nord-Neu-Guinea

Die nachfolgend beschriebenen Spinnen wurden während der Monate Februar bis August 1903 im Norden von Niederländisch-Neu-Guinea gesammelt und zwar in erster Linie durch die Herrn L. F. DE BEAUFORT und H. A. LORENTZ, die beiden Zoologen der Niederländischen Expedition, die unter Leitung von Prof. A. WICHMANN im Jahre 1903 das genannte Gebiet untersuchte

Analysis of current epilepsy treatment guidelines

Introduction: In 2017, the International League Against Epilepsy (ILAE) published a new classification of seizures. The purpose of this publication is to analyze the use of antiepileptic drugs in epilepsy therapy depending on the types of seizures classified according to ILAE 2017. State of the art: The new basic classification emphasizes mainly the location, where seizures begin in the brain, as the most important criterion to classify epileptic seizures. In focal onset seizures, 1st line of treatment in children is oxcarbazepine, while carbamazepine, levetiracetam, phenytoin and zonisamide is 1st choice in younger adults and gabapentin and lamotrigine in elderly patients. In younger adults valproic acid can be considered as second line treatment. In generalized tonic and atonic seizures carbamazepine, phenobarbital, phenytoin, topiramate, oxcarbazepine and valproic acid can be used both in children and adults. Safe and effective drugs in myoclonic and myoclonic-atonic seizures in all age groups are topiramate and valproic acid. In absence seizures, 1st line treatment in children is ethosuximide (used exclusively in this seizures type) and valproic acid, while carbamazepine, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, topiramate, valproic acid, gabapentin, levetiracetam and vigabatrin are commonly used in adult patients. Non-pharmacological approaches, used in refractory epilepsy, include: surgical resection of the seizure focus, the ketogenic diet, vagus nerve stimulation and responsive neurostimulation. Summary: The new ILAE classification corresponds well with the old guidelines well, which leads to simplifying and spreading the knowledge about epileptic seizures treatment

A neoplasm associated with the meninges of the spinal canal – a case report

Introduction: Spinal canal neoplasms are a heterogeneous group of diseases including both primary and metastatic tumors, either benign or malignant. These tumors can develop both intraspinally and peripherally. Spinal canal tumors are four times less frequent than intracranial tumors. Four-limb paresis may be one of the leading symptoms of a spinal canal tumor. Case report: A 76-year-old female patient was admitted to Neurology Dept. Due to progresive paresis of the lower limbs, muscle weakness, gait disorders and urinary incontinence. A spine MRI revealed a contrast enhancement of the meninges of the spinal cord over the entire length of the spinal cord in the sections covered by the MRI, as well as numerous focal lesions associated with the meninges, which were most likely cancer metastatic foci. CT of the chest, abdominal cavity and pelvis showed no signs of primary neoplasm. A PET scan was scheduled for a patient, but it was abandoned due to haemorrhagic incydent within the brain of the patient. Head MRI revealed no signs of primary cancer focus as well. Histopathological examination of the CSF revealed no specific changes. The patient died, and the autopsy was not performed accordingly to family’s request. Discussion: Cancers of unknown primary origin constitute 3-5% of all cancer cases. These, usually fast-progressing cancers are a huge diagnostic difficulty, which results in mediocre effects of treatment of patients who already have cancer metastases, but it is not known what type of cancer doctors are dealing with. In approximately 20% of patients with cancer with an unknown origin, the primary tumor cannot be determined despite the specialized examinations. In such cases, often only post-mortem examination gives a chance to make the correct diagnosis

Oligoclonal bands as predictors of multiple sclerosis in clinically isolated syndrome

Clinically Isolated Syndrome (CIS) is the first episode of inflammatory and demyelinating symptoms. According to the classification criteria of multiple sclerosis (MS) from 2013, CIS is defined as the first clinical manifestation of the disease. McDonald's 2010 criteria, considered the gold standard in the diagnosis of MS, are based on the clinical symptoms and the characteristic changes in magnetic resonance imaging (MRI). Unfortunately, up to 60-70% of patients with CIS do not meet the criteria for diagnosing MS at an early stage. At the same time, approximately 85% of patients with CIS will develop clinically defined MS (CDMS) in the future. When looking for other diagnostic tools, attention was paid to the role of oligoclonal bands (OBs) as predictors of MS development. Oligoclonal bands are immunoglobulins produced intrathecally by B-lymphocytes and plasma cells. Their level is examined in cerebrospinal fluid (CSF) collected by lumbar puncture. Studies carried out on a group of patients with CIS showed that people with positive test results for oligoclonal bands are twice as likely to develop MS than people with negative OBs. These conclusions are reflected in the revised McDonald's criteria in 2017, where OBs are used in the diagnosis of CIS patients with absence of new symptoms of the disease and changes in MRI. Early diagnosis makes possible to implement modifying disease drugs in the initial stage and, consequently, to achieve better therapeutic effects. The emphasis is also put on the development of other predictors in body fluids, which are effective in the diagnosis of people with CIS and negative oligoclonal bands. Many factors, including Epstein-Barr virus, chitinase-3 like 1, chitinase-3 like 2, chitotriosidase, multi-specific response to measles, rubella and varicella known as "MRZ reaction" or T-cell gene mutation are studied as a potential risk factors for MS development. Their use in diagnostics would improve the detection of MS in earlier stages, and thus the treatment of larger population of patients

Atresia of the esophagus - thoracotomy vs thoracoscopy

Esophageal atresia is a congenital medical condition associated with the disorder of the alimentary tract. It is usually associated with one or more fistulas to the trachea. Esophageal atresia is often associated with other congenital defects. The most frequent anomalies with atresia of the esophagus are those that occur in the VACTERL association. The incidence of oesophageal atresia mention in the literature varies 0.7-4.55/10000, because of the different percentage of defects other than esophageal atresia and associated with esophageal atresia changes. The etiology of esophageal atresia is mainly unknown, but it is considered multifactorial, including genetic and environmental factors. Indeed, 6-10% of cases of esophageal atresia have been diagnosed with a chromosomal abnormality or syndrome. For the purpose of this study, we analyzed the current papers on esophageal atresia found in the PubMed database. Traditionally, the esophageal atresia has been operated by the right posterior thoracotomy. The first thoracoscopic repair of classic esophageal atresia was performed in 1999, and the first successful thoracoscopy of the tracheo-oesophageal fistula a year later. Together with these milestones, numerous health centers have begun adapting this surgical technique. Although thoracoscopic surgery in the case of esophageal atresia in patients with tracheo-bronchial fistula was conducted in many highly developed children's surgery centers, the safety and efficacy of this method remained controversial. The benefits of thoracoscopic surgery are obvious, including excellent visualization, less use of post-operative drugs and cosmetic effects. Jaureguiza et al. described the "scaly scapula", chest wall deformity, scoliosis and the development of the bad nipple in patients who underwent open surgery due to esophageal atresia with the accompanying tacha-oesophageal fistula. In the case of open thoracotomy, it was necessary to withdraw the lungs to expose the posterior mediastinum, resulting in lung damage and respiratory complications. Compared to the open surgery, thoracoscopy significantly reduced the time of hospital stay and the moment of the first oral meal. However, thoracoscopy was associated with a longer time of surgery. The incidence of leaks, narrowings, pulmonary complications, and blood loss were similar in both surgical technique. It seems that the benefits of thoracoscopy are significant

Airplane headache – an underestimated problem?

The airplane headache is an incident of severe, clinically stereotypical pain during ascent or descent of an airplane. The entity is considered rare; however, growing numer of passengers in air transport results in better recognition of the problem. The airplane headache typically lasts less than 30 minutes and is unilateral, most often in fronto-orbital region and is connected with take-off or (more often) landing of the aircraft. The most important causative factor is sinus barotrauma attributed to changes in air pressure in passenger airliners during different phases of flight. So far there are only single cases or case series described in the literature. However, the problem can affect even a few percent of airline passengers. The condition is rare among children. The most effective treatment are triptans, but naproxen, paracetamol and nasal decongestants may play an important role either. There is an urgent need to conduct more researches on epidemology, pathogenesis and treatment of the headache attributed to airplane travel