Disorders of executive consciousness

Executive function is a higher order cognitive capacity that involves memory, perception and performance of complex tasks. Disorders of the executive functions are sign of lesions in the prefrontal cortex, involving the prefrontal-striatal-thalamic networks and the parietal association areas. According to signs and localization, five basic prefrontal syndromes are recognised. 1. Damage in posterior dorsolateral prefrontal cortex and subcortical nuclei causes the dorsolateral syndrome with impaired decision making, working memory and planning. 2. The ventromedial-orbitofrontal syndrome: if lesion spares the basal forebrain, memory can be preserved, but poor social decision making develops. 3. The dorsomedial syndrome consists of attention disorder, akinesia, mutism and apathy. 4. The bilateral ventrolateral prefrontal regions serve perception of self and environment. 5. The ventral lateral (verbalizer) area of the dominant hemisphere coordinates language. Executive impairments can be found in cerebrovascular, Parkinson's and other diseases of basal ganglia, and in frontotemporal lobar degeneration. The dorsolateral syndrome can be examined by the use of Wisconsin card sorting test, self ordered pointing task and the delayed response task. Prefrontal-basal function can be assessed by Gambling-, Faux Pas-, and Emotion identification tasks. Conclusions: 1. A dysexecutive syndrome does not fulfil the criteria of dementia. 2. A "frontal syndrome" is an indefinite eponym. Focal lesions in prefrontal systems lead to localization-specific symptoms, which can be defined by psychometric tests. 3. In neurological diseases associated with multifocal damage of the brain neuropsychologic tests may help to determine strategic lesions, which are responsible for the actual syndromes.     

Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient

Background: Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy.Objective: The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy.Methods: Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient.Results: After treatment, the patient experienced 3 years of disease-free follow-up.Conclusion: Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.     

Regulation of tissue factor expression in smooth muscle cells with nitric oxide

OBJECTIVE: This study was undertaken to determine the effect of nitric oxide (NO) on tissue factor (TF) expression in vascular smooth muscle cells. STUDY DESIGN: Rat aortic smooth muscle cells (RASMCs) were exposed to NO delivered exogenously with the NO donor S-nitroso-N-acetylpenicillamine (SNAP) or produced endogenously after infection with an adenoviral vector carrying human inducible NO synthase (AdiNOS). Functional TF activity was assessed with chromogenic TF assay. TF antigen was determined with immunohistochemistry. Northern blot analysis was used to determine steady- state TF messenger RNA (mRNA). Electrophoretic mobility gel shift assay was performed to determine the nuclear binding activity of nuclear factor kappa-B (NFkappaB). NFkappaB activity was inhibited by either prior transduction of RASMCs with mutant IkappaB or treatment with pyrrolidine dithiocarbamate. RESULTS: RASMCs exposed to SNAP or infected with AdiNOS exhibited increased functional TF activity and antigen. Regardless of the source of NO, a time-dependent and concentration-dependent increase in TF activity was observed. Steady-state TF mRNA levels were also increased by NO delivered via either method. NFkappaB nuclear binding activity was also increased by NO. Inhibition of NFkappaB activity by either pyrrolidine dithiocarbamate treatment or mutant IkappaB transduction abrogated NO-induced enhancement of TF mRNA and functional activity. CONCLUSION: In RASMC, NO exposure results in upregulation of TF functional activity, antigen, and mRNA. This effect appears to be mediated by an NFkappaB-dependent pathway.     

Value of testing the abdominal leak point pressure in the differential diagnosis of urinary stress incontinence

INTRODUCTION: The two main reasons of stress incontinence, according to the present consensus, are urethral hypermotility due to descended bladder floor and intrinsic sphincter deficiency. Distinction between them used to be achieved by determining urethral pressure profile only. In recent years a less invasive method, measuring the Valsalva Leak Point Pressure, has been developed for a differentiation. AIMS: To determine Valsalva Leak Point Pressure using a simple technique for differential diagnosis of stress incontinence without a complete urodynamic test. METHOD: A minimally invasive technique is presented. Authors have performed parallel measurements of leak point pressure and urethral pressure profile during urodynamic examination in 43 stress incontinent patients. Difference in the results have also been evaluated. RESULTS: A specificity of 98% and a sensitivity of 51% with the method was found in intrinsic sphincter deficiency. In cases without vaginal descent the sensitivity was 100%, while in patients with urethral hypermobility the sensitivity and the specificity were 91% and 58% respectively. CONSEQUENCES: In stress incontinent patients without urethral hypermotility an abdominal leak point pressure of less than 40 H2O cm perfectly reflects weakness of the urethral sphincter. Based on these data we suggest that the invasive urethral pressure profile test can be avoided in appr. 20% of stress incontinence cases by weakness of the sphincter.     

Prevalence of atopic dermatitis in school children of Baranya county

INTRODUCTION: The prevalence of atopic dermatitis (AD) in children has significantly increased worldwide in the past decades. Although it is well known that the number of AD patients has also been growing in Hungary no prevalence studies on a given population have been performed so far. METHODS: The present research investigated the prevalence of AD in school children by means of questionnaires. The data of 1454 (771 girls, 683 boys) children aged 6-14 years in a big city (Pécs, Hungary) and three small settlements (Bóly, Magyarbóly, Villány; Hungary) were analyzed. RESULTS: Applying the standard point values of the Schultz-Larsen questionnaire the prevalence of AD accounted for 15.1%; it was higher in the big city (16.5%) and lower in the small settlements (13.7%). In girls the prevalence of AD (15.9%) was greater than in boys (14%); this difference was more remarkable in the big city (18.2% vs. 14.8%). The first symptoms of AD appeared before the age of two in 58.8% and it was significantly higher in the big city (63.5%) as in the small settlements (52.6%). Among the 221 AD patients there were 38 patients (17.1%) with asthma and 93 (42.1%) with allergic rhinitis. The AD family (parents, brothers and sisters, great parents) proved to be positive in 72.8%. CONCLUSIONS: The results indicate the high prevalence rate of AD in school children in Baranya County, Hungary reaching or nearly approaching the significantly high values registered in the welfare countries.