Rare case of congenital transsphenoidal meningoencephalocele causing respiratory problems

INTRODUCTION: Congenital meningoencephalocele is a rare and severe malformation. AIMS: The authors describe the case of congenital, basal transsphenoidal meningoencephalocele associated with other neurological malformations, which projected between the margins of palatoschisis producing respiratory problems at neonatal age. METHOD: Presented with detailed photo-documentation. RESULTS: Cranial meningoencephalocele reconstruction with an approach of bifrontal craniotomy was performed. The base of skull was closed multilaminarly with auto-graft gained from parietal bone and Lyodura. The closure of nasopharyngeal sac was performed in second sitting. Postoperatively the progression of hydrocephalus was so extensive, that implantation of ventriculo-peritoneal shunt was unavoidable. Later on closure of tracheotomy performed for continued air passage support was done. The authors report the course of disease and the surgeries performed. CONCLUSIONS: Auto-graft from skull bone for closure of large basal-cranial defect proved to be ideal. Prognosis depends on other malformations. Successful treatment needs co-operation of different specialties.     

Incidence of risk factors in parents with acute myocardial infarction at young age and in their children

INTRODUCTION: The preliminaries of the cardiovascular diseases can be traced back to the childhood. The authors tried to find relationship between parents with early onset myocardial infarction (AMI) and incidence of risk factors for ischemic heart disease in their children as compared to respective data for families with no incidence of myocardial infarction. METHODS: The study population consisted of 38 persons with early onset AMI myocardial infarction (age < 55 y) and their 66 children, and 38 adult control subjects and their 33 children. In each person arterial blood pressure, body weight, body height, waist circumference were recorded and body mass index (BMI: kg/m2) was calculated. Eating habits and life style practices were recorded in a questionnaire in the case of each participant. Laboratory variables were determined in the blood sera as follows, glucose, triglycerides (Tg), total cholesterol (T-C), HDL-cholesterol, LDL-cholesterol, apolipoprotein-A, apolipoprotein-B, and lipoprotein (a). The atherogenic index (LDL-C/HDL-C) (LDL-cholesterol/HDL-cholesterol) was also calculated. STATISTICAL EVALUATION: Data were evaluated statistically using the SPSS for Windows 9. RESULTS: According to the mean BMI values all groups of parents belonged to the overweight category. The mean cholesterol levels of all adults were in the borderline high category. In males with early onset myocardial infarction sera concentrations of HDL-cholesterol and apolipoprotein-A were significantly lower, whereas triglyceride and atherogenic index were significantly higher than respective data for control parents. In all groups of parents, fasting mean serum glucose concentrations were higher than the reference value, serum total-cholesterol concentrations were in the borderline high category. In the daughter of the parents with early onset myocardial infarction had a higher atherogenic index than that of controls. Eating habits did not essentially differ between case vs. control families. Consumption of milk, dairy products, fruit and vegetables was insufficient in each group. Incidences of smoking for parents and children were 55% and 35% in the myocardial infarction group and 44% and 37% in the control group, respectively. Physical activity was completely insufficient in each group studied. CONCLUSION: Since no considerable differences were seen between the case vs control families in the parameters tested, therefore it is presumed that the offspring born to parents with or without early onset myocardial infarction are at equal risk to develop cardiovascular diseases unless lifestyle practices are profoundly changed.     

Market share of the for-profit and not-for-profit sector from health insurance expenditures

AIM: The aim of the study is to analyze the market share of for-profit private and not-for-profit sector from the expenditures on medical services of the Hungarian National Health Insurance Fund (NHIF), to show its changes in the last years and to show on which field they can be found. DATA AND METHODS: The data derives from the financial database of the National Health Insurance Fund (NHIF) covering the period 1995-2002. The analysis includes the medical provisions (primary care, health visitors, dental care, out- and inpatient care, home care, kidney dialysis, CT-MRI). RESULTS: In 1995 only 6.91% (12.5 billions Ft) of total expenditure for medical services went to for-profit private providers. By 2002 the market share of private providers increased to 15.95% (78.5 billions Ft). During the same period we realized a dynamic increase in the market share of non-profit sector: from 1.04% in 1995 to 2.58% in 2002. The role of private providers is dominant in the case of general practitioners, dental care, transportation, kidney dialysis, CT/MRI and home care (home nursing). CONCLUSIONS: The financial data of the NHIF showed the dynamic increase of market share of for-profit private providers and non-profit sector in many field of health care, although they role in the two most important fields (out- and inpatient care) is still negligible.     

Examination of the anthraquinone composition in root-stock and root samples of Rubia tinctorium L. plants of different origins

The aim of our work was to identify the anthraquinone derivatives in the underground organs (root-stock and root) of the madder root live plant sortiment Rubia tinctorium L, furthermore to isolate populations the anthraquinone compostitions of which are optimal from therapeutical point of view. In the course of the examinations, we studied the anthraquinone composition in root-stock and root samples of plants originating from 11 different habitats. The identification of the anthraquinone derivatives we carried out after the hydrolysis of these samples with HCl solution, by HPLC method and by use of UV-VIS spectrophotometric and mass spectrometric detection. In the samples we identified 6 anthraquinone-aglicones. The main components were alizarin (9.6-21.8 mg/g), purpurin (3.7-12.3 mg/g), and lucidin (1.8-5.7 mg/g). The total anthraquinone-derivative content varied between 15.6 and 39.4 mg/g. After the evaluation of the results it can be stated that from therapeutical point of view the most favourable biggest ratio of total anthraquinone amount/lucidin amount (11.97) and one of the biggest total anthraquinone-derivative contents (38.1 mg/g) are found in the Rubia tinctorium sample marked R02 originating from Aachen (Germany). These results enable us at the same time to find--through the establishment of further collections and through the exploration of the biodiversity of these--basic material with more favourable composition than at present, especially in relation to lucidin derivatives which are risk factors.     

Heterodimerization and cross-desensitization between the mu-opioid receptor and the chemokine CCR5 receptor

Cross-desensitization between micro-opioid receptor agonists and CC chemokines was shown to occur in immune cells and in the central nervous system. However, these cells do not permit examination of potential mechanisms at cellular levels due to low levels and mixed populations of receptors. In this study, we investigated possible interactions and biochemical mechanisms of cross-desensitization between the mu-opioid and chemokine CCR5 receptors coexpressed in Chinese hamster ovary (CHO) cells. Hemagglutinin (HA)-tagged micro-opioid receptor coimmunoprecipitated with FLAG (Asp-Tyr-Lys-Asp-Asp-Asp-Asp-Lys)-tagged chemokine receptor CCR5 in cells expressing the two receptors, but not in a mixture of cells transfected with one of the two receptors, indicating that the two receptors form heterodimers. Treatment with the mu-opioid receptor agonist DAMGO ([D-Ala(2), N-Me-Phe(4), Gly(5)-ol]-enkephalin), the chemokine RANTES (Regulated on Activation, Normal T cell-Expressed and -Secreted) (CCL5), or both, did not affect the level of coimmunoprecipitation. DAMGO and RANTES (CCL5) induced chemotaxis in CHO cells coexpressing both receptors, and preincubation with either DAMGO or RANTES (CCL5) profoundly inhibited chemotaxis caused by the other. DAMGO pretreatment enhanced phosphorylation of the chemokine CCR5 receptor and reduced RANTES (CCL5)-promoted [35S]GTP gamma S binding. Conversely, RANTES (CCL5) preincubation slightly increased phosphorylation of the mu-opioid receptor and significantly reduced DAMGO-induced [35S]GTP gamma S binding. These results indicate that activation of either receptor affected G protein coupling of the other, likely due to enhanced phosphorylation of the receptor. Heterodimerization between the two receptors may contribute to the observed cross-desensitization.     

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.