Severe cardiovascular autonomic dysfunction in a patient with Guillain-Barre syndrome: a case report.

Autonomic dysfunction is a frequent and severe complication of Guillain-Barre syndrome. It is often responsible for cardiovascular abnormalities, even cardiac arrest. We report a 49-year-old patient, who suffered from Guillain-Barre syndrome necessitating mechanical ventilation. He showed wide fluctuations of blood pressure and heart rate spontaneously or in relation with medical procedures. Though heart rate variability (HRV) and baroreflex sensitivity (BRS) values derived from different methods were extremely low, vigorous stimuli, like eyeball pressure test and carotid sinus massage, produced exaggerated responses, like severe bradycardias, hypotension and cardiac arrest. Despite the plasma exchange and supportive therapies, the patient finally developed adult respiratory distress syndrome (ARDS), sepsis and died due to septic shock.

Segregated parallel inputs to the brachial spinal cord from the cingulate motor cortex in the monkey.

The corticospinal projection from the cingulate motor cortex to the lower cervical enlargement (C5-T1) was investigated in four rhesus monkeys. Each received an injection of biotinylated dextran amine involving the arm representation of M3 (area 24c) or M4 (area 23c). In M3 cases, contralateral terminal label occurred in the lateral part of laminae V and VI of the intermediate zone including the reticulated marginal border. Lighter labeling was found in laminae IV, VII and the dorsolateral part of the anterior horn (lamina IX). In marked contrast, M4 cases demonstrated contralateral terminal labeling in the medial part of the dorsal and intermediate zones (laminae III, IV, V and VI). Lighter labeling involved the medial part of laminae VII, X and the dorsolateral anterior horn (lamina IX). Our experiments demonstrate that the corticospinal projection from the arm representations of M3 and M4 innervate distinct and separate parts of the spinal gray. Along with the noted differences in the cortical inputs to M3 and M4, these data suggest that the two cingulospinal systems may mediate independent and specialized forms of information effecting upper limb movement.

[Management of severe orthostatic hypotension by head-up-tilt posture and administration of fludrocortisone]. / Súlyos fokú orthostaticus hypotonia kezelése "head-up-tilt" fektetéssel és fludrocortisonnal.

A case of a 66-year-old man with recurrent episodes of syncope is reported. The syncopal attacks started five years ago in sitting and standing positions. At the time of admission the fainting attacks occurred 2-3 times per day. The diagnostic tests revealed severe orthostatic hypotension. The medical treatment was started with salt enriched diet and fludrocortisone. The efficacy of the therapy was tested by using the tilt table test with a self developed computer system consisting of a non-invasive finger blood pressure monitor and ECG. The orthostatic tolerance improved with the medical therapy, however remained unsatisfactory for the patient's daily activity. Though the patient had less frequent symptoms, he had still sustained episodes of recurrent syncopes. The medical therapy was than combined with sleeping in the 15 degrees head-up-tilt position. The repeat tilt table test was performed two weeks after initiation of the 15 degrees head-up-tilt sleeping. The orthostatic tolerance was markedly improved. The patient became free of symptoms and during a four-week follow-up his condition remained stable. At the control the patient reported about deterioration of his symptoms as a result of the discontinuation of sleeping in "head-up-tilt" position for two weeks. The objective signs leading to aggravate his symptoms was documented by the tilt table test. We reinstituted the "head-up-tilt" sleeping in his therapeutic management.

[Management of septic complications od acute necrotizing pancreatitis]. / Az akut nekrotizáló pancreatitis szeptikus szövödményének kezeléséröl.

The authors present the case of a 47 year old male patient with acute necrotizing pancreatitis complicated with widespread mesenteric necrosis and abscess. The critically ill patient (APACHE score: 28.5) underwent on seven operations and required 50 days of intensive care. The authors analyse the conditions of successful treatment and emphasize the importance of new available therapeutic approaches and instruments.