Rates of electroconvulsive therapy use in Hungary in 2002.

OBJECTIVE: In Hungary there has been no systematic evaluation of ECT use since 1992. Nine years ago, the legal regulation of ECT practice changed. Since 1994, the collaboration of a specialist in anesthesiology is a legal obligation. However, the introduction of the new antipsychotic and antidepressant drugs expanded the possibilities in psychopharmacological treatment. These events basically influenced ECT use. The aim of this study was to obtain an overview of ECT practice in Hungary after these changes. METHODS: A 13-item containing questionnaire was sent to all psychiatric departments. RESULTS: All departments except 1 replied by mail, by phone, or by e-mail. Forty-three departments indicated the use of ECT, but in clinical practice only 34 departments applied ECT in 2002. The average number of treated inpatients was 9 on ECT using departments. Altogether 0,6% of all hospitalized psychiatric inpatients received ECT in 2002. The indication for ECT was schizophrenia in 55.6% of the patients and affective disorder in 40% of the cases. Mostly bitemporal electrode placement was used usually thrice weekly. Most commonly used sleep induction agents were thiopental and propofol. CONCLUSION: The rate of ECT use in Hungary is significantly lower than in the United States, in the United Kingdom, or in the Scandinavian countries and similar than in Hong Kong. The indication of ECT was schizophrenia in 55.6% of the cases.

Importance of platelet functions in Alzheimer's disease.

The function of platelets of patients with Alzheimer's disease has been characterized. The shape of platelets is more spherical and the initial rate of platelet aggregation caused by different agonists measured in plasma is faster in the case of Alzheimer's disease and senile dementia of the Alzheimer-type than that of other demented patients: multi infarct dementia and probable vascular dementia. Although fast aggregation is characteristic of activated platelets but the Alzheimer platelets are not hypersensitive. The activation of Alzheimer platelets makes the velocity of ADP induced aggregation slower and it is different than the behaviour of normal activated platelets. The shape-associated parameter and the initial rate of 50 microM ADP-induced aggregation of platelets non-activated and activated by cytochrome C are recommended for establishing the diagnosis of Alzheimer's disease and senile dementia of the Alzheimer-type. The evaluation of these parameters has been discussed. The cytochrome C may be useful to normalize the function of Alzheimer platelets in plasma, not only in vitro.

[Echocardiographic diagnosis of intermittent failure of a mitral valve prosthesis]. / Intermittáló mitralis mübillentyü "beragadás" echocardiographiás diagnózisa.

Three cases are reported who had intermittent diastolic jamming of a mitral tilting disc valve. The clinical presentation of this unfrequent but catastrophic early postoperative complication was different in all cases: the first patient presented with heart failure, the third patient had loss of consciousness with enuresis and the second patient was asymptomatic at the time of the diagnosis. Electromechanical dissociation was first suspected by clinical examination in 2 cases but it was confirmed in all 3 cases by 2 dimensional and Doppler echocardiography. Transesophageal echocardiography did not provide any additional information. Besides opening failure of the valve Doppler echocardiography also demonstrated incomplete or delayed opening in the asymptomatic period. Survival is dependent on correct diagnosis and urgent surgical treatment of this type of prosthetic valve dysfunction.

[Transcranial Doppler sonographic study of the effect of electroconvulsive therapy on the circulation in the median cerebral artery]. / Az electroconvulsiv kezelés transcranialis Doppler sonographiás módszerrel megfigyelt hatása az arteria cerebri media keringésére.

The authors monitored the circulation of middle cerebral artery in subdominant hemisphere using the transcranial Doppler sonographic method during electroconvulsive treatment. They intravenously administered the patient 500 mg propanididum to put him/her to sleep and 150 mg of suxamethonium for muscle relaxation. The phasis of narcosis and awakening were continuously recorded under the treatment. After the administration of propanididum a sudden brief rise in flow velocity was measured with transient bradycardia followed by tachycardia. After the muscle relaxation the peak flow velocity diminished long lasting and the mean flow velocity fell from 60 cm per second to 30 cm per second average. At the beginning of the electroconvulsive treatment the velocity suddenly rose. The flow velocity increased significantly during the clonic phase of convulsive jerks with the pulsatility indices falling rapidly. Very low pulsatility indices lasted for long period of time during and following clonic convulsions.

Phage pattern and antibiotic resistance pattern of coagulase-negative staphylococci obtained from immunocompromised patients.

A total of 152 coagulase-negative staphylococcal strains were isolated from clinical samples of 14 patients hospitalized after bone-marrow transplantation in a specialized hospital ward in Hungary, during an 18-month period between 1987 and 1989. Two species, Staphylococcus epidermidis and Staphylococcus haemolyticus, predominated (each, 45%). Using Pulverer and co-workers' phage set for typing, 68% of the isolates were typable; 16 phage patterns were observed. A characteristic long pattern with phages Ph10/Ph13/Ph15/U4/U15/U16/U20/U33 /U46 appeared only in S. epidermidis, among 5 of 11 colonized patients (8.5% of all strains). Single lysis with phage Ph13 was observed in 7 of the 14 patients (49% of all strains), in species S. capitis, S. epidermidis, S. haemolyticus, S. hominis, and S. warneri. In S. haemolyticus, non-typable strains predominated (66%); this character occurred only in 2% among other species. The strains colonizing the immunocompromised patients differed from each other in phage pattern, antibiotic resistance pattern, and/or slime production. No hospital infection was suggested. On the other hand, high incidence of two well-definable phage patterns raises some relationship between phage receptors or some regulatory systems in phage multiplication and factors responsible for special colonization as common surface properties.

[Subclavian steal syndrome examined by transcranial Doppler sonography]. / A subclavian steal syndroma transcranialis Doppler sonographiás leletéröl.

Authors are presenting the diagnostic problems of subclavian steal syndrome, they are using the transcranial Doppler sonography (TCD). This method completes the traditional sonographic possibilities. With help of specific signs there is the possibility to confirm the clinical diagnosis and we can reach data from the dynamic of cerebral circulation and the situation of the circulation of the intracerebral collateral system, too. Authors briefly summarise the clinical signs of subclavian steal syndrome and the verification of the signs and the opinions, concerning the angiographic and sonographic method and the possibilities of surgical treatment.

[Transcranial Doppler sonography]. / A transcranialis Doppler sonographia.

The authors present the method of transcranial Doppler sonography and that technic of this method, too. Briefly describe the clinically important physical parameters. They present the possibility of use this method in clinical practice, referring the frequency analysis, the investigation of flow figures in the cerebrovascular diseases, respectively in stenosis, occlusions, malformations of blood vessels and the diagnostic possibilities in aneurysms.

[Gilles de la Tourette's disease]. / A propos de la maladie de Gilles de la Tourette.

The case of a seventeen-year-old girl in whom typical particularly disabling Gilles de la Tourette syndrome had developed three years earlier is reported. The usual therapeutic agents (benzodiazepines, clomethiazole, paraldehyde, choline chloride) had proved totally or partially ineffective. Under 300 mg of tiapride per day given intramuscularly, the hyperkinesia and phonatory tics resolved rapidly. Conversion to a daily dosage of 900 mg of tiapride given orally ensured the permanence of this improvement and the patient was able to resume a nearly normal life.

[A clinical trial of tiapride in neurology (author's transl)]. / Expérience clinique du tiapride en neurologie.

Results in twenty-three patients given tiapride are reported on. As an analgesic, tiapride's efficacy was questionable. In patients with delirium, sedation was not completely satisfactory; however, this may be due to the small number of patients and to the low doses given. The excellent results recorded in patients given tiapride for extrapyramidal hyperkinesia due to various etiologies are consistent with previous reports in the medical literature.