[Recognizing delusional misidentification syndromes]. / Misidentificatiewanen herkennen.

Delusional misidentification syndrome is a less common neuropsychiatric symptom and can occur in different diseases as dementia and psychiatric diseases or as part of a somatic disease. It can be difficult to recognise and can give a high burden for the formal caregiver. In this article we describe three cases, the pathophysiology and the possible treatment of a delusional misidentification syndrome.

The interaction between cerebrovascular disease and neuroticism in late-life depression: a cross-sectional study.

OBJECTIVE: Vascular disease and neuroticism are both risk factors for late-life depression. In this study we examined the interaction between vascular disease and neuroticism as determinants of clinically relevant depressive symptoms (CRDS) in late-life. METHODS: Multivariate logistic regression in a survey of 1396 population-dwelling people aged ≥70 years. CRDS were defined as scoring ≥16 on the CES-D. Vascular disease was categorised into four levels: none, ≥2 vascular risk factors, cardiac disease or stroke. RESULTS: Neuroticism was strongly associated with CRDS in women (OR: 1.6, 95% CI: 1.4-1.8). In men vascular disease interacted negatively but significantly with neuroticism (cardiac disease by neuroticism: OR: 0.8, 95% CI: 0.6-0.9; stroke by neuroticism: OR: 0.8, 95% CI: 0.6-0.96) when predicting CRDS. CONCLUSIONS: In men vascular disease attenuates the predictive value of neuroticism in CRDS, which might be mediated by apathy caused by cerebrovascular disease.

Apathy, anhedonia, and psychomotor retardation in elderly psychiatric patients and healthy elderly individuals.

Normal aging of the brain affects the basal ganglia-thalamocortical circuits. These circuits are implicated in several neuropsychiatric disorders. Normal aging may therefore influence the symptomatology of psychiatric disorders in the elderly. We investigated motivational behavior that is associated with the function of these circuits, such as apathy, anhedonia, and psychomotor retardation in healthy elderly subjects and psychiatric inpatients (age > or = 60 yr). Apathy, anhedonia, and psychomotor retardation were assessed with the Apathy Evaluation Scale, the Snaith-Hamilton Pleasure Scale, and the Widlöcher Retardation Rating Scale. Other measurements included the Comprehensive Psychopathological Rating Scale, the Mini-Mental State Examination, and the assessment of vascular risk factors. We found some evidence for age-related changes in motivational behavior. In the healthy elderly group (n = 64), increasing age was associated with anhedonia, and in the patient group (n = 62), increasing age was associated with psychomotor retardation. Motivational disturbances could be the effect of an interaction between brain aging and the neuropathology of psychiatric disorders in the elderly.

The diagnostic value of stapedius reflex and stapedius reflex exhaustion in myasthenia gravis.

Authors studies impedance, stapedius reflex thresholds and stapedius muscle exhaustion on 31 ears of 16 MG patients. Investigations were carried out using GSI 33 computer-assisted middle ear analyzator. Stapedius reflex threshold values were increased in 93% of patients. Stapedius exhaustion was observed in 71% of patients. After the administration of the reversible cholinesterase inhibitor Mestinon (60 mg pyridostigmin bromide), reflex threshold decreased and exhaustion occurred in only 50% of cases. Authors review the literature in context with the audiometric diagnostics of MG and also recommend the use of these methods in more complicated ocular and bulbar cases of MG.

Otoacoustic emission in myasthenia gravis patients and the role of efferent activation.

We performed transient evoked otoacoustic emission (TEOAE) measurements on 29 ears of myasthenia gravis (MG) patients. The purpose of the study was to support the role of acetylcholine (ACh) in the efferent innervation of cochlear outer hair cells (OHCs). Another aim was to establish additional diagnostic tools for the early determination of MG. Initially, threshold audiometry and impedance measurements showed normal values on the ears examined. The main finding was that TEOAE values were significantly lower in MG patients than in healthy controls. Mestinon, a reversible cholinesterase inhibitor, resulted in a significant increase in mean values of TEOAEs, although these values were still lower than normal. The results suggest that in MG, acetylcholine receptor (AChR) autoantibodies inhibit the function of OHC AChRs. Thus, the TEOAE generated by the active movements of OHCs is decreased in MG. Mestinon prevents the degradation of ACh, and thus stimulates efferent function and increases TEOAE values. The results obtained in this study support the role of ACh in the efferent function of OHC, as well as the impaired function of hair cell AChRs in MG patients. Consequently, measuring TEOAEs may be useful in the early diagnosis of some forms of MG. These results reinforce the importance of collaboration between neurologists and otolaryngologists in the management of diseases with pathological neurotransmission.

[The KT 1000 arhtrometer in the comparative study of stability of knee joints operated on for instability]. / Instabilitás miatt operált térdízületek KT 1000 arthrométerrel meghatározott stabilitásának összehasonlító vizsgálata.

In 1981 through 1989 authors performed 160 complex reconstruction operations for instability of the knee joint according to the basic principles of W. Müller, striving to restore all structures injured. 92 patients with 378 operations were controlled. The assessment of the results was based on the physical examination, the measurement of ligament laxity with the K 1000 arthrometer, the opinion of the patients, the level of their activity and Lysholm's functional point system was used. The stability of the knee could be restored in 73 per cent of the cases. The patients have thought the knees, found more stable with the arthrometer, really more stable. There was however no unambiguous relation between the knee stability and the level of activity of the patients. The most frequent complaint was pain, increased synovial fluid and the hindrance of squatting. The results were better if the patient had no previous operation in an other department and in those who did not need menisectomy, who had less operations, less body weight and better muscular force.

[Covering of residual palatal defects by a combination of prostheses]. / Maradék szájpadi defektus fedése kombinált fogpótlással.

We carried out successful oral rehabilitation of a 17 year old female patient, who had a congenital cleft lip and palate. Having been operated on several times, she still had residual cleft on her palate. We used removable metal plate clipped to the cemented circular bridge to cover the communication. It is known that fixed prostodontics are more acceptable for patients, and cause less psychical difficulties, especially in cases of patients with congenital disorders, which have already caused psychical disturbances.

[Measuring the looseness of the knee joint by using the Kt 1000 arthrometer]. / A térd lazaság mérése MEDmetric KT 1000 arthrotméterrel.

Authors measured the stability in the sagittal plane of the intact knee joints of 50 young men with the MEDmetric KT 1000 apparatus. The greatest movement during the measurements on 100 knees was observed in 25 degrees flexion and during the application of force 89N. In 70 degrees flexion the movement was only half of that observed in 25 degrees flexion. The difference of the average movements measured bilaterally was neither in active nor in passive experiments more than 0.5 mm. The difference between the average values of the compliance indexes on the left and right side was only 0.01 mm. In all measurements the frequency distribution of the differences between the two sides was essentially the same. The difference between the movements on the two sides did not exceed 2 mm-s in 90-100 percent of the cases.

Energy-dispersive, bulk specimen X-ray microanalytical measurement of the intracellular Na+/K+ ratio in human laryngeal tumors.

Energy-dispersive X-ray microanalysis was performed on human biopsy materials taken during laryngoscopic intervention in 18 cases. The removed tissue pieces were divided into two parts. One of them was used for pathohistological studies, the other was processed for X-ray microanalysis by the freeze-fracture freeze-drying method. Of the cases investigated 4 proved to be of benign character, whereas the rest contained carcinoma planocellulare keratoides or non-keratoides. Bulk specimen energy-dispersive X-ray microanalysis of 135 cells from the benign tissue samples revealed an average Na+/K+ molar ratio of 0.13 +/- 0.01 (SEM) in the intracellular space, with a regular Gaussian distribution. In the cases of carcinomas 641 cells were measured, the average of the same ratio was 0.67 +/- 0.03 (SEM) due mostly to an increase in the Na+ content. The distribution of data was apparently not normal in the cancerous samples. These observations and some theoretical considerations support the notion that the intracellular Na+/K+ ratio correlates with the proliferative capacity of tissues. The relevance of some recent biochemical results is also discussed in this respect.

[Effect of porphyrin ring ligands on the affinity of heme iron to axial ligands]. / Vliia nie ligandov porfirinovogo kol'tsa na srodstvo zheleza gema k akshal'nym ligandam.

To clarify the influence of protein surrounding on the heme reactivity in heme proteins the effect of interaction between a porphyrin ring and pi-acceptor molecule, 1,2,4-trimethyl-pyridinium (TMP), on the affinity of deuteroheme to axial ligands (imidazole and cyanide) has been studied as a model system. It is shown that TMP induces the fourfold decrease in equilibrium constant of imidazole to deuteroheme. From the analysis of the two stages for cyanide binding it is concluded that TMP decreases the binding constant of the first cyanide by 40 times and does not apparently influence the second ligand binding. The effect of TMP on the reactivity of deuteroheme to axial ligands is interpreted as a result of a decrease in the electron density on the iron orbitals which is due to the altered pi-eleectron density in the porphyrin pi-system through the donor-acceptor interaction with TMP molecules. The possible significance of the contacts between the porphyrin and neighboring amino acid residues in determining heme affinity to axial ligands is discussed.

[Experimental and clinical study of d, 1-oxyphedrin]. / Eksperimental'noe i klinicheskoe izuchenie d, 1-oksifedrina

Comparative pharmacological and toxicological studies were carried out on animals covering the preparation d,1-oxyphedrine (myophedrine), put out in the GDR, as against the drug 1-oxyphedrine. The activity of both drugs showed no material difference. Clinical trials demonstrated good tolerance of the drug both by healthy persons and patients with its intravenous administration twice a day in amounts of 1 mg, or by mouth--3 times a day in amounts of 8--16 mg. In outpatients with anginal pains after sustained myocardial infarction and also in institutionally treated patients with myocardial infarction the activity of d,1-oxyphedrine proved to be not inferior to that of 1-oxyphedrine.