Současná neuropsychologie značnou měrou přispívá k pochopení těch aspektů schizofrenního onemocnění, které přímo souvisí s kognicí. Jedním z vlivných neuropsychologických přístupů je takzvaná dyskonekční hypotéza, která předpokládá, že dysfunkční nejsou pouze jednotlivé oblasti mozku schizofrenních pacientů, ale hlavně komunikace mezi těmito oblastmi. Podkladem dyskonekce může být dysfunkce na anatomické, neurochemické nebo funkční úrovni. Tento článek se primárně zaměřuje na úroveň poslední a zužuje svou pozornost na dysfunkční komunikaci mezi frontálním a temporálním kortexem. Je zde nastíněn vývoj takzvané funkční fronto-temporální dyskonekce a podrobněji popsány možné souvislosti této dyskonekce s rozličnými kognitivními poruchami a psychiatrickými fenomény. Zdá se, že by narušená komunikace mezi zmiňovanými oblastmi mohla být jednou z příčin poruch paměti, řeči nebo exekutivních funkcí u schizofrenie. Mohla by také vysvětlit princip vzniku některých sluchových halucinací. Jestli lze funkční fronto-temporální dyskonekci považovat také za trait marker schizofrenie je ještě třeba potvrdit.
Contemporary neuropsychology contributes extensively to the understanding of those aspects of schizophrenia that are directly related to cognition. One of the most influential approaches to schizophrenia is the so-called 'disconnection hypothesis'. This approach assumes that, in addition to disfunctions in separate brain regions, communication between them is disturbed. The cause of the disconnection may be in anatomical, neurochemical or functional disturbances. This article is aimed at functional disconnection and pays attention to dysfunctional communication between the frontal and temporal lobes. It also outlines the development of the so-called functional fronto-temporal disconnection and its hypothetical connection to various cognitive dysfunctions and psychiatric phenomena. The disturbed communication between frontal and temporal regions may cause memory, speech or executive dysfunctions. The fronto-temporal disconnection could also explain how some auditory hallucinations arise. It is not clear whether this disconnection could be one of the trait markers of schizophrenia.
V práci na základe skúsenosti pracoviska od roku 1983 sa analyzuje postavenie azygoportálnej dekonexie v liečbe komplikácií portálnej hypertenzie. V porovnaní celého obdobia počet výkonov klesol na podklade extenzívneho použitia endoskopickej diagnostiky a liečby. Azygoportálna dekonexia však naďalej ostáva súčasťou chirurgickej intervencie v indikovaných prípadoch, hlavne pri sekundárnom hypersplenizme a nezvládnuteľnom krvácaní.
Based on experience at their department since 1983 the authors analyze the position of the azygoportal disconnection in the treatment of complications of portal hypertension. During the observation period the number of operations declined due to extensive use of endoscopic diagnosis and treatment. However the azygoportal disconnection still remains part of surgical intervention in indicated cases, in particular in secondary hypersplenism and profuse haemorrhage.
Autoři poukazují ve své práci na dobré výsledky dekonexe při krvácení z jícnových varixů a to jak v bezprostředním průběhu, tak i dlouhodobém. Zejména je zdůrazněna ta okolnost, že dekonexi lze použít i tehdy, kdy jiné metody jsou z různých důvodů neproveditelné. Tento fakt dokládají autoři na třech nemocných, jejichž složitá anamnéza i celkový stav vedly k tomu, že dekonexe byla jediným východiskem z dané situace.
The authors draw attention to their favourable results of disconnection in haemorrhage of oesophageal varices.This favourable result applies to immediate results as well as long-term results. They emphasize in particular the fact that disconnection can be used also when other methods are not feasible for various reasons. This fact is demonstrated by the authors on three patients whose complicated history and general condition were such that disconnection was the only solution of the situation.
In a subset of patients with acute necrotizing pancreatitis, segmental necrosis affecting the main pancreatic duct may result in a discontinuity between the left-sided pancreas and the duodenum. Such an interruption in the setting of a viable upstream portion of the gland can give rise to the disconnected pancreatic duct syndrome (DPDS). By maintaining its secretory function, the disconnected segment may lead to persistent external pancreatic fistulae, recurrent pancreatic fluid collections, and/or obstructive recurrent acute or chronic pancreatitis of the isolated parenchyma. There are currently no universally accepted guidelines for the diagnosis or treatment of DPDS, and because the condition is underrecognized, the diagnosis is often delayed. DPDS is associated with a prolonged disease course and poses a burden on patients' quality of life as well as high health care resource utilization. The aim of our review is to summarize current knowledge, discuss diagnostic approaches, outline management options, and raise awareness of this challenging complication of necrotizing pancreatitis.
- Publication type
- Journal Article MeSH
A 4-year-old girl with intractable epilepsy due to left-side hemispheric cortical dysplasia underwent a hemispherotomy. She was seizure-free after the surgery. EEG showed persistent abundant epileptiform activity over the left (disconnected) hemisphere, including ictal patterns that neither generalised nor had clinical correlates. Antiepileptic medication was completely withdrawn four years following the surgery. One week after the withdrawal, she developed episodes of intense left-sided hemicranias (ipsilateral to the surgery) with vomiting and photophobia that did not resemble her habitual seizures and were unresponsive to non-steroidal anti-inflammatory drugs. Video-EEG showed association of the headache attacks with ictal patterns over the disconnected hemisphere. Brain MRI revealed increased signal changes in the left hemisphere. Attacks responded promptly to i.v. midazolam and carbamazepine at a low dose. Mechanisms underlying peri-ictal headache originating in the disconnected hemisphere are discussed. [Published with video sequences].
- MeSH
- Anticonvulsants therapeutic use MeSH
- Headache complications pathology MeSH
- Electroencephalography MeSH
- Epilepsy complications pathology surgery MeSH
- Functional Laterality MeSH
- Hemispherectomy MeSH
- Carbamazepine therapeutic use MeSH
- Humans MeSH
- Midazolam therapeutic use MeSH
- Brain pathology MeSH
- Neurosurgical Procedures MeSH
- Child, Preschool MeSH
- Seizures complications pathology MeSH
- Check Tag
- Humans MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Souhrn: Akutní pankreatitida je reverzibilní zánětlivý proces pankreatu, který může být provázen lokálními a systémovými komplikacemi. U podskupiny pacientů s těžkou akutní pankreatitidou může vést nekróza zasahující hlavní pankreatický vývod k diskontinuitě mezi levostrannou částí pankreatu a duodenem. Při zachování exokrinní funkce takto izolované distální části žlázy vzniká syndrom odpojeného pankreatického vývodu, který je všeobecně považován za diagnosticky a terapeuticky obtížný stav. Tento syndrom je spojen s vleklým průběhem, snížením kvality života pacientů a jeho léčba je náročná na zdroje zdravotní péče. V současné době nemáme k dispozici všeobecně akceptovaná doporučení pro diagnostiku a léčbu, syndrom je často opomíjen a stanovení diagnózy opožděno. Cílem našeho přehledového článku je zvýšit povědomí o této závažné komplikaci akutní pankreatitidy.
Summary: Acute pancreatitis is a reversible pancreatic inflammatory process that may be accompanied by local and systemic complications. In a subset of patients with severe acute pancreatitis, necrosis affecting the major pancreatic duct may result in a discontinuity between the left-sided pancreas and duodenum. Such an interruption in the setting of a viable upstream portion of gland parenchyma gives rise to the disconnected pancreatic duct syndrome, which is generally regarded as a diagnostically and therapeutically diffi cult condition. The syndrome is associated with a prolonged disease course and poses a burden on patients’ quality of life and high health care resource utilization. There are currently no universally accepted guidelines for the diagnosis and treatment, the syndrome is often neglected and diagnosis delayed. The aim of our review article is to raise awareness of this serious complication of acute pancreatitis.
- Keywords
- pankreatické vývody, syndrom odpojeného pankreatického vývodu, ohraničené nekróza,
- MeSH
- Pancreatitis, Acute Necrotizing MeSH
- Diagnostic Imaging methods MeSH
- Humans MeSH
- Necrosis MeSH
- Pancreatic Fistula pathology therapy MeSH
- Pancreatic Pseudocyst diagnosis pathology therapy MeSH
- Pancreatitis * diagnosis complications therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
INTRODUCTION: Psilocybin is one of the most extensively studied psychedelic drugs with a broad therapeutic potential. Despite the fact that its psychoactivity is mainly attributed to the agonism at 5-HT2A receptors, it has high binding affinity also to 5-HT2C and 5-HT1A receptors and indirectly modulates the dopaminergic system. Psilocybin and its active metabolite psilocin, as well as other serotonergic psychedelics, induce broadband desynchronization and disconnection in EEG in humans as well as in animals. The contribution of serotonergic and dopaminergic mechanisms underlying these changes is not clear. The present study thus aims to elucidate the pharmacological mechanisms underlying psilocin-induced broadband desynchronization and disconnection in an animal model. METHODS: Selective antagonists of serotonin receptors (5-HT1A WAY100635, 5-HT2A MDL100907, 5-HT2C SB242084) and antipsychotics haloperidol, a D2 antagonist, and clozapine, a mixed D2 and 5-HT receptor antagonist, were used in order to clarify the underlying pharmacology. RESULTS: Psilocin-induced broadband decrease in the mean absolute EEG power was normalized by all antagonists and antipsychotics used within the frequency range 1-25 Hz; however, decreases in 25-40 Hz were influenced only by clozapine. Psilocin-induced decrease in global functional connectivity and, specifically, fronto-temporal disconnection were reversed by the 5-HT2A antagonist while other drugs had no effect. DISCUSSION: These findings suggest the involvement of all three serotonergic receptors studied as well as the role of dopaminergic mechanisms in power spectra/current density with only the 5-HT2A receptor being effective in both studied metrics. This opens an important discussion on the role of other than 5-HT2A-dependent mechanisms underlying the neurobiology of psychedelics.
- Publication type
- Journal Article MeSH
Patients with Alzheimer's disease (AD) related dementia and mild cognitive impairment experience difficulties with spatial navigation (SN). However, SN has rarely been investigated in individuals with subjective cognitive decline (SCD), a preclinical stage with elevated progression rate to symptomatic AD. In this study, 30 SCD subjects and 30 controls underwent cognitive scale (CS) evaluation, a 2D computerized SN test, and resting-state functional magnetic resonance imaging scanning. Two SN brain networks (ego-network and allo-network), each with 10 selected spherical regions, were defined. We calculated the average network functional connectivity (FC) and region-to-region FC within the two networks and evaluated correlations with SN performance. Compared with the controls, the SCD group performed worse in the SN test and showed decreased FC between the right retrosplenial and right prefrontal cortices in the ego-network, and between the right retrosplenial cortex and right hippocampus in the allo-network. The logistic regression model based on SN and FC measures revealed a high area under the curve of .880 in differentiating SCD individuals from controls. These results suggest that SN network disconnection contributes to spatial deficits in SCD, and SN and FC measures could benefit the preclinical detection of subjects with incipient AD dementia.
