Currently accepted diagnostic criteriafor the Creutzfeldt-Jakob disease are presented.The prion theory of the disease pathogenesis isoutlined and essential data on its epidemiology aregiven. Attention is drawn to some recently obtainedevidence of the "mad cows' disease" effecton the emergence of a new form of human spongyencephalopathy. Clinical characteristics of the diseaseare discussed.
The paper presents the Lyme borreliosis–a disease induced by Gram-negative bacteriatreponemaBorreliaburgdorferi. The disease is moreand more often recognized in Poland due both toavailability of specific serologic methods and toa growing body of knowledge. The treponema reservoirin the natural environment includes rodents,domestic and wild animals, as well as birds, while thebacteria vector are tics of the Ixodes family. Aboveall, the disease affects foresters farmers and huntersas high-risk groups. In the pathogenesis ofborreliosisimmunomodulatory and immunostimulating role of the bacteria cell components should be taken intoaccount. This pertains especially to its surface antigensevoking cross-reactions will other bacteria. Twostages can be distinguished in the course of thedisease: (1) limited infection (an early form), and(2) disseminated infection (multiple erythema migrans,early neuroborreliosis, dermatitis, neurologicalsymptoms, arthralgia symptoms, and pathologicalchanges in other organs). Pathogenesis, clinical pictureand treatment of the disease are discussed, withan emphasis on efficacy of cephalosporins administeredin various forms of borreliosis. As regardsprevention, a preliminary evaluation is presented ofa vaccine introduced in the United States.
The essential method in the laboratorydiagnostics of borreliosis (the Lyme disease)is serologic tests indicating the presence of antibodiesfor Borreliaburgdorferi. The value of test resultsdepends not only on specificity and sensitivityof the method used, but also on the patient's individualcharacteristics and on his/her antibodieslevel. In order to avoid false positive and falsenegative serologic tests results, either a highly specific and sensitive ELISA test with appropriatelymatched B. burgdorferi protein fractions as the diagnosticantigen should be wed, or a two-stageexamination is recommended, i.e. positive anddoubtful positive screening test results should beconfirmed by means ofthe Western-blot technique.Due to a limited sensitivity of serologic tests .in some cases, the PCR test may serve as an auxiliarydiagnostic technique. The diagnostic valueof both serologic test and PCR results dependson appropriate selection of clinical material fortest purposes.
Classification of the rabies virusand epidemiology of the disease in all continents inrecent years are discussed in the paper. A typicalcourse of rabies infection in man and in some domesticand wild animals is presented. Laboratorydiagnostics of rabies, using mostly immunofluorescencemethods, is highly sensitive. The currentlymost important method of the disease preventionconsists in putting out oral vaccine for animalsliving in the wild, especially for foxes. Since verygood results have been obtained using this methodin Western regions of Poland, it is presently beingimplemented all over the country.
Cytokines are produced by the immunological, hormonal and nervous system cells. They consist of peptides and proteins affecting cell junctions and their mutual interactions. The role of cytokines in the central nervous system (c.n.s.) is complex. They not only control proliferation and differentiation of cells, but also participate in inflammatory reactions (becoming also a pathogenic factor), and in reparatory processes. The role of various types of cytokines is discussed as regards the occurrence of inflammatory reaction in the nervous tissue, immunological activation of glial cells, and determining the course of inflammatory diseases. Examples of the crucial role of cytokines in some inflammatory diseases are given.
An attempt was made to assess theeffect of the direction of the puncture needle insertionon the frequency of headaches following the lumbar puncture. Data obtained from 150 lumbarpunctures indicate that if the needle bevel is parallelto longitudinal fibers of spinal duramater,then the incidence of headache after the punctureis significantly lower.
Due to their multifarious action statinesare a promising drug in the pharmacotherapyof dyslipidemia. The paper presents the role of thisgroup ofpharmaceuticals in the prevention of atherosclerosis,as well as their side effects concerning the central and peripheral nervous system.
Bladder dysfunction found in over70% of patients with sclerosis multiplex (SM) leads to severe problems, usually in later stages of the disease. The most frequent bladder disturbancesinclude hyperreflexia of the detrusor muscle,and dyssynergia between the detrusor and sphincter.The most important test of bladder dysfunctionis an assessment of the degree of bladdervoiding by the patient on his own. The treatment is long lasting and requires not only considerableflexibility, but also a good co-operation betweenthe patient, his neurologist and urologist. Anappropriate treatment may considerably relievethe ailments.
Imidazoline (I) receptors in thebrain and their role in the pathogenesis of mentaldisorders are discussed. I1 and I2 receptors were found to be of importance in the etiology of depression,panic attacks, generalized anxiety, obsessive-compulsive disorder, schizophrenia, mania,alcohol dependence, and drug abuse. I receptorsparticipate in the mechanism of action of MAOinhibitors, antagonists of serotonin re-uptake, andtricyclic antidepressants. Endogenous agonists of I receptors are neurotransmitters in the centralnervous system (c.n.s.). Their neuromodulatoryaction is not excluded. Many research findings evidencethat the imidazoline system disorders mayresult in a decreased release of noradrenalin (NA)and serotonin (5-HT) in the c.n.s. and in depressivesymptoms.
The paper presents the state-of-the-art knowledge (clinical observations, experimentalresearch results andfindings obtained by means of neuroimaging techniques) about the cerebrallateralizationof emotions in healthy people, patients withmental disorders, and patients with unilateral brainlesions. An attempt was made to systematize methodsused in the research on emotions. A large number of studies, diversity of research procedures used to assesscerebrallateralization of emotions, discrepanciesin obtained researchfindings indicate the complexityof cerebral hemispheres specialization and collaboration,as well as the lack of a consistent theory of theresearch subject.
The effect of brain damage, andparticularly, of motor disorders and emotional factors, on the course of relaxation was analyzed.Subjects in the study were 60 patients withbrain damage of various etiologies and 45 healthycontrols. Relationships between 3 relaxation parameters(frequency, intensity and duration) andspastic hypertonia, paresis, decreased general physicalfitness and frequency of experiencing selectednegative and positive emotions were assessed.Brain damaged patients differed significantly fromthe controls as regards frequency, intensity andduration of relaxation. A significant, althoughweak association was found between spastic hypertoniaand all the three relaxation parameters.Motor disorders were related only to the frequencyand intensity of relaxation. Out of a number of analyzed emotions only three turned outto be related to all the relaxation parameters,and namely: joy, satisfaction, and acceptance of one's illness.
An overview is presented of studiespublished in the past decade, on changes of psychologicalfunctioning in patients after surgical treatmentof the ischaemic heart disease. An impairmentof mental status after surgical cardiac revascularizationby means of coronary artery bypass graft(CABG) was found in about 25% of cases. Amongpsychopathological symptoms depression and anxietypredominated. The most frequently described predictorsidentifying patients from the high-risk grouppre-operatively are the following: depression,anxiety, female gender, lack of social support, a lowsocioeconomic status, and a weak mechanism ofrepression. It is believed that high-risk individualsmay be offered a prevention program in the form ofpsychological assistance to facilitate their recoveryto fully adequate psychosocial functioning.
The paper presents an evolution of the terminology and meaning of the notion of a disorder determined by many factors and currentlyknown as the "alcohol dependence syndrome".Characteristic features of the syndrome include psychologicaland physical dependence, as well aschanged alcohol tolerance. Diagnostic criteria of alcohol dependence according to the internationalclassification of diseases are listed. Specific traits of alcohol dependent persons' behavior during themedical interview and their most frequent ailmentsare outlined. The issue of epileptic fits in such casesis mentioned. As regards alcohol treatment, essential requirements for conducting psychotherapy arereminded. Results attained by AA groups participationand the 12 Steps approach are highlighted.