bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal Osteodystrophy in Developing Countries
Authors: Afifi Adel
Published: March 2003

Abstract: There are distinct differences between developing and developed countries regarding the pathogenesis and management of renal osteodystrophy. Such differences are due to ethnic factors, dialysis quality, types of membranes, dialysate water, lack of technical facilities to perform bone biopsies, β2‐microglobulin, aluminium and strontium toxicity, and iron overload as well as economic factors hampering the use of effective yet more expensive phosphate binders and active vitamin D. The prevalence of renal osteodystrophy in developing countries is higher than in developed countries. It ranges from 24.4% to 63%. Aluminium related bone disease is a common cause. High strontium levels and iron overload in developing countries play a major role in the development of renal bone disease among dialysis patients.
Online Parameter Identification of Second‐Order Systemic Circulation Model Using the Delta Operator
Authors: Kosaka Ryo , Sankai Yoshiyuki , Jikuya Tomoaki , Yamane Takashi , Tsutsui Tatsuo
Published: March 2003

Abstract: To develop effective medical care with the artificial heart, we proposed a new method that can calculate the time varying and unmeasured hemodynamics of the human body from measured physiological data: aortic pressure, aortic flow, and pump flow in real time. This method comprises first, the second order of systemic circulation model, which consists of aortic compliance (Ca), aortic resistance (Ra), aortic inertia (L), and total peripheral resistance (Rp); and second, system identification using the delta operator. In the computer simulation, we confirmed the effectiveness of this method. During the animal experiment with the left ventricular assist system, the physiological parameters could be identified online: mean Ra = 0.04 mm Hg s/ml, mean Ca = 0.65 mm Hg/ml, mean L = 0.004 mm Hg s2/ml, and mean Rp = 0.3 mm Hg s/ml. This new method efficiently identified the physiological parameters, which are important not only to support the medical care but also to develop the control method adapted to the physiological behavior.
Extracorporeal Membrane Oxygenator Compatible with Centrifugal Blood Pumps
Authors: Motomura Tadashi , Maeda Tomohiro , Kawahito Shinji , Matsui Takahiro , Ichikawa Seiji , Ishitoya Hiroshi , Kawamura Masaki , Nishimura Ikuya , Shinohara Toshiyuki , Oestmann Daniel , Glueck Julia , Kawaguchi Yoichiro , Sato Koshiro , Nosé Yukihiko
Published: March 2003

Abstract: Coil‐type silicone membrane oxygenators can only be used with roller blood pumps due to the resistance from the high blood flow. Therefore, during extracorporeal membrane oxygenation (ECMO) treatment, the combination of a roller pump and an oxygenator with a high blood flow resistance will induce severe hemolysis, which is a serious problem. A silicone rubber, hollow fiber membrane oxygenator that has a low blood flow resistance was developed and evaluated with centrifugal pumps. During in vitro tests, sufficient gas transfer was demonstrated with a blood flow less than 3 L/min. Blood flow resistance was 18 mm Hg at 1 L/min blood flow. This oxygenator module was combined with the Gyro C1E3 (Kyocera, Japan), and veno‐arterial ECMO was established on a Dexter strain calf. An ex vivo experiment was performed for 3 days with stable gas performance and low blood flow resistance. The combination of this oxygenator and centrifugal pump may be advantageous to enhance biocompatibility and have less blood trauma characteristics.
Systemic Consequences of Ventricular Assist Devices: Alterations of Coagulation, Immune Function, Inflammation, and the Neuroendocrine System
Authors: Hampton Craig R. , Verrier Edward D.
Published: March 2003

Abstract: Implantable ventricular assist devices have proven efficacious as a bridge to transplantation and as a bridge to recovery. Although current indications for use of assist devices are somewhat limited, they are likely to expand in the upcoming years, including their use as destination therapy for end‐stage heart failure. Recipients of assist devices, however, are prone to certain device‐specific complications, including excessive postoperative bleeding, late propensity for thromboembolism, infections, and systemic inflammation, which may contribute to end‐organ dysfunction. This article reviews the systemic biochemical alterations underlying these clinical phenomena. As assist devices are increasingly used, better understanding of these systemic perturbations is imperative.
Nonlinear Controller for Ventricular Assist Devices
Authors: Giridharan Guruprasad A. , Skliar Mikhail
Published: March 2003

Abstract:This paper presents the design of a gain‐scheduled proportional integral (PI) feedback controller for ventricular assist devices to maintain physiologically motivated perfusion. The selected control objective is to maintain an average differential pressure ΔPbetween the left ventricle and the aorta. Computer simulations for different pathological conditions, ranging from the normal heart to left heart asystole, and a wide range of physiological scenarios, ranging from rest to strenuous exercise, were used to validate the performance of the controller and the effectiveness of the selected control objective in ensuring physiologically adequate perfusion under different clinical and cardiac demand conditions.
Improved Therapeutic Efficacy in Cardiomyocyte Transplantation for Myocardial Infarction with Release System of Basic Fibroblast Growth Factor
Authors: Yamamoto Masaya , Sakakibara Yutaka , Nishimura Kazunobu , Komeda Masashi , Tabata Yasuhiko
Published: March 2003

Abstract: Several studies have demonstrated that cell transplantation was effective for the therapy of myocardial infarction. However, little care has been taken for the blood supply indispensable to cell transplantation. This study is an investigation to evaluate the feasibility of in advance angiogenesis by gelatin microspheres incorporating basic fibroblast growth factor (bFGF) for the transplantation therapy of cardiomyocytes with an ischemic cardiomyopathy model. Rats with myocardial infarction received the intramuscular injection of culture medium (Control), or that containing fetal cardiomyocytes (TX) or gelatin microspheres incorporating bFGF (FGF), and gelatin microspheres incorporating bFGF plus fetal cardiomyocytes 1 week later (FGF‐TX). The left ventricle (LV) function of rat hearts was assessed by echocardiography and cardiac catheterization 4 weeks later. The LV maximum time‐varying elastance was significantly higher in the FGF‐TX group than in other groups. The combination of bFGF‐induced angiogenesis and cardiomyocyte transplantation is a promising procedure to improve the LV function in rats with myocardial infarction.
In Vivo Test of Pressure Head and Flow Rate Estimation in a Continuous‐Flow Artificial Heart
Authors: Tanaka Akira , Yoshizawa Makoto , Abe Ken‐ichi , Takeda Hiroshi , Yambe Tomoyuki , Nitta Shin‐ichi
Published: March 2003

Abstract: To avoid using sensors with low biocompatibility and low durability in implantable total artificial heart (TAH) systems, the authors previously proposed a new method for estimating instantaneous values of flow rate and pressure head on the basis of voltage, current, and rotational speed in a motor driven centrifugal pump. The previous in vitro experiments showed that the proposed estimator could automatically compensate for the effect of the change in blood viscosity on the estimation accuracy by employing two kinds of autoregressive exogenous models. In this study, validity and reliability of this estimation method were ascertained in an acute animal experiment. In the experiment, two centrifugal blood pumps were implanted into an adult goat as a total artificial heart. Results of estimation were compared with true values when blood viscosity was changed by injecting physiological saline. The results indicated that the system could successfully estimate pressure head by compensating the change of viscosity, although the estimation accuracy of the in vivo estimation was not so high as that of the previous in vitro tests.
Initial In Vivo Experience of the VentrAssist Implantable Rotary Blood Pump in Sheep
Authors: Meer Anita L. van der , James Natalie L. , Edwards Glenn A. , Esmore Donald S. , Rosenfeldt Franklin L. , Begg John D. , Woodard John C.
Published: March 2003

Abstract: VentrAssist (VentrAssist Division, Ventracor Ltd., Chatswood, NSW, Australia) has developed an implantable centrifugal blood pump with an integrated rotor and impeller that is hydrodynamically suspended. Bench testing has been used to assess the performance of the pump under a broad range of operating conditions. This study examined the performance of the pump in vivo up to 90 days implantation. Pumps were implanted via a left lateral thoracotomy. The inflow cannula was inserted at the apex of the left ventricle. The outflow cannula was anastomosed to the descending thoracic aorta. Eighteen implants were performed. Poor recovery from surgery was the main cause of early study termination. These studies demonstrate the suitability of the animal model for evaluation of the VentrAssist rotary blood pump. Further in vivo studies prior to preclinical trials are in progress.
A Study on an Energy Supply Method for a Transcutaneous Energy Transmission System
Authors: Ozeki Toshinaga , Chinzei Tsuneo , Abe Yusuke , Saito Itsuro , Isoyama Takashi , Ono Toshiya , Kouno Akimasa , Ishimaru Mitsuhiko , Takiura Koki , Baba Atsushi , Toyama Takahiro , Imachi Kou
Published: March 2003

Abstract: This study proposes a new type of a transcutaneous energy transmission system (TETS) that can supply electrical power for an implanted device without an external battery. In this system, the power is supplied from the floor to the shoes of the patients through coils that are set beneath the floor and the bottom of the shoes. If the patients wear the special shoes, they will be able to move freely on the specially designed floor without an external battery. Direct current (DC)‐DC power efficiency was measured in the experiments, and the results showed that it varies with relative positions between the shoe and the floor coils. The results suggested that three‐layered floor coils would enable the system to meet the demand for providing the required power anywhere on the floor without intermission. DC‐DC power efficiency could be kept over 60% under the practical condition. It can then be concluded that the proposed system has a potential to provide better quality of life for the patients using a TETS.
Total Artificial Heart: The Adaptation and Pathophysiological Deviations in the Recipient
Authors: Vašků J. , Dobšák P.
Published: March 2003

Abstract: In the short historical review the principal technical and pathophysiological approaches of the Czech total artificial heart (TAH) research are emphasized. Survival was endangered by arterial and venous hypertension, especially the central venous pressure (CVP) increase, mineralization of driving diaphragms, thromboembolization, and infection. By the appropriate combination of antihypertensive, antimineralization, and anticoagulation treatment and of measures against infection, the survival of the experimental calves was increased (the longest one was 314 days of pumping). Technical and constructional improvement of the blood pumps was another cause of successful experiments. All details are issued in the references.
Computational Flow Visualization in Vibrating Flow Pump Type Artificial Heart by Unstructured Grid
Authors: Kato Takuma , Kawano Satoyuki , Nakahashi Kazuhiro , Yambe Tomoyuki , Nitta Shin‐ichi , Hashimoto Hiroyuki
Published: March 2003

Abstract: Computational flow visualization in the casing of vibrating flow pump (VFP) was made for various conditions based on the novel techniques of fluid dynamics. VFP type artificial heart can generate the oscillated flow and can be applied to the left ventricular assist device. Flow pattern of blood in an artificial heart is closely connected to mechanical performance and serious biomechanical problems such as hemolysis and blood coagulation. To effectively design the VFP for a left ventricular assist device, the numerical codes for solving Navier‐Stokes equations were developed for three‐dimensional blood flow based on the finite volume method. Furthermore, the simulation techniques based on the artificial compressibility method and the unstructured grid were also developed here. The numerical calculations were based on the precise configurations and the flow conditions of the prototype device. From the viewpoint of computational fluid dynamics (CFD), the detailed discussion of flow patterns in the casing of VFP, which were closely connected with hemolysis and blood coagulation, was made and the computational results were visualized by the use of the recent technique of computational graphics. Some useful design data of VFP were presented.
Looking for a Path to Sustainability in Eastern Siberia
Authors: Glazyrina Irina P.
Published: March 2003

ABSTRACT

The purpose of this work is to describe a version of sustainable development strategy for the so‐called “resource dependent territories” (RDT) of Eastern Siberia, which is based on a paradigm of “the infinite value of the integrity of an ecosystem.”

The main feature of RDTs is that the use of nature (natural resources) is practically the only source of economic growth for these regions. This is the result of a long history of previous economic development. RDTs have enormous possibilities both for the destructive and environmentally acceptable use of nature. However, incomes from the destructive use are far greater than those derived from renewable use. The differences often reach two‐to‐three orders of magnitude. We cannot expect market mechanisms in the economies of the RDTs to guarantee a sustainable use of the environment.

It is declared a priori that the value of ecosystem integrity is much larger than any benefit from the use of its resources. This paradigm can be supported by a comprehensive system of institutional and legal tools. The main directions of this strategy should be defined as follows:
Epidemiology and Ecosystem Health: Natural Bridges
Authors: Rapport David J.
Published: March 2003

ABSTRACT Epidemiologic concepts have important applications in the assessment of ecosystem health and ecosystem health is a critical determinant of some epidemiologic events. Thus the two are intimately interrelated and concepts from one find ready applications in the other. The temporal and spatial spread of ecological degradation across the earth's ecosystems has some of the characteristics of an epidemiologic process, with humans as the “infective” agent. Elevated disease prevalence in both plants and animals is one of the key indicators of ecosystem pathology, and conversely, pathologic ecosystems place increased risks to the health of all components, thus ecosystem health becomes a major determinant of risks to the health of component populations. These relations suggest important links between the areas of epidemiology, phytopathology, and systems ecology. Understanding these links can provide enhanced capacities for diagnosis and risk assessment in all three areas.
Lead Shot Contamination in Edible Portions of Game Birds and Its Dietary Implications
Authors: Tsuji Leonard J.S. , Nieboer Evert , Karagatzides Jim D. , Hanning Rhona M. , Katapatuk Billy
Published: March 2003

ABSTRACT Lead exposure for First Nation Cree of the Mushkegowuk region (western James Bay area of northern Ontario, Canada) through ingestion of game hunted with lead shot is of concern and was investigated in this study. All lead concentrations in tissues of mammals (n = 45) and fish (n = 30) harvested in the Mushkegowuk Territory were at a level below the guideline set by Health Canada for human consumption of fish protein (i.e., <0.5 μg/g wet weight [ww]). No guidelines exist for game birds and mammals. However, livers of 2% (5/233) of the game birds collected showed lead concentrations> 0.5 μg/g ww. Moreover, 9% (33/371) of the gizzard (striated muscle) tissue samples obtained through harvesting of waterbirds and upland game birds employing lead shot, showed lead levels greater than the indicated arbitrary guideline. The presence of lead was shown by radiography and atomic absorption spectrometry to be the result of lead pellets and/or lead fragments being embedded in the striated muscle. People who consume any game species harvested with lead shot risk exposure to this metal by way of ingestion of tissue‐embedded lead pellets and fragments. Although Canada will be banning the use of lead shot for all migratory bird hunting in 1999, its extension to all game hunting should be considered because of potential human health concerns.
Chronic Cluster Headache: Provocation With Carbon Dioxide Breathing and Nitroglycerin
Authors: Hannerz Jan , Jogestrand Tomas
Published: March 2003

Nine patients with chronic cluster headache were studied as to end‐tidal PCO2 , heart rate, blood pressure, common carotid artery blood flow, vascular resistance, and intensity and duration of painbefore, during, and after breathing 6% CO2 in air for 6 minutes and before and after administration of 1 mg nitroglycerin sublingually. End‐tidal PCO2 was low at rest without provocation indicating that chronic cluster head. ache patients hyperventilate. Carbon dioxide provocation induced an increase in common carotid artery/blood flow. This provocation, previously shown to induce pain in episodic cluster headache patients, did not result in unilateral pain in chronic cluster headache patients. Nitroglycerin did not provoke any pain in 4 of 5 chronic cluster headache patients in contrast to the effects in episodic cluster headache patients in a cluster period. In one chronic cluster headache patient, short‐lasting attack of moderate pain intensity was provoked. The results agree with the hypothesis that chronic cluster headache patients have changed vascular reactivity due to permanent sympathicoplegia unilaterally in the middle fossa in contrast to episodic cluster headache patients who it has been suggested have a nonpermanent sympathicoplegia unilaterally in the same region.
Pediatric Headaches: What Do the Children Want?
Authors: Lewis Donald W. , Middlebrook Margaret T. , Mehallick Lissa , Rauch Trudy Manning , Deline Carole , Thomas Elise F.
Published: March 2003

One hundred consecutive children (aged 3 to 17 years), drawn from primary care pediatric clinics, with a greater than 3‐month history of headaches completed surveys to determine the type and associated features of their headache and to query their reasons for wanting to see a physician. Additionally, the children were asked to draw pictures of how they felt when they had a headache to assess their nonverbal perceptions. Over 90% of the headaches were migrainous (65% common, 23% classic, 5% basilar). The children wanted three answers from the physician: what was the cause of their headache, what would make it better, and reassurance that they had no life‐threatening illness. Furthermore, 33%, of the children's illustrations disclosed depressive features of helplessness, frustration, and anger. Over 20% of the adolescents depicted themselves as dead, dying, or about to be killed by their headache.
Maintenance of Effects in the Nonmedical Treatment of Headaches During Pregnancy
Authors: Scharff Lisa , Marcus Dawn A. , Turk Dennis C.
Published: March 2003

In a previous study, 30 pregnant women suffering from headaches were treated with physical therapy, relaxation training, and biofeedback. Eighty percent of these women experienced significant relief of headaches following treatment. Although this study demonstrated the effectiveness of nonmedical treatment during pregnancy, little is known about the influence of changing hormones during pregnancy on fluctuations in headache. One purpose of this study was to present a follow‐up of the women who were included in the previous study to determine whether the results from the nonmedical treatment were maintained up to a year after giving birth. In addition, this study examined the influence of headache diagnosis and breastfeeding on changes in headache activity and maintenance of treatment effects. The results indicate that the reductions in headache activity were maintained at follow‐up in the majority of the women treated, with 67.5% of the sample maintaining a significant decrease in headache up to 1 year after giving birth. Neither IHS diagnosis nor breastfeeding was related to maintenance of headache improvement. We conclude that the beneficial effects of nonpharmacological treatment of headaches during pregnancy demonstrated in a previous study are maintained up to 1 year following delivery. Headache diagnosis and breastfeeding were not related to treatment outcome, a finding that contradicts the reports of many retrospective studies.
Teaching Headache Management to Medicine Residents
Authors: Kumar Kusum L. , Joos Sandra K.
Published: March 2003

Background.—To evaluate the effect of teaching headache management to PG‐1 medicine residents.

Design.—Observational study using prerotation and postrotation ratings by residents of improvement in their knowledge of etiology, diagnosis, appropriate use of narcotics, and treatment of headache.

Setting.—Veterans Affairs Outpatient Clinic.

Participants.—Twenty‐two medicine residents.

Measurements and Results.—There was small but significant improvement in the total knowledge score (P=.03) and in areas of etiology of headache (P =.02) and appropriate use of narcotics (P =.001).

Conclusion.—We found there were substantial increases in residents’ subjective levels of understanding, history‐talking and in the diagnosis and treatment of headache (P<.0001) in contrast to the objective knowledge test.
Evaluation of β‐Endorphin Secretion in Patients Suffering From Episodic Cluster Headache
Authors: Franceschini R. , Leandri M. , Gianelli M.V. , Cataldi A. , Bruno E. , Rolandi E. , Barreca T.
Published: March 2003

In order to obtain data regarding peripheral levels of β‐endorphin in head pain syndromes, we evaluated the plasma β‐endorphin secretory pattern in 12 adult male patients suffering from cluster headache. Blood samples were drawn every 2 hours for a 24‐hour period, and in addition at 30‐minute intervals for 120 minutes during cluster attacks. The same sampling was repeated during an asymptomatic period. Cluster headache patients showed no significant β‐endorphin circadian rhythm and a delayed acrophase during cluster periods compared with that recorded in the remission period and in normal subjects. Eighteen cluster headache attacks were recorded during the study day, 13 (72%) of which were followed by a significant increase in β‐endorphin levels. No correlation was found between β‐endorphin maximum net increase and intensity and/or duration of pain. These data suggest the hypothesis of a temporary alteration of β‐endorphin circadian secretion, probably related to involvement of neural structures controlling biorhythm pacemakers.
Headache Intensity and Quality of Life in Adolescents. How are Changes in Headache Intensity in Adolescents Related to Changes in Experienced Quality of Life?
Authors: Langeveld Johannes H. , Koot Hans M. , Passchier Jan
Published: March 2003

Objective.‐To investigate the relationship between changes in actual presence of headache and the experience of different subdomains of quality of life (QoL) in adolescents.

Design.‐Diary entered measurements of headache intensity and frequency were related to simultaneously recorded data on a QoL questionnaire for adolescents.

Setting.‐Subjects completed both the QoL questionnaires and the headache diaries at home.

Subjects.‐Subjects were selected by screening the total population of two secondary schools (N=1566) for headache and migraine symptoms. Sixty‐four students subject to chronic headache or migraine participated in the study. All subjects were diagnosed by a neurologist, following the IHS criteria for migraine.

Conclusion.‐Changes in headache intensity and frequency were related to changes in self‐reported QoL within all QoL subdomains. More headache coincided with a lower self‐reported QoL.
Middle Turbinate Headache Syndrome
Authors: Anselmo‐Lima Wilma Terezinha , de Oliveira José A. A. , Speciali José Geraldo , Bordini Carlos , dos Santos Antonio Carlos , Rocha Katianne Vanderley , Pereira Eduardo Scandiuzzi
Published: March 2003

The middle turbinate and nasal septum are innervated by the anterior ethmoidal nerve, a branch of the ophthalmic division of the trigeminal nerve. As reported in the classical work of Wolff (1948), stimulation of these regions causes pain in the medial canthus of the supraorbital region. Periorbital pain due to middle turbinate compression against the septum or the lateral wall of the nose may be due to congestion of the nasal mucosa or to pneumatization of the middle turbinate (concha bullosa). The diagnosis is made by exclusion and requires a high index of suspicion, anterior rhinoscopy, computerized tomography (CT), and confirmation by the lidocaine test. We present five cases of middle turbinate headache syndrome, all with contha bullosa. Four were treated surgically by partial middle turbinectomy and septoplasty more than 1 year ago, with excellent results. One patient refused surgical treatment which was suggested after failure of medical treatment with antihistamines, decongestants, and a topical corticosteroid, and continues to be symptomatic. Despite the small number of cases studied, the authors conclude that the procedure used was effective for the resolution of headache.
Droperidol Treatment of Status Migrainosus and Refractory Migraine
Authors: Wang Shuu‐Jiun , Silberstein Stephen D. , Young William B.
Published: March 2003

We conducted a pilot study of intravenous droperidol in 35 patients (32 women and 3 men; mean age 43 years) with status migrainosus (n=25) or refractory migraine (n=10) in an ambulatory infusion center. Headache was graded as severe in 21 patients and moderate in 14. An intravenous line was started and kept open. Droperidol (2.5 mg) was given intravenously every 30 minutes until either three doses were given or the patient was completely or almost headache‐free prior to the next dose.

Seven patients received one dose, 12 received two doses, and 16, three doses (mean 5.6 mg). Our success rate (headache‐free or mild headache) was 88% (22 of 25) in patients with status migrainosus and 100% (10 of 10) in patients with refractory migraine. The average time to headache improvement was 40 minutes (n=35), to mild headache ‐ 60 minutes (n=32), and to headache‐free ‐ 105 minutes (n=28). Nausea, vomiting, and light and sound sensitivity resolved in all but 5 patients. Four patients had an asymptomatic systolic blood pressure drop ≤ 20 mm Hg. Most patients were sedated (34 of 35). Five patients developed akathisia and I dystonia. At follow‐up 24 hours after discharge, the recurrence rate (headache intensity from none or mild to moderate or severe) was 23% in status migrainosus and 10% in refractory migraine. Twenty‐one patients were sedated, while 19 had extrapyramidal symptoms, mainly restlessness.

Droperidol is effective and safe in treating status migrainosus or refractory migraine. Hypotension was uncommon. Patients should be warned of sedation and akathisia.
Transdermal Clonidine in the Prophylaxis of Episodic Cluster Headache: An Open Study
Authors: Leone Massimo , Attanasio Angelo , Grazzi Licia , Libro Giuseppe , D'Amico Domenico , Moschiano Franca , Bussone Gennaro
Published: March 2003

Transdermal clonidine has recently been reported to be efficacious in the prophylaxis of cluster headache. A 2‐week course of transdermal clonidine (5 mg the first week, 7.5 mg the second week) prceded by a 5‐day run‐in period, was administered to 16 patients with episodic cluster headache in an active cluster period. In 5 patients, the painful attacks. disappeared after the seventh day of treatment. For the group as a whole, no significant variations in headache frequency. pain intensity, or attack duration were observed between the run‐in period and the first and second weeks of treatment (ANOVA). Further studies are necessary to clarify the effectiveness of transdermal clonidine in the prophylaxis of episodic cluster headache.
Death By Managed Care—Denial of Hospitalization for Headache
Authors: Young William B.
Published: March 2003

A 47‐year‐old man with a severe headache disorder, taking meperidine injections 8 to 12 times a day and approximately 6 butalbital‐containing tablets per day, was denied hospitalization for the management of headache and died while awaiting evaluation for detoxification by a psychiatric facility. The criteria for hospitalization and the implications of the denial of care by insurance companies are explored. The biases against the publication of such cases are reviewed.
The First‐of‐Ramadan Headache
Authors: Awada A. , Jumah M. Al
Published: March 2003

This study was designed to estimate the frequency and characteristics of headaches occurring on the first day of Ramadan (Moslems' fasting month) and to determine possible causes. One hundred fifty copies of a specially designed questionnaire were distributed on the second day of fasting to a random sample of hospital staff. Completed questionnaires were obtained from 116 subjects (77%). Headaches were reported by 37 (41%) of the 91 persons who had fasted as compared to 2 (8%) of those 25 who did not fast (P=.002). The headache was of tension type in 78% of the cases. Headache frequency increased with the duration of fasting and affected mainly those prone to have headaches, more particularly of the tension type and the most important exogenous‐associated factor was caffeine withdrawal. Other factors such as lack of sleep, hypoglycemia, and dehydration may have been contributory in a small number of cases. A progressive reduction of caffeine consumption in the weeks preceding the month of Ramadan and a cup of strong coffee just before the start of the fast may prevent the occurrence of first‐of‐Ramadan headache.
Treatment of Migraine With Pulsing Electromagnetic Fields: A Double‐Blind, Placebo‐Controlled Study
Authors: Sherman Richard A. , Acosta Nancy M. , Robson Linda
Published: March 2003

The effect of exposure to pulsing electromagnetic fields on migraine activity was evaluated by having 42 subjects (34 women and 8 men), who met the International Headache Society's criteria for migraine, participate in a double‐blind, placebo‐controlled study. Each subject kept a 1‐month, pretreatment, baseline log of headache activity prior to being randomized to having either actual or placebo pulsing electromagnetic fields applied to their inner thighs for 1 hour per day, 5 days per week, for 2 weeks.

After exposure, all subjects kept the log for at least 1 follow‐up month. During the first month of follow‐up, 73% of those receiving actual exposure reported decreased headaches (45% good decrease, 14% excellent decrease) compared to half of those receiving the placebo (15% worse, 20% good, 0% excellent). Ten of the 22 subjects who had actual exposure received 2 additional weeks of actual exposure after their initial 1‐month follow‐up. All showed decreased headache activity (50% good, 38% excellent). Thirteen subjects from the actual exposure group elected not to receive additional exposure. Twelve of them showed decreased headache activity by the second month (29% good, 43% excellent). Eight of the subjects in the placebo group elected to receive 2 weeks of actual exposure after the initial 1‐month follow‐up with 75% showing decreased headache activity (38% good, 38% excellent).

In conclusion, exposure of the inner thighs to pulsing electromagnetic fields for at least 3 weeks is an effective, short‐term intervention for migraine, but not tension headaches.
Estrogen Replacement and Migraine Aura
Authors: MacGregor Anne
Published: March 2003

Objective.—To assess the association between estrogen replacement therapy and migraine aura.

Background.—Estrogen replacement therapy is increasingly used by perimenopausal and postmenopausal women for management of menopausal symptoms and for long‐term protection against osteoporosis and arterial disease. There are few reports about the effects of estrogen replacement therapy on migraine.

Method.—Case reports were collected from women developing migraine aura related to use of estrogen replacement therapy.

Results.—Four patients who developed migraine aura associated with the use of estrogen replacement therapy are described. In all cases, reducing the dose of estrogen or changing the route of delivery was associated with loss of aura.

Conclusion.—These findings suggest that high levels of estrogen in women using replacement therapy can trigger migraine aura.
Pregnancy Outcome Following Prescription for Sumatriptan
Authors: Olesen Charlotte , Steffensen Flemming Hald , Sørensen Henrik Toft , Nielsen Gunnar Lauge , Olsen Jørn
Published: March 2003

Background.– Some 2.5% of fertile Danish women use sumatriptan, and the drug is also taken during pregnancy. Although sumatriptan reacts selectively in brain vessels, the possibility of reactions with placental blood flow and uterotonic activity cannot be ruled out. The aim of our study was to examine the association between sumatriptan exposure during pregnancy and the risk of preterm delivery and low birth weight.

Methods.– Data from the Pharmaco‐Epidemiological Prescription Database of North Jutland county regarding all women who had given birth in the county of North Jutland from 1991 to 1996 were linked to the Danish Medical Birth Registry. Women who were exposed to sumatriptan during pregnancy were identified (
n=34), and using logistic regression models their pregnancy outcome was compared with two groups of pregnant women: (1) healthy women (
n=15  955) and (2) migraine controls (
n=89), defined as migraine patients who did not redeem prescriptions for migraine treatment during pregnancy.

Results.– The risk of preterm delivery was elevated among women exposed to sumatriptan compared with migraine controls (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.2–32.0) and healthy women (OR 3.3, 95% CI 1.3–8.5). The odds ratio for having a newborn with a low birth weight was increased (OR 3.0, 95% CI 1.3–7.0) for all migraine patients who delivered at term (
n=115) compared with the outcome of healthy pregnancies.

Conclusions.– We found that sumatriptan exposure during pregnancy was associated with an increased risk of preterm delivery and low birth weight. These findings may be due to drug exposure, but they may also reflect the impact of disease severity rather than the treatment itself, or confounding, or chance.
Acquired Transient Stuttering During a Migraine Attack
Authors: Perino Michele , Famularo Giuseppe , Tarroni Paolo
Published: March 2003

Stuttering is an abnormality in the fluency of speech, which is characterized by interruption of the normal rhythm due to involuntary repetition and prolongation, or arrest, of uttered letters or syllables.

The aphasic syndrome and dysarthria can be associated with classic migraine, but, to our knowledge, no study has so far described stuttering as the only neurological symptom accompanying an attack.
Roller Coaster Migraine: An Underreported Injury?
Authors: McBeath Juanita G. , Nanda Anil
Published: March 2003

A 28‐year‐old woman presented with severe headache, sleep problems, memory problems, and irritability 2 months after a violent roller coaster ride. She was diagnosed with posttraumatic migraine, and intravenous dihydroergotamine resolved her symptoms. Imaging studies, electroencephalogram, and visual and auditory evoked responses were normal. Imipramine, divalproex sodium, and propranolol were prescribed to prevent the headaches from recurring and dihydroergotamine nasal spray was prescribed for breakthrough headaches. We consider the many short but significant brain insults delivered during the roller coaster ride a critical factor in triggering this instance of posttraumatic migraine, which while unmanaged was a source of significant disability for the patient.
Amitriptyline Treatment in Chronic Drug‐Induced Headache: A Double‐Blind Comparative Pilot Study
Authors: Descombes S. , Brefel‐Courbon C. , Thalamas C. , Albucher J.F. , Rascol O. , Montastruc J.L. , Senard J.M.
Published: March 2003

Objective.—To assess the effects of amitriptyline and sudden analgesic withdrawal on headache frequency and quality of life in patients suffering from chronic daily headache related to analgesics abuse.

Methods.—Seventeen nondepressed patients with chronic drug‐induced headache were included in a 9‐week, parallel‐group, randomized, double‐blind, placebo‐controlled study. After abrupt analgesic withdrawal, amitriptyline or an active placebo (trihexyphenidyl) was started. The primary efficacy variable was headache frequency recorded on a headache diary in the last 4 weeks of each treatment. The secondary efficacy variable was quality of life (Nottingham Health Profile).

Results.—Headache frequency decreased by 45% in the amitriptyline group and by 28% in the trihexyphenidyl group. Amitriptyline enhanced all the dimensions of quality of life and significantly improved emotional reaction and social isolation.

Conclusion.—This pilot study suggests a beneficial effect of amitriptyline on headache frequency and quality of life for patients with chronic drug‐induced headache.
Ophthalmoplegic Migraine With Reversible Thalamic Ischemia
Authors: Shin Dong‐Jin , Kim Jong‐Ho , Kang Sung‐Soo
Published: March 2003

Two patients who presented with ophthalmoplegic migraine underwent electroencephalography, brain magnetic resonance imaging, cerebral angiography, and technetium Tc 99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) during an attack. Follow‐up SPECT was performed after neurologic symptoms resolved. In both patients, SPECT during an attack of ophthalmoplegia and headache demonstrated significantly decreased regional cerebral blood flow (rCBF) in the thalamus on the side of the ophthalmoplegia; rCBF reverted to normal on a follow‐up SPECT during the symptom‐free period. These findings suggest reversible ischemia in the territories of perforating branches of the posterior cerebral artery may accompany ophthalmoplegic migraine and possibly bear some relationship to the clinical features.
The Patient's Perspective: A Friend Like No Other
Authors: Bisconti Laurie Batitto
Published: March 2003

Ms. Bisconti is a history teacher, migraine sufferer since aged 12 years, and a patient of Dr. Larry Newman.
Migraine and Raynaud Phenomenon: Possible Late Complications of Kawasaki Disease
Authors: Constantinescu Cris S.
Published: March 2003

Migraine and Raynaud phenomenon often coexist and may reflect similar vascular reactions. Both have been associated with vascular endothelial cell dysfunction. Kawasaki disease is a systemic vasculitis of unknown etiology that affects children and may lead to the formation of coronary artery aneurysms. Endothelial cell dysfunction has been demonstrated late in Kawasaki disease and is not restricted to coronary vessels. We report the case of a patient who developed typical migraine with aura and Raynaud phenomenon at the age of 14, 12 years after onset of Kawasaki disease. His migraine responded well to pizotifen, and both migraine and Raynaud phenomenon improved after initiation of treatment with valproic acid. We postulate that both migraine and Raynaud phenomenon in this case represent late consequences of Kawasaki disease and result from extracoronary endothelial dysfunction.
Quality of Life in Young Italian Patients With Primary Headache
Authors: Nodari E. , Battistella P.A. , Naccarella C. , Vidi M.
Published: March 2003

Objective.—To compare the quality of life of young Italian patients with headache with that of the juvenile Italian population free of chronic disease.

Methods.—The Quality of Life Headache in Youth (QLH‐Y) Questionnaire developed by Dutch investigators was translated into Italian and validated in a young Italian population. The forward/backward translation and, for psychometric testing, the factor analysis and Cronbach coefficient α were used. A new instrument (Questionnaire for Young Subjects Affected by Primary Headache) was developed to assess psychological, physical, and social functioning and functional status and was used to compare the quality of life of the patients with headache with that of headache‐free controls.

For psychometric testing (via the questionnaire), we selected a sample of 394 subjects (178 males and 216 females, aged 10 to 18 years): 320 subjects from three schools of North Italy and 74 patients with headache from the Paediatric Headache Center of Padua. In the latter group, 48 patients had tension‐type headache and 26 had migraine without aura, according to the International Headache Society diagnostic criteria.

Results.—The data derived from the comparison of 84 headache‐free subjects (control group) and the 74 young patients with headache confirmed that primary headache negatively influenced the latter's quality of life: patients scored significantly (P<.05) lower on psychological, physical, and social functioning than the headache‐free controls.

Conclusions.—Quality of life is compromised significantly in young patients with primary headache disorders. The questionnaire used in this study is a valid and reliable self‐administered instrument that may facilitate clinical research in headache.
Borderline Personality Disorder and the Chronic Headache Patient: Review and Management Recommendations
Authors: Saper Joel R. , Lake Alvin E.
Published: March 2003

Background.—Physicians and psychologists who treat headache not infrequently encounter patients with borderline personality disorder (BPD). BPD patients frequently suffer from headache, and often pose special problems in treatment. Few guidelines exist for the management of the BPD headache patient.

Objectives.—To provide an overview of current concepts on BPD, including comorbidity, psychopathophysiology, and treatment. To provide an explicit framework for managing borderline behavior in patients with chronic headache.

Methods.—A literature review combined with clinical observations from the tertiary treatment of intractable headache in outpatient and inpatient settings.

Results.—BPD is found in almost 2% of the general population, with increased prevalence in patients with comorbid psychopathology and substance abuse. Severe headaches and migraine appear to be more prevalent in patients with BPD than the general population. A reported history of abuse is common, but must be interpreted with caution. Recent research has found reduced hippocampal volume in women patients with BPD; hypometabolism in the premotor, prefrontal, and anterior cingulate cortex, as well as the thalamic, caudate, and lenticular nuclei; and serotonergic dysfunction. Opioid medications may have an adverse influence on certain clinical features of BPD. Some patients show at least short‐term improvement in dissociative behavior when given opioid antagonists. Treatment should combine appropriate pharmacotherapy with ongoing psychotherapy. Early identification of BPD is likely to improve the course of treatment. Treatment often requires explicit contracts, consistent limit‐setting, confrontation, and communication between different treating professionals to avoid “splitting.” The recognition and management of the doctor's own countertransference is important to successful management. Noncompliant patients may need to be terminated from treatment.

Conclusions.—Specific management guidelines and the use of explicit treatment contracts can help sustain patients in treatment, reduce the risk of medication abuse, and minimize distress in the treating professional. Headaches and other symptoms in patients with BPD can be successfully managed over the course of a long‐term relationship with clearly defined limits.
A Headache Diagnosis Project
Authors: Pryse‐Phillips William , Aubé Michel , Gawel Marek , Nelson Robert , Purdy Allan , Wilson Keith
Published: March 2003

Background.—Despite the availability of objective criteria, the diagnosis of migraine is thought to be missed frequently in primary practice.

Objective.—To determine the most important questions assisting in the clinical diagnosis of migraine headache.

Methods.—A cohort of 461 patients referred to headache specialists in Canada was assessed using a pro‐forma questionnaire that was completed by the patients alone or administered by the physicians themselves. A final clinical diagnosis was recorded after a complete clinical evaluation. In a subsequent validation study, three questions derived from the results of the first phase of the study were administered to a new cohort of 128 patients, and diagnoses of “migraine” or “not migraine” were recorded according to the decision generated in the first part of the study. The final clinical diagnosis was taken as the “gold standard” for diagnosis, and the results from the two independently derived diagnostic methods were compared.

Results.—Statistical analysis of the responses from part 1 of the study yielded three questions (related to daily occurrence, unilaterally, and functional impairment) that distinguished between pure migraine and other headache diagnoses with high reliability and validity. The sensitivity and selectivity of the three‐question protocol exceeded 91%.

Conclusions.—The use of three questions related to headache frequency, laterality, and impact on functioning may represent an attractive screening instrument in primary care practice, alerting physicians to the diagnosis of migraine in patients or to the possibility of a second or alternative headache diagnosis in patients in whom their diagnosis of migraine previously has been made. The presence of multiple headache syndromes in individual patients, as is common in tertiary referral practice, may reduce the discriminating power of the three‐question protocol.
Intractable Cluster Headaches in a Migraineur
Authors: Rothrock John F. , Mathew Ninan T. , Kaup Alex O. , Evans Randolph W.
Published: March 2003

Some migraineurs have the additional misfortune of suffering from cluster headaches; this situation can be challenging.
Intravenous Dipyrone in the Acute Treatment of Migraine Without Aura and Migraine with Aura: A Randomized, Double Blind, Placebo Controlled Study
Authors: Bigal Marcelo E. , Bordini Carlos A. , Tepper Stewart J. , Speciali José G.
Published: March 2003

Background.— Dipyrone (Metamizol) has been used in the acute treatment of migraines in Brazil. Some investigators have found it to be a highly effective medication for migraine pain and associated symptoms.

Objective.—To conduct a randomized, placebo controlled, double blind study to assess the effect of dipyrone on the pain and symptoms associated with migraine without aura or with aura and the adverse effect profile of this medication.

Methods.—For the migraine without aura group, 44 patients were assigned at random to receive 1 g intravenous dipyrone, and 30 patients received 10 mL 0.9% physiological saline. For the migraine with aura group, 30 patients received both dipyrone or placebo. We used seven parameters of analgesic evaluation and an analog scale to assess nausea, photophobia, and phonophobia.

Results.—Patients receiving dipyrone demonstrated a statistically superior improvement (P<.05 andP<.01) in pain and all associated symptoms compared with control subjects.

Conclusions.—Dipyrone is an effective drug for the relief of acute migraine pain and associated symptoms.
Safety of a Patented Special Butterbur Root Extract for Migraine Prevention
Authors: Danesch Ulrich , Rittinghausen Reiner
Published: March 2003

Objective To report on the safety of a patented special butterbur root extract used for migraine prevention.

Background Two placebo‐controlled clinical trials have been conducted supporting the beneficial use in humans.

Methods Results from acute, subchronic and chronic animal toxicity studies as well as from mutagenicity studies are reported. Safety data gained from clinical trials, postmarketing surveillance studies and pharmacovigilance are evaluated and discussed.

Conclusion The patented special butterbur root extract is safe for the treatment in humans.