bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Interdialytic Weight Gain and Acid‐Base Status in Hemodialysis by Bicarbonate
Authors: Agroyannis B. , Fourtounas C. , Tzanatos H. , Dalamangas A. , Vlahakos D.V.
Published: March 2003

Abstract: The aim of this study was to determine the relationship between interdialytic weight gain and acid‐base balance pre‐ and posthemodialysis in uremic patients undergoing hemodialysis with a high bicarbonate dialysate (39 mmol/L). To this end we studied 8 stable uremic patients on regular hemodialysis thrice weekly who had stable hematocrit values for at least 3 months, similar clinical characteristics including dry weight but widely varying interdialytic weight gain. Arterial line blood samples were collected anaerobically in heparinized syringes pre‐ and posthemodialysis in 4 consecutive hemodialysis sessions for the determination of pH, Paco2, and HCO3. Prehemodialysis values (mean ± SD) were pH = 7.34 ± 0.03, Paco2 = 36.43 ± 1.4, and Hco3 = 20.1 ± 1.55. Posthemodialysis values were pH= 7.47 ± 0.02, Paco2 = 38.72 ± 2.0, and HCO3 = 27.73 ± 1.72. In other words, patients were moderately acidemic prior to and moderately alkalemic after the hemodialysis session. Of note, a significant negative correlation was revealed between the interdialytic weight gain and the values of prehemodialysis blood pH (r = −0.721, p < 0.001) and HCO3 (r = −0.836, p < 0.001) and posthemodialysis pH (r = −0.533, p < 0.001), Paco2 (r = −0.623, p < 0.001) and HCO3 (r = −0.815, p < 0.001), suggesting an important role of the interdialytic weight gain on acid‐base equilibrium of uremic patients undergoing hemodialysis. Thus, patients with high interdialytic weight gains may require higher bicarbonate concentrations to achieve normal acid‐base status whereas patients with low interdialyic weight gains may require lower bicarbonate concentrations to prevent alkalemia at the end of dialysis.
Patient Safety Technology for Microadsorbent Systems in Extracorporeal Blood Purification
Authors: Falkenhagen D. , Strobl W. , Hartmann J. , Schrefl A. , Linsberger I. , Kellner K.‐H. , Aussenegg F. , Leitner A.
Published: March 2003

Abstract: Alternative technologies for extracorporeal blood purification systems based on microadsorbents in suspension are discussed. Principally, microadsorbents offer higher efficiency and flexibility when compared to conventional column‐based adsorption systems. Systems already clinically employed (e.g., BioLogic DT) or close to clinical application (e.g., the microspheres‐based detoxification system, MDS) are described. The MDS technology, in particular, is characterized by efficiency and a high degree of flexibility with respect to both the use of different adsorbents as well as the combination with hemodialysis/hemofiltration therapy. It was designed for continuous use in intensive‐care units, but enables also the removal of low‐density lipoprotein, fibrinogen, autoimmune antibodies, immune complexes, and other pathophysiologically relevant substances. Alternative anticoagulation regimes and safety systems on fluorescence sensor technology have recently been developed for the MDS and are presented in this paper.
SiO2 Entrapment of Animal Cells: Liver‐Specific Metabolic Activities in Silica‐Overlaid Hepatocytes
Authors: Muraca Maurizio , Vilei Maria Teresa , Zanusso Gian Eros , Ferraresso Chiara , Boninsegna Sara , Dal Monte Renzo , Carraro Paolo , Carturan Giovanni
Published: March 2003

Abstract: Rat hepatocytes in a collagen‐gel sandwich configuration were exposed to silicon alkoxides in a gas phase, yielding a 0.05 to 0.15 μm porous silica layer on the gel surface. Cell viability was unaffected by the procedure. After 24 h, bilirubin conjugation, ammonia removal, urea synthesis, and diazepam metabolism were unaffected by the procedure. However, both the ammonia removal rate and diazepam metabolism were increased after 48 hr, whereas urea synthesis was unaffected. These data indicate that silica overlay allows efficient metabolic activity of collagen‐gel entrapped hepatocytes. The fact that the KM of bilirubin conjugation was unaffected by the presence of the silica membrane suggests that the transport of albumin‐bound substrates is not decreased. The enhancement in some metabolic activities found 48 h after the entrapment procedure may be the result of favorable changes in the hepatocyte microenvironment. These characteristics might be useful for the development of organotypical bioartificial liver devices.
Optimal Arterial Cannulation Technique for Selective Cerebral Perfusion in Thoracic Aortic Surgery
Authors: Ohata Toshihiro , Sakakibara Tetsuo , Takano Hiroshi , Ishizaka Toru , Tsujimoto Masahiko
Published: March 2003

Abstract: Despite advances in surgical procedures, anesthetic management, and cardiopulmonary bypass, brain injury remains a major source of morbidity and mortality in patients undergoing operations on the thoracic aorta. Here, we report our experience with arch vessel cannulation for selective cerebral perfusion in 32 consecutive patients with thoracic aneurysms who underwent total arch replacement between 1998 and 2000. The innominate vein was divided, and intraoperative epiaortic echography was performed to identify the least atherosclerotic site on brachiocephalic and left carotid arteries before establishment of cardiopulmonary bypass. There were no in‐hospital deaths, and only 1 patient (3.1%) had a perioperative stroke. Identifying the least atherosclerotic site in cephalic branches is important for safely establishing selective cerebral perfusion and for preventing perioperative cerebral embolism during total arch replacement.
Biodegradation and Biocompatibility of Polyorganophosphazene
Authors: Kawakami Hiroyoshi , Kanezaki Shota , Sudo Miyuki , Kanno Masayoshi , Nagaoka Shoji , Kubota Sunao
Published: March 2003

Abstract: We investigated biodegradation and biocompatibility of poly(organophosphazenes). We prepared poly(organophosphazenes) having different side chain groups. The blood compatibility of poly(organophosphazenes) containing fluorinated side groups, poly(bis[trifluoroethoxy]phosphazene) (PbFP) and poly([trifluoroethoxy][ethyl glycinate]phosphazene) (PFGP), without heparinization were evaluated in vitro. The deformation and aggregation of platelets adhered on PbFP and PFGP were not observed and they suppressed platelet activation. Additionally, PbFP and PFGP showed a higher degradation rate, despite their high hydrophobic nature. We found that the high mobility of water in PbFP and PFGP was one of the important factors facilitating their degradation. Their polymer structures were formed in a more open nature, indicating that water easily attacked the backbone of the phosphorus and nitrogen atoms in the poly(organophosphazene). On the other hand, the proliferation of HeLa cells cultured on poly(organophosphazene) was reduced compared with that on the control tissue culture polystyrene.
Coronary Artery Bypass Grafting in Patients on Chronic Hemodialysis: Diabetic Nephropathy Versus Nondiabetic Nephropathy
Authors: Hirose Hitoshi , Amano Atsushi , Takahashi Akihito , Takanashi Shuichirou
Published: March 2003

Abstract: Patients with both end‐stage renal disease and diabetes mellitus carry an increased risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote outcome of diabetic nephropathy patients on hemodialysis undergoing coronary artery bypass grafting (CABG). We retrospectively analyzed the results of CABG performed between September 1, 1993 and August 31, 2001. Preoperative, perioperative, and follow‐up data of patients with hemodialysis primarily due to diabetic nephropathy (Group D, n = 31, 22 males and 9 females with a mean age of 60.1 ± 6.6) were collected and compared to patients with hemodialysis primarily due to nondiabetic nephropathy (group N, n = 21, 17 males and 4 females with a mean age of 60.9 ± 11.2). Preoperative risk factors between the 2 groups were not significantly different. The mean number of distal anastomoses was 2.5 ± 1.2 in Group D and 2.5 ± 1.0 in Group N (p = not significant [NS]). All patients received at least 1 internal mammary artery graft. There was 1 in‐hospital death in each group. Postoperative recovery, mortality, and morbidity were not significantly different between the two groups. At the mean follow‐up of 2.7 years, the actuarial 3 year survival rate was 72.8% in Group D and 78.7% in Group N (p = NS). The actuarial 3 year cardiac event‐free rate was 79.7% in Group D and 74.7% in Group N (p = NS). CABG for hemodialysis patients can be performed with acceptable risks. Diabetic nephropathy has no impact on early or remote patient outcomes among patients on hemodialysis.
Numerical Calculation of Hemolysis Levels in Peripheral Hemodialysis Cannulas
Authors: De Wachter Dirk , Verdonck Pascal
Published: March 2003

Abstract: Hemolysis in extracorporeal life support systems presents an underestimated problem. In this article, we investigate the hemolytic potential of peripheral hemodialysis cannulas numerically. An axisymmetrical finite element model of 3 cannula sizes was built (13G, 14G, and 16G) that was refined sufficiently in the vicinity of the cannula tip to compute accurately scalar shear stresses. Scalar shear stresses were utilized in Giersiepen's equation to calculate the red blood cell damage (RBD) along streamlines. The streamlines were chosen such that they bound a percentage of the blood flow through the cannula. By integration of the RBD results, the total damage of the cannula was determined and expressed in modified index of hemolysis for comparison with published results. Calculated RBD was overestimated by Giersiepen's equation. The ranking of the cannulas according to their hemolytic potential was preserved. This indicates that power‐law equations may be suited for hemolysis prediction of laminar flow devices.
Safety and Efficacy of Off‐Pump Coronary Artery Bypass Grafting in Chronic Dialysis Patients
Authors: Papadimitriou Lila J. , Marathias Katerina P. , Alivizatos Petros A. , Michalis Alkiviadis , Palatianos George M. , Stavridis George T. , Demesticha Theano , Koussi Theophili , Agroyannis Basil , Vlahakos Demetrios V.
Published: March 2003

Abstract: Off‐pump coronary artery bypass grafting (CABG) has been recently revived, because cardiopulmonary bypass (CPB) appears to worsen the multiple organ dysfunction after conventional CABG. To evaluate the safety and efficacy of the off‐pump CABG in chronic dialysis patients, we compared the perioperative morbidity and mortality between 15 dialysis patients who underwent off‐pump CABG at our center over the past 8 years with that of a concurrent group of 19 patients who underwent conventional CABG. Patients were selected for off‐pump CABG only when complete revascularization was technically feasible. We found that off‐pump CABG is as safe and effective as conventional CABG in selected dialysis patients. It might even be beneficial, because it is associated with less hematocrit drop and blood product use, a lower catabolic rate, and fewer dialysis requirements after surgery. However, the impact of off‐pump technique on the long‐term clinical outcome and resource utilization in renal patients requires further investigation.
Progress in the Control System of the Undulation Pump Total Artificial Heart
Authors: Saito Itsuro , Chinzei Tsuneo , Abe Yusuke , Ishimaru Mitsuhiko , Mochizuki Shuichi , Ono Toshiya , Isoyama Takashi , Iwasaki Kiyotaka , Kouno Akimasa , Baba Atsushi , Ozeki Toshinaga , Takiura Koki , Tohyama Takahiro , Nakagawa Hidemoto , Imachi Kou
Published: March 2003

Abstract: The undulation pump total artificial heart (UPTAH) is a small implantable total artificial heart. As the UPTAH generates outflow and inflow at the same time, control of the UPTAH is very difficult. Therefore suitable control methods specifically for the UPTAH should be established. Various motor control, left‐right flow balance control, and physiological control methods were examined and tried for the UPTAH control in this study. The control system is divided into seven categories. It has a hierarchical structure and all control modes work at the same time. The UPTAH with the newly developed control method has been implanted into the chest cavities of 48 goats. Until now, six goats survived for more than one month, including 63 days in the longest case. The good condition of the UPTAH implanted animal could be maintained with the newly developed control scheme, consisting of the 1/R control and several other additional controls.
Ecosystem Health, Landscape Vulnerability, and Environmental Risk Assessment
Authors: Vilchek Gregory E.
Published: March 2003

ABSTRACT

Ecosystem health is evaluated as an integrated assessment based on ecosystem stability, resilience, and vulnerability concepts. Special emphasis is focused on two dimensions in the ecosystem health concept: a geocentric approach (i.e., considering any impacts or interactions in terms of their effects on natural geosystems or ecosystems) which deals with assessment of natural ecosystems and their disturbance; and an anthropocentric approach, which concerns effects on human beings and human environment. Analysis of the relevant terminology leads to the development of a conceptual framework for ecosystem health. A suggested method of environmental risk assessment is based on ranking and merging into one criterion a series of individual estimates: bioresources abundance, biodiversity, ecosystem stability and resilience, and feedback effects of a disturbed environment on human beings and their activities.
Modelling the Temperature Sensitivity of Some Physiological Parameters of Epidemiologic Significance
Authors: Massad Eduardo , Forattini Oswaldo Paulo
Published: March 2003

ABSTRACT

Anthropogenic emissions of greenhouse gases are enhancing the natural greenhouse effect. It is almost universally accepted that this will lead to a warming of the earth’s surface. It is also accepted that this warming will lead to a spread of the insects that transmit several infections, currently restricted to the tropics, such as malaria, leishmaniasis, yellow fever, and dengue fever, among others. We calculated the expected increase in the density of female adult forms of anopheline mosquitoes by assuming temperature‐dependent functions on the rates of the mosquitoes life cycles. Other mosquito characteristics, such as the feeding interval, were also calculated as functions of environmental temperature. The resultant increase in the density of adult females as a function of the increase in temperature was related to an increase in malaria risk by the calculations of the basic reproductive ratio and the vectorial capacity, which permitted the application of the mathematical model for malarial transmission.
Gender, Risk, and Scientific Proceduralism
Authors: Boetzkes Elisabeth
Published: March 2003

ABSTRACT

In this article, I consider the implications of gender differences for determining acceptable risk. Although often unacknowledged, values are ineradicable from risk identification, estimation, and acceptability. Because empirical studies, including some conducted by McMaster University’s Eco‐Research group, show significant gender differences in risk assessment, democratic decisions about acceptable risk must reflect the values of females as well as males. I argue that Kristin Shrader‐Frechette’s model of scientific proceduralism, modified to incorporate findings about gender differences, can contribute to fairness in decision‐making about risk. Furthermore, because females are more environmentally concerned than are males, especially at local levels, ecosystem health would be well‐served by decentralizing environmental decision‐making and ensuring gender representation.
Assessing the State of Arctic Ecosystem Health: Bridging Inuit Viewpoints and Biological Endpoints on Fish Health
Authors: Pellerin Jocelyne , Grondin Jacques
Published: March 2003

ABSTRACT

As with all of the world’s ecosystems, the Arctic ecosystem is challenged by anthropogenic inputs. As a result of their global vision of the ecosystem in which they live, the Inuit community is concerned with the fact that traditional food may not be edible due to pollution. As part of a broader ecosystem health research program examining the biological, economic, and cultural impacts of environmental contamination in the Arctic, the aim of our project was to assess Arctic ecosystem health by the tentative bridging of scientific and traditional knowledge. Specifically, the goal was to verify a possible relationship between Inuit perception of the health of their ecosystem and scientific assessment of deformities, pollutant levels, and parasites in Arctic char, an important food source for the Inuit. In order to do this, it was necessary to take into account Inuit knowledge of contamination and perceived effects on human and ichtyofauna health.

Two fish sampling sites were chosen in Ungava Bay, Nunavik, (northern Québec, Canada) and field sampling took place in August 1994 during the upstream migration of Arctic char. While large amounts of parasites were observed, there were no evident signs of fish health alteration such as deformities or very low condition factors despite the common observation by Inuit that deformities were more abundant than in the past. Although the hypothesis that a possible increase in parasitism in fish due to anthropogenic pollutants could be neither proved nor completely disproved (in particular because of a lack of unhealthy fish), the research process has still proved to be useful; namely, to reassure stakeholders about the quality of the fish stocks studied, to enhance dialogues between researchers and the communities involved in the project, to provide an opportunity for regional stakeholders to guide locally relevant research, and to provide researchers with some understanding of the differences between risks perceived by the general population and dangers identified by the experts.
Benign Valsalva's Maneuver‐Related Headache: An MRI Study of Six Cases
Authors: Calandre L. , Hernandez‐Lain A. , Lopez‐Valdes E.
Published: March 2003

Cough headache is not infrequent, but there have not been any series studied with current neuroimaging techniques, and effective therapy has seldom been reported. In a large series from an outpatient clinic of a general hospital, we have studied, with MRI, eight cases of headache related to situations provoking sudden increase of intrathoracic pressure (cough, straining, stooping), similar to that elicited by a Valsalva's maneuver. One case showed hindbrain herniation and another showed isolated hydrocephalus. Symptoms did not differ between these two cases and the six cases without MRI abnormality. Initial symptoms presented between 49 and 67 years of age, and headache was of variable location and duration, mostly global and short‐lasting. During a mean follow‐up of 13.3 months, one patient became spontaneously asymptomatic, one improved on indomethacin, and two improved after treatment with propranolol. We propose the eponym, benign Valsalva's maneuver‐related headache (as more appropriate than the equivalent “cough headache”), for cases in which headache is related to such situations and structural lesions are excluded by MRI or similar tests.
Acetazolamide Testing of Cerebral Vasodilator Capacity Provokes “Vascular” But Not Tension Headaches
Authors: Shirai T. , Meyer J.S. , Akiyama H. , Mortel K.F. , Wills P.M.
Published: March 2003

Cerebrovascular capacitance was tested by measuring local cerebral blood flow (LCBF) by xenon‐contrasted CT scanning before and after the oral administration of 14.3 mg/kg of acetazolamide among 45 subjects including 15 age‐matched controls without history of headache, 20 migraineurs with and without aura, 3 patients with cluster headache, and 7 patients with tension‐type headache. Percentage increases of LCBF were measured in 10 regions located throughout both hemispheres. Laterality indices for asymmetric LCBF increases were calculated. Local cerebral blood flow in cortical gray matter increased 5.9% in controls, 9.9% in patients with tension headaches, but 18.6% in both migraine and cluster headache patients; significantly greater LCBF increases than among controls or among patients with tension headaches (P<0.05). Increases in LCBF were significantly asymmetric among migraine and cluster patients and provoked typical unilateral vascular headaches which responded to sumatriptan. Maximal asymmetric LCBF increases also corresponded to the reported side of the induced headaches confirming their vascular pathogenesis. Patients with tension headaches and controls without history of headache did not develop head pain after acetazolamide.
‘Skin Roll’ (‘Pinch and Roll’) Test: Skinfold Thickness and Tenderness
Authors: Bansevicius Dalius , Pareja Juan A. , Sjaastad Otter
Published: March 2003

Skinfold thickness and tenderness are variables that have been used in the diagnosis of headaches ofcervical origin. In order to assess these variables in actual patients, the normal limits have to be properlyknown. Skinfold thickness and tenderness during the “skin roll” (“pinch and roll”) test were, therefore,investigated simultaneously in a group of 95 healthy individuals. Three positions (trapezius, mandibular,and supraorbital areas) were used.

The following values for skinfold thickness in healthy individuals during the skin roll test were obtained:trapezius position 5 to 26 mm (mean 11.2 mm, SD 3.9), mandibular 3 to 12 mm (mean 6.5 mm, SD 1.8), andsupraorbital 3 to 9 mm (mean 4.6 mm, SD 0.8).

Strong positive correlation was found between subject height and skinfold thickness in the mandibularposition. Skinfold thickness in the mandibular (P=0.003), as well as in the trapezius position (P=0.023)correlated positively with age. In 13 individuals (13.7%), tenderness to a varying extent was found in theshoulders (trapezius position). No pain was recorded in the other positions.

No correlation was found between skinfold thickness and tenderness (P=0.66).
Idiopathic Intracranial Hypertension and Seventh Nerve Palsy
Authors: Capobianco David J. , Brazis Paul W. , Cheshire William P.
Published: March 2003

Patients with idiopathic intracranial hypertension may occasionally present with coexisting lower motor neuron facial weakness. This study reviews a 6‐year experience at Mayo Clinic. The aim of this study was to determine the possible association of idiopathic intracranial hypertension and facial paresis. Two cases were identified. Both fulfilled the modified Dandy's diagnostic criteria for idiopathic intracranial hypertension. Treatment consisted of steroids in one, and emergent optic nerve sheath fenestration in the other. The cranial nerve palsies resolved in both cases.
Antihistamine Responsive Cluster Headache in a Teenaged Girl
Authors: Neubauer David , Kuhar Marjana , Ravnik Igor M.
Published: March 2003

Episodic cluster headache is a well‐recognized entity usually starting in the second decade of life. Uncommonly, the first typical symptoms may present in the first decade of life, but are rarely recognized as such during childhood. We report a 12‐year‐old girl who presented with a 1‐year history of bouts of right‐sided hemicrania with ipsilateral, clearly demarcated, redness and itching of the skin of the face, lasting from 15 minutes to 2 hours per day. The episodes recurred up to several times daily for a few days and were followed by remissions lasting up to 2 months. Thorough investigations failed to prove any definite cause. Antihistamine prophylaxis, first with astemizole and then with Ioratadine, proved to be very effective. During the follow‐up period of more than 3 years, such a prophylactic regimen provided excellent relief, with only two relapses due to noncompliance. We suggest that in a sequential treatment trial for cluster headache during childhood, antihestamines should have their place, especially in those cases where clinical evidence may suggest histamine involvement.
Positron Emission Tomography Studies in Headache
Authors: Diener Hans‐Christoph
Published: March 2003

Positron emission tomography (PET) allows the quantitative measurement of regional cerebral flow (rCBF) in humans in quantitative terms. Gross changes in rCBF are due to variation in vessel diameter. Changes of rCBF also reflect synaptic activity (inhibition and excitation). Therefore, PET was used to monitor changes in blood flow during the aura and headache phase of a migraine attack and to investigate focal areas of increased or decreased blood flow, eg, in the brain stem and midbrain. Hemispheric rCBF was unchanged in spontaneous migraine attacks without aura. This was true for the headache side as well as for the nonheadache side. Sumatriptan had no effects on cerebral blood flow. Regional cerebral blood flow was increased in midline brain stem structures during the headache phase, but also when the headache had been treated with sumatriptan. This persisting increased activity might reflect activity of a presumed migraine center in the brain stem. These changes are specific for migraine attacks and are not seen during attacks of cluster headache. Positron emission tomography measurements in the early phase of a migraine attack in a single subject showed flow reductions in the occipital cortex spreading forwards; an observation which would be compatible with the existence of spreading depression in humans. Our attempts to study the aura phase with PET have, to date, been unsuccessful.
Weekend Headache: A Retrospective Study in Migraine Without Aura and Episodic Tension‐Type Headache
Authors: Torelli Paola , Cologno Daniela , Manzoni Gian Camillo
Published: March 2003

Our retrospective study was aimed at determining the existence of weekend headache and, if so, whether it has the same clinical features as migraine without aura and episodic tension‐type headache, or whether it occurs as a separate form of headache which could find its own place in the International Headache Society classification.

For this study, we reviewed the clinical records of 120 patients with migraine without aura and 120 patients with episodic tension‐type headache randomly selected among all those referred to the Headache Center of the University of Parma Institute of Neurology between 1985 and 1996.

A review of these records suggests that weekend headache exists for both types of headache considered. Clinically, it is interesting to note that the male‐to‐female ratio for the weekend form of tension‐type headache was 1:1, as opposed to 1:3 for general episodic tension‐type headache. As regards classification, no evidence so far seems to suggest that weekend headache should be considered as an independent entity. Apart from certain features that appear to be peculiar to this form of headache—such as increased pain intensity—it thoroughly fulfills the diagnostic criteria of the primary headaches from which it evolves. Finally, a few clinical features suggest that the weekend may simply be a triggering factor in migraine without aura attacks, while playing a major role in episodic tension‐type headache. However, weekend headache is a clinical entity that clearly needs further study.
Time‐Series Analyses of General Arousal and Headache Activity in the Natural Environment
Authors: Cathcart Stuart , Pritchard Donald
Published: March 2003

A naturalistic longitudinal study was conducted to examine temporal relationships between subjective dimensions of general arousal and headache activity. The “tense arousal” dimension of Thayer's biopsychological model of mood and arousal (The Biopsychology of Mood and Arousal. New York: Oxford University Press; 1989) was recorded using the Activation‐Deactivation Adjective Check List (ADACL). Recordings were made eight times daily, every 2 hours from awakening, in conjunction with a clinical diary recording head pain intensity and duration. Three time series of daily, half‐daily, and bihourly headache and tension scores were modeled and cross‐correlated. Results indicated moderate positive same‐time correlations, but revealed large interindividual and intraindividual variation in temporal relationships.
Predisposing and Provoking Factors in Childhood Headache
Authors: Anttila Pirjo , Metsähonkala Liisa , Helenius Hans , Sillanpää Matti
Published: March 2003

Objective.–To study the differences in predisposing and provoking factors between childhood migraine and nonmigrainous headache.

Background.–Information on the predisposing and provoking factors of headache could help to find ways to prevent it. Differences in predisposing and provoking factors between migraine and nonmigrainous headache are largely unknown.

Methods.–An unselected, population‐based, prospective, follow‐up study on the occurrence of headache in schoolchildren was carried out in 1290 children aged from 8 to 9 years. The children who had reported headache during the 6 months prior to the study ( n=725) were sent a more detailed questionnaire about factors that might give rise to headache. Six hundred twenty‐two (86%) children returned questionnaires that were completed to an acceptable degree.

Results.–The occurrence of familial paroxysmal headache and unhappiness in the family independently predicted the occurrence of migraine in children, but this was not the case for nonmigrainous headache.

Conclusions.–In particular, the family occurrence of paroxysmal headache increases the risk of migraine in a child. The risk is still greater if their living conditions are experienced as unsatisfactory by the family.
Perceived Self‐efficacy and Headache‐Related Disability
Authors: French Douglas J. , Holroyd Kenneth A. , Pinell Cornelia , Malinoski Peter T. , O'donnell Francis , Hill Kimberly R.
Published: March 2003

Background.—Headache‐specific self‐efficacy refers to patients' confidence that they can take actions that prevent headache episodes or manage headache‐related pain and disability. According to social cognitive theory, perceptions of self‐efficacy influence an individual's adaptation to persistent headaches by influencing cognitive, affective, and physiological responses to headache episodes as well as the initiation and persistence of efforts to prevent headache episodes.

Objective.—The objective of the present study was to construct and validate a brief measure of headache specific self‐efficacy and to examine the relationship between self‐efficacy and headache‐related disability.

Methods.—A sample of 329 patients seeking treatment for benign headache disorders completed the Headache Management Self‐Efficacy Scale and measures of headache‐specific locus of control, coping, psychological distress, and headache‐related disability. A subset of 262 patients also completed 4 weeks of daily headache recordings.

Results.—As predicted, patients who were confident they could prevent and manage their headaches also believed that the factors influencing their headaches were potentially within their control. In addition, self‐efficacy scores were positively associated with the use of positive psychological coping strategies to both prevent and manage headache episodes and negatively associated with anxiety. Multiple regression analyses revealed that headache severity, locus‐of‐control beliefs, and self‐efficacy beliefs each explained independent variance in headache‐related disability.
Chronic Paroxysmal Hemicrania‐Tic Syndrome
Authors: Martínez‐Salio A. , Porta‐Etessam J. , Pérez‐Martínez D. , Balseiro J. , Gutiérrez‐Rivas E.
Published: March 2003

The coexistence of chronic paroxysmal hemicrania and trigeminal neuralgia is called chronic paroxysmal hemicrania‐tic syndrome. We describe the case of a man who has suffered both types of pain occurring synchronously but with different localization on the ipsilateral side. The pain attacks could be abolished with indomethacin and carbamazepine. To the best of our knowledge, this is the third case to be reported, the first in the male sex. We review this new disorder and discuss the pathophysiology.
Treatment of Migraine in Canada With Naratriptan: A Cost‐Effectiveness Analysis
Authors: Caro J. Jaime , Getsios Denis , Raggio Gabriel , Caro Graciela , Black Libby
Published: March 2003

Objective.—To evaluate the cost‐effectiveness of naratriptan for the treatment of migraine in Canada.

Background.—The substantial disability brought on by migraine, coupled with the high prevalence of this disorder, leads to substantial costs. Naratriptan is a newly developed triptan shown to be effective in the treatment of migraine.

Methods.—Monte Carlo modeling techniques were used to simulate the experience of Canadian migraineurs over the course of 1 year. Data from a multinational study comparing oral naratriptan 2.5 mg to customary therapies were used in the cost‐effectiveness analysis.

Results.—Naratriptan leads to an annual reduction in symptom duration of 225 hours compared to customary therapy not including other triptans. Reductions in lost productivity yield savings of Can $390 (1998 Canadian dollars) relative to customary therapy, which exceed the increase in drug costs resulting in overall savings of Can $109 per year.

Conclusions.—The use of naratriptan in the treatment of migraine is an economically attractive option, leading to savings in overall costs. Increases in drug costs seem acceptable in light of reductions in symptom duration.
Headache As Only Symptom in Multiple Cervical Artery Dissection
Authors: Buyle Maarten , Engelborghs Sebastiaan , Kunnen Jan , De Deyn Peter Paul
Published: March 2003

We describe a patient with atypical headache as the only presenting symptom of spontaneous triple cervical artery dissection. As the patient suffered from arterial hypertension, a causative relation between headache and arterial hypertension was initially taken into consideration. However, four‐vessel arteriography disclosed a dissection of both internal carotid arteries and the right vertebral artery.

This unique case highlights the value of conventional arteriography for diagnosing cervical artery dissection. Since multiple cervical artery dissections are not rare, all cervical arteries should be examined by means of conventional arteriography when a dissection is suspected.
Effect of Rizatriptan and Other Triptans on the Nausea Symptom of Migraine: A Post Hoc Analysis
Authors: Lipton Richard B. , Pascual Julio , Goadsby Peter J. , Massiou Helene , McCarroll Kathleen A. , Vandormael Kristel , Jiang Kaihong , Lines Christopher R.
Published: March 2003

Objective.—To compare the effects of oral rizatriptan, sumatriptan, naratriptan, and zolmitriptan on the relief and emergence of nausea during a migraine attack.

Methods.—Data from five randomized, placebo‐controlled, double‐blind clinical trials in which oral rizatriptan 10 mg was directly compared with oral sumatriptan 100 mg (N = 772), 50 mg (N = 1168), 25 mg (N = 1180), naratriptan 2.5 mg (N = 406), or zolmitriptan 2.5 mg (N = 571) for the acute treatment of a migraine attack were retrospectively analyzed. Migraine was diagnosed according to International Headache Society criteria. Presence or absence of nausea was recorded at baseline and at 0.5, 1, 1.5, and 2 hours after dosing. The end points analyzed were relief of nausea in those who had it at baseline and emergence of nausea in those who were free of it at baseline. Treatments were compared using odds ratios estimated from logistic regression models at 2 hours, and averaged odds ratios for the first 2 hours posttreatment.

Results.—Approximately 60% of patients in each treatment group had nausea at baseline. In those patients with nausea at baseline, significantly more patients treated with rizatriptan 10 mg were free of nausea at 2 hours compared with sumatriptan 100 mg (66% versus 58%, P = .043), sumatriptan 50 mg (68% versus 57%, P = .010), sumatriptan 25 mg (68% versus 59%, P = .017), and naratriptan 2.5 mg (59% versus 45%, P = .014). Averaging over the four posttreatment time points in the first 2 hours, significantly more patients treated with rizatriptan 10 mg were free of nausea compared with sumatriptan 100 mg (P = .004), sumatriptan 50 mg (P = .001), and naratriptan 2.5 mg (P = .015). No significant differences in nausea relief were seen between rizatriptan 10 mg and zolmitriptan 2.5 mg, either at 2 hours (65% versus 61%, P = .210) or over the first 2 hours (P = .781). Rates of treatment‐emergent nausea at 2 hours ranged from 11% to 18% with placebo, from 5% to 13% with rizatriptan 10 mg, and from 10% to 20% with other comparator triptans.

Conclusions.—Oral rizatriptan 10 mg was more effective than oral sumatriptan and naratriptan at eliminating nausea within 2 hours in patients who had it at baseline. Rates of emergent nausea in patients who were free of it at baseline were low, and no consistent differences were observed between active treatments.
Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II
Authors: Lipton Richard B. , Stewart Walter F. , Diamond Seymour , Diamond Merle L. , Reed Michael
Published: March 2003

Objective.—To describe the prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population‐based study employing identical methods.

Methods.—A validated, self‐administered questionnaire was mailed to a sample of 20 000 households in the United States. Each household member with severe headache was asked to respond to questions about symptoms, frequency, and severity of headaches and about headache‐related disability. Diagnostic criteria for migraine were based on those of the International Headache Society. This report is restricted to individuals 12 years and older.

Results.—Of the 43 527 age‐eligible individuals, 29 727 responded to the questionnaire for a 68.3% response rate. The prevalence of migraine was 18.2% among females and 6.5% among males. Approximately 23% of households contained at least one member suffering from migraine. Migraine prevalence was higher in whites than in blacks and was inversely related to household income. Prevalence increased from aged 12 years to about aged 40 years and declined thereafter in both sexes. Fifty‐three percent of respondents reported that their severe headaches caused substantial impairment in activities or required bed rest. Approximately 31% missed at least 1 day of work or school in the previous 3 months because of migraine; 51% reported that work or school productivity was reduced by at least 50%.

Conclusions.—Two methodologically identical national surveys in the United States conducted 10 years apart show that the prevalence and distribution of migraine have remained stable over the last decade. Migraine‐associated disability remains substantial and pervasive. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.
Perceived Scintillation Rate of Migraine Aura
Authors: Crotogino Jennifer , Feindel Anna , Wilkinson Frances
Published: March 2003

Objective.—To measure the perceived rate of flicker (temporal frequency) observed during visual auras.

Background.—The flickering or scintillating quality of aura elements is a commonly described characteristic of visual migraine auras. Hypotheses about the neural mechanisms involved in aura have rarely taken this feature into account, perhaps because of a lack of quantitative data on this aspect of the aura. While a rate of 10 Hertz had been suggested in the literature, estimates have been speculative due to the difficulty of judging temporal frequencies subjectively.

Methods.—Eleven participants were given portable devices that contained an adjustable light‐emitting diode with which to match the flickering of their auras. Observers were asked to make flicker matches at two time points so that rate change during aura progression could be analyzed.

Results.—Data were obtained for 36 aura episodes. The mean rate of flicker across individuals was 17.8 Hertz. Rates varied widely between individuals, but were more consistent across multiple episodes in the same observer. Rate of flicker did not appear to relate to aura side or type, or to individual characteristics such as migraine history. When episodes were analyzed for change in flicker rate over time, patterns of increase (n = 7), decrease (n = 4), and no change (n = 22) were all observed.

Conclusions.—When measured with an objective task, aura scintillation rates were found to be somewhat higher than previous anecdotal observations had suggested. These data are discussed in the context of two competing hypotheses concerning the neural mechanism underlying the flicker percept during migraine aura.
Migraine With Aura After Intracranial Endovascular Procedures
Authors: Beekman R. , Nijssen P.C.G. , Van Rooij W.J. , Wijnalda D.
Published: March 2003

Objective.—To describe three cases of migraine (two with aura) after an intracranial endovascular procedure.

Method.—Retrospective.

Results.—One patient had an attack of migraine with prolonged aura after embolization of a dural arteriovenous fistula. Another patient had an attack of migraine with aura (and hemiparesis) after a diagnostic angiogram. The third patient already suffered from migraine with aura and had a migraine attack after embolization of an occipital arteriovenous malformation. A quadrantanopia persisted in this patient. Outcome of the other two patients was good.

Conclusion.—Intracranial endovascular procedures can induce migraine with aura. We could not identify the underlying pathophysiological mechanism, but mechanical, chemical, immunological, or hemodynamic factors could be involved.
Mouth‐Dispersible Aspirin in the Treatment of Migraine: A Placebo‐Controlled Study
Authors: MacGregor E. Anne , Dowson Andrew , Davies Paul T.G.
Published: March 2003

Objective.—To compare the efficacy of mouth‐dispersible aspirin 900 mg and placebo in the treatment of migraine.

Background.—Aspirin is widely accepted as an effective therapy for migraine. Previous studies have indicated that gastric stasis and delayed gastric emptying, which occur during migraine attacks, delay aspirin absorption. Mouth‐dispersible formulations are considered to be more quickly absorbed than solid formulations and, therefore, may be more effective in treating migraine.

Design.—Randomized, double‐blind, placebo‐controlled, crossover study in four specialized migraine clinics in the United Kingdom.

Methods.—One hundred one patients diagnosed with migraine (according to the International Headache Society diagnostic criteria) participated in the study. Patients received either single doses of mouth‐dispersible aspirin (3 × 300 mg) or placebo for moderate pain in the treatment of two migraine attacks. Rescue medication could be taken after 2 hours, if required.

The primary efficacy parameter was response to therapy at 2 hours posttreatment. Other efficacy parameters were response to treatment, pain‐free, and pain intensity at all other time points. Functional disability, nausea, vomiting, photophobia, phonophobia, symptom relief, patient and investigator global evaluation, use of rescue medication, headache recurrence, and palatability and convenience were also recorded.

Results.—Of 101 patients, 73 took both treatments. At 2 hours, 48% of patients taking mouth‐dispersible aspirin responded, compared to only 19% taking placebo (P = .0005). Mouth‐dispersible aspirin was significantly better than placebo for response to treatment (P<.05) and pain intensity difference (P<.01) at all time points from 30 minutes posttreatment; for pain‐free (P<.05) and use of rescue medication (P<.01) from 3 hours posttreatment; for headache recurrence (P<.05); and for patients' and investigators' global evaluations of efficacy (P = .0001 in both cases).

Conclusions.—Mouth‐dispersible aspirin 900 mg is effective compared with placebo for the treatment of moderate migraine head pain, with relief seen from as early as 30 minutes after taking medication.
Predicting the Number of Headache Visits by Type of Patient Seen in Family Practice
Authors: Hasse Lora A. , Ritchey P. Neal , Smith Robert
Published: March 2003

Objective.—To examine the number of visits involving a headache diagnosis among patients to four family practice sites between July 1, 1995 and December 31, 1998.

Background.—Although the majority of care‐seeking headache sufferers are seen in the primary care setting, few studies have attempted to document the relationship between type of headache as diagnosed by the family practice physician, and number of the patient's headache visits.

Design.—Secondary analysis of administrative claims data.

Methods.—We compared headache visits per person‐year by the age and sex of patient among patients classified according to headache diagnosis received: tension‐type only; headache not otherwise specified (NOS) only; migraine only; tension‐type and headache NOS; tension‐type and migraine; headache NOS and migraine, and migraine, tension‐type, and headache NOS. Patients with an International Classification of Diseases (version 9) code of 346 were considered to have a diagnosis of migraine, with 307.81 representing tension‐type headache, and 784 representing headache NOS. Age was measured from date of birth to initial visit in the study period and patients were subdivided into 5‐year age groups. Person‐years “at risk” for each diagnosis was measured from the time of initial visit during the study period to December 31, 1998.

Results.—We examined data from 4,112 patients who made 9,322 visits with a headache diagnosis. We found that the average number of visits per person‐year increases as the number of different types of headache diagnoses increased and were greatest for patients having migraine as opposed to headache NOS and tension‐type diagnoses.

Conclusions.—Headache type is an important predictor of the number of office visits involving a headache diagnosis in family practice. Patients with multiple headache diagnoses have more visits. Patients with combinations of headache diagnoses involving migraine are the most frequent visitors.
Effectiveness of Topiramate in the Prevention of Childhood Headaches
Authors: Hershey Andrew D. , Powers Scott W. , Vockell Anna‐Liisa B. , LeCates Susan , Kabbouche Marielle
Published: March 2003

Background.—Migraine is a significant problem for many children. Topiramate has been suggested to be effective for the prophylaxis of migraine in adults, but has not yet been examined in children. The drug has been demonstrated to be safe and effective for childhood seizure disorders. The objective of this study was to demonstrate the safety and efficacy of topiramate for the prevention of pediatric migraine.

Methods.—Children with frequent migraine were prescribed topiramate for headache prevention. Dosages, serum levels, and Serum Glutamic Oxalacetic Transaminase (SGOT) levels were monitored. Changes in frequency, severity, and duration of headaches were recorded and changes in headache‐related disability using PedMIDAS also were measured.

Results.—Ninety‐seven children were treated with topiramate, and 75 were reevaluated 88.7 ± 35.7 days later, 41 were seen at a second follow‐up, and 17 were seen at a third follow‐up evaluation. The daily dose reached at second evaluation was 84.0 ± 38.6 mg/day or 1.42 ± 0.74 mg/kg/day. This corresponded to a mean serum level of 2.8 ± 1.6 μg/mL. The mean headache frequency was reduced from 16.5 ± 10.0 to 11.6 ± 10.2 days per month (P<0.001) with a further reduction to 9.4 ± 8.4 days by the second follow‐up (P<0.001). Severity and duration of headache also were reduced. Headache disability improved, with a reduction of Pediatric Migraine Disability Assessment score from 36.0 ± 42.3 to 20.8 ± 34.0 at the first follow‐up (P<0.05), 19.1 ± 22.0 at the second follow‐up (P<0.005), and 10.9 ± 16.9 at the third follow‐up (P<0.001). Most patients tolerated topiramate well. The most common side effects reported were cognitive (12.5%), weight loss (5.6%), and sensory (2.8%).

Conclusions.—Topiramate is potentially an effective prophylactic medication for children with frequent migraine.