bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumour budding as prognostic factor in stage I/II colorectal carcinoma
Authors: Prall F , Nizze H , Barten M
Published: June 2005

Aims : The term tumour ‘budding’ has been coined for the detachment of tumour cells from the neoplastic glands of adenocarcinomas and is presumed to be an early step in the metastatic process. A limited number of studies have shown budding to be an adverse prognostic factor.

Methods and results : All primary single, non‐metachronous TNM stage I/II colorectal carcinomas without neoadjuvant treatment resected in the years 1994–1999 were included (n = 186). Tumour buds were counted in pan‐cytokeratin immunostains in a 0.785‐mm2 field of vision (250 ×). During follow‐up 21 patients had distant metastases and 12 patients died of their disease. Budding was determined at 14 and 20.46, median and mean, respectively (range 0–120). A cut‐off of 25 was found to be sensitive (0.76) and specific (0.739). Kaplan–Meier survival analysis showed high budding to be a strong adverse prognosticator. By Cox regression, high budding together with venous angioinvasion were independent prognostic factors.

Conclusions : This study confirms the prognostic value of budding in a contemporary series of colorectal carcinomas that by TNM were low risk. Technically easy, rapid and robust to determine, budding quantified in pan‐cytokeratin stains significantly aids in the identification of high‐risk patients and is recommended for more general use in surgical pathology.
WT1 expression in angiogenic tumours of the skin
Authors: Timár J , Mészáros L , Orosz Z , Albini A , Rásó E
Published: June 2005

Aims : To determine the expression of WT1 in endothelial proliferations and tumours. Endothelial cells are derived from angioblasts which differentiate into bone marrow stem cells (BMSC). BMSC are characterized by the constitutive expression of the WT1 gene and we have postulated that its expression may be maintained during the differentiation of angioblasts to endothelial cells.

Methods and results : The expression of WT1 was studied in human umbilical vein‐derived (HUVEC) and brain microvascular endothelial cells (HBME) as well as in a Kaposi sarcoma (KS) cell line in vitro. Forty‐two human skin biopsy samples of endothelial proliferations and tumours were analysed for the protein expression of WT1 using the monoclonal antibodies for wt‐WT1 (6F‐H2) and its 17AA+ variant (2C12). WT1 expression was detectable in HUVEC and KS cells and all WT1 splice variants examined (17AA+/– KTS+/–) were detectable in KS cells, while the 17AA+/– and KTS– variants were present in HUVEC. Immunohistochemical analysis of the 42 human skin biopsy samples revealed cytoplasmic WT1 expression using wild‐type specific antibody (6FH2) in microvessels, which is maintained during neoangiogenesis (inflammation, haemorrhage, peritumoral angiogenesis). Around one‐third of haemangiomas (3/10) and non‐HIV‐Kaposi sarcomas (7/18) expressed the WT1 protein in the cytoplasm of tumour cells compared with its frequent expression in angiosarcomas (7/8) using the same antibody (6FH2). The nuclear 17AA+ isoform of WT1 was detectable at protein level in a small proportion of KS cases exclusively (3/7).

Conclusion : Our data suggest that WT1 protein expression is maintained during angiogenesis and malignant transformation of endothelial cells and can be considered as a new endothelial marker.
Changing phenotype of gastrointestinal stromal tumours under imatinib mesylate treatment: a potential diagnostic pitfall
Authors: Pauwels P , Debiec‐Rychter M , Stul M , De Wever I , Van Oosterom A T , Sciot R
Published: June 2005

Aims : The diagnosis of gastrointesinal stromal tumours (GISTs) is widely based on morphological features and KIT (CD117) immunoreactivity. Most patients with advanced GISTs show a major clinical response after treatment with imatinib mesylate. The histopathological features of GISTs in patients on prolonged imatinib treatment have, thus far, not been addressed in detail. In this report, we present three patients with metastatic GISTs, who received more than 1 year of therapy with imatinib, and whose tumours changed their morphological and immunohistochemical characteristics during continued treatment with the drug.

Methods and results : All three primary GISTs from these patients were classical spindle‐type tumours, showing diffuse, strong CD117, CD34, and focal α‐smooth muscle actin expression. During treatment, two clinically progressive and one clinically stable GIST revealed a diffuse epithelioid, or pseudopapillary epithelioid growth pattern, characterized by rounded cells with eosinophilic cytoplasm and uniform round‐to‐ovoid nuclei. In addition, GIST specimens from patients on therapy showed complete loss of CD117 immunoreactivity. Remarkably, two of these tumours also became CD34 immunonegative and in one case the progression was accompanied by desmin expression. KIT mutational analysis revealed the presence of distinct exon 11 mutant isoforms in all cases examined, while the same genotype was sustained in the base line and on‐therapy tumour specimens, proving the common origin of analysed specimens.

Conclusions : GISTs subject to imatinib treatment can undergo striking (immuno)phenotypic changes, which are not necessarily corroborated by new genotypic modifications. Because these may mimic other tumour types, this feature creates a differential diagnostic challenge, of which the pathologist should be aware.
Diagnostic utility of immunohistochemistry in morphologically difficult prostate cancer: review of current literature
Authors: Varma M , Jasani B
Published: June 2005

Immunohistochemistry is widely used to distinguish prostate cancer from benign mimics and to establish the prostatic origin of poorly differentiated carcinoma. We critically review the recent advances in prostate cancer immunohistochemistry, including the introduction of newer basal cell markers such as p63 and the discovery of the overexpression of α‐methylacyl coenzyme A racemase (AMACR) in prostate cancer. The description of newer urothelial markers to aid the distinction of prostate cancer from urothelial carcinoma is also presented together with refinements in the quality control of PSA and PSAP immunostaining. Although AMACR is a useful immunohistochemical marker for prostate cancer, it has significant limitations. These limitations are discussed and the need for interpreting AMACR immunoreactivity in the appropriate morphological context and in conjunction with basal call markers is emphasized. We also describe the utility of an immunohistochemical panel composed of PSA, PSAP and high molecular weight cytokeratin for distinguishing poorly differentiated prostate cancer from high‐grade urothelial carcinoma. A morphological differential diagnosis based selection of immunohistochemical markers is highlighted as a novel approach in the diagnosis of prostate cancer in routine surgical pathology practice.
Identification of a novel HLA‐DRB1 allele (HLA‐DRB1*111902*)
Authors: Li D. , Gao H.F. , Liu X. , Jiang D. , Li Z. , Liu Y.H. , Jiang Y.Z. , Li L. , Lan G.X. , Zhao C.Z. , Guo T. , Cai B. , Wang D. , Sun G.Y. , Zhang D. , Lu D.P.
Published: June 2005

Abstract:  In this paper, we report a new HLA‐DRB1 allele identified in a male acute myeloid leukaemia Chinese patient. This sample was initially typed as DRB1*11XX using commercial polymerase chain reaction‐sequence‐specific primers kit. When it was typed using a chip‐based sequence‐specific oligonucleotide technique, a novel hybridization pattern that does not match any known alleles was observed. Through sequencing, we have identified this allele as a new HLA‐DRB1 allele, which was later named HLA‐DRB1*111902 by the WHO Nomenclature Committee. The sequence of this new allele differs from DRB1*111901 by one nucleotide (from G to C) at 203nt of exon 2 but does not cause any amino acid substitution.
Identification of a new allele in a Sicilian individual: HLA‐DPB1*0302
Authors: Sheldon M.H. , Azzaro M.P. , Sayer D. , Bunce M. , Sortino G.
Published: June 2005

Abstract:  We report here the identification and characterization of a novel human leucocyte antigen (HLA)‐DPB1 allele that was subsequently named HLA‐DPB1*0302 by the WHO Nomenclature Committee. HLA‐DPB1*0302 was identified in a single Sicilian individual by a combination of sequence‐specific primers, reverse line sequence‐specific oligonucleotide probing and DNA sequencing‐based typing. The DPB1*0302 allele is most similar to the DPB1*3101 allele, differing by a single mismatch at nucleotide position 301 (T to G).
HLA‐B27 polymorphism in Mumbai, Western India
Authors: Chhaya S.U.
Published: June 2005

Abstract:  Human leucocyte antigen (HLA)‐B27 encompasses an increasing number of subtypes that show diverse racial/ethnic prevalence in the world. One thousand‐one‐hundred and seventy unrelated individuals from Mumbai, Maharashtra, Western India were typed for HLA‐B27 antigen by serological methods. HLA‐B27 positivity was confirmed by polymerase chain reaction using sequence specific primers. High‐resolution typing using sequence specific primers for HLA‐B27 alleles (B*2701 – B*2721) was carried out in 70 HLA‐B27‐positive individuals. The frequency of B27 ranged between 1.48 and 9.6% among the caste groups studied. HLA‐B27 subtyping identified B*2702 (1.43%), B*2704 (14.29%), B*2705 (70%), B*2707 (12.86%) and B*2718 (1.43%), respectively. The findings illustrate substantial genetic variation and heterogeneity within population groups from India. Extensive subtyping in other Indian caste groups will be necessary to resolve the evolutionary implications of HLA‐B27 subtypes and their relationship to disease association in the Indian context.
Chimerism analysis by sex determining region Y (SRY) and major histocompatibility complex markers in non‐human primates using quantitative real‐time polymerase chain reaction
Authors: Sieverkropp A.J. , Andrews R.A. , Gaur L. , Shields L.E.
Published: June 2005

Abstract:  The ability to discriminate and further quantify the proportion of donor and host cells is essential in hematopoietic stem cell transplant protocols. In human sex‐mismatched transplants, this can be easily accomplished by the use of commercially available fluorescent in situ hybridization (FISH) probes. In many animal models, including non‐human primates, this methodology is not possible due to the lack of commercially available FISH probes. In animal models, donor cell detection could be accomplished if there is a known species‐specific sex determining region Y (SRY) (male) or other unique DNA sequence using either semiquantitative or quantitative real‐time polymerase chain reaction (PCR). The use of real‐time quantitative PCR has the obvious advantage of providing detailed enumeration of the percentage of donor cells present. We report the development of extremely sensitive primer and probe combinations for male (SRY) and major histocompatibility complex (MHC)‐DQA sequences in the macaque and baboon non‐human primate models. This assay has a sensitivity of a five‐log range and can detect less than four target cells in the presence of 105 background cells (approximately 0.001%) and fetal DNA obtained from maternal serum from Macaca nemestrina. The SRY (male) primer and probe combination has similar sensitivity in Macaca fasicularis, Macaca mulatta, and Papio cynocephalus anubis.
Pre‐ovulatory temperature gradients within mammalian ovaries: a review
Authors: Hunter R. H. F. , Einer‐Jensen N.
Published: June 2005

The existence of a temperature gradient between the testis and deep body temperature has been accepted for many years. It is based on two simultaneous principles: cooling of the testis through the scrotal wall and transfer of heat between the testicular blood vessels. The ovary is positioned in the abdomen; a temperature difference parallel to the male system therefore seems less likely. However, the temperature of large follicles has been found to be 0.5 to 1.5 °C cooler than the ovarian stroma in rabbits, pigs and, probably, women. The temperature difference seems to be based on a heat‐consuming process in the expanding follicullar fluid, and a local transfer of heat between intra‐ovarian blood vessels. The reason for the temperature gradient is not yet known; one may speculate of a common reason for the cooling of the gamete in male and female.
Effects of long‐term growth hormone‐releasing factor treatment on growth, feed conversion efficiency and dry matter intake in growing female buffaloes (Bubalus bubalis)
Authors: Mondal M. , Prakash B. S.
Published: June 2005

Effects of long‐term growth hormone‐releasing factor (GRF) on growth performance, feed conversion efficiency (FCE) and dry matter intake (DMI) were studied in growing buffaloes. Twelve female Murrah buffaloes of 6–8 months of age were divided into two groups of six each on the basis of their body weights so that the average body weights of the groups did not differ (p > 0.05). Animals of each group were administered intravenously with either sterile distilled water (control group) or equal volume of GRF solution containing 10 μg GRF (1–44)‐NH2/100 kg body weight (treatment group) at fortnight interval from week 6 (5‐week pre‐treatment period) for 36 weeks (weeks 6–42 treatment period). Thereafter a 10‐week post‐treatment period was added. All the animals were weighed consecutively 2 days in a week and the average body weight of the two observations in the week was thus considered for further calculation. Dry matter intake was recorded daily. Average daily gain, FCE and DMI/100 kg body weight were also calculated. Plasma progesterone was estimated in the samples collected twice a week at 3–4‐day intervals to assess whether either group had begun ovarian cycles. It was found that ADG and FCE were higher (p < 0.01) in GRF‐treated animals during treatment and even 10‐week post‐treatment period. Interestingly, total DMI was not different (p > 0.05) between the groups during treatment period but found to be lower in GRF treated animals during post‐treatment period. The DMI/100 kg body weight was lower (p < 0.01) in GRF‐treated animals during treatment and even after cessation of treatment for 10 weeks. The GRF administration for long‐term increased (p < 0.05) plasma progesterone. Plasma progesterone concentrations suggest that no animal from either group reached puberty till the end of the experiment. In conclusion, repeated GRF administration for longer term decreased (p < 0.01) DMI/100 kg body weight and increased (p < 0.01) FCE and enabled the animals to grow faster.
Disseminated cryptococcosis in a human immunodeficiency virus‐negative patient: a case report
Authors: Kokturk Nurdan , Ekim Numan , Kervan Firdes , Arman Dilek , Memis Leyla , Çaglar Kayhan , Kalkanci Ayse , Demircan Sedat , Kurul Cuneyt , Akyurek Nalan
Published: June 2005

Cryptococcus neoformans is a widely distributed saprophytic fungus that may cause opportunistic infections in normal and immunocompromised individuals particularly in patients with HIV infection. Disseminated infection in HIV‐negative individuals is occasionally seen: a 57‐year‐old HIV‐negative Turkish female initially presented with enlarged mediastinal lymph nodes and a large pulmonary parenchymal nodule, eventually diagnosed with disseminated cryptococcosis and tuberculosis.
Xanthogranulomatous inflammation presenting as a submucosal mass of the sigmoid colon
Authors: Oh Young‐Ha , Seong Sang Seokg , Jang Ki‐Seok , Chung Yong Woo , Paik Chang Hee , Park Yong Wook , Han Dong Soo
Published: June 2005

Xanthogranulomatous inflammation (XGI) is a well‐recognized disease process in the kidney and gallbladder. However, involvement of the colon is extremely rare. On the other hand, it is important to recognize that clinically and radiologically, XGI could be misinterpreted as an infiltrative cancer. Recently the authors encountered a 38‐year‐old woman who presented with a submucosal mass‐like lesion in the sigmoid colon. Radiological imaging had also suggested a possibility of sigmoid colon cancer as well as pelvic inflammatory disease or actinomycosis. Although XGI may rarely occur in the large bowel, it should be considered in patients with a colonic submucosal mass. In addition, it is important to make an intraoperative pathological diagnosis in order to avoid any excessive operative stress.
Outcome of oesophagectomy for adenocarcinoma of the oesophagus and oesophagogastric junction
Authors: Zhang Xun , Watson David I. , Jamieson Glyn G. , Lally Carolyn , Bessell Justin R. , Devitt Peter G.
Published: June 2005

Background:  Oesophageal adenocarcinoma is becoming an increasingly important problem in the Western world. Its incidence is increasing and its prognosis is poor. Because most reports of outcomes following oesophagectomy include patients with squamous cell carcinoma, the outcome following oesophagectomy for adenocarcinoma was evaluated at Flinders Medical Centre, Royal Adelaide Hospital and associated private hospitals.

Methods:  The study group consisted of 121 patients with oesophageal adenocarcinoma or adenocarcinoma of the oesophagogastric junction who underwent an attempted oesophagectomy between 1985 and 2003. Thirty‐two of these patients underwent surgery before 1999 at the Royal Adelaide Hospital. These patients were reviewed retrospectively. In 1999 the recording of details of all patients undergoing oesophagectomy was commenced on a prospectively maintained database. From 1999 to 2003, 89 patients underwent oesophagectomy at either the Royal Adelaide Hospital, Flinders Medical Centre or associated private hospitals. Overall, there were 101 male and 20 female patients, with a median age at surgery of 63 years (range 36−80). Survival data were available for all patients. The present study analysed factors affecting survival in these patients.

Results:  Tumours were located entirely within the oesophagus in 83 patients, and involved the gastro‐oesophageal junction in 38. Eighty‐nine underwent an Ivor Lewis oesophagectomy; 20, a cervico‐thoraco‐abdominal oesophagectomy; nine, a cervico‐abdominal oesophagectomy (with either transhiatal or blunt oesophageal dissection); and four procedures were abandoned. Sixty‐four per cent of patients had evidence of Barrett's oesophagus in the resection specimen. The overall resection rate was 97%. Significant postoperative morbidity occurred in 36%, and the in‐hospital mortality rate was 5% (30‐day mortality 3%). The overall 1‐year survival rate was 80%, and the 5‐year survival rate (including surgical deaths) was 20%. Poorer survival was associated with advanced T stage, and lymph node metastasis. The outcome following resection of tumours confined to the oesophagus was similar to that for tumours involving the gastro‐oesophageal junction. Since 2000, the number of oesophagectomies performed in men for adenocarcinoma has doubled, whereas the number performed in women and for squamous cell carcinoma has remained constant.

Conclusions:  Oesophagectomy can be performed for patients with adenocarcinoma with an acceptable perioperative mortality rate. However, the longer term outlook following oesophagectomy for most patients with adenocarcinoma remains poor. Nevertheless, early stage tumours are associated with much better survival. For this reason, efforts to diagnose this disease at an early stage are likely to offer the best chance for improving outcomes.
Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma
Authors: Cheung Man‐Chiu , Lee Yee‐Mun , Rindani Rahul , Lau Howard
Published: June 2005

Background:  Laparoscopic renal surgery is now accepted within the urological community and its indication is extended to oncological operation. The oncological outcome and survival of patients undergoing laparoscopic radical nephrectomy for clinically localized renal cell carcinoma were evaluated.

Methods:  From October 1998 to July 2003, 100 patients underwent laparoscopic radical nephrectomy for clinically localized renal cell carcinoma. All operations were performed by transperitoneal approach with early vascular control. Perioperative events and pathological data were recorded prospectively. Patients were followed up by clinical examination, chest radiograph, ultrasonography and/or computed tomography where appropriate.

Results:  The median age of patients was 61 years. Median operating time was 120 min and blood loss was 100 mL. There were five open conversions. There was no perioperative mortality but 11 patients had complications. Resection margins were clear in all but one patient. The median tumour size was 4.6 cm. The median follow‐up time was 30 months. All patients survived up to the date of review. No patient developed port‐site recurrence but two patients had recurrence at the renal bed 1 year after the operation. Five patients developed distant metastases involving liver, lung and bone.

Conclusion:  Laparoscopic radical nephrectomy is a safe and efficacious treatment option for clinically localized renal cell carcinoma. The intermediate‐term oncological outcome appears favourable.
PROVENANCE OF MEDIEVAL PIETRA OLLARE ARTEFACTS FOUND IN ARCHAEOLOGICAL SITES OF CENTRAL–EASTERN ITALY: INSIGHTS INTO THE ALPINE SOAPSTONE TRADE*
Authors: SANTI P. , ANTONELLI F. , RENZULLI A.
Published: June 2005

Medieval archaeological findings made of pietra ollare (basic and ultrabasic metamorphic rocks belonging to the greenschist facies) and coming from central–eastern Italy have been characterized through a petrological study (modal mineralogy, whole‐rock geochemistry, XRD and SEM–EDS analyses). The pietra ollare artefacts considered in this work consist of fine‐grained, grey to pale‐grey, magnesite‐bearing talc‐schists (i.e., soapstones). In order to determine their production centres, Alpine soapstones quarried in ancient times were selected on the basis of their mineralogical and textural compatibility with the archaeological findings. The mineralogy and chemistry (major and trace elements) contributed to establishing the ancient quarries of the Valchiavenna (central Alps) as the probable provenance area. This archaeometric investigation proves that Alpine artefacts made of pietra ollare spread to the south of the Po Plain during the Middle Ages. It can be inferred that the Alpine soapstone trade towards the Marche and Abruzzo regions was addressed through the main waterways: Lake Como, the Adda and Po Rivers and finally the Adriatic Sea.
MEDIEVAL BRICK‐BUILDING IN THE CENTRAL ALPS*
Authors: GOLL J.
Published: June 2005

Since Roman times, the Alpine area has been the scene of all movements in brick construction—certainly only in a few places, but always at a high technical and aesthetic level. This is all the more surprising as in the mountain areas sufficient stone material is available in a suitable quality for building. Obviously, brick materials displayed overwhelming advantages. Via the mediation of the Church and the secular managerial class, the latent capacity of brick technology was able to rapidly gain a foothold as ideas began to flow internationally. Every era has discovered particular advantages in the use of brick and has expressed them in its architecture.
Measures of Forehead and Finger Temperature, Frontalis EMG, Heart Rate and Finger Pulse Amplitude During and Between Migraine Headaches
Authors: McArthur David L. , Cohen Michael J.
Published: June 2005

SYNOPSIS

Finger and head temperature, frontalis electromyography (EMG), heart rate, and finger pulse amplitude (FPA) were measured from eight migraine headache patients both during and between migraine headaches. T‐tests for correlated measures revealed significant differences between the headache‐present and headache‐free states in frontalis EMG and finger pulse amplitude, but not in the measures of temperature or heart rate. During headaches EMG was 260% greater while finger pulse amplitude constricted to about 25% of the headache‐free estimates.
Leucocyte Histamine Release in Migraine
Authors: Sanders William M. , Zimmerman Andrew W. , Mahoney Mark A. , Ballow Mark
Published: June 2005

SYNOPSIS

Although histamine has been suggested as a possible vasoactive mediator in the pathogenesis of migraine, the mechanism of histamine release and its exact role in the pathophysiology of migraine is unclear. The spontaneous release of histamine from plasma‐free leucocyte suspensions was examined in 9 patients with 5 types of migraine. The patients were 7 to 46 years of age and had migraine for 1 to 17 years. All were symptom‐free for at least one week before the study and none had a history of food allergy. Nine control individuals (2–32 years old) had other types of headache, seizure disorders, or other medical problems.The mean spontaneous histamine release (SHR) was 73.7% ± 14.88 by leucocytes from migraine patients and 22.8% ± 11.67 in control patients (p<0.001). These preliminary findings indicate that the SHR assay may be a useful clinical marker for migraine and may provide additional information on the pathogenesis of migraine.
MMPI Patterns in Common Headache Disorders
Authors: Sternbach Richard A. , Dalessio Donald J. , Kunzel Minerva , Bowman Gerald E.
Published: June 2005

SYNOPSIS

The results of the study support the findings that vascular headache patients obtain lower MMPI scores than do muscle contraction and mixed headache patients. We suggest that this may be due to more frequent and longer pain‐free intervals. We also note a tendency for male muscle contraction headache patients to be somewhat more morally self‐righteous than the other categories, but this finding requires confirmation. Comparisons between these headache patients (all categories) and 50,000 general medical patients showed the former to obtain scores markedly greater than the latter on most scales; this also may reflect greater duration and severity of subjective distress.
Cognitive Behavioral Treatment of Chronic Headache
Authors: Bakal Donald A. , Demjen Stefan , Kaganov Judith A.
Published: June 2005

SYNOPSIS

A cognitive behavioral treatment study based on 45 chronic headache patients is presented. The sample included patients who had been diagnosed as suffering from muscle contraction, migraine or combined muscle contraction‐migraine headaches. The treatment procedure followed Meichenbaum's cognitive theory of self‐control and had, as its theoretical basis, a psychobiological model of headache. Patients were given individual training in the use of behavioral and cognitive techniques which were designed to modify the sensations, thoughts, and feelings identified by the patients as forming part of their headache syndrome. Treatment effectiveness was examined in relation to a number of topographical characteristics of each patient's headache pattern. The topographical data were collected with a self‐observation record which provided information with respect to: duration of attacks, intensity of pain, time of onset, proportion of attacks associated with various head pain locations, presence of associated headache symptoms and medication usage.

The results showed a significant overall treatment effect that was maintained at 6‐month follow‐up. An analysis of covariance revealed that the treatment gains were similar across diagnostic groups. Treatment gains were also found to be largely independent of the headache parameters obtained from the self‐observation record. Head pain locations and symptoms thought to be diagnostic of migraine and muscle contraction headache were not predictive of response to treatment. However, it was observed that headache patients who experienced continuous or near‐continuous pain during their waking hours were not responsive to the treatment procedure. The significance of these findings for the behavioral management of headache is discussed along with their significance for understanding the psychobiological processes controlling chronic headache.

The authors wish to express their gratitude to Merleen Hodgson for her contributions to this project.
The Differential Contribution of Muscle Contraction and Migraine Symptoms to Problem Headache in the General Population
Authors: Kaganov Judith A. , Bakal Donald A. , Dunn Bruce E.
Published: June 2005

SYNOPSIS

The present study examined the prevalence of musculoskeletal, vascular and autonomic symptoms in headache sufferers in the general population. The differential contribution of these different categories of symptoms to varying degrees of problem headache was also examined. The symptoms were assessed by a 14–item questionnaire that permitted the respondents to indicate the extent to which each of the symptoms was perceived to be present across all headache attacks. In addition, a single item was included to assess the extent to which the respondents perceived their headache attacks to be a problem. Questionnaires were obtained from a systematic random sample of 1551 urban‐based households. Thirteen of the 14 symptoms showed a positive relationship between the frequency of occurrence and the extent to which headaches were perceived to be a problem. In addition a positive relationship emerged between the number of muscle contraction symptoms reported and the number of migraine symptoms reported. Additional analyses demonstrated that a reversal in symptom dominance occurred across the problem dimension in that musculoskeletal symptoms were more prevalent for headache sufferers who never or seldom perceived their headaches to be a problem while vascular symptoms were more prevalent for headache suffers who often or always perceived their headaches to be a problem. The reversal was only partial however, since the musculoskeletal symptoms of neck pain, back of head pain and feelings of tightness and pressure were found to differentiate the problem headache sufferer from the nonproblem headache sufferer. Overall, the data were viewed as providing additional support for the severity model of headache.
Behavioral Assessment Considerations in the Management of Headache
Authors: Lake Alvin E.
Published: June 2005

SYNOPSIS

Effective behavioral and psychophysiological treatment requires careful assessment of three components of the headache experience: (1) observable behavior, including activity, verbal complaints, moaning and grimmacing, and medication use, (2) cognitions, including self–statements and images, and (3) physiological functioning, including symptoms associated with various levels of skeletal, autonomic, end cortical arousal. In addition, behavioral assessment includes functional analysis of the antecedents and consequents of headache episodes. Antecedents include factors external to the person, from social situations to meteorological changes, as well as internal factors including behavior patterns, thoughts, and physiological arousal. Consequents – events following the occurrence of headache – include the response of other people in the patient's environment, patterns of avoiding activities because of headache, as well as the person's own subsequent behavior, thoughts, and emotional reactions.

The importance of these assessment considerations in the design of appropriate treatments is illustrated with examples from patient records. These cases suggest that effective behavioral and psychophysiological intervention may depend more on the profile revealed by this type of assessment than on the diagnosis of headache type.
The Effect of Infused Prostacyclin in Migraine and Cluster Headache
Authors: Peatfield R.C. , Gawel M.J. , Rose F. Clifford
Published: June 2005

SYNOPSIS

Prostacyclin appears to be the most active of the vasodilating prostaglandins with inflammatory and hyperalgesic properties. Its actions are very similar to those of prostaglandin E1, which has long been known to cause “vascular‐type” headaches. We have assessed the role of prostacyclin by infusing it into eight patients with migraine and eight with cluster headache. Most of the subjects developed a dull throbbing headache during the infusion. In most cases the nature of the induced headaches was different from those usually experienced, and not significantly different from those induced in three normal subjects.

Prostacyclin, therefore, does not appear to act as sole mediator of vascular headaches, though may still do so synergistically with one of a variety of amines and peptides.
Vertigo, Motion Sickness and Migraine
Authors: Kuritzky Arieh , Ziegler Dewey K. , Hassanein Ruth
Published: June 2005

SYNOPSIS

The frequency of vestibular symptoms in 104 headache patients during the headache‐free phase was studied. The group was comprised of 84 patients with migraine (24 classical and 60 common) 12 with tension and 8 with cluster headache. Fifty‐four headache‐free subjects served as controls. All the participants filled out a vestibular symptom questionnaire.

Patients with classical migraine reported significantly more vestibular symptoms than the controls. Specifically they had more dizzy spells (r = 0.002) and vertigo episodes (r = 0.01) not associated with the headache. They also had more frequent motion sickness spells. Of the classical migraine patients reporting motion sickness 87% experienced it at least once in 6 weeks compared to only 11% of the controls. Classical migraine patients also probably have an especially “sensitive” vestibular system, as evidenced by increased tendency to visual vertigo (r = 0.005) and significantly increased dizziness when they themselves were spinning.

The common migraine patients showed a tendency to vestibular impairment that was not statistically significant. Recent findings of vestibular function abnormalities in this group may suggest an evolving dysfunction that is not yet symptomatic. Patients with tension and cluster headache did not differ from the controls in all the vestibular symptoms studied.

In summary, our findings indicate clearly a vestibular impairment in classical migraine. The relation to “benign recurrent vertigo,” problems in the relationship of the occurrence of motion sickness to migraine and the possible mechanism causing the vestibular dysfunction are discussed.
Tyramine Sensitivity in Dietary Migraine: A Critical Review
Authors: Kohlenberg Robert J
Published: June 2005

SYNOPSIS

The hypothesis that oral tyramine causes migraine headache in certain patients was proposed by Hanington in 1967. In all, there are 11 published reports that experimentally test the hypothesis. Six of these studies provide support for the hypothesis whereas the results of four studies are clearly not supportive. All of the supporting evidence was generated in one laboratory (Hanington). In an attempt to evaluate this conflicting evidence, a comparison was made of outcome measures, subject selection procedures, and various methodological differences. There were some anomalous findings, most notably that there were marked differences in "placebo" headaches elicited by lactose capsules from study to study. Further, methodological differences among the studies preclude direct comparisons of the results. Taking these differences into account, the tyramine hypothesis appears to have some validity. The implications of these findings were discussed.
An Occurrence of Complicated Migraine During Propranolol Therapy
Authors: Gilbert Gordon J.
Published: June 2005

SYNOPSIS

A second case is reported wherein cerebral infarction complicated the course of a migraine attack during propranolol therapy.
Variation in Meaning of Pain Descriptors for Different Headache Types as Revealed by Psychophysical Scaling
Authors: Blanchard Edward B. , Andrasik Frank , Arena John G. , Teders Steven J.
Published: June 2005

SYNOPSIS

Tursky's (1976) set of pain descriptors for the intensity and reactivity dimensions were psychophysically scaled by patients with either tension, migraine, combined migraine and tension or cluster headaches and by a group of non‐headache sufferers. The reactivity descriptors consistently discriminated headache from non‐headache subjects and tended to be aligned consistent with the severity of the pain experienced in the various kinds of headaches.
Clues in the Tempos of Cluster Headache
Authors: Kunkle E. Charles
Published: June 2005

SYNOPSIS

Three striking features of the usual time patterns of cluster headache, each involving a trade‐off, offer provocative clues to headache mechanisms: (1) The high intensity is consistent with involvement of the internal carotid within its canal in an unproven but plausible process of dilatation with edema and possible sterile inflammation; the brevity of the attack may result from factors instrinsic to this arterial segment or from unusually effective pain‐suppressing feedback. (2) Rarely, in the patient with cluster headache a separate kind of pain develops, even more intense but tic‐like, possible arising from compromise of the trigeminal ganglion by the subjacent “carotid process”. (3) The major enigmatic tempo, clustering of attacks of headache separated by prolonged remissions, may denote fluctuations in autonomic vasomotor function, secondary in some individuals to changing life stress and in others to endogenous biologic rhythms. A search is warranted for biochemical evidence for cycles in activating or suppressor mechanisms, through serial assays, as of serum, in patients accessible to long‐term study.
Brainstem Influences on the Cephalic Circulation: Experimental Data From Cat and Monkey of Relevance to the Mechanism of Migraine
Authors: Lance J.W. , Lambert G.A. , Goadsby P.J. , Duckworth J.W.
Published: June 2005

SYNOPSIS

Stimulation of the locus ceruleus produces vasoconstriction in the intracerebral circulation and vasodilatation in the extracerebral circulation. The latter is mediated by the seventh cranial nerve, involving a non‐cholinergic transmitter. These vascular changes are reminiscent of those occurring in migraine. Stimulation of the trigeminal ganglion or of the trigeminal divisions produces a reflex dilatation in the external carotid territory also mediated by non‐cholinergic fibers in the seventh nerve.

It is postulated that, in migraine, activation of the locus ceruleus would produce vasoconstriction in the cerebral circulation and dilatation extracerebrally. Such an effect would account for both the neurological symptoms of migraine and the observed changes in blood flow and vascular reactivity. Dilatation in the external carotid territory could lead to further reflex changes by activation of the central pathways described. Changes in locus ceruleus activity could be responsible for the pain of the headache phase of migraine, by disrupting a descending pain control system.
Behavioral Assessment and Treatment of Child Migraine: Implications for Clinical Research and Practice
Authors: Hoelscher Timothy J. , Lichstein Kenneth L.
Published: June 2005

SYNOPSIS

Behavioral assessment and treatment strategies for adult migraine have gained wide acceptance during the past decade. However, very little research exists on the use of behavioral methods for child migraine. The present paper reviews clinical research and practice in the behavioral assessment and treatment of child migraine. Based on the available medical literature, it appears thatchild migraine closely parallels adult migraine, excepting for some neurological signs, a higher proportion of affected males, and the greater prominence of gastrointestinal upset characterizing the former. Assessment methods that have proven useful with adult migraineurs, including interview data and headache diaries, have yet to be validated with a child population. Several behavioral and social validation measures are proposed as additional assessment strategies for child migraine. Although recent studies evaluating the use of relaxation, biofeedback, and other behavioral approaches for child migraine have been encouraging, methodological shortcomings in these studies make the drawing of firm conclusions premature. It is concluded that child migraine presents a very promising research domain in light of recent successes in therapeutic trials with children and the background of successful behavioral interventions established with adults.
Is the Muscular Model of Headache Still Viable? A Review of Conflicting Data
Authors: Pikoff Howard
Published: June 2005

SYNOPSIS

Recent behavioral studies have called into question the accepted model of muscle contractionheadache. This review examines origins of the model, supportive and disconfirming findings,methodological issues, and an alternative view of muscle contraction as precipitant, consequence, oraltogether absent in headache. It is concluded that overuse has weakened but not completelydiscredited the muscular model. Although some headaches are doubtless caused by muscularhyper‐activity, true muscle contraction headache is probably far less common than traditionallyassumed.
Predisposing, Precipitating and Relieving Factors in Different Categories of Headache
Authors: Drummond P.D.
Published: June 2005

SYNOPSIS

Six hundred headache patients were questioned systematically about factors which precipitated, aggravated or relieved headache, their personal well‐being, symptoms of muscular contraction, and other features thought to be associated with headache (migraine in the immediate family, ice cream headache, icepick‐like pains, symptoms of orthostatic hypotension, travel sickness, and allergies). These items were analysed in relation to the clinical diagnosis (classical migraine, common migraine, tension‐vascular, tension or cluster headache), to two sets of migrainous features (symptoms of common migraine and neurological disturbances during headache), as well as the time course of headache (episodic, constant dull with more severe episodes, or constant). Differences between cluster and noncluster headache in age and sex distribution, precipitating and relieving factors, and family history of migraine supported the view that cluster headache is a distinct entity. The results of other analyses emphasized the continuum between migraine, tension‐vascular and tension headache. Indications of neurovascular involvement both during and between headache episodes were most apparent toward the migraine end of the headache spectrum, whereas psychological factors and symptoms of muscular contraction were associated more frequently with constant than with episodically‐recurring headache.
Migraine and the Noradrenergic Control of Vasomotricity: A Study With Alpha‐2 Stimulant and Alpha‐2 Blocker Drugs
Authors: Martucci N. , Manna V. , Porto C. , Agnoli A.
Published: June 2005

SYNOPSIS

Involvement of the sympathetic nervous system in the pathogenesis of migraine attack has long been hypothesized, on the basis of anatomical, clinical and biochemical data.A double‐blind placebo‐controlled randomized study was carried out on 2 groups of 20 patients each: the first was affected by common migraine, the second by tension headache. Clonidine and mianserine effects were evaluated by testing the threshold of histamine‐induced migraine, the intensity of induced pain and the migraine attacks' characteristics, after 90 days' preventive treatment. Hamilton Rating Scale for Depression was administered to evaluate anxiety and depression during the treatment. A long‐term preventive effect on migraine incidence was registered using both drugs.
Concubine Syndrome: An Example of Interactionism in the Clinical Assessment of Headache
Authors: Diamond Seymour , Maliszewski Michael
Published: June 2005

SYNOPSIS

Psychological and psychiatric factors contributing to headache etiology and prevalence have been reported over the past four decades. While intrapsychic and environmental explanations have been offered, no conceptual models have been suggested which accommodate both perspectives. Proposing to remedy this deficit with the presentation of a new model, we outline a case study of what is termed the “concubine syndrome,” that is a diagnostic classification which serves to illustrate the interaction of personality traits and external stressors that contribute to a particular type of headache problem. Using an interactional model of conceptualizing and treating this disorder, a discernible improvement was noted in reduction of headache pain. Aside from presenting criteria for differential diagnosis, we recommend further research and clinical evaluations which consider using this approach to assessing and treatment of headache disorders.
Dietary Factors in Migraine Precipitation: The Physicians' View
Authors: Blau J.N. , Diamond Seymour
Published: June 2005

SYNOPSIS

Five hundred and fifty questionnaires were sent to members of the American Association for the Study of Headache as well as to British physicians with a known interest in migraine. Of the 327 that replied, only 21% favored the term “dietary migraine.” To determine the presence of food sensitivity in their patients 71% relied on information from the patient's history alone. However, 21% employed special tests in addition to the history.

Estimates of the percentage of patients in whom dietary factors were operative ranged from 0–80%. Seventy‐four percent were in the 0–20% range (some indicating an incidence nearer 1–5% or less). Sixteen percent estimated the range of their patients in whom diet provoked migraine was between 20–40%, three percent estimated 40–60%, and two percent 60–80%.

The foods most commonly cited as triggering agents are presented in descending rate of frequency: chocolate, alcohol, cheese, monosodium glutamate, nuts, citrus fruit, meat, coffee, nitrates, fish, dairy products, onions, hot dogs, pizza, wheat products, bananas, tomatoes, apples, and various vegetables.

Individual comments invited on the questionnaire are described.

The consensus is that foods or alcohol can provoke occasional attacks in some patients. They conclude that the appropriate term is “dietary precipitated migraine.”
The Influence of Plasma Free Fatty Acids and Cholesterol on the Aggregation of Blood Platelets in Migraine Patients
Authors: Kozubski Wojciech , Stanczyk Lidia
Published: June 2005

SYNOPSIS

The Platelet Aggregate Ratio (PAR) was determined in 34 women with common migraine during headache‐free intervals. Fourteen of them were studied also during migraine attacks.

The levels of FFA and total cholesterol in the blood were determined simultaneously to assess their influence on aggregation of blood platelets.

Plasma FFA levels rose significantly during headache (r<0.001). The levels of total blood cholesterol did not show a homogenous distribution. In 20 patients blood cholesterol was elevated; in the remaining 14 patients levels were within the standard range.

The migraineurs with high cholesterol showed a significantly lower PAR during headache‐free intervals than did the control subjects (r<0.001). There was no significant difference between PAR in migraineurs with normal cholesterol and the controls. A significant fall of PAR during migraine attacks was observed only in migraineurs with high cholesterol (r<0.01). There was a significant correlation between the falling of PAR and the level of blood cholesterol (r<0.05). The same correlation was found between the falling of PAR and the rising of FFA during migraine attacks (r<0.05).

We suggest that FFA can raise the number of circulating platelet aggregates during migraine episodes. Total blood cholesterol is one of the factors which define migraine populations with respect to platelet aggregation.
Unnecessary Dental Treatment of Headache Patients for Temporomandibular Joint Disorders
Authors: Reik Louis
Published: June 2005

SYNOPSIS

The charts of 100 consecutive headache clinic patients were reviewed retrospectively to determine the frequency of prior dental treatment for TMJ disorders. Twenty had been treated, but only 4 satisfied our diagnostic criteria for the TMJ pain‐dysfunction syndrome. The other 16 satisfied conventional criteria for other headache diagnoses, and none of them had improved with dental treatment. Increased patient awareness of the TMJ syndrome, inappropriate referral by physicians and incorrect diagnosis by dentists all probably led to the unnecessary dental treatment.