bluuebunny/crossref_metadata_2025 huggingface dataset:
A Preliminary Report on Hyperbaric Oxygen in the Relief of Migraine Headache
Authors: Myers Daniel E. , Myers Roy A.
Published: May 2005

Oxygen inhalation was early advocated as a treatment for migraine headache. It has been theorized that the efficacy of raising blood oxygen levels in vascular headache is mediated by vasoconstriction and metabolic effects. Hyperbaric oxygen can provide a much greater level of blood oxygenation than normobaric oxygen, and in recent studies it has been used in the treatment of cluster headache. The purpose of this study was to compare the effects of hyperbaric oxygen and normobaric oxygen in migraine. Twenty migraineurs were divided randomly into two groups and studied in a hyperbaric chamber during a typical headache attack. Global headache severity was measured by a verbal descriptor scale before and after exposure to oxygen. One group received 100% oxygen at I atmosphere of pressure (normobaric) while the other received 100% oxygen at 2 atmospheres of pressure (hyper‐baric). One of the 10 patients in the normobaric group achieved significant relief of headache symptoms, while 9 of 10 in the hyperbaric group found relief. Based on a chi‐square test, this difference is significant at the P<.005 level. Those patients who did not find significant relief from normobaric oxygen were given hyperbaric oxygen as above. All nine found significant relief. The results suggest that hyperbaric (but not normobaric) oxygen may be useful in the abortive management of migraine headache. Possibilities for the mechanism of this effect, in addition to vasoconstriction, include an increase in the rate of energy‐producing and neurotransmitter‐related metabolic reactions in the brain which require molecular oxygen.
The Impact of Migraine on Health Status
Authors: Essink‐Bot Marie‐Louise , van Royen Leona , Krabbe Paul , Bonsel Gouke J. , Rutten Frans FH
Published: May 2005

Problems.‐What is the effect of migraine on health status, defined as the patient's physical, psychological, and social functioning? And, suppose that the health status of migraine sufferers appears to be impaired, to what extent is this a consequence of migraine‐associated comorbidity rather than of migraine itself? Methods.‐A group of 846 migraineurs, selected from the general population following IHS criteria, and a control group were surveyed with the Medical Outcomes Study 36‐item Short‐Form Health Survey, Nottingham Health Profile, EuroQol instrument, end the COOP/WONCA charts. Questions on demographic characteristics and comorbidity were included. Results.‐The health status of migraineurs appeared to be significantly impaired in comparison to the control group. Because statistical significance is distinct from relevance, effect size estimators were employed. Although the direction of the differences indicated consistently a worse health status of the migraineurs, regardless of the instrument used, the sizes of the differences were small to medium. Self‐reported comorbidity, especially depression, was more prevalent in the migraine group. However, this offered only a partial explanation for the impaired health status of the migraine group. Conclusions.‐Migraine has an independent moderately deteriorating effect on the daily functioning of individuals.
Metabolism and Menstrual Cycle Rhythmicity of Serotonin in Primary Headaches
Authors: D'Andrea G. , Hasselmark L. , Cananzi A.R. , Alecci M. , Perini F. , Zamberlan F. , Welch K.M.A.
Published: May 2005

We investigated the platelet and plasma levels of serotonin and its metabolite, 5‐hydroxyindoleacetic acid, in patients suffering from episodic tension‐type headache and migraine with and without aura, during headache‐free period. In female subjects, blood samples were drawn during the follicular, ovulatory, and late luteal phases of the menstrual cycle. In tension headache and migraine with aura, the group mean values of serotonin and 5‐hydroxyindoleacetic acid in platelets and plasma were significantly increased, but migraine without aura patients' levels were normal. The pattern of menstrual cycle‐related fluctuations in platelet serotonin levels were similar in female patients with tension headache and in controls, with a maximum value in the follicular phase. In both migraine groups, in contrast, the peak occurred in the ovulatory phase. The results are discussed in view of whether these aberrations in peripheral markers of the metabolism and menstrual cycle‐related rhythmicity of serotonin may reflect similar alterations in the central nervous system.
Dopamine Hypersensitivity in Migraine: Role in Apomorphine Syncope
Authors: Del Zompo Maria , Lai Marina , Loi Vincenzo , Pisano Maria Rosaria
Published: May 2005

There is some evidence supporting a potential role of hypersensitivity of the dopaminergic system in the pathogenesis of migraine. In this case report, we describe a syncopal episode in a patient with migraine without aura after the administration of a very low dose of apomorphine, a classical agonist of dopaminergic receptors. The absence of cardiovascular risk factors in this patient suggests that the clinical event might have been caused by hypersensitivity of the dopaminergic system.
Headache and the Human Immunodeficiency Virus Type I Infection
Authors: Holloway Robert G. , Kieburtz Karl D.
Published: May 2005

This review focuses on the prevalence, causes, evaluation, and treatment of headache in individuals infected with human immunodeficiency virus type 1 (HIV‐1). Headaches, one of the commonest medical complaints in the general population, occur frequently in patients infected with the HIV‐1. HIV‐related headaches can occur at any time during the infection: at seroconversion, during the incubation period, in patients with symptomatic HIV‐1 infection, or after an AIDS‐defining illness. Causes of HIV‐related headaches include HIV‐1 itself, opportunistic conditions, or HIV‐specific medications. Migraines, tension‐type headaches, depression, and substance abuse enter into the differential diagnosis, particularly in the early stages of disease. The headaches seen in this population reflect a complex web of interactions imposed by immune competency, multiple etiologies, treatments, and premorbid conditions. Prompt recognition and early treatment of headache is essential since it may improve quality of life and, depending on the diagnosis, prolong survival. Physicians need to be alert and adaptable when assessing HIV‐infected individuals with headache since multiple causes can exist in the same patient and new syndromes, complications, and investigational drugs are continually being identified.
Comparison of Dihydroergotamine With Metoclopramide Versus Meperidine With Promethazine in the Treatment of Acute Migraine
Authors: Scherl Eileen R. , Wilson John F.
Published: May 2005

Migraineurs often seek office‐based treatment for acute headache. To compare the efficacy and side effect profile, we entered 27 migraineurs into a prospective, randomized, double‐blind study where each patient received either 75 mg meperidine with 25 mg promethazine IM or .5 mg dihydroergotamine with 10 mg metoclopramide IV. After I hour, pain relief was similar in the two groups, but side effects were significantly greater in the meperidine with promethazine regimen group. The dihydroergotamine with metoclopramide regimen is effective, and has minimal side effects, making it an attractive method for office‐based treatment of acute migraine.
Improvement of Decreased Critical Flicker Frequency (CFF) in Headache Patients With Drug Abuse After Successful Withdrawal
Authors: Schnider Peter , Maly Joachim , Grünberger Josef , Aull Susanne , Zeiler Karl , Wessely Peter
Published: May 2005

A considerable proportion of headache patients fulfill the criteria of “drug abuse” (definition according to the International Headache Society [IHS] criteria). These patients exhibit markedly reduced vigilance and continuous performance, as shown by the results of critical flicker frequency (CFF) analysis.

The present study deals with the question whether this impairment of vigilance and continuous performance is reversible. Forty‐eight headache patients with drug abuse were investigated three times by means of CFF analysis: immediately before (A), immediately after (B), and 3 weeks after having finished (C) inpatient drug withdrawal.

Immediately after withdrawal, a significant decrease of headache intensity was observed. The CFF values, however, remained unchanged at a depressed level, probably due to withdrawal medication and the initial sedative side effects of thymoleptic agents (given as prophylaxis).

Three weeks after withdrawal, however, the CFF values were significantly improved, and were now within a range not far from the normal values known from a healthy general population. Thus, even after many years of drug abuse, headache patients have a good chance to improve their vigilance and continuous performance and to reach normal or close to normal levels.
A Comparative Study of Selected Patient Variables as Risk Factors in Hospitalization for Chronic Headache
Authors: Villarreal Sylvia Sullivan
Published: May 2005

Patients seeking relief for chronic headache at specialized headache treatment centers are offered a multidisciplinary approach to treating their disorder. Neurologists, who specialize in headache, offer both inhospital and outpatient treatment programs. Clinicians and researchers experienced in headache disorders have advocated inpatient treatment for certain patients. Hospital programs address such issues as elevated anxiety and depression levels, overuse of analgesics, and related factors. This study was undertaken to investigate those differences, long observed by clinicians, between patients assigned to inpatient or outpatient care or to both. In view of the ever‐tightening purse strings of third‐party payers, the results may aid in delineating some of the forthcoming practice guidelines for dealing with headache sufferers. This study suggests: (a) significant differences do exist between the groups, (b) hospitalized patients may indeed require more complex interventions than those managed with outpatient care, and (c) documenting some of the etiologic factors that predict hospitalization may help alert providers at the front end and preclude some of the current need for hospital care.
Changes in Cerebral Blood Flow Velocity Associated With Biofeedback‐Assisted Relaxation Treatment of Migraine Headaches are Specific for the Middle Cerebral Artery
Authors: Wauquier Albert , McGrady Angele , Aloe Louise , Klausner Todd , Collins Brad
Published: May 2005

Twenty‐five patients with diagnosed migraine headaches were randomly assigned to a biofeedback‐assisted relaxation therapy group or to a group who relaxed on their own. This study confirmed that the biofeedback trained group significantly decreased pain and medication more than the self‐re‐lax group. The best responders were those with the more elevated initial cerebral blood flow values and the changes in cerebral blood flow were specific for the middle cerebral artery.
Migraine, Personality, and Psychiatric Comorbidity
Authors: Breslau Naomi , Andreski Patricia
Published: May 2005

The purpose of this report is to examine the association between migraine and personality, taking into account history of co‐occurring psychiatric disorders. Data came from an epidemiologic study of young adults in the Detroit, Michigan metropolitan area. Migraine, defined according to 1988 IHS criteria, and major depression and anxiety disorders were ascertained by a structured diagnostic interview. Migraine was associated with neuroticism, but not with extraversion or psychoticism, measured by the Eysenck's Personality Questionnaire. The association remained significant, when sex and history of major depression and anxiety disorders were controlled. An excess of 25% of persons with migraine alone, uncomplicated by psychiatric comorbidity, scored in the highest quartile of neuroticism. The results suggest that migraine sufferers might be more vulnerable to psychopathology and poor adjustment to their medical condition.
A Comparison of Frontal Electromyographic Biofeedback Training, Trapezius Electromyographic Biofeedback Training, and Progressive Muscle Relaxation Therapy in the Treatment of Tension Headache
Authors: Arena John G. , Bruno Glenda M. , Hannah Susan L. , Meador Kimford J.
Published: May 2005

This study is the first systematic examination of a trapezius EMG biofeedback training regimen with tension headache sufferers. It evaluated the differential effects of three psychophysiological treatments for tension headache: (1) a standard 12‐session frontal EMG biofeedback training regimen (n=8), (2) a 12‐session upper trapezius EMG biofeedback training regimen (n=10), and (3) a standard seven‐session progressive muscle relaxation therapy regimen (n=8). Posttreatment assessment at 3 months following cessation of treatment revealed clinically significant decreases in overall headache activity (50% or greater) in 50% of subjects in the frontal biofeedback group, 100% in the trapezius biofeedback group, and 37.5% in the relaxation therapy group. Chi‐squared analyses indicated that the trapezius biofeedback group was more effective in obtaining significant clinical improvement than the frontal biofeedback and relaxation therapy groups (which did not differ from each other). The three treatments did not differ on secondary measures of headache improvement (number of headache‐free days, peak headache activity, and medication index). Implications for the psychophysiological treatment of tension headache, as well as future research directions, are discussed.
Resolution of Migraine Following Bromocriptine Treatment of a Prolactinoma (Pituitary Microadenoma)
Authors: Hartman Neil , Voron Stephen C. , Hershman Jerome M.
Published: May 2005

A 39‐year‐old male physician with a 27‐year history of chronic severe migraine had a prolactin‐secreting pituitary microadenoma diagnosed as an incidental finding following an automobile accident. Treatment of the prolactinoma with bromocriptine provided complete and lasting resolution of the migraine as well, suggesting a possible etiologic relationship between these two prevalent conditions, and the possibility of treating at least some cases of migraine with bromocriptine.
Subjective Stress and Coping in Recurrent Tension‐Type Headache
Authors: Ficek Shelley K. , Wittrock David A.
Published: May 2005

Subjects with tension‐type headache and headache‐free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week‐long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache‐free controls. Headache subjects also rated these events as causing more stress.
ACE Inhibitors for Prophylaxis of Migraine Headaches
Authors: Bender William I.
Published: May 2005

Seventeen patients with migraine headaches, occurring at least twice a month, were successfully treated with an ACE inhibitor for prophylaxis. Most were given enalapril, some used lisinopril. Duration of treatment ranged from 3 months to 3 years. Side effects were generally not noted. Cough occurred in four patients. The mechanism of action is unknown. The lack of side effects and the presence of clearly sustained benefit in this small group of migraineurs should prompt further study and use of this class of drugs for prophylaxis.
An MMPI Control Study: Chinese Migraineurs During Frequent Headache Attack Intervals
Authors: Fan Arthur Yin , Gu Ren‐Juan , Zhou An‐nan
Published: May 2005

The investigation of personality traits of migraineurs with the Minnesota Multiphasic Personality Inventory (MMPI) is an important line of research, but so far has led to diverse conclusions. In this study, the MMPI (Chinese edition) responses of 50 Chinese subjects (10 men, 40 women) with migraine (4 migraine with aura, 46 without aura), during frequent headache attacks were compared with 30 nonheadache healthy control subjects (6 men, 24 women). Statistical analysis was made between the two groups. The results revealed that subjects in the migraine group had significantly higher scores on subtests of neurotic, (hypochondriasis, depression, hysteria, and psychasthenia), schizophrenia, and social introversion (P<0.05 to 0.001). Utilizing the American T‐score, we found the migraine group's MMPI profile was a typical 1.2.3.7 model. These results suggest migraineurs with frequent headache attacks have multiphasic personality abnormalities and partial cerebral function disturbances.
The Relationship of Locus of Control and PsychosociaI‐Behavioral Response in Chronic Headache
Authors: Scharff Lisa , Turk Dennis C. , Marcus Dawn A.
Published: May 2005

It has been suggested that patients' perceptions of the impact chronic headache has on their lives as well as perceived control of their headaches may be associated with the intensity, duration, and exacerbation of pain they experience. The present study examined associations among International Headache Society (IHS) diagnostic category, pain characteristics such as severity and duration, perceived impact and control of headaches, and adaptive response. Two hundred twenty‐five patients with migraine, tension‐type, or combined migraine and tension‐type headache served as subjects. General activity level was related to IHS diagnosis, with migraine headache patients reporting that they are more active than tension‐type headache patients (F(2, 196) = 5.69, P < .01). Headache locus of control was not significantly related to IHS diagnosis, however external headache locus of control was significantly related to headache intensity (r = .32, P < .001, r = .25, P < .001), as well as to patients' perceptions of the extent to which pain interfered with various domains of their lives (r = .33, P < .001, r = .28, P < .001), and adaptive response (F(6, 402) = 4.68, P < .001). It appeared that perceived control over headaches and perceived impact of headaches were not related to IHS diagnostic category and were not strongly related to each other, but were related to headache severity.
Valproic Acid Treatment of Chronic Daily Headache
Authors: Vijayan N. , Spillane Thomas
Published: May 2005

The efficacy of valproic acid in the treatment of intractable chronic daily headache, unresponsive to traditional prophylactic medications, was examined prospectively in 16 patients. Dosage of the medication was adjusted to maintain serum valproic acid levels between 50 and 100 μg/mL, provided there were no significant side effects at that level. Valproic acid prophylaxis was of some benefit in only 2 of 16 patients. One of these two patients discontinued therapy due to side effects. Eight of the 16 patients reported side effects which included nausea, diarrhea, anorexia, lethargy, sleepiness, confusion, blurred vision, and decreased libido. In conclusion, valproic acid was not effective in controlling chronic daily headache in the majority of patients in whom conventional therapy had failed, and 50% of patients reported side effects. There is a significant disparity in the reported efficacy of this drug in treating chronic daily headache. This disparity is most likely due to the poorly‐defined nature of this variety of headache. It is, therefore, recommended that more stringent definition of this disorder be developed before therapeutic regimens are evaluated.
Clinical Experience With Headaches in Preadolescent Children
Authors: Pascual Julio , Berciano José
Published: May 2005

We have reviewed the diagnoses of 654 children aged from 7 to 14 years who attended a neurologist for headache evaluation. Headaches beginning between the age of 7 and 14 represented a higher percentage (18.3%) than the proportion of preadolescent children in our health area (12.9%). Headaches were more common in girls; although cluster, posttraumatic, benign exertional headaches, and the only case of brainstem glioma were restricted to boys. Despite the female predominance, the proportion of males with migraine was significantly higher in the preadolescents than in the over 15 age group. Migraine accounted for the majority of diagnoses (609 ‐ 93% of the total series), while tension‐type headache (27 ‐ 4%), and headache associated with sinus infection (7 ‐ 1%) were the diagnoses which followed in frequency. There were only two headaches (0.3%) associated with intracranial masses.

Even though, in terms of frequency, headache is a very common reason for neurology consultation, the present results show that the majority of preadolescents consulting because of headache suffer from benign conditions.
EMG Levels in Children Who Suffer From Severe Headache
Authors: Pritchard Donald
Published: May 2005

Very little information exists about the physiology of pediatric headache and in particular, the role that skeletal musculature plays in the genesis of head pain. This study explored EMG levels in the neck and forehead in a group of 12 children who complained of severe headache. Comparisons were made with a matched group of 12 children who were headache‐free. Results suggested that children with headache suffer from very tense neck muscles which may reflect high levels of anxiety.
Migraine With Aura as the Presentation of Leukemia
Authors: Geller Eric B. , Wen Patrick Y.
Published: May 2005

We present the case of a man with new onset of migraine with aura as the presenting sign of acute promyelocytic leukemia and disseminated intravascular coagulation. This previously unreported association may support theories of platelet serotonin involvement in the pathogenesis of migraine. It would be valuable in the future to evaluate other patients with disseminated intravascular coagulation or acute promyelocytic leukemia for the presence of migrainous auras or headaches, symptoms which may be underreported by patients, particularly in the setting of severe illness.
Characteristics of Patients Successfully Treated for Cervicogenic Headache by Surgical Decompression of the Second Cervical Root
Authors: Pikus Harold J. , Phillips Joseph M.
Published: May 2005

We have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty‐five sequential C2 decompressions performed on 31 patients who were pain‐free or significantly improved in follow‐up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT‐guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.
Responders and Nonresponders to Autogenic Training and Cognitive Self‐hypnosis: Prediction of Short‐ and Long‐term Success in Tension‐Type Headache Patients
Authors: Kuile Moniek M. ter , Spinhoven Philip , Linssen A. Corry G.
Published: May 2005

The present study was conducted to determine whether demographic variables, medical status variables, and psychological measures at pretreatment were related to pain reduction immediately following behavioral treatment for headache and at a 6‐month follow‐up. The study sample consisted of 156 subjects, who were selected for participation in a behavioral outcome study on the efficacy of autogenic training and cognitive self‐hypnosis training. A Headache Index based on pain diaries constituted the main outcome measure. Psychological measures included the Symptom Checklist‐90, Dutch Personality Questionnaire, Coping Strategy Questionnaire, Multidimensional Locus of Pain Control Questionnaire, and treatment expectations. Subjects who expected more pain reduction at pretreatment achieved a lower level of pain at posttreatment, independent of pretreatment pain levels. None of the other pretreatment variables were related with pain reduction at posttreatment or at the follow‐up. Finally, at the 6‐month follow‐up, 43 subjects were classified as responders (more than 50% pain reduction) and 113 as nonresponders (less than 50% pain reduction and dropouts). At pretreatment, the responders perceived more pain control than the nonresponders. None of the other pretreatment differences between responders and nonresponders proved to be significant. The main conclusion that could be drawn from this study was that pain reduction, in the short‐ and long‐term, cannot be predicted with any accuracy by demographic and medical status variables or scores for psychological distress, personality traits, coping strategy use, and pain appraisals.
War, Rivalry, and State Building in Latin America
Authors: Thies Cameron G.
Published: May 2005

Scholars of Latin America have recently begun to apply the bellicist approach to state building to the region, the central claim of which is that wars are a great stimulus to centralizing state power and building institutional capacity. This article argues that current applications of these models of state building are too narrowly specified to be of much use in Latin America or elsewhere in the developing world. Replacing the focus on interstate war with the more general phenomenon of interstate rivalry, alongside the consideration of intrastate rivals, allows us to account for the impact of both external and internal forces on the development of the state. I demonstrate the utility of this approach through several cross‐sectional time‐series analyses that provide evidence that external and internal rivals affect the Latin American state in a manner consistent with the general nature of bellicist theory.
Old Times There Are Not Forgotten: Race and Partisan Realignment in the Contemporary South
Authors: Valentino Nicholas A. , Sears David O.
Published: May 2005

Our focus is the regional political realignment that has occurred among whites over the past four decades. We hypothesize that the South's shift to the Republican party has been driven to a significant degree by racial conservatism in addition to a harmonizing of partisanship with general ideological conservatism. General Social Survey and National Election Studies data from the 1970s to the present indicate that whites residing in the old Confederacy continue to display more racial antagonism and ideological conservatism than non‐Southern whites. Racial conservatism has become linked more closely to presidential voting and party identification over time in the white South, while its impact has remained constant elsewhere. This stronger association between racial antagonism and partisanship in the South compared to other regions cannot be explained by regional differences in nonracial ideology or nonracial policy preferences, or by the effects of those variables on partisanship.
Congressional Politics of International Financial Rescues
Authors: Broz J. Lawrence
Published: May 2005

In the 1990s, the American executive organized financial rescues for Mexico and several Asian economies. These rescues were controversial in Congress, where members voted repeatedly to reduce or eliminate the executive's freedom to engage in them. I analyze these roll calls with an eye toward explaining who opposes and who supports international financial rescues. I argue that the interests of private actors (district constituencies and interest groups) have an important effect on member voting. Following Stolper‐Samuelson reasoning, I find that a member is significantly more likely to favor (oppose) rescues as the proportion of high‐skilled (low‐skilled) workers in a district increases. In addition, I find that campaign contributions from international banks increase the probability that a member will vote in favor of rescues. Overall, the findings suggest that the distributional effects of rescues find expression in Congress and constrain U.S. international financial policymaking.
Manufactured Responsiveness: The Impact of State Electoral Laws on Unified Party Control of the Presidency and House of Representatives, 1840–1940
Authors: Engstrom Erik J. , Kernell Samuel
Published: May 2005

The modern history of divided government in America suggests that the framers succeeded in creating a government unresponsive to popular passions. Yet in the nineteenth century the party winning the presidency almost always captured control of the House of Representatives. Why and how could nineteenth century national elections be so responsive that they resemble parliamentary outcomes? We identify electoral institutions present in the states that directly linked congressional elections to presidential coattails. Specifically, we estimate the impact of state ballot laws and the strategic design of congressional districts on presidential coattail voting from 1840 to 1940. We find that presidential elections, as mediated by state electoral laws, strongly account for unified party control of the House and the presidency throughout the nineteenth century.
Do Economic Sanctions Destabilize Country Leaders?
Authors: Marinov Nikolay
Published: May 2005

Do economic sanctions destabilize the governments they target? A form of foreign pressure, sanctions are typically meant to alter the policies of other countries. There is much pessimism on whether they ever work. This article shows that economic pressure works in at least one respect: it destabilizes the leaders it targets. I present a theoretical argument that explains why destabilization is a necessary condition for successful coercion. I find evidence that pressure destabilizes in a large panel of cross‐country time‐series data. The destabilization finding indicates that sanctions may be more effective at altering policies than we think. I conclude by noting that greater optimism regarding the effectiveness of sanctions should be balanced by a careful consideration of the policy's real and sizeable costs for those caught in the middle.
The Strategic Sources of Foreign Policy Substitution
Authors: Clark David H. , Reed William
Published: May 2005

While a growing body of work provides empirical support for the notion that political leaders “substitute” foreign policies depending on a variety of domestic political and economic conditions, little work examines the underlying strategic causes of substitution. This article argues that foreign states behave strategically in order to (a) avoid becoming the targets of domestically troubled executives or (b) to take advantage of the domestic trouble another state endures. Such “strategic interaction” delimits the set of foreign policies reasonably available to leaders in trouble at home, thus producing the impetus for policy substitution. This article develops a theoretical model of strategic behavior and policy substitution and reports empirical results of a multivariate probit model.
The Effects of Capital Mobility, Trade Openness, and Democracy on Social Spending in Latin America, 1980–1999
Authors: Avelino George , Brown David S. , Hunter Wendy
Published: May 2005

Empirical studies measuring the impact of globalization on social spending have appeared recently in leading journals. This study seeks to improve upon previous work by (1) employing a more sophisticated and comprehensive measure of financial openness; (2) using a more accurate measure of trade openness based on purchasing power parities; and (3) relying on social spending data that are more complete than those used by previous studies on Latin America. Our estimates suggest that several empirical patterns reported in previous work deserve a second look. We find that trade openness has a positive association with education and social security expenditures, that financial openness does not constrain government outlays for social programs, and that democracy has a strong positive association with social spending, particularly on items that bolster human capital formation.
Stunning of the Left Atrium after Conversion of Atrial Fibrillation: Predictor for Maintenance of Sinus Rhythm?
Authors: Ökçün Bariş , Yiǧit Zerrin , Arat Alev , Baran Türker , Küçükoǧlu M. Serdar
Published: May 2005

Recurrence of atrial fibrillation (AF) after cardioversion (CV) to sinus rhythm (SR) is determined by various clinical and echocardiographic parameters. The aim of this study was to determine the value of mitral inflow A‐wave velocity, performed at 24 hours after CV in estimation of AF recurrence. The study group consisted of 187 consecutive patients with nonvalvular atrial fibrillation, who had been cardioverted to SR from 1998 to 2000. Transthoracic echocardiography was performed in all cases recruited for the study 24 hours after CV. Left atrial (LA) diameter, left ventricular ejection fraction, and mitral inflow A‐wave velocity were measured. The patients were evaluated in five groups according to their recurrence time (<30 days, 31–90 days, 91–180 days, 181–365 days, and >365 days). Maintenance of SR was determined to have a negative linear correlation with age (r =−0.97, P = 0.006), LA diameter (r =−0.93, P = 0.02), and AF duration (r =−0.93, P = 0.02), while having a positive linear correlation with mitral inflow A‐wave velocity (r = 0.96, P = 0.008). In the maintenance of sinus rhythm, age, LA diameter, and AF duration were not affected from the method of CV, while mitral inflow A‐wave velocity was found to be affected with the method of CV. No relationship was determined between mitral inflow A‐wave velocity and the maintenance of sinus rhythm in those performed electrical cardioversion, while frequency of recurrence was found to be higher in those with slow mitral inflow A‐wave velocity who were performed pharmacological cardioversion (r = 0.89, P = 0.004). In conclusion, age, duration of AF, LA diameter, and the mitral inflow A‐wave velocity can be used to predict the maintenance of SR after CV.
Catheterization–Doppler Discrepancies in Nonsimultaneous Evaluations of Aortic Stenosis
Authors: Aghassi Payam , Aurigemma Gerard P. , Folland Edward D. , Tighe Dennis A.
Published: May 2005

Prior validation studies have established that simultaneously measured catheter (cath) and Doppler mean pressure gradients (MPG) correlate closely in evaluation of aortic stenosis (AS). In clinical practice, however, cath and Doppler are rarely performed simultaneously; which may lead to discrepant results. Accordingly, our aim was to ascertain agreement between these methods and investigate factors associated with discrepant results. We reviewed findings in 100 consecutive evaluations for AS performed in 97 patients (mean age 72 ± 10 yr) in which cath and Doppler were performed within 6 weeks. We recorded MPG, aortic valve area (AVA), cardiac output, and ejection fraction (EF) by both methods. Aortic root diameter, left ventricular end‐diastolic dimension (LVIDd) and posterior wall thickness (PWT) were measured by echocardiography and gender, heart rate, and heart rhythm were also recorded. An MPG discrepancy was defined as an intrapatient difference > 10 mmHg. Mean pressure gradients by cath and Doppler were 36 ± 22 mmHg and 37 ± 20 mmHg, respectively (P = 0.73). Linear regression showed good correlation (r = 0.82) between the techniques. An MPG discrepancy was found in 36 (36%) of 100 evaluations; in 19 (53%) of 36 evaluations MPG by Doppler was higher than cath, and in 17 (47%) of 36, it was lower. In 33 evaluations, EF differed by >10% between techniques. Linear regression analyses revealed that EF difference between studies was a significant predictor of MPG discrepancy (P = 0.004). Women had significantly higher MPG than men by both cath and Doppler (43 ± 25 mmHg versus 29 ± 15 mmHg [P = 0.001]; 42 ± 23 mmHg versus 32 ± 15 mmHg [P = 0.014], respectively). Women exhibited discrepant results in 23 (47%) of 49 evaluations versus 13 (25%) of 51 evaluations in men (P = 0.037). After adjustment for women's higher MPG, there was no statistically significant difference in MPG discrepancy between genders (P = 0.22). No significant interactions between MPG and aortic root diameter, relative wall thickness (RWT), heart rate, heart rhythm, cardiac output, and time interval between studies were found. In clinical practice, significant discrepancies in MPG were common when cath and Doppler are performed nonsimultaneously. No systematic bias was observed and Doppler results were as likely yield lower as higher MPGs than cath. EF difference was a significant predictor of discrepant MPG. Aortic root diameter, relative wall thickness, heart rate, heart rhythm, cardiac output, presence or severity of coronary artery disease, and time interval between studies were not predictors of discrepant results.
Mitral Annular Subvalvular Left Ventricular Aneurysm
Authors: Chen Chung‐Chang , Hsiung Ming‐Chon , Wei Jeng , Chang Wei‐To , Yin Wei‐Hsian , Young Mason S.
Published: May 2005

Annular subvalvular left ventricular aneurysm was first reported in 1962. This type of aneurysm usually arises from the annular subaortic or submitral region of the left ventricle. It should be differentiated from the left ventricular false aneurysm, which was caused by myocardial necrosis. The etiology of subvalvular aneurysm remains unclear. We have presented a case of annular submitral left ventricular aneurysm. The patient had no history of coronary artery disease. Two‐dimensional echocardiography and magnetic resonance image (MRI) showed a huge left ventricular aneurysm existed. An annular submitral left ventricular aneurysm was confirmed by an open heart surgery and pathological examination.
Correlation between Right Ventricular Indices and Clinical Improvement in Epoprostenol Treated Pulmonary Hypertension Patients
Authors: Nath Jayant , DeMarco Teresa , Hourigan Lisa , Heidenreich Paul A. , Foster Elyse
Published: May 2005

The aim of this study was to evaluate which parameter of right ventricular (RV) echocardiographic best mirrors the clinical status of patients with pulmonary arterial hypertension. Patients with pulmonary arterial hypertension on epoprostenol therapy were identified via hospital registry. Twenty patients, (16 females, 4 males) were included in the study, 9 with primary pulmonary hypertension and 11 with other diseases. Echocardiograms before therapy and at 22.7 (±9.3) months into therapy were compared. The right ventricular myocardial performance index (RVMPI) was measured as the sum of the isometric contraction time and the isometric relaxation time divided by right ventricular ejection time. Other measures included peak tricuspid regurgitation jet velocity (TRV), pulmonary artery systolic pressure (PASP), pulmonary valve velocity time integral (PVVTI), PASP/PVVTI (as an index of total pulmonary resistance) and symptoms by New York Heart Association (NYHA) functional class. Echo parameters of right ventricular function were analyzed in patients, before and during therapy. There was significant improvement of NYHA class in patients following epoprostenol therapy (P < 0.0001). Peak tricuspid regurgitant jet velocity (pre 4.2 ± 0.6 m/sec, post 3.8 ± 0.7 m/sec, P = 0.02) and PASP/PVVTI (pre 6.7 ± 3.3 mmHg/m per second, post 4.8 ± 2.2 mmHg/m per second, P < 0.0001) were significantly improved during treatment. RVMPI did not improve (pre 0.6 ± 0.3, post 0.6 ± 0.3, P = 0.54). Changes in NYHA class did not correlate with changes in RVMPI (P = 0.33) or changes in PASP/PVVTI (P = 0.58). Despite significant improvements in TRV, PASP/PVVTI, and NYHA class, there was no significant change in RVMPI on epoprostenol therapy. Changes in right ventricular indices were not correlated with changes in NYHA class.
A Right Atrial Mass and a Pseudomass
Authors: Chen Michael S. , Sun Jing‐Ping , Asher Craig R.
Published: May 2005

Right atrial (RA) masses are rare entities often detected incidentally during imaging studies. Leading etiologies of right atrial masses are tumor, thrombi, and vegetations. We present two cases of right atrial masses, a cardiac lipoma and an artifact. Clinical and echocardiographic characteristics of benign cardiac tumors are reviewed. We then highlight the importance of considering artifact in the differential diagnosis of atrial masses. Finally, we discuss echocardiographic characteristics of right atrial masses that may provide clues for diagnosis. Right atrial masses, often detected incidentally during imaging studies, are uncommon and can be due to many etiologies including tumors, thrombus, vegetations, normal variants, and artifacts. We describe 2 patients with RA masses detected on routine transthoracic echocardiogram.
A Rare Case of Lactobacillus acidophilus Presenting as Mitral Valve Bacterial Endocarditis
Authors: Makaryus Amgad N. , Yang Rayson , Hahn Rebecca T. , Kort Smadar
Published: May 2005

Lactobacillus acidophilus is a gram‐positive rod that is a commensal of human mucosal tissues. They are usually considered nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus is a rare cause of endocarditis with less than 50 cases reported in the world literature to date. We report the case of a 63‐year‐old woman who developed native mitral valve endocarditis secondary to L. acidophilus, and examine the literature regarding this rare entity.
Pulmonary Transit of Echocontrast Agents during Mechanical Ventilation: A Clinical Transthoracic Echocardiographic Study
Authors: Bilotta Federico , Agati Luciano , Fiorani Laura , Madonna Mariapina , Pinto Giovanni , Rosa Giovanni
Published: May 2005

In this study, we investigated whether the ultrasound contrast agents Levovist® or Sono Vue® injected intravenously during mechanical ventilation effectively pass through the pulmonary circulation. With echocardiography, we measured the time for the contrast to pass through the lungs; and the intensity of right and left ventricular cavity opacification at four time points: during spontaneous breathing (baseline), 5 minutes after the beginning of mechanical ventilation, and 5 minutes and 30 minutes after extubation. Forty patients undergoing elective peripheral neurosurgical procedures were prospectively and randomly enrolled: 20 patients received intravenous Levovist 1 g and 20 patients received intravenous Sono Vue 1 mL, at the four predefined time points. After intravenous injection, both Levovist and Sono Vue effectively passed through the lungs and opacified the right and left ventricular cavities, at the four time points. Pulmonary transit times were similar and constant for the two contrast agents tested: 6 ± 2 seconds at baseline, 5 ± 2 seconds during mechanical ventilation, 7 ± 2 seconds at 5 minutes and 6 ± 2 seconds at 30 minutes after extubation with Levovist; and 6 ± 4 seconds at baseline, 6 ± 3 seconds during mechanical ventilation, 6 ± 2 seconds at 5 minutes and 7 ± 3 seconds at 30 minutes after extubation with Sono Vue. In all patients, each of the four contrast injections achieved high‐grade right and left ventricular chamber opacification. In conclusion, both the ultrasound contrast agents tested in this study, Levovist and Sono Vue, after intravenous injection pass through the pulmonary circulation during mechanical ventilation. Ultrasound contrast agents with these characteristics are suitable for intraoperative organ perfusion studies, with intravenous injection.
Continuous Intraoperative Transesophageal Echocardiography during Pericardiectomy for Constrictive Pericarditis Revealing Dynamic Change in Chamber Size
Authors: Kasravi Babak , Ng Daniel , Chandraratna P. Anthony
Published: May 2005

We review a case of a 50‐year‐old man with diagnosis of constrictive pericarditis, who underwent pericardial stripping with continuous intraoperative transesophageal echocardiography (TEE). This patient demonstrates the immediate dynamic changes in chamber size after successful surgical removal of pericardium as demonstrated by TEE.
The Importance of Increased Interatrial Septal Thickness in Patients with Atrial Fibrillation: A Transesophageal Echocardiographic Study
Authors: López‐Candales Angel , Grewal Harpreet , Katz William
Published: May 2005

Background: Histological studies in animal models have showed that extensive atrial fibrosis or fatty deposition as a result of loss of atrial cardiomyocytes increases the propensity to develop atrial fibrillation (AF). Although several reports have suggested that AF in humans may be a consequence of these mechanisms, no study has correlated the presence of AF with interatrial septal thickness (IAST). Methods: Accordingly, we conducted a prospective analysis in 150 consecutive patients referred for transesophageal echocardiography (TEE) for numerous medical reasons. A total of 105 patients (mean age 62 ± 14 years) who met inclusion and exclusion criteria were included for analysis. Pertinent demographics, echocardiographic chamber dimensions, left ventricular ejection fraction (LVEF), color flow, and spectral Doppler analysis, as well as IAST measured in both systole (S) and diastole (D) were obtained. Results: When patients with a documented history of AF were compared to patients without documented AF, no statistical difference was noted in terms of patients’ height, weight, IVS thickness, or LVEF. Patients with AF had a significantly larger left and right atrial dimensions (P < 0.001), lower left atrial appendage emptying velocities (P < 0.002), and pulmonary vein systolic Doppler signal (P < 0.01). The IAST in systole in patients with AF was 0.75 ± 0.27 cm versus 0.60 ± 0.16 cm in patients without AF (P < 0.006) while the IAST in diastole was 0.61 ± 0.22 cm versus 0.49 ± 0.12 cm, respectively (P < 0.009). However, no statistical difference was noted between IAST in either systole (P < 0.8) or diastole (P < 0.8) among patients with AF based on the duration of this arrhythmia. Conclusions: The results of this prospective TEE study show a statistically significant increase in IAST with the presence of AF independent of patient's age, height, weight, and the degree of IVS thickness. In addition, since no significant valvular abnormalities or compromise in left ventricular systolic function were present, the increase in IAST in patients with AF then suggest possible changes in the material properties of the atrial wall, easily identified by TEE on the interatrial septum, either as a cause or as a result of AF. Since no correlation was found between the degree of IAST and the duration of AF, the presence of IAST not only might identify patients with a higher propensity to have or develop this atrial arrhythmia; but also be a surrogate marker of changes within the components of the atrial wall in AF.
Assisted reproductive technologies and birth defects
Authors: Shiota Kohei , Yamada Shigehito
Published: May 2005

ABSTRACT  In vitro fertilization (IVF) and other assisted reproductive technologies (ART) are effective treatments for infertility and are widely provided at infertility clinics. Although IVF and related ART procedures are generally considered safe, some studies have suggested an excess occurrence of major malformations, low birth‐weight and other perinatal complications in babies conceived by ART. Further, it was recently reported that IVF and intracytoplasmic sperm injection (ICSI) are associated with imprinting disorders in the offspring such as Beckwith‐Wiedemann syndrome and Angelman syndrome. Here we review the human and animal studies investigating the potential risks of ART, and discuss the need for further investigation.