bluuebunny/crossref_metadata_2025 huggingface dataset:
Restitution of Reaching and Grasping Promoted by Functional Electrical Therapy
Authors: Popovic Mirjana B. , Popovic Dejan B. , Sinkjær Thomas , Stefanovic Aleksandra , Schwirtlich Laszlo
Published: March 2003

Abstract: Functional electrical therapy (FET) is a new term describing a combination of functional electrical stimulation that generates life‐like movement and intensive exercise in humans with central nervous system lesions. We hypothesized that FET can promote a significant recovery of functioning if applied in subacute stroke subjects. The study included 16 stroke subjects divided into a low functioning group (LFG) and a high functioning group (HFG) based on their ability to control wrist and fingers and randomly associated into FET and controls. The FET consisted of 30 min daily sessions during 3 weeks. The exercise comprised functional use of daily necessary activities (e.g., writing, using a telephone receiver, and drinking from a can). The outcome presented in this article is the upper‐extremity function test performed before and after the therapy. The change in performance of the HFG group was significant. The number of successful repetitive movements in 2 min was doubled and 1.6 times increased for controls, and the time to perform the movement was decreased by 71% percent and by 36% in controls. In the LFG FET group, the difference in performance was the following. First, the number of tasks was increased from 0 to 6 (total of 11 tasks). Second, the averaged number of successful repetitive movements was increased from 0 to 3. The functional improvement in the FET LFG is probably not sufficient to make the more affected arm/hand effective for daily necessities; thus, the FET effects could deteriorate over a longer time. The subjects from the control LFG made only a marginal improvement. The follow‐up for each subject will continue for 12 months after the beginning of the treatment.
Hemodynamic Evaluation of Stentless Mitral Valve Replacement
Authors: Walther Thomas , Falk Volkmar , Lehmann Sven , Walther Claudia , Doll Nico , Bucerius Jan , Gummert Jan , Mohr Friedrich W.
Published: March 2003

Abstract: The purpose of this study was to evaluate the perioperative and postoperative hemodynamic function of recently introduced stentless mitral valves (SMVs). Forty‐two selected patients who had received the SMV since 1997 had preoperative, postoperative, and follow‐up transthoracic echocardiographic (TTE) examinations. Transesophageal echocardiography (TEE) was applied routinely during the operation as well as postoperatively if indicated. Adequate SMV function was seen in all patients perioperatively. Echocardiographic prediction of valve size and of papillary muscle distances was correct in 37 of 42 patients. Transvalvular blood flow velocities were 1.6 ± 0.2 m/s postoperatively versus 1.8 ± 0.3 m/s at 1 year and 1.7 ± 0.3 m/s at 3‐year follow‐up. Mean transvalvular gradients were 4.3 ± 1.6, 3.8 ± 1.9, and 4.7 ± 1.1 mm Hg, respectively. TEE and TTE are extremely useful to assist SMV implantation as well as for regular follow‐up evaluation. The hemodynamic function after SMV implantation with preservation of the annulo‐ventricular continuity is promising.
A Magnetic Suspension Theory and Its Application to the HeartQuest Ventricular Assist Device
Authors: Chen Chen , Paden Brad , Antaki James , Ludlow Jed , Paden Dave , Crowson Randolph , Bearnson Gill
Published: March 2003

Abstract: Motivated by the design of the HeartQuest magnetically levitated left ventricular assist device, closed form expressions have been developed to compute forces and stiffnesses of magnetic suspensions. The theory applies to any combination of concentric permanent magnet rings, and its accuracy and versatility were verified by experiments. The equations adapt to spreadsheet implementation and numerical optimization, providing a powerful tool of optimal design of magnetically levitated ventricular assist devices (VADs). The method was applied to the development of the HeartQuest VAD which achieved remarkable compactness and stable operation.
Pediatric Physiologic Pulsatile Pump Enhances Cerebral and Renal Blood Flow During and After Cardiopulmonary Bypass
Authors: Ündar Akif , Masai Takafumi , Beyer Erik A. , Goddard‐Finegold Jan , McGarry Mary Claire , Fraser Charles D.
Published: March 2003

Abstract: Controversy over benefits of pulsatile flow after pediatric cardiopulmonary bypass (CPB) continues. Our study objectives were to first, quantify pressure and flow waveforms in terms of hemodynamic energy, using the energy equivalent (EEP) formula, for direct comparisons, and second, investigate effects of pulsatile versus nonpulsatile flow on cerebral and renal blood flow, and cerebral vascular resistance during and after CPB with deep hypothermic circulatory arrest (DHCA) in a neonatal piglet model. Fourteen piglets underwent perfusion with either an hydraulically driven dual‐chamber physiologic pulsatile pump (P, n = 7) or a conventional nonpulsatile roller pump (NP, n = 7). The radiolabeled microsphere technique was used to determine the cerebral and renal blood flow. P produced higher hemodynamic energy (from mean arterial pressure to EEP) compared to NP during normothermic CPB (13 ± 3% versus 1 ± 1%, p < 0.0001), hypothermic CPB (15 ± 4% versus 1 ± 1%, p < 0.0001) and after rewarming (16 ± 5% versus 1 ± 1%, p < 0.0001). Global cerebral blood flow was higher for P compared to NP during CPB (104 ± 12 ml/100g/min versus 70 ± 8 ml/100g/min, p < 0.05). In the right and left hemispheres, cerebellum, basal ganglia, and brainstem, blood flow resembled the global cerebral blood flow. Cerebral vascular resistance was lower (p < 0.007) and renal blood flow was improved fourfold (p < 0.05) for P versus NP, after CPB. Pulsatile flow generates higher hemodynamic energy, enhancing cerebral and renal blood flow during and after CPB with DHCA in this model.
Savings in Dialysis Treatment?
Authors: Klefter Romana , Nielsen Bent
Published: March 2003

Abstract:The steadily increasing number of dialysis patients prompts considerations on possibilities for budget reductions with maintenance of treatment quality. A literature survey is presented concerning trends of population increase, individual treatment costs, rationing of patient intake, and consequences of delayed progress of renal insufficiency as well as of savings during both the initial and the later phases of regular dialysis therapy. Cost reduction in one area may well induce rising total budgets and influence clinical outcome. A multidisciplinary approach is suggested to obtain answers to several questions: Can the economic burden of the changing patient demography be counterbalanced by a reorganized staff structure? Will early referral, good predialysis control, and incremental dialysis start imply longer survival? Will increased dialysis doses be economically neutralized by less staff requirements, drug consumption, and patient morbidity? Should dialyzer reuse be abandoned? Can pretransplant dialysis periods be reduced or omitted by improved planning?
Growth of Human Endothelial Cells on Different Concentrations of Gly‐Arg‐Gly‐Asp Grafted Chitosan Surface
Authors: Chung Tze‐Wen , Lu Ya‐Fen , Wang Hsin‐Ya , Chen Weng‐Pin , Wang Shoei‐Shen , Lin Yeong‐Shang , Chu Shu‐Hsun
Published: March 2003

Abstract: To improve the adhesion and growth of endothelial cells on chitosan, different concentrations of cell adhesive peptide, Gly‐Arg‐Gly‐Asp (GRGD), were photochemically grafted to its surface. After different concentrations of GRGD‐SANPAH (N‐Succinimidyl‐6‐4′‐azido‐2′‐nitrophenylamino]—hexanoate) solutions were formed, they were grafted to chitosan surfaces by performing surface adsorption of the peptide solutions and subsequent ultraviolet (UV) irradiation to induce photoreaction. The grafted efficiency for GRGD peptide to chitosan surface was higher than 80%, as semiquantitatively analyzed by a high performance liquid chromatography (HPLC). FTIR spectra and electron spectroscopy for chemical analysis (ESCA) also confirmed that GRGD was successfully grafted to form chitosan‐GRGD surfaces. For example, the composition fraction of nitrogen (N1s) for chitosan‐GRGD surface grafted at 0.05 M GRGD was 6.8% instead of 3.2% for chitosan only. Human umbilical vein endothelial cells (HUVECs) adhered well and grew on different GRGD grafted concentrations of chitosan‐GRGD surfaces after 36 hrs of incubation, but not on the chitosan surface. Furthermore, viability for the growth of HUVECs was increased with an increase in initial concentration of GRGD grafted chitosan‐GRGD surfaces analyzed by MTT assay. In conclusion, an increased concentration of GRGD grafted on the chitosan‐GRGD surface leads to more HUVECs adhered and grown on the surface.
Outflow Control for Avoiding Atrial Suction in a Continuous Flow Total Artificial Heart
Authors: Olegario Paul S. , Yoshizawa Makoto , Tanaka Akira , Abe Ken‐ichi , Takeda Hiroshi , Yambe Tomoyuki , Nitta Shin‐ichi
Published: March 2003

Abstract: Continuous flow blood pumps, such as axial flow and centrifugal pumps, have been gaining interest as circulatory devices for total artificial hearts (TAHs) because of their smaller size and simpler structure compared to pulsatile pumps. However, continuous flow pumps are more prone to atrial wall suction than pulsatile pumps are. Sudden increases in flow rate to meet changes in physiological demand, especially in the left pump, often cause atrial wall suction. In this study, a control algorithm to prevent atrial wall suction from occurring in the left atrium by controlling the rotational speed of the right pump, instead of reducing the cardiac output of the left pump, was developed and investigated. The method was tested in a mock circulatory system and in acute animal experiments with adult goats. Two centrifugal pumps were used to totally replace the circulatory function of the natural heart. The cardiac output of each pump was determined independently by a control algorithm running on a computer connected through a serial interface to the pump driving units. Results showed that left atrial wall suction could be prevented using this method, and that the method could be performed simultaneously with physiological control of the artificial heart.
Development of Disposable Self‐Regulating Blood Pumps and Automatically‐Controlled Portable Extracorporeal Membrane Oxygenation Systems for Neonatal Extracorporeal Membrane Oxygenation
Authors: Seo Takahiko , Ando Hisami , Ito Takahiro , Takagi Hiroyuki , Inagaki Yoshitaka , Suzuki Akira
Published: March 2003

Abstract: For safer and simpler neonatal ECMO management, the authors have been developing an innovative, automatically‐controlled ECMO machine using self‐regulating blood pumps. The newest model is an air‐driven, tube‐type blood pump. A pair of blood pumps are placed in parallel and actuated alternately with compressed air. The pump flow is automatically regulated in accordance with hemodynamic changes of the body. The need for a venous reservoir is eliminated because the circuit does not generate excessive negative pressure when there are shortages of draining blood. Therefore, the priming volume of the circuit is only 85 ml. This ECMO apparatus has three driving modes, one of which is a “delay” mode. This enables the pump flow to easily be varied from 10 to 500 ml/min under automatic control, and it can be used when the pump flow is decreased for weaning. This newest ECMO apparatus was clinically used in 3 neonates with severe lung hypoplasia and persistent fetal circulation. The ECMO duration was 139 h to 168 h, and the maximum ECMO flow 71.3 to 109.0 ml/min/kg. Thanks to the self‐regulation, intensive observation of the circuit was not necessary during ECMO. Damage to blood cells was less significant, and the use of blood products was only minimal (15.7 ml/kg/day) because a large volume of blood to stabilize the pump performance was not necessary. In conclusion, the automatically‐controlled ECMO apparatus worked well without complications by changing the ECMO flow automatically in accordance with hemodynamic changes. This automatic ECMO system required fewer personnel expenditures and was also favorable in terms of hematological findings.
Higher Plant Assays for the Detection of Genotoxicity in Air Polluted Environments
Authors: Grant William F.
Published: March 2003

ABSTRACT

Since the beginning of time pollution has been created by human activities. However, the intensity and the severity of the different kinds of pollution have emerged only in the last few decades and many intricate facets have been revealed. It is gradually being recognized that our health and the ecosystem are being severely affected by environmental chemicals that enter the atmosphere. Plants comprise a large portion of our biosphere and constitute a vital link in the food chain. In this review, types of mutagenic chemicals found both indoor and outdoor are given and several higher plant bioassays for screening and monitoring environmental mutagens are discussed. One plant ideal for monitoring and testing for air pollution is Tradescantia. This species has been used to test for mutagenicity of radioisotope‐contaminated air following the Chernobyl nuclear accident and monitoring around nuclear power plants. One of the greatest contributions of plant bioassays will be their continued use for ambient air monitoring and testing for genotoxicity which can be carried out on a global scale.
Applying an Ecosystem Approach to the Determinants of Health in Centro Habana
Authors: Yassi Annalee , Mas Pedro , Bonet Mariano , Tate Robert B. , Fernandez Niurys , Spiegel Jerry , Perez Mayilee
Published: March 2003

ABSTRACT The difficult economic times that Cuba has had to face have taken a considerable toll on its urban ecosystems, with data suggesting that indicators of health, the environment, and social services have been deteriorating. This has been particularly evident in Centro Habana, a municipality with the highest population density in the country. More than half the population was without daily access to potable water, waste disposal was insufficient, overcrowding was serious, disease vectors were prevalent, and rates of various infectious as well as noncommunicable diseases and injuries were highest in the country. To improve the situation, the municipality requested help from the National Institute for Hygiene Epidemiology and Microbiology (INHEM) to determine the best use of scarce resources to improve health. INHEM performed an ecological descriptive study and conducted focus groups in five communities to assess perceptions of health, social, and environmental factors, followed by a household survey. INHEM then engaged collaborators at the University of Manitoba to assist in developing a framework, analyzing the data, and planning and undertaking the evaluation requested. Maximum likelihood factor analysis was used to reduce the dimensionality of the data. The perception data were then merged with the ecological level health and environmental data to ascertain the relationship between these two data sources and determine which indicators might be useful for an intervention analysis. The perception results indicated that the greatest community concern was quality of housing, but that the risk perception results were independent of ecological data on morbidity, mortality, and basic sanitation indicators. Based on this conclusion, it was decided to use a combined qualitative and quantitative approach to evaluate actual and potential interventions, using the driving force‐pressure‐state‐exposure‐effects‐action (DPSEEA) framework. It was also decided to adopt an ecosystem approach that fully involves the community in developing a set of ecosystem human health indicators. Data from repeat focus groups and household surveys are planned, with these data to again be integrated with ecological data including environmental, socioeconomic, and health outcome information, using a pre‐ versus postintervention with concurrent control design. Our findings in this first phase indicated that an ecosystem framework is invaluable in ascertaining determinants of health and prioritizing and evaluating interventions to improve the health of communities.
Using Science to Advocate Action on Climate Change
Authors: Fulton Jim
Published: March 2003

ABSTRACT Climate change is probably the greatest threat to global ecosystems that humanity has ever faced. Greenhouse gases, primarily from the production and combustion of fossil fuels for human energy needs, are heating up our atmosphere, changing our climate, and threatening the health and well‐being of people the world over. Predicted consequences of climate change include more frequent extreme weather events such as intensive precipitation, drought and floods, rising sea levels, increased smog in cities, and the possible spread of tropical diseases to more temperate climes. These grim effects can be limited if societies throughout the world act quickly to reduce greenhouse gas emissions. Substantially reducing emissions, however, means a fundamental shift in the way we produce and consume energy. To help bring about change, scientists, health professionals and nongovernment organizations such as the David Suzuki Foundation must work together to educate and motivate the public, industries, business organizations, and governments to take actions that will reduce the threat of global warming.
The Role of Integrating Concepts in Watershed Rehabilitation
Authors: Hildén Mikael
Published: March 2003

ABSTRACT Watershed rehabilitation affects a large array of variables: ecological, economic, cultural, and sociopolitical. Synoptic approaches aim at accounting for “everything” relevant by specifying the watershed and objectives for its development unambiguously. One could then calculate the optimal state of the watershed and use experts to specify the means for achieving this state. The development and use of integrating concepts such as “ecosystem health,” a “living river,” or “river health” that aim at describing the overall state of the watershed and general objectives for its improvement may appear to support the synoptic approach. The present study shows that the synoptic approaches and the integrating concepts are partly incompatible. The integrating concepts evolve continuously and cannot as such yield a complete objective calculation that would specify an optimal level of rehabilitation. The integrating concepts are mainly useful in a context of communicative planning that accepts and encourages their evolution as new knowledge is gained and as stakeholders interact. Large‐scale rehabilitation, therefore, must be supported by processes and institutional arrangements that facilitate specification of the desired states at the watershed level. The present study provides an example of such a process and the corresponding institutional arrangement.
Integrating Catchment Ecosystems and Community Health: The Value of Participatory Action Research
Authors: Parkes Margot , Panelli Ruth
Published: March 2003

ABSTRACT Understanding links between catchment management and community health demands consideration of complex bio‐physical, socio‐economic, and public health relationships. These relationships cut across a spectrum of health, environment and development considerations and highlight the need for appropriate and integrative modes of inquiry and decision making. What can Participatory Action Research (PAR) contribute towards achieving an integrated approach to catchment management and community health issues? In addition to a methodological overview of Participatory Action Research, this paper reviews other participatory, community, action, and ecosystems‐based methods. Commonalities in principles and methods are highlighted across a number of fields of research and practice including rural and community development, public health and health promotion, natural resource management, environmental health, and integrated ecosystem‐based approaches. Lessons learned from application of Participatory Action Research are described in relation to a catchment and community health project, based in the Taieri River catchment, New Zealand. The case study emphasizes the importance of both horizontal and vertical connections between diverse coalitions of catchment stakeholders and the contribution of PAR cycles of inquiry, reflection, and action, toward this type of integration. Both generic and location‐specific examples highlight the value of participatory methods that respond to the challenge of how to integrate the complex social and bio‐physical processes that characterize human and ecosystem health.
Prepregnancy Headache and the Well‐being of Mother and Newborn
Authors: Aromaa Minna , Rautava Päivi , Helenius Hans , Sillanpää Matti L.
Published: March 2003

Women (n = 1443) expecting their first child were studied to examine whether prepregnancy headache predicts problems in the well‐being of pregnant women and newborns. Subject collection was based on stratified randomized cluster sampling.

Impairment of health during the first trimester was more often reported by women with frequent prepregnancy headache than by nonsufferers. They also made more visits to a doctor and had more pregnancy symptoms during the third trimester. Use of any medication during the first trimester was also more common in the headache group. Mental health status was worse, fatigue and depression increased during pregnancy more often, and stress and anxiety about delivery were more common in this group. The relationship with spouses worsened during pregnancy in the headache group and seemed to be predicted by impairment of somatic health during the first trimester and increasing depression during pregnancy. No statistical differences between groups were found in variables measuring the well‐being of the newborns.

Frequent prepregnancy headache proved to be a strong predictor of ill‐being in pregnant women. This result should find practical applications in the preventive work of maternity health care clinics.
Migraine Stroke: A Possible Complication of Both Migraine With and Without Aura
Authors: Narbone Maria Carola , Leggiadro Nestore , La Spina Paolo , Rao Renata , Grugno Rosario , Musolino Rossella
Published: March 2003

We describe four migraine patients who developed an ischemic stroke during their typical migraine attacks.

Cerebral infarction as a possible complication of migraine without aura is discussed.

We propose a review of the migraine stroke definition of the International Headache Society.
The Actions of Valproate and Neurosteroids in a Model of Trigeminal Pain
Authors: Cutrer F. Michael , Moskowitz Michael A.
Published: March 2003

Gamma‐aminobutyric acid (GABA) receptors are ubiquitous inhibitory receptors in the central and peripheral nervous systems. Valproic acid (2‐propylpentanoic acid), which enhances GABA synthesis and blocks degradation, is useful in migraine treatment and may act through activation of GABA receptors to modulate trigeminal nociceptive neurons innervating the meninges. To investigate this possibility, we tested the effect of valproate and allopregnanolone, a metabolite of progesterone, which binds and modulates the GABA receptor in an animal model of cephalic pain.

One hundred ten Hartley guinea pigs were pretreated with either valproate or allopregnanolone 30 minutes prior to activation of trigeminal afferent fibers via intracisternal injection of the irritant, capsaicin. The effects of valproic acid and allopregnanolone were examined on c‐fos expression within the trigeminal nucleus caudalis (lamina I, II0), the termination site for small unmyelinated C fibers projecting from the meninges. C‐fos positive cells were counted at three representative levels (rostral, middle, and caudal) by an observer naive to the treatment group.

We found that valproate ( ³³10 mg/kg, IP) reduced labeled cells by 52% (P<0.05) and allopregnanolone ( ³³100 mg/kg, IP) reduced labeled cells by 42% (P<0.01). Bicuculline (GABAA antagonist), but not phaclofen (GABAB antagonist), blocked the valproate effect, thereby documenting the importance of GABAA receptors.

We conclude that the attenuation of c‐fos‐LI by valproate and allopregnanolone is mediated via GABAA receptors. These studies complement prior experiments showing that valproic acid and allopregnanolone block neurogenic inflammation within the meninges via GABAA receptor‐mediated mechanisms. The findings suggest a potential strategy for discovering new antimigraine drugs with high affinity for the GABAA receptor and its modulatory sites.
Interictal and Ictal Phase Study With Tc 99m HMPAO Brain SPECT in Juvenile Migraine With Aura
Authors: Soriani S. , Feggi L. , Battistella P.A. , Arnaldi C. , De Carlo L. , Stipa S.
Published: March 2003

Single photon emission computed tomography (SPECT) was performed on 30 juvenile patients suffering from different types of migraine with aura. SPECT was carried out only during the pain‐free interval in 11 patients. The other 19 patients underwent SPECT ictally and 9 of them also interictally. During the pain‐free interval, the investigation was normal in 16 of 20 cases and revealed hypoperfused areas in 4 of 20 cases. Ictally, regional cerebral blood flow (rCBF) abnormalities were found in 14 of 19 cases: hypoperfusion in 11 patients and hyperperfusion in 3 patients. In most cases, rCBF abnormalities corresponded to the topography of neurologic symptoms. Our intericta period results do not agree with the previous studies in juvenile migraineurs, while during the ictal phase we demonstrated, for the first time, significant rCBF abnormalities in juvenile patients suffering from migraine with aura.
Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay
Authors: Duyff R.F. , Snijders C.J. , Vannesle J.A.L.
Published: March 2003

A 36‐year‐old man with a history of migraine without aura, presented with recurrent bouts of severe headache, perception of flashing lights in both visual fields, and transient bilateral neurological deficits. In view of his history, migraine with aura was considered. Ancillary investigations showed bilateral extracranial internal carotid artery dissection. This case illustrates that when attacks of severe headache with scotomata and transient bilateral neurological deficits occur in a patient with a history of migraine, the diagnosis of carotid artery dissection should be considered, especially when the pattern of headache is different or when some clinical characteristics have not been experienced previously.
Effect of Chinook Winds on the Probability of Migraine Headache Occurrence
Authors: Piorecky J. , Becker W.J. , Rose M.S.
Published: March 2003

Our objective was to determine if Chinook weather conditions in the Calgary area increase the probability of headache attacks in migraine sufferers.

Environment Canada meteorologic summaries for January through June 1992 were analyzed and times of Chinook wind onset identified. Chinook weather conditions were defined as calendar days when Chinook winds were present and the calendar day immediately preceding Chinook wind onset. The diaries of 13 migraine patients were analyzed, and times of headache onset classified according to the existing weather conditions.

The probability of migraine headache onset was greater on days with Chinook weather (17.26%) than on non‐Chinook days (14.65%) (P = 0.042). Older patients appeared more weather sensitive than younger patients. For patients over age 50, the probability of migraine occurrence on Chinook weather days was much greater than on non‐Chinook days (P = 0.007).

Chinook weather conditions increase the probability of migraine headache occurrence. Older migraine sufferers appear particularly vulnerable to this effect.
Growth Environment and Personality in Adult Migraineurs and Their Migraine‐Free Siblings
Authors: Persson Bertil
Published: March 2003

The aim of the study was to compare adult migraine discordant full siblings in terms of personality and psychosocial environment during childhood. The study, involving 30 sibling pairs and use of various personality instruments (Eysenck Personality Inventory [EPI], Color Word Test [CWT], Visual Aftereffects [VAE], Meta Contrast Technique [MCT], Cesarec‐Marke Personality Schedule), showed the migraineurs scored significantly higher on neuroticism (EPI), also called emotional stress or trait anxiety; to be more sensitive (MCT); and to display signs of greater anxiety (VAE, CWT). Furthermore, migraineurs tended to report greater scarcity of friends during childhood and less verbal, as well as, nonverbal encouragement from their parents, than their migraine‐free siblings. Neuroticism was found to correlate significantly with migraine, but not with headache frequency or severity in the migraine group. It is argued that, due to the high neuroticism of some migraineurs, psychotherapy should be considered as an alternative to other prophylactic treatments such as use of β‐adrenoceptor blockers, although the acute migraine onset should be pharmacologically treated.
Prevalence and Clinical Features of Chronic Daily Headache in a Headache Clinic
Authors: Srikiatkhachorn Anan , Phanthurachinda Kammant
Published: March 2003

Although chronic daily headache is regarded as a syndrome encountered in headache clinics, clinical characteristics have only rarely been studied and the condition has not been documented in Thailand. To investigate the prevalence as well as clinical features of chronic daily headache in Thai patients, 220 patients visiting Chulalongkorn Headache Clinic were examined. Sixty cases (27.3%) were diagnosed as suffering from chronic daily headache (male to female ratio, 1:5.7).

The average age of these patients was 32.7 ± 9.6 years. Based on the International Headache Society (IHS) criteria, 30% of patients with chronic daily headache could be diagnosed as suffering from migraine end 36.7% from chronic tension‐type headache, whereas the remainder had combined features of both headache types and were not classifiable. Diffuse steady pain was the most common headache type reported (65%), however, associated features characteristic of migraine were often noted. These included photophobia (70%), phonophobia (56.7%) and nausea (43%). Thirty‐four cases (56.7%) reported that their headache could be aggravated by stress. Daily use of analgesics was reported in 58.3% of cases. We concluded that chronic daily headache is a common problem. Although the mechanism has not been fully clarified, the prevalence of associated psychological factors and analgesic overuse imply their involvement in the pathogenesis of this condition. The criteria of the IHS are not entirely suitable for diagnosis and classification of this disorder, and modification of this classification system is needed.
Cerebral Vasomotor Changes in the Transient Syndrome of Headache With Neurologic Deficits and CSF Lymphocytosis (HaNDL)
Authors: Kappler Joachim , Mohr Stephan , Steinmetz Helmuth
Published: March 2003

We report two patients with the recently described transient syndrome of headache with neurologic deficits and CSF lymphocytosis (HaNDL). Transcranial Doppler sonography performed during and after attacks of HaNDL showed asymmetrical decreases or increases in blood flow velocity of the middle cerebral artery, accompanied by increases or decreases in pulsatility suggesting fluctuations of arteriolar tone. The findings demonstrate focal vasomotor disturbances that link the transient headaches and deficits of HaNDL with attacks of migraine.
Familial Hemiplegic Migraine With Crossed Cerebellar Diaschisis and Unilateral Meningeal Enhancement
Authors: Crawford Jacqueline S. , Konkol Richard J.
Published: March 2003

A 6‐year‐old boy with a family history of hemiplegic migraine had a hemiplegic migraine lasting for 6 days complicated by prolonged fever, lethargy, and two brief focal seizures. An acute single photon emission computerized tomogram (SPECT) demonstrated decreased blood flow in the symptomatic cerebral hemisphere as well as crossed cerebellar diaschisis not previously documented in migraine. Another unique finding was the MRI with enhancement of the meninges and pial vessels over the symptomatic cerebral hemisphere. These findings suggest cerebellar and extra‐axial involvement as components of hemiplegic migraine.
Herpes Zoster Ophthalmicus Mimicking Carotid Artery Dissection: A Case Report
Authors: Verghese Joe , Kachroo Arun , Sparr Steven A.
Published: March 2003

Herpes zoster is a common viral illness presenting with vesicular eruptions which are usually preceded by pain, erythema, and tenderness in a dermatomal distribution. The ophthalmic division of the trigeminal nerve is commonly involved (herpes zoster ophthalmicus). Early diagnosis before eruption of vesicles can be difficult and symptoms may be confused with other neurologic disorders. We present a patient with herpes zoster ophthalmicus who presented with face and neck pain associated with visual symptoms mimicking carotid artery dissection. Atypical presentation and benefits of early antiviral treatment are discussed.
Mast Cell Activation in Children With Migraine Before and After Training in Self‐regulation
Authors: Olness Karen , Hall Howard , Rozniecki Jacek J. , Schmidt Wendy , Theoharides T.C.
Published: March 2003

Migraine may affect as many as 9% of all schoolchildren and often presents with abdominal symptoms of pain, nausea, and vomiting. Even though the pathophysiology of migraine remains unknown, self‐regulation techniques appear to be more effective in prevention of childhood migraine than conventional pharmacotherapy which is often associated with adverse effects. Mast cells have been implicated in the pathogenesis of migraine in adults, but have not been previously studied in children with migraine.

Mast cells are found close to the vessels and nerves in the meninges where they can release multiple vasoactive, neurosensitizing, and pro‐inflammatory mediators. Therefore, we investigated whether children with migraine may have increased urinary levels of mast cell mediators and whether practicing relaxation imagery exercises has an effect on the frequency of headache, as well as on mast cell activation.

Urine was collected for 24 hours from children with and without migraine after a 5‐day amine‐restricted diet. Children with migraine also collected urine during migraine episodes. The mean levels of urinary histamine, its main metabolite, methylhistamine, and the mast cell enzyme, tryptase, were higher in children than generally found in adults, but they did not differ statistically in any of the categories studied. However, in 8 of 10 children who practiced relaxation imagery techniques and successfully reduced the number of migraines, the urine tryptase levels were also significantly lower. There was no relationship between successful practice and sex or age of the child. These results suggest that stress may activate mast cells which could be involved in the pathophysiology of migraine.
Tension‐Type Headache: Pain, Fatigue, Tension, and EMG Responses to Mental Activation
Authors: Bansevicius Dalius , Westgaard Rolf H. , Sjaastad Ottar M.
Published: March 2003

Twenty patients with tension‐type headache (14 chronic and 6 episodic) and 20 group‐matched controls were selected for this study. They participated in a 1‐hour, complex, two‐choice, reaction‐time test, as well as 5‐minute pretest and 20‐minute posttest periods. Subjects reported any pain in the forehead, temples, neck, and shoulders, as well as any feelings of fatigue and tension during the pretest, and every 10 minutes during the test and posttest by visual analog scales. Superficial electromyography was recorded simultaneously from positions representing the frontal and temporal muscles, neck (mostly splenius), and trapezius muscles. The location of pain corresponded to the position of the electrodes, but extended over a larger area. The test provoked pain in the forehead, neck, and shoulders of patients, ie, pain scores from these regions increased significantly during the test. The pain scores continued to increase posttest. In patients, the EMG response of the trapezius (first 10 minutes of the test) was elevated relative to pretest. In controls, only the frontal muscles showed an EMG test response. Patients showed significantly higher EMG responses than controls in the neck (whole test period) and trapezius (first 10 minutes of the test period).

There were significant differences in pain and fatigue scoring between patients and controls in all three periods and in tension scoring posttest. Fatigue correlated with pain, with increasing significance for all locations examined, while tension was mainly associated with the neck pain. The meaning of the variables “tension” and “fatigue” in headache, and their association with recorded muscle activity in various regions is discussed. The EMG response of the trapezius muscle to the test is discussed in comparison with similar responses observed in patients with other pain syndromes.
Sensitivity to Various Stimuli in Primary Headaches: A Questionnaire Study
Authors: Vingen Jolanta Vanagaite , Sand Trond , Stovner Lars Jacob
Published: March 2003

Questions about discomfort or pain produced by various stimuli (eg, light, sound, exercise, neck movements) are currently used to differentiate between various primary headache disorders. In order to evaluate the usefulness of differences in sensitivity to physical stimuli in headache diagnosis, the answers to a questionnaire about sensitivity to various stimuli were compared in 68 patients with migraine, 45 with tension‐type headache, 46 with cluster headache, and 23 patients with cervicogenic headache, and in 71 controls. Even among controls, a high proportion reported that many of these stimuli could elicit some degree of discomfort or pain. Without headache, migraineurs differed from the other patients with headache and controls mainly in their increased sensitivity to light. With headache, patients with tension‐type headache were the least sensitive and migraineurs were the most sensitive to all stimuli, except for stimuli stemming from neck movements, to which patients with cervicogenic headache were most sensitive. Migraineurs also reported the highest degree of sensitivity regarding aggravation and provocation of headache. However, the most striking finding was that all patient groups, cluster headache in particular, became significantly more sensitive with headache than without headache to almost all stimulus categories. This may indicate that these headaches share important pathogenetic mechanisms. The fact that no headache had a very specific sensitivity profile may point to weaknesses of present headache classification systems.
Incidence of Medically Recognized Migraine: A 1989‐1990 Study in Olmsted County, Minnesota
Authors: Rozen Todd D. , Swanson Jerry W. , Stang Paul E. , McDonnell Shannon K. , Rocca Walter A.
Published: March 2003

Objective.–To investigate the incidence of medically recognized migraine in Olmsted County, Minnesota, during the years 1989 to 1990.

Methods.–We used the records‐linkage system of the Rochester Epidemiology Project to identify all subjects who sought medical attention for their headache and had their initial visit for migraine within the study period. Incident cases were classified using specified criteria.

Results.–From 9837 records screened, we found 713 incident cases. The average annual incidence rate (new cases per 100 000 person‐years) was 343.0 in both sexes combined, 481.6 in women, and 194.4 in men. In women, incidence rates were low at the extremes of age and higher among those aged between 10 and 49 years, with a striking peak at the age of 20 to 29 years. Migraine without aura was the most common type of migraine in women. Men had a more constant risk of migraine throughout life with a lesser peak at the age of 10 to 19 years, and they were equally affected by all types of migraine. Women had consistently higher incidence rates than men at all ages, and there were strikingly higher incidence rates of migraine without aura in women than in men.

Conclusions.–Although our incidence rates were restricted to medically recognized cases of migraine, we confirmed previously reported epidemiological patterns.
Cluster Headache Is Not Associated With Signs of a Systemic Inflammation
Authors: Remahl Ingela Nilsson , Waldenlind Elisabet , Bratt Johan , Ekbom Karl
Published: March 2003

Objective.–To investigate whether there is clinical or biochemical evidence for a transient systemic inflammation during active periods of cluster headache.

Methods.–Twenty‐seven male and female consecutively selected patients with episodic cluster headache filled in questionnaires aiming at detecting any concurrent systemic vasculitic or rheumatoid disease. They were physically examined by both a neurologist and a rheumatologist independent of each other. Blood and urine samples were taken one to three times during an active cluster period and once in remission. The following analyses were performed: hemoglobin, erythrocyte sedimentation rate, C‐reactive protein, complete blood counts including differential counts, creatinine, albumin, creatine kinase, electrophoreses of serum (with haptoglobin, orosomucoid, IgG, IgM), von Willebrand's factor, antinuclear antibodies, rheumatoid factor, cytoplasmic antineutrophil cytoplasmic autoantibodies, perinuclear antineutrophil cytoplasmic autoantibodies, and routine urinary tests. An age‐ and sex‐matched control group of 99 consecutive patients attending the Outpatient Department of Neurology for symptoms/diseases other than severe headache completed the same questionnaire as the patient group.

Results.–Only one patient with cluster headache showed clinical signs (livedo reticularis) that could have been due to an ongoing systemic vasculitis. Most symptoms were equally or even more prevalent in the control group than among the patients with cluster headache. However, cold feet were about twice as prevalent among female patients with cluster headache than in the control group. This was considered due to their smoking habits. Laboratory tests showed no statistically significant differences between the active cluster periods and remission. There were some slightly abnormal values in single laboratory tests, some of which were probably due to concurrent upper respiratory infections. The findings of laboratory tests for one patient could have been due to nephritis. All patients were negative for cytoplasmic antineutrophil cytoplasmic autoantibodies and perinuclear antineutrophil cytoplasmic autoantibodies.

Conclusions.–These results were taken as evidence that no systemic inflammation is present during the active cluster headache period. However, whether a local retro‐orbital inflammation underlies the pathophysiology of cluster headache remains obscure.
Bilateral Subdural Hematomas Following Routine Lumbar Diskectomy
Authors: Burkhard Pierre R. , Duff John M.
Published: March 2003

Intracranial hypotension is a rare, and possibly underrecognized, cause of headache in middle age. Occurring spontaneously in the vast majority of cases, it has been occasionally reported after certain neurosurgical procedures involving craniectomy. We report a unique situation in which a patient developed severe postural headache typical of intracranial hypotension, which was complicated by bilateral subdural hematomas, immediately following a routine lumbar diskectomy; the headache resolved spontaneously. We suggest that an intraoperative microscopic dural breach was the site of sustained, but self‐limited, cerebrospinal fluid leakage that eventually led to intracranial hypotension.
Prevalence and Predictors of Headaches in US Adolescents
Authors: Rhee Hyekyun
Published: March 2003

Objectives.—To examine the prevalence of headaches among US adolescents; to explore the differences in prevalence by sex, race, and age; and to test the nature of the association between headaches and depression, self‐esteem, and insomnia.

Methods.—This longitudinal study used a nationally representative sample of adolescents (n = 6072) who were interviewed in 1995 (wave 1) and then interviewed a year later in 1996 (wave 2). Path analyses were used to test for the relationships among headaches, insomnia, depression, and self‐esteem.

Results.—More than 90% of subjects had experienced one or more headaches during the past 12 months. Of that 90%, about 30% reported recurrent headaches occurring weekly or more frequently. Girls tended to report more recurrent headaches (37.6%) than boys (21.3%). American Indians experienced the highest rate (35.6%) of recurrent headaches followed by white adolescents (32.1%). Depression and low self‐esteem in wave 1 were found to precede the headaches in wave 2 in girls, but not in boys. No causal relationship was found between insomnia and headaches.

Conclusions.—Headaches are prevalent among US adolescents, especially in girls and American Indians. This study suggests the existence of different paths involving different factors in headache‐presenting behavior for boys and girls. Further studies are needed to illustrate the different mechanisms of headache in the two sexes.
Traumatic Intracerebral Venous Thrombosis Associated With an Abnormal Golf Swing
Authors: Saneto Russell P. , Samples Stephen , Kinkel R. Philip
Published: March 2003

Objectives.—To describe the occurrence of cerebral venous thrombosis in a 40‐year‐old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature.

Background.—Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing.

Results.—Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false‐positive VDRL, previous deep vein thrombosis, renal disease, factor V Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event.

Conclusions.—Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.