bluuebunny/crossref_metadata_2025 huggingface dataset:
Nociceptive Blink Reflex and Visual Evoked Potential Habituations Are Correlated in Migraine
Authors: Di Clemente Laura , Coppola Gianluca , Magis Delphine , Fumal Arnaud , De Pasqua Victor , Schoenen Jean
Published: August 2010

Background.—Lack of habituation, as reported in migraine patients between attacks for evoked cortical responses, was also recently found for the nociceptive blink reflex (nBR) mediated by brainstem neurons. It is not known if both brain stem and cortical habituation deficits are correlated in the same patient, which would favor a common underlying mechanism.

Objective.—To search for intraindividual correlations between habituation of pattern reversal‐visual evoked potentials and that of the nociception‐specific blink reflex in migraineurs and in healthy volunteers (HV).

Methods.—We recorded 15 HV and 15 migraine without aura patients between attacks. Habituation for visual evoked potentials was measured by comparing the N1–P1 amplitude change (%) between the first and sixth block of 100 sequential averaged responses. Habituation for the nBR was defined as the percentage change of the R2 response area between the 1st and 10th block of five averaged EMG responses, elicited by stimulating the right side every 2 minutes for 32 minutes. We also calculated the slope of N1–P1 amplitude and R2 response area changes from the first to the last response and the correlation with attack frequency.

Results.—A significant habituation deficit in both cortical and brain stem evoked activity characterized on average the group of migraineurs compared to controls. In migraine patients, but not in HV, we found a significant positive correlation between habituation of pattern reversal‐visual evoked potentials and that of the nociception‐specific blink reflex both for the degree of habituation between first and last blocks of averagings (r = 0.703; P= .003) and for the habituation slope (r = 0.751; P= .001). Moreover, nBR habituation was positively correlated with attack frequency (r = 0.548; P= .034).

Conclusion.—The positive correlation between visual evoked potential and nBR habituations is consistent with the idea that in migraine the same neurobiological dysfunction might be responsible for the habituation deficit both in cortex and brain stem. As nBR habituation increases with attack frequency, its interictal deficit is unlikely to be due to trigeminal sensitization.
The Numb Chin Syndrome as an Early Manifestation of Giant‐Cell (Temporal) Arteritis: A Case Report
Authors: Abilleira Sònia , Bowler John V.
Published: August 2010

We describe a 70‐year‐old woman with a 2‐month history of a numb chin and gradually increasing bilateral headache and malaise. Neurological examination disclosed chin hypoesthesia while investigations showed a normocytic anemia, ESR of 100, and CRP of 72. A CT brain scan, chest X‐ray, and bone scan showed no evidence of malignancy. Temporal arteritis was suspected and prednisolone started with prompt resolution of the headache, chin hypoesthesia, ESR, and CRP. This case illustrates an unusual etiology of the numb chin syndrome, which in most occasions is associated with malignancy. Temporal arteritis should be borne in mind as a possible explanation for this as it is a treatable condition with potentially serious, life‐threatening complications.
Psychiatric Comorbidity of Migraine
Authors: Hamelsky Sandra W. , Lipton Richard B.
Published: August 2010

Migraine affects nearly 12% of the adult population in the United States and causes significant lost productivity and decrements in health‐related quality of life. The burden of migraine and the challenge in managing it are increased by the comorbid psychiatric conditions that occur in association with it. Studies in both clinical and community‐based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. This review will focus on the relationships between migraine and depression, generalized anxiety disorder, panic disorder, and bipolar disorder. In large scale population‐based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Migraine is also comorbid with generalized anxiety disorder (Odds Ratio [OR] 3.5 to 5.3), panic disorder (OR 3.7), and bipolar disorder (OR 2.9 to 7.3). A diagnosis of migraine should lead to a heightened level of diagnostic suspicion for these comorbid psychiatric disorders. Similarly, a diagnosis of one of these psychiatric disorders should increase vigilance for migraine. Treatment plans for migraine should be mindful of the comorbid conditions.
Reversible Anorgasmia With Topiramate Therapy for Headache: A Report of 7 Patients
Authors: Sun Christina , Lay Christine , Broner Susan , Silberstein Stephen , Tepper Stewart , Newman Lawrence
Published: August 2010

Objective.—To describe 7 patients who developed new onset anorgasmia while using topiramate therapy for migraine prophylaxis.

Background.—Topiramate is an effective drug for the prevention of migraine headaches. Though it is generally well tolerated, it may be associated with a dose‐related anorgasmia.

Methods.—Case reports

Results.—Seven patients (5 women, 2 men), between the ages of 40 and 62, developed anorgasmia while using topiramate for headache prevention. Four women and 2 men had migraine without aura, and 1 woman had migraine with aura. None had a prior history of anorgasmia or sexual dysfunction. Doses associated with this side effect ranged from 45 to 200 mg daily. All subjects had symptom resolution. Six patients had resolution within 7 days of discontinuing or decreasing the medication; the exact time frame of resolution for the seventh patient is unknown.

Conclusion.—In our series, anorgasmia was a reversible, dose‐related adverse effect of topiramate. Physicians need to be aware of the potential for topiramate to cause sexual side effects, and should inquire about these symptoms in patients for whom this agent has been prescribed.
Square One: Headache Education for the Medical Student
Authors: Young William B. , Rosen Noah , Sheftell Fred
Published: August 2010

Headache education for the physician begins in medical school. The American Headache Society has endorsed a curriculum and core competencies.
Diffusion MRI During Migraine With Aura Attack Associated With Diagnostic Microbubbles Injection in Subjects With Large PFO
Authors: Dinia Lavinia , Roccatagliata Luca , Bonzano Laura , Finocchi Cinzia , Del Sette Massimo
Published: August 2010

The relationship between migraine with aura and patent foramen ovale (PFO) is still debatable. We report 2 cases of migraine with aura attacks after diagnostic microbubble injection for contrast transcranial Doppler (cTCD), in subjects with large PFO. In one case MR images, including diffusion weighted imaging and apparent diffusion coefficient, performed during aura did not show any signal abnormality. Patients with migraine with aura may have an attack during cTCD, probably by a “non‐ischemic” mechanism.
Giant Cell Arteritis With Multiple Cranial Nerve Palsy and Reversible Proptosis: A Case Report
Authors: Liou Li‐Min , Khor Gim‐Thean , Lan Sheng‐Hsing , Lai Chiou‐Lian
Published: August 2010

Giant cell arteritis (GCA) often presents with symptoms of headache, jaw claudication, polymyalgia rheumatica, and blurred vision. GCA is relatively rare and may have atypical manifestations in Asians, including multiple cranial nerve palsy and reversible proptosis. A high suspicion of GCA is suggested when any older Asian suffers from headache that is new‐onset or different from the previous pattern, even without other typical manifestations of GCA.
Looking to the Future: Research Designs for Study of Headache Disease Progression
Authors: Lipton Richard B. , Bigal Marcelo E.
Published: August 2010

Evidence from clinical observation and population studies suggests that migraine sometimes transforms into chronic migraine. Risk factors for progression include headache frequency, obesity, snoring, stressful life events, and head injury. Other candidate risk factors include depression, anxiety, and lifestyle factors. Progression in a subgroup only raises the possibility that risk factor management or other forms of treatment may prevent migraine progression. Herein, we consider the design of clinical trials for interventions which could prevent the transformation of migraine to chronic migraine. We recommend enrolling individuals at high risk for progression based on baseline high headache frequency, delivering intervention in the context of a double‐blind randomized trial and assessing either the onset of chronic migraine or major change in headache frequency as outcomes.
Drug Induced Intracranial Hypertension Associated With Sulphasalazine Treatment
Authors: Sevgi Eser , Yalcin Gul , Kansu Tulay , Varli Kubilay
Published: August 2010

A 25‐year‐old female patient developed headache and papilledema under sulphasalazine treatment for ulcerative colitis. The patient met the International Headache Society's criteria for idiopathic intracranial hypertension. Sulphasalazine was discontinued and the patient was given azathioprine for ulcerative colitis and acetazolamide for intracranial hypertension. Three weeks later, her examination was normal and lumbar puncture revealed an opening pressure of 180‐mm H2O. Sulphasalazine is a product of 5 aminosalicylate (5 ASA) and there seems to be a relationship between the administration of sulphasalazine and the onset of intracranial hypertension symptoms. Early diagnosis of intracranial hypertension is important in patients with ulcerative colitis receiving 5 ASA treatment to prevent visual complications.
Ruptured Intracranial Dermoid: An Unusual Cause of Headache in an Older Patient
Authors: Rajapakse Anoja , Diack Alison
Published: August 2010

A 76‐year‐old woman with a history of migraine presented with worsening headache. Computerized tomography brain scan and magnetic resonance imaging brain scan showed the presence of fat globules in the cerebrospinal fluid space. This appearance was suggestive of ruptured intracranial dermoid. She recovered spontaneously. While headache is a known presentation of ruptured intracranial dermoid, the condition is unusual to present in older people.
Characteristics of Migraine Attacks and Responses to Almotriptan Treatment: A Comparison of Menstrually Related and Nonmenstrually Related Migraines
Authors: Diamond Merle L. , Cady Roger K. , Mao Lian , Biondi David M. , Finlayson Gary , Greenberg Steven J. , Wright Pamela
Published: August 2010

Objectives.— To compare the clinical characteristics of menstrually related migraines (MRMs) and nonmenstrually related migraines (nonMRMs) and to investigate the efficacy of almotriptan in the treatment of these migraine subtypes.

Design/Methods.— These are post hoc analyses of data from the AXERT® Early miGraine Intervention Study (AEGIS), a multicenter, double‐blind, parallel‐group trial that evaluated adults with IHS‐defined migraine with and without aura. Patients were randomized 1 : 1 to treat 3 consecutive headaches with almotriptan 12.5 mg or matching placebo at the first sign of headache typical of their usual migraine, at any level of pain intensity but within 1 hour of onset. MRMs were defined as those occurring ±2 days of the first day of menstrual flow. Post hoc analyses to describe headache characteristics pooled all migraine attacks experienced by patients who reported ≥1 menses during the study regardless of assigned treatment group. The post hoc efficacy analyses included outcomes of almotriptan treatment compared with placebo treatment for all migraines in patients with a menstrual record.

Results.— Of the 275 women in the AEGIS intent‐to‐treat population, 190 (69.1%; 97 almotriptan, 93 placebo; aged 18‐54 years) reported ≥1 menses during the trial. Of the 506 migraines reported by these patients, 95 (18.8%) occurred ±2 days of the first day of menstrual flow and were defined as MRM. Aura was associated with 11.7% of MRM and 15.0% of nonMRM. Allodynia‐associated symptoms were present with 62.8% of MRM and 57.0% of nonMRM. Prior to treatment, 19.1% of MRM were associated with normal functional ability, 68.1% with disturbed functional ability, and 12.8% required bed rest compared with 18.9%, 68.8%, and 12.3%, respectively, of nonMRM. Pretreatment pain intensity was mild in 40.0%, moderate in 47.4%, and severe in 12.6% of MRM compared with 43.6%, 47.2%, and 9.2%, respectively, of nonMRM. Almotriptan treatment efficacy outcomes for MRM vs nonMRM, respectively, were: 2‐hour pain relief, 77.4% vs 68.3%; 2‐hour pain free, 35.4% vs 35.9%; and sustained pain free, 22.9% vs 23.8%. Almotriptan was similarly effective in relieving migraine‐associated symptoms and improving functional disability associated with both MRM and nonMRM.

Conclusions.— Prior to treatment, the presence of migraine‐associated characteristics including aura, allodynia‐associated symptoms, photophobia, phonophobia, and nausea were similar for both MRM and nonMRM attacks. The pretreatment levels of pain intensity and functional disability were likewise similar across the migraine subtypes. Almotriptan was equally effective in the treatment of both MRM and nonMRM attacks and was associated with an adverse event profile that was similar to placebo treatment.
SB 242084: A Selective 5‐HT2CReceptor Antagonist
Authors: Di Matteo Vincenzo , Di Giovanni Giuseppe , Esposito Ennio
Published: August 2010

SB 242084 is the most potent and selective 5‐HT2Creceptor antagonist thus far available. Thus, SB 242084 has high affinity for the cloned human 5‐HT2Creceptor with a pKiof 9.0, a much lower affinity for the human cloned 5‐HT2B(pKi7.0) and 5‐HT2A(pKi6.8) receptors, and low affinity for other 5‐HT, dopamine, and adrenergic receptors. In the 5‐HT‐stimulated PI hydrolysis model of 5‐HT2Creceptor function, SB 242084 was found to be a competitive antagonist with a pKBof 9.3. A series ofin vivostudies have shown that SB 242084 is a very effective antagonist of behavioral responses mediated by 5‐HT2Creceptors such as penile erections, and the hypophagic and hypolocomotor effect of mCPP in rats. In addition, this compound has anxiolytic‐like properties. Moreover, SB 242084 increases the basal activity of dopaminergic neurons in the VTA and thein vivoDA release in the nucleus accumbens, and it is capable of blocking the inhibitory effects of mCPP and RO 60‐0175 on mesolimbic dopaminergic activity. These data are consistent with the evidence that 5‐HT2Creceptors exert an inhibitory control upon the mesolimbic dopaminergic system.

Taken togheter, the available data on SB 242084 might have implication for the possible use of this compound in the treatment of anxiety, depression, and the negative symptoms of schizophrenia.
Ion Channel Diseases of the Central Nervous System
Authors: Li Ming , Lester Henry A.
Published: August 2010

In the last decade, advances in molecular genetics and cellular electrophysiology have increased our understanding of ion channel function. A number of diseases termed “channelopathies” have been discovered that are caused by ion channel dysfunction. Channelopathies can be caused by autoimmune, iatrogenic, toxic or genetic mechanisms. Mutations in genes encoding ion channel proteins that disrupt channel function are now the most commonly identified cause of channelopathies, perhaps because gene disruption is readily detected by the methods of molecular genetics. Ion channels are abundant in the central nervous system (CNS), but CNS channelopathies are rare; however, they overlap with some important neurological disorders, such as epilepsy, ataxia, migraine, schizophrenia, Alzheimer's disease and other neurodegenerative diseases. It is possible that more CNS channelopathies will be discovered when additional ion channels are characterized and the complex mechanisms of brain function are better understood. At present, increased knowledge of the identity, structure and function of ion channels is facilitating diagnosis and treatment of many channelopathies.
Fluvoxamine as an Adjunctive Agent in Schizophrenia
Authors: Silver Henry
Published: August 2010

Schizophrenia is a common mental disorder that has an early onset and rates high as a cause of medical disability. Antipsychotic agents are the mainstay of treatment but response is often inadequate. Negative symptoms (disturbances in volition, social interaction and affective functions) are particularly difficult to treat and form a major obstacle to rehabilitation. A promising approach to improve response of negative symptoms has been to add a selective serotonin reuptake inhibitor (SSRI) antidepressant to antipsychotic treatment. This review examines evidence pertaining to the efficacy, tolerability, and safety of the SSRI fluvoxamine, combined with antipsychotic agents, in the treatment of negative symptoms in schizophrenia. Important methodological issues, such as differentiating primary and secondary negative symptoms, are discussed. The balance of available evidence indicates that fluvoxamine can improve primary negative symptoms in chronic schizophrenia patients treated with typical antipsychotic s and suggests that it may also do so in some patients treated with clozapine. This combination is generally safe and well tolerated although, as antipsychotic drug concentrations may be elevated, attention to dose and drug monitoring should be considered appropriately. Combination with clozapine may require particular caution because of potential toxicity if serum clozapine levels rise steeply. The fluvoxamine doses effective in augmentation are lower than those usually used to treat depression. Evidence regarding the use of fluvoxamine augmentation to treat phenomena, such as obsessions and aggression, which may be associated with Schizo Prenia, is also examined. An impartant goal of future studies will be to define which patint groups can benefit from combined treatment.
YM872: A Selective, Potent and Highly Water‐Soluble α‐Amino‐3‐Hydroxy‐5‐Methylisoxazole‐4‐Propionic Acid Receptor Antagonist
Authors: Takahashi Masayasu , Kohara Atsuyuki , Shishikura Jun‐ichi , Kawasaki‐Yatsugi Sachiko , Ni Jian Wei , Yatsugi Shin‐ichi , Sakamoto Shuichi , Okada Masamichi , Shimizu‐Sasamata Masao , Yamaguchi Tokio
Published: August 2010

This review focuses on thein vitroandin vivoneuropharmacology of YM872, a potential neuroprotective agent currently undergoing clinical trials in the United States (trial name: AMPA Receptor Antagonist Treatment in Ischemic Stroke — ARTIST). Its neuroprotective properties in rats and cats with induced focal cerebral ischemia are described. YM872, [2,3‐dioxo‐7‐(1H‐imidazol‐1‐yl)‐6‐nitro‐1,2,3,4‐tetrahydroquinoxalin‐1‐yl]‐acetic acid monohydrate, is a selective, potent and highly water‐soluble competitive α‐amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionic acid (AMPA) receptor antagonist. YM872 has a potent inhibitory effect on [3H]AMPA binding with aKivalue of 0.096 μM. In contrast, YM872 has very low affinity for other ionotropic glutamate receptors. The solubility of YM872 is approximately 500 to 1000 times higher than that of the other competitive AMPA antagonists: YM90K, NBQX, or CNQX. The neuroprotective efficacy of YM872 was investigated in rats and cats subjected to permanent occlusion of the left middle cerebral artery. The animals were assessed either histologically or neurologically following ischemia. In rats with occluded middle cerebral artery (MCAO) YM872, by i.v. infusion, significantly reduced infarct volume measured at 24 h and 1 week after ischemia. Significant neuroprotection was maintained even when drug administration was delayed for up to 2 h after ischemia. In addition, YM872 significantly improved neurological deficit measured at 1 week after ischemia. In cats with MCAO YM872, by i.v. infusion, dose‐dependently reduced infarct volume at 6 h after ischemia. YM872 produced no behavioral abnormalities and was not nephrotoxic. The evidence for the neuroprotective efficacy of YM872 suggests its therapeutic potential in the treatment of acute stroke in humans.
Dihydroetorphine: A Potent Analgesic: Pharmacology, Toxicology, Pharmacokinetics, and Clinical Effects
Authors: Ohmori Satoshi , Morimoto Yasunori
Published: August 2010

Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. Severalin vitroandin vivostudies have shown that DHE is a selective μ‐opioid receptor (OP3) agonist that also binds and activates all human recombinant μ‐, δ‐, and k‐opioid receptors (OP3, OP1, and OP2). The onset of the analgesic effect of DHE in rodents is rapid, 5 to 15 min after parenteral administration; the duration of action is short, the analgesic effect disappears within 120 min after administration. By oral administration much higher doses of DHE are required to produce analgesic effects. These characteristics are accounted for by the pharmacokinetic properties of DHE in the rat, namely, by rapid distribution of DHE from the injection site to the brain and rapid metabolism by glucuronidation in the gut and liver followed by elimination into the bile. Continuous infusion and repeated administration of DHE lead to the development of tolerance to analgesia, physical dependence, and a rewarding effect in normal rats but not in animals with formalin‐induced inflammation. Although formalin‐induced inflammation is only one type of pain stimulus, these findings suggest that DHE addiction would be observed only in the case of pain‐free conditions. Clinical reports in China show that sublingual doses of DHE, 20 to 180 μg, produce a potent analgesic effect with only mild side effects, including dizziness, somnolence, nausea, vomiting, constipation, and shortness of breath. To improve the short‐lasting effect following sublingual administration, transdermal delivery of DHE via a patch has been investigated. The patch formulation of DHE produces continuous analgesic effect with minimal physical dependence and rewarding effect in rats suffering from chronic pain. This patch formulation, which is very suitable for DHE, may be viable for the treatment of severe pain and is likely to improve patients' quality of life.
BAY 38–7271: A Novel Highly Selective and Highly Potent Cannabinoid Receptor Agonist for the Treatment of Traumatic Brain Injury
Authors: Mauler Frank , Horváth Ervin , De Vry Jean , Jäger Rainer , Schwarz Thomas , Sandmann Steffen , Weinz Corinna , Heinig Roland , Böttcher Michael
Published: August 2010

Traumatic brain injury (TBI) is the most common cause of mortality and morbidity in adults under 40 years of age in industrialized countries. Worldwide the incidence is increasing, about 9.5 million people are hospitalized per year due to TBI, and the death rate is estimated to be more than one million people per year. Recently BAY 38–7271 has been characterized as a structurally novel, selective and highly potent cannabinoid CB1/CB2receptor agonistin vitroandin vivowith pronounced neuroprotective efficacy in a rat traumatic brain injury model, showing a therapeutic window of at least 5 h. Furthermore, neuroprotective efficacy was also found in models of transient and permanent occlusion of the middle cerebral artery and brain edema models as well. In this article we review thein vitroandin vivopharmacology of BAY 38–7271, the results from acute and subacute toxicity studies, pharmacokinetics and drug metabolism in animals and healthy male volunteers. In phase I studies BAY 38–7271 was safe and well tolerated when administered by i.v. infusion for either 1 or 24 h.

As the doses of BAY 38–7271 in animals needed for maximal neuroprotective efficacy were significantly lower than those inducing typical cannabinoid‐like side effects, it is to be expected that the compound will offer a novel therapeutic approach with a favorable therapeutic window for the treatment of TBI or cerebral ischemia.
The Pharmacology of Chlormethiazole: A Potential Neuroprotective Agent?
Authors: Wilby M. J. , Hutchinson P. J.
Published: August 2010

Chlormethiazole is a thiazole derivative with a long history of use as a sedative agent. The mode of action of the drug has been partly worked out and has been established with recognition that its mechanism of action involves potentiation of GABA activity, the major intrinsic inhibitory neurotransmitter. Animal models of stroke ranging from rodents to primates have suggested an optimistic role for chlormethiazole in preventing both anatomical and functional deleterious effects of stroke. Phase III clinical trials, therefore, proceeded but unfortunately with very little success. Recently, the animal models have been revisited in an attempt to identify causes for this discrepancy between the results from pre‐clinical and clinical studies. This review studies the pharmacological roots of chlormethiazole from its origin through to its licensed and novel applications. Emphasis is placed on discussing the animal experiments which led to its grooming as a neuroprotective agent and also on the human trials. The review seeks to explain the discrepancies between animal and human studies, which include short survival times of experimental subjects, speed of drug administration and fundamental differences between species. The primate model of stroke perhaps offers the nearest alternative to phase III trials and has recently been used to compare a number of newer neuroprotective agents with greater efficacy than chlormethiazole. In addition, novel approaches involving human neurochemical analyses in vivo are described which may help bridge the gap between animal models and future phase III trials.
Preclinical Neuropharmacology of Naratriptan
Authors: Lambert Geoffrey A.
Published: August 2010

The basic CNS neuropharmacology of naratriptan is reviewed here. Naratriptan is a second‐generation triptan antimigraine drug, developed at a time when CNS activity was thought not to be relevant to its therapeutic effect in migraine. It was, however, developed to be a more lipid‐soluble, more readily absorbed and less readily metabolized variant on preexisting triptans and these variations conferred on it a higher CNS profile. Naratriptan is a 5‐HT1B/1Dreceptor agonist with a highly selective action on migraine pain and nausea, without significant effect on other pain or even other trigeminal pain. Probable sites of therapeutic action of naratriptan include any or all of: the cranial vasculature; the peripheral terminations of trigeminovascular sensory nerves; the first‐order synapses of the trigeminovascular sensory system; the descending pain control system; and the nuclei of the thalamus. Naratriptan may prevent painful dilatation of intracranial vessels or reverse such painful dilatation. Naratriptan can prevent the release of sensory peptides and inhibit painful neurogenic vasodilatation of intracranial blood vessels. At the first order synapse of the trigeminal sensory system, naratriptan can selectively suppress neurotransmission from sensory fibers from dural and vascular tissue, while sparing transmission from other trigeminal fibers, probably through inhibition of neuropeptide transmitter release. In the periaqueductal gray matter and in the nucleus raphe magnus, naratriptan selectively activates inhibitory neurons which project to the trigeminal nucleus and spinal cord and which exert inhibitory influences on trigeminovascular sensory input. Naratriptan has also a therapeutic effect on the nausea of migraine, possibly exerting its action at the level of the nucleus tractus solitarius via the same mechanisms by which it inhibits trigeminovascular nociceptive input. The incidence of naratriptan‐induced adverse effects in the CNS is low and it is not an analgesic for pain other than that of vascular headache. In patients receiving selective serotonin uptake inhibitors (SSRIs) naratriptan may cause serotonin syndrome‐like behavioral side effects. The mechanism of action involved in the production of behavioral and other CNS side effects of naratriptan is unknown.
Clinical Significance of the Reversed Mitral Annular Motion Velocity Wave at the Beginning of the Mitral Valve Closure
Authors: Mizuguchi Yukio , Oishi Yoshifumi , Miyoshi Hirokazu , Iuchi Arata , Nagase Norio , Oki Takashi
Published: August 2010

Background: Pulsed tissue Doppler imaging is increasingly used to record mitral annular motion (MAM) velocity pattern. A reversed MAM velocity wave (Cm) is commonly seen at the beginning of the mitral valve closure in timing, whereas the underlying mechanism and clinical significance have not been studied. Methods: Conventional, pulsed Doppler, pulsed tissue Doppler, and two‐dimensional strain echocardiography were performed in 100 consecutive patients with cardiovascular risk factors. Results: There were no correlations between the peak Cm and the ratio of peak early diastolic transmitral flow velocity to peak early diastolic MAM velocity (E/Em) and Tei index. The peak Cm correlated with left ventricular (LV) ejection fraction, left atrial volume index (LAVI) and left atrial ejection fraction, isovolumic relaxation time, peak LV systolic strains and strain rates during atrial systole in the longitudinal and circumferential directions, and peak LV systolic strain rates in the longitudinal, circumferential, and radial directions. Multivariate linear regression analysis revealed that LAVI is a independent predictor related to peak Cm. Conclusion: The Cm is regulated by mitral annular motion velocity toward the LA due to closing of the mitral valve, and may be used as a predictive tool for determining the “disease history” of chronic LV diastolic dysfunction in patients with no marked elevation in the LV filling pressure. (Echocardiography 2010;27:784‐790)
Surgery for Ruptured Sinus of Valsalva Aneurysm into Right Ventricular Outflow Tract: Role of Intraoperative 2D and Real Time 3D Transesophageal Echocardiography
Authors: Gadhinglajkar Shrinivas , Sreedhar Rupa
Published: August 2010

A major limitation of the 2D echocardiography during surgery for a complex cardiac lesion is its inability to provide an accurate spatial orientation of the structure. The real time 3D transesophageal echocardiography (RT‐3D‐TEE) technology available in Philips IE 33 ultrasound machine is relatively new to an operation suite. We evaluated its intraoperative utility in a patient, who was operated for repair of a ruptured sinus of Valsalva aneurysm (RSOVA) and closure of a supracristal ventricular septal defect. The VSD and RSOVA were visualized through different virtual windows in a more promising way on intraoperative RT‐3D‐TEE than on the 2D echocardiography. The acquired images could be virtually cropped and displayed in anatomical views to the operating surgeon for a clear orientation to the anatomy of the lesion. RT‐3D‐TEE is a potential intraoperative monitoring tool in surgeries for complex cardiac lesions. (Echocardiography 2010;27:E65‐E69)
Continuing Medical Education Program in Echocardiography
Authors: Fan Pohoey , Mizuguchi Yukio , Oishi Yoshifumi , Miyoshi Hirokazu , Iuchi Arata , Nagase Norio , Oki Takashi
Published: August 2010

Article Title: Clinical Significance of the Reversed Mitral Annular Motion Velocity Wave at the Beginning of the Mitral Valve Closure (Echocardiography 2010;27:783)
The OAS Democratic Solidarity Paradigm: Questions of Collective and National Leadership
Authors: Cooper Andrew F. , Legler Thomas
Published: August 2010

This article examines the prospects for an interamerican “paradigm of democratic solidarity.” Although the region has seen genuine progress in the promotion and defense of democracy, a significant deficit in collective and national leadership hinders the consolidation of hemispheric prodemocracy activism. As illustrated by a number of recent cases, including the controversy over Peru's May 2000 election, these impediments are not only situational but structural. This article concludes with a discussion of ways to move beyond these problems and to buttress the democratic solidarity doctrine.
The Politics of Retrenchment: The Quandaries of Social Protection under Military Rule in Chile, 1973–1990
Authors: Castiglioni Rossana
Published: August 2010

Chile's military government replaced the country's universalistic social policy system with a set of market-oriented social policies. Taking evidence from three areas (pensions, education, and health care), this study seeks to explain why the military advanced a policy of deep retrenchment and why reform of health care was less thorough than it was in pensions and education. The radical transformation of policy relates to the breadth of power concentration enjoyed by General Pinochet and his economic team, the policymakers' ideological positions, and the role of veto players. The more limited reform of health care is linked to the actions of a powerful veto player, the professional association of physicians.
Money, Elections, and Democracy in Brazil
Authors: Samuels David
Published: August 2010

Brazil’s 1993 law requiring candidates to report their campaign contributions has generated a new source of data to explore the supposition that Brazilian elections are extraordinarily expensive. An examination of these data from Brazil’s 1994 and 1998 general elections reveals that most money for Brazilian electoral campaigns comes from business sources and that leftist candidates have extremely limited access to such financing. The effect on democracy is that Brazil’s largely unregulated campaign finance system tends to decrease the scope of interest representation.
Labor Reform and Dual Transitions in Brazil and the Southern Cone
Authors: Cook María Lorena
Published: August 2010

The sequencing of transitions to democracy and to a market economy shaped the outcome of labor law reform and prospects for expanded labor rights in Argentina, Brazil, and Chile. Argentina and Brazil experienced democratic transitions before market economic reforms were consolidated in the 1990s. During the transition, unions obtained prolabor reforms and secured rights that were enshrined in labor law. In posttransition democratic governments, market reforms coincided with efforts to reverse earlier labor protections. Unable to block many harmful reforms, organized labor in Argentina and Brazil did conserve core interests linked to organizational survival and hence to future bargaining leverage. In Chile this sequence was reversed. Market economic policies and labor reform were consolidated under military dictatorship. During democratic transition, employers successfully resisted reforms that would expand labor rights. This produced a limited scope of organizational resources for Chilean unions and reduced prospects for future improvements.
From Bullets to Ballots: The Emergence of Popular Support for Hugo Chávez
Authors: Canache Damarys
Published: August 2010

The election of Hugo Chávez as Venezuela's president in 1998, less than seven years after his unsuccessful military coup attempt, marked a pivotal moment in one of the most dramatic political transformations in the nation's history. This article explores public reaction to Chávez's shift, especially the question of why Venezuelans would entrust democratic governance to a man who had once attempted to topple the nation's democratic regime. Two hypotheses are proposed: one of converted militancy and one of democratic ambivalence. Analysis of survey data from 1995 and 1998 demonstrates that Chávez's initial base of support drew heavily on Venezuelans who were ambivalent or hostile toward democracy. By 1998, and consistent with the converted militant hypothesis, Chávez won support from a substantial portion of citizens who valued democracy. Yet democratic ambivalence also contributed to Chávez's winning electoral coalition.
An Illusion of Omnipotence: U.S. Policy Toward Guatemala, 1954–1960
Authors: Brockett Charles D.
Published: August 2010

Based primarily on declassified U. S. government documents, this study analyzes the U. S. effort to build a “showcase for democracy” in Guatemala following the U. S.-engineered regime change of 1954. The effort was doomed, for the U.S. government lacked both unity of purpose and the necessary continuous commitment at the top. The documents also demonstrate limited consideration of the sociopolitical constraints that U. S. policy objectives would face. This is clear from examining three key U. S. objectives: to eliminate the “communist threat”; to create a stable, legitimate, democratic government; and to develop a free, independent labor movement. Domination and the limits of power are equally central to understanding the relationship between the Eisenhower administration and Guatemala, a case study that also has more general utility.
The Origins of Security Cooperation in the Southern Cone
Authors: Resende-Santos João
Published: August 2010

Argentine-Brazilian relations have undergone a remarkable transformation over the last two decades, from enduring rivalry to cooperation. Dating back to the late 1970s, security cooperation has been a byproduct of two different sets of factors, strategic and military organizational, that propelled the two countries independently but simultaneously toward peaceful settlement. The 1979–80 settlement of disputes over hydroelectric power and nuclear technology not only ended centuries of militarized competition but established the first institutional structures of what is today one of the world's most durable security regimes.
Can Mercosur Survive? Domestic and International Constraints on Mercosur
Authors: Carranza Mario E.
Published: August 2010

Mercosur has survived several crises by resorting to presidential diplomacy, but it risks becoming an empty shell unless member states work to coordinate macroeconomic policies. Its survival depends on the outcome of domestic political struggles in Brazil and Argentina and on the harmonization of exchange-rate policies between the two countries. This article examines the Argentine-Brazilian “trade wars” provoked by successive devaluations of the Brazilian currency, aggravated in 2001 by the Argentine economic crisis. The social explosion in Argentina in December 2001 showed that domestic actors can successfully challenge proglobalization policies. To consolidate, Mercosur will have to address the democratic deficit while building supranational institutions and an effective dispute-settlement system.
Selling Sustainable Development and Shortchanging Social Ecology in Costa Rican Forest Policy
Authors: Silva Eduardo
Published: August 2010

Costa Ricans have worked hard to weave the norms and principles of sustainable development into their nation's environmental policies, especially with respect to natural renewable resources, such as the forest. As a result, the nation is known as a leader in innovative environmental initiatives. But sustainable development is a complex, evolving concept. This paper analyzes how the emphasis on biodiversity conservation during the 1990s and early 2000s has, rhetoric notwithstanding, neglected the social equality, or livelihood, component of sustainable development. This trend stands in sharp contrast to earlier periods, when decisionmakers crafted policies and institutions that supported social ecology. The article concludes with a few observations on building political will to revive the grassroots development component of sustainable development.
Contradiction without Paradox: Evangelical Political Culture in the 1998 Venezuelan Elections
Authors: Smilde David
Published: August 2010

Venezuelan Evangelicals' responses to candidates in that country's 1998 presidential election seem to confirm the view that their political culture is inconsistent, contradictory, and paradoxical. Not only were they just as likely to support nationalist ex–coup leader Hugo Chávez as was the larger population, they also rejected Venezuela's one Evangelical party when it made a clientelist pact with the infamous candidate of Venezuela's discredited Social Democratic party. This article uses concepts from recent cultural theory to analyze qualitative data from these two cases and make sense of the contradictory nature of Evangelical politics.
Radical Change at the Ballot Box: Causes and Consequences of Electoral Behavior in Venezuela's 2000 Elections
Authors: José E. Molina V. , Carmen Pérez B.
Published: August 2010

This study aims to explain the victory of Hugo Chávez and his party in the 2000 Venezuelan elections, to analyze the factors that made this victory possible, and to examine the consequences for future developments in the Venezuelan political system. The decay of traditional party loyalties without the emergence of new parties deeply rooted in society (dealignment without realignment); underdevelopment; and an institutional setting dominated by a president elected by a plurality electoral system have opened the door to personality-centered politics and weak parties, which are the main features of the current political situation. Compared to the 1993 and 1998 elections, the 2000 elections once again confirm an increase in personality politics and the decay of parties as instruments for articulating interests, representation, and governance. As a consequence, this article argues, instability is likely to remain a feature of Venezuela's party system for some time.
Taming the Tiger: Voting Rights and Political Instability in Latin America
Authors: Colomer Josep M.
Published: August 2010

This article discusses the relationship between certain institutional regulations of voting rights and elections, different levels of electoral participation, and the degree of political instability in several Latin American political experiences. A formal model specifies the hypotheses that sudden enlargements of the electorate may provoke high levels of political instability, especially under plurality and other restrictive electoral rules, while gradual enlargements of the electorate may prevent much electoral and political innovation and help stability. Empirical data illustrate these hypotheses. A historical survey identifies different patterns of political instability and stability in different countries and periods, which can be compared with the adoption of different voting rights regulations and electoral rules either encouraging or depressing turnout.
Insurance for Good Losers and the Survival of Chile's Concertación
Authors: Carey John M. , Siavelis Peter M.
Published: August 2010

In the transition from military rule to democracy, the government of Augusto Pinochet bequeathed to Chile a unique electoral law by which all legislative seats are contested in two-member districts. A key implication of this rule is that in order to secure legislative majorities, coalitions have to put their strongest candidates in the most precarious electoral list positions. This generates a divergence of interests between coalitions and politicians. Chile's largest coalition, the Concertación, has resolved the dilemma by providing appointed posts to unsuccessful congressional candidates who accept personal political risk on the coalition's behalf. This study argues that this insurance system has provided the critical glue to hold the coalition together since Chile's transition to democracy in 1990. Recent changes in the electoral environment could threaten the Concertación's control over the appointed posts that have sustained this informal institution. This could jeopardize the Concertación's cohesion during the process of negotiating coalition candidate lists for the 2005 legislative elections.
U.S. Power and the Politics of Economic Governance in the Americas
Authors: Phillips Nicola
Published: August 2010

This article examines the nature of the emerging regional economic regime in the Americas and argues that the dominant approach to economic governance is one defined by the assertion of U.S. power in the region and oriented toward distinctively U.S. interests and preferences. This has been clearly evident in the evolution of the Free Trade Area of the Americas but also, with the deceleration and fragmentation of that process during 2002 and 2003, in the growing prioritization of bilateralism. The leverage afforded by the bilateral negotiation of trade agreements acts to situate primary influence in shaping the rules that constitute the regional economic regime, and the primary functions associated with governing in this context, firmly within the agencies of the U.S. state. This essay therefore explores how the hegemonic power of the United States manifests itself in the substance of the hemispheric project and the shape of the economic regime associated with it.
Indictments, Myths, and Citizen Mobilization in Argentina: A Discourse Analysis
Authors: Armony Ariel C. , Armony Victor
Published: August 2010

Most accounts of the turmoil that shook Argentina in 2001–2 focused on the harmful impact of the financial environment, imprudent policymaking, and institutional weaknesses. These explanations paid little attention to the cultural frames and cognitive patterns that underlie the connection between civil society and political society. Based on a discourse analysis of Internet forums and presidential speeches, this article argues that the Argentine crisis cannot be fully grasped without considering the link between collective behavior and ingrained conceptions of national identity. The analysis finds that national myths and definitional questions of national purpose are key factors in the way citizens behave in the context of an economic and political crisis.
Decentralization's Nondemocratic Roots: Authoritarianism and Subnational Reform in Latin America
Authors: Eaton Kent
Published: August 2010

This study challenges the common view of authoritarianism as an unambiguously centralizing experience by investigating the subnational reforms that military governments actually introduced in Latin America. It argues that the decision by military authorities to dismiss democratically elected mayors and governors opened a critical juncture for the subsequent development of subnational institutions. Once they centralized political authority, the generals could contemplate changes that expanded the institutional, administrative, and governing capacity of subnational governments. This article shows how cross-national variation in the content and consistency of the generals' economic goals led to quite distinct subnational changes; in each case, these reforms profoundly shaped the democracies that reemerged in the 1980s and 1990s.
Correlates of Levels of Democracy in Latin America during the 1990s
Authors: McClintock Cynthia , Lebovic James H.
Published: August 2010

Does the conventional wisdom about the relationships between economic, cultural, and political party variables and democracy stand up in the Latin American experience of the 1990s? This study, utilizing new data sets for the region, finds that some traditional hypotheses are upheld better than others. It sustains the conventional wisdom that economic development, economic growth, democratic values, and (with a two-year lead) education correlate positively with the level of democracy. Surprisingly, however, neither social trust nor the number of political parties is significantly correlated with the level of democracy. The study suggests various possible explanations for the weak or nonexistent relationships for social trust and number of parties, in the hope that these surprising results will stimulate further research.