bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstruction of Right Ventricular Outflow Tract with Stentless Xenografts in Ross Procedure
Authors: Tsukube Takuro , Kawanishi Yujiro , Murakami Hirohisa , Hino Yutaka , Matsukawa Ritsu , Ozaki Nobuchika , Okada Kenji , Matsuda Hitoshi , Wakita Noboru , Nishiwaki Masami , Okita Yutaka
Published: March 2003

Abstract: To investigate whether the use of a stentless porcine aortic xenograft can be an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure, 9 patients underwent the Ross procedure and RVOT reconstruction with a stentless xenograft since January 2000. After the aortic valve was replaced with a pulmonary autograft, a stentless xenograft with a xeno‐ pericardial roll was implanted in the RVOT. One patient required subsequent aortic valve replacement because of severe regurgitation of the pulmonary autograft. All patients recovered well from the operation. The right ventricle‐pulmonary arterial pressure gradient was 18 ± 7 mm Hg at discharge and was not significantly increased during the 2‐year follow‐up period. Although 1 patient died of ventricular arrhythmia 5 months after, his cardiac function was normal, and transpulmonary valve pressure was 19 mm Hg in the follow‐up. The other 7 patients are currently in New York Heart Association functional Class I. Although long‐term follow‐up is required to explain the durability, the stentless xenograft with a pericardial roll is considered to be an alternative for reconstruction of the RVOT within 2 years after the Ross procedure.
Overview: End‐Stage Renal Disease in the Developing World
Authors: Barsoum Rashad S.
Published: March 2003

Abstract:Although the vast majority of patients with end‐stage renal disease (ESRD) worldwide live in what is called thedeveloping world,little is known about its epidemiology and management. With the current paucity of credible and adequately representative registries, it is justified to resort to innovative means of obtaining information. In this attempt, world‐renowned leading nephrologists in 10 developing countries collaborated in filling a 103‐item questionnaire addressing epidemiology, etiology, and management of ESRD in their respective countries on the basis of integrating available data from different sources. Through this joint effort, it was possible to identify a number of important trends. These include the expected high prevalence of ESRD, despite the limited access to renal replacement therapy, and the dependence of prevalence on wealth. Glomerulonephritis, rather than diabetes, remains as the main cause of ESRD with significant geographical variations in the prevailing histopathological types. The implementation of different modalities of renal replacement therapy (RRT) is inhibited by the lack of funding, although governments, insurance companies, and donations usually constitute the major sponsors. Hemodialysis is the preferred modality in most countries with the exception of Mexico where chronic ambulatory peritoneal dialysis (CAPD) takes the lead. In several other countries, dialysis is available only for those on the transplant waiting list. Dialysis is associated with a high frequency of complications particularly HBV and HCV infections. Data on HIV are lacking. Aluminum intoxication remains as a major problem in a number of countries. Treatment withdrawal is common for socioeconomic reasons. Transplantation is offered to an average of 4 per million population (pmp). Recipient exclusion criteria are minimal. Donor selection criteria are generallylooseregarding tissue typing, remote viral infection, and, in some countries, blood‐relation to the recipient in live‐donor transplants. Cadaver donors are accepted in many countries participating in this survey. Treatment outcomes with different RRT modalities are, on the average, inferior to the internationally acknowledged standards largely due to infective and cardiovascular complications.
Computational Flow Modeling in Hollow‐Fiber Dialyzers
Authors: Eloot Sunny , De Wachter Dirk , Van Tricht Ilse , Verdonck Pascal
Published: March 2003

Abstract: A three‐dimensional finite volume model of the blood‐dialysate interface over the complete length of the dialyzer was developed. Different equations govern dialyzer flow and pressure distribution (Navier‐Stokes) and radial transport (Darcy). Blood was modeled as a non‐Newtonian fluid with a viscosity varying in radial and axial direction determined by the local hematocrit, the diameter of the capillaries, and the local shear rate. The dialysate flow was assumed to be an incompressible, isothermal laminar Newtonian flow with a constant viscosity. The permeability characteristics of the membrane were calculated from laboratory tests for forward and backfiltration. The oncotic pressure induced by the plasma proteins was implemented as well as the reduction of the overall permeability caused by the adhesion of proteins to the membrane. From the calculated pressure distribution, the impact of flow, hematocrit, and capillary dimensions on the presence and localization of backfiltration can be investigated.
Light and Electron Microscopic Analyses of Autologous Pericardial Tissue Used as a Small‐Diameter Arterial Graft in Dogs
Authors: Kim Won Gon , Yang Ji Hyuck , Sung Sang Hyun
Published: March 2003

Abstract: As a form of small‐diameter arterial graft, we implanted fresh autologous pericardium and pericardium treated with 0.6% glutaraldehyde in the bilateral carotid arteries of dogs and then compared the time‐related changes of the grafts explanted after the predetermined periods. The pericardial grafts were implanted in 1 animal each for scheduled periods of 3 days, 2 weeks, 1 month, 3 months, and 6 months. The retrieved grafts were processed for light and electron microscopic analyses following gross observation. The glutaraldehyde‐treated small‐diameter pericardial vascular grafts showed a better endothelialization of the blood‐contacting surface and a slower fragmentation of the collagen layers than the fresh grafts although it has yet to be proven whether these differences are so significant as to affect the patency results between the groups.
Numerical Analysis of the Three‐Dimensional Blood Flow in the Korean Artificial Heart
Authors: Shim Eun Bo , Yeo Jong Young , Ko Hyung Jong , Youn Chan Hyun , Lee Young Ro , Park Chan Young , Min Byoung Goo , Sun Kyung
Published: March 2003

Abstract: Flow in the blood sac of the Korean artificial heart is numerically simulated by finite element method. Fluid‐structure interaction algorithm is employed to compute the three‐dimensional blood flow interacting with the sac material. For verification of the numerical method of fluid‐structure interaction, two‐dimensional flow in a collapsible channel with initial tension is simulated and the results are compared with numerical solutions from the literature. Incompressible viscous flow and linear elastic solid are assumed for the blood and the sac material in the device, respectively. The motion of the actuator is simplified by a time‐varying pressure boundary condition imposed on the outer surface of the sac. Numerical solutions on the unsteady three‐dimensional blood flow in the sac are provided for the cactus‐type model in this study. During systole, the inlet is closed and the blood sac is squeezed by the action of the prescribed pressure on the surface. During diastole, the sac is filled with the blood coming from the inlet while the outlet is closed. A strong flow to the outlet and a stagnated flow near the inlet are observed during systole. Shear stress distribution is also delineated to assess the possibility of thrombus formation. We also simulate numerically the hemodynamics of “the reversed model” where the inlet and outlet are reversed for surgical convenience. It is observed that a recirculating flow was generated near the inner corner of the sac in the reversed model. To assess the material strength of the sac, the shear stress distribution in the solid material is also presented.
Ciguatera (Fish Poisoning), El Niño, and Pacific Sea Surface Temperatures
Authors: Hales Simon , Weinstein Phil , Woodward Alistair
Published: March 2003

ABSTRACT Ciguatera (fish poisoning) is the most frequent cause of human illness caused by ingestion of marine toxins. The toxins are ingested by herbivorous fish which feed on marine algae and are then passed up the food chain to humans eating reef fish. We have used a unique database of reported fish poisoning cases in the South Pacific islands to investigate the relationship between fish poisoning and El Niño Southern Oscillation, a periodic disruption of global climate that is associated with marked changes in rainfall, temperatures, and ocean currents. This provides an opportunity to study the effects of a strong climate signal on a sensitive ecosystem in a region that has been less subject to local human disturbance than most others. Using a mixed ecological study design, we calculated correlations between reports of fish poisoning in individual Pacific Islands, estimates of local sea surface temperature, and the Southern Oscillation Index. Strong positive correlations between the annual incidence of fish poisoning and local warming of the sea surface were found in a group of islands which experience warming during El Niño conditions. In another group of islands, which experience cooling of the sea surface during El Niño events, there were weaker negative correlations between fish poisoning and local sea surface temperature. The results are consistent with other evidence suggesting a close interdependence of marine ecosystems and climate. Increases in ciguatera may result if the climate continues to warm as a result of the enhanced greenhouse effect. Coral reefs have been under increasing pressure from human populations in recent years; ciguatera may be a sensitive indicator of environmental disturbance in tropical marine ecosystems.
Ecosystem Health as a Clinical Rotation for Senior Students in Canadian Veterinary Schools a
Authors: Ribble C. , Hunter B. , Larivière M. , Bélanger D. , Wobeser G. , Daoust P.Y. , Leighton T. , Waltner‐Toews D. , Davidson J. , Spangler E. , Nielsen O.
Published: March 2003

ABSTRACT We describe 4 years of an experimental rotation in ecosystem health offered to senior veterinary students in Canada. Faculty from the four Canadian veterinary colleges collaborated in offering the rotation once annually at one of the colleges. The first rotation was held in Guelph, Ontario, in 1993, followed in successive years by rotations at Saskatoon, Saskatchewan, Saint‐Hyacinthe, Québec, and Charlottetown, Prince Edward Island. The rotation is a predominantly field‐based experience that allows students to work with veterinary and other role models who are actively engaged in clinical research related to ecosystem health. Five specific field studies that worked particularly well during the rotations are presented. These studies involved investigating mortality in wildlife due to botulism, designing an environmental surveillance system around herds of beef cattle, using belugas to evaluate the health of the St. Lawrence River, dealing with competition for water use by aquaculture and agriculture, and exploring the role of veterinarians during major coastal oil spills. The experience has resulted in our developing the subject matter, field examples, teaching approach, and confidence necessary to make ecosystem health the focus of a productive clinical rotation for senior year veterinary students.
Landscape Pattern Metrics and Regional Assessment
Authors: O'neill Robert V. , Riitters K.H. , Wickham J.D. , Jones K. Bruce
Published: March 2003

ABSTRACT The combination of remote imagery data, geographic information systems software, and landscape ecology theory provides a unique basis for monitoring and assessing large‐scale ecological systems. The unique feature of the work has been the need to develop and interpret quantitative measures of spatial pattern—the landscape indices. This article reviews what is known about the statistical properties of these pattern metrics and suggests some additional metrics based on island biogeography, percolation theory, hierarchy theory, and economic geography. Assessment applications of this approach have required interpreting the pattern metrics in terms of specific environmental endpoints, such as wildlife and water quality, and research into how to represent synergystic effects of many overlapping sources of stress.
Coral Reef Ecosystems and Human Health: Biodiversity Counts!
Authors: Adey Walter H.
Published: March 2003

ABSTRACT The health of human populations requires a wide variety of chemical and physical supports from their associated ecosystems, as well as from the global ecosystem. Ecosystems can be “ecologically engineered” to improve the efficiency of that service, particularly when ecosystem health fails due to human overloads. Less well recognized is an entirely different dimension of ecosystem support of human populations; namely the pharmacological value of ecosystem biodiversity. Natural product chemistries are an extremely important resource in the ever‐expanding human battle with health degrading microbes.

Coral reefs are the most diverse ecosystems in the sea and have the highest density of biodiversity globally. High diversity density gives rise to intense species competition and the subsequent organism capability to construct exotic defensive and offensive chemicals, many with pharmacological value. Coral reefs are being rapidly degraded, anthropogenically, both locally and globally. It is estimated that less than 10% of reef biodiversity is currently known and only a small fraction of that percent has been tested for “active compounds”. Many species extinctions are likely in the coming decades, and badly needed pharmacological potential will subsequently be lost.

Sophisticated coral reef and reef organism culturing capability is now available that would allow the prospecting of reefs, the efficient analysis of organisms and eventually the mass culturing of those organisms for their secondary compounds without ecosystem damage. The economic value of this pharmaceutical potential needs to be directed by governments to an international crash project to conserve coral reefs and their biodiversity.
Menstrual Migraine With Features of Cluster Headache. A Report of 10 Cases
Authors: Robbins Lawrence
Published: March 2003

Ten patients with menstrually related migraine headaches and significant features of cluster headache are described. The mean age of onset of the headache was 29 years. The duration of the pain was more typical for migraine, with an average of 3 days. The pain was sharp with associated tear formation and nasal congestion. Eight of the women described significant nausea. Only one reported any type of cluster headache outside of the menstrual time. Four patients experienced tension headaches, and four also had migraines not related to menses (without cluster features).

Preventive medications were generally not helpful. The abortive medications that did help included sumatriptan, Cafergot PB® suppositories, and corticosteroids. Oxygen was useful in two patients. While analgesics did help three patients, lidocaine nasal spray was ineffective in four of the women.
The Prevalence of Headache in Greece: Correlations to Latitude and Climatological Factors
Authors: Mitsikostas D.D. , Tsaklakidou D. , Athanasiadis N. , Thomas A.
Published: March 2003

A questionnaire study on headaches, using a door‐to‐door survey, was carried out in a representative sample of the general Greek population, including 1737 men and 1764 women, from 15 to 75 years of age. The parameters evaluated included age, sex, education, socioeconomic status, region of domicile, frequency of headache, use of medication, medical consultation, and family history. Latitude and climatologic factors such as humidity, temperature, and atmospheric pressure were also investigated. Headaches were not classified because the interviewers were not specialists. Nineteen percent of men and 40% of women (mean 29%) suffered from headaches in the prior year. Headaches were more frequent in lower social classes, in people with less education, and in those between 45 and 64 years of age. Nineteen percent of sufferers did not take any medication and 33% used medication every time that they had a headache, while 36% sought medical consultation. Twenty‐nine percent of headache sufferers had a family history of headaches. Daily headache was present in 15% of headache sufferers. Humidity and atmospheric pressure were not correlated to headache frequency. However, in the northern areas of Greece, as well as in the regions with low mean temperature, more people suffered from daily headaches. These data may explain the lower 1 ‐year prevalence of headaches in Greece as compared to the prevalence of headaches in other northern European countries.
Migraine: A Symptomatic Case History
Authors: Edinger J. Raymond
Published: March 2003

Data from 28 years of the author's personal migraine diary are analyzed for patterns of aura and headache. A total of 186 occurrences of migraine are analyzed. A migraine‐interval histogram suggests that, although the median interval between attacks is 37 days, there is an underlying cyclical interval of just 6 to 10 days. Distinct patterns are found for specific combinations of aura and symptoms depending on whether both sides, the right side, or the left side of the head were involved in the attack.
Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature
Authors: Milos Peter , Havelius Uif , Hindfelt Bengt
Published: March 2003

A man had left‐sided atypical clusterlike headache for II years before he developed symptoms and signs consistent with acromegaly. Preoperative evaluation revealed raised levels of somatomedin C and growth hormone. An MR indicated a left‐sided intrasellar mass measuring 8 x 7.5 x 10 mm. He underwent surgery and microscopy confirmed the diagnosis of a benign hypophyseal adenoma. Postoperatively, the acromegalic features regressed, and for the last 4 years the patient has been completely free from headache attacks. On pharmacological testing of the pupillary response to 19 and 5% phenylephrine and 2% tyramine solutions, there was no convincing evidence of persistent sympathetic dysfunction on the earlier symptomatic side.
Prescribing Practices for the Management of Headache in Newfoundland and Labrador
Authors: Furlong Stephen , Pryse‐Phillips William , Crowley Mary , Turner Christopher J.
Published: March 2003

To assess the impact of sumatriptan in clinical practice, we undertook a retrospective analysis of the government of Newfoundland and Labrador's prescription drug program data base for 35 consecutive patients prescribed sumatriptan. The number of doses of all drugs prescribed ranged from 121 to 18874 on from 4 to 357 prescriptions per patient over 1 to 19 months. The mean number of doses of analgesic drugs prescribed before sumatriptan therapy was 56 per month and after initiation of sumatriptan was 46 per month. The prescribing of multiple analgesics was common; 79% received three or more different analgesics. Twenty‐two (63%) patients were prescribed medications indicated for the prophylaxis of migraine concomitantly with drugs indicated for symptomatic treatment. Twenty‐four (69%) patients were prescribed medication capable of inducing migraine. We conclude that sumatriptan did not have a major impact on the outcomes of these patients judged by their use of analgesics. The simplest explanation is that many of the patients were suffering from analgesic‐induced headache rather than migraine. In addition, we conclude that there were deficiencies in prescribing practices including numbers, quantities, and choice of analgesics; the use of analgesics concomitantly with drugs indicated for migraine prophylaxis; and the use of drugs capable of inducing migraine. Further research is required to validate these findings.
An Epidemiological Study of Headaches Among Medical Students in Athens
Authors: Mitsikostas D.D. , Gatzonis S. , Thomas A. , Kalfakis N. , Llias A. , Papageoergiou C.
Published: March 2003

In order to study the prevalence of frequent headaches among the medical students of Athens University, an epidemiological survey was carried out among 588 medical students (318 men and 270 women), with mean age 23.5 years. Two questionnaires were designed for the study: one general, consisting of 10 questions and a second one, specific for headache sufferers, consisting of 117 questions. All those with headache who voluntarily completed the two questionnaires also underwent a neurological examination. Thirty point eight percent of men and 50.3% of women reported various headache attacks during the previous 6 months (39.6% in both sexes). However, only the 11.9% of students (from both sexes) reported that they suffered from disturbing headaches. The 6‐month prevalence of migraine was 2.4% and 9.5% for tension‐type headache (in both sexes). Cluster headache was not traced. The prevalence of nonclassifiable headaches (according to the criteria of the International Headache Society) was 0.85%. Headache was correlated to sex (more frequent among women) and anxiety level (Hamilton scale for anxiety). Headache prevalence was not correlated to smoking and social class.
Relative Contributions of Life Events Versus Daily Hassles to the Frequency and Intensity of Headaches
Authors: Fernandez Ephrem , Sheffield Jeanie
Published: March 2003

This study investigated headache parameters (frequency and intensity) in relation to (the number and severity of) two types of psychosocial stress: major life events (as assessed by a revised Social Readjustment Rating Scale) and minor daily hassles (as assessed by a revised Hassles Scale). Subjects were 261 volunteers reporting headache. Results revealed that both headache frequency and intensity were significantly predicted by daily hassles, in particular, the average severity of these hassles, but there was a negligible relationship between headache parameters and any of the life event measures. Furthermore, a significant relationship emerged between life events and daily hassles themselves. This fits with recent findings that life events (while exerting little direct effect on headache) may trigger a succession of hassles which culminate in headaches. Also, it is not the number of hassles, but the perceived severity of these hassles that best predicts headache frequency and intensity. Finally, though significant as predictors, daily hassles explained a small portion of the variance in headache, thus pointing to the host of other possible biological and psychosocial contributions to headache.
Chronic Daily Headache. A Clinical and Psychological Profile Before and After Treatment
Authors: Mongini Franco , Defilippi Nadia , Negro Cesare
Published: March 2003

To assess the clinical and personality characteristics of patients with chronic daily headache before and after treatment, 20 patients were examined and the Minnesota Multiphasic Personality Inventory (MMPI [Italian 356‐item abbreviated version]) and the Stait and Trait Anxiety Index 1,2 (STAI) administered. There were two groups: group 1 (n=6), with a “conversion V” configuration (with elevation of hypochondria and hysteria scales, the depression scale being somewhat lower); and group 2 (n=13) with elevation of depression and of other MMPI scales. One patient had no scale elevation. STAI 1,2 scores were high in both groups. Several psychosomatic symptoms and some migraine features were present in almost all patients. Occurrence, severity, and duration of headache were recorded regularly and the MMPI and the STAI administered again after treatment. Improvement of headaches and a decrease of several MMPI and STAI 2 scores were observed. However, 12 of 20 patients showed a conversion V configuration after treatment. It is concluded that chronic daily headache was transformed migraine in most cases and was accompanied by high anxiety levels in all patients and hysteric traits in some. With time, these patients may develop a depressive disorder. After treatment, hysterical traits are still present at a lower level in those showing these traits before treatment and may be unmasked in those that had depression.
Prevalence of Migraine and Headache in a High‐Altitude Town of Peru: A Population‐Based Study
Authors: Jaillard Assia S. , Mazetti Pilar , Kala Edwin
Published: March 2003

A door‐to‐door population‐based epidemiological study of the prevalence of migraine and headache in a sample of 3246 people older than 15 years of age was carried out in Cuzco, a high‐altitude town in the Peruvian Andes, located at 3380 meters.

Among the 3246 screened people, there were 172 cases of migraine and 930 cases of headache, yielding a crude 1‐year prevalence of 5.3% for migraine (2.3% among men and 7.8% among women) and 28.7% for headache (17.5% among men and 38.2% among women). Our results suggest that migraine prevalence in Cuzco is close to that of other developing countries, whereas headache prevalence may be higher than in other developing countries. Multivariate logistic regression suggested that both migraine and headache were related to the female sex, age, and anxiety and/or depression.

This study suggests that migraine is a relatively common disorder in Cuzco, but does not show any difference which could be significantly related to altitude. In contrast, our results suggest that headache may be more frequent at high altitude than at sea level.
Idiopathic Hypertrophic Cranial Pachymeningitis: An Unusual Cause of Subacute and Chronic Headache
Authors: Phanthumchinda Kammant , Sinsawaiwong Suwanna , Hemachudha Thiravat , Yodnophaklao Praphan
Published: March 2003

Three cases of idiopathic hypertrophic cranial pachymeningitis are presented. The diagnosis was based on the CT scan or MRI findings (or both) of thickened enhancing dura. In all cases, meningeal biopsies were performed and microscopic findings were compatible with non‐specific inflammation. All cases presented with subacute and chronic localized headache. Two cases had associated chronic meningitis. One case presented with a syndrome of multiple cranial nerve involvement (polyneuritis cranialis). Corticosteroids, in the form of prednisolone 60 mg/day, were effective in all cases. Two cases with less severe pachymeningitis received corticosteroids for 2 weeks, then were tapered off in 4 to 6 weeks. A case with extensive lesions needed a long‐term low dosage of prednisolone, 5 to 10 mg/day for maintenance therapy. Idiopathic hypertrophic cranial pachymeningitis may be related to the Tolosa‐Hunt syndrome, the syndrome of polyneuritis cranialis, and multifocal fibrosclerosis.
Effects of a Mass Media Behavioral Treatment for Chronic Headache: A Pilot Study
Authors: de Bruijn‐Kofman A.T. , van De Wiel H. , Groenman N.H. , Sorbi M.J. , Klip E.
Published: March 2003

This article presents the results of a pilot study evaluating the efficacy of a mass media self‐help behavioral treatment program for chronic headache.

The program consisted of a self‐help textbook, an exercise book, 10 television programs, 11 radio programs, and 3 audiocassettes with relaxation training. Approximately 15000 headache sufferers purchased the book and relaxation tapes. A random sample of 271 respondents participated in the effect study; the pretraining and posttraining data of 164 subjects were available for analysis.

Multivariate testing of the pretraining and posttraining results showed highly significant reductions in headache activity and medication intake at 4‐month follow‐up. A reduction of 50% or more in headache parameters and medication intake was achieved by 40% to 60% of the patients. Work absenteeism was significantly reduced. The differences between the diagnostic groups were not significant. Mass media behavioral treatment seems to be a viable treatment alternative for chronic headache and highly promising in terms of gain in quality of life, decrease in economic loss, and cost‐effectiveness in health care.
Headache Interference as a Function of Affect and Coping: An Artificial Neural Network Analysis
Authors: Cathcart Stuart , Materazzo Felicity
Published: March 2003

Artificial neural networks present a technique for modeling relationships between variables in complex systems. The negative effects of headache are determined by many “biopsychosocial” elements that represent a complex system. Artificial neural networks may therefore be useful for examining psychological factors in headache. To test this hypothesis, we trained an artificial neural network to predict life‐style interference attributed to headache from psychological measures of anger, depression, and coping appraisal and strategies. The artificial neural network demonstrated a better fit of the data than that obtained by multiple regression, and predicted interference levels to within 10% error for 80% of novel cases. Artificial neural networks may be a useful technique for examining psychological correlates of headache.
Effect of Guided Imagery on Quality of Life for Patients With Chronic Tension‐Type Headache
Authors: Mannix Lisa K. , Chandurkar Rohit S. , Rybicki Lisa A. , Tusek Diane L. , Solomon Glen D.
Published: March 2003

Objective.—To determine the effect of adjuvant guided imagery on patients with chronic tension‐type headache.

Background.—Management of chronic tension‐type headache often requires a combination of pharmacological and nonpharmacological therapies. Guided imagery is a relaxation technique based on visualizing pleasant images and body awareness.

Methods.—One hundred twenty‐nine patients with chronic tension‐type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF‐36) at their initial visit to a specialty headache center and again 1 month after the visit. In addition to individualized headache therapy, patients listened to a guided imagery audiocassette tape daily for the month. One hundred thirty‐one control subjects received individualized therapy without guided imagery.

Results.—Controls and the patients who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery patients (21.7%) than controls (7.6%) reported that their headaches were much better (P.004). The guided imagery patients had significantly more improvement than the controls in three of the SF‐36 domains: bodily pain (95% CI; guided imagery patients 11.0, controls 0.2), vitality (95% CI; guided imagery patients 10.9, controls l.7), and mental health (95% CI; guided imagery patients 7.8, controls 0.4).

Conclusions.—Guided imagery is an effective adjunct therapy for the management of chronic tension‐type headache.
Fatal Cardiac Arrhythmia After Oral Sumatriptan
Authors: Laine K. , Raasakka T. , Mäntynen J. , Sakko P
Published: March 2003

Typically, 3% to 5% of patients experience sensations of heaviness, pressure, and tightness in the chest after administration of sumatriptan, but there is little ECG evidence of ischemia.1,2 The serious cardiovascular incidents after consuming sumatriptan have been associated mostly with the subcutaneous dosage form of this drug and with patients with underlying cardiovascular risk factors. We report a case of fatal cardiac arrhythmia in an otherwise perfectly healthy patient with migraine after consuming a single 100‐mg dose of oral sumatriptan.
Central Nervous System Superficial Siderosis, Headache, and Epilepsy
Authors: Iannaccone S. , Golzi V. , Sferrazza B. , de Rino F. , Smirne S. , Ferini‐Strambi L.
Published: March 2003

Almost 95 cases of superficial siderosis of the central nervous system have been reported in the literature. These patients showed a clinical syndrome characterized by ataxia, deafness, pyramidal system involvement, and mental deterioration with xanthochromic cerebrospinal fluid and neuroradiological findings of hemosiderin deposits. About 30% of the patients had headache as an accompanying symptom. In the present case report, we describe a 33‐year‐old man with the typical clinical features of superficial siderosis, who complained, since aged 8, of a severe recurrent frontal headache often associated with loss of consciousness occurring after at least 2 hours of pain. The MRI and CSF findings were consistent with subarachnoid bleeding. In our patient, headache due to meningeal irritation by subarachnoid blood induced seizures as a probable reflex of extreme pain. Carbamazepine and nimodipine prophylaxis dramatically reduced the frequency of headaches and seizures.
Headaches in a Pediatric Emergency Department: Etiology, Imaging, and Treatment
Authors: Kan Li , Nagelberg Joy , Maytal Joseph
Published: March 2003

Objective.– To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint.

Methods.– A 1‐year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint.

Results.– One hundred thirty patients (0.7% of all pediatric emergency department visits, mean age = 9.3 years) were included in the study. Primary headaches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and respiratory illnesses (
n=37, 28.5%), while the majority of the secondary neurological headaches included 26 posttraumatic (20%), 15 possible ventriculoperitoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3%). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningitis). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clearly explain the headache. Approximately 10% (5/53) of the CT scans of the head that were performed showed new abnormal findings including hydrocephalus secondary to ventriculoperitoneal shunt malfunction (2), subdural hematoma (1), epidural hematoma (1), and skull fracture (1). Forty‐two patients (32%) were treated pharmacologically. Thirty‐nine of the 42 treated patients (93%) were given over‐the‐counter analgesics, and 9 (21%) were given prescribed analgesics.

Conclusions.– The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high‐risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.
Spinal Cord Infarction During Use of Zolmitriptan: A Case Report
Authors: Vijayan N. , Peacock John H.
Published: March 2003

A 50‐year‐old woman with a history of migraine without aura, predominantly occurring around her menstrual periods, developed a spinal cord lesion following the use of zolmitriptan. The partial lesion of the cord at T7 predominantly involved the spinothalamic pathways on the left side. Clinical features suggested that the lesion was an ischemic infarct, and this was confirmed by an MRI scan. There were no other known risk factors for vascular disease. There has been mild improvement of her symptoms, but most of the symptoms did not resolve. There are isolated case reports of stroke secondary to the use of triptans, however, this is the first case of spinal cord infarction reported following the use of this group of drugs. The temporal relationship suggests that the spinal cord infarction may be related to the use of zolmitriptan.
Montelukast in the Prophylaxis of Migraine: A Potential Role for Leukotriene Modifiers
Authors: Sheftell F. , Rapoport A. , Weeks R. , Walker B. , Gammerman I. , Baskin S.
Published: March 2003

Objective.–Clinical observation of a decrease in migraine frequency in patients with comorbid asthma taking montelukast, a specific D4 leukotriene receptor antagonist, or zafirlukast, another leukotriene receptor antagonist, prompted us to explore a possible role for leukotriene modifiers in the treatment of migraine. (A further prompt was a pharmacist colleague's observation that a number of patients on these agents reported a decreased sensitivity to perfume triggers and improvement in migraine.)

Background.–Nonsteroidal anti‐inflammatory agents have been used widely in the treatment of migraine. Another class of anti‐inflammatory agents, known as leukotriene modifiers, have not been studied to date with regard to their possible role in the treatment of migraine. The name “leukotriene” is derived both from the parent molecule, which was originally isolated from leukocytes, and from its three double‐bond carbon backbone or triene structure. Both prostaglandins and leukotrienes are derived from the metabolism of arachidonic acid, with prostaglandins coming off the cyclooxygenase pathway and leukotrienes derived via the enzyme 5‐lipoxygenase. Both prostaglandins and leukotrienes mediate inflammatory responses. The latter have been studied with regard to their role in the pathophysiology of asthma.

Methods.–A prospective, open‐label study evaluating the efficacy of montelukast, 10 mg or 20 mg, in the prophylaxis of migraine in 17 patients is presented in this paper. All 17 patients completed the study that consisted of a 2‐month baseline run‐in period and a 3‐month treatment phase.

Results.–Montelukast was extremely well tolerated, and no adverse events were reported by any of the patients. Fifty‐three percent showed a reduction of greater than 50% (P<.025) in the frequency of severe attacks, with 41% showing a reduction of greater than 60%. Responders, including modest responders, rated the drug as excellent.

Conclusions.–We conclude, given the limitations of an open‐label study design and the small sample size, that montelukast shows potential as an effective, well‐tolerated prophylactic agent in migraine. Double‐blinded, placebo‐controlled studies are warranted. In addition, the leukotrienes, as suggested previously in the literature, may play a role in the pathogenesis of migraine.
Use of Percutaneous Electrical Nerve Stimulation (PENS) in the Short‐term Management of Headache
Authors: Ahmed Hesham E. , White Paul F. , Craig William F. , Hamza Mohamed A. , Ghoname El‐sayed A. , Gajraj Noor M.
Published: March 2003

Objective.–To evaluate the short‐term effects of percutaneous electrical nerve stimulation (PENS) in the management of three types of chronic headache.

Background.–Traditional electroanalgesic therapies have been reported to be effective in the management of acute headache symptoms. However, no controlled studies have been performed in patients with chronic headache.

Methods.–Thirty patients with either tension headache, migraine, or posttraumatic headache symptoms of at least 6 months' duration were randomized to receive PENS (needles with electricity) or “needles alone” according to a crossover study design. All treatments were administered for 30 minutes, three times a week for 2 consecutive weeks with 1 week off between the two different treatments. For the PENS treatments, an alternating electrical stimulation frequency of 15 and 30 Hz was used. Pain, activity, and sleep scores were assessed using a 10‐cm visual analog scale, with 0 corresponding to the best and 10 to the worst, during the 48‐hour period prior to the beginning of the two treatments, immediately before and after each treatment session, and 48 hours after completing each treatment modality.

Results.–Compared with the needles alone, PENS therapy was significantly more effective in decreasing the overall VAS pain scores for tension‐type headache, migraine and posttraumatic headache (58%, 59%, and 52% versus 20%, 15%, and 20%, respectively). Similarly, PENS therapy produced greater improvement in the patients' physical activity (41% to 58% for PENS versus 11% to 21% for needles only) and quality of sleep (41% to 48% for PENS versus 12% to 20% for needles only). However, there were no differences in the pattern of the response to PENS therapy among the three headache groups.

Conclusions.–Percutaneous electrical nerve stimulation appears to be a useful complementary therapy to analgesic and antimigraine drugs for the short‐term management of headache. Interestingly, the analgesic response to PENS therapy appears to be independent of the origin of the headache symptoms.
Tolosa‐Hunt Syndrome Preceded by Facial Palsy
Authors: Tessitore Enrico , Tessitore Alessandro
Published: March 2003

The Tolosa‐Hunt syndrome consists of a painful ophthalmoplegia related to a granulomatous inflammatory process in the cavernous sinus, which may be documented by cerebral magnetic resonance imaging with gadolinium enhancement.

Two cases of Tolosa‐Hunt syndrome preceded by facial palsy observed in 1998 at the Department of Neurosurgery of the Second University of Naples are presented here. Both patients developed Tolosa‐Hunt syndrome following an ipsilateral facial palsy that resolved in about 15 days with medical treatment. Cerebral magnetic resonance imaging with gadolinium enhancement showed, in both cases, inflammatory tissue in the cavernous sinus. The patients underwent corticosteroid therapy (prednisolone, 80 mg per day, intravenously) with pain regression. In the first case, the patient experienced recurrence of the syndrome that was definitively resolved with further corticosteroid treatment.

The rare reports of facial palsy in patients with Tolosa‐Hunt syndrome suggest the inclusion of this disease in the so‐called multiple cranial nerve palsy syndrome. It is probable that Tolosa‐Hunt syndrome has an inflammatory pathogenesis.
The Misdiagnosis of Cluster Headache: A Nonclinic, Population‐Based, Internet Survey
Authors: Klapper Jack A. , Klapper Amy , Voss Tracy
Published: March 2003

Objective.—We conducted the first nonclinic, Internet‐based survey of cluster headache to investigate this population with regard to diagnostic problems encountered, effective and ineffective medications, problems obtaining medications through third‐party payers, and symptoms as they relate to International Headache Society criteria.

Background.—Previous cluster headache surveys have been at specialty centers. These patients might be different from cluster headache sufferers in the general population. An Internet‐based population of cluster headache sufferers who connected to a Web site responded to the questionnaire, and e‐mailed it back to our site to be analyzed. We analyzed a total of 789 respondents, 76% men and 28% women.

Results.—Eighty‐seven percent of respondents qualified as having cluster headache according to International Headache Society criteria. However, diagnosis was delayed an average of 6.6 years from the onset of symptoms. The average number of physicians seen before the correct diagnosis was made was 4.3, and the average number of incorrect diagnoses was 3.9. Seventy‐one percent of respondents had undergone unnecessary magnetic resonance or computed tomography scans, and 4% had unnecessary sinus or deviated septum surgery. We found that many inappropriate medications such as propranolol, amitriptyline, and antibiotics were prescribed and that successful medications for clusters such as sumatriptan and oxygen were often denied due to a failure to understand the nature of this disorder. Seventy‐seven percent of respondents were smokers. Seventy‐four percent stopped smoking in an attempt to improve their condition; however, only 3% experienced relief.

Conclusions.—The most alarming finding was the delay in diagnosing cluster headache in this population—an average of 6.6 years. The selection of medications demonstrated to be successful in the treatment of clusters proved effective for the majority of this population. Many respondents reported being denied some of these effective medications by their physicians or third‐party payers. Using International Headache Society criteria for cluster headache, 87% of the respondents should have been correctly diagnosed by the first physician seen.
Medication‐Induced (Analgesic Rebound) Headache: Historical Aspects and Initial Descriptions of the North American Experience
Authors: Capobianco David J. , Swanson Jerry W. , Dodick David W.
Published: March 2003

A review of the initial descriptions of medication‐induced (misuse) headache in the North American literature indicates that this disorder was first identified in the mid‐1950s. It was not until the early 1980s that this phenomenon became well established.
Comparison of Intravenous Valproate Versus Intramuscular Dihydroergotamine and Metoclopramide for Acute Treatment of Migraine Headache
Authors: Edwards Keith R. , Norton Judith , Behnke Michele
Published: March 2003

Objective.—To determine the effectiveness and tolerability of intravenous valproate for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with intramuscular metoclopramide 10 mg followed 10 minutes later by intramuscular dihydroergotamine 1 mg.

Background.—Divalproex sodium is approved for prophylaxis of migraine headache. We studied the possible effectiveness of intravenous sodium valproate for the treatment of acute migraine headache. Valproate offers a treatment option for patients with migraine who recently have used a triptan or dihydroergotamine, theoretically avoiding the risk of drug interactions or cardiovascular complications.

Design/Methods.—In an open‐label randomization, patients with an established diagnosis of migraine with or without aura were administered either intravenous valproate or intramuscular dihydroergotamine with metoclopramide to treat moderate‐to‐severe migraine headache of 24 to 96 hours' duration. Forty patients alternately received either 500 mg intravenous valproate or 10 mg metoclopramide intramuscularly followed by 1 mg dihydro‐ ergotamine. Patients rated severity of headache and the presence or absence of nausea, photophobia, or phonophobia at baseline, and at 1, 2, 4, and 24 hours.

Results.—With intravenous valproate, 50% of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60% reported such improvement at 2 hours, 60% at 4 hours, and 60% at 24 hours. Corresponding improvement rates for dihydroergotamine were 45% at 1 hour, 50% at 2 hours, 60% at 4 hours, and 90% at 24 hours. Intravenous valproate and intramuscular dihydroergotamine provided similar relief from associated migrainous symptoms (nausea, photophobia, and phonophobia) during the first 4 hours following treatment. While none of the patients who received intravenous valproate experienced drug‐related side effects during treatment, 15% of patients who took dihydroergotamine experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment.

Conclusions.—Intravenous valproate is similar in effectiveness to dihydroergotamine/metoclopramide as abortive therapy for prolonged moderate‐to‐severe acute migraine headache. Although the results were not statistically significant (P = .3635), intravenous valproate appears to offer a safe, effective, and well‐tolerated treatment for patients with acute migraine. Relative to dihydroergotamine/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with intravenous valproate.