bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting curable disease following hepatectomy for colorectal metastases
Authors: Metcalfe Matthew , Mann Chris , Mullin Emma , Maddern Guy
Published: June 2005

Introduction:  Although resection may be curative for patients with hepatic colorectal metastases, recurrence occurs in the majority. Recurrence is occasionally amenable to repeated resection. The aim of the present study was to evaluate which modalities, at what intervals, detected potentially curable resection.

Methods:  The records of patients undergoing hepatectomy for colorectal metastases over 10 years in one centre were retrospectively reviewed to determine when and how recurrence was diagnosed. Specific attention was paid to the detection of potentially curable disease.

Results:  Of 41 recurrences, 22 occurred in the first year postoperatively, 21 of which were suitable for palliative treatment only. Ten of 19 recurrences occurring after 1 year underwent potentially curative intervention, 10 were diagnosed by computed tomography (CT). Carcinoembryonic antigen did not diagnose any curable recurrence.

Conclusions:  A follow‐up protocol is proposed, based on annual CT.
Skin antiseptics and the risk of operating theatre fires
Authors: Spigelman Allan D. , Swan Judith R.
Published: June 2005

Background:  Following press reports of patients catching fire or receiving chemical burns in the operating theatre, a review was conducted on the flammability of skin antiseptics. The purpose of the paper was to clarify confusion regarding povidine‐iodine (Betadine), which had been reported as being flammable, and also to determine the use of alcohol‐based solutions in the Hunter Area Health Service. A risk assessment was conducted and risk reduction strategies outlined.

Methods:  Risk assessment was made following a literature review and an audit of 10 operating theatres in the Hunter Area Health Service.

Results:  Risk for operating room fires from alcohol‐based skin antiseptics was confirmed. Antiseptics in aqueous solutions only smoulder. The Hunter Health survey indicated that although alcohol‐based solutions were not used in operating theatres, they were used in anaesthetic bays for insertion of epidural and central line catheters. Strategies to reduce the risk of fire include discontinuation of use of alcohol‐based skin antiseptics in operating theatres; using fire retardant surgical drapes; installing over‐current protection devices on electrical equipment; minimizing flammable conditions by avoiding nitrous oxide and using the lowest required concentration of inspired oxygen; use of non‐flammable cuffed endotracheal tubes; education and training of operating theatre personnel in fire hazards.

Conclusions:  Operating theatre fires continue to be a major risk for patient safety. In order to reduce this risk, the strategies outlined here should be followed.
Gall bladder injuries as part of the spectrum of civilian abdominal trauma in South Africa
Authors: Zellweger René , Navsaria Pradeep H. , Hess Florian , Omoshoro‐Jones Jones , Kahn Delawir , Nicol Andrew J.
Published: June 2005

Background:  Trauma to the gall bladder is rare, but when missed or improperly managed it may be associated with significant morbidity. The aim of the present study was to review the management and outcomes of gall bladder trauma in a trauma centre.

Methods:  Forty‐three patients with gall bladder injury due to abdominal trauma were reviewed over a 3‐year period. Surgical management, associated injuries, morbidity and mortality rates were determined.

Results:  Among 1242 patients undergoing laparotomy for acute trauma, 43 patients (3.46%) with gall bladder injuries were identified. Forty patients sustained penetrating injuries (37 with gunshot wounds and three with stab wounds), and three patients suffered from blunt trauma. All patients with gall bladder injury underwent abdominal exploration because of associated intra‐abdominal injuries. Thirty‐six patients were treated with cholecystectomy, four patients underwent primary suture repair of the gall bladder perforation, while three patients with gall bladder injury were treated without any surgical intervention at laparotomy. No complications could be attributed to the gall bladder trauma or surgery.

Conclusion:  Cholecystectomy is the preferred procedure of choice for gall bladder injuries and is associated with no morbidity.
Breast cancer in young Asian women: Study on survival
Authors: Foo Chek Siang , Su David , Chong Chee Keong , Chng Hong Chee , Tay Khoon Hean , Low Sze Chuan , Tan Su Ming
Published: June 2005

Background: Breast cancer in young patients is often associated with a poorer prognosis, but there has been a paucity of published data in an Asian population.

Methods: One hundred and six patients (12.6%) under the age of 40 years with breast cancer (group V) were compared with 737 patients with breast cancer aged 40 years or more (group W). Demographics, presentations, pathological profiles, treatment and survival measures were analysed.

Results: Median tumour size was similar in both groups. Group V had more patients with grade 3 tumours and nodal involvement compared to group W (51.5% vs 38.1%,P = 0.012 and 52.5% vs 41.8%,P = 0.045). The mean Nottingham prognostic index (NPI) score was significantly higher in group V compared to group W (4.75 vs 4.26,P < 0.001). The incidences of chemotherapy and radiotherapy in group V were higher than group W (69.2% vs 35.2%,P < 0.001 and 41.1% vs 24.4%,P = 0.002). There were no differences in overall survival and disease‐free survival (local recurrence).

Conclusion: Patients below 40 years with breast cancer have tumours with a poorer prognostic profile. However, this did not translate into a poorer overall survival, and this might be attributable to more aggressive adjuvant treatment of younger patients.
Regional anaesthesia and propofol sedation for carotid endarterectomy
Authors: Barringer Christopher , Williams John M. , McCrirrick Alastair , Earnshaw Jonothan J.
Published: June 2005

Background:  Many surgeons now perform carotid endarterectomy under regional anaesthesia. The aim of the present study was to review a sedation technique using a computer‐controlled infusion of propofol.

Methods:  A consecutive series of 84 carotid endarterectomies done by a single surgeon and commenced under regional anaesthesia with sedation was studied. There were 54 men and 27 women (three bilateral procedures), with a median age of 71 years (range 48−87 years). All patients had carotid stenosis >70% 80 procedures were done for symptomatic disease and three asymptomatic patients were treated before cardiac surgery (one bilateral).

Results:  Seventy‐seven procedures were completed under regional anaesthesia and sedation alone; seven required conversion to general anaesthetic, usually for intolerance of the operation. An intraoperative shunt was required on only four occasions (5%). Postoperatively eight patients required critical care monitoring, usually for blood pressure control. The remainder were nursed on the vascular ward, and 68% were discharged home on the day after surgery. No patient died, but there were two neurological complications. One patient had a cerebellar stroke 10 days after surgery, but recovered fully after 4 months. A second developed cerebral oedema due to severe intraoperative hypertension and required intensive care for 15 days. He too recovered fully. Five patients had a further episode of transient cerebral ischaemia within 1 month of operation, but in all cases duplex imaging showed a widely patent carotid and there were no sequelae.

Conclusion:  Target controlled propofol infusion is an effective method of sedation in patients undergoing carotid endarterectomy.
NEOLITHIC ‘GREENSTONE’ AXE BLADES FROM NORTHWESTERN ITALY ACROSS EUROPE: A FIRST PETROGRAPHIC COMPARISON*
Authors: D’AMICO C.
Published: June 2005

Neolithic polished stone axe blades, manufactured with uncommon lithologies such as Alpine eclogites, jades and other HP metaophiolites, were exploited from primary and secondary occurrences in Piemonte and Liguria and dominate the north Italian and south‐east French polished stone blades used as functional tools (for deforestation and woodworking). In other European countries the same lithologies are found less frequently or only occasionally as axe blades; in north‐west Europe they were frequently used for manufacturing ceremonial axes that have shapes that are not present in the Italian Neolithic tradition. This paper undertakes a preliminary examination of the case, prevalently from a petrographic point of view, comparing the well‐established Italian petroarchaeometric knowledge with the rather poorer petrographic basis of the European eclogite/jade axes. A provisional picture of the distribution of these axes in Europe is provided and some interim interpretations and open problems are discussed.
PROVENANCE STUDY OF MARBLE ARTEFACTS FROM THE ROMAN BURIAL AREA OF FASCHENDORF (CARINTHIA, AUSTRIA)*
Authors: UNTERWURZACHER M. , POLLERES J. , MIRWALD P.
Published: June 2005

Numerous marble artefacts were among the extraordinary findings excavated at the Roman burial area of Faschendorf (Carinthia, Austria). The provenance of marble objects, particularly in the Roman provinces, is mostly unclear. Predominantly Mediterranean marbles have been used, but there are also some marble occurrences in the eastern Alpine regions that were exploited in those times. Besides a mineralogical–petrographic analysis, grain‐size evaluation in particular, and the determination of carbon and oxygen isotopes allow an effective characterization of the Faschendorf materials. Their provenance from the Gummern Marble complex in Carinthia is very likely.
COLOUR ATTRIBUTES OF MEDIEVAL WINDOW PANES: ELECTRON PARAMAGNETIC RESONANCE AND PROBE MICROANALYSES ON STAINED GLASS WINDOWS FROM PAVIA CARTHUSIAN MONASTERY*
Authors: AZZONI C. B. , MARTINO D. DI , MARCHESI V. , MESSIGA B. , RICCARDI M. P.
Published: June 2005

Stained glass windows from the Carthusian Monastery of Pavia, dating back to the 15th century, were studied by combining two analytical techniques: electron probe micro‐analysis (EPMA) and electron paramagnetic resonance (EPR). Chemical compositions and oxidation states of the transition ions, present as minor elements, were investigated by EPMA and EPR, respectively, in order to ascertain the role played by chromophorous ions in the glass coloration. The investigated glass can be defined as K–Ca glass, and the panes with red, green and blue colours were produced using flashing techniques.
THE ALPS—A BARRIER OR A PASSAGE FOR CERAMIC TRADE?*
Authors: MAGGETTI M.
Published: June 2005

The Alpsas a barrier: ceramic remnants of the so‐called Laugen‐Melaun culture (c. 11th to c. sixth centuries bc) can be found in the northern Italy (Trentino/Alto Adige)—eastern Switzerland—Liechtenstein and western Austria region. A petrographic study of 454 sherds from this area covering a time span of 500 years reveals the following. (1) The pottery from the Trentino/Alto Adige contains a predominantly volcanic temper, which can be linked to the volcanic rocks of the Bolzano area—in other words, to the core region of this culture. This material is therefore of a local/regional production. (2) These ceramics were imported from the Bolzano region to southeastern Switzerland (the Inn Valley) and the amount of imported pottery decreases markedly from the 11th century bc (approximately 70% imported) to the seventh to sixth centuries bc (approximately 10% imported). (3) No imported pottery can be detected north of the Alpine crest in Switzerland, Liechtenstein and Austria, and in this region serpentinite temper was preferred by ancient potters. These results demonstrate that long‐lasting contacts and ceramic trade existed between the populations of the Inn Valley and the Trentino/Alto Adige. Such contacts could have been motivated by intermarriages between the two populations and/or economic exchange. The potters north of the Alpine ridge adopted the Laugen‐Melaun style and produced such pottery locally. The use of serpentinite temper is puzzling and not related to any technological advantage. (Could it be recycled material? Or does it have any sociocultural specificity?)

The Alps as a passage: 59 fragments of a black gloss ware, the so‐called Campana, unearthed at 11 Late Latene sites (second to first centuries bc) in Switzerland and neighbouring Germany were analysed chemically by X‐ray fluorescence. The results revealed: (1) that all of them were produced either in Italy or Lyon and then exported to the north; (2) that two principal south–north exchange routes existed, (a) fluviatile, along the Rhône–Rhine corridor and (b) trans‐Alpine, using the Alpine passes, such as the Simplon and the Grand St Bernard.
ARCHAEOLOGICAL AMBERS FROM NORTHERN ITALY: AN FTIR–DRIFT STUDY OF PROVENANCE BY COMPARISON WITH THE GEOLOGICAL AMBER DATABASE*
Authors: ANGELINI I. , BELLINTANI P.
Published: June 2005

European geological ambers of five different localities and types, and Italian geological ambers from seven different deposits have been studied with Fourier transform infrared spectroscopy (FTIR) and diffuse‐reflectance infrared Fourier transform (DRIFT). Ambers from several localities have been characterized for the first time. The research aims to create a database of European ambers, containing both FTIR and DRIFT data. The FTIR spectra are easily comparable with the data commonly available in the literature, whereas DRIFT analyses are shown to be more useful to characterize the archaeological finds. The provenance of several archaeological ambers from northern and southern Italy, dating from the Middle Bronze Age to the Iron Age, is assessed on the basis of the developed database. Of the 35 analysed archaeological objects, all but five are composed of Baltic succinite amber.
LAND USE IN THE EASTERN ALPS DURING THE BRONZE AGE—AN ARCHAEOBOTANICAL CASE STUDY OF A HILLTOP SETTLEMENT IN THE MONTAFON (WESTERN AUSTRIA)*
Authors: SCHMIDL A. , KOFLER W. , OEGGL‐WAHLMÜLLER N. , OEGGL K.
Published: June 2005

Investigations of the oldest prehistoric settlement in the western Austrian county of the Vorarlberg reveal a deeper insight into the colonization of the Alps. The human presence is recorded from the Late Neolithic (c. 3000 cal. bc) onwards, reflecting farming and possible mining activities. Three distinct settlement phases are recognized palynologically: (1) in the Early and Middle Bronze Ages (c. 1700 cal. bc), (2) during the Iron Age (c. 500 cal. bc) and (3) at the beginning of the medieval era (c. cal. ad 800). In addition plant macrofossil analyses of soil samples from the archaeological excavation of the Bronze Age settlement of Friaga indicate a complex subsistence strategy of the Middle Bronze Age settlers, whereby cereals and pulses reveal a balanced diet.
ORGANIC RESOURCES AT THE IRON AGE DÜRRNBERG SALT‐MINE (HALLEIN, AUSTRIA)—LONG‐DISTANCE TRADE OR LOCAL SOURCES?*
Authors: BOENKE N.
Published: June 2005

Remarkable preservation circumstances for organic material at the Iron Age salt‐mine on the Dürrnberg Mountain offered the opportunity to analyse a large amount of wood and human faeces. One aim of the studies was to discover the origin of the important resources food and wood. Concerning the question of ‘the linking role of the Alps in past cultures’, the archaeobotanical record proves intracultural but no intercultural connections at this place in Celtic times. The preliminary results show that the Dürrnberg population used differentiated strategies to manage a continuous food and wood supply. While the wood supply was based on the management of local sources, the food supply had to be linked into a regional and long‐distance trade system.
Out with ‘Rainbow Government’ and in with ‘Iraqgate’: The Finnish General Election of 2003
Authors: Downs William M. , Riutta Satu
Published: June 2005

Finland's March 2003 general election saw Anneli Jäätteenmäki lead her opposition Centre Party to a narrow victory over Prime Minister Paavo Lipponen's Social Democrat-led ‘rainbow government’. A generally lacklustre campaign, highlighted by concerns over unemployment, Finland's place in Europe and uncomfortable foreign policy decisions, is notable for making Jäätteenmäki Finland's first female prime minister and for making the country the first in the EU to have women as both prime minister and president. These distinctions proved fleeting, as scandal –‘Iraqgate’– drove Jäätteenmäki from office after only two months. Scandal aside, the election demonstrates the difficulties for still-new EU members of juggling domestic economic concerns with European and broader international commitments.
Platelet Antagonists in Migraine Prophylaxis A Clinical Trial Using Aspirin and Dipyridamole
Authors: Masel Brent E. , Chesson Andrew L. , Peters Bruce H. , Levin Harvey S. , Alperin Jack B.
Published: June 2005

SYNOPSIS

The platelet hyperaggregability of the migraine population has lead us to postulate that platelet antagonists might be effective in migraine prophylaxis.

A double‐blind cross‐over study of aspirin, 325 mg BID, combined with dipyridamole, 25 mg TID, compared to placebo and pretreatment conditions was undertaken. Platelet aggregation studies were done during the three month active medication and placebo periods.

In patients with platelet hyperaggregability significant improvement occurred in headache frequency, intensity, and limitation of activity with no change in headache duration. Regardless of platelet aggregability, the 25 patients comprising the total sample significantly improved as compared to placebo. Sixty‐eight percent of the patients tested reported subjective improvement while taking the active medication. No side effects related to the medication were reported and no patients, including those who withdrew from the study for other reasons, reported worsening of headache while on the active medication.

Although the significance of platelet hyperaggregability in migraine patients, and the pharmacological effect of aspirin and dipyridamole on this, is unclear, these medications may have potential as a method of migraine prophylaxis.
Biofeedback Control of Skin Temperature and Cerebral Blood Flow in Migraine
Authors: Mathew Roy J. , Largen John W. , Dobbins Ken , Meyer John S. , Sakai Fumihiko , Claghorn James L.
Published: June 2005

SYNOPSIS

Theoretical mechanisms offered to account for the therapeutic gains observed in migraine patients trained in hand warming via biofeedback techniques have been inconsonant and lack a sufficient data base. The effects of directional skin temperature self‐regulation upon regional cerebral blood flow (rCBF) were measured in two groups of migraine patients trained either to increase or decrease hand temperature. Following training, serial measurements of rCBF by 133Xe inhalation were made during a steady‐state condition and another during skin temperature self‐regulation. Both mean hemispheric and regional CBF changes occurred during volitional alteration in skin temperature. Changes tended to differ in direction and/or magnitude, depending upon whether the hands were warmed or cooled. The hypothesis was supported that skin temperature control contributes to rCBF changes which may be responsible for the reduction of migraine symptoms. Comparison of rCBF changes measured in migraineurs and normal volunteers suggested that cerebral vasomotor reactivity was increased in migraineurs.
Reliability and Concurrent Validity of Headache Questionnaire Data
Authors: Andrasik Frank , Holroyd K. A.
Published: June 2005

SYNOPSIS

Psychometric properties of a brief headache questionnaire were evaluated in three samples of headache sufferers awaiting treatment. Although the test‐retest reliability of the headache questionnaire was substantial over a two‐week period, on several headache indices mean symptom levels were significantly different at the two administrations. Furthermore, when questionnaire reports were compared with daily headache recordings there was minimal correspondence between these two assessment methods. Although questionnaire methods of assessing headache symptoms appear reliable these findings suggest questionnaires may lack concurrent validity. It is suggested that headache questionnaires be supplemented with daily headache recordings whenever possible.
A Computer‐Based Headache Interview: Acceptance by Patients and Physicians
Authors: Bana D. S. , Leviton A. , Swidler C. , Slack W. , Graham J. R.
Published: June 2005

SYNOPSIS

Forty patients who presented to the Headache Research Foundation in Boston during the winter of 1978/1979 completed an interview, in dialogue with a computer, and then evaluated the program. Ninety‐five percent of the patients thought that the computer interview was easy to use, and 55 percent thought that the computer had obtained a complete history of their headaches. After the computer interview, a summary was printed for physician use, and patients were then seen by one of seven headache clinicians, who subsequently evaluated the computer summary. In 55 percent of encounters, the summary was considered useful.
The Syndrome of Aphasia, Headaches, and Left Temporal Spikes
Authors: Riley Terrence L. , Massey E. Wayne
Published: June 2005

SYNOPSIS

The value of the EEG for evaluation of patients with headache, and the interrelationship of migraine and epilepsy remain unsettled issues. Three patients with the syndrome of aphasia, headache, and left temporal spikes, all of whom were successfully treated with phenytoin, suggest a common pathophysiology. Since the symptoms in these patients lack some of the cardinal features of migraine, and yet fulfill definitions of epileptic disturbance, it is probably worthwhile to recognize this syndrome as an epileptic disturbance which appears responsive to phenytoin. These three cases also serve to emphasize the remaining value of the EEG as a diagnostic tool even in the age of radioisotope and computerized tomography scanners.
Naproxen in the Prevention of Migraine Attacks. A Double‐blind Placebo‐controlled Cross‐over Study
Authors: Lindegaard Karl‐Fredrik , Övrelid Lars , Sjaastad Ottar
Published: June 2005

SYNOPSIS

The efficacy of naproxen, a potent prostaglandin synthetase inhibitor, in migraine prophylaxis was assessed in a double‐blind placebo‐controlled cross‐over study in 28 migraine patients. After a drug‐free interval of at least 2 months, placebo and naproxen were given for 6 weeks each, with an interposed placebo week in between the two treatment periods. The dose of naproxen was 250 mg b.i.d. Naproxen seems to exert a moderate, but significant beneficial effect, with regard to headache days as well as headache indices. In a direct comparison, a significant number of patients preferred naproxen to placebo. Side effects were negligible. A systematic search for substances with antimigrainous properties should be made among the nonsteroidal, anti‐inflammatory group substances.
C‐1 Inhibitor Levels in Migraineurs and Normals
Authors: Sovak M. , Kunzel M. , Dalessio D.J. , Lang J.H.
Published: June 2005

SYNOPSIS

Recent evidence has indicated activation of the serum complement system in some migraine sufferers. Using a new accurate method for the determination of C‐1 inhibitor in serum, we found an average of 17.33 mgdl (S.D. = 1.82) in 23 normal females. In 23 female migraineurs, the C‐1 average value was 17.87 mgdl (S.D. = 2.66). The value in 4 normal males was 18.82 mgdl (S.D. = 2.16) and in 4 male migraineurs 18.34 mgdl (S.D. = 3.36). No correlation of C‐1 inhibitor concentration with the type or severity of migraine was identified.
Comprehensive Biofeedback Versus Self‐Monitored Relaxation in the Treatment of Tension Headache
Authors: Steger Jeffrey C. , Harper Robert G.
Published: June 2005

SYNOPSIS

Muscle contraction headaches have been demonstrated to significantly decrease following EMG biofeedback as well as general relaxation practice. This study contrasted the efficacy of a comprehensive biofeedback and stress management strategy and a self‐monitored home relaxation program in the treatment of 20 tension headache sufferers. The results suggested that while both treatment strategies successfully increased patients' ability to relax and reduce frontalis EMG levels, only the comprehensive biofeedback program was successful in reducing reports of headache pain and feelings of psychological distress. The findings support the utility of a headache treatment model beginning with simple relaxation and progressing on a case by case basis to more comprehensive tension and stress management strategies (like EMG biofeedback and cognitive stress coping techniques) only when the less costly relaxation proves ineffective in altering subjective feelings of pain or distress.
Migraine in Patients Attending a Migraine Clinic: An Analysis by Computer of Age, Sex and Family History
Authors: Steiner T.J. , Guha P. , Capildeo Rudy , Rose F. Clifford
Published: June 2005

SYNOPSIS

A survey is in progress of patients attending the Charing Cross Hospital Migraine Clinic in London. Information collected is stored for retrieval and analysis by computer. This paper reports some initial findings from patients seen during the first 212 years since the clinic opened.

Patients registering with such a specialized clinic are not representative of the migraine population at large.

Migraine sufferers present to the clinic at all ages from 6 to 70, but in three peaks, at 21–30, 41–45 and 51–55 years. Although onset of migraine tends to be earlier in males than in females, the latter are more likely to present during the first of these peaks.

Migraine in younger clinic patients is predominantly classical in type. This predominance declines with increasing age at onset and may reverse when onset is delayed beyond 40.

An inverse correlation exists in both sexes between age at onset of classical or common migraine and strength of family history. Females have a strong family history more commonly than males, except in those with onset in childhood. The mother is the more frequently affected parent, but involvement of the father may be associated more closely with early onset.

Therefore, although migraine appears predominantly to be a disease of females with a female parental history, in clinic patients with early onset there is a relative preponderance of males and of male parental history.
Correlation of Headache Complaints With Some Physiological Parameters in a Healthy Population
Authors: Korczyn A.D. , Carel R.S. , Pereg I.
Published: June 2005

SYNOPSIS

In a generally healthy population, 75.8% complained of headache. Based on answers to a questionnaire, 18.9% were defined as suffering from migraine and 8.8% from tension headache. The prevalence of headache was more common among females and this was mainly due to the fact that migraine was more common in this sex. Abnormal visual acuity, abnormal (high or low) blood pressure, increased intraocular pressure, polycythemia and anemia occurred in the same frequencies in the headache and non headache groups (and in various subgroups). It is concluded that abnormalties in these physiological parameters cannot be a common cause of headache.
Review Article: Current Thoughts on Migraine
Authors: Diamond Seymour , Medina Jose L.
Published: June 2005

SYNOPSIS

Current theories of migraine etiology and migraine mechanisms are reviewed. A complete discussion of general therapeutic measures, abortive, and prophylactic treatments, their indications and proper selection of patients is presented.
Ocular Migraine in a Patient with Cluster Headaches
Authors: Kline Lanning B. , Kelly Christopher L.
Published: June 2005

SYNOPSIS

A 48‐year‐old man, with a long standing history of cluster headaches, developed repeated transient episodes of monocular visual reduction lasting one to two minutes. These attacks were documented with fundus photography, fluorescein angiography, and pattern‐reversal visual evoked responses. Results of these tests included narrowing of the retinal veins, delay in the appearance of fluorescein dye in branches of the central retinal artery yet prompt filling of two cilioretinal vessels, and abolition of the visual evoked response. Hematological and cardiac investigations were normal and no clinically significant abnormalities were found on carotid angiography. Diagnosed as having ocular migraine, the patient was placed on propranolol with prompt cessation of his visual symptoms.
Dichotomous vs. Interval Rating of Headache Symptomatology: An Investigation in the Reliability of Headache Assessment
Authors: Thompson J. Kevin , Figueroa Jorge Luis
Published: June 2005

SYNOPSIS

The present study compared reported frequencies of headache symptoms assessed by dichotomous and interval rating scales. Reliability estimates, measured by per cent agreement, were obtained between the two scales for 26 common symptoms. Ninety‐eight undergraduate students and 25 chronic headache patients completed the symptom checklist using both rating procedures. Results suggested very low agreement between scales. In addition, a curvilinear relationship was discovered between per cent agreement and subjects' ratings of degree of headache problem. Severe and non‐problem headache groups were more reliable across scales than slight or moderate headache sufferers. Data also suggested wide variability in reliabilities for specific symptoms although symptom classes (vascular, autonomic, musculoskeletal) were similar in per cent agreement with a slight tendency for autonomic symptoms to be more reliable. Migraine patients were more reliable than chronic muscle contraction (CMC) individuals and these differences were consistent across symptom classes. Overall, the data support the hypothesis that an interval scale is a more sensitive index of headache symptomatology characteristics than dichotomous ratings. Results are discussed with regard to the role of reliability in questionnaire research and its facilitative effect in reducing error variance across headache investigations.
Conversion Headache
Authors: Packard Russell C.
Published: June 2005

SYNOPSIS

The literature pertaining to conversion headache is briefly reviewed and problems with definition are discussed. There is often confusion about the concept of “psychogenic” headache and whether or not there are underlying local physiological changes present in cases of conversion headache. For the purposes of this paper conversion headache is defined as a headache in which the prevailing clinical disorder is a conversion reaction and a peripheral pain mechanism is not present. A case will be described to provide a clinical description of the disorder and to demonstrate some of the features that can be helpful in establishing the diagnosis. Discussion considers factors important in the pathogenesis and diagnosis of conversion headache, such as the significance of symbolization, secondary gain, and other features associated with the conversion reaction.
Headache Medication Habits in Northern Finland
Authors: Nikiforow Rita
Published: June 2005

SYNOPSIS

In a survey conducted by questionnaire of an urban and a rural area in Northern Finland the respondents were asked about their headache medication habits. Of the 2018 persons who had suffered from headache during the year previous to the survey, 400 (20%) had managed entirely without medicine and 548 (27%) with less than 10 tablets a year, these including some suffering from frequent severe headaches. Only 4% took 10 tablets a week or more. The men and women took almost equal amounts of medicine, the rural women taking more than their urban counterparts. The use of medication for headache increased with age, was more abundant in those with exhaustion or depressive traits, and was possibly influenced by education. Less than half of those who had migraine diagnosed acquired an ergotamine prescription, and only 4 persons, all women, took more than 10 mg of ergotamine a week.
Post Traumatic Headache Caused by Hematoma of the Corpus Callosum
Authors: Rapoport Alan M. , Falvey Catherine F.
Published: June 2005

SYNOPSIS

A patient with a hematoma of the corpus callosum producing transient memory, speech and motor defecits as well as post traumatic type 1 headaches is presented. This is the first known demonstration of a resolving hematoma of the corpus callosum by CT scan and the first case report of a post traumatic headache caused by hematoma of the corpus callosum.
The Effect of Ergotamine on Prostaglandin Formation in Guinea Pig‘s Ear Slices
Authors: Zijlstra Frederik J. , Spierings Egilius L.H. , Vincent J. Eric
Published: June 2005

SYNOPSIS

We have studied the effect of ergotamine tartrate (10−7 and 10−5 M) on prostaglandin (PG) formation in guinea pig's ear slices because of the suggested role of PGs in the pathophysiology of the migraine attack. The ear slices were incubated with arachidonic acid (AA) and the amount of different PGs (6‐keto‐F1a, F2a, E2, D2 and A2) in the incubation medium was determined. The results indicate that ergotamine is an inhibitor of PG synthesis and that it probably affects either the phospholipase A2 or the cyclo‐oxygenase activity.
“Benign Recurrent Vertigo” and Its Connection with Migraine
Authors: Moretti G. , Manzoni G.C. , Caffarra P. , Parma M.
Published: June 2005

SYNOPSIS

Slater recently described a vertiginous episodic syndrome almost constantly associated with migraine and proposed giving this syndrome the name of “Benign recurrent vertigo”. Five additional cases with the same clinical features are reported, confirming that: (a) this syndrome is clearly distinguishable from other previously described paroxysmal vestibulopathies, its most significant characteristics having a very high prevalence in women, recurrence of attacks, time correlation with menstrual phases, absence of cochlear and neurologic abnormalities; (b) association with either headache episodes or family history of migraine is almost constant, although there is no time relationship between vertigo and migraine attacks. We conclude that this syndrome appears, in descriptive terms and apart from its etiopathogenetic nature, as a distinct clinical entity and deserves to be further researched in its own right and also for its relationship with migraine.
A Bedside Test for Determining the Sub‐types of Vascular Headache
Authors: Louis Sydney
Published: June 2005

SYNOPSIS

A simple bedside test is described using the Valsalva maneuver and superficial temporal artery compression which permits discrimination of extracranial vascular dilatation headache from intracranial vascular dilatation headache. The test is useful as an aid in determining the type of headache in an acute situation. It may also have a useful role in determining ergot responsiveness.
Mechanism of the Biofeedback Therapy of Migraine: Volitional Manipulation of the Psychophysiological Background
Authors: Sovak M. , Kunzel M. , Sternbach R.A. , Dalessio D.J.
Published: June 2005

SYNOPSIS

Twenty‐nine female migraineurs were assigned to biofeedback and 20 to drug therapy. The average personality profile of the two groups showed neuroticism, with scores on scales 1, 2 and 3 statistically equal between the two groups. Following the therapy, neuroticism significantly improved in the clinically improved biofeedback group, but remained unchanged in clinically unimproved biofeedback and medication, as well as medication improved groups. Neuroticism thus seems to be an integral part of migraine etiology rather than a result of chronic pain. Therefore, volitional alteration of the psychophysiological background of migraineurs by biofeedback as a causative therapy should be preferred to the drugs whenever possible.
Prophylaxis of Migraine and Mixed Headache. A Randomized Controlled Study
Authors: Mathew Ninan T.
Published: June 2005

SYNOPSIS

The three most commonly used modalities in the prophylactic treatment of headache, namely propranolol, amitriptyline and biofeedback training, were compared individually and in combination. Three hundred forty patients with migraine end 375 patients with mixed headache were randomly allotted to 8 therapeutic categories. The total duration of the study was 312 years and the therapeutic groups were evaluated for a period of 7 months including I month of pretreatment observation. Improvement was assessed by percentage of change in the average headache index during the last three months of evaluation from the pretreatment headache index. In the migraine group 273 patients completed the study. Improvement was significantly higher in patients receiving prophylactic treatment compared to control patients who were on abortive Ergotamine treatment. Propranolol plus biofeedback yielded the best results in the migraine group and addition of amitriptyline did not significantly change the percentage of improvement. Propranolol alone (62%) was significantly superior to amitriptyline (42%) (p < 0.01). The differences between propranolol alone and propranolol plus amitriptyline was not statistically significant.

In the mixed headache group 281 patients completed the study. The most effective treatment was combination of amitriptyline, propranolol and biofeedback training. Amitriptyline alone was superior to propranolol alone in the treatment of mixed headache (p<0.01). A combination of propranolol and amitriptyline was superior to either of those alone. Biofeedback, though by itself, did not appear to be the treatment of choice, significantly contributed to better results as an adjunct when it is combined with pharmacological agents. Concomitant use of propranolol and amitriptyline did not result in any adverse reactions or clinical incompatibility.
Pupillary Dysautonomia and Migraine: Is Adie's Pupil Caused by Migraine?
Authors: Massey E. Wayne
Published: June 2005

SYNOPSIS

Adie's pupil and migraine occur in the same population. Migraine is an extremely common disease and Adies is not rare. Among 22 patients presenting with Adie's pupillotonia, eight patients had a migraine history and nine had a family history of migraine. Therefore, if a history is meticulously undertaken in patients with Adie's Syndrome, the history of migraine in the patient or in his family may be found. Since Adie's Syndrome is a dysfunction of the autonomic nervous system, as is the migraine syndrome, these entities may be related.
The Temporomandibular Joint Pain‐dysfunction Syndrome: A Frequent Cause of Headache
Authors: Reik Louis , Hale Mahlon
Published: June 2005

SYNOPSIS

One hundred consecutive headache clinic patients were evaluated prospectively for features of the temporomandibular joint (TMJ) pain‐dysfunction syndrome. The syndrome was identified in 14, mainly young women, who differed significantly in physical findings and headache associated symptoms from those with tension or vascular headache, but not in the frequency of anxiety‐relieving chronic oral habits usually said to be causal. They resembled tension headache patients in their high incidence of associated depression, and most improved following treatment with physical therapy and tricyclic antidepressants. Radiologic joint abnormalities were uncommon. The TMJ pain‐dysfunction syndrome appears to be a frequent, easily diagnosed, and easily treated, but usually unappreciated cause of headache distinct from other headache entities.
MMPI Profiles of Headache Patients Using Self‐regulation to Control Headache Activity
Authors: Werder Dolores Soto , Sargent Joseph D. , Coyne Lolafaye
Published: June 2005

SYNOPSIS

The MMPI was administered to 51 persons with headache complaints (tension, migraine, or both) at their initial visit to the Menninger Foundation Headache Treatment Center. Three months after self‐regulation training was concluded each S was rated as to their ability to use the non‐drug technique to control headaches effectively. Success was determined by reduction of headache activity by 51% or more. There were 32 Successful Ss and 19 Unsuccessful Ss. Characteristics of both groups were very similar except for age, with the Unsuccessful group having significantly older Ss. Further investigation also indicated that number of headache days per month was significantly more for Unsuccessful Ss.

A multivariate analysis, with age as covariate, was done to compare differences between the 12 MMPI clinical scale means. Peak scores were found on Scales 1 (HS) and 3 (HY) for the Unsuccessful Ss with lower scores on Scale 2 (D) indicating the typical “Conversion V” profile. Peak score for the Successful Ss was on Scale 2 (D), and they scored significantly higher than the Unsuccessful Ss on Scale 0 (SI). Similar findings were observed for females only in both groups.

It was suggested that Successful Ss had increased depression with less somatization than Unsuccessful Ss and were, therefore, more acutely aware of their internal discomfort. This resulted in increased motivation to seek change, and willingness to give up medication. Another indicator of their internal focus was the higher scores on introversion which may contribute to success in using self‐regulation techniques.
Empty Sella Headache
Authors: Moretti Giacomo , Manzoni Gian Camillo , Mainini Paolo , Pasetti Stefano , Parma Mario
Published: June 2005

SYNOPSIS

Headache was studied in a series of empty sella cases and the findings were compared with previous observations. Headache appeared to be very frequently associated with empty sella and its clinical features appeared distinguishable from migraine and tension headache, but very similar to pituitary chromophobe adenoma headache. Such an association seems to be in most cases pathogenetically significant and empty sella headache should therefore be included among the “secondary” headaches to be considered in the current diagnosis.
Superior Laryngeal Neuralgia: Carotidynia or Just Another Pain in the Neck?
Authors: O‘Neill Brian P. , Aronson Amold E. , Pearson Bruce W. , Nauss Lee A.
Published: June 2005

SYNOPSIS

A clinical pain syndrome similar to "carotidynia" developed in a patient several years after undergoing carotid endarterectomy. The pain was reversed by superior laryngeal nerve block, followed by superior larnygeal neurectomy. A diagnosis of superior laryngeal neuralgia was suggested by several characteristic features: (1) pain along the anterior cervical triangle, with extension to the ipsilateral ear and eye, (2) hoarseness, and (3) paralysis of the ipsilateral cricothyroid muscle on laryngoscopy. Carotidynia usually refers to neck pain arising from the carotid artery in the neck and is often viewed as a migraine variant. Our observations suggest that carotidynia may not be a migraine variant and that "carotidynia" may not be an accurate term for all pains in the anterior cervical triangle. We suggest that evaluation of neck pain include speech pathology and otolaryngologic consultations (including laryngoscopy) if any voice disorder is reported or noted. Since the superior laryngeal nerve is the neural structure most contiguous to the bifurcation of the carotid artery, the superior laryngeal nerve may have become entrapped in a fibrotic process that developed after carotid endarterectomy. Such pain may be a rare complication of carotid endarterectomy. When other causes have been excluded and pain continues, a superior laryngeal nerve block should be considered.
Ergotamine vs. Metoclopramide vs. Their Combination in Acute Migraine Attacks
Authors: Hakkarainen Heikki , Allonen Hannu
Published: June 2005

SYNOPSIS

The effect of ergotamine tartrate was compared with that of the antiemetic agent metoclopramide and with those of two combinations in a double‐blind trial of 24 adult female patients with migraine. The following combinations of the drugs were used in oral administration in a total of 176 acute migraine attacks: (a) Ergotamine 1 mg, (b) Metoclopramide 20 mg, (c) Ergotamine 1 mg + metoclopramide 20 mg, (d) Ergotamine 2 mg + metoclopramide 20 mg. The duration of attacks was significantly shorter on both of the combinations compared with the single drugs. The intensity of the pain was somewhat weaker and the appearance of nausea and vomiting somewhat but not significantly less during the combination treatments. In their overall opinion the patients favored the 2 mg + 20 mg combination significantly more than the others. Both ergotamine and metoclopramide are efficient in acute migraine attacks. Their combination seems to enhance the therapeutic response in some respects.
Systemic Arterial Pressure and Heart Rate Changes During Migraine and Cluster Headaches: Preliminary Study
Authors: Cirignotta F. , Sacquegna T. , D‘Alessandro R. , Baldrati A. , De Carolis P. , Coccagna G. , Lugaresi E.
Published: June 2005

SYNOPSIS

In a case of common migraine and in two cases of cluster headache we monitored the arterial pressure and the heart rate by means of polygraphic recordings before, during and after headache attacks.During migraine attacks the arterial pressure did not show significant changes; the heart rate increased. During cluster attacks the arterial pressure increased with frequent hypertensive peaks; the heart rate on average slowed down and showed marked irregularities.
Prostaglandin Inhibition and Cerebrovascular Control in Patients with Headache
Authors: Amano Takahiro , Meyer John S.
Published: June 2005

SYNOPSIS

Effects of aspirin and indomethacin on cerebral blood flow (CBF) and cerebral vasomotor responsiveness (VMR) to 5% CO2 and 100% O2 inhalation were compared in patients with vascular and non‐vascular headaches. Indomethacin was 60 times as potent as aspirin in inhibiting cerebrovascular prostacyclin (PGI2) synthesis in humans, as judged by CBF and VMR effects. 972 mgs of aspirin, a dose known to inhibit thromboxane synthesis and platelet aggregation had minimal effects on CBF (−3.8%), attributed to partial PGI2 inhibition, since there was no effect on VMR to 5% CO2. Indomethacin (25–50 mgs) reduced CBF (−17.8%), VMR to 5% CO2 (−72%) and VMR to 100% O2 (−75%). PGI2 plays an important role in cerebrovascular control of human subjects. Inhibition of PGI2 synthesis by indomethacin relieves cluster‐type headaches more consistently than other headaches. Evidence is offered that 100% O2 inhalation causes cerebral vasoconstriction by inhibiting cerebrovascular PGI2 synthesis, thereby benefitting cluster headaches. Migraineurs appear to have excessive PGI2 synthesis. Patients with hemicephalalgia show asymmetric hemispheric responses to indomethacin, ascribed to asymmetric neurogenic influences on PGI2 synthesis.
Pheochromocytoma: Paroxysmal Hypertensive Headaches
Authors: Bridgwater Gary R. , Starling James R.
Published: June 2005

SYNOPSIS

A thirty‐year‐old female reported episodic vascular headaches for one year. On physical examination during a headache her average systolic and diastolic blood pressure rose 33 mm Hg and 18 mm Hg respectively. Her headaches ceased after removal of a 100 g left intra‐adrenal tumor located by abdominal CAT scan. Details of the patient's diagnosis and the general evaluation of headache patients for pheochromocytoma are discussed.
Prolonged Benign Exertional Headache: Its Clinical Characteristics and Response to Indomethacin
Authors: Diamond Seymour
Published: June 2005

ABSTRACT

Fifteen patients with prolonged benign exertional headaches are described. The headaches were mostly bilateral (nine), throbbing (eight), occurring during exertion and lasting an average of four hours. Their ages at the onset of the headache varied from eight to fifty‐four. In all of them, Neurological examination, neurological tests, including (CAT) computerized axial tomography, were normal. Indocin (indomethacin) completely or almost completely controlled the exertional headaches in thirteen out of fifteen patients (86%) in a period of one to four weeks. This improvement was maintained as long as the patients were taking Indocin. The entire follow‐up period ranged from three to eighteen months.