bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostaglandin Synthesis Inhibitor Affects Humoral Conditions and Oxygen Metabolism During Normothermic Cardiopulmonary Bypass
Authors: Takewa Yoshiaki , Taenaka Yoshiyuki , Tatsumi Eisuke , Sato Koichi , Ohnishi Hiroyuki , Oshikawa Mitsuo , Nishinaka Tomohiro , Takano Hisateru
Published: March 2003

Abstract: We have reported that infusion of prostaglandin synthesis inhibitor (PGSI) reduced the severity of hypotension during normothermic cardiopulmonary bypass (CPB). In the present study, we investigated the effects of PGSI on humoral conditions and whole body oxygen metabolism during normothermic CPB conducted for 60 min in 8 adult goats. The PGSI group (n = 4) was administered 100 to 150 mg of flurbiprofen, a potent PGSI, before and during CPB, and the control group (n = 4) was administered noradrenaline (NA) to restore hypotension. The prostaglandin E2 (PGE2) and NA concentrations in the PGSI group were significantly lower than those of the control group (PGE2 8.8 ± 1.0 versus 30.3 ± 11.5 pg/ml, NA 431 ± 197 versus 3847 ± 2,153 pg/ml). The adrenaline concentration was not significantly different between the groups. The oxygen consumption and the oxygen extraction rate were not significantly different between the groups, but the blood lactate level in the PGSI group was lower than that of the control group (34.3 ± 7.6 versus 43.7 ± 3.8 mg/dl). In conclusion, PGSI improves humoral disorder and thus prevents inadequate tissue oxygen delivery.
Second‐Generation Microstimulator
Authors: Arcos Isabel , Davis R. , Fey K. , Mishler D. , Sanderson D. , Tanacs C. , Vogel M.J. , Wolf R. , Zilberman Y. , Schulman J.
Published: March 2003

Abstract: The first‐generation injectable microstimulator was glass encased with an external tantalum capacitor electrode. This second‐generation device uses a hermetically sealed ceramic case with platinum electrodes. Zener diodes protect the electronics from defibrillation shocks and from electrostatic discharge. The capacitor is sealed inside the case so that it cannot be inadvertently damaged by surgical instruments. This microstimulator, referred to as BION, is the main component of a 255‐channel wireless stimulating system. BION devices have been implanted in rats for periods of up to 5 months. Results show benign tissue reactions resulting in identical encapsulation around BION and controls. Stimulation threshold levels did not change significantly over time and ranged between 0.81 to 1.35 mA for all the animals at a 60 μs pulse width. All of the tests performed to date indicate that the BION is safe and effective for long‐term human implant. We have elected to develop BION applications by seeking collaboration with the research community through our BION Technology Partnership.
The Hemodynamic Function of Intrathoracic Skeletal Muscle Ventricles After Recovery from Surgery in Pigs
Authors: Capoccia Massimo , Sutherland Hazel , Salmons Stanley , Jarvis Jonathan C.
Published: March 2003

Abstract: The shortage of donor organs for heart transplantation highlights the need for new approaches to end‐stage heart failure. A promising experimental technique is the use of pumping chambers formed from the latissimus dorsi muscle. We formed such skeletal muscle ventricles (SMVs) and connected them to the descending thoracic aorta in a single surgical procedure in pigs. Activation of conditioned SMVs from the end of systole for 80% of diastole increased mean aortic diastolic blood pressure by 11.2 ± 1.6% in 1 animal and by 15.8 ± 0.3% in another. The left‐ventricular stroke work in the postassisted beat was decreased by 8.7 ± 5.8% and 10.1 ± 2.2% and the overall stroke work by 7.4 ± 1.2% and 9.4 ± 0.8%. The key to forming and connecting the SMV in a single procedure was the use of a composite homograft lining. In future clinical practice, this component could be replaced by a synthetic composite or by a tissue lining produced in vitro.
Clinical Elements for the Neuromuscular Stimulation and Functional Electrical Stimulation Protocols in the Practice of Neurorehabilitation
Authors: Dimitrijevic Meta M. , Dimitrijevic Milan R.
Published: March 2003

Abstract: The physicians and their multidisciplinary teams involved in the clinical practice of neurological rehabilitation have more and more opportunities to apply neuromuscular stimulation (NMS) and functional electrical stimulation (FES) of peripheral nerves as a part of their daily practice. In this article, we outline clinical protocols of NMS and FES in the following clinical conditions of upper motor neuron dysfunction: to prevent consequences of disuse of the neuromuscular system of the upper motor neuron, to facilitate recovery processes of impaired upper motor neuron functions due to acute and/or subacute neurological conditions, to maintain or enhance the trophic state of the muscle, to modify altered control of muscle tone, to modify altered patterns of automatic and volitional functional movements, to enhance functional movement of the single joint muscle group within intact functional multijoint movement, and to modify altered neurocontrol of posture, locomotion, and skillful movements. We emphasize the importance of understanding the motor control alteration while developing clinical protocols and defining the goals. It is very important to be aware that similar clinical findings and due to the same cause can have different features of residual motor control, and therefore potentials for recovery or modification can be very different.
A Pilot Study to Investigate the Combined Use of Botulinum Neurotoxin Type A and Functional Electrical Stimulation, with Physiotherapy, in the Treatment of Spastic Dropped Foot in Subacute Stroke
Authors: Johnson Catherine A. , Wood Duncan E. , Swain Ian D. , Tromans Anthony M. , Strike Paul , Burridge Jane H.
Published: March 2003

Abstract: The objective was to inform sample size calculations for a full randomized controlled trial (RCT). The design included an RCT pilot trial with a 16 week study period, including a 4 week baseline phase. The subjects were adults within 1 year of first stroke, ambulant with a spastic dropped foot. Twenty‐one participants were recruited from the stroke services of 4 centers. For intervention all participants received physiotherapy; the treatment group also received botulinum neurotoxin Type A (BoNTA) intramuscular injections to triceps surae (800 U Dysport) and functional electrical stimulation (FES) of the common peroneal nerve to assist walking. The main outcome measure was walking speed. The result was a significant upward trend in median walking speed for both the control (p = 0.02) and treatment groups (nonstimulated p = 0.004, stimulated p = 0.042). Trend lines were different in location (p = 0.04 and p = 0.009, respectively). In conclusion, there is evidence of an additional, beneficial effect of BoNTA and FES. Sufficient information has been gained on the variability of the primary outcome measure to inform sample size calculations for a full RCT to quantify the treatment effect with precision.
Single‐Center Experience with the Bicarbon Bileaflet Prosthetic Heart Valve in Japan
Authors: Misawa Yoshio , Saito Tsutomu , Konishi Hiroaki , Oki Shin‐ichi , Kaminishi Yuichiro , Tezuka Yasuhiro , Aizawa Kei , Takahashi Hideki , Hasegawa Nobuyuki , Kamisawa Osamu , Kato Morito , Fuse Katsuo
Published: March 2003

Abstract: We analyzed midterm results using the Bicarbon valve in a single center. Forty‐four patients had aortic valve replacement (AVR), 48 had mitral valve replacement (MVR), and 13 had both aortic and mitral valve replacement (DVR). The mean age of the 105 patients was 61.2 ± 11.3 years. The mean follow‐up was 1.8 ± 1.1 years with a cumulative follow‐up of 188 patient‐years. There were 5 early deaths (4.7%: 4 in the AVR group and 1 in the MVR group) and 5 late deaths (2.7% per patient‐year: 3 malignancy, 1 cerebral hemorrhage, 1 myocardial infarction). Survival at 3 years was 91 ± 4% in the AVR group, 92 ± 5% in the MVR group, and 66 ± 23% in the DVR group. The linearized incidence of thromboembolic complications, hemorrhagic complications, and paravalvular leaks in all patients was 1.06 ± 2.34%, 1.60 ± 2.53%, and 0.53 ± 2.22% per patient‐year, respectively. No other complications were observed. In conclusion, the Bicarbon prosthetic heart valve has shown excellent clinical results associated with a low incidence of valve‐related complications.
Artificial Mimicking of Physiological Active Transport by a Membrane Co‐cultured with Two Different Cells: Hepatic Origin HepG2 and Renal Origin PCTL‐MDR
Authors: Endo Mitsufumi , Enosawa Shin , Ozaki Michitaka , Tsuruoka Shuichi , Hiramatsu Shinya , Kim Kazumi , Omasa Takeshi , Matsumura Toshiharu , Aoki Tatsuya , Koyanagi Yasuhisa , Suzuki Seiichi
Published: March 2003

Abstract: We designed a membrane culture unit on which 2 different cell lines were co‐cultured to achieve selective and active transport of toxins. Hepatic origin HepG2 and renal origin multidrug‐resistant gene‐transduced proximal convoluted tubular cell line (PCTL‐MDR) were cultured on the opposite sides of an expanded polytetrafluoroethylene membrane. The activity of testosterone hydroxylation by original HepG2 was very low; however, the cytochrome P450 (CYP) 3A4–transduced recombinant HepG2 metabolized the substrate efficiently. Testosterone added into the outer medium was hydrolyzed by HepG2, and the metabolites were preferentially transported to the inner medium by PCTL‐MDR. [3H]‐digoxin and [14C]‐inulin were added to the outer medium; the digoxin was transported from the outer to inner space through the cell monolayer but the inulin was not, suggesting that the membrane actively transported only the substrate of the channel protein, MDR. The cells were irradiated (10 Gy) to prevent a membrane leak due to overgrowth. The irradiation did not induce apoptosis but resulted in long‐lasting membrane function without leakage. The membrane co‐cultured with hepatic and renal origin cells will enable a novel hemofiltration system with selective and active transport activities.
Malignant Tumors After Renal Transplantation
Authors: Haberal Mehmet , Karakayalı Hamdi , Emiroğlu Remzi , Başaran Özgür , Moray Gökhan , Bilgin Nevzat
Published: March 2003

Abstract: The rate of certain malignancies in renal transplant recipients is 14 to 500 times higher than the rate in the general population. The reported prevalence rates for malignant tumors in various kidney recipient series range from 4% to 18% with an average of 6%. The tumors occur in patients who are younger than individuals affected in the general population, and the incidence rates rise with each year after transplantation. Since 1975, we have recorded 52 cases of malignancy development in 50 (3.7%) patients who were treated with P + AZA, P + CsA + AZA, or P + CsA + MMF therapy (P, prednisolone; AZA, azathioprine; CsA, cyclosporin A; MMF, mycophenolate mofetil). In this article, 50 renal transplant recipients who developed malignancy and were followed by the Transplantation Center at Başkent University Faculty of Medicine were analyzed. Analysis revealed that patients who received CsA had a higher incidence of Kaposi's sarcoma than those who received the standard regimen. Regarding other tumor types, our results showed no statistical differences among the incidence rates in the different treatment groups.
Incorporation of Electronics within a Compact, Fully Implanted Left Ventricular Assist Device
Authors: Bourque Kevin , Gernes David B. , Loree Howard M. , Richardson J. Scott , Poirier Victor L. , Barletta Natale , Fleischli Andreas , Foiera Giampiero , Gempp Thomas M. , Schoeb Reto
Published: March 2003

Abstract: The promise of expanded indications for left ventricular assist devices in the future for very long‐term applications (10+ years) prompts sealed (i.e. fully implanted) systems and less‐obtrusive and more reliable implanted components than their external counterparts in percutaneous configurations. Furthermore, sealed systems increase the fraction of total power losses dissipated intracorporeally, a disadvantage that must be carefully managed. We set out to incorporate the motor drive and levitation control electronics within the HeartMate III blood pump without substantially increasing the pump's size. Electronics based on a rigid‐flex satellite printed circuit board (PCB) arrangement that could be folded into a very compact, dense package were designed, fabricated, and tested. The pump's lower housing was redesigned to accommodate these PCBs without increasing any dimension of the pump except the height, and that by only 5 mm. The interconnect cable was reduced from 22 wires to 10 (two fully redundant sets of 5). An ongoing test of the assembled pump in vitro has demonstrated no problems in 5 months. In addition, a 20‐day in vivo test showed only 1°C temperature rises, equivalent to pumps without incorporated electronics at similar operating conditions.
The Balance of the Impeller‐Driver Magnet Affects the Antithrombogenicity in the Gyro Permanently Implantable Pump
Authors: Ichikawa Seiji , Nishimura Ikuya , Mikami Minoru , Nonaka Kenji , Linneweber Joerg , Kawahito Shinji , Motomura Tadashi , Ishitoya Hiroshi , Glueck Julia , Shinohara Toshiyuki , Nosé Yukihiko
Published: March 2003

Abstract: The Gyro permanently implantable (PI) pump is activated magnetically when a double pivot bearing supported impeller is rotated at predetermined revolutions per minute (rpm). The male bearing shaft of the impeller is supported by the top and bottom female pivot bearing in a loosely mated fashion. The Gyro PI pump's impeller transfers to a floating condition when the rpm is increased. The design objective of the Gyro PI pump is to drive the impeller while maintaining a top contact position to prevent thrombus formation. As a left ventricular assist device (LVAD), the Gyro PI pumps achieved long‐term survivals in calves without thrombus formation. However, thrombus formation occurred during a biventricular assist device (BVAD) implantation. Our hypothesis was that the impeller remaining in the bottom contact position during the BVAD experiment caused this thrombus formation. Therefore, a replica of the Gyro PI pump housing was fabricated from a transparent plastic to observe the floating conditions of the impeller. When simulating an LVAD animal experiment, the impeller was at a non‐bottom contact position. However, when simulating the BVAD animal experiment, the impeller remained at the bottom contact position. This study shows that the magnet balance affects the antithrombogenicity in a Gyro PI pump.
Powering an Artificial Heart: Birth of the Inductively Coupled‐Radio Frequency System in 1960
Authors: Schuder John C.
Published: March 2003

Abstract: In mid‐1960, our group initiated a research program focused on studying pain‐free electromagnetic methods of furnishing energy to an implanted heart without piercing the skin. During the last half of 1960, we derived a detailed theoretical rationale for a radio frequency system involving inductive coupling between a thin, small, pancake‐shaped coil on the surface of the chest and a similar coil either within the chest or, alternatively, subcutaneously. Having an efficiency of about 95%, the system was evaluated in dogs at 50 and 69 W levels, respectively. Thus was born what is now termed the transcutaneous energy transformer (TET).
Computational Fluid Dynamics Analysis of an Intra‐Cardiac Axial Flow Pump
Authors: Mitoh Ayumi , Yano Tetsuya , Sekine Kazumitsu , Mitamura Yoshinori , Okamoto Eiji , Kim Dong‐Wook , Yozu Ryohei , Kawada Shiaki
Published: March 2003

Abstract: A low rate of hemolysis is an important factor for the development of a rotary blood pump. It is, however, difficult to identify the areas where hemolysis occurs. Computational fluid dynamics (CFD) analysis enables the engineer to predict hemolysis on a computer. In this study, fluid dynamics throughout intracardiac axial flow pumps with different designs were analyzed three‐dimensionally using CFD software. The computed pressure‐flow characteristics of the pump were in good agreement with the measurements. The Reynolds shear stress was computed along particle trace lines. Hemolysis was estimated on the basis of shear stress (τ) and its exposure time (Δt): dHb/Hb = 3.62 × 10−7τi2.416×Δti0.785. Particle damage increased with time along the particle trace lines. Hemolysis of each of the pumps was measured in vitro. The computed hemolysis values were in good agreement with the experimental results. CFD is a useful tool for developing a rotary blood pump.
Landscape Ecology as a New Infrastructure for Improved Management of Plant Viruses and their Insect Vectors in Agroecosystems
Authors: Barnes John M. , Trinidad‐Correa Rodolfo , Orum Thomas V. , Felix‐Gastelum Ruben , Nelson Merritt R.
Published: March 2003

ABSTRACT Pest and disease problems in agriculture frequently extend beyond the boundaries of an individual grower’s fields, therefore management strategies in some pest and disease pathosystems may be more effectively addressed regionally. In the late 1980s, the tomato processing industry in the Del Fuerte Valley of Sinaloa, Mexico, became concerned about a complex of virus diseases affecting tomatoes. The principles of landscape ecology and the tools of geographic information systems were applied to help organize a cooperative regional approach to disease management of specific cropping systems. The major tomato producers in the region provided skilled personnel to assess the risk of virus disease incidence at the time of planting for specific fields and to assess virus disease incidence later in the growing season. All data were spatially referenced using a geographic information system (GIS) and global positioning systems. Summary maps of perceived site risk and observed disease incidence for the region were made using geostatistics and GIS. Classical plant virus disease management strategies (avoidance or removal of sources of the viruses and their insect vectors, use of virus‐free seed and transplants, etc.) were focused on areas of highest risk and incidence. The use of pesticides to manage the vectors of the virus pathogens was actively discouraged and greatly reduced. The incidence of tomato virus diseases (representing as many as 10 possible viruses) in the Del Fuerte Valley peaked at an average of over 7% in 1991–1992 with disease incidence in individual fields varying from 0% to 69% and dropped consistently each year to less than 1% in the 1995–1996 season with disease incidence in individual fields varying from 0% to 11%. Geographic information systems and landscape ecology provided a regional perspective that was crucial in spatially referencing, interpreting, and communicating information necessary to implement a regional disease management program. As geographic information system tools become increasingly available, one of the challenges and opportunities will be the integration of agroecosystem data at the regional level to promote the health of whole agroecosystems.
The Epidemiology of Antimicrobial Resistance
Authors: Goldmann Donald A.
Published: March 2003

ABSTRACT Antimicrobial resistance is increasing at an alarming rate, leading to profound crises in the treatment of common infectious diseases. Although bacteria have “natural” resistance to some antibiotics, most resistance can be attributed to over‐prescription of antibiotics by physicians, over‐the‐counter use of antibiotics in many countries, “indigenized” use of antibiotics in developing countries, and application of antibiotics for growth promotion and treatment and prevention of infection in animal husbandry and farm fishing. The development of antimicrobial resistance involves four factors: mutation, directional selection, amplification, and geographic dissemination. Although the pharmaceutical industry is endeavoring to develop new classes of antibiotics, it is unlikely that new agents alone will solve the antimicrobial resistance problem. Rather, a coordinated, multidisciplinary approach is required, including reduction in inappropriate use of antibiotics in humans and agriculture, education of consumers, and application of established infection control techniques to limit the spread of resistant microorganisms in hospitals and other settings that favor amplification of resistance.
Assessing Environmental Conditions of Major River Basins in Africa as Surrogates for Watershed Health
Authors: Singh Ashbindu , Dieye Amadou , Finco Mark
Published: March 2003

ABSTRACT There is a growing recognition of the importance of transboundary shared natural resources. However, with limited resources, international policymakers need to be able to prioritize regions before allocating resources and addressing transboundary problems. River basins are perhaps the most natural transboundary division and, as such, provide an ecological framework for environmental assessments. The health of watersheds that are divided by political boundaries are at particular risk due to differential land management practices within each watershed. In Africa, more than any other continent, over 60% of the geographical area is a transboundary watershed. In this article, a comparative study of the five major basins in Africa—the Congo, Chad, Nile, Niger, and Zambezi—has been carried out using consistent geospatial data sets at 1‐km resolution. Population, land cover type, and protected areas were used to assess the current status, characteristic differences, and impending pressure on river basin resources for each watershed. In addition, a focused study within the Nile River basin is used to compare the particular differences between countries.
Effect of Hyperbaric Oxygen on the Immunoreactivity to Substance P in the Nasal Mucosa of Cluster Headache Patients
Authors: Sabato Francesco Di , Giacovazzo Mario , Cristalli Giovanni , Rocco Monica , Fusco Bruno M.
Published: March 2003

Exposure to hyperbaric oxygen has been shown to the effective in cluster headache, but the mechanism of the action is still not clear. Primary nociceptive neurons, containing neuropeptides such as substance P and particularly those innervating the nasal mucosa, could be involved in the pathogenesis of cluster headache. The present study evaluated the effect of an exposure to hyperbaric oxygen on the content of substance P in the nasal mucosa of patients affected by cluster headache. The results were compared with those observed in another group of cluster headache patients who underwent a placebo procedure. The samples of nasal mucosa were analyzed by immunocytochemical methods. A qualitative analysis of the slides was carried out by an operator under “blinded conditions.” A marked decrease in the content of immunoreactivity for substance P was found in the patients exposed to hyperbaric oxygen. The decrease was statistically significant when compared with the findings of the placebo procedure. The results of the present study indicate that an influence on the content of peripheral neuropeptides could be involved in the mechanism of action of the beneficial effect of hyperbaric oxygen in cluster headache.
Outdoor Pollution and Headache
Authors: Nattero Giovanni , Enrico Annalisa
Published: March 2003

The aim of this study was to clarify a possible relationship between pollution and worsening of headache in the industrial city of Turin.

October 1992 to June 1993, we examined a group of 32 patients suffering from various headache types. During these months, they kept a daily record of their headaches and associated isturbances. Changes in pain frequency and severity were recorded every hour of the day and compared hour to hour with the various degrees of pollution recorded in the main streets by a monitoring station. The influence of meteorological parameters was also taken into consideration.

During winter, carbon monoxide and nitrogen dioxide showed a simultaneous hyperconcentration on the same days and the same hours. Increased incidence of headache attacks and increase in severity corresponded to the same hours, days, and months. The findings were statistically significant (P=0.008, Student's t‐test). An isolated increase in nitrogen dioxide only (without an increase in carbon monoxide which was only recorded once) induced headache a couple of hours after the peak concentration was reached.

Among the meteorological factors, only the highest values in wind velocity were shown to exert a significant influence on worsening headache frequency and severity.
Nitric Oxide, Endothelin‐1, and Transcranial Doppler in Migraine. Findings in Interictal Conditions and During Migraine Attac
Authors: Nattero G. , Mengozzi G. , Inconis T. , Paradisi L.
Published: March 2003

The role of vascular phenomena taking place during an attack of migraine are poorly understood. The aim of this study was to measure systemic levels of nitric oxide and endothelin‐1, two of the most potent vasoactive mediators known, and to assess vasomotor responses through transcranial Doppler ultrasound monitoring in patients suffering from migraine without aura, both during the headache event and in headache‐free periods as well as after pharmacologically induced pain relief. Seven patients (mean age 31.3 years, range 24 to 49 years), five women and two men, were enrolled in the pilot study. Transcranial Doppler recordings were performed according to conventional procedure. Endothelin‐1 concentrations were measured by means of radioimmunoassay, whereas nitric oxide levels were estimated using electron paramagnetic resonance spectroscopy. Ultrasound evaluation did not show significant changes during migraine attacks compared to the interictal condition. Nitric oxide levels showed only slight differences between basal and attack conditions (0.85 ± 0.46 versus 1.56 ± 0.88, expressed as arbitrary units), and were raised after pharmacological intervention (2.91 ± 1.93, P<0.05). Plasma endothelin‐1 concentrations decreased during migraine attacks with respect to interictal conditions (3.99 ± 1.21 pg/mL versus 4.23 ± 1.19), and returned to basal values (4.44 ± 1.08 pg/mL) after relief of pain. Coupling the measurements of systemic levels of nitric oxide and endothelin‐1 with transcranial Doppler velocity results will provide useful information on the hemodynamic changes of cerebral blood flow regulation in migraineurs, thereby adding new insights into the mechanisms of the migraine attack.
The Comparison of Individuals With Tension‐Type Headache and Headache‐Free Controls on Frontal EMG Levels: A Meta‐Analysis
Authors: Wittrock David A.
Published: March 2003

For many years, the dominant theory of tension‐type headache has been that individuals who suffer from these headache have elevations in electromyographic (EMG) activity at rest or during stressful life experiences, This theory was come under increasing attack in recent years. Although the research that is relevant to this controversy has been reviewed previously using box score and voting methods, no one has analyzed the relevant data using a statistical approach. This study used meta‐analysis to summarize the studies that have directly compared individuals with tension‐type headache to headache‐free control subjects on measures of frontal EMG at baseline and during rest. Twenty‐three studies were included in the analysis. The overall effect size was 395; however, there was heterogeneity of effect size. Several potential moderator variables were investigated. Perhaps the most interesting moderator variable was whether the studies clearly stated that subjects were headache‐free during assessment. This group of studies produced a nonsignificant effect size that had homogeneity of effects. Several interpretations of the results are presented.
Extratrigeminal Episodic Paroxysmal Hemicrania. Further Clinical Evidence of Functionally Relevant Brain Stem Connections
Authors: Dodick David W.
Published: March 2003

A woman, aged 59 years, developed a constant, left, occipital headache associated with episodes of discrete exacerbations occurring three to five times daily for 3 days, each lasting 15 to 20 minutes, and associated with left ptosis, conjunctival injection, and redness of the left ear. Pain‐free remissions, which usually lasted 2 weeks, ceased after a mild neck injury, but the headaches responded promptly to indomethacin.

This case, illustrating a transition from an occipital episodic to chronic paroxysmal hemicrania, is discussed as a variation of the trigeminal‐autonomic cephalalgias.
Management of Chronic Daily Headache Utilizing a Uniform Treatment Pathway
Authors: Rothrock John F.
Published: March 2003

Objective.—To determine if the use of a uniform treatment pathway might be effective in treating patients with primary chronic daily headache.

Methods.—Thirty‐three consecutive patients with primary chronic daily headache were managed according to a treatment pathway which involved sequential administration of divalproex sodium, amitriptyline, amitriptyline plus phenelzine, or methadone.

Results.—Twenty‐two patients (67%) reported a 50% or greater reduction in headache days per month following initiation of treatment. Most positive treatment responses (17 [77%] of 22) were attributed to divalproex sodium.

Conclusion.—Implementation of a uniform treatment pathway may result in significant clinical improvement in a sizable proportion of patients with chronic daily headache.
Patients With Acenocoumarol Treatment and Migraine
Authors: Morales‐Asín F. , Iñiguez C. , Cornudella R. , Mauri J.‐A. , Espada F. , Mostacero E.
Published: March 2003

Objective.– The aim of our study was to investigate the possible effect of acenocoumarol, which is indicated for nonneurological disease, on headache.

Background.– It has been suggested that anticoagulation can have beneficial effects in the control of migraine attacks.

Methods.– Four hundred randomized patients on oral anticoagulant therapy were asked to complete a questionnaire regarding their headaches.

Results.– Headache was present before or during oral anticoagulation in 166 (66 migraineurs and 100 nonmigraineurs) of 326 respondents. The major finding was that oral anticoagulation produced improvement in 63% of patients with migraine versus 38% of patients with nonmigranous headache. Improvement was related to the severity of migraine but not to age.

Conclusions.– Oral anticoagulant therapy can improve migraine. The way in which anticoagulant therapy acts on migraine is unknown, but potential mechanisms include its effect on platelet aggregability and pharmacological effects such as suppression of enhanced nitric oxide.
Behavioral Self‐management in an Inpatient Headache Treatment Unit: Increasing Adherence and Relationship to Changes in Affective Distress
Authors: Hoodin F. , Brines B.J. , Lake A.E. , Wilson J. , Saper J.R.
Published: March 2003

Objective.–To evaluate prospectively the contribution of a psychological self‐management program to the amelioration of headache‐related distress of patients with intractable migraine treated in a comprehensive, multidisciplinary, inpatient program.

Background.–Previous research has shown the effectiveness of this overall inpatient program but did not examine the relationships between the use of relaxation and other headache‐related behavioral factors.

Methods.–Data from 221 admissions to a Commission on Accreditation of Rehabilitation Facilities‐accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (average length of stay, 12.9 days), subjects completed a 7‐day retrospective, self‐report questionnaire assessing health behavior compliance and emotional factors. The intervention consisted of intensive medical therapy in addition to cognitive‐behavioral treatment delivered in a group setting.

Results.–Adherence increased significantly for relaxation practice and life‐style modifications of diet, exercise, and sleep regulation for headache prevention (P<.00001). Beck Depression Inventory scores decreased significantly (P<.00001), and a greater decrease in depression by the end of the program was reported by subjects who practiced relaxation most compared with those who practiced relaxation least.

Conclusions.–Low baseline adherence rates for health behavior increased significantly during the final week of inpatient treatment. Behavioral self‐management variables, not headache reduction, were significantly associated with patients' reduction in affective distress.
Blood Nitrite Levels in Patients With Migraine During Headache‐Free Period
Authors: Shukla R. , Barthwal M.K. , Srivastava N. , Nag D. , Seth P.K. , Srimal R.C. , Dikshit M.
Published: March 2003

Objective.—To investigate blood nitrite levels after migraine attacks and to assess whether or not the change in nitric oxide levels observed during acute migraine persist after the attacks.

Background.—Involvement of nitric oxide has been suggested in the initiation of acute migraine. Recent studies have shown alteration in the platelet response and platelet nitrite levels during migraine attacks.

Methods.—Patients with migraine with aura and patients without aura were included in the study. The study was conducted on 50 patients with migraine and 90 healthy controls. Blood from the patients was collected at least 7 ± 0.8 days after the last attack of migraine. Nitrite levels in the polymorphonuclear leukocytes, platelets, and plasma were estimated. Platelet aggregation response in some of these patients was also studied.

Results.—No significant change in the polymorphonuclear leukocyte, platelet, and plasma nitrite levels in patients with migraine compared to controls was observed. Patients with migraine with aura had significantly lower polymorphonuclear leukocyte nitrite levels compared to those without aura (P<.05). In addition, no significant difference in the adenosine diphosphate–induced platelet aggregation was observed in the migraineurs compared to the healthy controls.

Conclusions.—Results obtained indicate that the platelet aggregation response and the blood nitrite levels were not altered significantly after an attack in the patients with migraine.
Blood Flow Velocity and Pulsatility Index Differences in Patients With Unilateral Migraine
Authors: Chernyshev Oleg Y. , Vein Aleksandr M. , Mathew Ninan T. , Kolosova Olga A. , Kailasam Jayasree , Frolov Anna , Danilov Andrei B. , Meadors Lori , Gentry Paula , Alexandrov Andrei V.
Published: March 2003

Objective.—To evaluate blood flow velocity and pulsatility in unilateral migraine without aura during the headache‐free period using transcranial Doppler (TCD) sonography.

Methods.—Patients with unilateral headache were recruited during the headache‐free period. Maximum mean flow velocity (MFV) and pulsatility index (PI) were measured in the middle cerebral (MCA) and basilar arteries. Controls were headache‐free individuals without cerebrovascular disease.

Results.—Twenty‐five patients with right‐sided migraine, 25 patients with left‐sided migraine, and 19 controls were studied. The MCA PI was higher on the right headache side versus the left headache side (0.97 ± 0.2 versus 0.86 ± 0.1 cm/s, P = .02) and versus controls (0.9 ± 0.2 cm/s, NS). The basilar artery MFV was higher in patients with right‐sided headache versus left‐sided headache (39.5 ± 5.6 versus 34.7 ± 8.2 cm/s, P = .02) and versus controls (38.2 ± 8 cm/s, NS). No decrease in MFV with age was observed in patients with migraine.

Conclusions.—Middle cerebral artery flow pulsatility and basilar artery velocity are higher in patients with right‐sided migraine compared with left‐sided migraineurs, during the headache‐free period. Although these parameters were similar to controls, the differences found during the headache‐free period in migraineurs may indicate vascular involvement predisposing to the unilateral headache recurrence.
Daily Migraine With Visual Aura Associated With an Occipital Arteriovenous Malformation
Authors: Spierings Egilius L.H.
Published: March 2003

A 51‐year‐old woman with daily attacks of migraine with visual aura is described. The aura always occurred on the right and the headache always on the left side of the head, suggesting a structural lesion in the left occipital lobe. The lesion appeared to be an arteriovenous malformation of which almost full obliteration resulted in a decrease in frequency of the aura and in intensity of the headache. Subsequent treatment of borderline hypothyroidism with levothyroxine brought about a dramatic improvement in frequency of both the aura and the headache. The case is discussed in the light of our present understanding of the pathogenesis of the migraine attack.
Coping Strategies in Episodic and Chronic Tension‐type Headache
Authors: Rollnik Jens D. , Karst Matthias , Fink Matthias , Dengler Reinhard
Published: March 2003

Objective.—To study the importance of coping with illness strategies in tension‐type headache (TTH).

Background.—The pathophysiology of TTH is complex, and coping with illness strategies might contribute to the transformation to a chronic form.

Methods.—We examined 89 subjects (mean age, 45.6 ± 14.8 years; range, 18 to 72 years) with episodic (n = 37) and chronic (n = 52) TTH. Patients were required to fill in a Freiburg Questionnaire of Coping with Illness (FQCI), a von Zerssen Depression Scale, quality‐of‐life questionnaires, and a headache home diary (over 4 weeks). In addition, pressure pain thresholds (temporal muscles) and total tenderness scores were obtained.

Results.—Patients with chronic TTH exhibited poorer quality‐of‐life measures, slightly more depressive symptoms, and significantly stronger avoidance behavior and endurance strategies on FQCI scales F4 and F5 (P<.05). There was no difference between episodic and chronic TTH with respect to measures of muscle tenderness or pain thresholds.

Conclusions.—We conclude that disadvantageous coping with illness strategies might contribute to a transformation to chronic TTH.
Hemiplegic Migraine During Pregnancy: Unusual Magnetic Resonance Appearance With SPECT Scan Correlation
Authors: Barbour Peter J. , Castaldo John E. , Shoemaker Elliot I.
Published: March 2003

Objective.—This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation.

Background.—We evaluated a 31‐year‐old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left‐sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific.

Design.—Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia.

Results.—Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere.

Conclusions.—We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.
Headache Syndromes Amongst Schoolchildren in Riyadh, Saudi Arabia
Authors: Al Jumah M. , Awada A. , Al Azzam S.
Published: March 2003

We evaluated 1400 randomly selected Saudi children in grades 1 through 9 to determine the prevalence of migraine and tension‐type headache.

Of the 1400 distributed questionnaires, 1181 (84.3%) were completed properly and so served as the basis for analysis. There were 573 boys (48.5%) and 608 girls (51.5%). Ages ranged from 6 to 18 years. Five hundred eighty‐eight children (49.8%; 272 boys and 316 girls) had recurrent headache episodes not related to febrile illness in the year preceding the survey. Eighty‐four children (7.1%; 37 boys and 47 girls) had recurrent episodes of migraine, and 504 (42.7%; 232 boys and 272 girls) had recurrent episodes of nonmigraine headache. For both boys and girls, the age‐specific prevalence rate for nonmigraine headache rose steadily from around 15% at aged 6 to 7 years to nearly 60% after aged 15. For migraine, there was a sharp increase in the prevalence rate (from around 2% to around 9%) at aged 10 to 11, also in both boys and girls. Age‐adjusted prevalence for migraine between aged 6 and 15 was 6.2%. Due to the relatively poor sensitivity of some of the IHS criteria in children, this figure may underestimate the true magnitude of migraine in the population studied.
Effects of the Headache State on Objective and Perceived Performance
Authors: Hovanitz Christine A. , Christianson Amy L. , Stokes‐Crowe Linda , Scheff Jackie
Published: March 2003

The reduced ability to perform tasks is generally reported by those who experience headache. However, in an experimental study, participants reporting onset of headache chose more ambitious tasks than participants remaining headache free. The purpose of this study was to reevaluate the objective ambition of subjects with headache onset, and to determine if perceptions of expended effort and performance accuracy contributed to this seemingly maladaptive behavior. These effects were evaluated while controlling for headache proneness.

A nonclinical sample was used. Measures of ambition, performance accuracy, perceived effort, and perceived accuracy for a headache‐developing group (n = 25) and a sex‐matched, headache‐free group (n = 25) were compared during a series of mental arithmetic problems.

Ambition among participants after headache onset was significantly higher than for the control group. There was little indication that inaccurate perceptions of effort or accuracy contributed to the observed heightened ambition. However, perceived accuracy was poorer for the headache‐developing group after onset of a headache state. Headache proneness did not eliminate the significance of any relationship between objective or subjective performance and headache state.
Headache Associated with Epileptic Seizures: Epidemiology and Clinical Characteristics
Authors: Förderreuther Stefanie , Henkel Anja , Noachtar Soheyl , Straube Andreas
Published: March 2003

Objective.—To investigate the incidence and characteristics of seizure‐associated headaches and the modalities of treatment.

Background.—Systematic investigations of the characteristics of seizure‐associated headaches are rare. Although data in the literature on the incidence of postictal headaches range between 37% and 51%, experiences with their treatment are limited and pathophysiological concepts do not exist.

Methods.—One hundred ten epileptic outpatients from an epilepsy referral center participated in a semi‐standardized interview about headaches associated with epileptic seizures. The characteristics of these patients and of 15 additionally recruited patients with known postictal headaches were analyzed.

Results.—The incidence of seizure‐associated headaches was 43% (n = 47). Forty‐three patients had exclusively postictal headaches. One patient had exclusively preictal headaches. Three patients had both pre‐ and postictal headaches. The duration of postictal headaches was longer than 4 hours in 62.5% of the patients. In the majority of patients, postictal headaches occurred in more than 50% of the seizures. Postictal headaches were treated by self‐medication in 19 patients (30%). No patient treated headaches according to a medical prescription. In 11 patients, postictal migraine was untreated. Postictal headaches were associated with focal seizures in 23 patients and/or with generalized seizures in 54 patients. According to the headache classification of the International Headache Society, headaches were classified as migraine‐type in 34% of patients and as tension‐type headache in 34% of patients. Headaches could not be classified in 21% of patients. Patients with and without postictal headaches did not differ as to localization of the epileptogenic zone or to the number of prescribed antiepileptic drugs. There was no relationship between the localization of the epileptogenic focus, localization of the headache, or the headache classification.

Conclusions.—Headaches associated with partial and generalized seizures are frequent and undertreated. Treatment should consider both the headache syndrome and the general guidelines for treating primary headaches. The pathophysiology of seizure‐associated headaches cannot be explained by the epileptic syndrome.
Efficacy of Topiramate in Migraine Prophylaxis: A Retrospective Chart Analysis
Authors: Von Seggern Randal L. , Mannix Lisa K. , Adelman James U.
Published: March 2003

Objective.— Topiramate, a broad‐spectrum anticonvulsant with multiple mechanisms of action, may be effective in preventing migraine headaches. We report the results of a retrospective chart review of patients treated with topiramate for prophylaxis of migraine.

Methods.—Patients with a diagnosis of migraine who had at least one follow‐up visit after 4 weeks on topiramate were eligible; 69 patients (56 women and 13 men) aged 18 to 68 years met these criteria. Charts were reviewed for frequency of mild or moderate/severe headaches at the start of topiramate (baseline) and at all subsequent visits up to 24 weeks.

Results.—The 28‐day frequency of moderate/severe migraines declined significantly from baseline to end of treatment (10.6 ± 8.4 to 7.4 ± 7.7, respectively; P = 0.0004), whereas that of mild headaches did not demonstrate a significant change (from 11.8 ± 8.9 to 11.0 ± 10.0). Among the 38 patients who had not responded previously to 9 preventive medications, the monthly frequency of moderate/severe (but not mild) headaches decreased significantly from baseline to end of treatment. Patients who previously had not responded to <9 prior medications experienced significant declines in both mild and moderate/severe headaches. The most common adverse events were paresthesias, drowsiness, diarrhea, decreased appetite, and weight loss. Twenty‐seven patients discontinued topiramate therapy, 20 as a result of adverse events and 7 due to lack of response.

Conclusion.—Topiramate may be effective in reducing the frequency of both mild and moderate/severe migraine headaches. In particular, topiramate may offer relief to patients with moderate/severe migraines who do not respond to other treatments.
Effectiveness of Multidisciplinary Intervention in the Treatment of Migraine: A Randomized Clinical Trial
Authors: Lemstra Mark , Stewart Brad , Olszynski W. P.
Published: March 2003

Objective.—To test the effectiveness of a multidisciplinary management program for migraine treatment in a group, low cost, nonclinical setting.

Design.—A prospective, randomized, clinical trial.

Background.—Although numerous studies document the efficacy of pharmacological migraine management, it is unclear whether an effective long‐term management approach exists.

Methods.—Eighty men and women were randomly assigned to 1 of 2 groups. The intervention group consisted of a neurologist and physical therapist intake and discharge, 18 group‐supervised exercise therapy sessions, 2 group stress management and relaxation therapy lectures, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard care with the patient's family physician. Outcome measures included self‐perceived pain intensity, frequency, and duration; functional status; quality of life; health status; depression; prescription and nonprescription medication use; and work status. Outcomes were measured at the end of the 6‐week intervention and at a 3‐month follow‐up.

Results.—Forty‐one of 44 patients from the intervention group and all 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups before intervention. Intention to treat analysis revealed that the intervention group experienced statistically significant changes in self‐perceived pain frequency (P  =  .000), pain intensity (P  =  .001), pain duration (P  =  .000), functional status (P  =  .000), quality of life (P  =  .000), health status (P  =  .000), pain related disability (P  =  .000), and depression (P  =  .000); these differences retained their significance at the 3‐month follow‐up. There were no statistically significant changes in medication use or work status.

Conclusions.—Positive health related outcomes in migraine can be obtained with a low cost, group, multidisciplinary intervention in a community based nonclinical setting.