bluuebunny/crossref_metadata_2025 huggingface dataset:
Freshwater crayfish farming technology in the 1990s: a European and global perspective
Authors: Ackefors H.E.G.
Published: March 2003

This paper aims to describe the state of crayfish farming technology in the USA, Australia and Europe, and to discuss some of the prerequisites for this industry. Data from Europe are partly based on replies from a questionnaire sent out to scientists in all European countries. For other parts of the world, the crayfish literature has been reviewed and data from the August 2000 meeting of the International Association of Astacology are also included. Issues addressed in this review are cultivated species, production and productivity figures, production technique with regard to enclosures, reproduction and feed items, disease problems, predators, pond vegetation and water quality.

Fewer than a dozen crayfish species are cultivated. The most attractive ones for culture and stocking in natural waters have been transferred to more than one continent. Pond rearing techniques predominate in all countries, and the technology required to achieve the spawning and rearing of juveniles is relatively simple. Pieces of fish, carrots and potatoes are frequent supplementary feed items; plants, cereals, pieces of meat, zooplankton and pellets are also common. Diseases are not usually a major concern, except in Europe where the American plague fungus, Aphanomyces astaci, has eradicated many European crayfish populations. Predators identified as common include insects and amphibians, as well as fishes, birds and mammals. Many water macrophytes are common in crayfish farms. These may either serve a useful function or cause problems for the crayfish farmer. Water temperature is the crucial factor for crayfish production. Water parameters such as pH and certain inorganic ion concentrations may also be of concern. Acidic waters that occur in some areas are generally detrimental to crayfish.

The total yield from crayfish production from farming and fishery is in the order of 120 000–150 000 tonnes, more than four times the quantity given by FAO statistics. The largest crayfish producer is the Peoples’ Republic of China, followed by the USA (70 000 and 50 000 tonnes in 1999, respectively). Of the quantity produced in the USA in 1999, about 35 000 tonnes was farmed. The yield in Europe was about 4500 tonnes in 1994, and of this quantity only 160 tonnes came from aquaculture. There are no official statistics for crayfish fishery production in Australia, but about 400 tonnes came from aquaculture in 1999.
On species and speciation with reference to the fishes
Authors: Wiley E O
Published: March 2003

The nature of species and the processes in which they participate are subjects of continuing debate among evolutionary biologists. I begin by examining how ichthyologists treat species empirically. Such treatments provide a pattern of species and their relationships over time and space. I suggest that this empirical record points to a predominant mode of speciation: vicariant, Model I, allopatric speciation. I also suggest that species are real and that they are individuals. There is a single species concept, the evolutionary species concept (ESC), that best captures the way we think about fish species. This concept is also well integrated with the manner in which species are treated in Phylogenetic Systematics and with the philosophical concept that species are particulars rather than universals.
Estimating illegal and unreported catches from marine ecosystems: a basis for change
Authors: Pitcher Tony J , Watson Reg , Forrest Robyn , Valtýsson Hreiðar Þór , Guénette Sylvie
Published: March 2003

To evaluate the impacts of fishing on marine ecosystems, the total extraction of fish must be known. Putting a figure on total extraction entails the difficult task of estimating, in addition to reported landings, discards, illegal and unmandated catches. Unreported catches cast various types of shadow, which may be tracked and estimated quantitatively. Some shadows of unreported catches are reviewed, for example, an innovative, well‐funded NGO publicizes illegal catch in the Southern Ocean. For various reasons, official figures often have the implicit but unacceptable assumption that such categories are null. We present an estimation procedure based on adjustment factors taken from observer reports, correspondents and published information that track changes in a regulatory regime, and hence reflect incentives and disincentives to misreport. Monte Carlo simulations address uncertainty using multiple sources of information to provide upper and lower estimates. Once in place, this method provides preliminary estimates that may be refined without disruption. The method is demonstrated for fisheries in Iceland and Morocco. We use a ‘by‐species’ approach for Icelandic cod and haddock, while the Moroccan catch is divided into demersal and pelagic categories. Results suggest that Icelandic cod catches may have been underestimated by between 1 and 14% at different times, and haddock by between 1 and 28%. Underestimation of Moroccan catches appears to have been as much as by 50%. These case studies show that it is possible to obtain estimates of misreporting, even when direct data are lacking. Our method encourages transparency because sources of information are presented so that uncertain values are easily identified, offering a basis for comment, collaboration and refinement in estimating illegal and unreported fishing.
Acute mania due to a right hemisphere infarction
Authors: Börnke Christian , Postert Thomas , Przuntek Horst , Büttner Thomas
Published: March 2003

A 67‐year‐old woman who developed acute secondary mania immediately after a mixed (perforating and cortical) embolic brain infarction in the territory of the right middle cerebral artery is described. According to neuroradiological findings ischemic lesions involving the basal and medial areas of the temporal lobe and the head of the caudate as well as the putamen were evident. In the pathogenesis of secondary mania due to cerebrovascular disease, the pattern of involved structures is unique and underlines the significance of lesion location after damage of the minor hemisphere.
Bilateral primary writing tremor
Authors: Jiménez‐Jiménez Félix J. , Cabrera‐Valdivia Francisco , Ortí‐Pareja Miguel , Gasalla Teresa , Tallón‐Barranco Antonio , Zurdo Martín
Published: March 2003

Primary writing tremor is a task‐specific tremor that is considered to be unilateral. We report a 59‐year‐old man with a 5‐year history of a typical primary writing tremor in the right hand who developed similar symptoms in teh left hand.
Cardiovascular autonomic function in patients with relapsing remitting multiple sclerosis: a new surrogate marker of disease evolution?
Authors: Nasseri Kambiz , Uitdehaag Bernardus M. J. , van Walderveen Maria A.A. , Ader Herman J. , Polman Chris H.
Published: March 2003

Twenty patients with active relapsing remitting multiple sclerosis (MS) were examined annually for 2 years with a set of autonomic function tests (AFT) consisting of heart rate variability during deep breathing (IE), standing‐up, and ratios of Valsalva manoeuvre (VR). Disease characteristies, including T2‐weighted magnetic resonance imaging (MRI) of the brain and the expanded disability status scale (EDSS) score were documented each year within 1 week of the AFT. The EDSS score, MRI load lesion and VR did not change significantly over the follow‐up period. The IE and initial heart‐rate on standing during the first 30 s (ΔHRMAX) showed significant worsening during follow‐up. No relationship was found between deterioration of AFT and EDSS score, number of exacerbations, duration of disease, gender, age, size and number of lesions on MRI. We conclude that patients with active relapsing remitting MS show progression of autonomic dysfunction over a relatively short time. Therefore, in the absence of changes in clinical disability or brain MRI lesion load, AFT might be useful as a sensitive surrogate outcome measure for demonstrating subclinical change in MS.
A phase II study in patients with Alzheimer's disease to assess the preliminary efficacy and maximum tolerated dose of rivastigmine (Exelon®)
Authors: Forette Françoise , Anand Ravi , Gharabawi George
Published: March 2003

Rivastigmine is a carbamate acetylcholinesterase (AChE) inhibitor with central selectivity. Early studies showed that daily doses up to 6 mg/day have some efficacy in patients with dementia of the Alzheimer type (DAT). The present study was designed to assess the safety, tolerability and efficacy of rivastigmine at doses up to 12 mg/day. A total of 114 patients with mild‐moderate DAT were randomly assigned to either rivastigmine (b.i.d. (twice daily) or t.i.d. (three times daily)) or placebo in a double‐blind fashion titrated to their maximum tolerated dose over 10 weeks followed by an eight‐week maintenance phase. The mean maximum tolerated dose was approximately 10 mg/day (b.i.d. or t.i.d.). Gastrointestinal complaints, the majority of which were mild to moderate, were the most frequently reported adverse events. No clinically relevant changes in vital signs, haematology or organ function were detected. Significantly more patients taking rivastigmine b.i.d. were considered improved according to the Clinicians' Interview‐Based Impression of Change‐Plus (CIBIC‐Plus) vs. placebo (57% vs. 16%, respectively; P=0.027). The Nurses' Observation Scale for Geriatric Patients (NOSGER) (memory component) and the Alzheimer's Disease Assessment Scale‐cognitive subscale (ADAS‐cog) also improved in the rivastigmine b.i.d. group vs. placebo (mean change from baseline on NOSGER =−0.7 vs. +1.3, respectively; P=0.037: mean change from baseline on ADAS‐cog=−2.7 vs. +0.2, respectively; P=0.054). Despite the relatively small size and limited duration of the study, the finding that rivastigmine induced changes in the same (positive) direction in all three dimensions measured suggests that rivastigmine at doses of up to 12 mg/day has useful efficacy in patients with mild‐moderate DAT. Reports from larger phase III studies confirm this finding. The results of this study also suggest that b.i.d. is the more efficacious regimen and has comparable tolerability to the t.i.d. regimen.
Infarct volume and functional outcome after pre‐ and postoperative administration of metyrapone, a steroid synthesis inhibitor, in focal brain ischemia in the rat
Authors: Risedal Anette , Nordborg Claes , Johansson Barbro B.
Published: March 2003

High blood levels of glucocorticoids are associated with increased mortality, confusion and poor functional outcome in stroke patients. It has been proposed that inhibition of glucocorticoids in acute stroke might be beneficial, but experimental data are conflicting and no long‐term follow‐up study has been reported. We have studied whether pre‐ or postoperative administration of metyrapone, a steroid synthesis inhibitor, can influence long‐term outcome after ligation of the right middle cerebral artery (MCA) distal to the striatal branches in hypertensive rats. Metyrapone (200 mg/kg) was administered either 30 min before or 1, 12 and 24 h after MCA occlusion. Limb placements and ability to traverse a rotating pole were evaluated pre‐ and postoperatively. Infarct size, histology and GFAP immunoreactivity were evaluated on 5 μm coronal sections from brains perfused in situ 4 weeks after the ischemic event. Pretreatment did not influence outcome, whereas postoperative administration of metyrapone significantly increased infarct volume (P<0.05). Posttreated rats performed significantly worse than vehicle‐treated rats on the rotating pole 3 weeks after the operation (P<0.05). Our results do not support the hypothesis that inhibition of glucocorticoid synthesis improves outcome after cerebral ischemia.
Expression of TNFα and TGFβ1 in Guillain–Barré syndrome: correlation of a low TNFα‐/TGFβ1‐mRNA ratio with good recovery and signs for immunoregulation within the cerebrospinal fluid compartment
Authors: Ossege L. M. , Sindern E. , Voss B. , Malin J.‐P.
Published: March 2003

In the pathogenesis of Guillain–Barré syndrome (GBS) a dysregulation of cytokines is supposed. The protein concentration and mRNA expression of TNFα and TGFβ1 were investigated in cerebrospinal fluid (CSF) and blood in 10 patients with GBS. TNFα‐mRNA was increased at the beginning of the disease and demonstrated a decline during the time course (P = 0.001). The level of TNFα protein was elevated in only a few
patients. TGFβ1‐mRNA (P = 0.001) and the active TGFβ1 protein (P < 0.05) increased during the course of GBS, and the level of total TGFβ1 protein was temporarily elevated (P = 0.005). A low ratio of TNFα‐/TGFβ‐mRNA expression correlated to a good clinical course (P < 0.05). The results indicate an association of TNFα with disease activity. TGFβ1 seems to terminate and limit the inflammatory reactions and to promote the healing course of GBS. In addition the investigations show that in GBS immunoregulatory mechanisms also take place in the CSF compartment itself and that CSF cells are involved in the production of pro‐inflammatory as well as immunosuppressive cytokines.
Ulnar neuropathy at the elbow due to unusual sleep position
Authors: Finsterer J.
Published: March 2003

Abnormal strain of the ulnar nerve over the sulcus due to an unusual sleep position is a rare cause of ulnar neuropathy at the elbow. A 57‐year‐old patient with Mandelung’s deformity developed progressive weakness in the flexion of fingers 4 and 5 and in finger straddling on the left side. Additionally, there was slight wasting of the left hypothenar and the left interossei muscles. Motor and sensory nerve conduction studies of the left ulnar nerve showed delayed conduction velocities over the left ulnar sulcus. He preferred to sleep in a left lateral position with his head lying on a headrest roll, his left forearm being flexed at 110° and his hand lying either under his cheek or placed on the roll. Only three weeks after the patient had been advised to change his sleep position and to sleep without the headrest roll, weakness markedly improved. This case shows that sleeping in a lateral position with the head on a headrest roll and the hand placed on the roll or under the cheek may cause ulnar neuropathy at the elbow. Change of such a habitual sleep position promptly resolves the symptoms.
Coexistence of dominant and recessive familial amyotrophic lateral sclerosis with the D90A Cu,Zn superoxide dismutase mutation within the same country
Authors: Khoris J. , Moulard B. , Briolotti V. , Hayer M. , Durieux A. , Clavelou P. , Malafosse A. , Rouleau G. A. , Camu W.
Published: March 2003

The Cu,Zn superoxide dismutase (Cu,Zn SOD) mutations described in amyotrophic lateral sclerosis (ALS) have, for the most part, a dominant influence . However, while a few cases with a heterozygous D90A mutation have been described in different countries, D90A has been recently proven to be recessively inherited with a common founder effect in Scandinavia. We screened French ALS families for Cu,Zn SOD mutations. The presence of the D90A allele was found in two index‐cases, and their families were subsequently studied. In the first family the ALS patients were homozygotes for D90A, while in the second, all ALS patients were heterozygotes. In both families the disease was found to initially involve the lower limbs with slower progression than in sporadic cases, and frequent atypical signs such as paresthesia and urgency of micturition. We determined the D90A allele frequency in controls (n = 200) and sporadic ALS patients (n = 408). No D90A allele was found. This is the first report of coexistence of dominant and recessive families with the D90A Cu,Zn SOD mutation within the same country.
Phenomenological diversity of spinal reflexes in brain death
Authors: Spittler J. F. , Wortmann D. , Von Düring M. , Gehlen W.
Published: March 2003

In brain death, spinal reflexes and automatisms are observed which may cause irritation and even doubt in the diagnosis. In the literature there are no dedicated descriptions of the diversity and of neuroanatomical considerations.

In 278 examinations of 235 patients for the determination of brain death, on 42 occasions obvious spinal reflexes and/or spinal automatisms were observed in 27 brain dead bodies. Because they were not systematically searched for, minute forms have probably been missed.

The reflexes (R) and automatisms (A) are described according to the time of observation in relation to the development of brain death, the presumable spinal localization and the possible phylogenetical interpretation. Especially disquieting examples are discussed in more detail, e.g. monophasic EndotrachealSuction–ThoracicContraction‐R supposedly switched in segments C2–6 or TrapeziusPinch–ShoulderProtrusion‐R conveyed by the accessory nerve (terminology according to the scheme: for the reflexes, Trigger‐Response‐R: for the automatisms, Movement‐A).

After these experiences a more thorough examination showed frequent observations of rather minute forms of spinal reflexes, as well as automatisms and even the Lazarus sign (in possibly more than two thirds of the examinations). An estimation of the factual frequency would necessitate special attention to those much more frequent but less obvious minute spinal reflexes and automatisms.
Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function
Authors: Damiano D. L. , Quinlivan J. , Owen B. F. , Shaffrey M. , Abel M. F.
Published: March 2003

Despite the lack of consensus of the role of spasticity in the observed motor disability in cerebral palsy (CP), alleviation of spasticity remains a primary focus in the clinical management of these patients. The purposes of this study were to: (1) quantify voluntary torque and passive resistance across speeds in the hamstrings and quadriceps muscle groups with respect to the presence of stretch responses and/or passive muscle stiffness in patients with CP compared to age‐related children without disability, and (2) relate these parameters to each other and to functional performance, as measured by the Gross Motor Function Measure (GMFM), in CP. Included were 23 subjects with CP, sub‐grouped by the presence or absence of stretch responses as determined by electromyography, and 9 subjects without CP. Results indicated that peak torque was considerably greater in the comparison group than for each of the CP groups and resistance was greater in the CP group with spasticity compared to the nonspastic CP group in both muscles at all speeds. Stiffness differed between the spastic CP group and the comparison group only for the quadriceps at the fastest speed. Higher passive resistance torque and stiffness were correlated with decreased voluntary torque, particularly for the antagonists, and with lower GMFM scores. In conclusion, strength and motor function are related to the magnitude of resistance torque and stiffness in CP, although the small amount of variance explained reinforces the multidimensional nature of this disorder, and the challenges inherent in managing it.
Management of the upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury: clinical implications
Authors: Autti‐Rämö I. , Larsen A. , Taimo A. , Von Wendt L.
Published: March 2003

The aim of this article is to describe our clinical experience in treating muscle imbalance in 49 children with spastic upper extremity involvement. We discuss four cohorts of children treated with botulinum toxin type A (BTX‐A), each with different treatment objectives. In the first group, 27 children were treated for functional improvement and, of these, 23 had a positive effect, while four had no objective benefit. In the second group, eight children were treated for purposes of presurgical planning; of these, four were referred for surgery, three continued with serial treatment and one child did not benefit from injection. The third group comprised six children who were treated to improve posture and care: in this group, four children demonstrated clear benefit and two children lost some function subsequent to injection. Finally, a fourth group of seven children were treated after acquired brain injury (three with severe tetraplegia, four with hemiplegia). In this group, all children experienced spasticity relaxation and two children with hemiplegia also gained functional benefit. In terms of adverse events, deterioration of upper extremity function was poorly tolerated but limited to the first 1–3 weeks postinjection. Grip strength or thumb grip were diminished if too high doses were used. Overall, our results with BTX‐A were rewarding in children with no fixed contracture, good motor learning capacity and high motivation to train. Additionally, BTX‐A treatment has proven valuable for counteracting spasticity in children with acquired brain injury. This treatment modality may not, however, be an appropriate treatment option for all children with severe upper extremity spasticity, due to the shorter duration of effect and the potential reduction in functional abilities seen in this cohort. In all cases, the selection of muscles to be treated needs careful clinical assessment. Dynamic EMG analysis should be performed whenever required to aid muscle selection, especially in children with spasticity combined with dystonia. Evaluation of M‐responses suggests that for the forearm muscles, doses of BTX‐A above 1.5 U/kg/muscle should not be used.
Sporadic ALS associated with the D90A Cu,Zn superoxide dismutase mutation in Russia
Authors: Skvortsova V. I. , Limborska S. A. , Slominsky P. A. , Levitskaya N. I. , Levitsky G. N. , Shadrina M. I. , Kondratyeva E. A.
Published: March 2003

Twenty blood samples from Russian patients (Moscow) with idiopathic motor neurone disease were analysed for mutations in the Cu,Zn superoxide dismutase (Cu,Zn SOD) gene. Two patients (10%) with the amyotrophic lateral sclerosis (ALS) form of the disease were found to have a disease‐related mutation. One patient appears to have autosomal recessive adult‐onset ALS associated with homozygosity for D90A and presents the characteristic phenotype of very slowly ascending paresis with both lower and upper motor neurone signs. Another patient, heterozygous for D90A, presents ALS with lumbar onset and rapid progression. This is the first report of a Cu,Zn SOD mutation in ALS in Russia.
The validity of Hodkinson’s Abbreviated Mental Test for dementia screening in Guipuzcoa, Spain
Authors: Sarasqueta C. , Bergareche A. , Arce A. , De Munain A. Lopez , Poza J. J. , De La Puente E. , Urtasun M. , Emparanza J. E. , Martí Masso J. F.
Published: March 2003

The objective of this research was to evaluate the validity of Hodkinson’s Abbreviated Mental Test (AMT) in screening for dementia and to identify the optimum cut‐off point to use in a prevalence survey. The study included two groups of persons: (i) a random sample of 183 individuals selected from census data, 96 of whom completed the study and (ii) another 36 persons with dementia were selected from a hospital outpatients department by sampling consecutive cases. The DSM‐IV criteria were used as the ‘gold standard’ to establish a diagnosis of dementia. The AMT was administered to the 132 participants who subsequently underwent independent clinical evaluation. In the community sample, 11 persons were diagnosed with dementia and 85 without. In the total sample, a score of 7 maximizes the efficacy of the test. The sensitivity for this cut‐off point is 91.5% (78.7–97.2%) and the specificity is 82.4% (72.2–89.5%). A score of 9 gives 100% sensitivity, but the proportion of false positives rises to 66%. Our results are consistent with other studies and suggest that the AMT is a valid instrument for use in screening for dementia in populations similar to the one in this study.
Increased intracortical facilitation in patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p
Authors: Nielsen J. E. , Jennum P. , Fenger K. , Sørensen S. A. , Fuglsang‐Frederiksen A.
Published: March 2003

There are at least seven clinically indistinguishable but genetically different types of autosomal dominant pure spastic paraplegia (ADPSP). In this study we investigated electrophysiological characteristics in patients with ADPSP linked to chromosome 2p (SPG4). Twelve patients from six different families with ADPSP linked to chromosome 2p and 15 control persons were included. Electromyography (EMG), motor and sensory nerve conduction, and motor evoked potentials using single and paired transcranial magnetic stimulation (PTMS) was performed. From the peripheral nervous system we found signs of motor and sensory axonal neuropathy. Motor evoked potentials disclosed greatly reduced corticospinal tract conduction velocity and amplitude of evoked potentials to the lower extremities indicating that the very marked spasticity predominantly seems to rely on dysfunction of the fast conducting axons of the pyramidal tract. PTMS showed an increased intracortical facilitation (ICF), which may reflect an impaired function of γ‐aminobutyric acid (GABA)‐controlled interneuronal circuits in the motor cortex, alternatively an increased glutamatergic transmission or a compensatory recruitment of a larger number of neurones with corticospinal projections.
Multiple sclerosis in Oslo, Norway: prevalence on 1 January 1995 and incidence over a 25‐year period
Authors: Celius E. G. , Vandvik B.
Published: March 2003

The Oslo Multiple Sclerosis (MS) Registry was established in 1990, and this is the first report on the prevalence and incidence of MS in the city of Oslo, Norway. The prevalence rate of definite MS on 1 January 1995 was 120.4/105. Inclusion of patients of native Norwegian ancestry only and exclusion of non‐Norwegian immigrants yielded a prevalence rate of 136.0/105. A similar prevalence rate (136.5/105) was found when patients and immigrants from the other Nordic countries (Finland, Sweden, Denmark) were included. Segregation of the native Norwegian patients according to the counties where they were born showed no significant differences except for a disproportionate increase of patients born in the inland county of Oppland.  A total of 794 cases were resident in Oslo at the time of a diagnosis of definite MS in the period 1972–99. The crude average annual incidence rate for each 5‐year period, between 1972 and 1996, increased significantly from 3.7/105 in the 1972–76 to 8.7/105 in the 1992–96 period. The increase was more marked in relapsing‐remitting (RR) than in primary progressive disease and in female cases.
Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma
Authors: Oberndorfer S. , Urbanits S. , Lahrmann H. , Kirschner H. , Kumpan W. , Grisold W.
Published: March 2003

In a 59‐year‐old female patient, a World Health Organization (WHO) grade II astrocytoma had been diagnosed 16 years ago, which finally progressed into WHO grade III. Several right frontal neurosurgical resections, local radiation and a local radioimplant had been applied. Despite this long record, she was reported alert with a Karnofsky index of 90% until admission. Within a few weeks she rapidly developed akinetic mutism. Upon admission, computed tomography (CT) scan showed a large cystic right frontal defect and a suggested small tumor recurrence. White matter of the frontal lobe appeared to be translucent and compatible with previous radiation. The severe mental changes were initially attributed to a delayed radiation encephalopathy. Neuropathologically, the white matter of the frontal lobe showed mild elevated cell density consistent with gliosis; however, a tumor recurrence invading the tip of the corpus callosum and invading the entire length both fornices appeared. From the neuropathological findings of massive local tumor recurrence in both fornices, together with the acute clinical onset, it seems unlikely that the sequel of radiotherapy caused akinetic mutism, but the symmetric and severe involvement of the limbic system. We conclude that the rapid progression from a state of alertness to a full clinical picture of akinetic mutism was because of infiltration of both fornices.
Prevalence and outcome of asymptomatic carotid stenosis: a population‐based ultrasonographic study
Authors: Mineva P. P. , Manchev I. C. , Hadjiev D. I.
Published: March 2003

The aims of this epidemiological population‐based cohort study were to examine the prevalence and outcomes of asymptomatic carotid stenosis (ACS) detected by duplex scanning and its relations to other vascular risk factors. A total of 500 volunteers, 200 men and 300 women, without signs and symptoms of cerebrovascular disease, aged 50–79 years, were enrolled in the study. The prevalence of ACS of 50% or greater was 6.4%. Only severe carotid stenosis was detected in 0.4% of the subjects examined. Significant relationships between ACS and coronary heart disease (CHD) [odds ratio (OR)=8.00], peripheral arterial disease (PAD) (OR=3.66), cigarette smoking in men (OR=4.39) and obesity in women (OR=0.31) were found. The biennial incidence rate of cerebral ischaemic events was 9.4%. A progression of ACS was revealed in 14% and a regression in 6.25% of the subjects. The patients with progressing ACS to more than 70% diameter reduction reached the end‐points. Follow‐up with repeated duplex scans in patients with advancing ACS of 50% or greater, especially smokers with CHD and PAD, is recommended.
The co‐occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway
Authors: Hagen K. , Einarsen C. , Zwart J.‐A. , Svebak S. , Bovim G.
Published: March 2003

We have evaluated the association between headache and musculoskeletal symptoms in a large cross‐sectional population‐based study. Between 1995 and 1997, all 92 566 adults in Nord‐Trøndelag County in Norway were invited to participate in a health survey. A total of 51 050 (55%) responded to questions concerning headache and musculoskeletal symptoms. Both migraine and non‐migrainous headache were strongly associated with musculoskeletal symptoms. However, frequency of headache had a higher impact than headache diagnosis on this association. Thus, the prevalence of chronic headache (headache >14 days/month) was more than four times higher (OR = 4.6; 95% CI 4.0–5.3) in the group of individuals with musculoskeletal symptoms than in those without. Individuals with neck pain were more likely to suffer from headache as compared with those with musculoskeletal symptoms in other restricted areas. In conclusion, there was a strong association between chronic headache and musculoskeletal symptoms, which may have implications for the choice of treatment.
Risk factors for cryptogenic ischaemic stroke
Authors: Karttunen V. , Alfthan G. , Hiltunen L. , Rasi V. , Kervinen K. , Kesäniemi Y. A. , Hillbom M.
Published: March 2003

This case–control study was designed to identify risk factors for cryptogenic brain infarction. We assessed the frequency of prothrombotic states, homocysteine, lipoprotein (a) [Lp(a)] and other lipids and the apolipoprotein E phenotype together with conventional risk factors in 46 patients (19 women and 27 men) with cryptogenic brain infarction aged from 15 to 60 years and in 104 community‐based controls. Multivariate odds ratios (ORs) for risk factors and 95% CIs were calculated by logistic regression. Hypertension (OR 4.5; 95% CI, 1.5–13.2; P = 0.006), current smoking (OR 2.9; 95% CI, 1.2–6.8; P = 0.012), low HDL cholesterol (HDL‐C) (OR 5.4; 95% CI, 1.1–25.5; P = 0.035) and high clotting factor VIII activity (OR 3.6; 95% CI, 1.1–12.2; P = 0.041) were variables associated with cryptogenic brain infarction. These risk factors were not equally frequent in women and men. Low HDL‐C and high factor VIII activity in the women, and hypertension, current smoking and a low level of plasma folate in the men were risk factors for cryptogenic stroke. Several of the observed risk factors for cryptogenic brain infarction were lifestyle‐associated, which emphasizes the role of health education in addition to pharmacological treatment in the prevention of stroke.
Detection of unknown primary tumours in patients with cerebral metastases using whole‐body 18F‐flouorodeoxyglucose positron emission tomography
Authors: Klee B. , Law I. , Højgaard L. , Kosteljanetz M.
Published: March 2003

Identification of the unknown primary tumours in patients presenting with cerebral metastasis is a continued diagnostic challenge. Despite extensive and lengthy diagnostic work‐up, the primary tumours will remain obscure in a significant proportion of the patients. The aim of this study was to evaluate the use of whole‐body 18‐F‐fluorodeoxyglucose positron emission tomography (18FDG PET) scanning in this pursuit. Sixteen patients aged 34–74 years, with histologically confirmed metastatic brain tumours, were included in the study. Whole‐body 18FDG PET identified pulmonary foci of probable primary tumours in all patients. Subsequent confirmation of tumour tissue was determined either by direct histological verification or indirectly by the observation of lesion appearance or lesion growth on structural imaging. This could only be obtained in eight of 16 patients, all defined as true positive. Of the remaining eight, a biopsy could not be sampled from seven patients, because of death or limited follow‐up investigations, and one patient had pulmonary malignant melanoma metastases. Whole‐body 18FDG PET scanning is a sensitive tool in the search for unknown primary tumours of patients with confirmed cerebral metastases allowing early and focused histological confirmation from suspicious lesions.
Serum ferritin levels and early prognosis of stroke
Authors: Erdemoglu A. K. , Ozbakir S.
Published: March 2003

Iron and ferritin are known to have an important role in stroke as well as in other disorders. This prospective study was designed to determine whether administering ferritin levels might help to estimate the severity and prognosis of stroke. Fifty‐one patients with a diagnosis of acute stroke were included in the study within 24 h from onset of symptoms. Serum ferritin and cortisol levels were assayed at admission. Clinical status was determined by the Canadian Stroke Scale at admission and on day 21. Serum ferritin level was found to be higher in patients with large lesion size (P < 0.01), deteriorated neurologic status during clinical follow‐up (P = 0.03) and deceased patients (P < 0.01). Serum ferritin level was correlated with neurologic deficit (r = 0.50, P < 0.001). No correlation was found between serum cortisol and ferritin levels (r = 0.07, P = 0.7). Serum ferritin level (P = 0.007; OR = 1.02; 95% CI, 1.01–1.03) and large size of lesion (P = 0.021, OR = 11.92; 95% CI; 1.46–197.12) were independently associated with mortality. Increased serum ferritin levels correlate to severity of stroke and the size of the lesion.
Botulinum toxin A (BoNT‐A) for spasticity in adults. What is the evidence?
Authors: Moore A. P.
Published: March 2003

There are now many reports from open, uncontrolled studies which suggest that botulinum toxin A (BoNT‐A) is valuable in treating spasticity. Evidence of its benefit is also gradually accumulating from randomized controlled trials (RCTs). In this presentation I will discuss the reasons why RCT evidence is being generated, and describe the findings currently available, including preliminary results from as yet unpublished trials. RCT data have been reported for leg and arm spasticity in a variety of diseases, but predominantly in stroke and multiple sclerosis patients. In most RCTs, the effects of BoNT‐A are compared with placebo over a single injection cycle. The outcomes are generally positive and support the use of BoNT‐A. However, data from RCTs are less convincing than those from open studies for a variety of technical reasons. These especially reflect the difficulties of finding good outcome measures for such a heterogeneous array of patients. There is good evidence that BoNT‐A has clinical benefit in treating the mechanical effects of spasticity. In order to further clarify its usefulness, future research should address the strategies of short‐ and longer‐term use of BoNT‐A, and the unresolved technical issues of how to get the best out of this new treatment.
A summary of spasticity management – a treatment algorithm
Authors: Ward A. B.
Published: March 2003

The muscle overactivity seen in spasticity results in limb stiffness and muscle spasm, to which there is both a neurogenic and a biomechanical component. Spasticity does not always cause harm and can assist in the rehabilitation process enabling a patient to stand when their limb weakness would not otherwise allow it. When it does cause harm, however, treatment is required. This aims to  (i) prevent provocative factors (ii) treat muscle overactivity; and (iii) prevent complications. Untreated, limb contracture, pain and other complications occur and early management can be most effective. Treatment is essentially physical, but, when this is inadequate, pharmacological intervention may be required. A strategy has been devised which shows that the first choice pharmacological treatment of focal spasticity is botulinum toxin. Over the past decade, the choice of treatment has become more ambitious with the establishment of new technologies. Good management now depends on an understanding of their role and application in relation to the needs of individual patients. To this end, a treatment algorithm which covers the salient facts in patient assessment and gives the indications for the range of available treatments, is the best approach. The indications and limitations of the available treatments are discussed, along with their place in the overall management of the patients. The evidence base for much of what is done is not strong and this summary examines the activities of proven value and of consensus view.
5‐hydroxytryptamine (5‐HT, serotonin) and Parkinson's disease – opportunities for novel therapeutics to reduce the problems of levodopa therapy
Authors: Nicholson S. L. , Brotchie J. M.
Published: March 2003

While Parkinson's disease is undoubtedly a disorder with a primary pathology of dopamine neuronal loss, that loss of dopamine and subsequent dopamine replacement therapy leads to imbalances in many non‐dopaminergic transmitter systems, including 5‐hydroxytryptamine (5‐HT). Recent advances in understanding the role of 5‐HT in parkinsonism and the generation of side‐effects of dopamine replacement therapy (e.g. wearing‐off and levodopa‐induced dyskinesia) have identified 5‐HT1A, 5‐HT1B and 5‐HT2C receptors as potential therapeutic targets in Parkinson's disease.
The differential diagnosis of Parkinson's disease
Authors: Poewe W. , Wenning G.
Published: March 2003

The diagnosis of Parkinson's disease continues to be challenging with misdiagnosis rates as high as 20–30% in early stages. Such diagnostic inaccuracy is largely due to failure to recognize atypical parkinsonian disorders including multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and dementia with Lewy bodies (DLB). These disorders are characterized by distinctive sets of atypical features that have been incorporated into recent consensus diagnostic criteria. Early diagnosis of atypical parkinsonian disorders is important not only because of prognostic implications, but also because of variable therapeutic targets such as autonomic failure, apraxia or dementia.
Forty-Five Years of Migraine-Observations and Reflections “From The Inside” by A Physician-Patient
Authors: Elkinton J Russell , Graham John R
Published: March 2003

A case is presented of severe migraine observed by a physician-patient for 45 years from the age of 27 to 72. A system was developed of grading headache frequency and severity which has permitted, over the last 33 years, a semi-quantitative analysis in terms of quarter years of: (1) the course of the disease, (2) the results of various treatments, and (3) the associated psychological tensions. The patient's mother and other family members of four generations had migraine. The frequency and severity of the patient's headaches increased over 22 years to a peak that coincided with his maximal professional work-load; they then receded and disappeared during the last 11 years of retirement. In the first 13 years of no prophylactic treatment a periodicity was present with a median span of 2.4 weeks. In these first 13 years, there was a left-sided preponderance of attacks. It is concluded that migraine is a complex disturbance comprising a genetic defect with an inbuilt biorhythm and a threshold for manifestation of headache sensitive to many physical, physiologic, and psychologic factors of stress in the life of the patient.
Bilateral Cerebral Occipital Calcifications and Migraine-Like Headache
Authors: Battistella Pier Antonio , Mattesi Pietro , Casara Gian Luca , Carollo Carla , Condini Antonio , Allegri Filippo , Rigon Franco
Published: March 2003

Computed tomography scanning in two young patients with recurrent, pulsating, migraine-like headache showed parieto-occipital calcifications. One patient presented with an atypical form of the Sturge-Weber syndrome, and the other with celiac disease and folic acid deficiency. The clinical features were analyzed and compared with those in other cases reported in the recent literature which have shown bioccipital calcifications but no cutaneous angiomas, sometimes associated with visual and/or intelligence deficit and epilepsy. Finally, the possible connection between cerebral calcifications and headache is discussed.
Cluster-Tic Syndrome
Authors: Klimek Andrzej
Published: March 2003

A case of cluster—tic syndrome is presented. A 51-year-old man developed pain attacks corresponding to the second branch of the trigeminal nerve. After treatment with 1200 mg carbamazepine daily, the attacks disappeared. Full remission was achieved, and carbamazepine therapy was continued. Pain attacks of a quite different character then appeared; their clinical picture corresponded to cluster headache. After treatment with cyproheptadine, the cluster headache attacks ceased, but 2 days later, before the discontinuation of the treatment, the attacks of trigeminal neuralgia reappeared. Treatment with carbamazepine was started again, and there was remission of the trigeminal neuralgia after several weeks.”
Migraine and Left-Handedness: Is There a Connection?
Authors: Messinger Harley B , Messinger Margaret I , Graham John R
Published: March 2003

In 1982, Geschwind and Behan reported an association between migraine headache and left-handedness. The present study was an attempt to test this hypothesis by comparing the frequency of left-handedness in migraine and tension headache patients at a headache center. Cluster headache cases were also included because Geschwind and Behan suspected that the association might be even stronger in this disorder. A special scoring method for handedness was devised by Geschwind and Behan to help identify a possible higher risk in mixed-handedness subjects. No significant associations emerged in any of these tests. A modest association of cluster headache and left-handedness disappeared when adjustment was made for the strong predilection of cluster headache for the male sex.
Cluster Headache: Forehead Sweating Pattern During Heating and Pilocarpine Tests: Variation as a Function of Time
Authors: Salvesen Rolf , Carvalho Deusvenir de Souza , Sand Trond , Sjaastad Ottar
Published: March 2003

Thirty-one patients with cluster headache were examined with regard to their forehead sweating pattern, by means of the Evaporimeter. Sweating was stimulated in two different ways: by body heating and by parenterally administered pilocarpine. The resulting increase in evaporation was frequently measured at different positions on both sides of the forehead, and the possibility of variations in the pattern related to the passage of time was specifically scrutinized. Some typical patterns emerged. The previously reported, marked asymmetries of response (deficient heat-induced sweating and pilocarpine supersensitivity of the symptomatic side) at the medial positions in the forehead were confirmed. However, the asymmetries invariably faded to some extent with the passage of time. Patients with cluster headache show gross similarities with, but also some minor differences from, the sweat pattern of patients with brain stem lesions causing a Horner's syndrome. A subdivision of the material into groups in accordance with the pupillometric pattern after sympathomimetic stimulation made it clear that the cases of definite evaporimetric asymmetries (“typical reactions”) belonged to the group with a typical pupillometric pattern. These results suggest that from an “autonomic” point of view, subpopulations may exist within the clinical entity of cluster headache.
Complicated Coital Cephalalgia: Three Cases with Benign Evolution
Authors: Martinez JM , Roig C , Arboix A
Published: March 2003

Three patients with a history of migraine and type-II coital cephalalgia with signs of vertebrobasilar deficiency are presented. Extensive studies including angiography did not show any vascular malformation. Together with the few reports in the literature our cases outline a benign form of complicated coital cephalalgia, possibly resulting from ischaemic disturbances triggered by haemodynamic changes occurring in orgasm.
Evaluation of Clinical Criteria for Cluster Headache With Special Reference to The Classification of The International Headache Society
Authors: Ekbom Karl
Published: March 2003

The diagnostic criteria issued by the International Headache Society (IHS) (1988) and those of the World Federation of Neurology (WFN) (1969) were evaluated vis-à-vis 163 consecutive cases of cluster headache diagnosed according to the criteria of Ekbom (1970). The agreement between the IHS and Ekbom criteria was very good (96.9%). The difference was explained by five patients who all lacked local autonomous symptoms and signs (conjunctival injection, lacrimation, etc.). At least one of these signs is mandatory according to the IHS and thus the patients escaped a definite diagnosis. Agreement between the WFN and Ekbom criteria was 84.0% ( n= 163) and between the WFN and IHS criteria only 76.0% ( n= 158).
Platelet Size and Volume Distribution Measured by Automated Platelet Analyzer
Authors: Pradalier A , Abuaf N , Launay JM , Vincent D
Published: March 2003

Thirty migraine without aura patients between attacks, 10 other during a migraine without aura attack and 30 normal subjects without headache were studied for platelet size and volume distribution using a new quantitative automated hematology analyzer (Coulter STKS). Platelet histograms, platelet counts and mean platelet volume were not significantly different in the three populations.
Cervical Headache: An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance
Authors: Watson Dean H , Trott Patricia H
Published: March 2003

In this study, 60 female subjects, aged between 25 and 40 years, were divided into two equal groups on the basis of absence or presence of headache. A passive accessory intervertebral mobility (PAIVM) examination was performed to confirm an upper cervical articular cause of the subjects' headache and a questionnaire was used to establish a profile of the headache population. Measurements of cranio-cervical posture and isometric strength and endurance of the upper cervical flexor muscles were compared between the two groups of subjects. The headache group was found to be significantly different from the non-headache group in respect to forward head posture (FHP) ( t = -5.98, p < 0.00005), less isometric strength ( t = 3.43, p < 0.001) and less endurance ( t = 8.71, p < 0.0005) of the upper cervical flexors. A statistically significant relationship was also established between natural head posture and isometric endurance of the upper cervical flexor musculature which demonstrated that FHP corresponded with a low endurance capacity (c2 = 13.2; p < 0.01). The outcome of this study highlights the need to screen for cervical etiology in patients who are suspected of suffering from common migraine.