bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTHROPOS AND ETHICS  Categories of Inquiry and Procedures of Comparison
Authors: Lewis Thomas A. , Wyn Schofer Jonathan , Stalnaker Aaron , Berkson Mark A.
Published: May 2005

Building on influential work in virtue ethics, this collection of essays examines the categories of self, person, and anthropology as foci for comparative analysis. The papers unite reflections on theory and method with descriptive work that addresses thinkers from the modern West, Christian and Jewish Late Antiquity, early China, and other settings. The introduction sets out central methodological issues that are subsequently taken up in each essay, including the origin of the categories through which comparison proceeds, the status of these categories in the process of comparison, and the goals of comparison. In considering the question of goals, the introduction draws connections between comparative study and historical study within one tradition. Both types of analysis can bridge the gap between historical and normative work by attending to the ways in which the questions a scholar asks—not just the answers found—vary from one context to another.
Management of acute musculoskeletal pain
Authors: SPEARING Natalie , MARCH Lyn , BELLAMY Nicholas , BOGDUK Nikolai , BROOKS Peter M.
Published: May 2005

The pain and disability associated with musculoskeletal conditions represent a significant and increasing health burden worldwide. Musculoskeletal conditions of acute onset and short duration occur commonly, affect all age groups, and are usually idiopathic. Successful management of acute pain is paramount if chronic pain conditions are to be avoided.

This article focuses on interventions for five areas of acute musculoskeletal pain (acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain and anterior knee pain). It summarizes the results of a multidisciplinary evidence review recently conducted by the Australian Acute Musculoskeletal Pain Guidelines Group.
A review of pulmonary involvement in rheumatoid arthritis
Authors: ANWAR A.
Published: May 2005

Pulmonary involvement in rheumatoid arthritis (RA) is a recognized complication but not often well described in the literature and also in major medical textbooks. Thus, for most medical practitioners who look after RA patients, pulmonary complications are often missed and not given much attention. This article will review the current literature of pulmonary involvement in RA and to increase awareness of its existence.
Risk factors for stroke among Filipino patients with systemic lupus erythematosus
Authors: REYES Candice Marie C. , NAVARRA Sandra V.
Published: May 2005

Aim:  To describe the risk factors for stroke among Filipino patients with systemic lupus erythematosus (SLE).

Methods:  This study retrospectively reviewed the medical records of Filipino patients with SLE seen at the Section of Rheumatology, Clinical Immunology and Osteoporosis of the University of Santo Tomas Hospital from 1998 to 2003. Assessment was made on the presence of known risk factors for stroke including age, hypertension, diabetes mellitus, dyslipidemia, personal or family history of coronary artery disease, family history of stroke, and SLE‐related factors such as antiphospholipid syndrome (APS) and nephrotic syndrome.

Results:  Of a total of 449 patients, 25 recorded 26 stroke events during the course of their SLE. Twenty‐four female patients and one male had a mean age at stroke occurrence of 38.08 ± 15.45 SD years, with a mean duration from SLE diagnosis to stroke event of 62.48 ± 54.58 SD months. Infarction was implicated in 19 of 26 (73%) events, four (16%) had transient ischemic attack, two (8%) had intracerebral haemorrhage, and one had amaurosis fugax. Eighteen (72%) had systemic arterial hypertension, three (12%) had diabetes mellitus, and nine (36%) had dyslipidemia. A significant family or personal history was present in eight (32%), and there were no smokers. Twenty‐one patients were on corticosteroid treatment with an average prednisone dose of 13.02 ± 10.95 SD mg/day. Nine (36%) were on immunosuppressive therapy prior to stroke, and two were on hydroxychloroquine. APS was diagnosed in three (12%), four (16%) each had nephrotic syndrome and extra‐CNS vasculitis. Hypocomplementemia was present in six (24%).

Conclusion:  Hypertension, dyslipidemia, and family or personal history were the predominant risk factors in this series, although SLE‐related factors also possibly contributed to the occurrence of stroke, particularly in the younger patients.
Cardiac involvement in patients with rheumatoid arthritis
Authors: COŞKUN Selçuk , ÖZORAN Kürşat , MERMERCI Bedriye , AYDOǦDU Sinan , KELEŞ Talat
Published: May 2005

Background and aim:  In rheumatoid arthritis (RA), although the target organ is the synovium, extra‐articular involvement is also seen. All layers of the heart can be inflamed and pericarditis is the most common type of involvement. The frequency of cardiac involvement in patients with RA and its relation with other patient characteristics were analysed in this study.

Methods:  One hundred patients with RA were included in the study. Patients were evaluated in terms of their sex, age, disease duration, activity of the disease and history of previous heart disease. Electrocardiography (ECG) and echocardiography were performed. The cardiac abnormalities, laboratory parameters, disease duration and the age of the patient were separately compared. Student t‐test was used for these comparisons and P < 0.05 was accepted to be statistically significant.

Results:  Ages of the patients, 15 of whom were male and 85 were female, varied between 19 and 78 years (mean 50.5 ± 12.7 years). 23% of the patients were RF‐negative and 77% were RF‐positive. The distribution of the patients according to the Steinbrocker's functional classification was as follows: 16 patients (16%) Class I, 55 patients (55%) Class II, 23 patients (23%) Class III and 5 patients (5%) Class IV. ECG abnormalities were found in 7 patients (7%).

Echocardiographic abnormality was detected in 67 of the 100 patients (67%) with minimal pericardial effusion in 15 patients (15%), mitral valvular involvement in 26 patients (26%), aortic valve involvement in 24 patients (24%), ascendant aorta dilatation in 7 patients (7%) and diastolic dysfunction in 57 patients (57%).

Conclusions:  Cardiovascular system involvement which is an extra‐articular involvement of RA is asymptomatic in most of the patients. Thus, we believe that by a periodical thorough evaluation of patients and aggressive treatment for identified problems can significantly reduce cardiovascular morbidity and mortality in patients with RA.
Is obesity a protective factor for osteoporosis?
Authors: BENER Abdulbari , HAMMOUDEH Mohammed , ZIRIE Mahmoud , HELLER Richard F.
Published: May 2005

Background:  Epidemiological evidence suggests that obesity has effects on bone density. Obese subjects have increased bone density relative to non‐obese subjects yet this relationship is not fully understood. However, the influence of these factors has not been well documented in Arabian Gulf women.

Aim:  The aim of this study was to determine the relationship between obesity and bone mineral density (BMD) as a risk factor for osteoporosis in premenopausal, menopausal and postmenopausal Qatari women.

Methods:  This is a cross‐sectional study, performed during a period from September 2003 to October 2004. A total of 1000 women were targeted for the study, however, only 649 healthy Qatari women aged 20–70 years had given consent and participated in this study. All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured. Dual‐energy X‐ray absorptiometry (DXA) was used to determine Bone Mineral Density (BMD) of the spine and femur. The main outcome measures were menopausal status, socio‐demographic, obesity and lifestyle factors and BMD measurements.

Results:  It is observed from our survey that 27.7% of the studied subjects had osteoporosis/osteopenia. Illiterate subjects were more likely to have low bone mineral density (35%). Walking daily for more than 30 minutes contributed to increase the BMD at spine and femur. Also, doing regular household work for 1–2 h/day also contributed towards high BMD. Multiple regression analysis showed that obesity, educational level and taking multivitamin supplements were strong positive indicators for BMD at spinal sites and for femoral sites, BMD was higher among the obese subjects. Finally, the present study revealed that obesity is a protective factor for osteoporosis.

Conclusion:  The study concludes that in a population of Qatari women there is a positive association between obesity and BMD at both spinal and femoral sites. BMD at spine and femur sites were higher in obese group and than the non‐obese group.
The role of lumbar spine radiography in the outcomes of patients with simple acute low back pain
Authors: DJAIS Nursamsu , KALIM Handono
Published: May 2005

Objectives:  To test the hypothesis that radiography of the lumbar spine in patients with simple acute low back pain (LBP) is not associated with improved patient outcomes.

Methods:  A small randomized unblinded controlled trial in patients with simple acute low back pain with duration of less than 12 weeks. This study was held in the outpatient Department of Rheumatology, Dr Saiful Anwar Hospital from May to September 2003. Intervention was usual care with lumbar spine radiography versus usual care without lumbar spine radiography. The outcome measures are Roland score, visual analogue scale for pain, EuroQol‐5 dimensions including the health status scale, at 3‐weeks after treatment. Statistical analysis with Mann–Whitney U‐test, χ2 test or Fisher's exact test with odds ratio. Analysis were performed using SPSS V. 10.0 for Windows.

Results:  During the 5 months of the study, 101 patients with LBP fulfilled the criteria of study presented at the Dr Saiful Anwar Hospital. Of the 101 patients, 75.2% patients completed the study. The intervention group significantly had a lower overall health status scale [70 (50, 80) vs. (80 (70, 90); Z = −2.28; P = 0.02] and slightly higher Roland and pain scores, [6.5 (2, 10) vs. 4.5 (2, 7); Z = −1.17; P = 0.25] and [4 (2, 6) vs. 3 (2, 5); Z = −1.82; P = 0.07], respectively.

Conclusions:  Radiography of the lumbar spine in patients with simple acute low back pain is not associated with improved patient functioning or severity of pain. Indeed, the overall health status of those who had a lumbar spine X‐ray appeared to be worse than those who did not.
Idiopathic Jaccoud's arthropathy
Authors: SIVAS Filiz , AYDOǦ Şükrü , PEKIN Yasemin , ÖZORAN Kürşat
Published: May 2005

We describe a patient who developed Jaccoud's type arthropathy without other prior rheumatic disease. Our patient's hand deformities were first noticed by chance at the age of 15 and gradually progressed over the next 4 years. We believe that after eliminating secondary causes, establishing a diagnosis of primary Jaccoud's arthropathy will prevent misdiagnoses and unnecessary treatment.
Successful treatment of two cases of resistant acquired angioedema
Authors: KAPLAN Mustafa , SAHAN Burak , OZMEN Namik , SOLMAZGUL Emrullah , SUNGUN Mutasim , NALBANT Selim
Published: May 2005

Angioedema has different causes and different clinical presentations that has two forms: acquired angioedema (types I and II) and hereditary angioedema. However, acquired angioedema type‐II is a very rare disorder and there is no significant treatment. So, in this paper, we propose to report the successful use of combination therapy of deflazacort and danazol for two such cases.
Outcomes of pregnancy complicated by thyroid disease
Authors: HARBORNE Lyndal R. , ALEXANDER Claire E. , THOMSON Andrew J. , O'REILLY Denis St J. , GREER Ian A.
Published: May 2005

Aims: To perform a case note review of pregnancies complicated by thyroid dysfunction to determine management and therapeutic intervention in relation to pregnancy outcome.

Methods: A retrospective case note analysis of 81 ongoing pregnancies in 70 pregnant women with a history of thyroid dysfunction over a period of 5 years at the Glasgow Royal Maternity Hospital (GRMH), Glasgow, Scotland, United Kingdom. The results of thyroid function tests and whether a change in treatment was instituted were recorded. Thyroid function was assessed by standard laboratory reference ranges for free thyroxine (FT4) and thyroid stimulating hormone (TSH) in all trimesters. Other parameters were also noted.

Results: Medication levels needed to be increased in the hypothyroid group (45%), and decreased (38%) in the hyperthyroid group.

Conclusion: Pregnancy outcome was good in majority of cases given appropriate replacement therapy for stated reference values.
Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging
Authors: DIETZ Hans Peter , PANG Selina , KORDA Andrew , BENNESS Christopher
Published: May 2005

Background: Paravaginal defects are often assumed to be the underlying anatomical abnormality in anterior compartment descent. Neither clinical examination nor ultrasound assessment are generally accepted diagnostic modalities.

Aims: To compare clinical examination and translabial 3D ultrasound in the detection of such defects.

Methods: Fifty‐nine women without previous prolapse or incontinence surgery were seen prospectively. Clinical and ultrasound assessments were carried out in blinded fashion. 3D translabial ultrasound was undertaken after voiding and supine. Volumes were acquired at rest, on Valsalva and on levator contraction. Loss of paravaginal support (‘tenting’) in the axial plane was taken to signify paravaginal defects.

Results: Paravaginal defects were reported clinically in 14 cases on the left (24%), 19 times on the right (32%). Two 3D ultrasound examinations did not yield satisfactory volumes, leaving 57 for analysis. Neither midsagittal nor coronal views yielded data that correlated with clinical assessments. In the axial plane there was absence of tenting at rest in 32/57 (57%) patients, but this did not correlate with clinical findings. Loss of tenting on Valsalva was observed less often (21/57, 37%) and was weakly associated with clinically observed lateral defects (P = 0.036).

Conclusions: Pelvic floor ultrasound in midsagittal, axial or coronal planes does not correlate well with clinical assessment for paravaginal defects. This could be due to poor clinical assessment technique or limitations of the ultrasound method. On the other hand, paravaginal defects may be uncommon or clinically irrelevant. On present knowledge, the paravaginal defect has to be regarded as an unproven concept.
Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women
Authors: OZDEMIR Ismail , DEMIRCI Fuat , YUCEL Oguz
Published: May 2005

Aims: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester.

Methods: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20–24, and 30–34 weeks’ gestation and the presence of a funnel was also noted. The study used the McNemar χ2 test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths.

Results: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10–14 weeks (P < 0.001). At 20–24 and 30–34 weeks’ gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20–24 week gestational age group, funnelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography.

Conclusions: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.
Bowel, bladder and sexual function in women undergoing laparoscopic posterior compartment repair in the presence of apical or anterior compartment dysfunction
Authors: THORNTON Michelle J. , LAM Alan , KING Denis W.
Published: May 2005

Objective: The aim of the study was to analyse the functional outcome of women undergoing a laparoscopic posterior compartment repair in the presence of anterior or apical compartment dysfunction.

Design: Prospective cohort study.

Methods: Forty women, median age 65 years (41–78), with symptoms of genital prolapse 31 (78%), urinary dysfunction 32 (80%) and bowel dysfunction 40 (100%), underwent laparoscopic posterior compartment repair in conjunction with an anterior compartment repair. Pre‐operative and postoperative bowel and bladder function was prospectively assessed with a Wexner continence score, Vienna constipation score and a urinary dysfunction score. Twenty‐eight (70%) and 24 patients (60%) had pre‐operative urodynamics and anorectal manometry. Post‐operatively all women were also assessed with a Watt's sexual dysfunction score and a linear analogue patient satisfaction score. Twelve women (30%) had postoperative anal manometry.

Results: At 20 months median follow‐up, 30 (97%), 20 (62%) and 12 (31%) women reported improvement in their prolapse, urinary and bowel symptoms, respectively. Post‐operatively, one woman reported denovo faecal incontinence, four worsening obstructive defecation and three denovo urinary dysfunction. Nine women (35%) reported denovo dyspareunia. The mean time to clinical deterioration following surgery was 11 months. Bowel function improvement was the only factor to significantly correlate with postoperative patient satisfaction.

Conclusion: The functional outcome of laparoscopic posterior compartment repair in the presence of anterior compartment dysfunction is disappointing. Preoperative counselling is important to ensure that patients have reasonable and realistic expectations from repair surgery, and an understanding that anatomical improvement might not be followed by long‐term functional improvement.
Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants – a regional review
Authors: WEST Claire R. , CURR Liz , BATTIN Malcolm R. , HARDING Jane E. , MCCOWAN Lesley M. , BELGRAVE Sue , KNIGHT David B. , WESTGATE Jenny A.
Published: May 2005

Background: Regional audits of term infants with neonatal encephalopathy (NE) provide an opportunity to examine issues related to causation and quality of care.

Aim: To document antenatal and intrapartum antecedents in a contemporary cohort of term infants with moderate or severe neonatal encephalopathy.

Methods: Term infants admitted with moderate‐severe neonatal encephalopathy over 4 years were identified. The clinical records were reviewed for information about the pregnancy and birth including interpretation of monitoring and subsequent management of the labour and delivery.

Results: Fifty‐two maternal records were reviewed. No mothers were diabetic or had gestations > 42 weeks, but 17% of the babies were small for gestational age (SGA). The cohort had evidence of antenatal hypoxia in 15%, a sentinel event in 25% and suboptimal fetal monitoring practice in at least 42% of cases.

Conclusions: Peripartum events were the major contributors to neurological damage in infants with neonatal encephalopathy. Suboptimal fetal monitoring practice and sentinel events remain the most common contributors. Ongoing education and training to address these issues should be available to all involved with intrapartum care in New Zealand.
Presenting symptoms of epithelial ovarian cancer
Authors: LATAIFEH Isam , MARSDEN Donald E. , ROBERTSON Greg , GEBSKI Val , HACKER Neville F.
Published: May 2005

Objectives: Epithelial ovarian cancer is a common disease with a high mortality, the latter being frequently attributed to late diagnosis due to failure to recognise symptoms of early disease. This study was designed to determine any differences in symptomatology between patients with early and advanced stage disease.

Design: A retrospective cohort study of 100 patients with stage 1 disease and 100 with stage 3 disease. Ten consecutive patients with stage 1 disease and 10 with stage 3 disease were identified from the database of patients treated each year from 1990 to 1999.

Setting: A tertiary referral centre for gynecological malignancy.

Outcome measures: The nature and duration of symptoms, age at presentation, and the size, histologic type and grade of tumour were determined by chart review, and the findings compared using logistic regression analysis.

Results: Ninety percent of women with early, and 100% with advanced disease reported at least one symptom. With early disease, abdominal pain was reported by 51% and abdominal swelling by 32%, and with advanced disease abdominal swelling by 62% and abdominal pain by 44%. Seventy percent of the early stage and 69% of the advanced stage cohorts reported symptoms of less than 3 months duration.

 Tumours less than 5 cm diameter were three times more likely to have advanced disease (P = 0.02).

 Grade 1 tumours were 40 times more likely to be early stage than grade 3 tumours.

 Serous tumours occurred in 25% of patients with early disease, and 45% with advanced disease (P = 0.01).

Conclusion: Patients with early stage ovarian cancer are likely to be younger and to have larger, better differentiated tumours that are more often non‐serous histologically. Advanced disease is not invariably due to delayed diagnosis.
Comparison of a self‐administered tampon ThinPrep test with conventional pap smears for cervical cytology
Authors: BUDGE Mardi , HALFORD Jenny , HARAN Mano , MEIN Jacki , WRIGHT Gordon
Published: May 2005

Aim: To assess a self‐administered tampon specimen as an alternative method of detecting cytological abnormalities and its acceptability in comparison with a conventional Papanicolou (pap) smear.

Design: Comparative observational study.

Setting/population: Two hundred and seventeen women were recruited from the colposcopy clinic of an outer urban public teaching hospital and from sexual health clinics at suburban and major metropolitan hospital clinics.

Methods: Participants inserted and immediately withdrew a tampon, then placed it into a vial of ThinPrep PreservCyt fluid. This was analysed by a local private pathology laboratory. Results were compared to a pap smear performed the same day or within the previous 6 months. All women with an abnormal result (tampon or pap smear) underwent a colposcopy, with or without biopsy as necessary. Participants completed a questionnaire after performing the tampon test.

Outcome measures: Probabilities of tampon test detecting (i) a high grade abnormality (pHG), (ii) any cervical intraepithelial neoplasia (CIN) changes (pCINany), and (iii) any abnormalities (pabn) compared to the conventional pap smear and, if abnormal, compared to the biopsy taken at colposcopy. Acceptability of the tampon test and conventional pap smear were also measured.

Results: Probabilities of the tampon test compared to pap smear: pabn sensitivity 33%, specificity 89%, PPV 59%, NPV 73%; pCINany sensitivity 23%, specificity 97%, PPV 71%, NPV 79%; pHG sensitivity 19%, specificity 98%, PPV 63%, NPV 89%. Acceptability for tampon test was 91.21% and for pap smear, 45.85%.

Conclusions: Although the self‐administered tampon ThinPrep method is a poor detector of cervical abnormalities compared to pap smear, it is highly acceptable to women. It has a relatively good negative predictive value (NPV). Our study suggests that if a more acceptable, sensitive method of cervical screening was found, which removed some of the existing barriers to conventional pap testing, screening rates for cervical cancer may improve.
Physiotherapy for female stress urinary incontinence: a multicentre observational study
Authors: NEUMANN Patricia B. , GRIMMER Karen A. , GRANT Ruth E. , GILL Virginia A.
Published: May 2005

Background: No previous data are available on the effectiveness of physiotherapy management of urinary stress incontinence with relevance to the Australian health system.

Aims: To evaluate Australian ambulatory physiotherapy management of stress urinary incontinence.

Methods: Observational multicentre clinical study of physiotherapy management of female stress urinary incontinence between February 1999 and October 2000, with 1‐year follow‐up. Outcome measures were a stress test and a 7‐day diary of incontinent episodes (pretreatment and at every visit) and a condition‐specific quality of life (QoL) questionnaire (pre‐ and post‐treatment). Subjects were followed‐up 1 year after treatment by questionnaire with a 7‐day diary, QoL questionnaire, and assessment of subjective outcome, subjective cure, satisfaction and need for surgery.

Results: Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (four to six) visits. At the end of the episode, 84% were cured and 9% improved on stress testing, whilst 53% were cured and 25% improved according to the 7‐day diary. Mean volume of urine loss on stress testing reduced from 2.4 (2.5) mL to 0.1(0.4) mL after treatment. There was a significant improvement in all QoL domains. Median (interquartile range) incontinent episodes per week were reduced from five (three to 11) to zero (zero to two) (P < 0.05) after treatment and to one (zero to four) at 1 year (P < 0.05). At 1 year, approximately 80% of respondents had positive outcomes on all outcome measures.

Conclusions: Physiotherapy management in Australian clinical settings is an effective treatment option for women with stress urinary incontinence.
Primary postpartum haemorrhage in an Australian tertiary hospital: a case‐control study
Authors: HENRY Amanda , BIRCH Mary‐Rose , SULLIVAN Elizabeth A. , KATZ Sue , WANG Yueping Alex
Published: May 2005

The present study aimed to determine the incidence of primary postpartum haemorrhage (PPH) after vaginal birth at an Australian tertiary hospital, and to investigate risk factors for primary PPH at this hospital. A case‐control study of women delivering vaginally at a tertiary hospital from February to June 2003 was performed. Demographic, antenatal, intrapartum, treatment and outcome data were abstracted from patient records. The study population comprised 125 cases and 125 controls, with a primary PPH rate of 12.1 per 100 vaginal births. Risk factors on multivariate analysis were past history of PPH, second stage labour > 60 min, forceps delivery, and incomplete placenta/ragged membranes.
Use of urethral plugs for urinary incontinence following fistula repair
Authors: GOH Judith TW , BROWNING Andrew
Published: May 2005

Astract

A common complication following anatomical closure of obstetric genito‐urinary fistula is urinary incontinence. Management is often suboptimal with lack of urodynamic equipment in most fistula centres in developing countries. Surgical interventions have been described with varying success. The aim of this paper is to describe the use of urethral plugs as an alternative management for women with postfistula incontinence, in a developing country. A pilot study was undertaken to assess the effectiveness of the urethral plugs in these women.

 The use of urethral plugs appear to be an effective short‐term management of women with postfistula incontinence, with minimal complications. Longer follow‐up and in larger numbers are required.
Pregnancy and the Rastelli operation
Authors: RADFORD Dorothy J. , STAFFORD Gregory
Published: May 2005

Background: The aim of surgical correction of congenital heart disease is for the patient to live a relatively normal life, including potential pregnancy and childbirth. The Rastelli repair operation using a valved conduit for certain complex congenital heart lesions has resulted in survival into adult life.

Aims: We reviewed reproductive outcome of 22 women over 18 years of age who were survivors of the Rastelli operation performed between 1977 and 1999.

Results: Six women had a total of 12 pregnancies with six live births. Three women, with complex transposition of the great arteries, developed more severe subaortic obstruction during pregnancy. All required further heart surgery. Delivery was by Caesarean section in three patients and vaginally in the other three. All infants were healthy and free from defects. Two women had tubal ligations because of their cardiac problems.

Conclusions: Women who have had Rastelli repair operation for complex congenital heart disease can have successful pregnancies. Subaortic stenosis can become a problem and should ideally be eliminated before pregnancy. Because of multiple operations, complications and genetic concerns, some women choose not to reproduce. Careful cardiac evaluation before, during and after pregnancy is essential.
Classification of Daily and Near‐Daily Headaches: Proposed Revisions to the IHS Criteria
Authors: Silberstein Stephen D. , Lipton Richard B. , Solomon Seymour , Mathew Ninan T.
Published: May 2005

SYNOPSIS

The International Headache Society (IHS) headache classification, while a major advance, does not adequately classify the daily and near‐daily headache disorders known as chronic daily headache (CDH). We believe that chronic daily headache is a group of disorders which includes chronic tension‐type headache (CTTH), transformed migraine (TM), new daily persistent headache (NDPH), and hemicrania continua (HC). We propose specific criteria for transformed migraine, new daily persistent headache, and hemicrania continua, and have modified the criteria for chronic tension‐type headache.
Visceral Pain Threshold is Deeply Lowered Far From the Head in Migraine
Authors: Nicolodi Maria , Sicuteri Riccardo , Coppola Giulio , Greco Enzo , Pietrini Umberto , Sicuteri Federigo
Published: May 2005

SYNOPSIS

A short‐lasting over‐distension of the hand‐forearm veins, obtained through a non‐invasive original maneuver (Hand Arm Vein Distension test) induces local pain when applied to mi‐graine sufferers in inter‐critical period. Conversely, subjects with an absolutely negative personal and family history for any type of idiopathic headache do not report any pain or only an uncertain, slight one.

The injection of 1 mL of 2% to 8% (i.e. 0.34 mol/L to 1.36 mol/L) hypertonic saline into the antecubital vein during an extemporary short 1 minute) circulatory blockage (ischemia induced to guarantee a strictly local action of the chemical stimulus) provokes moderate, strong or unbearable local (arm vein) pain in migraine sufferers but not in subjects with a personal and family history absolutely free from any type of headache. These results show for the first time that migraineurs show a proneness to visceral pain in viscera (veins) distant from the head (arm‐hand). Such finding is consistent with the theory that migraine pain is due to a central derangement of the viscerosensory system.
Chronic Paroxysmal Hemicrania and Hemicrania Continua: Orbital Phlebography and MRI Studies
Authors: Antonaci Fabio
Published: May 2005

SYNOPSIS

Six patients with chronic paroxysmal hemicrania (CPH) and 10 patients with hemicrania continua (HC), two indomethacin‐responsive, unilateral, headache syndromes, were investigated with orbital phlebography and magnetic resonance imaging of the brain. Orbital phlebography apparently showed pathological findings more frequently in CPH than in HC. Such abnormalities did not always show preference for the side of headache. MR scans were grossly normal in these headaches.
Neuropeptide Y in Juvenile Migraine and Tension‐Type Headache
Authors: Gallai Virgilio , Sarchielli Paola , Trequattrini Alberto , Paciaroni Maurizio , Usai Francesca , Palumbo Renato
Published: May 2005

SYNOPSIS

Neuropeptide Y (NPY) is widely distributed throughout sympathetic nerve endings where it is co‐stored and co‐secreted with noradrenaline. It is considered a marker of noradrenergic function. To determine the role of NPY in the pathogenesis of juvenile headache, we determined its plasma levels in two groups of young migraine patients (with and without aura), in a group of episodic tension‐type headache patients and in a group of age and sex‐matched healthy subjects. Significantly lower plasma levels of NPY were evident in the migraine patients with aura (P<0.001) and, to lesser extent, in the migraine patients without aura (P<0.02), both assessed in the interictal period, with respect to the control group. Plasma NPY levels tended to significantly increase during attacks in migraine patients with aura (P<0.0009). A less evident, though significant increase was also present during attacks in migraine patients without aura (P<0.02). No significant variations were observed between headache‐free periods and attacks in tension‐type headache patients. Reduced NPY levels in the interictal period can be considered further evidence of the derangement of the sympathetic function in the course of migraine, particularly that with aura. The increase in NPY levels during migraine attacks could be an expression of sympathetic activation, even though the functional status of this system is less efficient.
Geomagnetic Activity, Humidity, Temperature and Headache: Is, There Any Correlation?
Authors: Matteis G. De , Vellante M. , Marrelli A. , Villante U. , Santalucia P. , Tuzi P. , Prencipe M.
Published: May 2005

SYNOPSIS

Meteorological factors influence several biological functions. Geomagnetic activity (GMA) can be considered a trigger factor of migraine attacks. We studied the possible relationship between 40 migraine patients and some meteorological factors: humidity, temperature and geomagnetic activity in particular. All frequency changes of geomagnetic activity, temperature and humidity values are recorded daily.

The study was performed from March to June 1988 over a geographically small area in order to avoid climatic and environmental influences. Our results indicate a significant correlation between geomagnetic activity and migraine attack frequency.

Controversial opinions concerning the modalities of data collection and the possible relationships between environment and headache raise the need of further studies.
Chronic Tension‐Type Headache, Mood Depression and Serotonin: Therapeutic Effects of Fluvoxamine and Mianserine
Authors: Manna Vincenzo , Bolino Francesca , Cicco Loredana Di
Published: May 2005

SYNOPSIS

Forty out‐patients affected by chronic tension‐type headache were selected according to the diagnostic criteria of International Headache Society (IHS) Headache Classification Committee. In a controlled trial patients received placebo for a four‐week baseline period, then they were randomized in double‐blind fashion to therapy with mianserine (30‐60 mg/day) or fluvoxamine (50‐100 mg/day) for another eight‐week period. Frequency of headache, pain severity and analgesic consumption were evaluated using a self‐monitoring system. Mood depression was evaluated at 0, 4 and 8 weeks by using Zung'ss Self‐Rating Depression Scale and Hamilton Rating Scale for Depression. Both drugs were beneficial in the treatment of chronic tension‐type headache. Non‐depressed subjects with more severe headache responded best to fluvoxamine, whereas mianserine was more effective in the treatment of depressed patients with moderate headache. These results suggest that central serotoninergic neurotransmission can play a role in the pathophysiology of chronic tension‐type headache also in non‐depressed patients.
Subcutaneous Sumatriptan in a Clinical Setting: The First 100 Consecutive Patients With Acute Migraine in a Tertiary Care Center
Authors: Sheftell Fred D. , Weeks Randall E. , Rapoport Alan M. , Siegel Sheryl , Baskin Steven , Arrowsmith Frances
Published: May 2005

SYNOPSIS

The first 100 consecutive patients at our center receiving subcutaneous sumatriptan (6 mg) were evaluated over a total of 455 migraine attacks. Parameters included overall efficacy, average time to relief, recurrence rate, average time to recurrence, adverse events, comparison to previous abortive agents, and subjective global ratings. Overall efficacy (defined as headache severity reduction from severe or moderate to mild or none) was 84%. Average time to relief was 40 minutes. Nine percent failed to respond at all. Recurrence rate was 46.5% with 36% of patients having no recurrence. Fourteen percent of patients reported 100% recurrence (minimum 3 attacks; average 5.4 attacks). Time to recurrence varied widely, but averaged 9.1 hours. Eighty‐one percent rated the drug better or much better than previous abortive medications in terms of sumatriptan's ability to abort the attack. Seventy‐seven percent reported some adverse event (generally mild and transient) with 23% reporting no adverse events, Sixty‐nine percent reported a global rating of Good to Excellent and 31% rated Poor or Fair. The rate of recurrence and average time to recurrence were the most significant factors affecting the global ratings.

These parameters were further evaluated with respect to a variety of subgroups: 1) migraine alone 2) migraine with coexistent tension‐type headache 3) drug‐induced headache (analgesic rebound headache) 4) posttraumatic headache 5) preventive versus no preventive medication 6) presence or absence of adverse events 7) presence or absence of recurrence and 8) average duration of migraine with no medication.
Cluster Headache: Pulse Rate Changes Evoked by Hyperoxia and Hypoxia
Authors: Shen Jie Ming , Schaanning Jan
Published: May 2005

SYNOPSIS

To test the influence of arterial O2 saturation (SaO2) on heart rate in cluster headache, changes in pulse rate induced by hyperoxia and hypoxia were monitored in 11 cluster headache patients (6 during cluster period, and 5 during remission). The results were compared with those obtained in 11 age and sex matched healthy individuals. The subjects were administered 5 min each of 100% O2 and 12% O2 in nitrogen in sequence. The aim of the latter procedure was to reduce SaO2 to approximately 80%. Pulse rate wasrecorded every minute from a finger pulse oximeter during the whole procedure.

Cluster headache patients, in particular during the bout, had a slightly lower basal pulse rate than controls (P>0.5, Student's t‐test).This tendency was maintained throughout the test. Hyperoxia and hypoxia resulted in a marked, significant decrease and increase,respectively, in pulse rate from baseline values within each group. However, the difference between groups was not significant at anystage. Cluster headache patients therefore seem to have the same heart rate response to changes in SaO2 as healthy individuals. Themarked heart rate changes which sometimes accompany cluster headache are unlikely to be caused by SaO2 changes.
Cluster Headache: The Peripheral Chemosensitivity as Indicated by the Single‐Breath CO2 Test
Authors: Shen Jie Ming , Schaanning Jan , Kruszewski Piotr , White Linda R.
Published: May 2005

SYNOPSIS

A single‐breath CO2 test was carried out in cluster headache patients both during bout and remission, and in matchedhealthy individuals (n = 10 for each group) to assess peripheral chemosensitivity. The test subjects inhaled one tidal breath of13% CO2 in air. The response was expressed as the maximal increase in inspiratory minute ventilation (VI) within 20 secondsfrom the exposure to CO2, divided by the increase in end‐tidal PCO2 (PETCO2) (the difference in PCO2 between the testbreath and the preceding control breaths): DVI/DPETCO2.

Under the initial resting condition, cluster headache patients within the bout showed a slight hyperventilation in that therewas a significantly reduced PETCO2 (P < 0.05, Student's paired t‐test), and during remission, higher VI, and a lower PETCO2 (P < 0.05, Wilcoxon signed rank test), in comparison with the controls. There was no statistically significantdifference as regards the peripheral chemosensitivity between cluster headache and control groups. These results indicatethat cluster headache patients have an intact and properly‐functioning carotid body.
Periorbital Venous Vasculitis, Intracranial Hypertension and Empty Sella
Authors: Hannerz Jan , Greitz Dan , Ericson Kaj
Published: May 2005

SYNOPSIS

Sixteen patients with chronic periorbital venous vasculitis without nerve involvement and 9 patients with active episodic cluster headache were studied as to cerebrospinal fluid (CSF) pressure. Eighty‐one percent of the patients with chronic and 33% with episodic symptoms had pathologically increased CSF pressure. Magnetic resonance imaging of the brains in the chronic group showed empty sella in 60%, cerebral atrophy in 21% and white matter lesions with high signal intensity on T2 weighted sequences in 29%. Abnormal obesity was found in 31% of the patients with chronic periorbital venous vasculitis under 60 years of age. Venous vasculitis is suggested as a cause of intracranial hypertension, empty sella, and endocrinologic dysfunctions.
Perimenstrual Migraine: Effect of Estraderm TTS(r) and the Value of Contingent Negative Variation and Exteroceptive Temporalis Muscle Suppression Test
Authors: Smite M.G. , van der Meer Y.G. , Pfeil J.P.J.M. , Rijnierse J.J.M.M. , Vos A.J.M.
Published: May 2005

SYNOPSIS

In 20 patients with pure menstrual migraine either Estraderm TTS 50° patches (E) or placebo (P) patches were applied during three successive menstrual cycles, randomly allocated to the treatment sequences E‐P‐E or P‐E‐P. Clinical neurophysiological tests, contingent negative variation (CNV) and exteroceptive temporalis muscle suppression test (ETST) were performed before treatment. The predictive value of these tests regarding the efficacy of Estraderm TTS was studied.

Neither the number, duration and severity of the migraine attacks, nor the consumption of analgesics and ergotamine differed significantly during Estraderm TTS and placebo treatment.

The ETST was consistent with migraine in 35% (95% confidence interval 15.4 to 59.2) of the patients. The CNV in 55% (31.5 to 76.9), and both tests in 25% (8.7 to 49.1%).

Regarding the prediction of the Estraderm TTS effect on the migraine attacks, the specificity of the ETST, CNV and the combination of ETST with CNV, calculated for the first two cycles, was respectively 81.8% (48.2 to 97.7), 45.5% (16.8 to 76.6) and 80% (28.4 to 99.5). For the last two cycles these values were respectively 75% (42.8 to 94.5), 50.0% (21.1 to 87.9) and 71.4% (29.0 to 96.3). The sensitivity of the tests was respectively 62.5% (24.5 to 91.5), 62.5% (24.5 to 91.5) and 66.7% (22.3 to 95.7) in the first 2 cycles. In the last 2 cycles 50.0% (15.1 to 84.3), 62.5% (24.5 to 91.5) and 60% (14.7 to 94.7).

This study did not demonstrate an effectiveness of Estraderm TTS in perimenstrual migraine, except for the subgroup of perimenstrual migraine patients in whom the ETST test results were consistent with migraine.
How Cluster Headache is Explained as an Intracavernous Inflammatory Process Lesioning Sympathetic Fibers
Authors: Hardebo Jan Erik
Published: May 2005

SYNOPSIS

A large body of evidence points to an inflammatory process in the cavernous sinus and tributary veins as being primarily responsible for cluster headaches. The inflammation obliterates the venous outflow from the cavernous sinus on one side and injures the through‐running sympathetic fibers to the eye, upper eye lid, forehead skin, and the intracranial internal carotid artery and its branches. The active period ends when the inflammation is suppressed and the sympathetic fibers partially or fully recover. Evidence is presented that the symptoms suggestive of an enhanced parasympathetic activity during attacks may alternatively be explained as local pain fiber activation or a stasis in the outflow from the cavernous sinus. Vasodilator agents like nitroglycerin induce an attack by enhancing the venous load on the cavernous sinus. Constriction of the proximal intracranial internal carotid artery, spontaneously induced by tressful pain activation of the perivascular sympathetic nerves, or by exogenous administration of serotonin 1 D‐like receptor agonists or oxygen, terminates the venous load and thus the pain and associated symptoms.
“Capsaicin‐Sensitive” Sensory Neurons in Cluster Headache: Pathophysiological Aspects and Therapeutic Indication
Authors: Fusco Bruno M. , Fiore Giuseppe , Gallo Francesca , Martelletti Paolo , Giacovazzo Mario
Published: May 2005

SYNOPSIS

Capsaicin, when repeatedly applied to the nasal mucosa of cluster headache patients, has been shown to prevent the occurrence of pain attacks. In order to investigate the mechanism of the drug's action, we evaluated the effect of repeated nasal application of capsaicin on the contents of sensory fibres immunoreactive to substance P and CGRP in the rat nasal mucosa. Further, considering the possible involvement of the cerebral circulation, we verified the effect of a single application of capsaicin on the blood flow velocity of the internal carotid and middle cerebral arteries (of both sides) and the basilar artery, in a group of healthy humans. The measurements were taken using Doppler devices. In order to verify the reproducibility of therapeutic effect of capsaicin, we carried out a 2‐year follow‐up study on patients affected by cluster headache (17 by episodic form, 8 by chronic form) who responded positively to the first treatment with capsaicin. During this period they were treated again with capsaicin in case of re‐occurrence of symptoms. Capsaicin depletes the fibers immunoreactive to substance P and CGRP in the rat nasal mucosa. In the healthy controls, a single application induced vasodilation in the internal carotid, whereas middle cerebral arteries and basilar artery were narrowed. The results of the follow‐up study, demonstrates that in 65% of the patients, the beneficial effect of capsaicin was again present when the treatment was repeated. In the chronic patients the therapeutic effect was always transitory (lasting, at maximum one month). The present findings indicate that a specific effect on the nociceptive fibers and perhaps the consequential reflex modifications in the cerebral circulation, could play a role in the therapeutic effect of capsaicin. This effect has been shown to be repeatable. The present results, apart from indicating future therapeutic strategies, also offered interesting clues for the interpretation of the pathophysiology of the syndrome.
MMPI Profiles of Turkish Headache Sufferers
Authors: Inan L. , Soykan C. , Tulunay F.C.
Published: May 2005

SYNOPSIS

The investigations of personality traits have been the issue of many studies on patients with headache. Minnesota Multiphasic Personality Inventory (MMPI) is the most popular assessment instrument used in these studies. MMPI responses of 36 cases (14 male, 22 female) with tension headache and 44 cases (11 male, 33 female) with migraine headache had been compared with 36 nonheadache controls (12 male, 24 female). Because of the inadequate number of male subjects, the statistical analyses were made between female groups. The results obtained revealed that subjects in the tension‐type headache group got significantly higher scores on neurotic subtests (hypochondriasis, depression, hysteria) than subjects in the control group. Likewise, migraine subjects got significantly higher scores on hysteria subtest than control subjects. No significant differences were noted between migraine and tension groups. However, none of the headache groups could be characterized by marked elevations on any of the validity and clinical scales. These results, support the finding that neurotic symptoms occur with a higher frequency in headache sufferers.