bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age at Diagnosis and Quality of Life in Breast Cancer Survivors
Authors: Cimprich Bernadine , Ronis David L. , Martinez‐Ramos Gloria 
Published: March 2003

purpose: The purpose of the study was to determine the relationship between life‐stage variables (ie, age at diagnosis and years of survival) and quality‐of‐life (QOL) outcomes in long‐term survivors of breast cancer.description of study: In this cross‐sectional study, 105 long‐term survivors of breast cancer participated in a mailed survey assessing QOL. Participants were selected from a cancer center tumor registry using a stratified random‐sampling procedure that was based on age at diagnosis. The Quality of Life‐Cancer Survivors scale was used to assess QOL outcomes in the physical, psychological, social, and spiritual domains.results: Long‐term survivors of breast cancer who had received diagnoses at an older age (> 65 years) showed significantly (P < .05) worse QOL outcomes in the physical domain, while those who had received diagnoses at a younger age (27–44 years) showed worse QOL outcomes in the social domain than other age groups. A nonlinear relationship was observed, with long‐term survivors who had received diagnoses in middle age (45–65 years) showing better QOL outcomes in the physical domain and in overall QOL. Age at diagnosis and years of survival were significant predictors of QOL outcomes.clinical implications: These findings indicate that the life stage at diagnosis can help to predict long‐term QOL outcomes in breast cancer survivors. Educational strategies to help oncology professionals develop a better understanding of the impact of age at diagnosis may be important in developing tailored interventions that respond to the specific needs of breast cancer survivors at each life stage.
Family Perspectives of Ovarian Cancer
Authors: Ferrell Betty , Ervin Kate , Smith Stephany , Marek Thais , Melancon Cindy 
Published: March 2003

purpose: This qualitative study explored quality of life (QOL) in family caregivers of ovarian cancer patients to better define their needs for support.description of study: One thousand one hundred pieces of correspondence written by family caregivers of ovarian cancer patients were contributed to the City of Hope investigators by the founder and editor of Conversations!: The International Newsletter for Those Fighting Ovarian Cancer. The investigators analyzed meaningful comments in the letters using content analysis methods.results: Comments by family caregivers reflected little concern for their own physical well‐being and, instead, focused on the psychological, social, and spiritual aspects of their experiences. Correspondence on the psychological effects of caregiving demonstrated poor QOL stemming from feelings of lack of control and helplessness. Social data showed that family caregivers lacked support, were given to feelings of isolation, and experienced considerable anxiety regarding the genetic nature of the disease. Spiritual well‐being was particularly important to caregivers, as they drew strength from their faith and were able to find positive meaning in their experiences.clinical implications: The study findings revealed that caregivers require additional support from the healthcare community, especially to address disease‐specific needs in patients with ovarian cancer. The correspondence demonstrates a need in family caregivers to connect with others fighting the same disease. This study also identifies the need for support for at‐risk women, as well as a continuing need for palliative‐care services.
Survivorship Resources for Post‐Treatment Cancer Survivors
Authors: Tesauro Gina M. , Rowland Julia H. , Lustig Craig 
Published: March 2003

purpose: The purpose of this project was to determine the scope of services and resources available to cancer survivors who have completed active treatment and their families at National Cancer Institute (NCI)‐designated comprehensive cancer centers.description of study: Patient education program contacts from the 37 NCI‐designated comprehensive cancer centers participated in a telephone interview. Program contacts were asked to identify the types of medical and psychosocial services that their respective cancer center offered.results: Telephone interviews were completed by patient education program contacts from all NCI‐designated comprehensive cancer centers for a total response rate of 100%. Services pertaining to lymphedema management were identified in 70% of cancer centers. Other common services identified specifically for post‐treatment cancer survivors at cancer centers were professionally led support groups (49% of cancer centers), long‐term medical care (38% of cancer centers), school re‐entry programs (19% of cancer centers), nutrition counseling (14% of cancer centers), and counseling addressing fertility and sexual concerns (14% of cancer centers).clinical implications: Results from this project outline the range of services and resources that are provided to post‐treatment cancer survivors by NCI‐designated comprehensive cancer centers, and can be used to develop standards of care for future cancer control programs.
Extreme Cases: A Strategy for Ecological Risk Assessment in Ecosystem Health
Authors: Hood Robert L. 
Published: March 2003

ABSTRACTI contend that focusing on the “absence of health,” or what I will call “extreme cases,” provides a basis for agreement about ecosystem health in ecosystem management. An extreme case is defined where there exists (1) scientific agreement about models, (2) scientific agreement about scale, (3) policy agreement that the risks will be great and unnecessarily so. Scientific agreement requires that a link be established between biodiversity and ecosystem processes, goods, and services. I discuss recent work concerning ecosystem engineers that demonstrates such a link. Agreement about scale requires consensus about the scale of management decisions, both spatial and temporal, and reconciliation of management goals and objectives of the various stakeholders in an ecosystem. Finally, policy agreement requires that ecological risks be great and unnecessarily so. Where these extreme cases do not apply, I suggest that it will be useful to appeal to stakeholder negotiations to seek agreement concerning ecosystem health.
Occipital Lobe Tumor Presenting as Migraine With Typical Aura
Authors: Verma Ashok , Rosenfeld Victor , Forteza Alajanc ro , Sharma Khema R. 
Published: March 2003

We report the case of a 60‐year‐old woman in whom migraine with typical aura heralded the presence of an occipital lobe tumor. Her headache was characterized by recurrent episodes of visual aura confined to the left visual field followed by right hemicranial throbbing headaches accompanied by nausea, photophobia, and phonophobia. Interictal neurologic and ophthalmologic examinations were negative, as was an unenhanced brain CT scan. The headaches increased in frequency over 4 months despite a number of medications known to prevent attacks of migraine.A low‐grade right occipital lobe tumor was eventually discovered on MR scan. This case illustrates that headache fulfilling the International Headache Society (IHS) criteria for migraine with typical aura can occur in association with an occipital lobe tumor.
The Placebo Effect in Acute Headache Management: Ketorolac, Meperidine, and Saline in the Emergency Department
Authors: Harden R. Norman , Gracely Richard H. , Carter Timothy , Warner George 
Published: March 2003

In a prospective, double‐blind, randomized study, ketorolac 60 mg, meperidine 50 mg plus promethazine 25 mg, and normal saline given by intramuscular injection were compared as treatment for acute headache crises. Thirty patients (6 men and 24 women) presenting to an urban emergency department with any type of benign headache were randomized into three groups and filled out the McGill Short‐Form Paint Questionnaire with a Pain Rating Index and a Visual Analogue Pain scale. They received one of the study medications and repeated the testing after I hour. The objective was to test the efficacy of ketorolac in this population.Separate analyses of the McGill Short‐Form (Total, Sensory, Affective, and Pain Rating Index scales) and the Visual Analogue Pain scale responses showed that the three treatments produced a significant reduction in pain (P<.0001), but that pain reduction did not differ among the treatments. This profound reduction observed after administration of a placebo prevented accurate evaluation of the effects of ketorolac. The placebo response must be considered in the design of future trials using intramuscular medications in the acute intervention of headache crises. In addition, the use of a standard analgesic is necessary to demonstrate both assay sensitivity and magnitude of response to placebo.
Treatment of Migraine With BMS180048: Response at 2 Hours
Authors: Couch James R. , Saper Joel , Meloche Jacques P. 
Published: March 2003

BMS180048 is a 5HT1D agonist that was well‐tolerated in early phase II trials. This study utilized a double‐blind, parallel‐group dose ranging format, comparing BMS180048 in doses of 25, 50, or 75 mg to placebo in effectiveness of treatment of a single migraine headache.To assess tolerability of BMS180048, patients received a test dose of the medication they would receive for a headache in the clinic under observation. If no significant side effects occurred, patients were allowed to treat a headache. Headaches were moderate or severe in intensity before treatment, and response at 2 hours was tabulated. Reduction to mild or no headache was the criteria for successful response. Response rates at 2 hours were as follows:

• placebo ‐ 19 of 53 subjects (35.8%)

• 25 mg ‐ 21 of 53 subjects (40.3%)

• 50 mg ‐ 34 of 53 subjects (64.2%)

• 75 mg ‐ 35 of 55 subjects (63.6%)

The improvement for subjects treated with 50 or 75 mg of BMS180048 when compared to placebo was highly significant (P<.01). Nausea, photophobia, and phonophobia improved 35% to 50% for BMS180048‐treated subjects and 20% to 24% in the placebo group. The improvement in these symptoms in comparison to placebo was statistically significant only for nausea in those treated with 75 mg of BMS180048 (P=.02). Side effects were mild for the most part, and no serious adverse events occurred. The study suggests BMS180048 is effective in acute symptomatic therapy of migraine.
Impact of Sumatriptan on Clinic Utilization and Costs of Care in Migraineurs
Authors: Litaker David G. , Solomon Glen D. , Genzen Jonathan R. 
Published: March 2003

Background.—Although migraine headaches affect a large segment of the population, no objective measure of therapeutic success is currently available. Comparing visit frequency and associated costs of care before and after introduction of a new therapy represents an important surrogatemeasure of success.Methods.—One hundred four patients regularly attending a headache clinic for migraines at a tertiary care hospital were instructed in the use of a new abortive migraine therapy. Medical appointment and financial systems were searched retrospectively for visit frequency and associated patient care and institutional costs. The number of visits and mean costs 18 months before and after initiation of therapy were compared using the signed rank test and paired t‐test, respectively.Results.—The median number of visits made by study subjects to the headache clinic fell significantly following sumatriptan test dosing (P<0.001). Prior to the new treatment, mean total patient care and institutional costs were $228.59 and $112.81 per person, respectively, and fell to $135.93 and $78.16 (P<0.001) after therapy began.Conclusions.—These data suggest that many patients with migraine benefit from sumatriptan, seek medical attention in a headache clinic less often, and incur fewer costs following initiation of treatment with this drug.
Frequency of Magnetic Resonance Imaging Abnormalities in Patients With Migraine
Authors: Cooney Brian S. , Grossman Robert I. , Farber Roger E. , Goin James E. , Galetta Steven L. 
Published: March 2003

Background.‐The frequency of magnetic resonance imaging (MRI) abnormalities in patients with migraine has been reported at 12% to 46%. We examined a series of patients to determine the frequency of MRI abnormalities, and any relationship of frequency with patient age, sex, migraine type, duration of symptoms, and other medical conditions.Methods.‐Magnetic resonance imaging findings were reviewed retrospectively with respect to presence of focal white matter hyperintensities in 185 consecutive patients. Patients had been diagnosed with migraine by a neurologist. All images had been interpreted by a neuroradiologist. Clinical information was obtained by chart review.Results.‐Sixteen percent had focal white matter abnormalities. Among patients less than 50 years old, and without other medical problems such as hypertension, atherosclerotic heart disease, diabetes mellitus, autoimmune disorder or demyelinating disease, only 6% had white matter abnormalities. Increased frequency of white matter abnormalities was associated with age and medical risk factors, but not with sex, migraine subtype, or duration of migraine symptoms.Conclusion.‐The observed frequency of MRI abnormalities in our series is lower than has been previously reported. In many cases, these abnormalities may be unrelated to migraine. When such changes are discovered in a patient with migraine, other etiologies should be considered.
Photophobia and Phonophobia in Migraineurs Between Attacks
Authors: Main Alan , Dowson Andrew , Gross Michael 
Published: March 2003

This study investigated whether migraineurs are more sensitive to light and sound while headache‐free than are: healthy people. Fifty‐two migraineurs (mean age 39 years) were selected using the International Headache Society diagnostic criteria for migraine. Forty‐eight healthy controls were matched for age, sex, and race (mean age 36 years). Visual and auditory discomfort thresholds were measured by exposing subjects to increasing light and sound until then complained of discomfort. There were significant differences; between groups in both the light discomfort threshold (P<0.90005) and the hearing discomfort threshold (P<0.0005) The thresholds for both were lower in the migraineurs.Overall, for both groups together, there was a significant negative correlation between light discomfort threshold and age (correlation coefficient ‐0.2276, P=0.011), but not for the hearing discomfort threshold and age (P=0.275).The results show that the migraineurs were significantly more sensitive to light and sound when headache‐free than were healthy controls. The apparent increased intolerance to light in both groups together noted with increased age, did not apply to the migraine group.
Painful Trigeminal Neuropathy: Clinical and Pharmacological Observations
Authors: Khurana Ramesh K. , Mayer Richard F. 
Published: March 2003

A 74‐year‐old woman had a 5‐year history of constant burning pain and numbness of the central face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving wore present. Oral administration of 500 mg dopa aggravated her pain and produced transient hypalgesia in the C2 through C5 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers.In conclusion: (1) Only the central region of the face is enclusively supplied by the trigeminal nerves. (2) Somato‐autonomic reflexes coupled with electrophysiological studies Iocalized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.
Cerebral Blood Flow in Chronic Posttraumatic Headache
Authors: Gilkey Stephanie J. , Ramadan Nabih M. , Aurora Taruna K. , Welch KMA 
Published: March 2003

Background and Purpose.‐Headache is the most common neurologic symptom following minor closed head injury. There is often a lack of objective evidence supporting an organic basis of cerebral pathology in these cases. This pilot study considers the possibility of alterations in cerebral blood flow, indicating evidence of an organic disorder in posttraumatic headache.Methods.‐Regional cerebral blood flow studies of 35 patients with chronic posttraumatic headache (PTH) (International Headache Society criteria), identified retrospectively from our cerebral blood flow data base, were compared with those of 49 nonheadache controls and 92 migraineurs (Ad Hoc Committee criteria). Regional cerebral blood flow (initial slope index method) was measured using the xenon Xe 133 inhalation technique.Results.‐Compared to migraineurs and controls, and after adjusting for differences (analysis of covariance) in baseline variables such as blood pressure, hematocrit, and Pco 2 , patients with PTH had: (1) significantly lower mean initial slope indices (P<0.001, P=0.002, respectively); (2) regional interhemispheric flow differences (rlFD), with higher distribution of regional asymmetrical probe pairs (rIFD≥7%: P[PTH versus control]=0.006, P[PTH versus migraine]=0.016; rIFD≥10%: P[PTH versus control]=0.011, P[PTH versus migraine]=0.003]; and (3) more hemispheric asymmetries (P[PTH versus control]=0.023, P[PTH versus migraine]=0.57). Lower mean initial slope indices and hemispheric asymmetry (mean interhemispheric flow difference ≥3.2%) predicted PTH over control (P=0.023 and 0.002, respectively). Lower mean initial slope indices predicted PTH over migraine (P=0.002).Conclusions.‐Patients with PTH have reduced regional cerebral blood flow, and regional and hemispheric asymmetries. These cerebral hemodynamic alterations support an organic basis to chronic posttraumatic headache.
Chronic Paroxysmal Hemicrania Presenting as Otalgia With a Sensation of External Acoustic Meatus Obstruction: Two Cases and a Pathophysiologic Hypothesis
Authors: Boes Christopher J. , Swanson Jerry W. , Dodick David W. 
Published: March 2003

Objective.—To describe two cases of chronic paroxysmal hemicrania manifested by otalgia with a sensation of external acoustic meatus obstruction and to suggest that the trigeminal‐autonomic reflex is a mechanism for the sensation of ear blockage.Background.—Maximum pain in chronic paroxysmal hemicrania is most often in the ocular, temporal, maxillary, and frontal regions. It is less often located in the nuchal, occipital, and retro‐orbital areas. Review of the literature on chronic paroxysmal hemicrania found no reports of pain primarily localized to the ear and associated with a sensation of external acoustic meatus obstruction.Methods.—The history, physical examination, imaging studies, and successful treatment plan in two patients with otalgia and ear fullness and a subsequent diagnosis of chronic paroxysmal hemicrania are summarized.Results.—The first patient was a 42‐year‐old woman with a 10‐year history of unilateral, severe, paroxysmal otalgia occurring five times a day with a duration of 2 to 60 minutes. During an attack, the ear became erythematous and the external acoustic meatus felt obstructed. There were no other associated autonomic signs. The second patient was a 49‐year‐old woman with a 3‐year history of unilateral, severe, paroxysmal otalgia occurring 4 to 15 times a day with a duration of 3 to 10 minutes. During an attack, her ear felt obstructed, and she noted ipsilateral eyelid edema and ptosis. Both patients quickly became pain‐free after taking indomethacin and required its continued use to prevent headache recurrence.Conclusions.—Chronic paroxysmal hemicrania may be manifested by otalgia with a sensation of external ear obstruction. When the otalgia is paroxysmal, unilateral, severe, frequent, and associated with autonomic signs, one should consider the diagnosis of chronic paroxysmal hemicrania, especially because of the prompt response to indomethacin. The most important feature to consider when making the diagnosis of chronic paroxysmal hemicrania is the frequent periodicity of discrete, brief attacks of unilateral cephalgia separated by pain‐free intervals. It is hypothesized that the sensation of ear obstruction in these patients is due to swelling of the external acoustic meatus mediated through increased blood flow by the trigeminal‐autonomic reflex.
Selective Serotonin Reuptake Inhibitors for Migraine Prophylaxis
Authors: Landy Stephen , McGinnis Judy , Curlin Dana , Laizure S. Casey 
Published: March 2003

The objective of this study was to assess the efficacy of sertraline in migraine prophylaxis. Other selective serotonin reuptake inhibitors have been studied for migraine prophylaxis, but this is the first report with sertraline. Twenty‐seven subjects were enrolled and baseline assessment of migraine frequency and severity were measured over a 4‐week period. Subjects were then randomized to receive placebo or sertraline in a double‐blind fashion with headache frequency and severity measured over an 8‐week period. Subjects completed a daily diary reporting the occurrence, severity, and degree of impairment associated with migraine.The headache index, a composite measure of migraine frequency and severity, scores did not significantly improve between assessments at baseline (20.8 ± 14.88), 8 weeks (17.6 ± 12.27), and 12 weeks (16.7 ± 6.38) in the treatment group (n=6) (P=0.956). This finding is compared to other studies with the serotonin selective reuptake inhibitors, fluoxetine, fluvoxamine, and paroxetine. The authors believe that the selective serotonin reuptake inhibitors are not as effective as conventional migraine prophylaxis medications such as β‐blockers, tricyclic antidepressants, or divalproex sodium, but that in patients with comorbid depression who have failed conventional therapy selective serotonin reuptake inhibitors may be effective.
Chronic Inflammatory Demyelinating Polyneuropathy Presenting With Headache and Papilledema
Authors: Morrison Karen E. , Davies Paul T.G. 
Published: March 2003

Chronic inflammatory demyelinating polyneuropathy is a disorder typified clinically by motor and sensory neuropathy of at least 2 months' duration and pathologically by multifocal inflammatory demyelination. Its usual presentation is with features reflecting the polyneuropathy, namely limb weakness with hyporeflexia or areflexia and sensory symptoms of glove and stocking distribution.In this report, we detail the course of a 53‐year‐old man who presented to our neurological service with a severe headache in association with papilledema. The initial diagnosis considered was of possible primary intracranial pathology. Two months later, he developed limb weakness and sensory symptoms typical of chronic inflammatory demyelinating polyneuropathy. His headache, papilledema, and limb symptoms responded to oral corticosteroid therapy, the standard treatment for this type of neuropathy. We hypothesize that his headache and papilledema were due to the elevated cerebrospinal fluid protein level as a result of the polyneuropathy. To our knowledge, this is the first report of headache being a prominent and early symptom of this disorder.