bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educating Patients on Sentinel Lymph Node Dissection for Breast Cancer
Authors: Swenson Karen K. , Sladek Mary L. , Lally Robin M. , Tuttle Todd M. 
Published: March 2003

Purpose: This article reviews the current literature on lymphatic mapping and sentinel lymph node dissection (SLND) for breast cancer and presents educational information for patients who are considering undergoing this procedure.Overview: Lymphatic mapping with SLND has been tested widely in patients with breast cancer, primarily in the context of clinical trials. Research studies have found a high degree of accuracy, with the sentinel lymph node (SLN) predicting the status of the axillary node basin. The ability of the surgeon to identify the SLN and the accuracy of the technique correlate with the number of procedures conducted. With the increase in the number of patients having lymphatic mapping and SLND for breast cancer who may not be part of a clinical trial, there is a need for educational materials to help clinicians teach patients about the procedure.Clinical implications: Because of the complexity of the information, patients need both written and verbal information to decide whether to undergo an SLND. In the setting of a clinical trial, patient education materials add to the informed consent document. As the use of SLND for breast cancer becomes more common, the need for clear, concise, informative patient education materials is even more imperative.
Hemodialysis‐Induced Hypophosphatemia in a Normophosphatemic Patient Dialyzed for Ethylene Glycol Poisoning: Treatment with Phosphorus‐Enriched Hemodialysis
Authors: Chow  , Lin  , Mitra  , Singh  , Lee  , Leehey  , Ing  
Published: March 2003

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.Hypophosphatemia developed in a normophosphatemic patient after 9 h of hemodialysis therapy (using a phosphate‐free dialysate) administered for the treatment of ethylene glycol poisoning. The hypophosphatemia was promptly improved with additional hemodialysis treatment using a phosphorus‐enriched dialysate.
Does the World Trade Organization Care about Ecosystem Health? The Case of Trade in Agricultural Products
Authors: Buckingham Donald E. 
Published: March 2003

ABSTRACTWe now live under a comprehensive international trading system which affects what we eat, wear, buy, and produce. As of January 1995, the General Agreement on Tariffs and Trade 1947 (GATT 1947) was replaced by the World Trade Organization Agreement (WTOA) which sets out rules affecting practically all trade in goods and services worldwide.The implications for trade in agricultural goods are enormous. Today, not only are rules concerning trade in goods generally applicable to trade in agricultural goods, but new rules specific to trade in such products are set out in the WTOA’s Agreement on Agriculture. The WTOA promises to limit national agricultural policies which impede international trade in agricultural products. The new WTOA rules should increase efficiency of and decrease friction arising in trade in agricultural products. These developments represent truly positive economic and political outcomes.But what will be the environmental effects of changes in trade flows facilitated by WTOA rules and institutions? How will the new rules affect ecosystem health? The truth is that the worlds of trade law and ecosystem health are light‐years apart. Advocates for free trade and those for the environment often distrust each other and think that the interests of one can be advanced only through the sacrifice by the other. The first part of this article traces some of the reasons for the evolution of this seemingly zero‐sum game. The second section of the article examines the historical development and current treatment of environmental measures under the WTOA.The agricultural sector is then highlighted as a microcosm of how the new WTOA rules will produce environmental effects which positively, although perhaps unintentionally, affect agroecosystems. The article concludes with speculation as to whether it is not now time to reorient the acrimonious trade/environment debate to one which is less adversarial and more focused on achieving ecosystem health while continuing to improve international market access and trade relations.
Animal Indicators of Adverse Effects Associated with Air Pollution
Authors: Saldiva Paulo Hilário Nascimento , Böhm György Miklós 
Published: March 2003

ABSTRACTThe possibilities for using animal indicators for air pollution studies are reviewed. Three major problems are discussed: bioconcentration of trace elements, alterations of physiological parameters, and genotoxic effects. Sentinel species seem to be useful bioaccumulators of environmental trace elements and may be the first choice for detecting pollutants whenever there is a high affinity between the pollutant and a specific animal tissue. Also metallothionein levels of different invertebrate organisms has been shown to be a very sensitive indicator of metal pollution. The assessment of the pulmonary functions, the regulation of airway caliber, and mucociliary clearance in animals exposed to polluted urban air is presented and their advantages for estimating physiological damages induced by air pollution are advocated. Considering the availability of easy techniques to evaluate genetic damage, sentinel species have proven to be an attractive approach to detect genotoxic effects in all kinds of environmental pollution. A continuous effort of the scientific community is necessary to establish the importance of animal sentinel studies on the process of evaluating risks and formulating regulatory procedures.
Sustainable Development: Lessons from the Paradox of Enrichment
Authors: Choi Jae S. , Pattent Bernard C. 
Published: March 2003

AbstractWith the current struggle to “sustainably” exploit our biosphere, the “paradox of enrichment” remains an issue that is just as relevant today as it was when it was first formalized by Rosenzweig in 1971. This paradox is relevant because it predicts that attempts to sustain a population by making its food supply more abundant (e.g., by nutrient enrichment) may actually have the reverse (paradoxical) effect of destabilizing the network. Originally, this paradox was based upon studies of “reasonable,” but quite simple, predator‐prey models. Here, we attempt a more “realistic” revision of the paradox that explicitly accounts for the embedded nature of the human system in a complexly interwoven set of hierarchical (spatial, temporal, and organizational) relations with the rest of the ecosphere‐a relationship whose exploitative nature continues to grow in intensity and extent. This revision is attempted with the aid of a combined thermodynamic and network approach. The result is that a scaledependent asymmetry in the action of the second law of thermodynamics is shown‐an asymmetry that results in the creation of two antagonistic propensities: local order and local disorder. The point of balance between these two propensities is empirically measurable and represents a balance between processes and constraints internal (growth and development) and external (interactive and perturbing influences) to a system‐a balance that may be called the most “adaptive” state (after Conrad 1983). The use of such an index of this balance is demonstrated and it is used to clarify the relevance of the paradox to more complexly organized systems. As a consequence, we conclude that the concept of “sustainable exploitation and growth” is an oxymoron.
What on Earth is Life? An Ecological View
Authors: Rowe Stan 
Published: March 2003

AbstractAlthough definitions of the meaning of “life” are various, none recognizes the importance of context. A partial explanation of the attribution of “life” only to organisms is the fact that the ecosphere–the context and source of organisms–has, until recently, been invisible. Further, the metaphorical nature of abstract language has conflated “organisms” and “life.” But just as the living parts of an organism depend on the vitality of the whole, so living organisms depend on the energetics of planet Earth from which they evolved and by which they are maintained. From an ecological viewpoint, planet Earth, the inclusive supra‐organic ecosphere, is a logical metaphor for “life.”
β‐Endorphin in Plasma and Monocytes in Juvenile Headache
Authors: Battistella P.A. , Bordin A. , Cernetti R. , Broetto S. , Corrá S. , Piva E. , Plebani M. 
Published: March 2003

Interictal serum levels of serotonin and plasma and mononuclear cell concentrations of β‐endorphin were measured in 20 juvenile patients (13 suffering from migraine without aura and 7 from episodic tension‐type headache) before and after 3 months of L‐5‐hydroxytryptophan treatment (5 mg/ kg/day) and compared with a control group of 17 headache‐free healthy subjects.While no significant differences in serum serotonin levels emerged between the three groups (migraine 104.6 ± 26 μg/ L, tension‐type headache 90.7 ± 26.2 μg/L, controls 96 ± 32.9 μg/L), significantly lower plasma and mononuclear cell concentrations of β‐endorphin were found in both patient groups by comparison with the healthy controls (β‐endorphin in plasma: migraine sufferers 16.2 ± 4.2 pmol/L [P<0.05], tension‐type headache subjects 14.5 ± 1.7 pmol/L [P<0.001] vs controls 21.3 ± 4.6 pmol/L and respectively, ß‐endorphin in mononuclear cells: migraine sufferers 110.5 ± 16.4 pmol/106 GB/L [P<0.001], tension‐type headache subjects 142.3 ± 22.7 pmol/106 GB/L [P<0.001] vs controls 359.3 ± 31.6 pmol/106 GB/L). No differences emerged between the two clinical forms of headache for the plasma and mononuclear cell concentrations of β‐endorphin.After L‐5‐hydroxytryptophan treatment, serum serotonin and both plasma and mononuclear cell βI‐endorphin levels tended to be higher, though not significantly so, than prior to treatment, and the clinical score (frequency x intensity of headache attacks) was significantly lower in both headache groups than at the baseline.This study supports the theory that opiate analgesic system function is abnormally low in juvenile primary headache as in adults, and confirms that administering serotoninergic precursor drugs increases β‐endorphin, even in the peripheral blood, and may favorably affect clinical symptoms.
Cluster Headache in Two Sisters. Pupillary Response to Phenylephrine and Tyramine
Authors: Havelius UIf , Milos Peter , Hindfelt Bengt 
Published: March 2003

Two sisters with cluster headache were studied with respect to the pupillary responses to instillation into the conjunctival sac of a single drop of a 1% solution of phenylephrine and a 2% solution of tyramine. The changes in pupillary diameters were documented by photographic pupillometry prior to and at 15, 30, 60, and 90 minutes after the instillations.Of the two sisters, one (case A) was examined during a symptom‐free interval, when she had been free from cluster headache attacks for 2 1/2 years. When the cluster headaches recurred, retesting was performed. The other sister (case B) had been free from cluster headaches for 9 years, when she was examined.The findings indicate hypofunction within the postganglionic sympathetic nerve fibers during a cluster headache period. The hypofunction is bilateral, and thus, can not be a consequence of the unilateral cluster headache attacks. During remissions, tyramine induces a marked mydriasis, particularly on the symptomatic side, tentatively indicating an excessive release of stored monoamines.
Ciliospinal Reflex Response in Cluster Headache
Authors: Havelius Uif , Heuck Martin , Milos Peter , Hindfelt Bengt 
Published: March 2003

The ciliospinal reflex response is mainly mediated by second‐ and third‐order sympathetic nerves to the dilatator muscle of the iris. As the pupillary response to various pharmacological agents indicates a sympathetic dysfunction in patients with cluster headache, the ciliospinal reflex was studied in 25 patients. Five of these patients with cluster headache exhibited a Horner‐like syndrome (miosis, ptosis) on the symptomatic side. The pupillary responses to phenylephrine and tyramine showed that the Horner‐like syndrome was due to postganglionic sympathetic nerve dysfunction. Their ciliospinal reflex response on the symptomatic side was significantly less than in controls and in other patients with cluster headache, lacking a Horner‐like syndrome. This also applied to the nonsymptomatic side compared to the majority of cluster headache patients without any clinical evidence of sympathetic nerve dysfunction.These findings seem to delineate those patients with a Horner‐like syndrome as a subgroup, distinctly separated from the majority of cluster headache patients. Furthermore, the findings indicate that the Horner‐like syndrome is not a consequence of repeated attacks of headache over many years, but is a manifestation of bilateral cephalic sympathetic dysfunction being more marked on the symptomatic side.In 18 (72%) of our 25 patients, an asymmetric and lower ciliospinal reflex response on the symptomatic side was seen. In 3 (12%) patients, there was no difference in the response. In 4 patients (16%), the incorrect side was indicated by an asymmetric reflex response. Two of these patients (8%) had suffered from cluster headache on alternating sides.In summary, the findings support the concept that dysfunction of the sympathetic nervous system, whether peripheral or central, is involved in the pathophysiology of cluster headache.
Headache and Stress in a Group of Nurses and Government Administrators in Japan
Authors: Nadaoka Toshihide , Kanda Hideto , Oiji Arata , Morioka Yukiko , Kashiwakura Masaki , Totsuka Shiro 
Published: March 2003

We surveyed a group of 311 nurses and 283 mid‐level government administrators in Yamagata Prefecture, Japan, to determine the prevalence and character of their headaches. We investigated the relationship of headaches to the subjects' stress, and their behaviour and coping patterns. The questionnaire we administered explored background factors, as well as the state of the respondents' mental health, life events, work motivation, support system, and interpersonal relationships.The questionnaire was completed by 76.8% of nurses and 100% of administrators. Of these, 40.6% of nurses and 19.1% of the administrators reported recurrent headaches Furthermore, the number of headache sufferers among the women administrators was significantly higher than in the men. The nurses and the administrators who reported headache scored significantly higher than the nonheadache groups on the questions measuring symptoms of burnout, General Health Questionnaire, and learned helplessness. The group of nurses with headache had higher scores for life events, decreased work motivation. and nervous behavior than the nonheadache group; the administrators with headache scored higher for daily hassles than those of the nonheadache groups. In this study of a Japanese sample, the character of the subjects' headache and the possible inducing factors are consistent with those reported in studies of Europeans and Americans using similar testing methods. However, the high prevalence of headache among nurses and women administrators seems to be related to psychological stress, particularly work stress, which may be characteristic in Japan.
The Enhanced Ciliospinal Reflex in Asymptomatic Patients With Cluster Headache is Due to Preganglionic Sympathetic Mechanisms
Authors: Havelius Ulf , Heuck Martin , Milos Peter , Hindfelt Bengt 
Published: March 2003

An amplified ciliospinal reflex response has been documented in patients with cluster headache, lacking a Horner like syndrome. The mechanism is unknown, Tentatively, it may be due to an increased release of monoamines from post‐ganglionic sympathetic nerve endings or an increased density of postsynaptic adrenergic receptors in the dilatator muscle of the iris.The instillation of a 1% phenylephrine solution into the conjunctival sac induces mydriasis by stimulating postsynaptic adrenergic receptors in the dilatator muscle of the iris, while the instillation of a 2% tyramine solution causes mydriasis by releasing noradrenaline from the presynaptic sympathetic nerve terminals in the iris.According to these premises, a positive correlation shouId be expected between the ciliospinal reflex response and the pupillary response to tyramine, if the enhanced ciliospinal so‐flex response was due to an increased presynaptic release of monoamines. No such correlation was found. Nor was there any positive correlation between the ciliospinal reflex response and the pupillary response to phenylephrine, contradicting an increased density of postsynaptic monoaminergic receptors in the dilatator muscle of the iris as the explanation. However, there was a significant positive correlation between the pupillary responses to phenylephrine and tyramine, ruling out any functionally caused “denervation” hypersensitivity in the dilatator muscle of the iris.It is concluded that the amplified ciliospinal reflex response in cluster headache patients (lacking a Horner‐like syndrome) reflects compensatory pathophysiological mechanisms proximal to the third‐order sympathetic neuron.
Multicenter Prospective Evaluation of Proposed Pediatric Migraine Revisions to the HIS Criteria
Authors: Winner Paul K. , Wasiewski W. , Gladstein J. , Linder S. 
Published: March 2003

Eighty‐eight children and adolescents were prospectively evaluated at eight specialty clinics comparing the diagnostic criteria of the International Headache Society (IHS) and the proposed revised (IHS‐R) classification to the clinical diagnosis. The proposed revisions to the IHS classification for pediatric migraine include: duration‐1 hour to 48 hours; Iocation‐bifrontal/bitemporal or unilateral; and symptoms‐to include photophobia or phonophobia. A comparison of the diagnostic rates of pediatric migraine with and without aura of the total sample revealed IHS (66%) versus IHS‐R (93%) and comparison of a subset of those patients less than 12 years of age (n=39) revealed IHS (49%) versus IHS‐R (87%).Significant improvement in the diagnostic sensitivity of migraine in the pediatric population was obtained by specific modifications to the IHS criteria pertaining to duration, location, and the symptoms of photophobia and phonophobia in an ongoing multicenter prospective study. These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine maintaining the IHS model.
Naratriptan is Effective and Well Tolerated in the Acute Treatment of Migraine. Results of a Double‐Blind, Placebo‐Controlled, Parallel‐Group Study
Authors: Klassen Arthur , Elkind Arthur , Asgharnejad Mahnaz , Webster Chris , Laurenza Antonio ,   on behalf of the Naratriptan S2WA3001 Study Group
Published: March 2003

Objective.‐To evaluate the efficacy and tolerability of naratriptan, a novel 5‐HT1 agonist, in the acute treatment of migraine.Design/Methods.‐Six hundred thirteen migraineurs, diagnosed according to International Headache Society criteria, treated a single migraine attack with naratriptan tablets (2.5 mg, 1 mg, 0.25 mg, or 0.1 mg) or placebo in a randomized, double‐blind, placebo‐controlled, parallel‐group study conducted at 54 United States centers. At dosing and at predetermined intervals beginning 30 minutes postdose, patients recorded migraine pain severity, clinical disability, and presence of associated migraine symptoms. Safety measures included adverse events, physical examinations, vital signs, ECGs, and clinical laboratory tests.Results.‐Headache relief (moderate or severe pain at dosing reduced to mild or no pain) 4 hours postdose was reported in 60% of patients receiving naratriptan 2.5 mg compared with 50%, 35%, 32%, and 34% of patients receiving naratriptan 1 mg, 0.25 mg, 0.1 mg, and placebo, respectively ( P < <0.05 naratriptan 2.5 mg and 1 mg versus placebo, 1 mg versus 0.1 mg, and 2.5 mg versus 0.1 mg and 0.25 mg). Clinical disability 4 hours postdose was reported as mild or none for 70% of patients receiving naratriptan 2.5 mg compared with 63%, 47%, 48%, and 48% of patients receiving naratriptan 1 mg, 0.25 mg, 0.1 mg, or placebo, respectively ( P <0.05 naratriptan 2.5 mg and 1 mg versus placebo, 1 mg versus 0.1 mg, and 2.5 mg versus 0.1 mg and 0.25 mg). Four‐hour efficacy for absence of nausea, photophobia, and phonophobia was similar to efficacy for headache relief at each dose. The adverse event profile of each dose of naratriptan was similar to that of placebo. No clinically relevant change in any safety measure was reported.Conclusions.‐Naratriptan is effective and well tolerated for the acute treatment of migraine. The 2.5‐mg dose appears to offer the optimum ratio of efficacy to tolerability.
Weekend Headache: A Possible Role of Work and Life‐style
Authors: Torelli Paola , Cologne Daniela , Manzoni Gian Camillo 
Published: March 2003

The purpose of our study was to determine whether or not patients reporting weekend headache exhibit distinctive features in their work habits, family life, and leisure on workdays and on weekends as compared to other headache sufferers, and whether or not they are inclined to change their living habits at the weekend.The study was done on an initial sample of 50 patients referred to the University of Parma Headache Centre between October 1996 and April 1997. These patients completed a specially designed questionnaire which, in addition to demographics, contained specific questions relevant to the subject matter being investigated. They were also given a diary which they had to complete for 8 consecutive weeks in order to determine the actual frequency of headache attacks over different days of the week.The questionnaire data were only analyzed for the 38 women in the sample, because there were too few male controls for an accurate comparison with weekend headache sufferers. Among the women with weekend headache, work habits, family life, and leisure were such as to suggest a possible increase in stress and frustration on weekends, which might have made them perceive the headaches occurring on Saturdays and Sundays as more severe. No changes were found in the intake of substances such as coffee and alcohol, nor in cigarette smoking over the different days of the week. Finally, analysis of the diaries showed an increased frequency of headache attacks on weekends only among the men, which seems to corroborate the hypothesis of weekend headache as a disorder typically affecting men.
Alteration in Nature of Cluster Headache During Subcutaneous Administration of Sumatriptan
Authors: Hering‐Hanit Rachel 
Published: March 2003

Objectives.– To document the relationship between the 5‐HT receptor agonist sumatriptan and a change in the nature of cluster headache in four cases. To relate the findings to the literature on the use of sumatriptan in both cluster headache and migraine.Background.– Studies of the efficacy and adverse effects of long‐term treatment with sumatriptan in cluster headache are limited and report conflicting findings.Methods.– Four cases are described.Results.– All four patients developed a marked increase in the frequency of attacks 3 to 4 weeks after initiating treatment with the drug for the first time. Three patients also developed a change in headache character, and 2 experienced prolongation of the cluster headache period. Withdrawal of the drug reduced the frequency of headaches and eliminated the newly developed type of headache.Conclusions.– Determination of the effects of long‐term use of sumatriptan will result in more precise guidelines for the frequency and duration of treatment with this otherwise extremely beneficial drug.