Demographic and clinical characteristics of patients with episodic migraine versus chronic daily headache

We compared data from 243 patients with episodic migraine (EM) and 132 patients with chronic daily headache (CDH). We divided the matter group into those with tension-type headache only (CDH Type 1) and those with headaches having migrainous features (CDH Types 2+3) and compared each with the EM group and all three groups with one another. CDH Type l patients differed from those in the other groups by virtue of gender (more often male) and mean age at headache onset (older). The CDH Types 2+3 and EM groups differed only in that the former were more likely to have undergone a brain-imaging study. These data suggest that CDH Type 1 may represent a distinct headache syndrome, while CDH Types 2+3 closely resemble episodic migraine.     

Partial tolerance in rat renal allograft recipients following multiple blood transfusions and concomitant cyclosporine

Multiple prior administrations of donor-strain blood while under limited cyclosporine cover, consistently induce extensive rat renal allograft survival and transplantation tolerance. Yet it was hypothesized that some chronic rejection mechanisms were nevertheless operative since consistent but nonprogressive minor renal dysfunction was observed long-term. A histopathologic study on these putative tolerant rats was undertaken to test this hypothesis. Twenty long-term LEW recipients of BN renal allografts receiving the blood-CsA regimen were examined histopathologically at day 100 post-transplant. Sixteen control LEW recipients receiving only a BN renal allograft were studied acutely at day 7 posttransplant. The control recipients demonstrated a range of lesions consistent with previous studies on acute renal allograft rejection in the rat. However, tolerant recipients demonstrated mild-to-moderate lesions consistent with chronic mechanisms of rejection including the following: moderate focal interstitial mononuclear inflammatory cellular infiltration, with periglomerular and perivascular accumulation; occasional arteriolar luminal obliteration and glomerular atrophy; focal areas of moderate interstitial fibrosis; mild interstitial hemorrhage; mild-to-moderate tubular atrophy; and focal tubular necrosis. Previously our laboratory has documented that tissue-specific renal basement membrane antigens may be responsible for inciting this pattern of focal chronic interstitial inflammation. However, from the present histopathologic studies, it would appear likely that chronic rejection mechanisms in these recipients, which were defined as tolerant by immunologic criteria, involve both tissue-specific and MHC determinants. Therefore, induction of transplantation tolerance in these indefinite survivors is partial or incomplete.     

Comparisons of different types and concentrations of alginates for encapsulation of Lagenidium giganteum (Oomycetes: Lagenidiales), a fungal pathogen of mosquito larvae

Six different types of alginates used to encapsulate Lagenidium giganteum gave similar levels of fungal infection in Culex quinquefasciatus larvae. Initial infection levels when the capsules were immersed in water after 6 days of storage (15 and 25 degrees C) were 100% for all types of alginate and after 42 days of storage was 62-100%, depending on the type of alginate. Infectivity was 24-100% after the encapsulated fungus were left in water for 7 days and after 15 days was 0 to 26%, depending on the alginate. When 2 of the alginates were tested at different concentrations to give high, medium and low viscosity solutions, the fungus encapsulated using lower concentration alginate solutions usually gave the highest level of infectivity.     

Aggressive behaviour in elderly people with dementia: A review

The progressive degeneration of the brain seen in dementia is often accompanied by behavioural disturbances. Aggressive behaviour is one of the most serious of these disturbances and is a common cause for psychiatric referral, admission to hospital and drug treatment. In this article, we discuss the conceptual issues associated with defining aggressive behaviour in cognitively impaired patients. We then review the aetiology, epidemiology, methods of assessment, and management of aggressive behaviour in elderly people with dementia.     

Morphine Enhances Pharmacological Preconditioning by Isoflurane: Role of Mitochondrial KATP Channels and Opioid Receptors

Background: Adenosine triphosphate-regulated potassium channels mediate protection against myocardial infarction produced by volatile anesthetics and opioids. We tested the hypothesis that morphine enhances the protective effect of isoflurane by activating mitochondrial adenosine triphosphate-regulated potassium channels and opioid receptors.

Methods: Barbiturate-anesthetized rats (n = 131) were instrumented for measurement of hemodynamics and subjected to a 30 min coronary artery occlusion followed by 2 h of reperfusion. Myocardial infarct size was determined using triphenyltetrazolium staining. Rats were randomly assigned to receive 0.9% saline, isoflurane (0.5 and 1.0 minimum alveolar concentration [MAC]), morphine (0.1 and 0.3 mg/kg), or morphine (0.3 mg/kg) plus isoflurane (1.0 MAC). Isoflurane was administered for 30 min and discontinued 15 min before coronary occlusion. In eight additional groups of experiments, rats received 5-hydroxydecanoic acid (5-HD; 10 mg/kg) or naloxone (6 mg/kg) in the presence or absence of isoflurane, morphine, and morphine plus isoflurane.

Results: Isoflurane (1.0 MAC) and morphine (0.3 mg/kg) reduced infarct size (41 +/- 3%; n = 13 and 38 +/- 2% of the area at risk; n = 10, respectively) as compared to control experiments (59 +/- 2%; n = 10). Morphine plus isoflurane further decreased infarct size to 26 +/- 3% (n = 11). 5-HD and naloxone alone did not affect infarct size, but abolished cardioprotection produced by isoflurane, morphine, and morphine plus isoflurane.     

The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

OBJECTIVE: To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART). DESIGN: Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98). SETTING: Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands. POPULATION: Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women. MAIN OUTCOME MEASURES: MTCT, preterm delivery, low birthweight, pre-eclampsia. RESULTS: MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls. CONCLUSIONS: We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.     

A study of 10 cases of velopharyngeal incompetence treated by flap pharyngoplasty

Velopharyngeal incompetence (VPI) is a condition of incomplete closure of V.P. port area, normally formed by velum and posterior pharyngeal watt. The condition primarily results in various types of speech defects, which form- the main complaint of the patient. We have studied 10 cases of VPI due to various causes and the speech improvement obtained by flap pharyngoplasty procedures. The results have been evaluated with a follow-up of six months. Highly encouraging results only indicate a more frequent need to undertake such surgery without any hesitation if the ENT surgeon is familiar with and has an adequate exposure to this simple and effective procedure.     

Zur Fermentbiologie der Syphilis und Syphilisähnlicher Krankheiten

Zusammenfassung Die Verminderung des Diastasegehalts im Liquor cerebrospinalis bei Syphilis wird auf die Wirksamkeit der Spirochaeta pallida zurückgeführt. Zum Beweis für diese Auffassung wird die Bestimmung des diastatischen Ferments im Hirngewebe bei Paralyse herangezogen: im Gegensatz zu nichtsyphilitischen Kontrollfällen findet sich im Gehirn der Paralytiker, besonders in den von den Spirochäten am stärksten angegriffenen Rindenpartien des Frontalhirns, eine Diastaseverminderung, vielfach ein völliger Diastaseschwund. Auch in vitro führt die Spirochaeta pallida, aus nässenden syphilitischen Papeln in eine Kochsalzaufschwemmung gebracht, zur Vernichtung des diastatischen Fermentes in normalen Liquores.Eine ähnliche Beeinflussung der Diastase ist durch weitere Erreger möglich, die der Spirochaeta pallida morphologisch und biologisch verwandt sind. Sie wird für die Trypanosomen (Nagana) und die Spirillen morsus muris, die Erreger der Rattenbißkrankheit (Sodoku), die in Kochsalzaufschwemmungen auf vorgelegte Diastaselösungen zur Einwirkung gebracht wurden, nachgewiesen. Recurrens- und Weil-Spiro-Chäten üben eine solche Funktion im selben Ausmaße nicht aus. Diese Ergebnisse werden als weitere Stütze für die Auffassung vonStühmer angesehen, daß die Trypanosomiasis und die Sodokuerkrankung im Tierexperiment als Modellinfektionen zum Studium der Biologie der Syphilis beim Menschen herangezogen werden können.An Trypanosomenaufschwemmungen wird geprüft, ob die Vernichtung des diastatischen Ferments allein eine Funktion der lebenden, vitalkräftigen und infektionstüchtigen Erreger ist, oder ob auch die abgetöteten Erreger oder schließlich die zwar beweglichen, aber in ihrer Vitalität und Infektiosität geschädigten Erreger diese Fähigkeit noch besitzen. Während unbeeinflußte Trypanosomen eine deutliche Abnahme im Fermentgehalt von Diastaselösungen bewirken, vermögen durch Aqua dest.-Zusatz, durch Aufkochen oder durch Ultraviolettlichtstrahlen getötete Trypanosomen keinerlei nennenswerten Einfluß auf den Diastasegehalt auszuüben. Nach Röntgenbestrahlung beweglich gebliebene, aber in ihrer Vitalität und Infektiosität geschwächte Trypanosomen lassen ebenfalls die vorgelegte Diastaselösung nahezu unbeeinflußt.Aus diesen Modellstudien wird geschlossen, daß möglicherweise auch bei der Syphilis die Verminderung des Diastasegehalts im Liquor cerebrospinalis auf die Anwesenheit vitalkräftiger und infektionstüchtiger Erreger zu beziehen ist. Die weitere Verwendung der Diastasebestimmung im Liquor cerebrospinalis für die Zwecke der Syphilisdiagnostik wird jedoch von einer Verbesserung der Glykogenbereitung abhängig gemacht, da nur durch ein gleichmäßig hergestelltes Glykogen die Konstanz der Untersuchungsergebnisse gesichert erscheint.Ausgeführt mit Unterstützung der Freiburger Wissenschaftlichen Gesellschaft.