Sumatriptan overuse in episodic cluster headache: lack of adverse events, rebound syndromes, drug dependence and tachyphylaxis.

This observational study was designed to examine the pattern of sumatriptan use in patients with cluster headache using more than the recommended daily dose of subcutaneously injected (s.c.) sumatriptan.

Simultaneous occurrence of ipsilateral cluster headache and chronic paroxysmal hemicrania: a case report.

A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996.

Cytokines and migraine: increase of IL-5 and IL-4 plasma levels.

Thirty-two patients suffering from migraine without aura were assessed during in interictal period to evaluate the contribution of cytokines to the pathophysiology of migraine. To this end, plasma levels of IFN-gamma, IL-4, IL-5, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) techniques. Plasma levels of both IFN-gamma and IL-10 were not increased in the patients and did not differ significantly from healthy controls.

Patient education and migraine: a pilot study.

Our study examines the effectiveness of an educational approach to migraine patients. A course in migraine education was set up for 30 patients suffering from this disease; meetings were structured taking into consideration specific educational aims, with parameters evaluated before the course, at the end of the course and at a 3-month follow-up. The results, particularly the increase in the migraineurs' knowledge of their disease and the decrease in the use of symptomatic drugs, suggest the effectiveness of the course.

Migraine with and without aura in the same patient: expression of a single clinical entity?

Migraine with aura and migraine without aura may be different clinical expressions of one disease. This theory is debated, however. In order to further address the issue, we administered a standardized questionnaire to 45 migraineurs.

A randomized controlled trial of thymosin-alpha1 versus interferon alfa treatment in patients with hepatitis B e antigen antibody--and hepatitis B virus DNA--positive chronic hepatitis B.

It has recently been shown that thymosin-alpha1(T-alpha1), a synthetic polypeptide of thymic origin, is able to promote disease remission and inhibition of hepatitis B virus (HBV) replication in patients affected by hepatitis B e antigen (HBeAg)-positive chronic active hepatitis. We evaluated the efficacy and safety of T-alpha1 treatment in patients with hepatitis B e antibody (anti-HBe) and HBV-DNA-positive chronic hepatitis. Thirty-three patients were randomly assigned to receive either T-alpha1 900 microg/m2 body surface area twice weekly (17 patients) or 5 MU of interferon alfa (IFN-alpha) three times weekly (16 patients) for 6 months.

Levosulpiride in functional dyspepsia: a multicentric, double-blind, controlled trial.

Abnormalities in gastrointestinal motility have been reported in a substantial proportion of patients with functional dyspepsia, supporting the use of prokinetic drugs for treatment of dyspeptic symptoms. To evaluate efficacy and safety of levosulpiride in short-term treatment, 1298 patients were enrolled in a double-blind multicentric study carried out in 45 Italian Gastroenterology Departments. Patients were randomly assigned to either levosulpiride (25 mg tid), domperidone (10 mg tid), metoclopramide (10 mg tid) or placebo (1 tablet tid) for 4 weeks.

The dyspeptic syndrome in migraine: morphofunctional evaluation on 53 patients.

The authors, in order to evaluate the important role of gastrointestinal dysfunction during the migraine attack, have studied 53 patients with migraine without aura during the asymptomatic stage between attacks. Patients were examined functionally with a pH meter test of the gastroesophageal tract over 24 hours and morphologically with esophagogastroduodenoscopy. The results of this study point out that in a high percentage of patients with migraine, both evaluations are normal.

Use of high sumatriptan dosages during episodic cluster headache: three clinical cases.

The authors describe three patients with episodic cluster headache whose attacks were all treated with subcutaneous sumatriptan. The patients described had a high frequency of attacks (more than two per day); therefore, far higher dosage of the drug was taken than commonly used in cluster headache. The patients did not experience any particular side effects, neither during the treatment period nor on abrupt withdrawal of the drug.

[Evaluation of the efficacy of oral sumatriptan in the management of migraine attacks. Clinical results].

This italian multicentre, double blind, parallel groups study compared the efficacy, safety and tolerability of oral sumatriptan, given as new film-coated tablet, with placebo in the acute treatment of migraine. 88 Patients received placebo and 162 patients received sumatriptan 100 mg (plus an optional dose 2 h later if the headache persisted plus a further optional dose for recurrence within 24 h). Sumatriptan was significantly more effective than placebo at releiving headache at 2 h (51% versus 31%, P = 0.

Octreotide blunts postprandial splanchnic hyperemia in cirrhotic patients: a double-blind randomized echo-Doppler study.

The effect of octreotide, a long-acting synthetic analog of somatostatin, on fasting and postprandial splanchnic hemodynamics was investigated in cirrhotic patients. Splanchnic hemodynamics were assessed using an echo-Doppler duplex system in a prospective, double-blind, placebo-controlled, crossover study performed on 2 separate days, 1 week apart, in 30 cirrhotic patients. Measurements of portal vein (PV) cross-sectional area (PV-A) and mean velocity (PV-V), and of superior mesenteric artery (SMA) mean velocity (SMA-V) and pulsatility index (SMA-PI) (an index of vascular resistance) were performed at baseline, 30 minutes after octreotide (200 micrograms subcutaneously) or placebo administration, and 30 and 60 minutes after the ingestion of a liquid meal.

Comparison between the effect of L-propionylcarnitine, L-acetylcarnitine and nitroglycerin in chronic peripheral arterial disease: a haemodynamic double blind echo-Doppler study.

The haemodynamic effects on the peripheral vascular bed of L-acetylcarnitine, L-propionylcarnitine, and nitroglycerin were tested by echo-Doppler in a double blind cross-over study. Eleven male patients suffering from peripheral arterial obliterative disease (PAOD) in the second stage of Fontaine's classification, and 11 matched control subjects were enrolled in the study. Each subject received one of three different treatments on each day of the study in a different order following a random assignment.

Vascular injuries in ergotamine abuse: a case report.

The case reported here concerns a 40-year-old woman who has suffered from severe migraine without aura since she was 23. The patient has been taking 1-3 suppositories of Virdex (2 mg of ergotamine tartrate, 250 mg of aminophenazone, caffeine) every day for the past three years. In addition to headache, the onset of short, sporadic cramps in the limbs together with paresthesia, hyposthenia, hypothermia and skin pallor with a slight increase in diastolic pressure, made hospital treatment necessary.

[Echo-color Doppler in the study of portal hypertension].

Color-Doppler US is currently an extremely valuable tool in the study of abdominal circulation, cirrhosis of liver and its complications, different kinds of portal hypertension, vascular/avascular liver malformations and, finally, in the evaluation of liver transplants. Moreover, its use in experimental studies has yielded good results. Even spontaneous porto-systemic shunts can be demonstrated in most cases (up to 88%).

Echo-Doppler evaluation of acute flow changes in portal hypertensive patients: flow velocity as a reliable parameter.

In order to evaluate the behavior of the portal vein cross-sectional area during changes in portal flow, two groups of subjects were analyzed in two blinded cross-over studies using echo-Doppler flowmetry. The first group (I) consisted of 21 patients with cirrhosis and 16 controls. They received a standardized meal which is known to increase portal flow.

[Symptomatic headaches in internal medicine: the classification, physiopathological and diagnostic aspects].

Symptomatic or secondary headache occurs when pain itself is a symptom of disease. It is well known that within the general population the percent frequency of secondary headache is lower than that of primary headache. Moreover, some forms do not seem to evidence particular clinical, diagnostic or physiopathological importance.

A randomized study of propranolol on postprandial portal hyperemia in cirrhotic patients.

Propranolol, a nonselective beta-adrenergic blocker, has been shown to reduce portal pressure and the risk fo variceal bleeding. The portal pressure-reducing effect of propranolol is mediated by splanchnic arterial constriction, which decreases portal flow. A double-blind randomized control study (crossover on 2 consecutive days) was designed to compare the effects of propranolol vs.

Opposite effects of cholestyramine and loxiglumide on gallbladder dynamics in humans.

The aim of this study was to conduct dose-response studies of the effect of cholestyramine, alone or in combination with a test meal, on gallbladder emptying studied by ultrasonography in 31 healthy volunteers. The role of cholecystokinin in mediating the effects of cholestyramine was studied using the cholecystokinin-receptor antagonist loxiglumide. In the absence of a test meal, cholestyramine produced a dose-dependent decrease in gallbladder volume; minimal residual volumes were 30% (2 g), 55% (4 g), and 110% (12 g) of the minimal volume produced by a test meal alone.

Gallbladder volume and emptying in diabetics: the role of neuropathy and obesity.

Gallbladder (GB) volume was monitored by real-time sonography in diabetics (n = 21) and healthy volunteers (n = 55) after a test meal. Seventeen controls and seven diabetics were obese; six patients had both autonomous and somatic neuropathy, and four had somatic neuropathy. Fasting GB volume was similar in controls and diabetics with and without autonomic neuropathy; it was correlated with body mass index (controls, r = 0.

[Brain aging and calcium antagonist drugs. A preliminary open study with nimodipine].

Forty patients aged 65-80 with minor-medium signs of brain aging were treated for 6 months with daily 90 mg doses of nimodipine. Treatment was well tolerated in that the minor side effects reported by a few of the patients never required withdrawal of the drug. Treatment proved useful, as shown by a variety of mental tests, in 69.

Acute systemic and splanchnic haemodynamic effects of L-carnitine in patients with cirrhosis.

L-carnitine (L-C) is a naturally occurring substance in mammalian tissues that has recently been proposed as a therapeutic agent in hepatic encephalopathy and liver steatosis. L-C also produces some acute, non-metabolic, haemodynamic effects that have not previously been studied in patients with cirrhosis. Therefore, the authors evaluated the acute effect of i.