Development and usability of a decision aid to initiate anti-osteoporosis medication treatment in patients visiting the fracture liaison service with a recent fracture.

Unlabelled: This study describes the development of a decision aid (DA), aimed at supporting patients in their decision whether to start anti-osteoporosis medication. People with recent fractures or osteoporosis and health professionals were supportive of the DA initiative. An experimental study been started to assess (cost-)effectiveness of the DA.

Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients.

Object: Cluster headache (CH) is the most severe of the primary headache disorders. Based on the finding that regional cerebral blood flow is increased in the ipsilateral posterior hypothalamic region during a CH attack, a novel neurosurgical procedure for CH was recently introduced: hypothalamic deep brain stimulation (DBS). Two small case series have been described.

Treatment of migraine with rizatriptan: when to take the medication.

Objective: To assess, in the setting of routine clinical practice, rizatriptan's effectiveness in treating acute migraine at its onset versus in a later phase of the attack.

Background: Although the efficacy and tolerability of rizatriptan have been well documented in clinical trials, no information is available about the impact of the timing of medication use on clinical outcome.

Methods: Migraineurs were enrolled in a prospective study and treated with rizatriptan 10 mg for two migraine attacks.

Interaction affinity between cytokine receptor components on the cell surface.

The anti-common gamma chain (gammac) mAb CP.B8 is shown to inhibit interleukin 4 (IL-4)-dependent proliferation of phytohemagglutinin (PHA) activated T cells noncompetitively with respect to cytokine by blocking the IL-4-induced heterodimerization of IL-4Ralpha and gammac receptor chains. Affinities for the binding of IL-4 to Cos-7 cells transfected with huIL-4Ralpha, and to PHA blasts expressing both IL-4Ralpha and gammac, were used to estimate the affinity of the key interaction between gammac and the binary IL-4Ralpha.

Molecular mapping with functional antibodies localizes critical sites on the human IL receptor common gamma (gamma c) chain.

The IL receptor common gamma (gamma c) chain is required for the formation of high affinity cytokine receptor complexes for IL-2, IL-4, IL-7, IL-9, and IL-15, and for signals regulating cell survival, growth, and differentiation. Our current understanding of how gamma c chain associates with multiple ligands and receptor subunits is drawn largely from its structural homology to the human growth hormone (hGH) receptor and known structure of the hGH/hGH receptor complex. These receptors share distinct features in their extracellular portions and are believed to function by a mechanism of ligand-induced association of receptor subunits.

Short-lived head pains.

There are several short-lived paroxysmal head pain syndromes, many of which are responsive to indomethacin, and some of which are potentially ominous. Included in this article are icepick headache, hypnic headache syndrome, chronic paroxysmal hemicrania, cough headache syndrome, coital headache, and thunderclap headache.

Approach to the patient with migraine.

Women with migraine often experience a worsening of symptoms at menopause. Use of exogenous estrogens is not helpful and may even exacerbate the condition. Although initial pharmacologic management generally is focused on control of individual headaches, attempts to stabilize the underlying migraine mechanism through serotonin receptor downregulation are likely to provide a better outcome.

Headache.

Headache-prone patients have many highly effective therapeutic options open to them. Used only at the time of headache, sumatriptan succinate by mouth or injection and dihydroergotamine nasal spray are novel choices now or soon to be available. The original migraine therapy, ergotamine, is highly effective in its rectal suppository formulation, when used at a subnauseating dosage.

Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale.

The antimigraine efficacy of many drugs may be mediated less through their primary modes of action than through the common pathway of serotonergic transmission stabilization. Migraine treatment may be symptomatic, acute/abortive, or prophylactic. Because oral drug absorption is impaired during attacks, parenteral agents are more appropriate for acute therapy.

Thoracic surgery in the AIDS patient.

AIDS is a syndrome caused by HIV. The virus is spread by homosexual or heterosexual transmission and by infected blood or certain body fluids. Respiratory infections are the commonest cause of death, and diagnosis may be difficult.

Antimigraine treatment for slit ventricle syndrome.

Slit ventricle syndrome is characterized by chronic or recurring headaches associated with subnormal ventricular volume in patients who have undergone shunt treatment for hydrocephalus. There appear to be at least three pathophysiological mechanisms that cause this syndrome: 1) intermittent shunt malfunction; 2) intracranial hypotension; and 3) paroxysms of increased intracranial pressure in the presence of normal shunt function. To treat seven patients with slit ventricle syndrome caused by paroxysms of elevated intracranial pressure, we successfully used antimigraine therapy rather than standard calvarial expansion procedures.

Modern pharmacotherapy of migraine.

Rectal ergotamine and naproxen are the major candidates for the ad hoc treatment of migraine attacks; for particularly dramatic episodes, intravenous DHE with prochlorperazine is the author's preference. For long-term stabilization, after simpler measures fail, valproate appears to be a major addition to migraine therapy.

Lumbar puncture headache: a review.

August Bier, the father of spinal anesthesia, suffered and reported the first lumbar puncture (LP) headache. On August 24, 1898 his assistant, a Dr. Hildebrandt, attempted to administer a spinal anesthetic to Dr.

Treatment of status migrainosus: the American experience.

Dependence upon a variety of drugs--ergotamine, analgesics, benzodiazepines, corticosteroids--is a major reason for patients to enter an intractable phase of their migrainous disorders. Repeated dosing of dihydroergotamine has proven to be remarkably effective in stabilizing the mechanism of migraine, allowing these patients to make the transition to a more reasonable as well as more specific form of therapy.

Pharmacology of migraine.

Stabilization of serotonergic neurotransmission by depressing the activity of serotonergic neurons may be the common mode of action of drugs effective in migraine. By serotonin receptor agonism, by prolonging the biologic half-life of serotonin in the synaptic cleft (through blockade of its re-uptake or metabolic degradation), by an increase in its synthesis, by inhibiting the release of serotonin, or by activation of cyclic AMP (fig), a unitary expression for the action of these drugs can be formulated which is corroborated, for many of the drugs, by direct measurement of serotonergic neuronal firing rates. However, there are at least three serotonin receptor sites in brain at which drugs would be effective, as assessed by differential responsiveness to agonists and antagonists and by different types of postsynaptic responses: presynaptically, postsynaptically, and at the autoreceptor itself.

Adenosine diphosphate ribosyl transferase responses to a standardized dose of hydrogen peroxide in the mononuclear leukocytes of patients with a diagnosis of cancer.

Mononuclear leukocytes from 151 patients with cancer of various organs and from 467 apparently cancer-free individuals were exposed, in vitro, to H2O2 (100 microM) and the effects of the exposure on the activity of adenosine diphosphate ribosyl transferase (ADPRT) were determined. First, the reproducibility of this test procedure was established as satisfactory, by comparing the results of assays performed independently by two investigators, and by measuring ADPRT in cells from two individuals over a 9-week period. The test data were analyzed by multiple linear regression, and the correlation of cancer diagnosis, age, sex and smoking habits with ADPRT values was determined.

Brain metastases in malignant pleural mesothelioma. Case report and review of the literature.

Recent advances in pleural malignant mesothelioma include the sequential use of palliative surgery, perioperative radiation therapy, and systemic chemotherapy. Radical treatments may not only palliate but also improve survival in some patients. The latter may be associated with the appearance of metastases in unusual sites including the central nervous system.

Chest wall stabilization using plate fixation.

Large defects of the chest wall require stabilization of the remaining thorax to prevent paradoxical movement. A technique of fixation using rib grafts and compression plates is presented.