Depression and anxiety disorders associated with headache frequency. The Nord‐Trøndelag Health Study

The aim of this large cross‐sectional population‐based study was to examine the association between migraine, non‐migrainous headache and headache frequency with depression, and anxiety disorders. From 1995 to 1997, all 92 566 inhabitants aged 20 years and above in Nord‐Trøndelag County in Norway were invited to participate in the Nord‐Trøndelag Health Study (‘Helseundersøkelsen i Nord‐Trøndelag’ = HUNT‐2). A total of 64 560 participated, whereof 51 383 subjects (80%) completed a headache questionnaire that was included. Of these 51 383 individuals, 47 257 (92%) completed the depression subscale items and 43 478 (85%), the anxiety subscale items of the Hospital Anxiety and Depression Scale (HADS). Associations were assessed in multivariate analyses, estimating prevalence odds ratios (OR) with 95% confidence intervals (CI). Depression and anxiety disorders as measured by HADS, were significantly associated with migraine (OR = 2.7, 95% CI 2.3–3.2; OR = 3.2, 95% CI 2.8–3.6) and non‐migrainous headache (OR = 2.2, 95% CI 2.0–2.5; OR = 2.7, 95% CI 2.4–3.0) when compared with headache‐free individuals. The association was stronger for anxiety disorders than for depression. The ORs for depression and anxiety disorders amongst both migraine and non‐migrainous sufferers increased with increasing headache frequency. Depression and anxiety disorders are associated with both migraine and non‐migrainous headache, and this association seems more dependent on headache frequency than diagnostic category.     

Convergence of occipital nerve and superior sagittal sinus input in the cervical spinal cord of the cat

Co-existence of facial and occipital pain may occur in occipital neuralgia, migraine and cluster headache; suggesting convergence of trigeminal and cervical afferents. Such convergence has been shown in humans and other animals, but the site and extent of this are uncertain. In anaesthetized adult cats, the superior sagittal sinus and occipital nerve were stimulated electrically, and extracellular recordings made in the dorsolateral area of the upper cervical cord using glass-coated tungsten electrodes. Of 49 units in 10 cats, 33 (67%) had input from the superior sagittal sinus and the occipital nerve. Thirteen (27%) had superior sagittal sinus input and 3 (6%) had occipital nerve input. Convergent receptive fields were identified mechanically in 7 units. These experiments in cats show convergent input from occipital nerve and superior sagittal sinus on dorsolateral area units in two-thirds of cases studied. This experimental site of trigeminocervical convergence may relate to referral of pain in occipital neuralgia and other headaches.     

Epidemiology of migraine headache in Santiago, Chile: a prevalence study

Objective . To describe the importance of migraine in Santiago, Chile, by analyzing its prevalence, clinical features and impact by age, gender and socioeconomic status. Methods . In 1993, a representative sample of 1,540 adults of the province of Santiago were interviewed using a standard questionnaire. A total of 1,385 (89.9%) subjects responded to the survey. Initially, a designated member of each household responded to the questionnaire. Subsequently, each household member with headaches was asked to respond to questions about severity, frequency, location, duration, associated symptoms and impact in work and social activities of their most frequent headaches. Migraine diagnoses were determined in accordance with the International Headache Society (IHS) criteria of 1988. Results. Recurrent headaches in the past year were found in 516 (36.82%) respondents, 145 (28.1%) males and 371 (71.9%) females. Total prevalence of migraine was found to be 7.3% (95%, CI 5.9–8.6); 11.9% (95% CI 9.6–14.2) in females and 2.0% (95% CI 0.9–3.0) in males. Overall, migraine constituted 19.6% (101/516) of all headaches reported in this sample. The prevalence did not vary significantly by age groups or socioeconomic status (SES). Migraine with aura had an overall prevalence of 3.5% (CI 0.8–7.1), and was significantly more frequent in females. In 60–70% of cases the attacks lasted 2–6 h and the frequency was 3.3 and 3.4 per month in females and males respectively. Both males and females reported significantly high percentages of attacks during work. Conclusions . Migraine prevalence in a sample of adults of Santiago is similar to that reported in previous studies using IHS criteria. Women of all socioeconomic levels are at an increased risk.     

小儿疳证源流考

疳作为一个病名，最早见于隋《诸病源候论》。首先将疳证作为儿科专有疾病者，为宋初《太平圣惠方》。本病分类最全面，收集方剂最丰富当推宋《幼幼新书》。南宋出版的《小儿卫生总微论方》首次将疳证归类为五疳。本草文献中对本病贡献最大的为明《本草纲目》。清《温病条辨》首次将本病治法作全面总结。１９９４年国家中医药管理局颁布的《中医病证诊断疗效标准》首次以法规的形式将本病作了统一规范     

小儿阑尾切除术1472例分析

目的 分析l472例小儿阑尾切除术的疗效，探讨小儿阑尾炎的诊治方法。方法 我院1982.8—2002．12行小儿阑尾切除术l472例。其中男l163例，女309例，男：女=3．76：l；平均年龄5．7岁(8天至14岁)，6～14岁973例(66．10％)。急诊手术1164例(79。08％)，择期手术308例(20．92％)，脓肿引流4例(0．27％)，阑尾切除1468例(99．73％)，其中296例(20．1l％)是在先天性巨结肠根治术或Meckel憩室切除术等手术中一并行阑尾切除的。结果 急性阑尾炎阑尾切除术后伤口感染83例(7．4％)，粘连性肠梗阻1l例(0．75％)，阑尾残端瘘3例(0．20％)，腹内脓肿3例(0.20％)，死亡l例(0.07％)。结论 小儿急性阑尾炎误诊率及手术前后并发症率高，小儿阑尾炎应早期诊断及尽早手术治疗。     

丙戊酸钠静脉滴注治疗偏头痛持续状态

目的评估丙戊酸钠治疗偏头痛持续状态的有效性和安全性。方法我们前瞻性地用静脉滴注丙戊酸钠来治疗偏头痛持续状态,然后比较患者治疗前与出院时视觉模拟评分(VAS)。并比较各种因素(一般情况,累计的丙戊酸钠剂量,合并用药)与治疗之间的关系。结果首次治疗中,26次(74.3%)治疗时患者VAS评分较治疗前减少50%或50%以上。所有治疗中,37次(82.2%)治疗使患者VAS评分较治疗前减少50%或50%以上。患者的性别与治疗反应无关。所有治疗中,合并用药(强痛定,索密通,散粒痛和达宁)和治疗时间与治疗反应呈负相关。仅3例(8.6%)出现短暂性眩晕。结论丙戊酸钠静滴是快速,有效和安全的止痛治疗。它对偏头痛持续状态有效。     

Neuropsychologic symptoms in the migraine syndrome

Twenty patients with complex neuropsychologic symptoms associated with classic migraine were selected from a group of 200 patients with vascular headache. Twenty types of symptoms were found and grouped into six categories (language, visual symptoms, cognitive-dysmnesic symptoms, olfactory-gustatory hallucinations, automatisms, and somatosensory symptoms). Some of the symptoms found have apparently not been reported previously. The importance of the analysis of this complex neuropsychologic set of symptoms and of the possible consequences of complicated, frequent vascular headache is emphasized.     

Molecular Pharmacology of Topiramate: Managing Seizures and Preventing Migraine

Topiramate is a neuromodulatory compound with stabilizing properties that was initially introduced for the management of partial seizures. Topiramate has been demonstrated to modify several receptor-gated and voltage-sensitive ion channels, including voltage-activated Na⁺ and Ca²⁺ channels and non-NMDA receptors. These receptors have been implicated in the pathophysiology of both epilepsy and migraine. The pharmacological mechanisms of action for topiramate that may explain its antiepileptic and migraine preventive activities will be discussed in this review. In addition, the potential relationship between the molecular activities of topiramate and its efficacy in epilepsy and migraine prevention will be emphasized.     

Atrial septal defect repair through limited lateral thoracotomy in children

Objective We have developed a surgical method for atrial septal defect repair through a limited right lateral thoracotomy in which the incision line begins 2 cm caudal from the lower angle of the scapula and ends at the midaxial line, thereby improving patient satisfaction with the cosmetic results of treatment. Methods We performed a retrospective review of 28 patients who underwent isolated atrial septal defect repair through a limited right lateral thoracotomy between January 2002 and August 2004. The mean age and mean body weight at the time of the operation were 85.8 months (range 9–236 months) and 23.0 kg (range 8.0–56.0 kg), respectively. All repaired defects were the ostium secundum type. Results There was no operative or late mortality and no late morbidity after a mean follow-up of 26 months (range 12–41 months). Echocardiography showed no residual shunt in any of the patients. The mean length of the skin incision was 7.8 cm (range 5.0–11.0 cm), and almost all the patients had satisfactory cosmetic results. Conclusion The atrial septal defect repair through a limited right lateral thoracotomy in pediatric patients showed satisfactory surgical results and excellent cosmetic results.