Noncompliance may render migraine prophylaxis useless, but once-daily regimens are better

Medicines work better if taken, which must be true of migraine prophylaxis. There is evidence that compliance with regular medication can be badly deficient. To assess how serious the problem might be in routine migraine management, we undertook a covert observational 2-month survey in a specialist headache clinic using objective measures of compliance. Subjects were 38 patients needing prophylaxis with medication prescribed once (od), twice (bd), or three times daily (tds). Medication was dispensed, unknown to them, in Medication Event Monitoring Systems (MEMS) to record openings in real time. Number, timing, and pattern of actual openings were compared with what was expected. Compliance rates averaged 66%, although returned pill counts indicated 91%. A substantial and significant difference was shown between od and bd or tds regimens. Measures of dosing interval—used-on-schedule rate and therapeutic coverage—averaged between 44% and 71%. Once-daily treatment was associated with a used-on-schedule rate more than double those of multiple daily dosing, but still only 66%. We conclude that routine use of drug prophylaxis in migraine may be so seriously undermined by poor compliance that it has little chance of efficacy. Returned-pill counting is inadequate for compliance assessment.     

山野豌豆黄酮类化学成分的研究

自山野豌豆(Vicia amoena Fisch.)全草的乙醇提取物中分得6个化合物,经波谱和化学分析鉴定其中一个为新的黄酮甙,命名为山野豌豆甙(amoenin A₃),其余5个化合物为槲皮素(quercetin D₂)、山奈酚(kaempferol D₁)、槲皮素-3-O-α-L-鼠李糖甙(quercetin-3-O-α-L-rhamnosideC1)、槲皮素-3-O-β-D-葡萄糖甙(quercetin-3-O-β-D-glucosideC2)、山柰酚-3,7-O-α-L-二鼠李糖甙(kaempferol-3,7-O-α-L-dirhamnoside A₂)。以上黄酮类化合物均为首次从山野豌豆中分得。     

Intraventricular mass lesions

Determining the precise etiology of an intraventricular mass can be a difficult diagnostic problem. CT and angiographic findings were reviewed in a series of 73 patients who had intraventricular masses. The histologic diagnosis can be suggested preoperatively by an analysis of the frequency of lesions occurring at a given ventricular location, lesion density before and after administration of contrast material, age and sex of the patient, morphologic appearance of the mass, and presence or absence of hydrocephalus. Angiography is useful when meningioma, choroid plexus papilloma and carcinoma, or arteriovenous malformation are considered. The differential features of each diagnostic entity are discussed.     

Arteriovenous access fistulae diminish cardiac reserve, anaerobic threshold and work capacity: A case for fistula closure in stable renal transplant recipients

Summary: A patent arteriovenous fistula (AVF) in stable renal transplant recipients may be viewed as 'insurance' against late graft failure and a return to haemodialysis. A patent AVF may, however, exert significant chronic demands on cardiac output (CO) which may in turn adversely affect the prognosis of patients already at risk of cardiac disease. Doppler echocardiography and anaerobic threshold (AT) assessment were used to measure the CO and the work capacity of nine stable renal transplant recipients > 15 months post transplantation who had patent AVF. Cardiac output fell from 6.9 ± 1.48L/min with the AVF open to 6.0 ± 0.97L/min with the AVF closed ( P < 0.002). the AT rose from 14.1 ± 5.67 with the AVF open to 16.5 ± 6.72 with the AVF closed ( P < 0.002). the work capacity to reach the AT improved from 68.7 ± 30.8 watts with the AVF open to 84.6 ± 38.0 watts with the AVF closed ( P < 0.004). This study suggests that a significant and chronic increase in left ventricular work-load accompanies a patent AVF resulting in a markedly reduced exercise efficiency. A patent AVF is ideal where graft survival is doubtful but, where long-term graft function is expected, the adverse effects of AVF patency, a chronic elevation in CO and reduced exercise capacity make a strong case for considering AVF closure. the prognostic advantage for left ventricular function may outweigh AVF preservation in stable renal transplant recipients.