Dietary migraine: recent progress in the red (and white) wine story

The concept of dietary migraine as a clinical entity remains controversial. We review here such objective evidence that has been put forward for its existence. Red wine, in particular, is commonly alleged to initiate attacks in susceptible individuals. We discuss how some of its recently described pharmacological properties might trigger off the sequence of events leading to migrainous headache.     

Applanation-Schiøtz Disparity afrer Retinal Detachment Surgery Utilizing Cryopexy

Previous reports of applanation-Schiøtz disparity following retinal detachment surgery involved patients whose detachments were treated with diathermy and scleral buckling. In 73 patients with retinal detachments treated by cryopexy and scleral buckling, applanation and Schiøtz pressures were measured before and after surgery. In the postoperative period, applanation tension values were significantly higher than Schiøtz values in the operated eyes only; the mean disparity was 6 mm Hg, with a range of 0 to 14 mm Hg. Sex, age, surgical aphakia, and length of time after surgery did not influence the data. Placement of the buckle, rather than extent of cryopexy, appeared to be the main factor in producing this disparity. Ophthalmologists who utilize the Schiøtz tonometer should be aware of the various conditions, including retinal detachment surgery, which produce low ocular rigidity.     

Doppler evaluation of extracranial cerebrovascular disease.

The carotid Doppler examination is an accurate means of screening the extracranial carotid system for stenotic lesions. Comparison of 100 patients (200 vessels) examined by the Doppler method and arteriography showed agreement in 90% of the vessels and a significant error rate in only 3.5%.     

Drug-drug interactions of antifungal agents and implications for patient care

Drug interactions in the gastrointestinal tract, liver and kidneys result from alterations in pH, ionic complexation, and interference with membrane transport proteins and enzymatic processes involved in intestinal absorption, enteric and hepatic metabolism, renal filtration and excretion. Azole antifungals can be involved in drug interactions at all the sites, by one or more of the above mechanisms. Consequently, azoles interact with a vast array of compounds. Drug-drug interactions associated with amphotericin B formulations are predictable and result from the renal toxicity and electrolyte disturbances associated with these compounds. The echinocandins are unknown cytochrome P450 substrates and to date are relatively devoid of significant drug-drug interactions. This article reviews drug interactions involving antifungal agents that affect other agents and implications for patient care are highlighted.     

Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy

PURPOSE: Patients requiring chronic anticoagulation are theoretically at increased risk for hemorrhage or thromboembolism perioperatively. Experience with laparoscopic renal/adrenal surgery in patients on chronic warfarin is limited. We assessed hemorrhagic/thromboembolic complications in this group of patients. MATERIALS AND METHODS: The records of 787 patients undergoing laparoscopic renal/adrenal surgery were retrospectively reviewed. A total of 25 patients on chronic oral anticoagulation with warfarin were identified. The indications for warfarin therapy as well as perioperative management were reviewed. Clinical parameters, including operative time, estimated blood loss, hemorrhagic/thromboembolic complications and transfusions, were documented and compared with those in patients not receiving chronic anticoagulation. RESULTS: Atrial fibrillation (56% of cases) and a prosthetic mitral valve (28%) were the most frequent indications for chronic anticoagulation. Bridging anticoagulation with unfractionated heparin was the most frequent management method (68% of cases). Patients with anticoagulation were older (p <0.001) and hospitalized longer (<0.001) than those without anticoagulation. Operative time, estimated blood loss and the conversion rate were not significantly different between the groups. However patients on chronic warfarin significantly more often required transfusion (24% vs 5.2%, p <0.005) and had more postoperative bleeding episodes (8% vs 0.9%, p <0.05) than patients not on chronic anticoagulation. No thromboembolic events occurred in the anticoagulated group, while 3 occurred in the nonanticoagulated group (p = 1). CONCLUSIONS: Laparoscopic renal/adrenal surgery in patients requiring chronic anticoagulation therapy can be performed safely. The risk of intraoperative bleeding is not increased, although the incidence of postoperative bleeding as well as transfusions is higher.