Ipsilateral cluster headache and chronic paroxysmal hemicrania: two case reports

We report two patients with ipsilateral attacks of cluster headache and chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral chronic paroxysmal hemicrania which showed a dramatic improvement with indomethacin 150 mg daily. After two days of complete remission, cluster headache attacks reappeared and persisted until verapamil, 360 mg a day, was added to indomethacin. The second patient, a 45-year-old man, first developed attacks of episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of chronic paroxysmal hemicrania, and two months later attacks of cluster headache. Under verapamil 240 mg daily, attacks of cluster headache disappeared, but those of chronic paroxysmal hemicrania increased in frequency until indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between cluster headache and chronic paraoxysmal hemicrania, and show the practical therapeutic interest of maintaining this distinction.     

Sclerosed liver hemangioma mimicking malignant tumor at MR imaging: Pathologic correlation

This case report illustrates atypical magnetic resonance (MR) imaging findings in a liver hemangioma mimicking a malignant lesion—lower signal intensity than cerebrospinal fluid on T2-weighted spin-echo images and lack of early enhancement on dynamic contrast material—enhanced gradient-echo images. Pathologic analysis demonstrated nearly total replacement of the vascular cavities by dense fibrous tissue. In this rare, sclerosed form, this lesion could not be defined as a hemangioma with MR imaging.     

A new approach to selection and weighting of items in evaluative composite measurement scales

Evaluative composite measurement scales (CMS) are increasingly used in medicine to measure complex constructs in the absence of a reference criterion or ‘gold standard’. However, the level of measurement provided by these instruments has usually been given little attention. This paper explores the influence of the characteristics of the item set and weighting on the level of measurment of an evaluative CMS. The approach is illustrated with an application to the scoring system of the Nottingham Health Profile. Simulations are provided to indicate when the composite score of item responses, on an ordinal or pass—fail scale, could be considered to achieve the properties of an interval scale.     

Clinical quiz. Rubinstein-Taybi syndrome (synonyms: broad thumbs and great toes, characteristic facies, and mental retardation -- broad thumb-hallux syndrome).

A 28-year-old mentally retarded, institutionalised woman was referred to us for evaluation of multiple plantar warts and ingrown nails of both great toes. The patient was born to unrelated parents of North African origin and had one brother and three half-brothers, all of whom were healthy. Physical examination revealed short stature, slight obesity, facial abnormalities (Fig. 1), short and broad thumbs and big toes (Figs. 2 and 3). A keloid was found on the right forearm, that had developed after surgical correction of a fracture (Fig. 4). Ill-defined hyperpigmented macules were observed on the trunk. The patient also presented pruritic eczematous lesions of the limbs and the back that had been present for some years and were recurrent despite treatment with emollients and local steroids. Androgenetic-type alopecia of moderate severity was seen on the vertex of the scalp. Past medical history included polydactylism of the feet and clinodactyly of the thumbs (both corrected surgically), respiratory tract infections, Wolf-Parkinson-White syndrome and refractive errors necessitating glasses.     

Synthesis and properties of (D)- and (L)-lactide stereocopolymers using the system achiral Schiff's base/aluminium methoxide as initiator

The polymerization of lactides with various D /L enantiomeric compositions using achiral Schiff's base/aluminium methoxide as initiator (SALENAlOCH₃) in dichloromethane solution at 70°C is reported. The conversion was kept below 70% in order to limit transesterification reactions. The polymers obtained after precipitation show a narrow molecular weight distribution (ratio of weight- to number-average molecular weights M _w/M _n = 1,1–1,2) and an optical rotation higher than that expected from the optical purity of the starting monomers. The examination of the thermal properties reveals that whatever their enantiomeric composition all the prepared polymers are crystalline. This unusual behavior is explained by an end-chain propagation mechanism producing stereocopolymers with long enantiomeric sequences, i.e., increased isotacticity as substantiated by an examination of the microstructure of the polymers by means of ¹³C nuclear magnetic resonance. A stereocomplex formation was observed for stereocopolymers with optical purities below 40%.     

Radiologic appearance of non-traumatic intracranial hemorrhage]

The diagnosis of nontraumatic intracranial hemorrhage is currently made by computed tomography and is rarely problematic. The causes of bleeding are very numerous. It is important to determine the cause of the hemorrhage promptly, because there may be a recurrence of bleeding. Guidelines for radiologists are proposed and discussed here.     

Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

OBJECTIVES: This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas. METHOD: We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared. RESULTS: The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs. CONCLUSIONS: The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.