Feverfew as a preventive treatment for migraine: a systematic review

Background : Feverfew is a popular herbal remedy advocated for the prevention of migraine. Aim : The aim of this systematic review was to look at the evidence for or against the clinical effectiveness of feverfew in migraine prevention. Data sources : Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM, and the Cochrane Library (all from their inception to April 1998). Study selection : Only randomized, placebo-controlled, double-blind trials were included. Data extraction : All articles were read by two independent reviewers. Data were extracted in a predefined, standardized fashion. The methodological quality of all trials was evaluated using the Jadad score. Main results : Five trials met the inclusion/exclusion criteria. The majority favor feverfew over placebo. Yet important caveats exist. Conclusion : The clinical effectiveness of feverfew in the prevention of migraine has not been established beyond reasonable doubt.     

Effective treatment of ruminations with Nissen fundoplication

Rumination is a syndrome characterized by the effortless regurgitation of recently ingested food. It has been linked to severe medical and psychosocial conditions including malnutrition, aspiration pneumonia, and complete social withdrawal. Psychotherapy, the current treatment modality for rumination, may improve symptoms but requires significant motivation and is rarely curative. We hypothesized that a complete fundoplication would eliminate, or at least impair, the ability to regurgitate gastric contents through the esophagogastric junction. We performed a Nissen fundoplication in five patients with a classic history of rumination. In all cases, symptoms had been resistant to medical and psychiatric intervention prior to fundoplication. Formal preoperative testing included esophageal manometry, 24-hour pH monitoring, endoscopy, and upper gastrointestinal barium swallow studies. All patients reported their primary symptom to be effortless recurrent postprandial regurgitation for 1 to 2 hours after meals consistent with rumination. Four (80%) of the five patients had low resting lower esophageal sphincter pressures with evidence of gastroesophageal reflux disease on 24-hour pH monitoring. All patients reported complete cessation of ruminating behavior after Nissen fundoplication. We report, for the first time, complete elimination of rumination symptoms after a Nissen fundoplication. Although further trials are needed to confirm our results, we recommend considering a Nissen fundoplication for treatment of rumination refractory to behavioral and medical interventions. Supported in part by a grant from U.S. Surgical, a division of Tyco, Inc.     

SEASON OF BIRTH IN DOWN'S SYNDROME

SUMMARY Previous studies have found a summer peak in the birth of individuals with Down's syndrome but have not tended to examine them into adulthood. The aims of this study were to look for evidence of a seasonal effect in birth and to uncover any differences in adulthood between those born in different seasons. The casenotes of all adults with Down's syndrome from the catchment area of a hospital for people with learning disability were examined. A summer peak in births was confirmed. Only 6% of births took place during January and February compared with the 17% expected (P=0.019); birth during these 2 months was associated with female sex (P=0.047). There was a trend for those born in December to March not to develop epilepsy (P=0.053).     

Bony inlet stenosis as a cause of nasal airway obstruction

Two cases of congenital bony stenosis of the nasal piriform aperture (anterior nares) are presented. Both patients experienced episodes of respiratory distress and clinical symptoms similar to those seen in patients with posterior choanal atresia. The underlying anatomic abnormalities in congenital bony inlet stenosis are quite different from those in choanal atresia and require different surgical approaches for correction. Computed tomography demonstrates in detail the underlying anatomic abnormality and allows differentiation of bony inlet stenosis from choanal atresia.     

P43 Effectiveness of a mechanic-chemical method in reducing malodor of dentures

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two-thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self-perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students' attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self-reported oral malodor prevalence ( P  < 0.05). However other oral or behavioral factors did not relate to the self-reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients' but also their own oral malodor problem.