Primary headache care delivery by nonspecialists in Brazil

Headaches are common disorders usually examined by nonneurologists. In order to assess how primary headache patients (IHS groups 1, 2, and 3) are generally managed by nonspecialists, 414 patients were asked about their previous headache care. Correct diagnosis had previously been made in only 44.9%, 6.7%, and 26.7% of the migraine, tension-type headache, and cluster headache patients, respectively. The patients underwent 501 investigative procedures motivated by the headache, averaging 1.21 examinations per patient, mostly EEGs. Preventive treatment was largely overlooked irrespective of the headache type. It is concluded that scientific improvements in headache care may be ineffective unless educational programs improve headache knowledge in general.     

No brain structure abnormalities in boys with Tourette's syndrome: A voxel‐based morphometry study

Morphometric findings in Tourette's syndrome (TS) are still inconsistent probably due to differences in analysis approaches as well as several confounders (coexisting psychiatric conditions, medication status, etc.). Our aim was to identify possible morphometric changes in a well‐defined sample of drug‐naïve boys with “pure” TS. High‐resolution structural magnetic resonance images of 38 boys with TS were compared with those of 38 healthy boys matched for age and IQ using voxel‐based morphometry (VBM). Coexisting psychiatric conditions and previous medication were excluded. The inclusion of 10‐ to 15‐year‐old boys minimized the well known compensatory changes due to tic suppression over many years. VBM analyses revealed no differences between the treatment naïve boys with “pure” TS and healthy controls. Brain morphology is not altered in boys with “pure” TS. Further studies should reveal whether previous findings might be ascribed to confounding factors like coexisting psychiatric conditions or long‐term compensatory mechanisms due to voluntary tic suppression. © 2009 Movement Disorder Society     

Phase II trial of thalidomide for patients with advanced renal cell carcinoma.

PURPOSE: To assess efficacy and toxicity of thalidomide in patients with advanced renal cell carcinoma (RCC). PATIENTS AND METHODS: Twenty-six patients with RCC were treated with thalidomide at a starting dose of 200 mg daily. Thalidomide was increased by 200 mg every 2 weeks until a maximum dose of 800 mg or prohibitive toxicity was reached. Fifteen patients had prior nephrectomy, 11 patients had no prior systemic therapy, and 15 had received one prior systemic regimen. RESULTS: A maximum dose of 800 mg, 600 mg, 400 mg, and 200 mg was reached in five, 10, eight, and three patients, respectively. Grade 2 and 3 dyspnea occurred in four and three patients, respectively. Grade 2 and 3 neurologic toxicity was observed in five and two patients, respectively. Of the 25 assessable patients, the best response was stable disease in 16 (95% confidence interval [CI], 43% to 82%) patients. The 6-month progression-free survival rate was 32% (95% CI, 14% to 50%). Three patients achieved prolonged stable disease of 16, 16+, and 18+ months, including two patients who were refractory to previous cytokine therapy. Fifty-seven percent were alive at 1 year (95% CI, 37% to 76%). CONCLUSION: This trial does not support the routine use of thalidomide to induce partial response for metastatic RCC. Because disease stabilization occurs as a part of the natural history of metastatic RCC, the potential effect of thalidomide on progression-free and overall survival for patients with advanced RCC is being addressed in a randomized phase III trial. New immunomodulatory analogs of thalidomide that have shown potentially greater antitumor effects in preclinical models warrant study in metastatic RCC.     

Interaction of Carbamazepine-10,11-Epoxide, an Active Metabolite of Carbamazepine, with Valproate: A Pharmacokinetic Study

The mechanism responsible for the valproate (VPA)-induced elevation of serum carbamazepine-10,11-epoxide (CBZ-E) levels was investigated in 6 normal subjects who received single oral doses of CBZ-E (100 mg) in a control session and during concurrent treatment with sodium VPA [500 mg twice daily (b.i.d.)]. VPA caused a significant prolongation of CBZ-E terminal half-life (t1/2 from 6.3 +/- 1.2 to 9.0 +/- 2.0 h, mean values +/- SD) and decreased CBZ-E clearance (from 90.6 +/- 18.8 to 63.2 +/- 16.1 ml h-1 kg-1, mean values +/- SD) without affecting CBZ-E apparent volume of distribution (from 0.82 +/- 0.19 to 0.81 +/- 0.24 l kg-1, mean values +/- SD). These findings indicate that VPA impairs the elimination of CBZ-E, presumably by inhibiting its metabolism.     

Prolonged unexplained pyrexia: A review of 221 paediatric cases from Kuwait

Summary Over a three year period (January 1985 through December 1987), 221 children with prolonged pyrexia were admitted to the paediatric departments in two regional hospitals in Kuwait. Infections, connective tissue diseases and malignancies constituted 78%, 5% and 2%, respectively, and 15% of the cases remained undiagnosed. Brucella was the most common infectious agent encountered (38% of all cases), followed by typhoid fever (9%). The duration of fever was more helpful in the differential diagnosis than its height or pattern. The erythrocyte sedimentation rate and the white blood count were of limited value, and the C-reactive protein was positive in bacterial infections, malignancies and connective tissue diseases. Since a child presenting with prolonged pyrexia in this country has over a 70% chance of having a bacterial infection, both diagnostic and therapeutic procedures should be performed as an emergency measure. Particular emphasis should be put on the exclusion of brucellosis.

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Anhaltendes Fieber unbekannter Ursache: Übersicht über 221 pädiatrische Fälle aus Kuwait

Zusammenfassung Innerhalb drei Jahren (Januar 1985 bis Dezember 1987) wurden in die pädiatrischen Abteilungen von zwei regionalen Krankenhäusern in Kuwait 221 Kinder mit anhaltendem Fieber unbekannter Ursache eingewiesen. 78% der Fälle beruhten auf Infektionen, 5% auf Erkrankungen des Bindegewebes, 2% waren maligne Erkrankungen; ohne ätiologische Abklärung blieben 15% der Fälle. Brucella war mit 38% aller Fälle der häufigste Infektionserreger. Die zweithäufigste Infektionskrankheit war Typhus mit 9% der Fälle. Von differential-diagnostischem Wert war mehr die Dauer als die Höhe des Fiebers und der Fieberverlauf. BKS und Leukozytenwerte waren von begrenztem Wert; das C-reaktive Protein war sowohl bei bakteriellen Infektionen wie bei Erkrankungen des Bindegewebes oder malignen Krankheiten erhöht. Die Tatsache, daß mehr als 70% der Fälle von anhaltendem Fieber bei Kindern in diesem Land durch Infektionen bedingt sind, rechtfertigt, sowohl die diagnostische Abklärung wie die Therapie unverzüglich einzuleiten. Auf den Ausschluß einer Brucellose sollte besonders großer Wert gelegt werden.