Cluster Headache: The Effect of Low Oxygen Saturation

The present study concerns the possible relationship between hypoxia and the generation of cluster headache attacks. Fifteen controls and 25 cluster headache patients were studied. The patients were allocated into two groups according to cluster headache stage, i.e. cluster or remission period. During the tests, all the subjects were asked to inhale 12% oxygen (88% N2) for 30 min, and the decreasing oxygen saturation (SaO2%) was monitored. Patients in the remission period showed nearly the same decrement of SaO2% as controls. At the end of the test, patients in the bout showed significantly less reduction of SaO2% than the controls. In 5 patients, the test was carried out both in and outside the cluster periods. The tendency to less decrement in oxygen saturation in the cluster phase was as marked with this comparison, but the difference between the groups was not significant, probably partly due to the low number of tests carried out. Only one patient got a typical attack. It seems that hypoxia of this magnitude per se is not the cause of attacks. The different pattern with respect to SaO2% following 12% O2 inhalation in cluster headache may be due to an abnormality in central regulation and/or chemoreceptor sensitivity.     

Bench-to-bedside review: Leadership and conflict management in the intensive care unit

In the management of critical care units, leadership and conflict management are vital areas for the successful performance of the unit. In this article a practical approach to define competencies for leadership and principles and practices of conflict management are offered. This article is, by lack of relevant intensive care unit (ICU) literature, not evidence based, but it is the result of personal experience and a study of literature on leadership as well on conflicts and negotiations in non-medical areas. From this, information was selected that was recognisable to the authors and, thus, also seems to be useful knowledge for medical doctors in the ICU environment.     

Assessment of Synvisc treatment in osteoarthritis

Background. Viscosupplementation is a relatively new method for the treatment of osteoarthritis (OA). The main goal of this project was to assess the safety and clinical utility of Hylan G-F20 (Synvisc(R)) in the treatment of pain associated with osteoarthritis of the knee. The type and frequency of additional therapies used during Synvisc(R) treatment were also assessed. It was a prospective project designed for monitoring Synvisc(R)-prescribing habits in usual medical care.
Material and method. One hundred ninety knee joints in 187 patients were studied (OA symptoms were bilateral in 3 women). Synvisc(R) was indicated for the local treatment of pain in osteoarthritis of the knee. After the diagnosis, Synvisc(R) therapy was started at the recommended dose of 2 ml per intra-articular injection once
a week (at 1-week intervals), three injections in total. The data collected, including medical history, physical examination, radiographic examination and treatment efficacy (overall assessment performed at each visit), were recorded on case report forms designed to facilitate statistical analysis. The physicians completed visual Analogue Scale (VAS) for overall assessment of OA pain at each visit. The clinical outcome was recorded after the end of therapy. The patient data were collected by physicians taking part in this project only.
Results. In 156 cases (82.1%) either a substantial improvement or subsidence of symptoms was observed. In 34 cases (17.9%) the improvement was small or there was no change in the patient's condition. There were local adverse reactions in 2 patients (1.07%). There was no need to cease the treatment, to hospitalise a patient or to start any additional treatment. In 167 patients (89.3%) there was no need to start any non-pharmacological concomitant treatment.
Conclusions. In summary, Synvisc(R) viscosupplementation should be rated among the safest and most effective methods for the treatment of OA, for it alleviates OA-related pain, thus reducing the need for NSAIDs and steroid injections. The use of Synvisc(R) in OA patients alleviates pain regardless of sex and age, the effect being the most pronounced in patients with low- and medium-grade radiographic changes.     

Recovery of T cell subsets after autologous bone marrow transplantation is mainly due to proliferation of mature T cells in the graft

In 22 patients with malignancies, treated with high-dose chemoradiotherapy and autologous bone marrow transplantation (BMT), peripheral blood T cell subsets and functions were studied. In ten cytomegalovirus (CMV)-negative patients, CD4+ and CD8+ T cells (representing T cells of the helper/inducer phenotype and T cells of the suppressor/cytotoxic phenotype, respectively), recovered slowly and simultaneously. In 12 CMV-positive patients, however, CD8+ T cells recovered more rapidly than CD4+ T cells and rose to increased counts. No T cells with an immature phenotype (CD1+, OKT6+) were observed. Lymphocyte stimulation by herpes simplex virus infected fibroblasts (and by CMV-infected fibroblasts in CMV-positive patients) in contrast remained high and even increased after BMT in both groups. These data indicate that T cell recovery after autologous BMT is mainly due to proliferation of mature T cells present in the BM graft and not to generation of new T cells from T cell precursors.     

Surgical decompression of Wirsung duct reduces serum concentration of SPINK1 in patients with chronic pancreatitis

Objectives

The primary aim of this study was to determine the blood levels of SPINK1 in patients with chronic pancreatitis (CP) submitted to surgical or endoscopic decompression of pancreatic duct (PD). Additionally, we measured trypsin activity levels.

Decreased deformability of erythrocytes from smokers

The deformability of erythrocytes from smoking and non-smoking human subjects was examined by filtration through 3-mu pores and capillary viscometry of cell suspensions. In both cases, small but significant differences were found between the two groups that are consistent with a reduction in the surface area-to-volume ratio and/or a diminished membrane flexibility in erythrocyte from smokers. Additional evidence suggests that these findings represent a chronic rather than an acute effect of smoking on erythrocyte deformability.     

Role of substance P and neurokinin A in toluene diisocyanate-induced increased airway responsiveness in rabbits

The aim of the present study was to examine the role of neuropeptides, especially substance P (SP) and neurokinin A (NKA), in toluene diisocyanate (TDI)-induced airway hyperresponsiveness (AHR) to acetylcholine aerosols. Thirty parts per billion of TDI in air administered over 4 hours caused a significant increase in the airway constrictive response to acetylcholine (ACH) aerosols in rabbits (R_I: 245 ± 30%, p < 0.005) without altering basic values of respiratory, cardiovascular or blood gas parameters. Inhalation of the aerosolized neuropeptides SP and NKA resulted in a similar increase in airway responsiveness (AR) to ACH as exposure to 30 ppb TDI. To determine whether neuropeptides contribute to TDI-induced AHR, we studied their effects after systemic treatment with capsaicin as well as after infusion of specific synthetic antagonists for SP and NK2 (NKA) receptors. CAPS treatment performed on 4 consecutive days as well as antagonists' infusion only moderately (p > 0.05) decreased airway responses to ACH. CAPS application prevented the TDI-induced increase in AR to ACH in all rabbits. The increase in airway resistance to ACH did not significantly change after TDI exposure (98 ± 22% of the control response before TDI, p > 0.05). Simultaneous infusion of specific synthetic SP and NK2 receptor antagonists also abolished the TDI-induced increase in airway responses to ACH in all animals investigated (P > 0.05). The results of this study demonstrate that neuropeptides, especially the tachykinins SP and NKA, are important mediators in TDI-induced AHR in rabbits. Offprint requests to: Dr. rer. nat. Wolfgang Marek     

Profound thrombocytopenia after abciximab administration in acute myocardial infarction and stent thrombosis following thrombocytopenia remission--a case report

Profound thrombocytopenia after abciximab administration in acute myocardial infarction and stent thrombosis. This article presents a case of a 62-years-old man with acute anterior myocardial infarction, treated with PCI and stent implantation, in whom profound acute thrombocytopenia was observed after abciximab administration. Nadir platelet count was 6 G/L (before treatment: 250 G/L). Pseudothrombocytopenia was excluded. The remaining antiplatelet drugs (heparin, ASA, clopidogrel) were discontinued. There were no symptoms of bleeding, but next morning (platelet count: 14 G/L) a gross hematoma at femoral puncture site was observed. The patient received 5 U transfusion of platelets. On the 4th day, when the platelet count reached 64 G/L, he was started again on ASA (150 mg) and clopidogrel (75 mg). On the 7th day (platelet count: 138 G/L) he developed anterior ischemia and stent reocclusion was diagnosed. After p.o. clopidogrel (300 mg), balloon PCI with i.c. heparin was performed and ischemia symptoms subsided. The platelet value before the patient's discharge, on subsequent therapy with ASA and clopidogrel, increased to 300 G/L. A review of current literature on this topic is provided.