Migraine-associated vertigo: clinical characteristics of Japanese patients and effect of lomerizine, a calcium channel antagonist

CONCLUSION: Lomerizine, a calcium channel blocker, may be effective as a treatment for migraine-associated vertigo (MAV). Objective. To determine the clinical characteristics of patients with MAV in Japan and the effectiveness of lomerizine. PATIENTS AND METHODS: This was a retrospective chart review carried out in a university hospital of 33 patients who fulfilled the diagnostic criteria for MAV. All patients were initially treated with dietary manipulation. If this therapy was unsuccessful, oral medications, mainly lomerizine, were administered. Medical records were reviewed to find clinical characteristics of patients with MAV and to evaluate the effects of the therapy on vertigo/dizziness symptoms. RESULTS: A marked female predominance was found (23 women, 10 men). The frequency and the duration of vertigo varied across patients. About 60% of the patients had cochlear symptoms during an attack, among which bilateral aural fullness was most frequent. Oto-neurological examination showed abnormalities in 33% of the patients. Overall, 27 of the 33 patients (82%) responded to our therapy. Among the 22 patients who were prescribed lomerizine, 19 patients (87%) showed resolution or significant improvement of the symptoms.     

Subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo

CONCLUSION: Patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) could have mild excitation in the vestibular system on the affected side. OBJECTIVE: p-BPPV is considered to be caused by small particles dislodged from the utricular macula. While subjective visual horizontal (SVH) mainly reflects utricular function, there is less documentation on SVH in patients with p-BPPV. The purpose of this study was to clarify whether p-BPPV could affect SVH. PATIENTS AND METHODS: Twenty-eight patients with unilateral idiopathic p-BPPV were enrolled. For comparison, 17 patients with vestibular neuritis and 45 patients with cerebello-pontine angle (CPA) tumor were also examined. For measurement of SVH, we used a device that has a red bar of light-emitting diodes (LEDs) in front of the patient. Subjects were asked to rotate the bar to the position that they felt was horizontal in a completely dark room. RESULTS: Deviation of SVH toward the unaffected side down was seen in 82.1% (23/28) of patients with p-BPPV. Mean+/-SD deviation of SVH from the true horizontal to the unaffected side down was 0.49+/-1.21 degrees. Conversely, deviation of SVH was toward the affected side down in 88.2% of patients with vestibular neuritis and in 75.6% of patients with CPA tumor.     

Superficial siderosis causing retrolabyrinthine involvement in both cochlear and vestibular branches of the eighth cranial nerve

Although superficial siderosis (SS) has been clinically characterized as a combination of sensorineural hearing impairment, cerebellar ataxia and pyramidal signs, precise evaluation of the function of the eighth cranial nerve has rarely been reported. The purpose of this study was to evaluate the audiological and vestibular function. We present a patient with complaints of progressive bilateral hearing loss and gait difficulty. We evaluated the audiological and vestibular functions with auditory brainstem responses and vestibular evoked myogenic potentials (VEMPs) by clicks and galvanic stimuli. The patient showed linear hypointensities surrounding the brainstem, cerebellum and the eighth cranial nerve on T2-weighted MRI images, which is characteristic of SS. Auditory brainstem response showed only wave I in the right ear and no response in the left ear. Click VEMPs and galvanic VEMPs showed no response on either side. The results of a neuro-otological examination suggested that both audiological and vestibular dysfunction in the patient with SS is of retrolabyrinthine origin.     

Effects of beta-blocker therapy on high sensitivity c-reactive protein, oxidative stress, and cardiac function in patients with congestive heart failure

BackgroundIt is uncertain whether β-blocker therapy affects serum C-reactive protein (CRP) level in patients with congestive heart failure (CHF). We attempted to determine if β-blocker therapy decreases serum CRP production and to correlate the production with biomarkers and cardiac function in such patients.Methods and ResultsFifty-two patients with mild to moderate CHF with a left ventricular ejection fraction (EF) <40% were enrolled. They were randomly assigned to metoprolol or carvedilol treatment groups. The CRP concentration decreased significantly in patients with higher baseline CRP concentration, but not in those with lower baseline CRP concentrations. There was an inverse correlation between ΔCRP and ΔEF 16 weeks after the start of β-blocker therapy for patients with higher baseline CRP concentrations. In patients with higher baseline concentrations, CRP decreased in patients who received carvedilol, but not in those who received metoprolol. Plasma lipid peroxide (LPO) concentration significantly decreased, and there was an inverse correlation between ΔCRP and ΔLPO 16 weeks after the start of therapy.ConclusionsAdministration of β-blockers is associated with attenuation of inflammatory marker in certain patients with CHF. The antioxidant effects of β-blockers, especially carvedilol, may play a role in mediating the phenomenon.     

Specific subtelomere loss on chromosome der(11)t(3;11)(q23;q23)x2 in anaplastic thyroid cancer cell line OCUT-1

One of the most aggressive human malignancies, anaplastic thyroid carcinoma (ATC), has an extremely poor prognosis that may be explained by its genomic instability. We hypothesized that the very rapid cell turnover observed in ATC might accelerate telomere shortening and chromosomal instability associated with tumor cell malignancy. To compare and measure chromosomal aberrations and telomere shortening in the anaplastic thyroid cancer cell line OCUT-1, we applied quantitative fluorescence in situ hybridization (Q-FISH) techniques. In all 15 metaphases studied, telomere length estimates from Q-FISH of chromosomes in ATC were shorter than those of a fibroblast cell line derived from the stroma adjacent to the carcinoma. OCUT-1 cells display several chromosomal abnormalities, but have a near-normal chromosome complement of 46, XX, making it easy to analyze the karyotype. The karyotype showed 50, XX, +7, +11, der(11)t(3;11)(q23;q23)x2, del(12)(p11.2p12), +20, +1mar. We analyzed carefully the abnormalities in karyotype of OCUT-1 associated with telomere shortening on each chromosome and expression of subtelomeres. Telomere lengths in the q-arms of the abnormal chromosome del(12)(p11.2p12) were shorter than the average length in the q-arms of the normal chromosome 12 in OCUT-1. Subtelomeres on the abnormal chromosome der(11)t(3;11)(q23;q23)x2 also showed loss of signals on 11p, but there was no loss of signals in the cytogenetically normal trisomies 7 and 20 or the abnormal chromosome del(12)(p11.2p12). Subtelomeres of 3q had eight signals, one pair remaining in place on 3q and another pair on the abnormal 11p. Our findings suggest that telomere shortening and subtelomere loss are correlated with genetic instability in this anaplastic thyroid carcinoma cell line.     

ELKS, a protein structurally related to the active zone protein CAST, is involved in Ca2+-dependent exocytosis from PC12 cells

The active zone protein CAST binds directly to the other active zone proteins RIM, Bassoon and Piccolo, and it has been suggested that these protein-protein interactions play an important role in neurotransmitter release. To further elucidate the molecular mechanism, we attempted to examine the function of CAST using PC12 cells as a model system. Although PC12 cells do not express CAST, they do express ELKS, a protein structurally related to CAST. Endogenous and exogenously expressed ELKS, RIM2 and Bassoon were colocalized in punctate signals in PC12 cells. Over-expression of full-length ELKS resulted in a significant increase in stimulated exocytosis of human growth hormone (hGH) from PC12 cells, similar to the effect of full-length RIM2. This increase was not observed following over-expression of deletion constructs of ELKS that lacked either the last three amino acids (IWA) required for binding to RIM2 or a central region necessary for binding to Bassoon. Moreover, over-expression of the NH(2)-terminal RIM2-binding domain of Munc13-1, which is known to inhibit the binding between RIM and Munc13-1, inhibited the stimulated increase in hGH secretion by full-length RIM2. Furthermore, this construct also inhibited the stimulated increase in hGH secretion induced by full-length ELKS. These results suggest that ELKS is involved in Ca(2+)-dependent exocytosis from PC12 cells at least partly via the RIM2-Munc13-1 pathway.     

Difficulty of food intake in patients with temporomandibular disorders

PURPOSE: Although patients with temporomandibular disorders (TMD) often report impaired eating, the features of food intake difficulty have rarely been estimated. This study compared subjective difficulty in 4 categories of food intake situations among 3 subgroups of TMD patients. MATERIALS AND METHODS: A total of 511 TMD patients (402 women, 109 men, mean age 36.4 +/- 15.4, range 12 to 82) participated in this study. Subjects were divided into 3 TMD subgroups: myofascial pain (MFP), disc displacement with/without reduction (DD), and arthralgia or osteoarthritis (Arth). Patients' level of food intake difficulty was assessed using a visual analogue scale (VAS) for 4 categories of food intake situations: difficulty in putting food into mouth (PUT), difficulty in biting off foods (BIT), difficulty in grinding down foods (GRD), and overall difficulty in consuming a meal (OAL). RESULTS: Nearly all patients (98.6%) exhibited food intake difficulty in at least 1 category. In the category of PUT, the DD group exhibited significantly more difficulty than the MFP and Arth groups (P < .048), and the Arth group had a higher VAS score than the MFP group (P = .030). With regard to BIT and GRD, there was no significant difference among the TMD subgroups. In OAL, the DD group showed more difficulty than the MFP group (P = .046). CONCLUSION: TMD patients experienced impaired food intake ability. In particular, the DD group experienced more difficulty than the MFP group. Concerns about types of food and food intake behavior for each TMD subtype should be taken into account in the management of TMD patients.     

Prevalence of Restless Legs Syndrome in Patients with Inflammatory Bowel Disease

Digestive Diseases and Sciences - There has been increased interest in sleep disorders in patients with inflammatory bowel disease (IBD). Studies in North America and Europe reported that the...