Prostaglandin analog mechanisms are not effective in refractory chronic cluster headache

Prostaglandin E analogs have been shown to be effective in the treatment of refractory trigeminal neuralgia in patients with multiple sclerosis. Prostaglandin E inhibits the functions of T lymphocytes which are involved in the pathophysiology of cluster headache. Therefore, a double-blind, placebo-controlled, crossover study on the efficacy of misoprostol in chronic refractory cluster headache was performed. Eight patients were treated with 600 micrograms misoprostol and with placebo for a 2-week period. No differences in attack frequency, intensity, global impression, and side effects could be detected, suggesting that prostaglandin E analogs are not effective in the treatment of chronic cluster headache.     

Headache associated with sexual activity: prognosis and treatment options

The aim of this study was to provide data on the prognosis and treatment options of headache associated with sexual activity (HSA). Sixty patients diagnosed with HSA between 1996 and 2004 were followed up between 2003 and 2006 at least 12 months after the first interview. The further course of the disease and their contentedness with therapy were requested. On average, the second interview was performed 35.9 months after the first examination. Of the 45 patients who had suffered from single attacks or bouts prior to baseline examination, 37 had no further attacks. Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up. Ten patients received indomethacin for preemptive therapy, with good results in nine patients. Eighteen patients received beta-blockers for prophylaxis, with good results in 15 patients. Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years. For patients with longer-lasting bouts or with chronic HSA, prophylactic treatment with beta-blockers or preemptive therapy with indomethacin are often successful.     

The influence of acetazolamide on cerebral low-flow regions in migraine--an interictal 99mTc-HMPAO SPECT study.

Acetazolamide, a carbonic anhydrase inhibitor, has proved to be useful in the assessment of "vasodilatory capacity" in cerebrovascular disease. To obtain further information on the nature of interictal low-flow regions in migraine, we reinvestigated 20 asymptomatic patients suffering from migraine with aura (n = 15) or without aura (n = 5) and who had either minor (n = 12) or marked (n = 8) regional hypoperfusion when examined in a previous 99mTc-HMPAO SPECT investigation. These patients received acetazolamide IV prior to tracer application. In 14/20 cases regional hypoperfusion resolved. Three patients with migraine with aura had less pronounced regional hypoperfusion compared to baseline. No change in baseline hypoperfusion was detectable in three older patients. No further decreases in flow were measured. In contrast to patients with cerebrovascular ischemia, in whom acetazolamide usually enhances low-flow regions, vasodilatory capacity appears intact in most migraine patients with interictal regional hypoperfusion. Thus, the "acetazolamide test" might be useful in the differential diagnosis of migraine with aura from transient cerebrovascular ischemia.     

Migraine and left-handedness are not associated. A new case-control study and meta-analysis

To investigate the possible association between migraine and left-handedness, we enrolled 100 patients with a diagnosis of migraine according to the International Headache Society diagnostic criteria and 100 age- and sex-matched control subjects into a case–control study. Handedness was determined by the Edinburgh Handedness Inventory. There was no significant difference in the frequency or grade of left-handedness between the two groups. Additionally, we pooled our data with those from five similar studies, which did not alter the result. Thus, neither our study nor the meta-analysis support Geschwind and Behan's hypothesis of an association between migraine and left-handedness.     

Anforderungen an eine interdisziplinäre Schmerzvorlesung

ZusammenfassungHintergrund Schmerztherapie ist auch nach der Neufassung der Approbationsordnung kein curricular verankerter Lehrgegenstand im Medizinstudium in Deutschland.Methodik Zur Erfassung der Wünsche von Studierenden an eine fakultative Lehrveranstaltung in Schmerztherapie ist während 2 Semestern an der Medizinischen Fakultät der Universität Münster eine Befragung unter Studierenden durchgeführt worden, die freiwillig eine solche Lehrveranstaltung besuchen wollten.Ergebnisse Die Hauptinteressen richten sich auf die Vermittlung konkreter Schmerzsyndrome (Rücken-, Kopf-, Tumorschmerz), der Pharmakotherapie und der Struktur der schmerztherapeutischen Versorgung. Weibliche Studierende äußerten ein signifikant stärkeres Interesse an der Schmerztherapie für bestimmte Zielgruppen (Frauen, Kinder, alte Menschen, Menschen mit HIV-Infektion). Als wichtigste Bestandteile von Lehrveranstaltungen wurden Fallbeispiele und Patientenvorstellungen gewünscht.Schlussfolgerung Die Analyse der gegenwärtig vorgeschlagenen Curricula für eine universitäre Lehrveranstaltungen in Schmerztherapie ergibt, dass die Curricula der IASP und der EFIC zu umfangreich bzw. zu theoretisch orientiert sind. Das Curriculum der DGSS deckt sich weitgehend mit den Wünschen von Studierenden. Fakultative Lehrveranstaltungen zur Schmerztherapie sollten die ermittelten Wünsche der Studierenden in der Themenauswahl und in den didaktischen Methoden berücksichtigen.     

Zur Korrelation klinisch-apparativer Differenzialdiagnosen mit neuropathologischen Diagnosen bei Patienten mit Aids

BACKGROUND: During the course of HIV infection, the majority of patients develop opportunistic cerebral neuro-manifestations. If conventional diagnostic tools are not sufficient, a stereotactic biopsy is often necessary. PATIENTS AND METHODS: In order to evaluate the correctness of the clinical diagnosis of cerebral neuro-manifestations in HIV-infected patients, we compared the results of cerebral biopsy or autopsy with the previous clinical diagnosis. A total of 19 biopsies and 49 autopsies could be analyzed. RESULTS: Except for HIV-associated encephalopathy, we detected a very high conformity between the clinical and the neuropathological diagnoses. We obtained the best sensitivity for progressive multifocal leukoencephalopathy (PML), whereas for cerebral toxoplasmosis the worst sensitivity and specificity was identified. CONCLUSION: We conclude that the diagnosis of PML can be made on clinical grounds alone, whereas the diagnosis of cerebral toxoplasmosis and lymphoma often requires a biopsy, which should be performed early.     

Engagement and detachment: understanding patients' experiences with nursing

This study aimed to understand what post-operative patients perceived was important about the nursing care they had experienced. The participants were nine women recovering from total hip replacement surgery which had been performed in a large public, acute care hospital in south Australia. Participants volunteered to be involved in the study and were interviewed pre- and post-operatively and interviews continued in their home environment following discharge. The study took place during 1995 within a 10-month time frame. Methodological guidance was sought from the phenomenology literature, with the ideas from Husserl and Heideggar providing shape for the interpretive framework. The analysis of data utilized Colaizzi's (1978) seven procedural steps. For the purposes of this paper the authors have selected to focus only on the findings of this study. Two major themes emerged from the conversations with women. Patients described nurses as being engaged or detached with their nursing care. These themes will be explicated in this paper. In the light of these dominant themes the nursing literature around engagement and detachment are examined. The implications for nursing practice are discussed.     

Vaginale Blutungen

Ohne Zusammenfassung     

Progressive multifokale Leukoenzephalopathie (PML) bei chronisch lymphatischer Leuk?mie (CLL) Literaturübersicht und Fallbeschreibung Literaturübersicht und Fallbeschreibung

Die progressive multifokale Leukoenzephalopathie (PML) ist eine durch das JC-Virus hervorgerufene Leukoenzephalopathie des Zentralnervensystems, die in den letzten Jahren insbesondere als opportunistische ZNS-Infektion bei HIV-Patienten an Bedeutung gewann. Die PML resuliert aus der Reaktivierung des JC-Virus und wird durch l?ngerfristige Immunsuppression ausgel?st. Die mittlere überlebenszeit der in der Literatur dargestellten F?lle (n=17) von PML bei chronisch lymphatischer Leuk?mie (CLL) betr?gt 4,3 Monate, etablierte Therapieverfahren existieren bislang nicht. Wir berichten über einen Patienten mit CLL, der an einer PML erkrankt ist. Die klinische Symptomatik besteht in einer geringgradigen rechtsseitigen Hemiparese mit Feinmotorikst?rung. MR-tomographisch zeigte sich eine typische subkortikale L?sion links hochfrontal, das JC-Virus wurde mittels PCR im Liquor nachgewiesen. Aufgrund positiver Ergebnisse der Behandlung der PML mit Cidofovir bei Patienten mit AIDS wurde diese Therapie eingeleitet. Nach 16-monatiger Behandlung ist kein Progress der PML vorhanden, es zeigte sich eine Regredienz der L?sionen in der MR-Tomographie. Das JC-Virus ist unter Therapie nicht mehr nachweisbar. Verglichen mit der Literatur besteht eine 4fach verl?ngerte überlebenszeit.