Combined pharmacological and short-term psychodynamic psychotherapy for probable medication overuse headache: a pilot study

We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A ( P  = 0.0108 and P  = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P  = 0.016, and 23%, OR 0.18, P  = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P  = 0.047) and 12 months (OR 2.75, P  = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM.     

Spatial extent of an outbreak in animal epidemics

Characterizing the spatial extent of epidemics at the outbreak stage is key to controlling the evolution of the disease. At the outbreak, the number of infected individuals is typically small, and therefore, fluctuations around their average are important: then, it is commonly assumed that the susceptible–infected–recovered mechanism can be described by a stochastic birth–death process of Galton–Watson type. The displacements of the infected individuals can be modeled by resorting to Brownian motion, which is applicable when long-range movements and complex network interactions can be safely neglected, like in the case of animal epidemics. In this context, the spatial extent of an epidemic can be assessed by computing the convex hull enclosing the infected individuals at a given time. We derive the exact evolution equations for the mean perimeter and the mean area of the convex hull, and we compare them with Monte Carlo simulations.     

Obesity and Migraine: The Effect of Age, Gender and Adipose Tissue Distribution

(Headache 2010;50:52‐62) Objective.— To evaluate the prevalence of migraine/severe headaches in those with and without general obesity and abdominal obesity (Abd‐O) and the effect of gender and age on this relationship. Background.— General, or total body obesity (TBO), as estimated by body mass index, is a risk factor for migraine chronification. However, there are conflicting data as to whether TBO is associated with migraine prevalence. Abd‐O has been shown to be a better predictor of various disease states than TBO, but has not been evaluated in general population studies in association with migraine. Methods.— Data from a general population survey, the National Health and Nutrition Examination Survey, were used to obtain demographics, self‐report of migraine/severe headaches and measured body mass indices, including height, weight, and waist circumference. All analyses were stratified by age and gender and multivariate analyses were determined through use of logistic regression models. Results.— A total of 21,783 participants were included in the analysis. Between 20‐55 years of age, the prevalence of migraine was increased in both men and women with TBO as compared with those without, (P ≤ .001). Migraine was also more prevalent in those with Abd‐O as compared with those without (men: 20.1% vs 15.9%, P < .001; women: 36.9% vs 28.8.2%, P < .001). After 55 years of age, the prevalence of migraine in men was no longer associated with either TBO or Abd‐O. Similarly, after 55 years of age, the prevalence of migraine in women was no longer associated with TBO. However, in women older than 55 years, the prevalence of migraine was decreased in those with Abd‐O as compared with those without Abd‐O (14.4% vs 17.4%, P < .05). After adjusting for demographics, cardiovascular risk factors and Abd‐O, results were similar for the association between migraine prevalence and TBO in both younger and older men and women. After adjusting for demographics, cardiovascular risk factors and TBO, migraine prevalence was no longer associated with Abd‐O in younger men, but remained associated with an increased odds ratio of having migraine in younger women, as well as a decreased odds ratio in older women. Conclusion.— The relationship between migraine and obesity varies by age, gender, and adipose tissue distribution (eg, TBO vs Abd‐O). In men and women ≤55 years old, migraine prevalence is increased in those with TBO, independent of Abd‐O. In addition, in men and women ≤55 years old, migraine prevalence is increased in those with Abd‐O; and in women this association is independent of TBO. In men older than 55 years, migraine is not associated with either TBO or Abd‐O. However, in women older than 55 years, migraine prevalence is decreased in those with Abd‐O and is independent of TBO.     

Conservation of erectile function following brachytherapy for low-risk prostate cancer

Brachytherapy (BT) is an effective option to treat low-risk prostate cancer (CaP). While oncological results are consistent with those reported following radical retropubic prostatectomy (RRP), attention may be given to the advantages in terms of functional results that a less invasive approach can ensure. The aim of this study is to assess the impact of the conservation of erectile function (EF) in patients who underwent BT with a short and medium term follow-up. MATERIALS AND METHODS. Between May 1999 and January 2005, 170 patients underwent BT for low-risk CaP (intracapsular prostate cancer, PSA , 10 ng/mL, Gleason score , 6). Among them, 58 patients (average age 65.6) with good preoperative erectile function (IIEF>22) and a minimum follow-up of 5 years were selected. The results were evaluated by comparing the values of pre- and postoperative IIEF questionnaire at 3 months, 1 and 5 years of medium follow-up. RESULTS. At a mean 3-month follow-up, a spontaneous recovery of EF (IIEF> 17), strongly influenced by urinary irritative disorders, was reported by 34/58 patients (58%). At 1 and 5 years, good EF (IIEF >22) was reported by 45/58 (78%) and 39/58 (68%) patients, respectively. DISCUSSION AND CONCLUSIONS. The recovery of EF was good one year after BT (78%). Urinary disorders are a significant limiting factor on this recovery. The deterioration of EF during the follow-up, which was already described in literature, is due not only to ageing but also to a delayed radioactive effect on pelvic structures.     

New analysis of the toxic compounds from the Androctonus mauretanicus mauretanicus scorpion venom

Scorpion venoms are very complex mixtures of molecules, most of which are peptides displaying different kinds of biological activity. Indeed, these peptides specifically bind to a variety of pharmacological targets, in particular ionic channels located in prey tissues, resulting in neurotoxic effects. Toxins modulating Na+, K+, Ca2+ and Cl(-) currents have been described in scorpion venoms. In this work, we have used several specific antibodies raised against the most lethal scorpion toxins already described to screen the Moroccan scorpion Androctonus mauretanicus mauretanicus venom in order to characterize new compounds. This immunological screening was also implemented by toxicity tests in mice and with mass spectrometry study, providing new informations on the molecular composition of this venom. In fine, we were able to determine the molecular masses of 70-80 different compounds. According to the immunological data obtained, many toxins cross-react with three sera raised against the most lethal alpha-toxins found in North African scorpion venoms, but not at all with those raised against the main beta-toxins from South and North American venoms. Some of the previously described toxins from Androctonus mauretanicus mauretanicus venom could thus be detected by combining immunological tests, toxicity in mice and molecular masses. Among these toxins, one of them, which showed a mild cross-reaction with the serum raised against AaH I (a highly potent toxin from the venom of Androctonus australis), was identified as Amm III and fully sequenced.     

Endocervical metastases secondary to breast carcinoma. A case report

Only 24 cases of breast cancer metastases to the uterine cervix have been reported to date. The present case present secondary cervical involvement in the absence of concomitant extragenital metastases. The patient did not present with abnormal vaginal discharge and the cervical lesion responded to conventional combination chemotherapy for breast cancer.     

Randomized comparison of two chemotherapy, radiotherapy schemes for stage III and IV unresectable squamous cell carcinoma of the head and neck.

Between August 1983 and December 1986, 116 previously untreated patients with squamous cell carcinoma of the head and neck were randomized to receive induction chemotherapy followed by radiotherapy given in conventional fractions (55 patients, arm A) or an alternating chemotherapy and radiotherapy (3 courses of 20 Gy, 10 daily fractions each; 61 patients, arm B). The same chemotherapy was used in both arms: 6 mg/m2 vinblastine sulfate, hour 0; 30 mg bleomycin, hour 6; 200 mg methotrexate, hours 24 to 26; 45 mg leucovorin, hour 48. Forty-five patients had stage III disease and 71 had stage IV disease. All patients were evaluated for survival, 112 for toxicity, and 105 for analyses of response and time from the start of treatment until progression of disease. At the end of the combined treatment, we observed an overall response rate of 52% in arm A and an overall response rate of 64.9% in arm B. The incidence of mucositis was more relevant in arm B compared to arm A (P less than .00004). The difference in complete response, progression-free survival, and survival was statistically significant, with an advantage for arm B (P less than .03, P less than .02, and P less than .03, respectively). The analysis at a median follow-up of 36 months (range = 19 to 59) demonstrates a higher effectiveness for the alternating program.     

Sinus histiocytosis with massive lymphoadenopathy (Rosai-Dorfman disease). Clinico-pathological analysis of a paediatric case

Histochemical and immunohistochemical studies performed in only a few cases of sinus histiocytosis with massive lymphoadenopathy (SHML) indicated that SHML cells belong to themacrophage — histiocyte system, though their exact origin is still uncertain. We analyzed the morphological, antigenic and enzymatic characteristics of the histiocyte-like cells in one paediatric case of SHML (also named Rosai-Dorfman disease). The SHML cells expressed the S-100 protein, lectins concanavalin A, peanut agglutinin andmonocyte-macrophage related antigens CD 11c, CD 14, CD 33, CD 68 and LN 5. Reactivity with other anti-macrophage antibodies (MAC 387, lysozyme, alpha-1 anti-chymotrypsin) was variable. The CD1a antigen was present only in scattered cells, whereas HLA-DR and the HLA-DR associated invariant chain were absent. Cytochemistry demonstrated an intense activity of acid phosphatase and non specific esterase of SHML cells. A large amount of medium sized mononuclear cells were located in the sinuses and intersinusoidal tissue. Our findings suggest that SHML cells have intermediate features between phagocytes and Langerhans cells/interdigitating reticulum cells. The heterogeneity of marker expression on SHML cells might be related to the local content of factors (e.g., cytokines), capable of modulating the phenotype of monocyted and derived cells.     

Recurrent chest pain as the presenting manifestation of spinal meningioma

We report the case of a 9-year-old boy with a spinal cord meningioma whose only manifestations were recurrent episodes of chest pain lasting for 2 years. This case shows that spinal cord meningioma should be considered among the possible causative factors of chronic chest pain in childhood. Chest pain, meningioma, spinal tumors