Femoxetine in the prophylaxis of migraine - A randomised comparison with placebo

The prophylactic effect in migraine of femoxetine, a 5-HT-uptake inhibitor, was compared to that of placebo in a double-blind group-comparative study. A total of 59 patients, referred to the department from general practitioners, was stratified according to age, sex, duration, and frequency of attacks and then allocated at random to treatment with either femoxetine or placebo. Each patient was treated for 12 weeks with 200 mg in the first week and 300 in the remaining weeks. Ten patients on femoxetine and four patients on placebo failed to complete the study. Headache index as well as number and severity of attacks showed a significant reduction with time. The patients on femoxetine showed the greatest improvement over time. It was, however, not statistically significant. Direct comparison between femoxetine and placebo revealed no statistically significant difference. Three patients in the femoxetine group withdrew due to side-effects combined with lack of therapeutic effect. Other side-effects were slight and infrequent. They did not interfere with the treatment. These results indicate that femoxetine could be useful in migraine as a prophylactic drug.     

Wilson shaft osteotomy for hallux valgus

The results of a modified Wilson shaft osteotomy for hallux valgus in 77 feet of 51 patients were excellent or good in 62 feet after 2 to 4 years. The correction of the hallux valgus angle and intermetatarsal angle was excellent or good in 69 feet. The operation is technically simple provided dorsal angulation of the distal fragment is avoided in the early postoperative period.     

Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections?

Summary In a prospective study 33 children (aged 6–14 years) consecutively referred for recurrent urinary tract infections (RUTI), underwent intravenous urography (IVU) as well as voiding cystography (VC). Seven children had unilateral and two children had bilateral renal scarring, while ten children had unilateral and six children had bilateral vesico-ureteral reflux (VUR). Following normal IVU VUR was demonstrated in 22% of the ureters, but in all cases of low grade. In abnormal IVU, i.e. renal scarring or dilatation of the ureters, VC showed high grade VUR in 54% of the ureters. Based on these results and the current theories on the significance of patient age and the grade of VUR, we conclude that in case of a normal IVU in children with RUTI and age of at least 6 years, there is no reason to supplement the pre-treatment evaluation with VC.     

Invasion of lumbosacral ventral roots and spinal pia mater by substance P-immunoreactive axons after sciatic nerve lesion in kittens

An indirect immunohistochemical technique was used to identify substance P immunoreactive nerve fibers in the ventral roots and spinal pia mater in kittens previously subjected to sciatic nerve lesion. It was shown that the ipsilateral L7 ventral root and spinal pia mater was invaded by substance P immunoreactive nerve fibers after the nerve lesion.     

Peptide neuroanatomy of adjuvant-induced arthritic inflammation in rat

The influence of adjuvant-induced arthritis of the rat on central and peripheral peptide neuroanatomy was investigated by immunohistochemistry. The most striking feature of arthritic rats was the differential intensification of neuronal proenkephalin- and prodynorphin-related staining in dorsal horn. Changes were ipsilateral in monoarthritic and bilateral in polyarthritic rats as compared to controls. Opioid responsive neurons were target of substance P (SP) and calcitonin gene-related peptide (CGRP) fibers. Changes of SP and CGRP predominated in peripheral inflamed tissue and consisted of intensified immunostaining and an apparent sprouting of sensory fibers particularly around venules, in the epidermis and in areas infiltrated by immunocompetent cells. Opioid staining was absent from primary afferents but present in some immune cells of inflamed tissue. Endogenous antinociceptive opioids and pro-nociceptive/pro-inflammatory SP and CGRP may be crucial in the concerted response of the neuroimmune system to chronic inflammatory pain.     

Impact of prenatal methylmercury exposure on neurobehavioral function at age 14 years

A cohort of 1022 consecutive singleton births was generated during 1987-1988 in the Faroe Islands, where increased methylmercury exposure occurs from traditional seafood diets that include pilot whale meat. The prenatal exposure level was determined from mercury analyses of cord blood, cord tissue, and maternal hair. At age 14 years, 878 of 1010 living cohort members underwent detailed neurobehavioral examination. Eighteen participants with neurological disorders were excluded. Blood and hair samples obtained from the participants were analyzed for mercury. The neuropsychological test battery was designed based on the same criteria as applied at the examination at age 7 years. Multiple regression analysis was carried out and included adjustment for confounders. Indicators of prenatal methylmercury exposure were significantly associated with deficits in finger tapping speed, reaction time on a continued performance task, and cued naming. Postnatal methylmercury exposure had no discernible effect. These findings are similar to those obtained at age 7 years, and the relative contribution of mercury exposure to the predictive power of the multiple regression models was also similar. An analysis of the test score difference between results at 7 and 14 years suggested that mercury-associated deficits had not changed between the two examinations. In structural equation model analyses, the neuropsychological tests were separated into five groups; methylmercury exposure was significantly associated with deficits in motor, attention, and verbal tests. These findings are supported by independent assessment of neurophysiological outcomes. The effects on brain function associated with prenatal methylmercury exposure therefore appear to be multi-focal and permanent.     

Left ventricular contractile function in trained dogs with cardial hypertrophy

Summary Eight mongrel dogs were exercised for 8 weeks by treadmill running at 20 per cent incline 20 to 25 minutes twice daily, 4–5 days/week. Another eight dogs which were kept in the cages for a similar period served as controls. The exercise program was effective in inducing myocardial hypertrophy since the ratio left ventricular weight/body weight was significantly (P<0.001) higher in the trained dogs (5.04 g/kg) than in the sedentary animals (3.83 g/kg). In morphine-chloralose anesthesia the dogs were studied by left heart catheterization and cineangiography at spontaneous heart rate (run I), at paced heart rate (run II), at paced heart rate following cardiac autonomic nervous blockade by bilateral vagotomy and the administration of propranolol (run III) and during acute pressure loading with methoxamine at constant heart rate (run IV). Intergroup comparison yielded no significant difference in any hemodynamic or volumetric parameter throughout the entire study. However, with intragroup comparisons between run III and run IV a less significant increase in left ventricular end-diastolic pressure (from 5 to 15 mm Hg; P<0.05) was observed in the trained animals than in the control dogs (from 6 to 25 mm Hg; P<0.001). Left ventricular end-diastolic volume increased significantly only in the control dogs during acute pressure loading. Mean aortic pressure and left ventricular peak dP/dt increased to a similar extent in both groups.Since in the trained dogs the left ventricle encroaches less on theFrank-Starling mechanism than in normal animals for overcoming an acute pressure burden it is concluded that the development of hypertrophy concomitant with chronic exercise represents an adaptive mechanism with evidence of beneficial consequences for the intrinsic contractile function of the myocardium.

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Die Funktion des linken Ventrikels des Hundes bei Trainingshypertrophie

Zusammenfassung Bei 8 Hunden wurde während 8 Wochen ein Laufbandtraining durchgeführt. Die Steigung des Laufbandes betrug 20%, die Trainingsdauer 20–25 Minuten zweimal täglich an 4 bis 5 Tagen pro Woche. Weitere 8 Hunde wurden während einer ähnlichen Zeitperiode in den Käfigen gehalten. Diese Hunde dieten als Kontrolltiere. Das Trainingsprogramm führte zu einer Myokardhypertrophie. denn bei der Autopsie war der Quotient linksventrikuläres Gewicht/Körpergewicht der trainierten Tiere signifikant (P<0,001) höher (5,04 g/kg) als bei den nichttrainierten Hunden (3,83 g/kg). In Morphin-Chloralose-Narkose wurden ein Linkskatheter und eine Kineangiographie des linken Ventrikels durchgeführt, und zwar (I) bei spontaner Herzfrequenz, (II) während rechtsatrialer Stimulation, (III) während Stimulation nach Vagusdurchtrennung und intravenöser Verabreichung von 0,5 mg/kg Propranolol zur autonom-nervösen Blockade und (IV) während akuter Druckbelastung mittels Methoxamininfusion bei konstant gehaltener Herzfrequenz. Während sämtlichen 4 experimentellen Zuständen zeigte kein hämodynamischer oder volumetrischer Parameter eine signifikante Verschiedenheit in den beiden Gruppen. Statistische Vergleiche innerhalb der beiden Gruppen ergaben jedoch unter akuter Druckbelastung einen Anstieg des linksventrikulären enddiastolischen Druckes von geringerer Signifikanz, bei den trainierten (von 5 auf 15 mm Hg; P<0,05) als bei den nichttrainierten Tieren (von 6 auf 25 mm Hg; P<0,001). Das linksventrikuläre enddiastolische Volumen nahm unter Methoxamin nur bei den Kontrollhunden signifikant zu. Der mittlere Aortendruck und max dP/dt nahmen in beiden Gruppen in ähnlichem Maße zu.Zusammenfassend kann festgestellt, werden, daß bei den trainierten Hunden der linke Ventrikel denFrank-Starling-Mechanismus in geringerem, Maße beansprucht als bei den Kontrolltieren, um eine akute Druckbelastung zu bewältigen. Die trainingsinduzierte Myokardhypertrophie darf deshalb als ein Adaptationsmechanismus mit günstigen Auswirkungen auf die Ventrikelkontraktilität bezeichnet werden.

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Mit 4 figures and 2 tables.

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This work was supported by a grant from the Swiss National Science Foundation.