scholarly journals Treatment of posttraumatic headache migraine phenotype with erenumab – An observational study

2019 ◽  
Vol 3 ◽  
pp. 205970021987829 ◽  
Author(s):  
James A Charles
Keyword(s):  
Large Scale ◽  
Impact Test ◽  
Head Impact ◽  
Posttraumatic Headache ◽  
Clinical Criteria ◽  
Migraine Headaches ◽  
Before And After ◽  
History Of ◽  
Small Cohort

Objective To report the observed effect of erenumab in mild posttraumatic headache migraine phenotype with and without aura. Background There is no clinical algorithm of pharmacotherapy for migraine following posttraumatic headache. Most migraine preventatives that are typically used are either ineffective or not tolerated. Methods Seven patients who met the clinical criteria for migraine with or without aura following posttraumatic headache who failed or were intolerant of conventional migraine preventatives were treated with erenumab 140 mg subcutaneously. Most had no history of migraine. In those patients with a history of migraine, the posttraumatic headache migraine headaches were different than the past migraine experience. Descriptive headache intensity or disability using the Head Impact Test-6 and monthly headache days were recorded before and after treatment. All patients were debilitated on presentation and demonstrated no signs of spontaneous resolution. Results Patients responded with a 95% (SD 1.22, p < .001) reduction in headache days. All Head Impact Test-6 scores went from disabling to non-disabling without adverse effects. Most required only one dose of erenumab with no migraine recurrence. Onset of efficacy often became apparent within days to four weeks. Extended follow-up six months after treatment revealed no relapses. Conclusions Erenumab is effective in the treatment of posttraumatic headache with migraine phenotype in this small cohort. Large-scale studies are urgently required for this highly prevalent, disabling, condition which has no effective established treatment.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobuaki Tanaka ◽  
KOICHI INOUE ◽  
Atsushi Kobori ◽  
Kazuaki Kaitani ◽  
Takeshi Morimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Large Scale ◽  
Multicenter Observational Study ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Af Recurrence

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p<0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p<0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p<0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

scholarly journals Does Solfinacin solve the urgency symptoms in postpartum women ?

2021 ◽  
Vol 23 (06) ◽  
pp. 375-394
Author(s):  
Dr. Anwar Khazal Jafar ◽  
◽  
Elaf Mahmood Shihab ◽  
Dr. Lewaa Arkan Jabar ◽  
Dr. Inas Taha Ahmed ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Significant Decline ◽  
Postpartum Women ◽  
Delivery Mode ◽  
Childbearing Age ◽  
Before And After ◽  
Urgency Symptoms ◽  
History Of ◽  
The Mean

Background: It is widely accepted that antimuscarinics are considered first-line treatment for patients with overactive bladder (OAB). However, the mechanism by which antimuscarinics improve the symptoms of OAB remains to be fully elucidated. Patients and methods: This study is a clinical prospective follow-up study carried out in the Consultancy Clinic of Al-Elwiya Maternity Teaching Hospital in Baghdad-Iraq. duration(November, 2019-April, 2020). inclusion criteria were adult postpartum women at childbearing age with symptoms of the overactive bladder treated by a Gynecologist with Solifenacin tablets. Results: a current study showed 34% of them were in the age group 20-29 years. The mean parity history of women with OAB was (3); 32% of them had a parity history of 1-3 para and 68% of them had a parity history of 4-6 para. delivery mode for 84% of women with OAB was a vaginal delivery, as well as 36% of women with OAB, had ≤7 times urinations a day, as well as a significant decline in score 2 observed after treatment with Solifenacin (p=0.01). No significant differences were observed in score 3 before and after Solifenacin treatment (p=0.06). A significant decline in score 4 was observed after treatment with Solifenacin (p=0.001). No significant differences were observed in women with OAB before and after Solifenacin treatment, soa highly significant increase in control of urination after treatment (p<0.001). Conclusion: solifenacin drug is effective in the reduction of overactive bladder syndrome score three months after treatment.

Posterior revision surgery using an intraarticular distraction technique with cage grafting to treat atlantoaxial dislocation associated with basilar invagination

2019 ◽  
Vol 31 (4) ◽  
pp. 525-533 ◽  
Author(s):  
Wanru Duan ◽  
Dean Chou ◽  
Bowen Jiang ◽  
Zhenlei Liu ◽  
Xinghua Zhao ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Posterior Approach ◽  
Clinical Symptoms ◽  
Japanese Orthopaedic Association ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Posterior Surgery ◽  
Before And After ◽  
History Of

OBJECTIVEThe treatment of atlantoaxial dislocation (AAD) and basilar invagination (BI) is challenging, especially in symptomatic patients with a history of previous surgery. Although seldom reported, posterior revision surgery to revise prior constructs can be advantageous over an anterior or combined approach. The authors describe their experience in performing posterior revision surgery using Goel’s technique.METHODSThe authors reviewed patients with AAD and BI who had undergone previous posterior surgery at the cranio-cervical junction between January 2016 and September 2017. All of these patients underwent revision surgery from a posterior approach. The Japanese Orthopaedic Association (JOA) score was used to assess clinical symptoms before and after surgery. The distance from the tip of the odontoid to Chamberlain’s line, atlantodental interval (ADI), and clivus-canal angle (CCA) were used for radiographic assessment before and after surgery.RESULTSTwelve consecutive patients were reviewed. Prior surgeries were as follows: 4 patients (4/12) with posterior osseous decompression without fusion, 7 (7/12) with reduction and fusion without decompression, and 1 (1/12) with posterior osseous decompression and reduction and fusion. With the use of Goel’s technique for revision in these cases, distraction using facet spacers afforded release of the anterior soft tissue from a posterior approach. The occiput was fixated to C2 using a cantilever technique, and autologous cancellous bone was grafted into the intraarticular joints. In all 12 patients, complete reduction of BI and AAD were achieved without injury to nerves or vessels. All patients had evidence of bony fusion on CT scans within 18 months of follow-up.CONCLUSIONSPosterior revision surgery using Goel’s technique is an effective and safe revision salvage surgery for symptomatic patients with AAD and BI.

Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus

1984 ◽  
Vol 61 (1) ◽  
pp. 156-162 ◽  
Author(s):  
Rolf Gruber ◽  
Peter Jenny ◽  
Bruno Herzog
Keyword(s):  
Clinical Course ◽  
Fluid Pressure ◽  
Shunt System ◽  
Slit Ventricle Syndrome ◽  
Content Type ◽  
Pediatric Hydrocephalus ◽  
Before And After ◽  
History Of ◽  
Slit Ventricle

✓ A follow-up study was performed on 41 hydrocephalic children with primary (10 patients) or secondary (31 patients) placement of an anti-siphon device (ASD) connected to their shunt. The clinical course before and after ASD implantation was compared in these two groups, including studies of the head circumference, the radiological ventricular size, cerebrospinal fluid pressure studies on the supine and upright patient, and the history of shunt-induced complaints and complications leading to hospitalization. The authors discuss the pathophysiological concept of the “chronic overdrainage” or slit-ventricle syndrome based on ventricular collapse due to chronic suction-induced overdrainage by the vertical shunt system in the upright patient. The use of an ASD in connection with the regular shunt system of children with hydrocephalus is proposed. This ASD-shunt combination successfully reduced the number of complaints and shunt dysfunctions over a period of more than 6 years.

Headstand for Rotator Cuff Tear: Shîrshâsana or Surgery

2006 ◽  
Vol 16 (1) ◽  
pp. 39-47
Author(s):  
Loren Fishman ◽  
Caroline Konnoth ◽  
Alena Polesin
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Repeated Measures ◽  
Shoulder Abduction ◽  
Inverted Position ◽  
Clinical Criteria ◽  
Repeated Measures Design ◽  
Cuff Tear ◽  
Before And After

Objective: Pilot study to demonstrate and explain the enabling effects of headstand and chair-supported headstand in the clinical management of patients with rotator cuff tear, also known as rotator cuff syndrome (RCS). Design: Prospective, unblinded single exposure study with repeated-measures design. Setting: Private outpatient medical office. Participants: Ten patients meeting clinical criteria for rotator cuff syndrome (RCS). MRI confirmed severe or total thickness tear of either the supraspinatus or infraspinatus muscles or both. Intervention: Participants were taught a version of shîrshâsana (headstand), and remained in the inverted position for 30 seconds. Participants practiced the inversion for 30 seconds once a day for six weeks thereafter. Data: Patients were tested for maximal voluntary abduction and flexion of the neutrally positioned arm, then rated their pain on maximal abduction before and after being taught a version of headstand, and at a six-week follow-up. Outcome Measures: Immediate (post-headstand) and six-week change in function, measured by active range of abduction and flexion of the neutrally positioned arm. Immediate (post-headstand) and six-week change in pain during abduction, measured by a 10-point visual analogue scale (VAS). Results: Mean voluntary abduction and flexion increased from 85 degrees each to 158 degrees and 162 degrees respectively. Mean VAS pain rating during abduction fell from 4.8/10 to 1.2/10. Further Investigation: Electromyographic (EMG) interference pattern changes showed that the subscapularis, anterior and lateral deltoid, and rhomboid major were significantly more active electrophysiologically during headstand, and in abduction and flexion following headstand, than in abduction and flexion performed prior to headstand. MRI confirmed subscapularis activation in post-headstand shoulder abduction. Conclusions: Headstand and a chair-supported version of headstand appear to improve function in the upper extremity after rotator cuff injury. EMG suggests that the subscapularis holds down the head of the humerus while the deltoid abducts the shaft. Using these two muscles together for abduction and flexion, in place of the supraspinatus, appears to be learned through brief exposure to a version of headstand.

scholarly journals Natural history of early gastric cancer: series of 21 cases

2019 ◽  
Vol 07 (01) ◽  
pp. E43-E48 ◽  
Author(s):  
Hiroyoshi Iwagami ◽  
Ryu Ishihara ◽  
Kentaro Nakagawa ◽  
Masayasu Ohmori ◽  
Kenshi Matsuno ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Natural History ◽  
Large Scale ◽  
Submucosal Tumor ◽  
Inclusion Criteria ◽  
Submucosal Tumors ◽  
History Of ◽  
Muscle Invasion

Abstract Background and study aims While knowledge of the natural history of early gastric cancer (EGC) may be useful in relevant clinical situations, few relevant reports are available. Therefore, we investigated the progression of EGC. We gathered data regarding 114 cases of EGC from 2005 to 2015 from a hospital cancer registry and analyzed 21 lesions that fulfilled five inclusion criteria. Deep progression was defined as submucosal invasion by a mucosal tumor and proper muscle invasion by a submucosal tumor. Lateral progression was defined as ≥ 20 % increase in size. During median follow-up of 23 months, one of 18 mucosal tumors showed deep progression and six showed lateral progression. Of three submucosal tumors, two showed deep progression and three showed lateral progression. Our study suggests that a certain proportion of mucosal cancers can lie dormant for several years. Further large-scale studies in a multicenter setting should overcome the limitations of this study.

The impact of Cyclone Fanele on sifaka body condition and reproduction in the tropical dry forest of western Madagascar

2011 ◽  
Vol 27 (4) ◽  
pp. 429-432 ◽  
Author(s):  
R. J. Lewis ◽  
F. Rakotondranaivo
Keyword(s):  
Evolutionary History ◽  
Large Scale ◽  
Global Climate ◽  
Tropical Dry Forest ◽  
Dry Forest ◽  
Natural Disturbances ◽  
Specific Effects ◽  
Before And After ◽  
History Of ◽  
The Impact

Cyclones have been suggested to play a major role in the evolutionary history of the flora and fauna of Madagascar (Wright 1999). In spite of the proposed significance of cyclonic activity, very little is known about the specific effects of cyclones on Malagasy ecosystems (Birkinshaw & Randrianjanahary 2007). Understanding the effects of these severe natural disturbances requires comparing data collected both before and after the event. Because cyclones are stochastic, researching the influence of cyclones on Madagascar's biodiversity is difficult and opportunities to study their impact on forests are rare. Nevertheless, studies of the impact of cyclones on Malagasy biota are imperative because models of global climate patterns predict that large-scale tropical disturbances will increase in frequency and intensity in the future (Metcalfe et al. 2008).

Biomechanical assessment of healthy and keratoconic corneas (with/without crosslinking) using dynamic ultrahigh-speed Scheimpflug technology and the relevance of the parameter (A1L−A2L)

2018 ◽  
Vol 103 (4) ◽  
pp. 558-564 ◽  
Author(s):  
Thomas A Fuchsluger ◽  
Susanne Brettl ◽  
Gerd Geerling ◽  
Wolfgang Kaisers ◽  
Philipp Franko Zeitz
Keyword(s):  
Control Group ◽  
Therapeutic Success ◽  
Corvis St ◽  
Biomechanical Assessment ◽  
Corneal Deformation ◽  
Before And After ◽  
Small Cohort ◽  
The Difference ◽  
Group 2

AimsTo examine corneal biomechanics in healthy and keratoconic eyes, with or without crosslinking obtained by ultrahigh-speed Scheimpflug measurements (Corvis ST).MethodsOne hundred and seventeen eyes were studied in three groups: group 1 (n=39) contained keratoconic eyes without crosslinking. Group 2 (CXL; n=28) comprised keratoconic eyes after crosslinking. These were compared with a control group (n=50 matched healthy eyes). In addition, 10 keratoconus patients, before and after CXL treatment, respectively, were examined.ResultsThe novel parameter A1L–A2L demonstrated highly significant differences between crosslinked corneas and untreated keratoconic or healthy corneas. Velocity during second applanation (A2V) and deformation amplitude (DA) were significantly increased in crosslinked keratoconic eyes both compared with untreated keratoconic eyes and with healthy controls. Radius at highest curvature also was significant among all groups. Inward applanation length (A1L) was significantly increased in controls, whereas outward applanation length (A2L) was significantly reduced in crosslinked keratoconic eyes compared with both other groups. The follow-up analysis revealed statistically significant changes in pachymetry and intraocular pressure and showed tendencies towards significance in applanation times 1 and 2 and in DA.ConclusionsBoth A2V and A2L are viable parameters to discriminate healthy from keratoconic but also crosslinked from non-crosslinked keratoconic corneas. The difference of A1L−A2L could reliably discriminate crosslinked from non-crosslinked and healthy corneas. Follow-up examination in a small cohort allows distinction between crosslinked and untreated keratoconus in follow-up examinations. The difference of A1L-A2L could reliably discriminate crosslinked from non-crosslinked and healthy corneas. Measurements of corneal deformation using dynamic ultrahigh-speed Scheimpflug technology are reproducible and provide useful information about keratoconus assessment and biomechanics. Therefore, the Corvis ST seems to provide useful technology to monitor therapeutic success of crosslinking treatment.

Intravenous Lignocaine (Lidocaine) Infusion for the Treatment of Chronic Daily Headache with Substantial Medication Overuse

Cephalalgia ◽  
2003 ◽  
Vol 23 (10) ◽  
pp. 963-971 ◽  
Author(s):  
DR Williams ◽  
RJ Stark
Keyword(s):  
Chronic Daily Headache ◽  
Pain Control ◽  
Medication Overuse ◽  
Published Data ◽  
Analgesic Agent ◽  
Migraine Headaches ◽  
History Of ◽  
Daily Headache

Patients with chronic daily headache with medication overuse are difficult to treat, especially when the doses of analgesia are substantial. We have previously shown that intravenous lignocaine (lidocaine) infusion is useful in maintaining pain control while the offending analgesic agent is withdrawn in these patients. The published data on long-term efficacy of this treatment is limited. We undertook a retrospective survey of 71 consecutive patients admitted for lignocaine infusion (mean 8.7 days) for treatment of chronic daily headache, with substantial analgesic abuse. Ninety percent of patients had a history of migraine headaches. In 80% of patients codeine was the predominant agent implicated in the analgesic rebound headaches (mean 1053 mg/week) and 24% used ergotamine-containing medications (mean 16 mg/week). Thirty-one percent frequently used injected narcotics. At completion 90% reported that their daily headache was absent or improved, and the analgesic agent was withdrawn successfully in 97%. At six month follow-up, 70% of patients reported that their daily headache was absent or improved and 72% of patients remained free of the offending analgesic agent. Intravenous lignocaine is a useful treatment in the management of chronic daily headache with substantial medication overuse. The benefits of the program last for at least six months.

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