Search Results - (Author, Cooperation:D. D'Amico)

2016-04-30

American Association for the Advancement of Science (AAAS)

0036-8075

1095-9203

Biology

Chemistry and Pharmacology

Computer Science

Medicine

Natural Sciences in General

Physics

1468-2982

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

A fall in nocturnal plasma melatonin occurs in patients with cluster headache, suggesting that melatonin may play a role in the promotion of attacks. During a cluster period, we administered melatonin to 20 cluster headache patients (2 primary chronic, 18 episodic) in a double-blind placebo-controlled study of oral melatonin 10 mg (n=10) or placebo (n=10) for 14 days taken in a single evening dose. Headache frequency was significantly reduced (ANOVA, p〈0.03) and there were strong trends towards reduced analgesic consumption (ANOVA, p〈0.06) in the treatment group. Five of the 10 treated patients were responders whose attack frequency declined 3–5 days after treatment, and they experienced no further attacks until melatonin was discontinued. The chronic cluster patients did not respond. No patient in the placebo group responded. There were no side effects in either group. Although the response rate is low, melatonin may be suitable for cluster headache prophylaxis in some patients, particularly those who cannot tolerate other drugs.

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1468-2982

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. Two neurologists evaluated the clinical records of 100 consecutive outpatients and transferred the data on headache and associated phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic criteria of primary headaches was: (i) “perfect” to “substantial” for the first IHS digit, being kappa = 1.0 for cluster headache and paroxysmal hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) “almost perfect” to “substantial” for the second digit (kappa = 0.94 for cluster headache; kappa = 0.90 for migraine with aura; kappa = 0.81 for episodic tension-type headache; kappa = 0.78 for migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the criteria; (iii) “moderate” for migrainous disorder (kappa = 0.48) and headache of the tension-type (kappa = 0.43) not fulfilling the criteria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced neurologists.

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1468-2982

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Opioid system hypofunction has been postulated in cluster headache (CH) on the basis of reduced opioid levels found in the cerebrospinal fluid (CSF). In this study beta-endorphin levels were monitored in the peripheral blood mononuclear cells of 65 episodic CH patients (32 in remission and 33 in cluster period) and 50 healthy controls. Beta-endorphin levels were significantly lower than controls in CH patients experiencing both phases of the illness (ANOVA, p 〈 0.0001). The persistence of this abnormality during pain-free remission suggests a primary alteration in the regulation of beta-endorphin in peripheral blood mononuclear cells. We speculate that these findings reflect reduced CNS levels of beta-endorphin in CH.

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1468-2982

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

The cyclic recurrence of cluster periods and the regular timing of headache occurrence in cluster headache (CH) induced us to study the circadian secretion of melatonin and cortisol in 12 patients with episodic CH, during a cluster period, and compare them with 7 age- and sex-matched healthy controls. Blood was sampled every 2, h for 24 h. All subjects were confined to a dark room from 22.00 to 08.00. Plasma melatonin levels were significantly reduced in CH patients (repeated measures ANOVA p 〈 0.03; mesor p 〈 0.02), and the cortisol mesor was significantly increased (p 〈 0.03). Amplitudes and acrophases did not differ between the groups. Individual cosinor analysis showed that 412 (33.3%) CH patients had no significant melatonin rhythm, and that 5/11 (45.5%) had no cortisol rhythm. Group analysis of cosinor revealed significant rhythmicity of melatonin and cortisol secretion in both groups. In controls, the timing of melatonin and cortisol acrophase significantly correlated with each other, indicating that the biorhythm controllers for the secretion of these hormones were synchronized. Such correlation was not found in the CH patients; mesor, amplitude and acrophase of melatonin and cortisol did not correlate with duration of illness, duration of headache in course, or time since last headache attack.

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1365-2222

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Multiple food intolerance in infants, including intolerance to extensively hydrolysed proteins (HP), is often difficult to treat. However, few data have been reported on clinical outcome and dietary treatment of these patients.〈section xml:id="abs1-2"〉〈title type="main"〉AimsTo evaluate the clinical characteristics of patients with HP-intolerance and the long-term outcome of treatment with ass' milk.〈section xml:id="abs1-3"〉〈title type="main"〉Patients and MethodsThis study included 21 HP-intolerant infants (15 males, median age at diagnosis 2 months) treated with an ass' milk-based diet and 70 cow's milk (CM) intolerant infants (40 males, median age at diagnosis 3 months) treated with casein hydrolysate milk-based diet. All patients were followed-up for a median period of 4 years. Both HP-intolerance and intolerance to other foods were diagnosed according to the double-blind placebo-controlled procedure. Formal CM-challenges were conducted at yearly intervals until tolerance was demonstrated. At diagnosis and after one year of the respective diets, the following growth parameters were determined: relative weight for sex and age, relative weight for height and height z-score.〈section xml:id="abs1-4"〉〈title type="main"〉ResultsDuring the study period, multiple food intolerance was documented in 21/21 HP-intolerant infants (ass' milk group) and in 20/70 infants with CM-intolerance but tolerating HP (casein hydrolysate group) (P 〈 0.0001). In the ass' milk group, the more frequent food intolerances were toward soya, oranges, tomatoes and fish; goat's milk intolerance was demonstrated in five out of six patients receiving this food, and sheep's milk derivatives intolerance in four out of seven; these patients tolerated ass' milk. During the study period 3/21 patients in the ass' milk group became ass' milk intolerant; they showed vomiting (one cases) or diarrhoea (two cases). A lower percentage (52%) of patients in the ass' milk group became CM-tolerant during the study period than in the casein hydrolysate group (78%) (P 〈 0.01) and the age of the children at CM-tolerance was higher in the ass' milk than in the casein hydrolysate-treated children (P 〈 0.05). At diagnosis, a higher frequency of cases with elevated serum total IgE and specific IgE to CM antigens (P 〈 0.01) was observed in the ass' milk group. No difference was recorded between the two treatment groups in any of the growth parameters considered either at diagnosis or during the follow-up.〈section xml:id="abs1-5"〉〈title type="main"〉ConclusionsHP-intolerant patients showed a higher frequency of persistent food intolerance and of multiple food intolerance than patients tolerating casein hydrolysate. Ass' milk feeding was confirmed as a safe and valid treatment of the most complicated cases of multiple food intolerance.

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1398-9995

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Background: In patients with cow's milk protein intolerance (CMPI), delayed clinical reactions to cow's milk (CM) ingestion may be misdiagnosed if the clinical symptoms are not “classical” and there is a long time lapse between ingestion of CM and the clinical reaction. The aim was to evaluate the clinical outcome of CMPI in a cohort of CM-intolerant children, with particular attention to the occurrence of clinical manifestations beyond 72 h after CM challenge. Methods: Eighty-six consecutive patients (44 boys, 42 girls) with new CMPI diagnoses were enrolled; median age at diagnosis was 4 months. Patients were followed up for a mean period of 40 months. In all patients, CMPI diagnosis was made on the observation of symptoms, their disappearance after elimination diet, and their reappearance on double-blind CM challenge. At CMPI diagnosis, immunologic tests to demonstrate IgE-mediated hypersensitivity were performed. After 12 months of CM-free diet, CM tolerance was re-evaluated with a CM challenge continued at home for up to 30 days, according to a double-blind, placebo-controlled method. Patients who did not achieve CM tolerance continued a CM-free diet and subsequently underwent yearly CM challenge. Results: The percentages of CMPI patients who became CM-tolerant after 1, 2, and 3 years of CM-free diet were 30%, 54.5%, and 70%, respectively. At the end of the follow-up period, 26/86 subjects showed persistent CMPI; these patients had a higher percentage of positivity of total serum IgE (P〈0.05), RAST (P〈0.01), and cutaneous prick tests for CM antigens (P〈0.001) than all the others. At CMPI diagnosis, all patients had a clinical reaction within 72 h from the beginning of the CM challenge; at the subsequent “cure” challenges, we observed patients who first reacted to CM more than 72 h after ingestion. In total, 10 out of 86 patients showed “very delayed reactions”; in these patients, the mean time between the beginning of CM challenge and the onset of a clinical symptom was 13.3 days (range 4–26 days). The number of “very late reactors” increased from the first to the third of the “cure” CM challenges, performed at yearly intervals. The “very delayed” CMPI manifestations in these subjects were constipation (five cases), wheezing (two cases), dermatitis plus constipation (two cases), and dermatitis alone (one case); in 6/10 patients, the symptoms observed at the “cure challenge” were different from those at CMPI onset. Conclusions: Very delayed clinical reactions to reintroduction of CM in the diet can occur in CMPI patients; thus, accurate follow-up and frequent outpatient observation in patients with a long history of CMPI are probably more useful and safer than prolonged CM challenge.

Electronic Resource

1365-2036

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Esomeprazole, the S-isomer of omeprazole, is the first proton pump inhibitor to be developed as an optical isomer. In patients with erosive oesophagitis, esomeprazole has produced significantly greater healing rates and improved symptom resolution vs. omeprazole.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:This study assesses the efficacy of esomeprazole for preventing relapse in patients with healed oesophagitis.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:In this 6-month US multicentre randomized double-blind placebo-controlled trial, 375 Helicobacter pylori-negative patients with endoscopically healed oesophagitis received esomeprazole 40 mg, 20 mg, 10 mg, or placebo once daily. The primary efficacy end-point was maintenance of healing at 6 months. Secondary end-points assessed changes in symptoms, and long-term safety and tolerability.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Significantly (P 〈 0.001) more patients remained healed with esomeprazole 40 mg (87.9%), 20 mg (78.7%), or 10 mg (54.2%), than with placebo (29.1%). Relapse, when it occurred, was later with esomeprazole. Sustained resolution of heartburn was observed in the 40 mg and 20 mg groups; there was a high correlation between absence of heartburn and maintenance of healing. Adverse effects were mild, infrequent and not significantly different between groups.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Esomeprazole is effective and well-tolerated in the maintenance of healing of erosive oesophagitis. Esomeprazole 40 mg and 20 mg offer significant clinical benefit to patients.

Electronic Resource

1365-2036

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

The pharmacologic profile of the new proton pump inhibitor esomeprazole has demonstrated advantages over omeprazole that suggest clinical benefits for patients with acid-related disease.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:1960 patients with endoscopy-confirmed reflux oesophagitis (RO) were randomized to once daily esomeprazole 40 mg (n=654) or 20 mg (n=656), or omeprazole 20 mg (n=650), the standard recommended dose for RO, for up to 8 weeks in a US, multicentre, double-blind trial. The primary efficacy variable was the proportion of patients healed at week 8. Secondary variables included healing and heartburn resolution at week 4, time to first resolution and sustained resolution of heartburn, and per cent of heartburn-free days and nights. Safety and tolerability were also evaluated.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Significantly more patients were healed at week 8 with esomeprazole 40 mg (94.1%) and 20 mg (89.9%) vs. omeprazole 20 mg (86.9%), using cumulative life table estimates, ITT analysis (each P 〈 0.05). Esomeprazole 40 mg was also significantly more effective than omeprazole for healing at week 4 and for all secondary variables evaluating heartburn resolution. The most common adverse events in all treatment groups were headache, abdominal pain and diarrhoea.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:Esomeprazole was more effective than omeprazole in healing and symptom resolution in GERD patients with reflux oesophagitis, and had a tolerability profile comparable to that of omeprazole.

Electronic Resource

1126-5442

Springer Online Journal Archives 1860-2000

Medicine

Electronic Resource

1126-5442

Springer Online Journal Archives 1860-2000

Medicine

Electronic Resource

0942-0940

Extradurally growing spinal meningioma ; magnetic resonance ; emergency operation ; reversibility neurological lesion

Springer Online Journal Archives 1860-2000

Medicine

Summary A rare case of an extradurally growing spinal meningioma in an elderly woman is reported. Neuro-imaging, particularly magnetic resonance (MR), allowed to recognize the lesion, which, otherwise, could raise problems of differential diagnosis with a spinal metastasis. An emergency operation, required by a sudden neurological deterioration, was decisive in recovery of neurological deficits. In a review of the literature, extradurally growing spinal meningiomas appear to occur with a higher frequency than it is thought. Therefore, they are to be suspected when dealing with extradural spinal lesions.

Electronic Resource

1432-2072

Nicotine ; Drug discrimination ; Smokers ; Training dose ; Subjective effects ; Sex differences

Springer Online Journal Archives 1860-2000

Medicine

Abstract Non-human research indicates that drug discrimination results may depend largely on the specific training conditions, including initial training dose. It has recently been shown that humans can discriminate among different doses of nicotine delivered by nasal spray. In this study, we examined the influence of training dose on subsequent behavioral discrimination of a range of nicotine doses. Male (n=17) and female smokers (n=16) were randomly assigned to “low” (10 µg/kg) versus “high” (30 µg/kg) nicotine training dose groups and trained reliably to discriminate this dose from placebo (0) on day 1 (≥80% correct identification). All but six subjects (four in low, two in high) learned this discrimination and continued on to day 2, in which both groups received 0, 5, 10, 20, and 30 µg/kg in ascending order (30 min between dosings) and were tested for generalization with their training dose using quantal and quantitative behavioral discrimination tasks. Subjective responses via traditional self-report measures were also assessed. Nicotine-appropriate responding on day 2 was significantly greater in low- versus high-dose groups, especially at 5 µg/kg. However, this difference due to training dose was seen more in women than in men. Discrimination behavior was associated with subjective effects of head rush in males, and with head rush and decline in urge to smoke in females. These results show that discriminative stimulus effects of nicotine are not fixed properties of the drug, but can be influenced by training conditions, and that effects associated with this discrimination may differ between men and women.

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1432-2072

Methysergide ; Denervation supersensitivity ; Serotonin ; 5-Hydroxytryptophan-induced myoclonic behavior

Springer Online Journal Archives 1860-2000

Medicine

Abstract The administration of 5-hydroxytryptophan to intact guinea pigs results in rhythmic myoclonic behavior. This behavior is blocked acutely by methysergide, but is intensified in animals chronically pretreated with methysergide. Brain serotonin concentrations of guinea pigs pretreated with methysergide did not differ from saline-treated animals. These results are compatible with the hypothesis that prolonged methysergide administration can result in pharmacologically-induced denervation hypersensitivity at central serotonin receptors.

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1590-3478

Pediatric headache ; Pharmacological treatment ; Behavioral approach ; Biofeedback

Springer Online Journal Archives 1860-2000

Medicine

Abstract The problem concerning the treatment of pediatric headache has been the object of several recent reports. Some of the same medications used to treat adult headache problems are also utilized with children but usually at smaller dosages and in different combinations. The recent application of behavioral approaches, in particular biofeedback, for treatment of children’s headaches has been an effective alternative to drugs without the problematic and dangerous side effects of pharmacological treatments. The purpose of this review is to give some indications about the most common pharmacological therapies for migraine and tension-type headache in children, and also to discuss the use of behavioral therapies, in particular biofeedback, as excellent alternatives to drugs.

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1590-3478

Neurofibromatosis I ; Neurofibromatosis II Neurinoma VIII ; Neurinoma of peripheral nervous system Muscular atrophy ; Hypoacusis

Springer Online Journal Archives 1860-2000

Medicine

Abstract A young woman aged 26 years presented with atrophy of the left quadriceps progressing over one year. Magnetic resonance imaging (MRI) showed a large lesion of the lumbar plexus compatible with neurinoma. Cerebral MRI revealed a lesion in the right eighth cranial nerve also compatible with neurinoma. On further questioning of the patient, it was learned that her mother had undergone surgery twice for acoustic neurinoma. Type II neurofibromatosis was diagnosed from the basis of clinical picture, neuroimaging findings and family history. This case is unusual for the lack of central nervous system (CNS) symptoms. Expansive radicular lesions compatible with neurinoma should prompt cerebral MRI. Regular examination of family members at risk and early diagnosis can decrease the high mortality associated with this condition.

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1590-3478

Migraine ; Acute treatment ; Prophylaxis ; Biofeedback ; Status migrainosus

Springer Online Journal Archives 1860-2000

Medicine

Sommario L'emicrania è un disturbo che colpisce circa il 15% della popolazione generale risultando spesso debilitante tale da risultare un problema clinico di rilievo soprattutto quando refrattario alla terapia. Questo articolo fornisce una guida razionale ed aggiornata al trattamento di questa malattia, sia per gli attacchi che per la profilassi. Per quanto riguarda gli attacchi i farmaci risultati efficaci nei diversi studi clinici controllati sono l'aspirina, gli analgesici, gli antiinfiammatori non steroidei, gli ergot derivati ed il sumatriptan. I farmaci riconosciuti efficaci nella profilassi dell'emicrania sono identificabili tra 5 principali categorie di sostanze: beta-bloccanti, calcio antagonisti, serotonino-modulatori, antiinfiammatori non steroidei e gli ergot derivati. Tra le terapie non farmacologiche, viene brevemente discussa l'utilità del biofeedback nella prevenzione di alcune forme di emicrania. Vengono inoltre discusse le numerose variabili che influenzano la scelta del farmaco sia per la profilassi che per l'attacco con le relative controindicazioni.

Abstract Finding the best treatment for a patient's migraine is often a problem in clinical practice since the condition is very common, often debilitating and may prove refractory to therapy. Over recent years, more effective migraine treatments have been found and validated, and the traditional remedies have undergone controlled testing. This article reviews the various therapies available for both the acute treatment and prevention of migraine. Treatments often effective against migraine attacks are: aspirin, analgesics, non steroid antiinflammatory drugs (NSAIDs), ergot derivatives and sumatriptan. Five main classes of prophylactic drug are currently used: beta-blockers, calcium antagonists, serotonin modulators, NSAIDs and ergot compounds. Biofeedback, one of the most efficacious non-pharmacological preventive treatments of migraine, is also discussed. The variables influencing the choice of acute and preventive treatments, including contriandications and drug availability, are also described in order to provide a practical and up-to-date guide to migraine therapy.

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1590-3478

Migraine without aura ; genetic hypothesis ; family history ; “sex-limited” transmission

Springer Online Journal Archives 1860-2000

Medicine

Sommario Allo scopo di comprovare la teoria genetica dell'emicrania, abbiamo studiato 68 pazienti consecutivi affetti da emicrania senz'aura insieme ai loro parenti attraverso quattro generazioni (N=394). Significativamente la maggior parte dei probandi erano donne e l'emicrania era più frequente tra i parenti di sesso femminile. Un'età di esordio più bassa era più comune tra i probandi di sesso maschile. L'esistenza di una componente genetica dell'emicrania senz'aura è indicata dall' alta incidenza di storia familiare positiva (almeno un parente affetto) uguale all'85.3% e da una costante prevalenza di malattia nei parenti di primo e secondo grado. Dall'analisi dei dati riguardanti le percentuali di probandi con genitori affetti da emicrania, sembra improbabile l'esistenza di una trasmissione di tipo autosomico. Viene proposta una trasmissione “sex-limited”.

Abstract 68 randomly selected patients with migraine without aura (M) and 4 generations of their relatives (N=394) were studied in order to probe the genetic hypothesis of migraine. Significantly more of the probands were women and M was significantly more frequent among female relatives. Earlier onset was commoner among male probands. A genetic component of M is indicated by the very high frequency of at least one affected relative (85.3%) and by a disease prevalence that is similar among both first and second degree relatives. A simple autosomal mode of transmission seems unlikely from analysis of the data on the affected relatives, while a “sex-limited” transmission mode is suggested.

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1590-3478

Cluster headache ; hypothalamic involvement ; plasma cortisol levels ; night-time melatonin peak ; THS response to TRH

Springer Online Journal Archives 1860-2000

Medicine

Sommario L'origine della cefalea a grappolo è a tutt'oggi sconosciuta. Il tipico periodismo e la presenza di sintomi autonomici relativi sia all'attività simpatica che parasimpatica suggeriscono l'interessamento di strutture del Sistema Nervoso Centrale, in particolare dell'ipotalamo. Allo scopo di esplorare il coinvolgimento dell'ipotalamo nella cefalea a grappolo, abbiamo condotto uno studio di tipo neuroendocrino. I nostri risultati indicano che il test di soppressione al desametazone (DST) è normale nella CH, mentre i livelli ematici di cortisolo alle ore 8 di mattino, prima e dopo DST, sono più elevati nei pazienti in remissione sia nei confronti dei controlli che dei cluster in fase di grappolo. La risposta del TSH al TRH è ridotta e il picco notturno della melatonina è più basso nei pazienti solo durante il periodo di grappolo. Le alterazioni neuroendocrine rilevate sia in fase di remissione che di grappolo confortano l'ipotesi di un coinvolgimento dell'ipotalamo nella cefalea a grappolo.

Abstract The origin of Cluster Headache (CH) is still unknown. The periodicty and presence of symptoms due to both sympathetic and parasympathetic activity suggest the involvement of central nervous system structures, particularly the hypothalamus. To investigate hypothalamic involvement in CH, we employed a neuroendocrinological approach. We observed a normal dexamethasone suppression test (DST) in all patients, increased cortisol plasma levels in remission patients at 8.00am before and at the end of the DST, while only in CH patients during cluster period did we find a reduced TSH response to TRH and a reduced night-time melatonin peak. The neuroendocrinological derangements found in CH may be consistent with hypothalamic involvement.

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