Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial.

OBJECTIVE: To investigate the efficacy of electroacupuncture, applied to distal acupoints only, for tension-type headache. BACKGROUND: Electroacupuncture is commonly used for tension-type headache, but when applied to distal acupoints only, evidence of its efficacy is lacking. DESIGN: A randomized, single-blinded, sham-controlled, crossover clinical trial. Methods.-The trial had 5 stages: baseline (2 weeks), phases I and II (each 4 weeks), washout period (2 weeks), and follow-up (3 months after phase II). Forty patients were randomly assigned to either group A or group B. Group A received real electroacupuncture during phase I, then sham electroacupuncture in phase II. Group B received the treatments in reverse order. Outcome measures were headache frequency and duration, pain intensity using a visual analog scale, mechanical pain threshold, headache disability, and sickness impact. Data were analyzed by univariate 2-way analysis of variance. RESULTS: Thirty-seven patients completed the trial. There were no significant differences between the 2 groups at baseline. At the end of phase I, group A, but not group B, demonstrated significant improvement in mean (standard error of the mean [SEM]) headache frequency (3.0 per month [0.3] versus 12.0 per month [1.7]), duration (13.3 hours [3.5] versus 32.0 hours [6.2]), pain intensity (32.8 mm [4.1] versus 47.5 mm [2.7]), pain threshold (right side, 2.9 kg/second [0.1] versus 0.9 kg/second [0.1]; left side, 2.4 kg/second [0.1] versus 1.1 kg/second [0.1]), headache disability score (6.0 [1.0] versus 16.3 [1.6]), and sickness impact score (288.7 [48.0] versus 687.1 [77.2]). For each parameter, significant differences also were demonstrated for both groups between baseline and phase II, and baseline and follow-up. There were no significant differences between the groups at the end of follow-up (P >.05). CONCLUSION: Electroacupuncture to distal points alone is effective for short-term symptomatic relief of tension-type headache.

Three-dimensional computed tomographic angiography in the preoperative evaluation of cerebrovascular lesions.

Although three-dimensional computed tomographic angiography was developed as a screening tool for use in patients with suspected cerebrovascular disease, this imaging modality has also proven to be of value in surgical planning for patients with large or unusual vascular lesions of the brain. The three-dimensional images generated by this technique yield valuable information regarding the size and configuration of intracranial aneurysms and vascular malformations, the presence and extent of intra-aneurysmal thrombus, the relationship of the vascular lesion to other cerebrovascular or skeletal structures, aneurysm wall thickness, and the presence and orientation of an aneurysm neck. The use of three-dimensional computed tomographic angiography in representative cases of patients with large or unusual cerebrovascular lesions is presented. It has been our experience that this imaging modality displays anatomical information that is not readily available from standard, intra-arterial angiography, provides better detail for surgical planning than magnetic resonance angiography, and is less expensive than either of these other imaging modalities.

Transurethral resection of prostatic abscess under sonographic guidance.

Transrectal ultrasound may establish the diagnosis of prostatic abscess in an ambiguous clinical setting. Transurethral resection (deroofing) is the treatment preferred by many clinicians, yet intraoperative complete abscess obliteration may be difficult to confirm endoscopically. We report on a patient with a complex prostatic abscess endoscopically resected under transrectal ultrasound guidance. Adequacy of treatment was proved pathologically.

Neuropsychological skills with motor dysfunctional and motor normal children.

A group of 40 children was selected from a larger sample based on their performance on motor coordination, motor speed, and motor inhibition tasks. Twenty of the children were classified as Motor Dysfunctional (MD) and 20 were classified as Motor Normal (MN). The groups were compared on several neuropsychological measures. The results indicated the MD children were significantly lower on a number of measures, particularly those requiring sensory integration. There were not significant differences on several of the tasks, including those more complex in nature. The results are discussed in relation to developmental models of neuropsychological functioning.

Gastrointestinal tuberculosis. The great mimic still at large.

Gastrointestinal tuberculosis has declined markedly in frequency since the introduction of antituberculous therapy. As a result, the diagnosis is often delayed in North American patients. Segmental colonic disease, especially in the absence of pulmonary tuberculosis, is often difficult to differentiate from Crohn's disease or a neoplasm. We describe a case of colonic tuberculosis mimicking carcinoma of the hepatic flexure of the colon.

Splenic atrophy in systemic lupus erythematosus.

Five of 70 patients with systemic lupus erythematosus seen over a 5-year period had peripheral blood films suggestive of hyposplenism. Technetium-99m-sulfur colloid scans showed no splenic activity in three patients. One of these three patients, who had a spontaneous remission of persistent thrombocytopenia concurrent with the appearance of functional asplenia, had splenic atrophy shown by computed tomography; a second patient, who died of pneumococcal septicemia, was shown to have splenic atrophy with lymphocyte depletion at autopsy. The development of functional asplenia in the third patient has now, to date, had any obvious effect on her disease. In the two patients with normal scans, blood film findings returned to normal with treatment of the underlying disease. Polyvalent pneumococcal vaccine is recommended for patients with lupus erythematosus who have splenic atrophy.