Osmophobia in migraine classification: a multicentre study in juvenile patients.

AIMS: This study was planned to investigate the diagnostic utility of osmophobia as criterion for migraine without aura (MO) as proposed in the Appendix (A1.1) of the International Classification of Headache Disorders (ICHD-II, 2004). METHODS: We analysed 1020 patients presenting at 10 Italian juvenile headache centres, 622 affected by migraine (M) and 328 by tension-type headache (TTH); 70 were affected by headache not elsewhere classified (NEC) in ICHD-II. By using a semi-structured questionnaire, the prevalence of osmophobia was 26.9%, significantly higher in M than TTH patients (34.6% vs 14.3%). RESULTS: Osmophobia was correlated with: (i) family history of M and osmophobia; and (ii) other accompanying symptoms of M. By applying these 'new' criteria, we found an agreement with the current criteria for the diagnosis of migraine without aura (MO) in 96.2% of cases; 54.3% of previously unclassifiable patients received a 'new' diagnosis. CONCLUSIONS: In conclusion, this study demonstrates that this new approach, proposed in the Appendix (A1.1), appears easy to apply and should improve the diagnostic standard of ICHD-II in young patients too.

Multi-center evaluation of analytical performance of the microparticle enzyme immunoassay for sirolimus.

OBJECTIVES: This study evaluated the analytical characteristics of the new Abbott microparticle enzyme immunoassay (MEIA) for sirolimus. DESIGN AND METHODS: The protocol consisted of nine sections: evaluation of antibody specificity, linearity, detection limit, quantification limit, endogenous interferents, exogenous interferents, precision, proficiency testing panel, and method comparison. RESULTS: The mean analytical detection limit was 0.68 microg/L. The sirolimus concentration corresponding to a total CV of 20% was 1.5 microg/L. Linearity of response was demonstrated across the dynamic range of the assay. Total precision (CVs) at QC control levels from 5 to 22 microg/L ranged from 5.7 to 12.6%. Assay standardization was found to be in good agreement with LC/MS/MS as compared with target values for spiked sirolimus proficiency samples from an international sirolimus proficiency testing program. Good correlations (R values) of the immunoassay were observed in comparisons to LC/MS/MS. R values tended to be lower in comparisons with LC/UV methods. Across both LC-based methods and all study sites, there was approximately 25% overall positive slope bias due to cross reactivity of the MEIA antibody to metabolites of sirolimus. The assay cross-reactivity to metabolites of sirolimus parent drug ranged from 6 to 63%. Assay interferences were minimal with the exception of hematocrit, which presented a negative relationship to measured sirolimus concentration. CONCLUSIONS: The MEIA demonstrated acceptable analytical characteristics for use for routine monitoring of sirolimus immunosuppressive therapy, and is a viable alternative to HPLC-based methods for sirolimus monitoring.

WITHDRAWN: Multi-center evaluation of analytical performance of the microparticle enzyme immunoassay for sirolimus.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Clin. Biochem. 39 (2006) 378-386, doi:10.1016/j.clinbiochem.2006.01.017. The duplicate article has therefore been withdrawn. This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.

Use of adsorptive mechanisms in continuous renal replacement therapies in the critically ill.

The pathophysiology of sepsis is becoming a more complicated scenario. In sepsis, endotoxin or other gram-positive derived products induce a complex and dynamic cellular response giving rise to several mediators known to be relevant in the pathogenesis of septic shock, such as specific mediators. substances responsible for up- or down-regulation of cytokine receptors and cytokine antagonists, inactivators of nuclear factor-kappaB or signal transduction pathways, and precursor molecules. In this article, we delve into some new concepts stemming from the use of sorbents in continuous plasma filtration. The rationale is based on the assumption that the nonspecific removal of several mediators of the inflammatory cascade and cytokine network may improve outcome in a rabbit model of septic shock and hemodynamics in a pilot clinical study. The importance of looking for innovative treatments specifically targeted for the special needs of the critically ill patients rather than using concepts and technology applied to the treatment of chronic renal failure is underlined.

Efficacy and efficiency of oral microemulsion cyclosporin versus intravenous and soft gelatin capsule cyclosporin in the treatment of severe steroid-refractory ulcerative colitis: an open-label retrospective trial.

We have used cyclosporin to treat patients with acute steroid-resistant ulcerative colitis since the beginning of 1991. Of the 55 patients so far elected for treatment, 40 received the drug intravenously at 2 mg/kg/day for 14 days, with the responders being maintained on traditional soft-gelatin-capsule cyclosporin at a dose of 6-8 mg/kg/day for 6 months; the remaining 15 received oral microemulsion cyclosporin, 5 mg/kg/day, for 3 months. The doses were titrated to ensure whole-blood drug concentrations of 60-240 ng/ml, with levels of approximately 200 ng/ml being attained by both regimens. One-hundred percent of the patients receiving oral microemulsion cyclosporin and 65% of those receiving the intravenous regimen achieved a short-term response (p = 0.011). Both the responder subsets received additional azathioprine and relapsed on treatment with the same frequency of 40%. However, 17% of the patients who received intravenous cyclosporin developed major toxicity (including one fatality), whereas no major toxicity was observed in the oral microemulsion cyclosporin group. The microemulsion formulation was therefore more effective than intravenous cyclosporin in achieving the short-term remission of steroid-unresponsive ulcerative colitis. As the maintenance drug, it led to the same frequency of disease relapse as traditional oral cyclosporin. However, because it did not involve invasive in-hospital procedures or cause major toxicity, it was more efficient than the combination of the intravenous and traditional oral drug.

Psychological characteristics of juvenile headache: differences between tension headache and migraine.

In 235 juveniles equalized for sex and averaging 10 years of age, comparisons were made between 76 with migraine without aura, 79 with episodic tension type H, and 80 normal controls, on the basis of five psychological characteristics and six formal tests. The results allowed the description of definitely different profiles for the two groups of headache sufferers.

Acute antihypertensive, diuretic and metabolic effects of etozolin and chlorthalidone.

Etozolin, a new diuretic agent, has shown a dose-dependent diuretic and saluretic effect in both experimental and clinical studies. Etoxolin, when compared to furosemide or thiazides, exerts a similar effect on urinary excretion of water and Na+, but induces a lower urinary K+ and Cl- excretion and a smaller activation of the renin-angiotensin-aldosterone system. Furthermore, the E series of the prostaglandin system seems to play a role in the mechanism of action of the drug. Seven uncomplicated hypertensive patients were included in this double blind, placebo controlled study, according to a latin square design. Each patient received three single oral doses of etozolin (200 mg, 400 mg, 600 mg), of chlorthalidone (25 mg, 50 mg, 75 mg) and one dose of placebo. Etozolin and chlorthalidone caused a similar, dose-dependent antihypertensive and diuretic effect. However, several haemodynamic and metabolic differences were observed between the two drugs. Etozolin, unlike chlorthalidone, caused no increase of heart rate, no decrease of serum K+ levels and a marked rise plasma PGE2. Moreover, etozolin caused a significantly smaller decrease of serum Na levels compared to chlorthalidone, and a significantly lower increase of supine and standing PRA, of plasma aldosterone and of the urinary excretion of Na and K. These results confirm that the acute antihypertensive and diuretic activity of etozolin occur with little involvement of the RAA system and with a significant but still unclear activation of the prostaglandin system.

TA 4-SCC versus CEA sensitivity for lung cancer.

The sensitivity of a new tumor marker, TA 4-SCC, for lung tumors is examined and compared with the performance of the already established CEA. TA 4-SCC sensitivity is only moderate (30%), and it presents no significant differences among the various histologic types of lung cancer. In addition, unlike CEA, TA 4-SCC is present in large amounts in the serum of many stage I and II patients. In fact, its sensitivity in still curatively operable tumors reaches 30% compared to 10% with CEA.

Double-blind randomized, crossover trial of calcium supplementation in essential hypertension.

In a double-blind, randomized, placebo-controlled, crossover trial, 23 middle-aged patients with mild to moderate essential hypertension were given an oral calcium supplement (1 g/day) for 8 weeks. At the end of this period, eight patients continued with this treatment for an additional 2 weeks but were also given 0.5 micrograms/day of 1,25-(OH)2 vitamin D3. In the 21 patients who completed the study, arterial pressure during the calcium-supplemented phase was almost identical to that of the placebo phase. In eight patients, mean arterial pressure (MAP) had changed by greater than 5 mmHg at the end of the calcium-supplemented period, compared with the end of the placebo phase (six patients showed an increase in MAP and two a decrease). Changes in arterial pressure were unrelated to age, plasma ionized calcium, parathyroid hormone (PTH), plasma renin activity (PRA), plasma aldosterone, 24-h urinary calcium, sodium and potassium and were only weakly related to body weight. In the eight patients who continued with the treatment of calcium plus 1,25-(OH)2 vitamin D3 after the 8-week study period, arterial pressure changed very little and not significantly. These results do not support the suggestion that calcium supplements lower arterial pressure in middle-aged subjects with mild to moderate essential hypertension.

[Ca 19-9 and Ca 50 in the diagnosis of bronchial carcinoma: comparison with CEA]. / CA 19-9 e CA 50 nella diagnosi del carcinoma bronchiale: comparazione con il CEA.

The search for early tumour markers has brought to light CA 19-9 and CA 50, glycoproteins recognised by monoclonal antibodies. Since these markers are mainly used on the digestive tract it was thought useful to investigate their value in the diagnosis of lung cancer which is only rarely identified by markers in its early stages. The two markers were compared with the better known CEA on 43 healthy volunteers, 42 patients with chronic lung conditions, 26 people with localised non-neoplastic lung shadows and 255 patients with staged and histologically identified lung tumours. The results obtained reveal the two markers to be of little use in lung cancer since though satisfactorily specific they are not at all sensitive even in the advanced stages of the disease. They could however be used to advise against surgery if positive.

Flunarizine and migraine in childhood. An evaluation of endocrine function.

Flunarizine was tested for prophylactic efficacy and for side effects in 10- to 13-year-old patients with severe migraine (greater than 2 attacks per month). The 13 preadolescents received a single 5-mg dose at night for 2 months. The attack frequency decreased significantly, and the effect was maintained over time. The endocrine status, investigated before and after treatment, showed no significant interference with pituitary, beta-pancreatic, or gonadal function.