The prevalence of headache in a population of health care workers and the effects on productivity costs.

BACKGROUND: Headache is reported as one of the most frequent causes of lost work time and reduced work efficiency. AIMS: The aim of this study was to determine the impact of headache and its consequences as regards absence from work among health care workers and reduced work efficiency. METHODS: The prevalence of headache and its effects on ability in daily activities and work productivity were studied and assessed on occasion of the periodic health examination of 3,620 health care workers of the Provincial Health Care Trust, Trento, by means of the MIDAS disability scale and parameters derived from criteria established by the International Headache Society. RESULTS: In the previous three months 27.1% had suffered from at least one episode of headache. The prevalence of migraine was 9.9%, with a significantly higher percentage among women (12.9%). The total administrative costs estimated per working year were about Euro 136,836 for migraine and about Euro 44,614 for tension-type headache (TTH). The prevalence and features of migraine and TTH were studied. CONCLUSIONS: Data regarding the prevalence of migraine were similar to the results reported in other studies. The vast majority of the individuals reported no absenteeism over the previous three months. The study confirmed that we should continue to manage the presumed job-related trigger factors in the best possible manner, counselling should be made available to health care workers during the periodic health examinations or upon request, and if needed, the patient should be sent to a neurology specialist for a free examination and appropriate pharmacological treatment.

Carotid atherosclerosis and ischemic stroke in young patients.

BACKGROUND: Epidemiological studies indicate a high prevalence of carotid atherosclerosis in elderly patients with ischemic stroke. The aim of this study was to investigate the presence of early carotid atherosclerotic lesions in young subjects with ischemic stroke, in the absence of the common atherosclerotic risk factors. METHODS: We studied 98 young patients with first ischemic stroke (54 males and 44 females; mean age 41.2 years; range 32-50) and 96 healthy controls. All subjects underwent ultrasonographic scanning of the carotid arteries according to a standardized protocol. RESULTS: The carotid intima-media thickness was significantly increased in the patient group (p<0.001) compared with controls. In addition, the prevalence of carotid atherosclerotic plaques was greater in the patients than in the controls (p<0.001). In particular, we detected 18 non-occlusive carotid plaques and 16 thrombotic occlusions. In 8 patients, the lesions were bilateral. The echographic pattern of the plaques was hard in 8 cases, soft in 5 cases, and mixed in the remaining 5 cases. CONCLUSIONS: We detected an increased wall thickness of the carotid arteries and an increased prevalence of carotid atherosclerotic lesions and carotid thrombotic occlusions in young patients with ischemic stroke, with a relative low incidence of cardiovascular risk factors. This finding suggests that arterial intima-media thickness per se is an important determinant of vascular disease in young patients. The data also provide indirect support for the potential role of genetic factors in the genesis of atherosclerosis in young patients.

Myocardial ischemia caused by an hydatid cyst of the interventricular septum successfully treated with albendazole.

We report the case of a 33-year-old patient with clinical history of echinococcosis admitted to our Hospital for the appearance of chest pain and electrocardiographic findings of anterior ischemia. The cardiac enzymogram was in the normal range, the chest roentgengram did not show any pathological findings, but two-dimensional echocardiography revealed the presence of a small circular area in the interventricular septum. Transesophageal echocardiography and cardiac nuclear magnetic resonance confirmed the presence of a small hydatid cyst in the middle ventricular septum; in addition, a myocardial scintigraphy revealed an apical stress defect with late reperfusion. Besides cardiologic therapy, the patient was treated with albendazole, an antiparasitic drug, 400 mg bid, for cycles of 28 days with 14 day withdrawal. After two cycles of albendazole therapy, two-dimensional echocardiography showed the absence of the round cystic mass of the interventricular septum previously described. In conclusion, in the case described, long-term therapy with albendazole determined the complete recovery from the illness with the simultaneous disappearance of the cyst and of clinical and electrocardiographic findings of myocardial ischemia.

Pulmonary hypertension associated with liver cirrhosis: an echocardiographic study.

Conflicting results about the prevalence of pulmonary hypertension, ranging from 0.25% to 20%, in liver patients with portal hypertension, have previously been reported. The aim of this study was to evaluate pulmonary arterial pressure in a consecutive series of cirrhotic patients, using a noninvasive method. A complete clinical, laboratory, ultrasonographic, and endoscopic evaluation were performed in 83 consecutive liver patients assessed according to Child's classification and Pugh's score and according to evidence of ultrasonographic and/or endoscopic signs of portal hypertension. A complete echocardiographic evaluation was also performed and pulmonary arterial systolic pressure (PASP) was estimated by measuring tricuspidal regurgitation, using the modified Bernoulli equation. These same evaluations were performed by the same observers in a group of 60 healthy volunteers. The results showed a surprisingly high prevalence (about 20%) of pulmonary hypertension. Patients with more severe liver damage and portal hypertension showed a high prevalence for pulmonary hypertension. A progression in the frequency of portopulmonary hypertension (PPH) was found in Child's classification A to C, and in patients without to patients with evidence of portal hypertension. However, increased PASP was detected in some patients belonging to Child's class A, without evidence of portal hypertension. In conclusion, the echocardiographic examination (a noninvasive technique), appears suitable for detecting pulmonary hypertension in patients with compensated liver cirrhosis, and can elucidate some aspects of the clinical course of the so-called PPH syndrome.

A light-sensitive yellow ommochrome pigment from the house fly.

A light-sensitive pigment (lambda max at 430 and 340 nm), extracted in acidic methanol from the Musca domestica heads, showed, in the absorption curve, a plateau at 480-500 nm and a new maximum at 400 nm, after visible light irradiation. The light-sensitive house fly pigment showed spectroscopic and chemical properties of the ommochrome pigments (Butenandt and Schäfer: Recent Progress in the Chemistry of Natural and Synthetic, Colouring Matters and Related Fields, Academic Press, New York, pp 13-33, 1962; Bolognese and Scherillo: Experientia 30:225-226, 1974). The treatment of the extracted pigment with a methanol-HClsat. mixture afforded some coloured compounds; two main products were identified by comparison of their chromatographic and spectral properties with authentic samples of 1-oxo-2H-3-carbomethoxy-5-methoxy-11-(fumaroyl-methylester)-pyrido [3,2-a] phenoxazine (compound 7) and 1-oxo-2H-3-carbomethoxy-5-methoxy-9-chlorine-11-(fumaroyl-methylester )-pyrido [3,2-a] phenoxazine (compound 8), obtained from the oxidation mixture of 3-hydroxykynurenine methylester (compound 9).