Greater occipital nerve blockade for cluster headache.

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1 + 23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P < 0.003, P = 0.003, P < 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.

Remitting form of hemicrania continua with seasonal pattern.

Hemicrania continua is a primary headache syndrome characterized by a continuous, unilateral headache that is completely responsive to indomethacin. Hemicrania continua exists in continuous and remitting forms. Ten cases of the remitting form have been reported, none of which have had a seasonal pattern. We report a patient with remitting hemicrania continua with a clear seasonal predilection.

Influence of vertical vibration on heart rate of pigs.

Pigs with a body weight between 15 and 20 kg were vibrated in the vertical direction for 1 h at 2, 8, and 18 Hz, in combination with root mean square (RMS) acceleration magnitudes of 1 or 3 m/s2. Welfare and stress were quantified by comparing heart rate characteristics during a control period (2200 to 0600) before vibration exposure and during vibration (1000 to 1100). The level of maximum heart rate and number of ventricular ectopic beats during vibration at 2 and 8 Hz in combination with a RMS acceleration of 3 m/s2 indicated a larger fear response than at 1 m/s2. Isocomfort contours based on mean heart rate during vibration showed the greatest specific sensitivity of the pigs to vibration at a frequency of 8 and 18 Hz, especially in combination with a RMS acceleration of 3 m/s2. During transport, RMS acceleration should be less than 3 m/s2 to protect pigs' welfare. Pigs were more sensitive to acceleration than to frequencies within the range of treatments in this investigation. Although the response of the pigs in this experiment fit within the model concept for adult humans and for domestic fowl, changes in heart rate are dependent on body weight.

Resonant frequencies of standing humans.

Many forms of industrial illness are thought to result from the effects of vibration on the human body. Prolonged exposure causes undue stress and discomfort. At the human whole-body resonant frequency there is maximum displacement between the organs and the skeletal structure and thus this is one frequency of vibration that should be minimized in the workplace and elsewhere. The vertical whole-body resonant frequencies of 113 fully-clothed standing humans were measured using a vibrating beam method, which imposed a very low acceleration magnitude at the subjects' feet. The overall range of resonant frequencies was found to be from 9 to 16 Hz and independent of mass, height and mass to height ratio. The mean values (+/-1 s.e.) were 12.2 +/- 0.1 Hz for males and 12.8 +/- 0.2 Hz for females with an overall mean population value of 12.3 +/- 0.1 Hz.

Effects of physician prompters on long-term screening test behaviors.

BACKGROUND: This study examines the long term effects of a prompter directed at a single screening test on the performance of preventive tests 12 to 24 months later. METHODS: A retrospective chart review was performed that compared 114 patients who had a Papanicolau (Pap) smear prompter placed on their charts in 1990 with 86 patients who did not have a prompter placed. Chart audits determined if a Pap smear, breast examination, mammogram, rectal examination, stool occult blood, or serum cholesterol determination was performed 12 to 24 months after the prompter had been placed. RESULTS: In the patient population that received prompters more than one year earlier, a significant increase was observed in Pap smears (40% vs 24%, p = 0.05), breast examinations (37% vs 20%, p = 0.009), and digital rectal examinations in patients 50 years of age and older (20% vs 0%). CONCLUSIONS: When a prompter is placed on a chart to change physician behavior, a lasting effect is seen over one year later. However, increased screening is only observed in patients who initially had prompters placed on their charts. This may indicate that this change in screening behaviors is due to alterations in patient and not physician behaviors.

The Papanicolaou smear as a sentinel screening test for health screening in women.

BACKGROUND: There has been evidence that, in primary care practices, health screening tests are not ordered in random fashion but instead are coupled or bundled into distinct groups. This study was performed to determine if the Papanicolaou (Pap) smear serves as a marker for other health screening tests. METHODS: The study consisted of a retrospective chart review of female patients over the age of 18 years at three rural health clinics, followed by a prospective study of patients during a 3-month period in five rural family practice clinics. The study focused on whether a Pap smear was performed and whether a breast examination, mammogram, rectal examination or stool occult blood test, or serum cholesterol testing was performed. RESULTS: In both the retrospective and prospective series, patients who received Pap smears were significantly more likely to receive breast examinations, mammograms, colorectal screening and cholesterol tests. In addition, the coupling of other screening tests with the Pap smear appeared to increase with advancing patient age, with a decline after age 70 years. In patients who did not have Pap smears, only cholesterol testing increased as patients aged. CONCLUSION: Health screening tests in women are associated with the performance of a Pap smear. Providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a "sentinel" test for health screening in women, and efforts to identify women at high risk and increase health promotion and disease prevention in this group should focus on women who have not received this test.

Pulmonary histoplasmosis. A possible risk in people who cut decayed wood.

We report three unrelated outbreaks of acute pulmonary histoplasmosis associated with cutting and gathering firewood in Minnesota. Clinical symptoms and laboratory findings from nine patients are reported. All recovered without treatment. This report emphasizes that physicians must consider cutting and gathering wood, especially decayed wood, as a potential risk for acute pulmonary histoplasmosis even in areas of the country where histoplasmosis is not considered prevalent.