The relationship between MMPI cluster membership and diagnostic category in headache patients.

Only one study has examined MMPI cluster profiles in the headache population. The present study expanded on this previous investigation by using a large sample size (N = 485) and a greater number of diagnostic categories. The five MMPI clusters replicated previous findings in the chronic pain literature. These MMPI cluster groups were compared to 5 diagnostic categories (migraine, cluster, post-trauma, tension, mixed). No relationship was found between cluster type and headache diagnosis. While the diagnostic groups were found to differ on measures of pain severity, sex and age, cluster groups did not. It is proposed that MMPI scale types reflect a patient's response to pain and are more likely to be the result of coping resources than headache-related personality style. Future research with additional, non-pain populations and prospective studies is suggested.

Chronic alcohol intake does not change thiopental anesthetic requirement, pharmacokinetics, or pharmacodynamics.

The anesthetic requirements of chronic alcoholics for induction of anesthesia with thiopental were investigated using an electroencephalographic (EEG) measure of thiopental's CNS drug effect and pharmacodynamic modeling to relate thiopental serum concentrations to drug effect. Eleven patients with a history of excessive alcohol intake were studied from an inpatient alcohol rehabilitation program and compared with nine control patients or volunteers who were social drinkers. The alcoholic population had consumed ethanol 9-17 days prior to the study. They had no evidence of acute intoxication or acute withdrawal at the time of the study. Five of the 11 alcoholic patients were restudied after 1 month of abstinence from alcohol consumption. Each study consisted of a thiopental infusion until EEG burst suppression (1-3 s of isoelectric signal) was achieved. Timed arterial and then venous blood samples were obtained for measurement of thiopental serum concentrations for up to 36 h. Pharmacokinetic differences between groups were analyzed using a three-compartment model. Power spectral analysis of the EEG allowed determination of spectral edge frequency. An inhibitory sigmoid Emax pharmacodynamic model combined with an effect compartment was used to analyze concentration-response relationships and to provide an estimate of brain sensitivity to thiopental in the study populations. The thiopental anesthetic dose requirement using the EEG was not different between alcoholics and nonalcoholics. The mean dose requirement (+/- SD) of alcoholics was 823 +/- 246 mg and the mean dose requirement of nonalcoholics was 733 +/- 218 mg. There were no differences in thiopental pharmacokinetic and pharmacodynamic parameters between alcoholics and nonalcoholics.(ABSTRACT TRUNCATED AT 250 WORDS)

Production and characterization of a human monoclonal antibody, reactive with a conserved epitope on gp41 of human immunodeficiency virus type I.

A human Epstein-Barr virus-transformed lymphoblastoid B-cell line was generated from peripheral blood mononuclear cells (PBMC) of an asymptomatic human immunodeficiency virus type I (HIV-1) seropositive donor, which produces a human monoclonal antibody K14 (IgG1), reactive with an epitope on the transmembrane part (gp41) of the envelope glycoprotein of HIV-1. This monoclonal antibody reacts with a lysate of HIV-1-infected H9 cells, gradient purified HIV-1, and a vaccinia recombinant HIV-1 gp160 protein, but not with HIV-2 antigens in an enzyme-linked immunosorbent assay (ELISA). When used as an immobilized ligand in an immune affinity column, K14 selectively purifies gp41 from a HIV-1-infected H9 cell lysate. Although no reactivity was observed in ELISA with a panel of partially overlapping synthetic nonapeptides spanning the whole length of HIV-1 gp41, it was shown to react with recombinant envelope proteins, provided that they did contain amino acids 643-692: deletion of this part resulted in the disappearance of the reactivity. Testing of an extensive panel of the sera from HIV-1 seropositive or seronegative donors from Europe and Africa, including a selected group of donors before and after HIV-1 seroconversion, in a competition ELISA with horseradish peroxidase-conjugated K14, showed that the epitope recognized on gp41 is immunodominant and conserved. K14 does not neutralize HIV-1 infectivity or virus-mediated cell fusion, and does not mediate antibody-dependent cellular cytotoxicity.

The vascular "cold patch" is not a prognostic index for headache.

Our previous research has determined that the vascular "cold patch" is a valid diagnostic "marker" and is a persistent constituent of the thermal geography of the external carotid region. It has been suggested by Dalla Volta and Anzola (1988) that the cold patch may be a prognostic index of vascular headache physiology; that is, as headaches improve through the use of vasoactive prophylactic medication, the cold patch would decrease in size or disappear. The purpose of this study is an attempt to replicate these findings. Forty migraine patients were randomly selected, and a thermographic re-examination of the external carotid region (forehead) was conducted. The post-treatment thermogram was then compared to the initial pre-treatment thermogram. Thirty subjects demonstrated an improved condition (IC) and ten subjects a worsened condition (WC). The IC Group exhibited a 73.2% reduction in headache frequency following a mean treatment period of 6.3 months. The WC Group demonstrated a 48.1% increase in headache occurrence at a mean treatment interval of fifteen months. Results demonstrated little thermographic difference between the two conditions. Within the IC Group, 46.7% of subjects exhibited and increase in cold patch size with an improved condition, 40% of cold patches remained stable, 6.7% of cold patches reduced in size, and zero cold patches disappeared with successful treatment. Within the WC Group, 20% of cold patches decreased in size with a worsened condition, 40% increased in size, and 40% remained stable. Chi square analysis determined there was no significant difference in cold patch changes between patients whose headache condition improved or worsened (p less than .70).(ABSTRACT TRUNCATED AT 250 WORDS)

Safety and effectiveness of cranial electrotherapy in the treatment of tension headache.

One hundred patients were enrolled in a multicenter double-blind study to evaluate the safety and effectiveness of the Pain Suppressor Unit, a cranial electrotherapy stimulator for the symptomatic treatment of tension headaches. Treatment consisted of extremely low level, high frequency current applied transcranially. Pain scores before and after 20 minute treatments of individual headaches as well as patient and physician global evaluations were the primary efficacy variables. Following use of the active unit, patients reported an average reduction in pain intensity of approximately 35%. Placebo patients reported a reduction of approximately 18%. The difference was statistically significant (p = 0.01). The active unit was rated as moderately or highly effective in 40% by physicians, and in 36% by patients. Both physicians and patients scored the placebo unit moderately or highly effective for only 16%. The difference in ordered outcomes was statistically significant (p = 0.004). Approximately 10% of patients in each group reported at least one minor adverse experience. Cranial electrotherapy stimulation is distinct from TENS, and is safe and often effective in ameliorating the pain intensity of tension headaches. It should be considered as an alternative to the chronic usage of analgesics.

Coronary vasospasm during percutaneous trigeminal rhizotomy.

A case of myocardial infarction as a result of coronary vasospasm during percutaneous trigeminal rhizotomy is presented. Potential consequences of the profound sympathetic response during this procedure are discussed. Invasive haemodynamic monitoring as well as prophylaxis with nitrates and calcium antagonists may be useful in patients prone to coronary vasospasm who undergo this procedure.

Intravenous anaesthetic agents. Pharmacokinetic-pharmacodynamic relationships.

The number and variety of intravenous anaesthetics available has increased dramatically in recent years. In order to administer these agents safely and rationally in the operating theatre, the anaesthesiologist needs to have a detailed understanding of their dose-response behaviour. The pharmacokinetic and pharmacodynamic profiles of these anaesthetics underlie this behaviour. In understanding and applying this information, an integrated approach involving combined pharmacokinetic and pharmacodynamic modelling has proved tremendously helpful. This approach has provided significant insight into the pharmacology of these drugs under conditions of normal and abnormal physiology. Intravenous anaesthetics may be classified as hypnotics, narcotics, or muscle relaxants. Through quantitative measures or drug effect, as provided by the electroencephalogram (EEG) in the former two classes or electromyography in the latter class, precise measures of end-organ (brain or neuromuscular junction) sensitivity have been generated using integrated modelling techniques. These values not only allow for dose potency comparisons within an anaesthetic class but, furthermore, may explain changes in drug response with ageing and disease. Incorporation within these models of an effect compartment, characterised by a rate constant for equilibration with plasma (keo), has proved to be essential in accurately describing the temporal lag between drug administration and effect. Quantitating the size of this lag has direct implications for the design of anaesthetic bolus and infusion regimens. Combined pharmacokinetic and pharmacodynamic modelling of intravenous anaesthetics provides a precise, rational basis for the clinical use of these classes of drugs.

Anaesthesia for colobronchial fistula.

The case of a patient with a colobronchial fistula is presented. The anaesthetic management using endobronchial intubation and one-lung anaesthesia is described and the problems presented by this rare condition discussed.

Development of Aspergillus sinusitis in a patient receiving amphotericin B. Treatment with granulocyte transfusions.

Fulminant Aspergillus sinusitis is a disease of immunocompromised hosts strongly associated with neutropenia. A case of sinusitis due to Aspergillus flavus that developed in a patient with acute leukemia during the third week of treatment with amphotericin B is described. Indium 111-labeled white blood cell scanning demonstrated uptake of granulocytes into the involved sinuses. Thereafter, use of granulocyte transfusions was associated with stabilization of the patient's clinical course.

Ambulatory ventricular tachycardia: characteristics of the initiating beat.

One hundred ten 24-hour Holter ECG recordings from 82 ambulatory patients with 341 episodes of ventricular tachycardia (VT) were analyzed. Most VT was precipitated by ventricular premature beats (VPBs) with prematurity indices (coupling interval/QT) between 1.0 and 2.0. However, a disproportionate number of VPBs initiating VT occurred early and late in the cardiac cycle compared with isolated VPBs. VT rate was not related to preceding heart rate, but faster basic rates appeared to protect against VT of extended duration. Approximately 80% of episodes of VT were initiated by VPB forms also seen in isolation. Of the 20% of VT initiated by a VPB of new morphology, one third occurred late in the cardiac cycle; almost none were early cycle.

Bacillus megaterium spore protease. Synthesis and processing of precursor forms during sporulation and germination.

The protease which initiates the rapid protein degradation during germination of Bacillus megaterium spores was synthesized during sporulation as a Mr = 46,000 polypeptide (P46) which was found in the developing forespore. P46 was processed during sporulation to a Mr = 41,000 species (P41) 2-3 h after P46 synthesis and at the time of or slightly before accumulation of dipicolinic acid. P41 was the predominant form of the protease in the dormant spore, with smaller amounts of unprocessed P46. In the first minutes of spore germination P41 was processed (t1/2 less than 10 min) to a Mr = 40,000 species (P40), which appeared identical to the subunit of the purified active enzyme. The latter processing reaction did not require metabolic energy, but P40 disappeared completely during further germination (t1/2 approximately 40 min) in a reaction which did require metabolic energy. It seems probable that precursors P46 and P41 of the spore protease are involved in the regulation of the activity of this spore enzyme.