Lateralized central facilitation of trigeminal nociception in cluster headache.

OBJECTIVE: To investigate whether central facilitation of trigeminal pain processing is part of the pathophysiology of cluster headache (CH). METHODS: Sixty-six patients with CH (18 episodic CH inside bout, 28 episodic CH outside bout, 20 chronic CH) according to the International Classification of Headache Disorders-II classification, as well as 30 healthy controls, were investigated in a case-control study using simultaneous recordings of the nociceptive blink reflex (nBR) and pain-related evoked potentials (PREP) following nociceptive electrical stimulation on both sides of the forehead (V1). RESULTS: nBR latency ratio (headache side/nonheadache side) was decreased in all CH patients independent from CH subtype compared with healthy controls indicating central facilitation at brainstem level. Area under the curve ratio was increased in patients with episodic CH inside bout only. PREP showed decreased N2 latency ratio in patients with chronic CH indicating central facilitation at supraspinal (thalamic or cortical) level. CONCLUSIONS: Asymmetric facilitation of trigeminal nociceptive processing predominantly on brainstem level was detected in patients with CH. This alteration is most pronounced in the acute pain phase of the disease, but appears to persist in remission periods. Only chronic CH patients show additional changes of PREP prompting to supraspinal changes of pain processing related to the chronic state of disease in regard to neuronal plasticity, which exceeds changes observed in episodic CH.

Epidermal growth factor receptor-immunohistochemical detection and clinical significance for treatment of primary breast cancer.

Epidermal growth factor receptor is considered to play an important role in the carcinogenesis and progression of breast cancer, but its clinical significance remains controversial mainly due to different methods and methodical problems. We determined EGF-R expression by an immunohistochemical assay on paraffin-embedded primary breast cancer tissue by means of the anti EGF-R mab E30 (Merck, FRG) and streptavidin-peroxidase technique. Material and clinical data were available from 111 patients with a mean follow-up time of 75.4 +/- 1.1 months (range 61-90 months). 21 (18.9%) of the breast cancer specimens showed positive staining for EGF-R 5 year-overall survival in patients with EGF-R negative tumors was 61.7% compared with 41.6% of patients with EGF-R positive breast carcinomas. No correlation was found between the expression of EGF-R and other prognostic factors except an inverse relationship with the expression of the estrogen receptor (p < 0.05). Whereas EGF-R expression demonstrated prognostic significance in univariate analysis, this could not be confirmed by multivariate analysis. Immunohistochemical determination of EGF-R represents a reliable and simple method to obtain more data about the biological behavior of malignant breast disease with increasing impact on therapeutic procedures.