Clinical features of migraine: a cross-sectional study in patients aged three to sixty-nine.

We investigated 260 consecutive patients classified as migraine cases aged 3-69 at two tertiary headache centres, one for children and adolescents and the other for adults to evaluate the relationship between age and clinical features of migraine cross-sectionally. We only included subjects with definite migraine without or with aura and we excluded subjects with coexisting tension-type headache, medication overuse and/or other clinically relevant disorders. The percentage of males decreased markedly from childhood to adulthood and this affected the evaluation of age-related changes in male patients, as only large differences reached the level of statistical significance. In females, the headache duration and the prevalence of unilateral, pulsating pain, photophobia and phonophobia increased, whereas the prevalence of aggravation by physical activity decreased with age. In conclusion, this cross-sectional, clinic-based study on a strictly defined sample of 260 consecutive patients with definite migraine covering a wide range of age from the very young to the old suggests marked age-related differences of the clinical features of migraine in females and failed to demonstrate similar differences in males due to the small number of adult male migraineurs.

[The sympathetic axons of the nerves of the hand]. / Die sympathischen Fasern der Nerven der Hand--eine immunhistochemische Studie.

PURPOSE: In the hand surgery literature, more and more studies seem to indicate that the number of sympathetic fibers in the median and the ulnar nerves varies. However, there are no studies that confirm this suspicion. METHOD AND MATERIAL: Six hours post mortem samples were taken from the median and ulnar nerves, the superficial branch of the radial nerve, and from all digital nerves (each five females and males, average age 78 years). 13 samples were taken from one hand. To make sympathetic fibers visible, the immunohistochemical staining technique with tyrosinhydroxylase (TH) antibodies was used. Quantitative assessment of the sympathetic axons was made in whole cross-sections of the nerve. Statistical evaluation was performed with Wilcoxon rank-sum tests. RESULTS: The TH-positive axons are arranged in groups and are located in the endoneurium. No isolated sympathetic fibers were found in the peri- and epineurium. TH-positive axons were present on the arterial walls including the smallest arterioles. Proximal to the wrist, the median nerve has more sympathetic fibers than the ulnar nerve. The number, however, of the fibers was the same in each fascicle. A comparison of the digital nerves shows significant differences only between the radial nerve of the thumb and the ulnar nerve of the ring finger and between the radial nerve of the index finger and the ulnar nerve of the little finger. CONCLUSION: Although the median nerve proximal to the wrist has on average 20 fascicles and the ulnar nerve only 14, the number of fibres in each fascicle is the same. Therefore, based on the present study we conclude that there is no significant difference in the sympathetic fiber distribution of the two nerves.

Are there predictive factors for long-term outcome after withdrawal in drug-induced chronic daily headache?

OBJECTIVES: To investigate prognostic factors for long-term outcome of patients after inpatient withdrawal because of drug-induced chronic daily headache. PROCEDURES: Fifty-five patients (36 females) were re-examined by means of a standardized interview after inpatient withdrawal. The mean observation period was 9.28 +/- 2.85 years (mean +/- SD; median 8.58; range 5.00-13.50). RESULTS: Five years after withdrawal, one-third of the patients (34.6%) had an overall favourable outcome, one-third (32.7%) had no recurrent drug overuse and reported a clear-cut improvement of headache, and one-third (32.7%) developed recurrent drug overuse. Most relapses occurred within 2 years, and a small percentage within 5 years. No predictors for long-term outcome after inpatient withdrawal were found. CONCLUSIONS: All patients with drug-induced chronic daily headache should be considered as good candidates for inpatient withdrawal, and no patient should be excluded from that therapy.

Does the BMI reflect body fat in obese children and adolescents? A study using the TOBEC method.

OBJECTIVE: Due to the fact that obesity is defined as excess of body fat mass, we tested the hypothesis whether the body mass index (BMI) can be used as a valid measure for the detection of the degree of obesity in individual obese children and adolescents. METHODS: A total of 204 obese children and adolescents (105 boys, 99 girls) aged 6-17 y, using total body electrical conductivity (TOBEC) for fat measurement, were included into this study. A multiple regression analysis was performed with percentage body fat (PBF) as dependent variable and BMI, age and sex as independent variables. First- and second-order interaction terms were also included. Since all interaction terms showed a significant influence on PBF, regression analysis was performed separately for boys and girls, dividing each group into two age subgroups (subjects younger than 10 y, and subjects 10 y or older). RESULTS: BMI and PBF were observed to be positively correlated (overall: r=0,65; P=0.0001; boys r=0.63 and girls: r=0.68). Through a multiple regression analysis 57% of the variance of PBF could be explained by the independent variables. In boys younger than 10 y 73% and in girls younger than 10 y 63% of the variance of PBF was explained by the BMI. In subjects 10 y or older the association was poor (boys: 27%; girls: 38%). It should be emphasized that there is a wide range in the relationship between PBF and BMI in the obese subjects. CONCLUSION: From these results we conclude that BMI might be a useful parameter for epidemiological studies: however in the individual pediatric patient, especially from 10 y onwards, it gives only a limited insight to the degree of obesity based on the definition.

Morphometric examination of straight, tapered titanium stems: a retrieval study.

Cementless straight, tapered rectangular cross section titanium stems have been used by the senior author since 1979. Thirty-four stems retrieved postmortem, after between 10 days and 15.2 years in situ, were studied morphometrically and histologically. Nineteen stems were first generation (1979-1986), with an incomplete sagittal taper and a mean surface roughness of 1 microm (Ra 1.23 +/- 0.3 microm); 15 stems were second generation after 1986, with a full biplane taper and a mean surface roughness of 4 microm (Ra 4.14 +/- 0.36 microm). Implant surface bony coverage was determined morphometrically in 10 segments of the stems, and expressed as a bone implant contact index. Histologically, there were no differences between implants with different levels of roughness. Morphometrically, the first-generation stems showed significant differences in coverage (distal > proximal); second-generation stems had a more uniform pattern. Stems retrieved early after arthroplasty had a mean bone implant contact index of 10%. The mean bone implant contact index showed attainment of maximum coverage by 5 years after arthroplasty, without additional apposition or loss thereafter. Patients younger than 65 years at arthroplasty had similar bone implant contact indices to patients 65 years or older; coverage in the six patients 80 years of age at retrieval did not differ from the rates in the other patients. Morphometry was able to provide objective evidence of design change effects. No differences in coverage were found in terms of times in situ, patient age at arthroplasty and at retrieval, and degree of stem surface roughness.

Serum dehydroepiandrosterone sulfate concentrations in men with erectile dysfunction.

OBJECTIVES: In 1994, the Massachusetts Male Aging Study presented the finding of an inverse correlation of the serum levels of dehydroepiandrosterone sulfate (DHEAS) and the incidence of erectile dysfunction (ED). Prompted by the positive results of a pilot study on the treatment of ED with dehydroepiandrosterone (DHEA), we performed a detailed investigation on the serum DHEAS levels in men with ED according to age category. METHODS: Inclusion criteria included a history of ED for more than 6 months, a body mass index less than 30, and a state of good general health. Serum DHEAS concentrations were determined in 309 patients with ED and 133 healthy volunteers. All participants were carefully screened to assess medical factors known or suspected to alter endocrine function. Questions 3 and 4 of the International Index of Erectile Function were used to evaluate erectile function. RESULTS: The mean serum levels of DHEAS in patients with ED were lower than in healthy volunteers until 60 years of age. The shape of the curve of the patients with ED indicated a quadratic decrease of DHEAS with age in contrast to a more linear decrease of DHEAS with age in the control group. CONCLUSIONS: Our results suggest that until the age of 60 years, the mean serum level of DHEAS is lower in patients with ED than in healthy volunteers.

Attitude towards prophylactic surgery and effects of genetic counselling in families with BRCA mutations. Austrian Hereditary Breast and Ovarian Cancer Group.

The intent of this study was to evaluate the effect that an awareness of being a BRCA1 or BRCA2 mutation carrier has on the attitude towards prophylactic surgery and on developing depression symptoms. Thirty-five families were selected on the basis of previously detected BRCA1 or 2 mutations and 90 family members were given the appropriate questionnaires. Prophylactic mastectomy (PM) was considered by 21% of the Austrian mutation carriers (29% affected and 8% non-affected carriers). The majority of affected and non-affected carriers expected PM to impair the quality of their life. Fifty per cent would undergo prophylactic oophorectomy (53% affected and 46% non-affected carriers). The self-rating depression scale indicated that following mutation result disclosure the depression scores of carriers decreased (40 baseline vs 38 after result disclosure, P = 0.3), whereas, for non-carriers, scores increased (36 baseline vs 40 after result disclosure, P = 0.05). We conclude that information about carrier status is not associated with increased depression symptoms in mutation carriers. In non-carriers, depression scores increased slightly, probably reflecting survivor guilt. The option of having PM was associated with a negative impact on the quality of life and was declined by the majority of Austrian mutation carriers.