Caffeine consumption as a risk factor for childhood and adolescence migraine.

BACKGROUND: Caffeine consumption is a risk factor for chronic daily headache but few studies have addressed relationships between pediatric patient caffeine levels and headache severity. We examined associations between serum and urine caffeine levels and headache severity in childhood and adolescent migraine cases. METHODS: Levels of caffeine and caffeine metabolites in serum and urine samples were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The Wilcoxon rank-sum test was used for comparisons of age, sleep time, headache severity, caffeine consumption, and caffeine detection. Spearman's rank correlation coefficient (ρ) was calculated for associations. Correlations where ρ ≥ 0.3 and differences where p < 0.05 were considered statistically significant. RESULTS: Of the 40 patients studied, 34 declared caffeine consumption and six declared no caffeine consumption. These two groups did not differ significantly in any of the above clinical parameters. Liquid chromatography-tandem mass spectrometry analysis of both serum and urine samples revealed nine caffeine-negative (level <0.0625 µM) and 31 caffeine-positive cases. The Headache Impact Test-6 (HIT-6) score was higher (p = 0.033) for the caffeine-positive group versus the caffeine-negative group. Caffeine was detected by LC-MS/MS in the serum and/or urine of three of the six patients who declared no caffeine consumption. No significant correlations were observed among age, sleep times, headache severity score, or levels of caffeine and caffeine metabolites. CONCLUSION: Thirty one of 40 (77.5%) cases of childhood/ adolescence migraine showed serum and urine caffeine positivity based on LC-MS/MS. The HIT-6 score, a measure of headache severity, was significantly higher for caffeine-positive versus caffeine-negative cases. Symptoms of childhood/adolescence migraine were exacerbated by caffeine consumption.

Lateral nasal advancement flap for reconstruction of the nasal sidewall and dorsum.

Malignant skin tumors and precancerous lesions have a predilection to be located in the nasal dorsum or sidewall. Although invasive reconstructions have been presented, no simple and suitable method has yet been reported for this area. The flap presented herein, named the lateral nasal advancement flap, is designed on the adjacent lateral region of the sidewall or nasal dorsum and advanced in the medial direction. Two Burow's triangles are removed in the upper and lower portions of the flap: the upper triangle along the nasofacial sulcus and the lower triangle along the nasofacial sulcus and/or the alar groove. Excellent results were obtained in the two clinical cases described in this report. Neither a trap door deformity nor dog-ears developed in either case. The postsurgical scars followed the aesthetic lines and became inconspicuous. A distinct angle was formed in the nasofacial sulcus without anchor sutures. This surgical procedure is technically simple and is performed under local anesthesia. Although the flap is a cheek-based advancement flap, postsurgical scars do not remain in the cheek; instead, they are located in the nasofacial sulcus and alar groove. The lateral nasal advancement flap is recommended for reconstruction of the nasal sidewall and dorsum.

Familial amyotrophic lateral sclerosis with a point mutation (G37R) of the superoxide dismutase 1 gene: a clinicopathological study.

A familial amyotrophic lateral sclerosis (FALS) patient with G37R mutation of superoxide dismutase 1 (SOD1) gene revealed an early onset and relatively slow progression. Neuropathological examination of this patient showed widespread neuronal degeneration extending to overall length of the spinal cord and the brainstem with extremely rare Lewy body-like inclusions (LBI), while there were no vacuoles in neurons, a characteristic feature in transgenic mice expressing G37R SOD1 mutation.