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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Accumulation of D-lactate after gastrointestinal surgery, particularly jejuno-ileal bypass, is an uncommon and often misdiagnosed clinical disturbance. The syndrome may be complicated by dizziness, ataxia, confusion, headache, memory loss, and aggressive behavior. Serum chemistries are often deceptive because the anion gap is frequently normal in spite of severe metabolic acidosis. Moreover, the urine anion gap may be positive, incorrectly suggesting a defect in renal net acid excretion. Indeed, the combination of a normal anion gap metabolic acidosis and positive urine anion gap may erroneously suggest a diagnosis of renal tubular acidosis. Importantly, all reported cases of D-lactic acidosis secondary to bypass surgery have been encountered within 5 to 10 years following the surgery. Here we present an unusual case of D-lactic acidosis (complicated by encephalopathy) presenting 23 years after a jejuno-ileal bypass procedure. The patient was initially diagnosed with a drug intoxication secondary to benzodiazepines. Ultimately, the diagnosis of D-lactate encephalopathy was established after challenging the patient with a carbohydrate load. Thus, administration of 40 kcal/kg over 16 hours reproduced the clinical syndrome and was accompanied by a marked increment in serum and urine D-lactate concentration. The patient had sustained resolution of her symptoms after treatment with oral vancomycin.
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PMID:D-lactic acidosis 23 years after jejuno-ileal bypass. 1092 30

We report 3 patients with Proteus syndrome (PS) who died suddenly from pulmonary embolism (PE). The first patient was a male diagnosed with PS at 12 years who had varicose veins, portal vein thrombosis, right iliac vein occlusion and recurrent PE. At age 25 years, he was admitted to the hospital with a severe headache. Despite therapeutic doses of warfarin, investigations for an acute episode of breathlessness showed PE and he was unable to be resuscitated. The second case was a 9-year-old male with PS who collapsed at home and could not be revived. Autopsy revealed that the cause of death was a PE associated with thrombosis of the deep veins (DVT). The third patient was a 17-year-old female undergoing inpatient treatment for sinusitis when she unexpectedly arrested. She could not be revived and a full autopsy revealed a large PE with no identified DVT. We conclude that PE is a serious complication of PS and recommend vigilance concerning the signs and symptoms of thrombosis and PE in individuals with PS, including children. Aggressive evaluation and treatment should be considered urgently in patients with PS and signs or symptoms of DVT.
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PMID:Sudden death caused by pulmonary thromboembolism in Proteus syndrome. 1114 Aug 39

We evaluate personality traits, anxiety and depression in a population of paediatric and adolescent patients, correlating personality characteristics with headache and sociodemographic variables. The clinical features of headache include specific personality traits. We report a clinical study of 57 patients (age 8-18 years), divided up as follows: 12 migraine with aura, 29 migraine without aura and 16 tension-type headache. One of Cattel's tests was administered to every patient; the Children's Depression Inventory test was administered to 53 patients and the Test Anxiety Inventory test to 43 subjects. The scores obtained by every patient in each test were correlated with the characteristics of headache and with sociodemographic data. We found that patients affected by idiopathic headache share some personality traits, mainly emotional rigidity and tendency to repress anger and aggression. These traits do not seem to be correlated with sociodemographic data and the duration of headache: we considered these as characteristic of migrainous patients.
Cephalalgia 2001 Feb
PMID:Personality traits in childhood and adolescent headache. 1129 64

Zygomycosis is rare but highly invasive fungal infection, with high mortality rate. A 67 years old diabetic man was presented with rhino-ocular form of the disease. Fungal elements invaded the skin and subutaneous facial tissue, with involvement of the nose, paranasal sinuses and orbit. The portal of entry of fungus was through paranasal sinuses, after the tooth extraction. Various clinical manifestations were presented: headache, facial swelling, tenderness over the involved sinuses, unilateral orbital cellulitis with proptosis, facial and orbital pain, black nasal discharge, decreased visual acuity, blindness. Patient was treated surgically and by liposomal amphotericin B. He underwent maxillectomy, ethmoidectomy and sphenoidectomy and orbital exenteration because of the dissemination of the disease into the orbit. The specific diagnosis of the infection was established upon the microscopic demonstration of casual agent in the debridement tissue. Early diagnosis was important in this highly fatal disease. Aggressive surgical debridement, therapy with amphotericin B and correction of underlying metabolic acidosis must be performed. The successful medical therapy in this patient suggests that lipid formulation of amphotericin B should be given, because this antifungal agent performed the best control of the infection with the minimal adverse effects.
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PMID:[Rhino-orbital zygomycosis]. 1176 21

Arrogance and aggressive behaviour occur more and more often in our lives. Especially at school there are observed negative attitudes of school youth. The aim of the study was to estimate the occurrence of aggressive behaviour among school youth towards teachers. Research based on questionnaires was carried out among 156 teachers (63.5% women and 36.5% men), aged 23-60 (mean 40 +/- 8.9) with time of employment ranking from 1-35 years (mean 14 +/- 9.2), working at vocational, technical and secondary schools as well as in the last classes of primary schools. Generally, aggressive behaviour more often occurs among school youth. It mainly includes verbal aggression, disrespectful attitude towards a teacher and refusal to follow his instructions. Other kinds of aggressive behaviour were observed rarely. More than half of the investigated persons did not feel distress at school, some of them only a little. The majority of subjects noticed the growing problem of negative behaviour among school youth during the last few years. Especially women defined their job as stressful and associated stress level with psychosomatic disorders (most often the increasing nervous stress and headache) they suffered from. Therefore, some teachers had to use tranquillizers to reduce stress level at work.
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PMID:Aggression and arrogance phenomenon among school youth as a health risk factor for teachers. 1197 62

Although abnormal personality traits have been frequently reported in patients with primary headaches, the overlaps between these domains need a clear standard definition, for example, by a five-factor personality model. Moreover, personality abnormalities in patients with episodic tension-type headache (ETH) and migraine with aura (MA) are less well studied. Therefore, we administered Zuckerman-Kuhlman's Personality Questionnaire to 72 patients suffering from chronic tension-type headaches (CTH), 33 with ETH, 15 with MA and 57 with migraine without aura (MO), as well as 58 healthy subjects. Depressive trends were measured with Plutchik-van Praag's Depression Inventory. Compared to healthy controls, the CTH, ETH and MO groups showed significantly greater neuroticism-anxiety and depression. In addition, the MO group scored significantly higher on aggression-hostility than healthy controls. No abnormal personality traits were found in patients with MA. This study, from the perspective of a five-factor model, confirms most previous reports about personality in patients with primary headaches and establishes elevated aggression-hostility only in MO sufferers.
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PMID:Personality traits in migraine and tension-type headaches: a five-factor model study. 1223 43

Research suggests that violence has entered the medical setting to a remarkable degree, causing medical professionals to be at the highest risk for becoming the victims of assaults and violent acts. This article reviews general theories of aggression and research on these theories, and uses them to assess risk factors in patients with chronic pain. There are data to suggest that pain may increase the risk of aggressiveness in some patients. However, it may decrease the risk in others paradoxically. The research available underscores the need for evaluating patients with pain for the risk of violent or aggressive behavior; specific recommendations are made in this regard.
Curr Pain Headache Rep 2003 Apr
PMID:Chronic nonmalignant pain and violent behavior. 1262 54

Basic personality traits and specific behavior characteristics were assess in 39 patients (12 to 15 years old) having chronic tension-type headache. Patients were referred for clinical examination to the Neural-pediatrics Ward of the Department of Pediatrics, Osijek, Croatia. Eysenck Personality Questionnaire--Juniors (EPQ-J), a new Croatian personality Questionnaire of domination, aggression, introversion and ambition (DAIA), were applied for the testing. The scores obtained by patients in personality questionnaires were compared with averages scores normal sample of healthy pupil same ages. Our patients were found to have no signs of emotional instability. Their behavior is prosocial, nonaggressive, and ambitious, aimed at the achievement of superior results at school and life although already quite successful in their studies. Tensions arising from the school setting seem to be important factors triggering tension-type headaches.
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PMID:Chronic tension-type headache in school-aged children--personality traits and behavior. 1295 5

Lymphocytic hypophysitis (LYH) is an uncommon autoimmune disease in which the pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages and its function is usually impaired. It has to be suspected in pregnant women and in women with recent delivery presenting with hyperprolactinemia, headache, visual field alterations and changes of one or more pituitary hormone secretions with secondary impairment of related peripheral target glands, especially when associated with other autoimmune endocrine or non-endocrine disorders. It can also occur less frequently in prepubertal or post-menopausal women and in men. Headache, visual field impairment and more rarely diplopia are due to extrasellar pituitary enlargement with optic chiasma compression and/or to invasion of cavernous sinuses. Among the 'isolated' pituitary hormone deficiencies, ACTH deficit is usually the earliest and most frequent hormonal impairment and in rare cases can induce an acute secondary hyposurrenalism as the first sign of the disease, with high mortality in affected patients. Histopathological findings from pituitary biopsy show lymphoplasmacytic infiltrate with lymphoid aggregates surrounding atropic acini of pituitary cells; immunohistochemical analysis shows numerous mast cells randomly distributed and also localized in the vicinity of capillaries, suggesting a possible influence on capillary permeability and angiogenesis, thus favoring the inflammatory and immunological aggression against pituitary cells. Nuclear magnetic resonance imaging shows uniform sellar floor depression and an extrasellar symmetrical pituitary enlargement, usually displacing the optic chiasma, which shows a rapid homogeneous enhancement after gadolinium also involving the adjacent dura (dural tail). Antipituitary antibodies have been detected in several patients with LYH but their role needs to be clarified. Since a possible spontaneous remission can occur, a careful follow-up is required in subclinical patients without important hyposurrenalism or symptomatic extrasellar expansion. Medical (immunosuppressive, replacement and antiprolactinemic) and neurosurgical (decompression) treatments are needed in clinical symptomatic patients.
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PMID:Lymphocytic hypophysitis: a rare or underestimated disease? 1458 81

Systemic mastocytosis (SM), as opposed to cutaneous-only mastocytosis, implies the presence of neoplastic mast cell infiltration in extracutaneous tissue. Mast cell disease in adults is often systemic and often involves the bone marrow. Typical clinical and laboratory features of SM include urticaria pigmentosa, mast cell mediator symptoms (eg, headache, flushing, lightheadedness, urticaria and pruritus, nausea, diarrhea, abdominal pain, and vasodilatory shock), bone pain (eg, osteoporosis, lytic bone lesions, and fractures), hepatosplenomegaly, cytopenia, eosinophilia, elevated serum tryptase and histamine, and bone marrow fibrosis and angiogenesis. SM may be indolent (no evidence of organ dysfunction), aggressive (presence of organ dysfunction), associated with another often chronic myeloid hematologic disease (SM-AHD), or present as mast cell leukemia or sarcoma. Mast cell-mediator symptoms are treated with histamine antagonists and cromolyn sodium. Indolent SM does not require cytoreductive therapy. Aggressive SM and SM-AHD are managed based on their molecular profile. Recent information suggests that FIP1-like-1-platelet-derived growth factor receptor-alpha(+) SM responds well to imatinib mesylate, whereas interferon-alpha should be considered as a first-line treatment in all of the other cases, including patients with Asp816Val(+) SM. Cladribine has been shown to be effective in patients who develop resistance to interferon treatment.
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PMID:Systemic mastocytosis: current concepts and treatment advances. 1508 68


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