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

The physicochemical properties, pharmacology, pharmacokinetics, cardiovascular and metabolic effects, adverse effects, dosage, and administration of doxazosin are described, and comparative clinical studies of doxazosin therapy in patients with mild to moderate hypertension are reviewed. Doxazosin mesylate, an alpha 1-adrenoceptor antagonist, is rapidly absorbed after oral administration and undergoes extensive hepatic metabolism. The drug decreases blood pressure by reducing peripheral resistance. Maximum hypotensive effects occur four to eight hours after the dose. Doxazosin favorably affects serum lipids by increasing concentrations of high-density lipoprotein (HDL) cholesterol, increasing the HDL:total cholesterol ratio, and decreasing concentrations of low-density lipoprotein cholesterol, total cholesterol, and triglycerides. In comparative clinical trials, doxazosin lowered standing and supine systolic and diastolic blood pressures as effectively as other alpha-adrenoceptor antagonists, beta-adrenoceptor antagonists, diuretics, angiotensin-converting-enzyme inhibitors, and calcium-channel-blocking agents. The most frequently reported adverse effects are dizziness, headache, nausea, lethargy, and fatigue. Doxazosin may be used either alone or in combination with a beta-adrenoceptor inhibitor or a diuretic. Orthostatic hypotension after the first dose occurs infrequently and may be minimized by initiating therapy at a dosage of 1 mg/day. The dosage may be increased at two-week intervals as needed, and blood pressure should be closely monitored. Doxazosin has blood-pressure-lowering effects comparable to those of other alpha 1-adrenoceptor inhibitors and to those of antihypertensives in other drug classes.
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PMID:Doxazosin: a new alpha 1-adrenergic antagonist. 134 55

Nineteen patients with advanced cancer were entered into a phase I clinical trial of Tumor Necrosis Factor (TNF) which was designed to determine the pharmacokinetic profile, safety, and maximal tolerated dose (MTD) of the recombinant human cytokine in vivo. TNF was administered by continuous infusion for 24 hours followed by pharmacokinetics and a 120-hour infusion repeated every 3 weeks. The initial dose was 40 micrograms/m2 and was ultimately escalated to 200 micrograms/m2. A total of forty 5-day cycles were administered to 18 of these patients; and all were evaluable for toxicity. Toxicities in this trial included fever, chills, rigors, hypotension, headaches, seizures, lethargy, weight loss, and malaise. At all dose levels, but more significantly at the highest doses, hematological toxicities were observed and grade 3 neurotoxicity (headache and confusion), and hypotension were noted. Two patients expired during the study, and this was felt to be related to septic episodes. Because of these severe toxicities, 160 micrograms/m2 was defined as the MTD. At 160 micrograms/m2 peak serum levels occurred within 5-20 minutes of initiation and were not detectable 1 hour later. No anti-tumor responses were observed. No measurable plasma levels of TNF were observed with the administration of doses of 80 micrograms/m2. This dose level could be further studied in phase II studies alone and in combination with other agents, utilizing a continuous infusion schedule.
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PMID:A phase I pharmacokinetic study of recombinant human tumor necrosis factor administered by a 5-day continuous infusion. 142 28

The effects of the exposure to ozone in the central nervous system are unknown, as it is doubtful if ozone enters beyond the respiratory tract. However, ozone exposure impairs human performance and induces subjective complaints such as fatigue, lethargy and headache. We studied electrographic aspects of sleep-wake organization in cats, and found that paradoxical sleep was promptly reduced during ozone exposure, followed by a dose-related increase of slow-wave sleep. These findings suggest that high concentrations of ozone or its reaction products induce striking changes in sleep patterns.
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PMID:Sleep-wake disorganization in cats exposed to ozone. 150 89

Symptomatic ventricular coaptation, or the slit ventricle syndrome, is frequently described and recognized as a clinical entity in the pediatric population. It is characterized by symptoms of shunt failure (i.e., ataxia, obtundation, nausea, vomiting, lethargy, irritability, and complaints of headache) and the CT findings of ventricular coaptation (slit-like ventricles). This study of twenty-two children with this syndrome reflects the variety of possible clinical presentations, and the variety of available treatment modalities. Multiple therapeutic approaches were required in seven of the patients. This illustrates not only an evolving treatment regimen, but also that a single treatment modality is not universally effective. Six patients needed only occasional symptomatic support. Blockage and/or removal of the shunt system was the definitive therapy in six patients, pressure augmentation in nine patients, and subtemporal craniectomy in one. This article outlines the theoretical pathophysiology, and a scheme for the management of patients with this syndrome.
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PMID:Slit ventricle syndrome in children: clinical presentation and treatment. 151 32

Neurologic disturbances are common following the intensive chemotherapy and radiotherapy of bone marrow transplantation (BMT) conditioning regimens. The somnolence syndrome, which occurs in most children treated for leukemia with prophylactic cranial irradiation, has previously not been reported following BMT. This syndrome consists of transient lethargy, irritability, headaches, low grade fevers, gastrointestinal disturbances and depression. We report the case of a 38-year-old female with acute non-lymphocytic leukemia who developed symptoms typical of the somnolence syndrome 8 weeks following 1320 cGy total body irradiation and cyclophosphamide conditioning. Encephalographic findings were consistent with the syndrome, and no additional infectious or metabolic disorders could be identified. As predicted by the pediatric experience, the symptoms were transient, resolving following steroid and anti-depressant therapy. Among patients undergoing radiation based conditioning regimens, especially those not receiving concurrent steroid therapy, the appearance of post-transplantation somnolence may be an expression of this syndrome.
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PMID:Post-irradiation somnolence syndrome in an adult patient following allogeneic bone marrow transplantation. 162 37

The case of a 49-year-old female with a left parietal convexity meningioma associated with an acute subdural hematoma is described. She was admitted because of sudden onset of severe headache accompanied by nausea and vomiting. She was also confused, and 6 hours after admission she developed lethargy, right hemiplegia, and left mydriasis with no pupillary reaction to light. Computed tomography disclosed a round, extra-axial mass in the left parietal region; it was heterogeneously enhanced. Emergency craniotomy, performed after carotid angiography, revealed a tumor with a massive underlying subdural hematoma. The histological diagnosis was meningotheliomatous meningioma, and there were many meningothelial cells within the hematoma.
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PMID:Meningioma associated with subdural hematoma--case report. 169 43

Hydrocephalus is marked by the excessive accumulation of cerebrospinal fluid within the ventricles. The disorder is characterized by an imbalance in the production and reabsorption of cerebrospinal fluid. Congenital hydrocephalus is usually the result of an intrauterine infection or maldevelopment of the aqueduct of Sylvius. Acquired hydrocephalus can be caused by infection, neoplasm or hemorrhage. In infants, hydrocephalus usually presents as progressive head enlargement. The presenting symptoms in children are irritability, headache, nausea, vomiting and lethargy. Diagnosis is made with ultrasonography, computed tomography or magnetic resonance imaging. The majority of patients are treated with cerebrospinal fluid shunt procedures, most commonly the placement of ventriculoperitoneal or lumboperitoneal shunts. The outcome of hydrocephalus is determined by the etiology, the presence or absence of associated anomalies, and the timeliness of diagnosis and treatment.
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PMID:Hydrocephalus in infancy and childhood. 173 57

A case of generalized choreic movement associated with subarachnoid hemorrhage is reported. A 71 year-old hypertensive woman suddenly developed severe headache 14 days before admission. Consciousness disturbance and involuntary movement involving the face and upper extremities appeared about 8 days after onset. The involuntary motion was diagnosed as generalized choreic movement. CT scans showed subarachnoid hemorrhage with ventricular dilatation and periventricular lucency involving bilateral caudate nuclei. On admission the patient was stuporous with Hunt & Kosnik Grade 4. She showed involuntary choreic movement in both arms, trunk and face; hemiparenis and hyperreflexia were absent. An angiography revealed a right internal carotid-anterior choroidal artery aneurysm with vasospasm. After clipping the aneurysm in the following day, the consciousness disturbance and choreic movement gradually improved. By eight days after operation, the choreic movement completely disappeared. An MRI showed lacunar infarcts in the bilateral basal ganglia, predominantly in the caudate nuclei. In our case, the choreic movement is supposed to have been caused by impaired circulation in the bilateral corpora striata due to vasospasm and hydrocephalus after subarachnoid hemorrhage, in addition to the preexisting lacunar infarcts in the basal ganglia. This is claimed to be the first reported case of generalized choreic movement in associated with subarachnoid hemorrhage, which improved after surgery.
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PMID:[Generalized choreic movement associated with subarachnoid hemorrhage]. 174 95

We report a case of gliomatosis cerebri in a 46-year-old woman with five-year history of seizures and psychiatric disturbance. There were also two episodes of lethargy, disorientation, and headache which cleared promptly with Mannitol. A 3rd episode terminated in her death. Remarkably, between the episodes of presumed increased intracranial pressure, the neurologic examination was normal except for the patient's denial of her illness. Postmortem examination revealed the entire right cerebral hemisphere to be enlarged and infiltrated by cells resembling astrocytes. The clinical signs, symptoms, and controversial histopathologic features of this rare entity are discussed.
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PMID:Gliomatosis cerebri: a case report. 176 54

The sick-building syndrome (SBS) is defined as the occurrence of an excessive number of subjective complaints by the occupants of a building. These complaints include headache, irritation of the eyes, nose, and throat, lethargy, inability to concentrate, objectionable odors, and less frequently, nausea, dizziness, chest tightness, etc. These complaints will always be reported by a fraction of the occupants of any building if a questionnaire is administered that asks the respondent to recall any subjective symptoms they remember having had in the last 2 weeks or or over some period of time. It is often considered that SBS symptom reports have a minimum prevalence of about 15 to 20% for a 2-week recall period. SBS symptoms reported by 30% or more of occupants are indicative of conditions in the building environment that warrant attention. It is not often that a clear, single cause is responsible for the excess symptom reports. The following factors, often in combinations, are seen to contribute to SBS: outdoor air supply that is inadequate, ventilation distribution or effectiveness that is inadequate, the presence of temporary or long-term sources of contaminants such as tobacco smoke, adhesives, composite materials such as chipboard, and the growth of microorganisms in the HVAC equipment or in carpets or other furnishings. Depending on which causes contribute, the condition may be intermittent or even temporary. Psychosocial factors such as labor-management relations and satisfaction or dissatisfaction with other factors in the work environment can have a profound influence on the level of response of the occupants to their environment. Although hard data are difficult to collect, it is likely that productivity in the office environment is sensitive to conditions causing SBS.
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PMID:Sick-building syndrome. 182 87


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