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We report a case of Creutzfeldt-Jakob disease in a 38-year-old man, transmitted by a cadaveric dural graft. In August 1985, he underwent cranial nerve decompression for hemifacial spasm and received a cadaveric dural graft for dural closure. He had been well until he began to complain of blurred vision and headache in May, 1990. He developed dementia, myoclonus and urinary incontinence over the subsequent 3 months. He was admitted to our hospital in August, 1990. On admission, he was somnolent and showed gait disturbance, myoclonus in extremities and elevated deep tendon reflexes symmetrically. The results of analysis of blood, urinary and cerebrospinal fluid were normal. The initial computed tomography (CT) and magnetic resonance imaging detected no abnormality. Electroencephalography showed typical periodic synchronous discharge (PSD). There was progressive worsening of his neurological symptoms, and this developed into mutism in September, 1990. CT, 11 months after clinical onset, showed marked enlargement of the ventricles and the sulci. In view of his rapid worsening clinical course, PSD findings on electroencephalography, and delayed progressive changes of CT findings, the diagnosis of CJD disease was made. The cadaveric dural graft was suspected as the cause of the patient's condition. Since Thadani et al reported the first case of CJD transmitted by cadaveric dural graft in 1988, 3 other cases have been reported. This is most likely the 5th reported case of Creutzfeldt-Jakob disease transmitted by cadaveric dural graft.
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PMID:[Creutzfeldt-Jakob disease transmitted by cadaveric dural graft: a case report]. 845 5

Nitroglycerin and the long-acting nitrates are effective antianginal agents that have been used in clinical medicine for over 100 years. These drugs are reliable, safe, familiar to clinicians, inexpensive, and easy to use. Side effects are limited to headache and postural hypotensive symptoms. Nitrate tolerance or attenuation, -ie, loss of, or decrease in, nitrate efficacy with repeated dosing-is common and represents the major drawback to chronic therapy. Carefully designed dosing regimens and/or appropriate use of nitrate formulations (to include a nitrate-free period each day) will decrease or eliminate the problem of nitrate tolerance. In head-on comparative studies, nitrates appear to be as effective as beta-blockers or calcium channel blockers in the monotherapy of chronic angina. Ideal patient characteristics for nitrate therapy include: predictably favourable response of chest pain to sublingual nitroglycerin; angina episodes suggestive of coronary vaso-constriction or spasm; left ventricular systolic dysfunction; symptoms of congestive heart failure (systolic or diastolic dysfunction).
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PMID:Therapy of angina pectoris with long-acting nitrates: which agent and when? 863 22

The aim of the study was to compare the tolerance of synthetic salmon calcitonin applied in two different ways, intramuscularly or intranasally, in 50 patients with postmenopausal osteoporosis with bone fractures. Thirty patients were treated with calcitonin in intramuscular or subcutaneous injections, whereas in 20 cases calcitonin was applied in nasal spray. In the first group several side effects were observed, like nausea, vomiting, abdominal pains, skin rush, headaches, dropping blood pressure, symptoms of bronchial spasm. Finally in 13 cases it was necessary to stop calcitonin therapy. On the other hand the patients receiving calcitonin in nasal spray did not manifest any severe side effects.
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PMID:[Comparison of calcitonin tolerance after intramuscular or intranasal administration in treatment for postmenopausal osteoporosis]. 871 Nov 77

Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal-infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.
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PMID:Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. 881 66

Magnesium ions (Mg2+) are pivotal in the transfer, storage and utilization of energy; Mg2+ regulates and catalyzes some 300-odd enzyme systems in mammals. The intracellular level of free Mg2+ ([Mg2+]i) regulates intermediary metabolism, DNA and RNA synthesis and structure, cell growth, reproduction, and membrane structure. Mg2+ has numerous physiological roles among which are control of neuronal activity, cardiac excitability, neuromuscular transmission, muscular contraction, vasomotor tone, blood pressure and peripheral blood flow. Mg2+ modulates and controls cell Ca2+ entry and Ca2+ release from sarcoplasmic and endoplasmic reticular membranes. Since the turn of this century, there has been a steady and progressive decline of dietary Mg intake to where much of the Western World population is ingesting less than an optimum RDA. Geographic regions low in soil and water Mg demonstrate increased cardiovascular morbidity and mortality. Dietary deficiency of Mg2+ results in loss of cellular K+ and gain of cellular Na+ and calcium ions (Ca2+). Blood normally contains Mg2+ bound to proteins, Mg2+ complexed to small anion ligands and free ionized Mg2+ (IMg2+). Most clinical laboratories only now assess the total Mg, which consists of all three Mg fractions. Estimation of the IMg2+ level in serum or plasma by analysis of ultrafiltrates (complexed Mg + IMg2+) is somewhat unsatisfactory, as the methods employed do not distinguish the truly ionized form from Mg2+ bound to organic and inorganic anions. Because the levels of these ligands can vary significantly in numerous pathological states, it is desirable to directly measure the levels of IMg2+ in complex matrices such as whole blood, plasma and serum. Using novel ion selective electrodes (ISE's), we have found that there is virtually no difference in IMg2+, irrespective of whether one samples whole blood, plasma or serum. These data demonstrate that the mean concentration of IMg2+ in blood is about 600 mumoles/litre (0.54-0.65 mmol/L, 95% Cl); 65-72% of total Mg being free or biologically-active Mg2+. Use of the NOVA and KONE ISE's for IMg2+ on plasma and sera from patients with a variety of pathophysiologic and disease syndromes (e.g., long-term renal transplants, liver transplants, during and before cardiac surgery, ischemic heart disease [IHD], headaches, pregnancy, neonatal period, non-insulin dependent diabetes (NIDDM), end-stage renal disease [ESRD], hemodialyse [HEM], and continuous ambulatory peritoneal dialysis (CAPD), hypertension, myocardial infarction [AMI] and after excessive dietary intake of Mg), has revealed interesting data. The results indicate that long-term renal transplant patients, headache, pregnant, NIDDM, ESRD, HEM, CAPD, AMI, hypertensive, and IHD subjects exhibit, on the average significant depression in IMg2+ but not TMg. Use of 31P-NMR spectroscopy on red blood cells, from several of these disease states, to assess free intracellular Mg ([Mg2+]i demonstrates a high correlation (r = 0.5-0.8) between IMg2+ and [Mg2+]i. Increased dietary load of Mg, for only 6 days, in human volunteers, resulted in significant elevations in serum IMg2+ but not TMg. Correlations between the clinical course of several of the above disease syndromes and the fall in IMg2+ and [Mg2+]i were found. The ICa2+/IMg2+ ratio appears, from our data, to be an important guide for signs of peripheral vasoconstriction, ischemia or spasm and possibly atherogenesis. Overall, our data point to important uses for ISE's for IMg2+ in the diagnosis and treatment of disease states.
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PMID:Role of magnesium in patho-physiological processes and the clinical utility of magnesium ion selective electrodes. 886 38

A variety of conditions are frequently associated with the occurrence of head and neck pain. The purposes of this review are: to describe the characteristics of several musculoskeletal, neurological, and systemic conditions frequently cited as possible causes of head and neck pain and to suggest a new technique for treating head and neck pain. The characteristics of musculoskeletal conditions, such as muscle spasm, tendinitis, trigger points, and joint inflammation, and their relationship to head and neck pain are considered. The features and clinical implications of neurologic conditions, such as atypical facial pain, trigeminal and glossopharyngeal neuralgia, reflex sympathetic dystrophy, and neurogenic inflammation, are also described. The distinguishing characteristics of headaches, including cluster, tension, chronic daily, rebound, posttraumatic, and postlumbar puncture, are detailed. This review also addresses the contributions of systemic disorders, such as osteoarthritis, rheumatoid arthritis and the variants, and rheumatoid-related conditions, like dermatomyositis, temporal arteritis, Lyme's disease, and fibromyalgia, to head and neck pain. The results of a recent pilot study of the effectiveness of intraoral circulating ice water for resolving symptoms related to head and neck pain secondary to neurogenic inflammation are presented in this work. Ice water circulating through hollow metal tubes was placed intraorally for 15 minutes in the posterior maxillary area on 12 individuals with cervical pain and muscle spasm. In nine of these individuals, reduced cervical pain perception, upper trapezius electromyography signal reduction, and increased cervical range of motion was produced. Six out of 12 individuals had accompanying headache, which was reduced or eliminated in four cases. These findings suggest a strong trigemino-cervical relationship to neck pain and headache.
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PMID:Head and neck pain review: traditional and new perspectives. 889 41

The exteroceptive suppression period (ES) of the temporalis muscle activity is a trigemino-trigeminal brain stem reflex. It will be elicited most when stimulating trigeminal sensory afferents by painful stimuli and typically leads to a biphasic interruption of voluntary muscle activity. The first phase of decreased voluntary activity is called the early exteroceptive suppression period (ES1), the second, the late exteroceptive suppression period (ES2). Between these two suppression periods a phase of increased muscle activity, the so-called facilitation period (FP), can be seen. This phenomenon can be modulated by different stimulating parameters and usually, in healthy subjects, this normal pattern of the exteroceptive suppression can be elicited regularly. The reflex answer may occur at low non-painful stimulus intensities; typically, however, it appears to be most pronounced with high-intensity stimuli. Because of the obvious relationship between stimulus intensity, pain perception and reflex, the reflex is regarded as an antinociceptive reaction. The absence of an inhibition of motor activity can be visualized, for example, in hemimasticatory spasm or dystonic disorders. However, above all the ES nowadays attracts most attention as a tool to analyse different pain syndromes. One main advantage of this method in man is the ability to evaluate certain antinociceptive brain stem mechanisms functionally by means of a simple noninvasive technique. A large number of results have been obtained showing that chronic pain syndromes such as chronic tension-type headache and migraine cause changes within the normal ES recording pattern. Furthermore, some substances used in pain therapy, such as serotonin agonists or antagonists, acetylsalicylic acid or naloxone, may also alter the general appearance of the ES. This review will summarize different parameters that influence the ES reflex answer. Furthermore, the diagnostic value of changes in the ES for pathophysiological processes regarding pain perception and processing in certain pain syndromes will be discussed.
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PMID:[Exteroceptive suppression of activity of the temporal muscle. Principles and applications]. 903 58

Ebu Ali Husein Ibn Ali Ibn Sina (or Avicenna) was primarily a philosopher with amusing knowledge, who dealt in all aspects of art of medicine, astronomer, poet, musician and psychologist. This giant with an encyclopedic knowledge has dealt in almost all scientific branches or praxis with the great success. Numerous statements of his have been cornerstone of many sciences for centuries; and some of them are (in the era of computers and Internet) still current. The best known treatise on medicine of his is El-Kanun, consisting of five volumes, wherein all medical achievements (including psychology, psychiatry and neurology) of that period were described clearly. In his psychology, Ibn Sina (Avicenna) analyses the essence of human soul, mind, psychical streams, intellectum, dreams and prophecy, man's desires etc. in details. It is unnecessary to point out how much these items are actual in the contemporary psychology. Ibn al-Nefis has described systematically the symptoms and recovery of "head sick" (including headaches, cerebral sick like cranitis, letargy, coma, demency, melancholy, insomnia, nightmares, epilepsy, appoplexy, paralysis, spasm and many others) in his Mujez al-Kanun, that is synopsis of Ibn Sina Kanun. We need much time to see magnificance of this philosopher, that is best known as the great one among the physicians. His writings could be found in whole Bosnia, but there were many few that would study him and his works. It is out task to enable the future generations not only to know those works exist, but, also, to realize the essence of this marvelous genius; because there are very few people that can be compared to him.
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PMID:[Ibn Sina--psychology and psychological disorders]. 932 66

Measurable sources of muscle tension include viscoelastic tone, physiological contracture (neither of which involve motor unit action potentials), voluntary contraction, and muscle spasm (which we define as involuntary muscle contraction). The latter two depend on motor unit action potentials to generate the tension. Total muscle tension is most accurately measured as stiffness. Thixotropy of muscle is an ubiquitous and functionally important phenomenon that is not commonly recognized. A clinical pain condition associated with increased muscle tension is tension-type headache, which is largely muscular in origin; it is often caused by myofascial trigger points, but not by a pain-spasm-pain cycle, which is a physiologically and clinically untenable concept. Clinical conditions associated with painful muscle spasm include spasmodic torticollis, trismus, unnecessary muscle tension, nocturnal leg cramps, and stiff-man syndrome.
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PMID:Understanding and measurement of muscle tone as related to clinical muscle pain. 953 69

Raynaud's phenomenon (RP) is a peripheral circulatory disorder characterized by sudden episodes of digital artery spasm, often precipitated by cold temperature or emotional stress. Although the cause of RP is not fully known, it appears to involve inappropriate adrenergic response to cold stimuli. Treatment of RP is conservative in most patients, but in patients with severe disease includes the use of agents that promote digital vasodilation. The calcium-channel antagonists, particularly the dihydropyridine derivative nifedipine, are the most thoroughly studied drug class for the treatment of RP. Approximately two thirds of patients respond favorably, with significant reductions in the frequency and severity of vasospastic attacks. Nifedipine use is often limited by the appearance of adverse vasodilatory effects such as headache or peripheral edema. The newer second-generation dihydropyridines such as amlodipine, isradipine, nicardipine, and felodipine also appear to be effective in patients with RP and may be associated with fewer adverse effects.
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PMID:Rational use of calcium-channel antagonists in Raynaud's phenomenon. 981 20


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