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

"Sick building syndrome" (SBS) is one of the more colorful terms describing an increasingly common pattern of symptoms found among workers in modern office buildings. Core symptoms include lethargy, mucous membrane irritation, headache, eye irritation, and dry skin. To prompt a diagnosis of SBS, these otherwise common symptoms must be "excessively" reported and primarily "work-related." The World Health Organization now estimates that 30% of new or remodeled office buildings show signs of SBS, and that between 10% and 30% of the occupants of these buildings are affected by SBS. Despite such figures, SBS remains poorly researched and even more poorly understood. The following review provides the clinician an overview of SBS that will allow a more accurate differential diagnosis and will help to prevent the widespread suffering that can accrue when SBS is not quickly recognized.
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PMID:Sick building syndrome. 198 30

Anticholinergic syndrome (AS) due to accidental poisoning is exceptional. Mandragora contains a high concentration of atropine, hiosciamine and scopolamine. We have evaluated 15 patients with AS due to poisoning by Mandragora autumnalis, distributed in two family groups. The latency period since the ingestion was 1-4 hours (Means = 2.7 +/- 0.9). The clinical features corresponded to an AS of variable severity. All patients had blurred vision and dryness of mouth, nine (60%) had difficult micturition, nine dizziness, nine headache, eight (53%) vomit, two difficult swallowing and two abdominal pain. There was no correlation between the latency period and the clinical severity. Blushing, areactive mydriasis and tachycardia were found in all, dry skin and mucosae in 14 (93%), hyperactivity/hallucination in 14 and agitation/delirium in nine (60%). One patient developed a florid psychotic episode. Prostigmine (2-6 mg) was administered to 11 patients and physostigmine (0.5-2 mg) to six. The time until a definite response was observed was variable (3-36 hours). The patients treated with physostigmine had a better reversal of the psychoneurological symptoms. Mandragora was identified intermingled with chard [correction of stalwort] (Beta vulgaris) and spinach (Spinacia oleracea) leaves, and atropine and hiosciamine were identified.
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PMID:[Atropine poisoning by Mandragora autumnalis. A report of 15 cases]. 208 9

Pituitary apoplexy is characterized by a wide spectrum of clinical features. A quite rare case of painless thyroiditis, hypopituitarism and central diabetes insipidus (DI) followed by pituitary apoplexy was presented. A 61-year-old woman was admitted to our hospital in May, 1986 because of marked general malaise, polydipsia and weight loss which became progressively worse. Four months earlier she had experienced episodes of abrupt onset of severe headache associated with nausea and blurring vision. Physical examinations revealed a fine tremor, dry skin and nervousness. The thyroid gland was not palpable. Visual fields were intact. Her blood pressure was 105/64 mmHg with variable tachycardia. The routine laboratory studies were normal or negative except for hypoalbuminemia, hypocholesterolemia and hypernatremia. Erythrocyte sedimentation rate was 12 mm/hr. An impairment in corticotropin secretion was suspected from the low plasma cortisol and the low urinary excretion of 17-OHCS and the sufficient response to ACTH. Basal levels of GH and gonadotropin were also low, and responses to the stimulation tests (Insulin-stress, L-DOPA, and LH-RH) were all blunted. Brain computed tomographic scan and magnetic resonance imaging demonstrated a suprasellar mass that, after infusion, developed peripheral ring-like enhancement and large hyperintense pituitary mass, respectively. A diagnosis of pituitary apoplexy with anterior pituitary failure was made. However, the initial levels of thyroid hormones showed elevated as follows: Free T3 7.6 pg/ml, Free T4 3.3 ng/dl and T3-resin uptake 41.1%. TSH responses to TRH were all suppressed. TSH receptor antibody (TBII) was negative. Both antithyroglobulin and antimicrosomal antibodies were repeatedly positive. A thyroid scan with 99mTc revealed no uptake in the thyroid area. These findings led us to the diagnosis of "painless autoimmune thyroiditis". She had become hypothyroid without any medication. At that time radioactive 99mTc and 123I uptakes increased significantly. When hydrocortisone was substituted, daily urine output abruptly increased to about 10 liters with low osmolality, and the presence of DI was suspected. This diagnosis was confirmed by water deprivation and hypertonic saline infusion tests and subsequent pitressin test. She is currently quite well on L-thyroxine, hydrocortisone and desmopressin (1988). This association with pituitary apoplexy must be a rare occurrence, as a literature search has failed to find a similar case. The pathogenetic trigger of "painless thyroiditis" in this case may be responsible for some immunological change due to secondary adrenal insufficiency after pituitary apoplexy.
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PMID:[An unusual association of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus associated with spontaneous pituitary apoplexy]. 230 57

In an attempt to increase the peak plasma levels of 13-cis-retinoic acid (13-cis-RA) and its efficacy in vivo, a Phase I study and pharmacokinetics of weekly high-dose, oral 13-cis-RA was conducted in 23 cancer patients who were refractory to conventional treatments. At 200 mg/sq m, the mean peak plasma level of 13-cis-RA was 1.5 +/- 0.1 (SE) micrograms/ml; at 400 mg/sq m, the mean peak plasma level increased to 3.8 +/- 0.7 micrograms/ml. Further increases of the 13-cis-RA dose up to 1800 mg/sq m did not lead to proportional increases in either the mean peak plasma levels or area under the curve, indicating a saturable absorption phenomenon. The terminal half-life was highly variable (range, 2.8 to 101.3 h) and was not related to the dose given. A secondary peak plasma concentration was seen in five patients, suggesting enterohepatic circulation. The toxicities such as headache, cheilitis, dry skin, and dry eyes were frequent on the weekly schedule but were not dose-limiting. One patient had an elevation of the triglycerides of 2 to 5 times the upper limit of normal; five patients had an elevation of 1.1 to 2 times normal. No objective responses were observed to treatment with 13-cis-RA. Of 20 patients receiving an adequate trial of the drug, 18 showed progression of their cancer, and two had stable disease.
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PMID:Phase I study and pharmacokinetics of weekly high-dose 13-cis-retinoic acid. 397 47

Random samples or the entire workforce in nine offices in which similar clerical work was being performed were studied using a doctor administered questionnaire that inquired into symptoms that have been linked with the "sick building syndrome." Five of the offices were fully air conditioned, one had recirculation of air and mechanical ventilation, and three were naturally ventilated. Workers in three air conditioned and three naturally ventilated buildings were interviewed blind. Seven of the buildings were studied at our request in the absence of any known problem. Comparison of prevalences of symptoms between the naturally ventilated and the other buildings showed a repeated pattern of nasal, eye, and mucous membrane symptoms with lethargy, dry skin, and headaches. There were highly significant excesses of these six symptoms in the air conditioned buildings when compared by chi 2 tests with the naturally ventilated buildings. It is suggested that these six symptoms represent the sick building syndrome and that the size of the problem is probably greater than is currently recognised. Possible causes are discussed.
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PMID:The sick building syndrome: prevalence studies. 643 23

We gave intravenous amrinone to 40 patients in heart failure, and oral amrinone to 18 patients. Acute intravenous administration caused a significant reduction in mean blood pressure and this was severe enough to require correction by plasma infusion in five patients. Oral amrinone was accompanied by thrombocytopenia in 10 patients but no complications were associated with the low platelet count. Other potentially serious adverse effects were: abdominal pain (two patients), nausea and vomiting (three patients), jaundice (one patient), myositis (one patient), pulmonary infiltrates (two patients), and polyserositis (one patient). Less serious adverse effects observed were: splenomegaly, eosinophilia, fever, headache, reduced tear secretion, dry skin, and nail discoloration. The potentially severe adverse reactions with amrinone need to be weighed carefully against its benefits in the treatment of heart failure.
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PMID:Side effects of amrinone therapy. 683 32

A 27-year-old Chinese woman with acute promyelocytic leukaemia in first relapse after the initial conventional induction chemotherapy 18 months earlier was treated with all-trans retinoic acid (ATRA) at an initial dose of 45 mg/m2 and subsequently increased to 65 mg/m2 on day 15. Complete remission was achieved after a total of 40 days of ATRA alone. Serial marrow examinations during induction showed progressive maturation of myelopoiesis without bone marrow hypoplasia. There was a significant reduction in number of cells with the t(15;17) translocation when complete remission was achieved. ATRA was very well-tolerated. The symptoms of dry skin and intermittent headache were self-limiting.
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PMID:Treatment of acute promyelocytic leukaemia in first relapse with all-trans retinoic acid. 760 89

Chemotherapy may decrease relapses of acute promyelocytic leukemia (APL) following induction with all-trans retinoic acid (ATRA), however the optimal timing of these two modalities remains to be determined. We treated eight patients with morphologic evidence of APL with intensive induction chemotherapy followed by ATRA (45 mg/m2/d for 10 weeks). All eight patients achieved a complete remission following chemotherapy. After a median follow-up of 29.0 months, seven patients remain in complete remission; one patient relapsed at 26.9 months. RT-PCR analysis for the PML/RAR alpha rearrangement was performed to monitor patients for evidence of minimal residual disease. Both of the patients with persistence of this rearrangement after induction chemotherapy converted to negative following ATRA. Toxicity of ATRA given in the post-remission setting was mild and consisted of headache, dry skin, and elevations of triglycerides and transaminases. No patient developed evidence of the retinoic acid syndrome. The administration of ATRA after intensive induction chemotherapy is associated with durable remissions and minimal toxicity in patients with APL. Disappearance of the PML/RAR alpha rearrangement after ATRA suggests that ATRA is effective against minimal residual disease.
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PMID:Pilot study of all-trans retinoic acid as post-remission therapy in patients with acute promyelocytic leukemia. 784 10

Retinoids have significant antiproliferative effect against chronic myelogenous leukemia (CML) cells in vitro. We conducted a pilot study to investigate the clinical effect of all-trans retinoic acid (ATRA) in patients with CML. Thirteen patients with Philadelphia chromosome (Ph)-positive CML in late chronic phase (n=7), accelerated phase (n=5), or blastic phase (n=1) were treated. All had been previously treated and 12 (92%) had disease refractory to interferon-alpha therapy. They received ATRA 175 mg/m2 orally in two divided doses daily until disease progression. The median duration of therapy was 56 days (range 11 to 190). Only one patient in late chronic phase had a transient decrease in WBC counts; all other patients in late chronic phase showed no response to therapy. Four of the five patients in accelerated phase showed evidence of antileukemia effect manifested by a decrease in bone marrow and/or peripheral blood blasts, promyelocyte and/or basophil percentages. In all cases the response was transient. The patient in blastic phase had no evidence of antileukemic effect. The treatment was well tolerated with the major side-effects being headache, nausea, dry skin, and dry mucosal membranes. One patient required dose reductions due to toxicity. We conclude that in this population of patients with extensively treated, advanced stage, Ph-positive CML, ATRA alone is ineffective for long-term therapy. The antileukemia effect seen in some patients warrants further investigation of retinoids in other schedules and in combinations in patients with CML.
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PMID:A pilot study of all-trans retinoic acid in patients with Philadelphia chromosome-positive chronic myelogenous leukemia. 920 70

The Radiation Therapy Oncology Group enrolled 30 patients with recurrent malignant astrocytomas onto a phase II study (RTOG 91-13). Patients were treated with all-trans-retinoic acid at a starting dose of 120 mg/m2 per day orally continuously until disease progression. Fourteen patients had glioblastoma, 14 had anaplastic astrocytoma, and 2 had other histologies; 53% were under 50 years of age. All patients had failed radiation therapy and/or at least one chemotherapy regimen. All patients had a Karnofsky performance status score of at least 70, but only 37% had a KPS of 90-100. Forty percent had a neurologic function status of grade 1 (able to work). A minimum of 4 weeks of all-trans-retinoic acid defined adequate treatment. Twenty-five patients received adequate therapy. Most common toxicities were dry skin, cheilitis, anemia, and headache; 3 patients had grade 3 headache requiring suspension of all-trans-retinoic acid. No grade 3 hematologic toxicity was observed. Of 25 adequately treated patients, 3 showed objective regression of tumor on magnetic resonance imaging and computed tomography scans, 3 patients remained stable, and 19 patients had disease progression. The median time to tumor progression was 3.8 months and the median survival time was 5.7 months. This study suggests that this dose of single agent all-trans-retinoic acid has modest clinical activity against recurrent malignant gliomas with tolerable side effects. A response rate of 12% and a stabilization rate of 12% are lower than expected. Future studies with higher dosage or in combination with biological response modifiers or chemotherapy may be warranted.
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PMID:All-trans-retinoic acid: a phase II Radiation Therapy Oncology Group study (RTOG 91-13) in patients with recurrent malignant astrocytoma. 921 68


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