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

Influenza infection is a significant cause of morbidity and mortality in immunocompromised hosts, but its importance in adult cancer patients is largely undescribed. We therefore conducted a prospective study of the incidence and clinical features of influenza infection in patients with acute or chronic leukemia. The cohort, which consisted of all adult leukemia patients undergoing remission-induction chemotherapy during the 1991-1992 influenza epidemic, was followed prospectively for development of signs and symptoms of acute infection of the upper or lower respiratory tract. Of these 294 patients, 111 received chemotherapy as inpatients and 183 as outpatients. Throat swabs and nasal washes for viral culture were obtained from all symptomatic patients, who were then followed until all signs and symptoms resolved. Symptoms of respiratory tract infection developed in 37 leukemia patients (13%). Among these, influenza (A/Beijing/ H3N2) caused 3 (21%) of the 14 infections that developed during hospitalization but only 1 (4%) of the 23 that developed in the community (P = 0.14). Influenza patients presented with fever, rhinorrhea, nasal congestion, headache, and myalgia; those with other infections presented with signs and symptoms of lower respiratory tract infection (productive cough, rales, or rhonchi). Development of pneumonia was common in influenza patients, 1 of whom died from secondary fungal and gram-negative pneumonia. Influenza A virus infections accounted for a substantial portion of acute respiratory infections among adult leukemia patients during a community epidemic. Most infections appeared to be nosocomial and the most likely sources were visitors or hospital personnel. Immunization of household contacts and hospital staff may reduce the risk of influenza infection and its pulmonary complications in leukemia patients.
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PMID:Epidemiology of influenza A virus infection in patients with acute or chronic leukemia. 765 81

We attempted to evaluate postoperative mucosal changes and symptomatic improvement in 99 patients who underwent functional endoscopic sinus surgery from September 1991 through August 1992. The patients were divided into 2-, 4-, 6-, and 12-month postoperative groups. Thickness of the maxillary sinus mucosa measured at the midpoint of the lateral sinus wall on a follow-up ostiomeatal unit computed tomogram (OMU CT) was compared with that of preoperative OMU CT. Postoperative endoscopic findings of the maxillary sinus and changes in presenting symptoms such as rhinorrhea, nasal obstruction, facial pain, headache, anosmia, epiphora, and referred otalgia were analyzed. Improvement in the diseased mucosa of the maxillary sinus, as evaluated on OMU CT, was observed in 69.7% of the patients, and such mucosal changes did not differ significantly among 2-, 4-, 6-, and 12-month follow-up groups. However, apparent mucosal changes exceeding marginal improvement was observed in 32.3% of the patients. The overall symptomatic improvement rate was 57.9% and improvement in endoscopic findings was observed in 46.3% of the patients. Although there was some discrepancy between radiologic and symptomatic improvement rates, symptomatic improvement was significantly related with radiologic improvement. It is suggested that removal of obstructive lesion in the ostiomeatal area might be beneficial in a seemingly early symptomatic improvement, but complete healing of the maxillary sinus mucosa as assessed by OMU CT might take longer than 12 months.
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PMID:Radiologic assessment of diseased mucosa of the maxillary sinus after functional endoscopic sinus surgery. 787 25

A prospective, comparative, random study was conducted with 40 patients treated with ebastine vs. terfenadine. The purpose of the study was to evaluate the efficacy of both as second generation antihistamines used in the treatment of allergic rhinitis. Ten milligrams of ebastine was administered once a day before breakfast (fasting), in 5 and 10 year old children and 20 mg in 11 to 15 year olds. Ebastine was more efficient in the control of symptoms (rhinorrhea, nasal obstruction, sneezing, eye and nose itching) than terfenadine from the seventh day on, (p 0.05). Tolerance to ebastine was good, although a small number of patients (1.5%) suffered collateral symptoms: sleepiness, headaches and nausea. The two doses of ebastine (10 or 20 mg depending on the patients age) had overall efficacy rates better than terfenadine (p 0.05%).
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PMID:[Ebastine vs terfenadine in allergic rhinitis]. 790 44

A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography.
Cephalalgia 1994 Aug
PMID:Vascular malformation of the cerebellopontine angle associated with "SUNCT" syndrome. 795 61

To demonstrate the typical clinical and CT features of sinonasal polyposis, we reviewed the clinical records and preoperative direct coronal CT scans of 35 patients with surgically proven disease. Symptoms included progressive nasal stuffiness (100%), rhinorrhea (69%), facial pain (60%), headache (43%) and anosmia (17%). We found associations with rhinitis (46%), asthma (29%) and aspirin sensitivity (9%). Coronal CT features included polypoid masses in the nasal cavity (91%), partial or complete pansinus opacification (90%), enlargement of infundibula (89%), bony attenuation of the ethmoid trabeculae (63%) and nasal septum (37%), opacified ethmoid sinuses with convex lateral walls (51%) and air-fluid levels (43%). The latter feature correlated with symptoms and signs of acute sinusitis in only 40% of patients. Recognition of sinonasal polyposis is important to the endoscopic surgeon since it can be the most troubling sinonasal inflammatory disease to manage due to its aggressive nature and tendency to recur despite appropriate treatment.
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PMID:Sinonasal polyposis: investigation by direct coronal CT. 799 Oct 94

Two female patients suffering from SUNCT syndrome are presented. They are the first female SUNCT cases reported (of a total of 16 cases hitherto seen by us, reported to us, or published). Also some minor modifications of the hitherto known clinical symptomatology of SUNCT syndrome have been observed. Attacks could be triggered in a variety of ways. A short latency between the application of a precipitating stimulus and the onset of pain was noted. An occasional inability of a given precipitating maneuver to activate the pain was also noted. The temporal pattern of pain was partly characterized by the typical, "plateau-like" pattern, but with ultrashort exacerbations. In part, the pain attacks were characterized by steeple or spike-like pain waves, that did not quite subside to the baseline ("repetitive pattern"). Autonomic signs such as lacrimation and conjunctival injection were rather marked, as is generally the case in SUNCT syndrome. Rhinorrhea was present in both patients, and in one patient the rhinorrhea was unusually marked. Carbamazepine treatment seemingly brought about a slight decrease in the frequency of attacks.
Headache 1994 Apr
PMID:SUNCT syndrome in the female. 801 38

We present a systematic review of meningitis associated with transsphenoidal surgery. Patients present within the first 4 days after surgery with symptoms of headache, fever, and confusion. Overt cerebrospinal rhinorrhea or nuchal rigidity at the time of presentation is an infrequent finding. Although postoperative aseptic meningitis may be difficult to distinguish from early bacterial meningitis, the findings of hypoglycorrhachia, pleocytosis, and hyperproteinemia in the setting of fever and neurological deficit strongly suggest bacterial infection. The preponderance of cases of gram-negative meningitis observed in this series and in previous reports related to posttraumatic CSF leaks indicates that empirical regimens should include agents suitable for treating infections caused by nosocomial pathogens. In general, patients with uncomplicated meningitis in this setting can be expected to recover and do well. Questions remain as to the role of prophylactic antibiotics in the development of gram-negative meningitis in the setting of transsphenoidal surgery. A multicenter trial might be better able to define this role.
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PMID:Gram-negative meningitis associated with transsphenoidal surgery: case reports and review. 803 9

Sinusitis is usually a mild illness in children, but intracranial complications can be life-threatening. We retrospectively reviewed nine cases of intracranial infections secondary to paranasal sinusitis that occurred over a 12-year period, excluding patients with orbital infection only. Cases were highly age- and sex-associated: the median age was 14 years, 89% of patients were > 9 years of age, and seven (78%) of the nine patients were male. Symptoms included fever (67%), headache (67%), eye swelling (56%), and seizure (33%). Rhinorrhea was uncommon (22%). Only two patients (22%) had had previous episodes of sinusitis. Staphylococcus aureus and anaerobes were the predominant intracranial isolates. Computed tomography scans of the head showed progression of disease in patients treated with antibiotics alone; surgical drainage was required for all patients. The duration of therapy after surgery was 3-8 weeks. Only one patient (11%) had persistent neurological sequelae. We conclude that (1) teenage males are at greatest risk of developing intracranial infections from sinusitis, (2) common symptoms of sinusitis such as rhinorrhea may not always occur, and (3) outcome can be excellent when a combined medical/surgical approach is used for therapy.
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PMID:Infectious intracranial complications of sinusitis, other than meningitis, in children: 12-year review. 807 64

An empty sella is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid (CSF). Empty sella is occasionally found as a normal anatomical variation, which is referred to as primary empty sella. On the other hand, empty sella is also seen after surgery, irradiation or medical treatment of pituitary adenoma, which is called secondary empty sella. Magnetic resonance imaging (MRI) is useful in diagnosing empty sella. Primary empty sella is usually free from clinical symptoms but sometimes associated with headache, obesity, visual disturbance, non-traumatic CSF rhinorrhea and pituitary insufficiency. These associated findings constitute the empty sella syndrome. CSF rhinorrhea, visual disturbance and severe increased intracranial pressure are the indications for surgical treatment. Non-symptomatic cases require no treatment but periodical follow up is necessary.
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PMID:[Empty sella syndrome]. 825 48

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (> or = 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 to 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing, nasal congestion, postnasal drip, coughing, wheezing, rhinorrhea, and headache, no single symptom was an acceptable predictor of abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95% and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic sinusitis among pediatric patients with chronic respiratory complaints. 825 16


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