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

Equal volumes (2.5 ml, 12.5 mg) of plain 0.5% bupivacaine (glucose-free) and hyperbaric 0.5% bupivacaine (in 8% glucose) were compared in a randomized double-blind study of 40 patients undergoing Caesarean section under subarachnoid anaesthesia. There were no differences in the rate of onset, maximum spread, number of patients with high cervical levels, duration of anaesthesia or incidence of post-spinal headaches between the two solutions. The median maximum cephalad levels of analgesia were (hyperbaric) T1 (range C1-T4), and (plain) T2 (range C1-T4). Thirteen patients in the hyperbaric group and 10 in the isobaric group required i.v. ephedrine to treat hypotension. Nine patients (23%) developed a post-spinal headache, and three were treated with an extradural blood patch.
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PMID:Subarachnoid analgesia for caesarean section. A double-blind comparison of plain and hyperbaric 0.5% bupivacaine. 354 93

The effect of food on the bioavailability of nifedipine (Procardia), 10 mg capsules, was studied. Each of 15 male volunteers received a single oral 10 mg dose with 120 ml water under three conditions: fasting, after a low-fat (high-carbohydrate) meal, and after a high-fat meal. An open, three-way Latin-square design was employed with a 4-day washout period between administrations. Serial blood samples were collected just before the dose (0 hour) and from 0 to 8 hours after administration. Nifedipine assays were performed by GLC/electron capture detection. Diet did not appreciably alter the AUC from 0 to 8 hours, the AUC from 0 to infinity, or the elimination half-life. The time to peak (tmax) and peak concentrations (Cmax) were significantly altered by food. The mean Cmax values for fasting, low-fat, and high-fat meals were 78.9, 42.2, and 58.7 ng/ml, respectively. The mean tmax values for these three conditions were 0.97, 1.89, and 1.07 hours, respectively. The results indicate that food, in particular a low-fat (high-carbohydrate) meal, slows the rate but does not alter the extent of nifedipine absorption. Insofar as certain side effects (e.g., flushing and headache) may be related to the high peak plasma levels associated with rapid absorption, administration with meals might serve to reduce the incidence of such effects. Clinical trials would be necessary to confirm this possibility. For the majority of patients on routine maintenance therapeutic regimens, nifedipine capsules may be administered without regard to food intake.
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PMID:Effect of food on nifedipine pharmacokinetics. 359 68

Twenty cases of cryptococcal CNS infection treated at the Alfred and Fairfield Infectious Diseases Hospitals from 1975 to 1985 were reviewed. A predisposing immunological deficit was present in 40% of the cases and nearly half had evidence of pulmonary involvement. Severe headache was an almost universal presenting feature but fever and meningismus were not. Measurement of CSF cryptococcal antigen and CSF culture were far more reliable diagnostic markers than Indian ink smears. Cerebral CT scanning identified abnormalities in nearly 30% of cases, including 2 with cystic lesions and 2 with mass lesions. Combination therapy with amphotericin B and 5-fluorocytosine was used as first line treatment. Ventricular shunts were required for 2 patients with hydrocephalus, and persistently raised intracranial pressure often required frequent lumbar punctures and corticosteroids for control. Mortality was 30% and correlated with the presence of impaired conscious state, hydrocephalus or other neurological deficit, underlying immunodeficiency and low CSF glucose levels.
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PMID:Cryptococcal infections of the central nervous system: a ten year experience. 366 61

A very rare case of peptostreptococcal meningitis associated with subarachnoid hemorrhage and subdural hematoma was reported. A 25-year-old man was admitted to St. Mary's Hospital on November 6, 1984 with a few day's history of headache and low grade fever. On admission, he had high grade fever (39.2 degrees C) and tachycardia (110/min). There were no neurological deficits other than neck stiffness and Kernig's sign. The cerebrospinal fluid (CSF) which was obtained through lumbar puncture showed watery clear appearance, white cell count of 32/3 mm3 (mononuclear: polymorphonuclear = 4:5), protein 76 mg/dl and glucose 8 mg/dl. It was found to be sterile. However, peptostreptococcus was found in his peripheral blood culture. He was diagnosed peptostreptococcal meningitis. After administration of antibiotics, laboratory test result of CSF improved gradually so as his meningeal irritation signs. After 25 days of hospitalization, he developed suddenly severe headache. CSF showed bloody and xanthochromic appearance, and CT scan revealed a subdural hematoma in the left fronto-temporal convexity. Although we suspected formation of mycotic aneurysm caused by the meningitis and its rupture, cerebral angiography revealed no abnormality except for the findings of subdural hematoma. The subdural hematoma was completely absorbed and he was discharged 79 days after admission without having any neurological deficit. We concluded that such a mycotic aneurysm was too small to be detected by the cerebral angiography.
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PMID:[A case of peptostreptococcal meningitis associated with subarachnoid hemorrhage and subdural hematoma]. 374 8

A patient with intrapericardial pheochromocytoma is presented and the literature on this subject is reviewed. The patient was a 45-year-old housewife who was first referred to Keio University hospital in February 1981 for a 6-year-history of headaches, palpitations and excessive sweating. An episode of hypertensive crisis was observed during surgery for myoma uteri 3 months before her admission. On physical examination, the patient was a normal-appearing, pleasant woman. Supine blood pressure was 130/80 mmHg and standing blood pressure was 124/72 mmHg. Results of routine laboratory studies (including fasting serum glucose and calcium determinations and thyroid function tests) were normal. A 24-hour-urine collection showed VMA level of 10.5 mg and noradrenaline of 809 micrograms. Also repeated measurements of plasma noradrenaline on supine position revealed averages of 2.45 ng/ml. These high levels of catecholamines, clinical manifestations, and provocative tests including a metoclopramide test were strongly suggestive of pheochromocytoma, and further studies for determination of the localization were performed. Results of computed tomography (CT), adrenal scintigraphy using 131I-adosterol and selective venous sampling for catecholamines were equivocal. Then she was followed in an outpatient clinic and treated with alpha- and beta-blocker. In October 1985, she was readmitted to our hospital because of paroxysms which had gradually increased in frequency and severity. Extensive venous sampling in order to determine the localization of the tumor was performed after demonstration of an increased uptake area in the anterior thorax in 131I-metaiodobenzylguanidine scintigraphy. Further, an anterior mediastinal mass was identified in the CT scan of the chest with contrast material. Finally, a thoracic angiogram revealed that the tumor was highly vascular and was fed by the branch of the left internal mammary artery. In January 1986, the patient underwent middle sternotomy with cardiopulmonary bypass. A 4.5 by 3.5 by 3.0 cm soft, dark brown tumor was found on the anterior surface of the heart and excised without difficulty. The tumor seemed to arise from the root of the aorta and main pulmonary artery, and extended inferiorly over the anterior surface of the right ventricle. It was also fed by branches of the right coronary artery. Histologically, the resected tumor was compatible with pheochromocytoma. The tumor content of noradrenaline was 3.34 mg/g wet tissue; however, adrenaline and dopamine were not detected. The postoperative course was uneventful.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Intrapericardial pheochromocytoma: a case report and review of the literature]. 380 33

Lumbar puncture has been in widespread clinical use for nearly a century. It is used in emergency medicine primarily as a tool for the diagnosis of meningoencephalitis and subarachnoid hemorrhage. The development of computed tomography has changed the position that lumbar puncture has held in the diagnostic sequence of a number of clinical entities. The procedure is contraindicated if there is soft-tissue infection adjacent to the puncture site and if there are findings of increased intracranial pressure due to a mass lesion. Performance in the setting of a coagulopathy may also be hazardous. The most serious potential complication is cerebral herniation. The commonest complication is postlumbar puncture headache, which is due to CSF hypotension resulting from persistent spinal fluid leakage through the meningeal puncture site. Spinal hematoma, diplopia, and intraspinal dermoid tumor formation are less common complications. Meningitis has been found to follow lumbar puncture in children with bacteremia. The lumbar puncture is a useful test for providing information regarding the cellular, chemical, and microbiologic composition of the CSF. Fluid obtained should be evaluated for cell count, Gram's stain, bacterial culture, glucose and protein levels, and other tests as clinically indicated.
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PMID:Lumbar puncture. 383 22

Thiazide therapy is a widely used first line treatment for arterial hypertension. Its useful value, particularly in mild or moderate hypertension, is sometimes reduced by metabolic side-effects, as hypokalaemia and hyperuricaemia. In the present study the antihypertensive efficacy of a new, non-sulphonamide diuretic Bay g 2821 (muzolimine) was evaluated in comparison with the combination of hydrochlorothiazide-amiloride over a period of 4 weeks. A highly significant decrease in systolic and diastolic blood pressures was produced by both treatments. No decrease in serum potassium nor an increase in cholesterol, triglycerides, uric acid or glucose was detected during the 4 week treatment period. Subjective side-effects, such as headache and dizziness, were very rarely observed during Bay g 2821 treatment. The new diuretic appears, therefore, to be effective in the treatment of arterial hypertension without untoward side-effects.
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PMID:Cross-over study of muzolimine and hydrochlorothiazide-amiloride in hypertensive patients. 400 27

The effect of 30-days of flunarizine (5 mg/day) therapy on pituitary, B-pancreatic, gonadic and adrenal function was studied in five adolescents with common migraine. Baseline concentration of growth hormone was significantly reduced after flunarizine therapy. The response of prolactin to thyrotrophin-releasing hormone was significantly increased after flunarizine therapy. The percentages of HbA1 and HbA1c were significantly higher after flunarizine therapy. The drug had no apparent effect on gonadic and adrenal function. Further studies are needed to confirm the effect of flunarizine on the hypothalamus-pituitary axis and glucose tolerance.
Cephalalgia 1985 May
PMID:Hormonal and metabolic changes induced by flunarizine therapy: preliminary results. 401 33

A review of the literature on primary diffuse meningeal gliomatosis (DMG) yielded three cases and we report a fourth. DMG is a syndrome characterized by extensive basal and spinal chronic meningitis with mental confusion, headaches, diplopia, papilledema and cranial nerve palsies. The cerebrospinal fluid (CSF) has a markedly elevated protein content, moderate mononuclear pleocytosis and a normal or low glucose. This picture invariably leads to the diagnosis and treatment of tuberculous or fungal meningitis despite persistently negative cerebrospinal fluid (CSF) cultures. Reaction of exfoliated CSF cells with glial fibrillary acidic protein (GFAP) immunoperoxidase labelled antibody is suggested as a diagnostic tool. A basal meningeal biopsy appears to be the only alternative diagnostic approach.
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PMID:Primary diffuse leptomeningeal gliomatosis. 405 90

The use of intraamniotic injection of hypertonic solutions for termination of pregnancy during the second trimester has been generally adopted. Because of side effects in such treatment with other agents, it was decided to use intraamniotic instillation of urea solution (Urevert) to induce midtrimester therapeutic abortion in 38 patients. The method was successful in 35 patients (92%) with a mean injection/abortion interval of 26.1 hours, shorter than that with the use of hypertonic saline or hypertonic glucose solutions. The side effects of headache, nausea, and vomiting were mild, and an endometritis in 1 patient responded well to antibiotic treatment. Intravenous oxytocin drip was necessary in patients with hypotonic contractions or in those who failed to react within 36 hours after injection. In 3 cases of missed labor, the urea solution injected induced labor within 5-8 hours, with no side effects. The mean in-patient hospital time was 4.3 days.
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PMID:Termination of midtrimester pregnancy by intramniotic injection of urea. 482 62


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