Dietary supplements at high doses as part of medical therapy have been controversial, but the evidence suggests that they play a significant role in prevention and treatment of diseases as well as protection from accelerated aging that results from oxygen free-radical damage, inflammation, and glycation. This literature review examines several ...

Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing. To assess the efficacy ...

The way in which medication overuse transforms episodic migraine into chronic daily headache is unknown. To search for candidate brain areas involved in this process, we measured glucose metabolism with 18-FDG PET in 16 chronic migraineurs with analgesic overuse before and 3 weeks after medication withdrawal and compared the data ...

Few poets have written on medical topics, but one who did was William Dunbar, an eighteenth century Scots poet who wrote of his headache. His headache was severe enough to confine him to his house, and may have been migraine, but this remains uncertain. Scotland's king at that time was ...

Tension-type headache (TTH) is a very common problem that usually causes only minimal to moderate discomfort and little disability. If episodic TTH evolves to chronic TTH, then the morbidity in terms of discomfort, disability, and use of medication escalates dramatically. There are no long-term studies, but inferences can be made ...

Intracerebral hemorrhage (ICH) is a devastating form of stroke that is associated with a very high mortality rate. Both medical therapies to control blood pressure, blood sugar, temperature, and surgical therapies to remove or contain clot remain controversial. The decision when to offer medical versus surgical treatment is very challenging ...

Reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) is the most important component of treatment, as it strongly influences short- and long-term patient outcome. The main objective of healthcare providers should be to achieve at least 75% of reperfusion therapy applied to patients suffering from STEMI in a timely manner, ...

OBJECTIVE: To survey the use of complementary and alternative medical therapies by pediatric pain management services affiliated with major universities. DESIGN: A telephone survey was conducted of pediatric anesthesia training programs accredited by the Accreditation Council for Graduate Medical Education in the United States. The survey instrument included questions on ...

Atrial fibrillation, the most common cardiac arrhythmia requiring medical attention, has effects that range from mild symptoms to devastating stroke. Although treatments have evolved since the foxglove plant (later identified as containing digitalis) was first administered to slow the heart rate, satisfactory drug therapy has not been developed. In this ...

This paper focuses on the medical management of malignant gliomas, which is currently undergoing change. It suggests that as surgery and radiotherapy are of limited benefit in the treatment of these tumours, medical therapies may have the potential to offer a better alternative. The current therapies for glioma and the ...

The investigation of medical options for the treatment of Peyronie's disease is lacking controlled clinical trials with uniform standardized assessments and objective measures of deformity, including curvature and circumference. A key to defining the beneficial effects of various medical therapies lies in standardizing the evaluation of the Peyronie's patient across ...

Pityriasis rubra pilaris (PRP) is a rare papulosquamous condition with an estimated incidence of one in 35,000 to one in 50,000. Psoralen and ultraviolet A (UVA) therapy has been used in its treatment but some patients are reported to be clinically photosensitive. We describe the photoinvestigation of a patient with ...

Botulinum toxin is regarded as the most lethal substance known. It is estimated that the human LD50 for inhalation botulism is 1 to 3 nanograms of toxin/kilogram body mass. Although only three cases of inhalational botulism have been described, an understanding of the pathophysiology of food-borne outbreaks, wound botulism, and ...

BACKGROUND: Approximately 4% of adults experience headaches nearly every day. Nonpharmacologic interventions for frequent headaches may be appropriate because medical management alone is often ineffective. OBJECTIVE: To assess the efficacy of acupuncture as an adjunct to medical management for chronic daily headache (CDH). METHODS: We conducted a randomized, controlled trial ...

Management of patients with gastroparesis is challenging. Although the syndrome has multiple causes and knowledge of the pathophysiology and natural history is far from complete, a number of common management principles can be applied. The relatively poor correlation between upper-gastrointestinal symptoms and disordered gastric emptying represents a major difficulty in ...

Recent progress in the therapy of GH-secreting pituitary tumors includes three treatment modalities: surgery, radiotherapy, and medications. A combination of treatment options is often required to attain therapeutic goals, increasing the potential for a combination of unwanted side effects. The focus of this review is to discuss medical therapy of ...

Extensive resection of the intestinal tract with resulting malabsorption is known as short bowel syndrome (SBS). Adaptation and rehabilitation of the remaining small bowel occurs spontaneously after resection and can be enhanced by diet, medications, and use of intestinal trophic factors such as recombinant human growth hormone (r-hGH). Many trials ...

We tested the computerised, structured medical record by entering and analysing the consecutive clinical sheets of primary headaches in the episodic forms (200) and chronic headache (200) and the corresponding output diagnoses of patients attending our Headache Centre. A diagnosis of one of the primary headache forms was obtained in ...

It has been established that mucus hypersecretion and decreased mucus clearance contribute to the morbidity of chronic obstructive pulmonary disease (COPD). Indeed, the classic definition of chronic bronchitis relies on determining the frequency and duration of sputum expectoration. Despite the well recognized importance of this symptom, there are few therapies ...

The majority of patients consulting a doctor for headache are generally suffering from a primary headache. Nevertheless, the possibility of it being symptomatic, and sometimes life threatening, must always be in the forefront of the doctor's mind. Medical history and clinical examination first, and instrumental examinations afterwards, are the keys ...

Genetic factors are involved in the regulation of body weight and in determining individual responses to environmental factors such as diet and exercise. The identification and characterization of monogenic obesity syndromes have led to an improved understanding of the precise nature of the inherited component of severe obesity and has ...

Medication overuse headache (MOH) is a clinically important entity and it is now well documented that the regular use of acute symptomatic medication by people with migraine or tensiontype headache increases the risk of aggravation of the primary headache. MOH is one of the most common causes of chronic migraine-like ...

BACKGROUND: Migraine is a genetically determined recurrent pain syndrome accompanied by neurological and gastrointestinal features, involving interaction of external triggers and internal pathophysiology and the cause of considerable disability to sufferers. OBJECTIVE: This article discusses the pathophysiology and diagnosis of migraine and outlines a patient centred approach to management. DISCUSSION: ...

PURPOSE: To describe and discuss short headache questionnaires, which can simplify and improve the diagnosis of migraine. DATA SOURCES: Review of the worldwide scientific literature on short diagnostic questionnaires for migraine. CONCLUSIONS: A new three-question Headache Screen addressing disability due to recurring headaches, headache duration, and changes in headache characteristics ...

Chronic cluster headache remains refractory to medical therapy in at least 30% of those who suffer from this condition. The lack of alternative medical therapies that are as effective as, or more effective than, lithium carbonate makes new therapies necessary for this highly disabling condition. Based on a previous report, ...

BACKGROUND: Pathological gambling is a rare potential complication related to treatment of Parkinson disease (PD). However, the etiology of this behavior is poorly understood. OBJECTIVE: To examine the relationship between medical therapy for PD and pathological gambling. METHODS: In our routine movement disorders practice (2002-2004), we encountered 11 patients with ...

To examine the influence of age and comorbidity on intensification of medical therapy for patients with poorly controlled diabetes mellitus (DM). Observational cohort study using data from Department of Veterans Affairs (VA) national databases. Thirteen VA medical centers in New England, Florida, and Puerto Rico. Participants: Veterans (N=5,317) with poorly ...

Sinus headache is a widely accepted clinical diagnosis, although many medical specialists consider it an uncommon cause of recurrent headaches. The inappropriate diagnosis of sinus headache can lead to unnecessary diagnostic studies, surgical interventions, and medical treatments. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck ...

Cluster headache is a well-known primary headache syndrome with a prevalence of about 5/10,000 of the adult population, making it much less common than migraine. Diagnostic terms such as histaminic cephalalgia, Horton's headache and ciliary neuralgia have been used for what is now known as cluster headache. This disorder can ...

Clinical integration of complementary and alternative medical (CAM) therapies, such as acupuncture and traditional oriental medicine, chiropractic, herbal medicine, massage therapy, and "mind-body" therapies, into conventional health care raises important legal and risk management issues. Understanding which CAM therapies patients use is legally prudent, as conventional treatment advice may interact ...

The effects of botulinum toxin have been demonstrated in pain syndromes such as migraine, tension headache, and postherpetic neuralgia. With this background data in hand, the authors planned a randomized, open-ended study to investigate the efficacy of botulinum injections in cases of refractory trigeminal neuralgia. In 8 patients with trigeminal ...

The aim of this study was to assess the proportion of subjects with transformed migraine (TM) who have 15 or more migraine days per month as a function of duration of chronic daily headache (CDH) in an adolescent sample. CDH is a syndrome characterized by 15 or more headache days ...

OBJECTIVE: To determine the status of headache education in American medical schools and Neurology Residency Training Programs. METHODS: One hundred and thirty-three programs were identified using the Association of University Professors of Neurology listing. Two hundred and seventeen surveys were mailed to departmental chairs (DC) and residency training directors (RTD) ...

BACKGROUND: Many studies suggest a major prevalence of atherosclerotic renovascular disease (ARVD), caused by mono or bilateral renal artery stenosis (RAS). Unfortunately, there is no definite therapy to cure this disease to date; therefore, ARVD is burdened by important clinical complications with high social and economic costs. The last few ...

OBJECTIVE: To explore the extent of headache education received by medical students and residents. BACKGROUND: Headache is a common, often severe, and sometimes disabling problem. However, 49% of sufferers do not seek professional treatment-of those who do, only 28% are very satisfied. One possible reason is limited education of physicians ...

INTRODUCTION: Nearly two-thirds of adults in the United States and an increasing percentage of the population worldwide are overweight or obese. The relationship of obesity to headache has received inadequate attention. We evaluated the incidence of headache in a sample of morbidly obese women. METHODS: Morbidly obese women, attending the ...

AIM: To assess the efficacy and safety of benzbromarone in patients with renal impairment and severe tophaceous gout (despite receiving optimal conventional therapy). METHODS: Six patients with refractory gout (despite optimal therapy) were treated with benzbromarone. Uric acid levels and number of gout attacks were recorded monthly. Adverse events to ...

Gabapentin is an antiepileptic medication that also has been used for restless legs syndrome. The mechanism of action is unknown. The most commonly reported adverse effects of this medication include somnolence, dizziness, ataxia, fatigue, nystagmus, and tremor. Myalgia has been reported in 2% of gabapentin users compared with 1.9% of ...

The onset of illness and/or disability in children may also create difficulties at psychosocial levels--for the child, the family, her network and even in relations between them and the medical team. Medical family therapy, coupled with salutogenic theory and Marte meo offers specific ways of working with such difficulties so ...

Topiramate infrequently induces anion gap metabolic acidosis through carbonic anhydrase inhibition on the distal tubule of the nephron--a type 2 renal tubular acidosis. We report on a 40 years old woman previously healthy that developed significant asymptomatic metabolic acidosis during topiramate therapy at a dosage of 100 mg/day for three ...

Chronic migraine is a recognized complication of episodic migraine. A high frequency of attacks and frequent use of abortive medications are important risk factors associated with conversion to a chronic condition. Prophylaxis is therefore recommended for patients with frequent episodic migraine. The agents approved for migraine prophylaxis are the anti-epileptic ...

Cluster headache is marked by its circadian rhythmicity and the hypothalamus appears to have a significant influence over cluster pathogenesis. However, as not all cluster patients present in the same manner and not all respond to the same combination of medications, there is likely a nonhypothalamic form of cluster headache. ...

A 17-year-old boy without a significant past medical history presented with recurrent cluster-like headaches induced by meals for 3 years. Magnetic resonance images showed a pituitary tumor. Just after starting treatment with cabergoline, the headaches resolved completely and the patient has been absolutely free from such headache attacks for 2 ...

We report a case of a 64-year-old man with secondary adrenocortical insufficiency who has been on a chronic transdermal fentanyl treatment because of sciatic pain syndrome. Shortly before admission to our hospital, the patient had discontinued his hydrocortisone medication. Adrenal crisis was assumed and during therapy with hydrocortisone infusion, the ...

With phosphodiesterase inhibitors, a safe and effective oral therapy has emerged for erectile dysfunction. Increasing awareness, particularly through the media, is inducing more men to seek help for this condition. Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection adequate for satisfactory sexual activity. The ...

PURPOSE OF REVIEW: This review examines progress being made in the treatment of cocaine abuse and dependence, with a particular focus on pharmacotherapies. Medications with apparently very different mechanisms of action have been reported to reduce cocaine use in controlled clinical trials in outpatient settings. This review will summarize the ...

OBJECTIVES: To compare the second edition of the International Classification of Headache Disorders (ICHD-2) and the Silberstein-Lipton (S-L) criteria in the classification of adolescents with chronic daily headache (CDH). METHODS: We reviewed the clinical records and the headache diaries of 170 adolescents (13 to 17 years) seen between 1998 and ...

Medical therapy plays an important role in the management of patients with acromegaly and is commonly used adjunctively after surgical resection of the pituitary tumor. Generally, surgery alone provides a 50 to 70% rate of cure; however, the outcome depends on the experience and ability of the surgeon and the ...

Excessive bleeding or thrombosis is a preeminent concern for all surgeons. Patients may be at risk because of medical therapy, underlying disease, or complications related to both. An understanding of the coagulation cascade--mechanisms and tests of function--permits a rational, if not always complete, basis for a plan of therapy. Newer ...

We set out to review early descriptions of chronic migraine and medication-overuse headache. The International Headache Society (IHS) recently gave criteria for chronic migraine and medication-overuse headache. Chronic migraine was absent from the 1988 IHS criteria. Peters and Horton described ergotamine-overuse headache in 1951. In the 1980s it was more ...