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Biomedical subjects

G Nappi

Publications and source records attributed to G Nappi.

At least 127 records · Page 7Linked to original sources
PubMed1998

Long-term outcome of migraine.

Migraine prevalence increases from childhood up until 40 years of age, and thereafter declines. Several hypotheses can be advanced to explain the decrease in migraine with advancing age: (i) favorable effect of preventive treatments; (ii) increased mortality in migraineurs (due to higher vulnerability to other fatal diseases); (iii) cohort effect (increased incidence in young subjects); (iv) spontaneous remission. The first two theses are poorly supported by data in the literature. Although a cohort effect may exist, a spontaneous remission of migraine in middle and old age (at least partially due to the loss of sex hormone changes after the menopause in females) is the more likely hypothesis. In a small subgroup of patients (most of them drug abusers), migraine has a "malignant" course and changes into chronic daily headache. The risk factors for a poor outcome of migraine have been little studied. In a case-control study, we found that a history of head trauma and a long duration of contraceptive intake were risk factors for a bad outcome, whilst a long duration of prophylactic treatments had a protective effect.

Age Distribution↗
PubMed1998

Psychiatric comorbidity in chronic daily headache.

Clinical evidence suggests that chronic daily headache (CDH) occurs in association with psychopathologies: previous studies have focused particularly on migraine. To evaluate this association, we studied, using the DSM-IIIR criteria, a population of 88 patients (18M, 70F) affected by CDH (mean duration 7.4 +/- 8.7 years). We documented the presence of a psychiatric disorder in 90% of this population. The most frequent diagnosis was a comorbidity of anxiety and mood disorders. The comorbidity of psychiatric disorders and headache has important implications as far as treatment is concerned.

Adult↗
PubMed1998

Headache as a major public health problem: current status.

Headache is one of the most prevalent neurological disorders diagnosed by practising neurologists. It is a public health problem of major concern in all countries, and it represents a drain on a country's productivity, its health systems, society, individuals, and families. The economic costs involved (direct and indirect) and the psychosocial and human costs are enormous burdens on society in general. While health status assessments that rely on traditional morbidity and mortality rates are of limited use in the evaluation of headache patients, it is important to create awareness and acceptance of these disorders that cause so much personal suffering and enormous public expense.

Cost of Illness↗
PubMed1998

Headache coding and diagnostic-related groups: a survey of one year's admissions to a neurological department.

In 1995, the introduction of Diagnostic Related Groups (DRGs) within the Italian National Health Service (NHS) significantly changed the mode of payment for hospital admissions. The ICD-IX system is the fundamental instrument by which to identify various clinical entities; however, its codes still refer to an old international classification of diseases. Headache disorders are now diagnosed according to the new classification of the International Headache Society, and their recognition using ICD-IX codes appears to be increasingly inadequate. We evaluated 1-year admissions for "headache" in our Department of Neurology according to the new DRG system, and paid particular attention to the problems related to compilation of the patient discharge schedule. The most common mistakes affecting the definition of DRGs and the admission costs for the NHS were also examined.

Data Collection↗
PubMed1998

Business management of headache centers.

Economic evaluation of the costs and benefits of a headache center or unit has become very important for headache specialists. Many of the problems concerning this "financial" approach to headache derive from the model of organization of the Headache Unit, which is dependent on the various approaches to healthcare practiced in the country considered. So far there are two models of headache center that are generally considered: the hospital-based center and the independent center. An argument favoring hospital-based headache clinics is the lower costs, primarily because of their functional connection with the services of a general hospital, i.e., neuroradiology, neurophysiology, routine laboratory analysis, etc. Another is that the headache specialist has the possibility to visit the patients presenting to the emergency room in the acute phase of headache. Independent clinics have greater costs, but are equally as effective as hospital-based models.

Ambulatory Care Facilities↗
PubMed1998

Effectiveness of ibuprofen-arginine in the treatment of acute migraine attacks.

The purpose of this study was to evaluate the effectiveness of a new formulation of ibuprofen (ibuprofen-arginine [IA]) in the treatment of migraine attacks. This is a faster absorbed formulation as compared with ibuprofen alone. The rapidity of action is considered to be a crucial factor in the treatment of migraine attacks. Forty migraine patients participated in this multicenter, double-blind, crossover, randomized, placebo-controlled trial. Each patient was treated with a single oral dose of IA 400 mg or placebo during two consecutive migraine attacks. The results confirm the efficacy of IA, with a significant (p < 0.05) improvement in pain relief at 30 min after treatment. A statistically significant (p < 0.001) reduction in pain intensity was observed at 1, 2, 4 and 6 h after treatment with ibuprofen as compared with placebo. IA was well tolerated and our data indicate that this new formulation of ibuprofen is valuable in the treatment of acute migraine attacks.

Acute Disease↗
PubMed1997

Simultaneous determination of L-dopa and 3-O-methyldopa in human platelets and plasma using high-performance liquid chromatography with electrochemical detection.

Various high-performance liquid chromatographic (HPLC) methods for the determination of plasma levels of L-dopa and of its metabolite, 3-O-methyldopa (3-OMD), have been previously described. In this study, we report a modification of these methods, that enables the assay of these two compounds in platelets and plasma obtained from the same sample of whole blood. Reversed-phase (RP) HPLC with electrochemical (coulometric) detection was used. The within-run and between-run coefficients of variations, for the two compounds, were less than 10%, in both platelets and plasma; the detection limits for platelet levels of L-dopa and 3-OMD were 2 and 6 ng/10(9) platelets, respectively. In plasma, the detection limits for L-dopa and 3-OMD were 1 and 3 ng/ml, respectively. The method is rapid and simple. When applied to a population of patients with Parkinson's disease under treatment with L-dopa, this method revealed detectable levels of L-dopa and 3-OMD in the platelets of all patients. The application of this technique may provide new insights into the pharmacokinetics of L-dopa in patients with Parkinson's disease.

Adult↗
PubMed1997

Opposite effects of L-arginine and nitroglycerin on cerebral blood velocity: nitric oxide precursors and cerebral blood velocity.

Nitric oxide (NO), a gaseous molecule synthesized in the arteriolar endothelium from the amino acid L-arginine (L-arg), has been identified as the previously described Endothelium-Derived Relaxing Factor (EDRF): nitroderivatives such as nitroglycerin are known to induce vasodilation via NO release. The aim of this study was to evaluate by Transcranial Doppler (TCD) monitoring any changes in cerebral hemodynamics induced by both the infusion of L-arg and the sublingual administration of nitroglycerin in 20 healthy subjects. L-arg infusion induced a significant increase in blood velocity compared to the baseline value (mean +/- S.D. percent change = 18 +/- 8.71; p<0.0001 ) and a slight but significant decrease in Pulsatility Index. By contrast, nitroglycerin was able to cause a significant decrease in blood velocity (mean +/- S.D. percent change = 24.8 +/- 7.68; p<0.0001), while leaving Pulsatility Index unchanged. These data suggest that L-arg and nitroglycerin, both hypothesized to use NO as the final product at the vascular level, result in opposite blood velocity patterns within the cerebral circulation. This may be due to the particular type of artery and/or to the local endothelial environment whereby the released NO may act.

Adult↗
PubMed1997

Stimulation of corticotrophin-releasing hormone release by the obese (ob) gene product, leptin, from hypothalamic explants.

Recent data have suggested that adipocytes synthesize and secrete a 16 kDa peptide which acts centrally to regulate weight gain by suppressing appetite and activating the sympathetic nervous system. To exert such effects, it may function as an endogenous ligand in the CNS, since specific receptors (OB-R) have been recently reported to be widely distributed in the brain. We have speculated that this peptide, now known as leptin, may act centrally by stimulating the release of corticotrophin-releasing hormone (CRH), a recognized potent inhibitory modulator of appetite. We tested in vitro the effect of murine leptin on CRH secretion in the dose range of 0.1 pM-100 nM. The static rat hypothalamic incubation system used involved fresh hypothalamic explants maintained in EBSS with consecutive 20 min incubations, and estimation of CRH concentrations in the medium by a specific and sensitive radioimmunoassay. The effect of heat-denatured leptin at a dose of 1 nM and 10 nM, was also investigated. Any possible modulation of leptin effects by adrenergic pathways was then explored by coincubating hypothalami with leptin 10 nM and equimolar concentrations of the alpha 1-adrenergic antagonist prazosin or the beta-adrenergic antagonist propranolol. The active leptin, but not the heat-inactivated peptide, caused a dose-dependent stimulation of CRH release in vitro (p < 0.05- < 0.0001 vs control), with a plateau effect at a dose of 10 nM. The addition of either prazosin or propranolol was without effect on leptin-dependent CRH stimulation. These findings are consistent with the reported presence of leptin receptors in the rat brain, and suggest that leptin may act to regulate appetite at least in part by directly modulating the secretion of CRH from the hypothalamus. It would also appear that such effect occurs via a non-adrenergic mechanism.

Analysis of Variance↗
PubMed1997

Is seborrhea a sign of autonomic impairment in Parkinson's disease?

An increase of sebum excretion rate (SER) is frequently observed in patients suffering from Parkinson's disease (PD). Some authors attribute it to the hyperactivity of the parasympathetic system, while others consider the possible action of androgens or of MSH-hormone. The aim of our study was to verify and quantify SER in 70 parkinsonian patients and compare it with SER in 60 normal subjects. We found higher values of SER in male subjects, both in normal and in parkinsonian patients. The highest rate of excretion was observed in parkinsonian males, in agreement with the possible main role of androgens or testosterone in sebum excretion, while the phenomenon did not appear to be related to abnormalities of the autonomic nervous system. The association of PD and sex hormones might therefore be crucial for the developing of seborrhea.

Aged↗
PubMed1997

Neurochemical mechanisms of nitroglycerin-induced neuronal activation in rat brain: a pharmacological investigation.

Nitroglycerin is a nitric oxide donor which induces sustained expression of Fos protein, a marker of neuronal activation, in specific neuronal groups in the central nervous system. The mechanisms which underlie nitroglycerin-induced neuronal activation are elusive at this time, although a precise role has been suggested for the pool of neurons containing nitric oxide synthase as well as for catecholaminergic and peptidergic pathways. The aim of this study was to provide further details on the central effect of nitroglycerin by means of a pharmacological manipulation of nitroglycerin-induced neuronal activation with inhibitors of the nitric oxide synthase, modulators of the sympathetic drive and mediators of pain perception. Adult male Sprague-Dawley rats received L-NGnitro-arginine methyl ester, 7-nitro-indazole, ephedrine sulfate, indomethacin, capsaicin or vehicle before the subcutaneous injection of nitroglycerin (10 mg/kg b.w.). They were sacrificed 4 hr after nitroglycerin administration and brain sections were processed for immunocytochemical visualization of Fos. All the pharmacological treatments administered before injecting nitroglycerin selectively influenced Fos expression in the different brain nuclei. The data obtained suggest that nitroglycerin-induced neuronal activation is mediated by nociceptive and barosensitive mechanisms. Nitric oxide seems to represent the most important mediator of this phenomenon. The sympathetic system and prostaglandin synthesis are also likely to be involved.

Animals↗
PubMed1997

Long-term follow-up of open commissurotomy versus bileaflet valve replacement for rheumatic mitral stenosis.

OBJECTIVE: Despite the achievements of third generation mechanical cardiac valve prostheses, conservative procedures are still considered the best surgical option for rheumatic mitral valve stenosis. To compare long-term results of open mitral commissurotomy (Group A) and mitral valve replacement with bileaflet prostheses (Group B) a 15-year follow-up study was carried out. METHODS: From January 1981 to May 1996, 540 consecutive patients with pure isolated rheumatic mitral stenosis underwent mitral valve surgery: 300 had mitral commissurotomy and 240 valve replacement. The follow-up was 99.05% complete and ranged between 1 and 185 months in Group A and from 1 to 171 months in Group B. RESULTS: Hospital mortality was 2% in Group A and 2.08% in Group B. Late mortality was 1% in Group A and 3% in Group B. The 10-year survival rates were 98.7% +/- 1% in Group A and 93.7% +/- 3% in Group B. There was a statistically significant difference of freedom from reoperation in Group B (97.7% +/- 1%) versus Group A (88.1% +/- 2%) (P = 0.04). In group A 14 embolic events occurred (93.7% +/- 2%), and 15 (6.52%) in Group B (83.9% +/- 7%). Haemorrhagic events were observed in 2 patients (0.68%) of Group A (99.3% +/- 0.5%) and in 3 patients (1.3%) of Group B (98.4% +/- 1%). CONCLUSIONS: Long term results of mitral commissurotomy were more satisfactory than those obtained with bileaflet valves. Reoperation rate was higher in mitral commissurotomy.

Adolescent↗
PubMed1997

Haemodynamic correlates of early and delayed responses to sublingual administration of isosorbide dinitrate in migraine patients: a transcranial Doppler study.

In normal subjects or migraine patients, nitrates induce a non-specific early headache caused by vasodilation of intracranial arteries. In migraineurs a delayed headache response to nitrates may have a typical clinical profile of a spontaneous migraine attack. The cerebral vasomotor changes of this delayed response require further study. Isosorbide dinitrate (IDN), an exogenous nitric oxide (NO) donor, was given at a dose of 5 mg sublingually and a bilateral transcranial Doppler device was used to monitor bilateral mean velocity (Vm) changes at the middle cerebral artery (MCA) after IDN administration and until delayed headache occurred. Spontaneous migraine-like headache occurred only in migraine patients during the delayed phase after IDN and was accompanied by a prolonged arterial vasodilation compared to normal subjects. This vasomotor response was more evident on the customary side of the head pain of a spontaneous migraine attack. Our findings suggest a particular vasomotor response to nitrates in migraine patients. This response is associated with the nitrate-induced headache and it is not evident in healthy pain-free controls during the delayed phase after administration of an NO donor. Owing to the short half-life of NO, the neurotransmitter released by IDN, and because of the late onset of headache, we believe the mechanism is unlikely to be vascular in origin, but may have a neurogenic component.

Administration, Sublingual↗
PubMed1996

An assessment of hypothalamo-pituitary-adrenal axis functioning in non-depressed, early abstinent alcoholics.

Chronic alcohol consumption has been shown to be associated with abnormalities in the regulation of the hypothalamo-pituitary-adrenal (HPA) axis in humans. However, conflicting data exist in the literature, with particular regard to studies performed in actively drinking or withdrawn alcoholics; in addition, the frequent presence of depressive disturbances in such patients may importantly affect the neuroendocrine findings. In this study, we investigated HPA function in 12 male alcoholics, in whom the presence of depression and other possible confounding factors was excluded, during the first and second weeks after cessation of ethanol intake. The plasma corticotropin (adrenocorticotropic hormone, ACTH) and cortisol levels in response to both a stimulation test with human corticotrophin-releasing hormone (CRH; 100 micrograms IV) and an insulin (0.15 UI/kg IV)-induced hypoglycaemia (ITT) were measured; the cortisol response to a standard overnight dexamethasone (1 mg) suppression test (DST) was also tested. While the mean baseline ACTH and cortisol levels, measured in the morning (0800-0830 h), were not different from those of controls, ACTH and cortisol responses to the CRH test were markedly reduced (area of secretion p < .01 and p < .05, compared to controls). Similarly, the patient group showed an almost absent ACTH and cortisol release following insulin infusion (area of secretion p < .01 compared to controls, in either case). In four patients, non-suppression of plasma cortisol levels was seen on the DST, but no significant difference from normal suppressors was noted as far as the clinical features were concerned. These findings suggest that impaired hypothalamic and pituitary responsiveness, unrelated to depressive disturbances, occurs in recently withdrawn chronic alcoholics. While the possible influence of the alcohol withdrawal syndrome should be taken into account, such a pattern may be due to increased activity of the HPA axis, even in the face of preserved basal adrenal secretion. Whether these findings reflect a direct effect of sustained ethanol exposure on the components of the HPA axis, or a non-specific marker of impaired adaptation in chronic alcoholics, deserves further investigation.

Adrenocorticotropic Hormone↗
PubMed1996

Pain pressure threshold in cluster headache patients.

Pain perception threshold (PPT) in the head was assessed with a pressure algometer in 58 cluster headache (CH) patients (52M, 6F; 41 episodic and 17 chronic). Fourteen patients in cluster period were retested in remission. Thresholds were assessed at 10 symmetrical points on each side of the head and at the deltoid. Compared with controls (n = 50), CH patients had lower PPT in the head and in the deltoid. PPT was lower on the symptomatic side than on the non-symptomatic side in patients with episodic CH during a cluster period (p < 0.001) and in patients with chronic CH (p < 0.05). This pattern was more evident during a cluster period than during remission (p < 0.05). A reduced PPT did not correlate with illness duration and pain side. The lowest PPT mean values were found at the anterior and intermediate levels of the temporal muscle on the symptomatic side. These results imply a central mechanism underlying the pathogenesis of CH.

Adult↗