Safety and efficacy of ticlopidine after stent placement.
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Abciximab↗
Biomedical subjects
P Henry
Publications and source records attributed to P Henry.
Chronic inflammatory demyelinating polyneuropathy associated with dysglobulinemia: a peripheral nerve biopsy study in 18 cases.
The possible occurrence of chronic inflammatory demyelinating polyneuropathy (CIDP) in association with an identified dysglobulinemic status is recognized and a causal relationship between the two has been suggested. We had the opportunity to study 18 patients presenting with CIDP and dysglobulinemia. This was an IgG monoclonal gammopathy (IgG MG) in 8 cases, an IgM monoclonal gammopathy (IgM MG) in 8, an IgG-IgM biclonal gammopathy in 1 case and an IgM monoclonal cryoglobulinemia in another. A peripheral nerve biopsy specimen was available for all patients and the morphological findings in these specimens in the cases of CIDP with IgG MG or cryoglobulin did not differ from those without, whereas characteristic features were observed in the cases of CIDP with IgM MG and anti-myelin associated glycoprotein activity.
Aged↗
Ergotamine in the acute treatment of migraine: a review and European consensus.
Ergotamine has been used in clinical practice for the acute treatment of migraine for over 50 years, but there has been little agreement on its place in clinical practice. An expert group from Europe reviewed the pre-clinical and clinical data on ergotamine as it relates to the treatment of migraine. From this review, specific suggestions for the patient groups and appropriate use of ergotamine have been agreed. In essence, ergotamine, from a medical perspective, is the drug of choice in a limited number of migraine sufferers who have infrequent or long duration headaches and are likely to comply with dosing restrictions. For most migraine sufferers requiring a specific anti-migraine treatment, a triptan is generally a better option from both an efficacy and side-effect perspective.
Analgesics, Non-Narcotic↗
Long-term residual musculoskeletal deficits after femoral shaft fractures treated with intramedullary nailing.
BACKGROUND: Locked intramedullary (IM) nailing has been recognized as one of the most reliable methods for treatment of femoral shaft fractures. Although IM nails are routinely used in the treatment of these fractures, the long-term effects of retained IM nails are unknown. METHODS: Seventeen patients with radiographically documented healed fracture of femoral diaphysis after locked IM nailing technique were evaluated at a follow-up of at least 18 months postoperatively. All patients had returned to their preinjury level of function and activity before the study. The bone mineral densities (BMD) of the injured and contralateral femora were measured using dual energy x-ray absorptiometry (DEXA). BMD of symmetrical regions in the femoral neck and medial and lateral femoral cortex of the implanted and contralateral femora were compared. Postinjury muscle function was assessed from measurement of the isometric strength of six separate muscle groups (quadriceps, hamstrings, hip extensors, hip flexors, hip abductors, and hip adductors) in treated and control extremities. RESULTS: The average BMD of the femoral neck region of instrumented femora was 9% less than in contralateral control. Within the medial cortex, BMD of the control femora was an average of 20% greater than in the implanted side. In the lateral cortex, the difference averaged 13%. The isometric dynamometric data demonstrated a statistically significant reduction in the strength of the quadriceps of the instrumented extremities as compared with the contralateral ones. There was no significant difference in the strength of the hamstrings, hip extensors, hip flexors, abductors, or adductors. In the control extremities, the average torque generated by isometric contraction of the quadriceps was 3.45+/-1.35 times greater than by the hamstrings. Torque in extension/flexion and abduction/adduction was also observed. CONCLUSION: Our data suggest that limbs with long-term retained IM nails experience a significant reduction in the femur BMD and quadriceps muscle strength. These findings may not be simply related to the implant, and further study is warranted to determine the causes of these changes.
Adolescent↗
Immediate and delayed implant placement into extraction sockets: a 5-year report.
BACKGROUND: As a complement to the earlier reported 3-year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the 5-year results are reported. PURPOSE: The purpose of this 5-year report was to evaluate the immediate and long-term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction. MATERIALS AND METHODS: This paper presents the 5-year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft-tissue healing time (3-5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used. RESULTS: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method. CONCLUSION: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.
Bone Density↗
Induction of apoptosis using sphingolipids activates a chloride current in Xenopus laevis oocytes.
The purpose of this study was to investigate whether the cell shrinkage that occurs during apoptosis could be explained by a change of the activity in ion transport pathways. We tested whether sphingolipids, which are potent pro-apoptotic compounds, can activate ionic currents in Xenopus laevis oocytes. Apoptosis was characterized in our model by a decrease in cell volume, a loss of cell viability, and DNA cleavage. Oocytes were studied using voltage-clamp after injection with N,N-dimethyl-D-erythrosphingosine (DMS) or D-sphingosine (DS). DMS and DS activated a fast-activating, slowly inactivating, outwardly rectifying current, similar to I(Cl-swell), a swelling-induced chloride current. Lowering the extracellular chloride dramatically reduced the current, and the channel was more selective for thiocyanate and iodide (thiocyanate > iodide) than for chloride. The current was blocked by 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB) and lanthanum but not by niflumic acid. Oocytes injected with a pseudosubstrate inhibitor of protein kinase C (PKC), PKC-(19-31), exhibited the same current. DMS-activated current was abolished by preexposure with phorbol myristate acetate. Our results suggest that induction of apoptosis in X. laevis oocytes, using sphingolipids or PKC inhibitors, activates a current similar to swelling-induced chloride current previously described in oocytes.
Animals↗
Re: A comparison of endosseous dental implant surfaces. Cochran DL (1999;70:1523-1539).
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Dental Implantation, Endosseous↗
[Is there a "migraine personality"?].
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Humans↗
Functional MR imaging analysis of pain-related brain activation after acute mechanical stimulation.
BACKGROUND AND PURPOSE: Most studies concerning imaging of pain processing have used thermal, chemical, or electrical nociceptive stimulation. The aim of the present study was to determine the cortical representation of mechanical pain. For this, using functional MR (fMR) imaging at 1.5 T, we compared activation patterns during painful and nonpainful tonic mechanical stimulation in healthy volunteers. METHODS: Eleven right-handed subjects ranging in age from 21 to 46 years underwent gradient-echo echo-planar fMR imaging while quantified tonic pressure was applied to the first metacarpophalangeal joint. Imaging parameters were 3,000/60 (TR/TE) with a 5-mm section thickness in a 7.30-minute sequence with 2 x 90 seconds of painful stimulation interleaved with 3 x 90 seconds of nonpainful stimulation. Functional images were processed using dedicated IDL software. RESULTS: Mechanical tonic nociceptive pressure was associated with activation of the primary somatosensory cortex contralateral to the hand stimulated and variable, often bilateral activation of the secondary somatosensory, temporal, anterior and posterior cingulate, insular, and prefrontal cortexes. Thalamic activation was inconsistent and always contralateral to stimulation. CONCLUSION: The interindividual variability found in this fMR imaging study calls for repetitive single-subject analysis or more extensive studies of large groups of patients. Either may be based on fMR imaging analysis of brain activation after tonic mechanically induced pain, which leads to deep pain sensation similar to patients' painful sensations most commonly encountered in clinical practice.
Adult↗
[Migraine: epidemiological data, repercussions on daily life and socioeconomic cost].
Studies made on the basis of IHS criteria on the prevalence of migraine show relatively homogeneous results, that is to say about 12% of the adult population is prone to migraine attacks, with a marked female bias (female/male ratio, 3.7:1). Migraine-associated comorbidity has not been extensively researched due to significant methodological problems. Migraine as a risk factor in relation to cardiovascular disease remains a subject of discussion, and migraine with aura appears to present a cerebral infarct risk in young women taking oral contraception. There is an established and significant association between migraine, anxiety and depressive disorders. Certain studies have determined the important repercussions of migraine on the quality of life. Some subjects are reluctant to contact a doctor, and therefore voluntarily deny themselves access to medical treatment to relieve their condition. The socioeconomic cost of migraine attacks is high, and the direct cost in France is estimated at about 4 billion French francs. It is quite probable that the indirect costs (e.g., absenteeism, reduced efficiency at work) are even higher.
Activities of Daily Living↗
[Management of chronic headache].
Chronic headache is an important public health issue since 30p. cent of the French population complains of recurrent headaches. An accurate diagnosis, going beyond approximations, is based on careful questioning and physical examination. Three nosologic entities may be specified: migraine, tension-type headache, and symptomatic headaches which are frequently overvalued. An accurate pathophysiological knowledge is necessary to approach suitable therapeutics. It is also necessary to explain the pathophysiological basis to the patient. It is essential to breath through the frequent nosophobia. When headaches are infrequent, symptomatic treatment is to be favored. Empirical therapy should be explained to obtain good therapeutic observance based on a confidence relationship essential for good patient care.
Chronic Disease↗
[Epidemiology of headache].
Previous classifications of headache have lacked accuracy. In 1988, the Headache Classification Committee of the International Headache Society (IHS) introduced operational diagnostic criteria for all headache disorders. Since then, epidemiological headache research has been substantially made easily. Although the use of uniform and specific diagnostic criteria may reduce diagnostic variability, several other methodologic problems remain: episodicity, coexisting headaches, measurement techniques, sample source, may explain the differences among studies. All these difficulties overlap and explain the wide range of overall prevalence from 35p.100 to 100 p. 100. Information on migraine epidemiology are available: a one-year prevalence of migraine in America and Western Europe in adults is about 10 à 15 p.100. In France, Henry et al. found a prevalence of 12.1 p.100 (6.1 p.100 for men and 17.6 p.100 for women) for migraine. The aura symptoms are extremely difficult to describe, explaining the heterogeneity of prevalence for migraine with aura. Sex and age distribution as well as the relationship with sociodemographic factors and associated pathologies (stroke, epilepsia.) are now well-known. Epidemiology of tension-type headaches has received less attention. This headache varies both in frequency and severity; this fact make epidemiologic studies more difficult. Cluster headache is better defined by IHS criteria, but its prevalence remains debated. Different methodological approaches could explain these difficulties, rather real differencies in frequency among various population. Cluster Headache prevalence varies from 0.006 p.100 in China to 0.07 p.100 of the population in the republic of San Marino and 0.24 p.100 in the general population of the United states. In conclusion, the development of IHS criteria has made possible the progress of epidemiologic research. Additional studies are required to better define the risk factors and conditions that act as co-morbidity factors.
Adult↗
[Headaches. Diagnostic approach].
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Chronic Disease↗
Production of type 2 cytokines by CD8+ lung cells is associated with greater decline in pulmonary function in patients with systemic sclerosis.
OBJECTIVE: This study addresses the hypothesis that a profibrotic pattern of cytokines is produced in the lungs of patients with systemic sclerosis (SSc) and causes fibrosis. METHODS: Using a reverse transcriptase-polymerase chain reaction technique, interleukin-4 (IL-4), IL-5, and interferon-gamma (IFNgamma) messenger RNA (mRNA) were measured in unseparated CD8+ and CD4+ bronchoalveolar lavage (BAL) cells from SSc patients and healthy controls. To confirm the results, CD8+ T cells were cloned from BAL fluids, and the pattern of cytokine mRNA made by these cells was determined. Serial pulmonary function tests were done. RESULTS: BAL cells from healthy controls made IFNgamma mRNA, with no or little IL-4 or IL-5 mRNA. In contrast, BAL cells from the majority of SSc patients made IL-4 and/or IL-5 mRNA, with or without approximately equal amounts of IFNgamma mRNA. This pattern of cytokines was made by CD8+ T cells, which were increased in the lungs of these SSc patients. Patients whose BAL cells made this type 2 pattern of cytokine mRNA had a significant decline in forced vital capacity over time after the BAL, whereas patients whose BAL cells made IFNgamma mRNA alone did not. Both wild-type and an alternative splice variant of IL-4 mRNA were increased in BAL cells from SSc patients. Both forms of IL-4 stimulated alpha2(I) collagen mRNA in human dermal and lung fibroblasts. CONCLUSION: The type 2 pattern of cytokine mRNA produced by BAL cells from SSc patients differs from unopposed IFNgamma production found in healthy BAL cells. This production of type 2 cytokine mRNA by CD8+ T cells is associated with a significant decline in lung function over time, which suggests a pathologic role for these T cells in interstitial fibrosis in SSc.
Adolescent↗
Usefulness of motor functional MRI correlated to cortical mapping in Rolandic low-grade astrocytomas.
The indications for surgery of slow growing tumours like low grade astrocytomas in eloquent areas are difficult. The timing and the benefit/risk ratio of the surgery must be evaluated, taking into account the potential post operative deficit. The purpose of this study was: a) to validate the data obtained with functional MRI (FMRI) by direct cortical stimulation in patients who are candidate for surgery; b) to demonstrate the usefulness of FMRI coupled with cortical brain mapping and 3D reconstructions of the surfaces of the brain in low grade astrocytoma. FMRI of the hand-motor cortex was performed in 8 patients with low grade astrocytomas. They subsequently underwent direct cortical mapping to correlate the results of FMRI and resective surgery sparing the functional area. In the 8 cases, the results of direct cortical mapping in the precentral region matched accurately those obtained from FMRI. When surgical resection of low grade astrocytoma in the motor areas is considered, FMRI used with intra-operative cortical mapping can help the surgeon to spare functional areas during tumour removal.
Adult↗
Incremental absenteeism due to headaches in migraine: results from the Mig-Access French national cohort.
OBJECTIVE: To assess the costs of headache-related absenteeism of community-dwelling migraineurs, and to compare the amount of absenteeism between migraineurs aged 18 and older and age, sex, and occupation-matched nonheadache-prone subjects. DESIGN: Follow-up over a 3-month period. SAMPLES: 385 migraineurs and 313 nonheadache subjects representative of the setting. METHODS: Every day, the participants recorded the presence of headache, if any, and the work situation (unemployment, holiday, weekend, medical reason, nonmedical reason). Sickness-related absenteeism was the number of workdays missed or interrupted for medical reasons. Headache-related absenteeism was the sickness-related absenteeism during workdays with headaches. The annual headache-related absenteeism costs in France were extrapolated from these data in accordance with the mean income per occupational category. The incremental absenteeism and related costs were the difference between the two samples. RESULTS: Of working migraineurs, 20% had at least one period of absenteeism. During the 3 months, they missed or interrupted on average 1.4 days for medical reasons, 0.25 of which for headaches. Sickness-related absenteeism was statistically higher in migraineurs than in nonheadache-prone subjects. This difference was due to a higher absenteeism for comorbidity reasons, not for headache reasons, representing 20% of all sickness-related absenteeism. Migraineurs avoided sick leave for headache reasons. As an incremental total, 1.68 days or approximately 0.7% of the annual number of working days are lost on average per individual with migraine. The annual incremental headache-related absenteeism cost was 5.22 billions, i.e. 1,551 FF (US$240) per migraineur.
Absenteeism↗
Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs.
Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35,805 day in group 1 and 29,109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 +/- 20 versus 32 +/- 19, P < .05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 +/- 20 in group 1, 45 +/- 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
Adult↗
Comparative efficacy and safety of calcium carbasalate plus metoclopramide versus ergotamine tartrate plus caffeine in the treatment of acute migraine attacks.
This randomized, double-blind, double-dummy, multicenter, parallel-group study aimed at comparing the efficacy and safety of calcium carbasalate (equivalent to 900 mg aspirin) plus metoclopramide 10 mg (CM) with ergotamine tartrate 1 mg plus caffeine 100 mg (EC) administered in the treatment of 2 acute migraine attacks. A total of 296 patients fulfilling the International Headache Society diagnostic criteria for migraine were enrolled. In total, one or two migraine attacks were treated in 268 and 235 patients, respectively. The primary endpoint for the first treated attack was headache relief, with intensity decreasing from moderate or severe to mild or absent 2 h after drug intake. Usual secondary efficacy endpoints were assessed. A superiority of CM over EC was observed for both treated attacks for the main endpoint: success in 54 versus 36%, p = 0.003 for the first attack and 60 versus 44%, p = 0.02 for the second attack. CM was also significantly superior to EC during the first attack for complete headache relief (20 vs. 8%, p = 0.006), nausea (42 vs. 63%, p = 0. 007) and willingness to take the drug again (90 vs. 80%, p = 0.043). The global efficacy evaluation, rated by the investigators, was significantly more favorable to CM for both attacks (p = 0.001 for the first attack and p = 0.02 for the second). The patients' evaluation was significant for the first attack (p = 0.002). The global incidence of adverse events was 45% higher with EC, though not significant (32 vs. 22%, p = 0.075). They were most often unspecific and mild to moderate in intensity. Gastrointestinal side effects were significantly less frequent with CM than EC (7 vs. 21%, p = 0.001). Thus, CM is more effective and has a better gastrointestinal safety than EC in the acute treatment of migraine attacks.
Abdominal Pain↗