Biomedical subjects
Publications and source records attributed to S Diamond.
Headache is a common complaint with many potential causes. Each patient should be thoroughly examined to identify the condition producing the headache. Appropriate treatment varies according to headache type, so therapy should not be initiated until the diagnosis has been established. Dr Diamond reviews the differential diagnosis of headache and techniques for managing its various forms.
Depth profile measurements of 137Cs and 134Cs were carried out in 11 permanent pastures that had been exposed to fallout from the Chernobyl accident. In addition to gamma-ray spectrometric analysis, the selected pastures were characterized by several soil parameters, the influence of which on transfer was investigated. Sampling of soil and pasture grass was undertaken during a period extending from the Spring of 1987 to the Autumn of 1988. The results show that there has been limited downward migration of Chernobyl-derived caesium. In October 1988 more than 88% of the 137Cs attributable to Chernobyl was mainly confined to the top 10 cm of undisturbed soil, with 79% on average in the top 5 cm. The distribution of pre-Chernobyl caesium at the 11 sites was also evaluated. In an investigation of the influence of soil parameters on transfer to grass, a negative correlation with pH was observed in 1987. In April 1987 concentration ratios for 137Cs in grass ranged from 0.03 to 0.49. In general, comparison of the concentration ratio values showed a decreasing trend over the 18 months.
Once the definitive diagnosis of migraine has been formulated, the physician has many options available for abortive and prophylactic therapy. Nonpharmacologic modalities, including behavioral modification methods such as biofeedback training, may also be considered. Migraine does not necessarily have to disrupt the lives of those afflicted. The patient with mixed headache presents a more difficult diagnostic and therapeutic problem. These patients can also be helped when the disorder is identified, and inpatient therapy for these patients may be required.
Migraine headaches can be successfully treated both abortively and prophylactically with carefully selected pharmaceutical agents. Mixed headache syndrome is complex and difficult to manage. Treatment is often complicated by patients' susceptibility to dependency and accompanying sleep disturbances, as well as by troublesome drug interactions. Cranial neuralgias can be successfully treated in the majority of cases. Since many patients with cranial neuralgias are elderly, careful monitoring of serum drug levels and frequent blood cell counts during therapy are crucial.
Platelet monoamine oxidase activity (MAO) in a group (n = 17) of white, female migraineurs during an acute migraine attack was similar to both the values obtained for the same group of patients two to three weeks after the headache episode (pain-free period) and to the results obtained for a group (n = 18) of sex and race-matched, age-comparable, drug-free healthy volunteers (blind study; substrate p-tyramine, 38.7 +/- 5.7, 41.9 +/- 8.8 and 43.0 +/- 3.4 or p-methoxybenzylamine, 178.9 +/- 11.3, 177.2 +/- 6.9 and 181.0 +/- 9.7 nmole/hr/10(9) platelets +/- SD respectively). With each patient serving as its own control, MAO activity during the migraine episode and when pain-free failed to show a significant trend. Neither a number of other medical conditions nor the use of several medications appeared to significantly influence our results. The present work, while dealing only with a small but well defined patient population, argues against the possible usefulness of platelet MAO activity as a biological marker for migraine headaches.
Radial keratotomy (RK) is one of several corneal surgery operations recently developed to change the refraction of the eye. RK consists of four to eight deep radial incisions extending from the corneal edge to a small central optical zone, which flattens when the corneal scars heal. This decreases the myopia, or excess corneal dioptric power by 2.00 to 6.00 diopters. The draw-backs of RK for aviators consists of the following problems and side effects: 1) several ocular surgical complications, which may cause loss of vision; 2) glare and dazzle inflight effects; 3) imprecise and unpredictable results; 4) diurnal change of refraction and vision; 5) residual regular and irregular astigmatism; 6) a decrease of best corrected vision; 7) late progressive hyperopia; and 8) greater susceptibility to aggravated ocular trauma. Radial keratotomy presently appears to be fraught with intrinsic hazards and is imprudent and inadvisable for pilots or aircrew, in whom long-term stable, non-fluctuating, asymptomatic, keen vision is required in both bright and dim light.
Many theories exist on the pathogenesis of migraine. However, the clinical picture of migraine is agreed on universally as a familial disorder characterized by recurrent attacks of headache that are variable in intensity, frequency, and duration. The attacks are usually unilateral and often associated with anorexia, nausea, and vomiting. Migraine therapy is complex and difficult, focusing on abortive and prophylactic regimens. General therapeutic measures, including diet and establishing schedules for meals and sleeping, may benefit many migraineurs. A variety of medications, including ergotamine, propranolol, the calcium channel blockers, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been beneficial in the prophylactic treatment of migraine. Ergotamine is the drug of choice in the abortive treatment, although other agents, such as the NSAIDs, have been used successfully. Inpatient therapy in a specialized unit for headache patients may be indicated for the recidivist patient, the patient habituated to analgesics or ergotamine, or the patient with the mixed headache syndrome, i.e., migraine occurring with coexistent muscle contraction headaches.
A number of classifications of headache have appeared in medical and professional journals. In addition to these formal diagnostic classifications, a number of articles have addressed the relationship of sexual functioning to headache etiology, course, and prevalence. To this end, many headache specialists have developed a classification for what are termed "sexual headaches." To date, these sexual headaches have been limited to migraine and muscle contraction (tension) headache patterns. We present, for the first time, two case studies documenting the role of sexual activity in both etiology and course of cluster headache.
An inpatient headache treatment unit provides a special environment for those patients whose headaches have failed to respond to outpatient therapy. Outpatient therapy may be precluded for a variety of treatment issues, including detoxification, initiation of copharmacy prophylactic medical therapy, and intravenous treatment for intractable chronic cluster headache and status migrainous headache. These complex medical treatments are viewed as some of the most valuable therapies by the patients and, at least in part, significantly decrease both headache indexes utilized in this survey. The various psychological, educational, and other adjunctive therapies utilized in an inpatient unit are considered beneficial by many patients. Psychological approaches are considered more useful to migrainous patients. Treatment failures may be due to variations in the etiology of chronic muscle contraction headache and posttraumatic headache. Denial of psychological factors in headache may also contribute to treatment failure. Habituation to analgesics and ergots may decrease patient response as compared with those not dependent.
Headache is the most common complaint encountered in clinical practice. Approximately 45 million people in the United States experience chronic headaches. The management of migraine headache involves both pharmacologic and nondrug therapy. Drug therapy for migraine involves the use of abortive and prophylactic agents. Abortive agents, such as ergotamine tartrate and ketoprofen, may be used to relieve the acute attack. Prophylactic therapy is focused on reducing the frequency and severity of the attacks. beta-Adrenergic blocking agents, such as propranolol, remain the primary agents for many migraine patients, although other drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ketoprofen, or calcium-channel blocking agents, such as verapamil, may be beneficial for many patients. For cluster headache and its variants, methysergide and corticosteroids are usually the drugs of choice. Patients with chronic cluster headache may achieve good results from long-term treatment with other therapies, including lithium carbonate, verapamil, and ketoprofen.
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1. Incubation of [3H]tyrosine methionine-enkephalin (6 x 10(-9) M final concentration) with human platelet-poor plasma (1:9 ratio to Trizma Base buffer, pH 7.4) results mostly (greater than 95%) in hydrolysis of the tyrosyl-glycine peptide bond. This enzymatic reaction is essentially completed within 90 min, showing a half-life, Km and Vmax of 12.8 +/- 2.5 min, 0.70 +/- 0.01 mM and 17.90 +/- 1.05 mumol/L/min, respectively. These values are comparable to those previously reported for the human plasma degradation of leucine-enkephalin. 2. As expected hydrolysis of the methionine-enkephalin tyrosyl-glycine peptide bond was blocked by the known aminopeptidase inhibitors bestatin and puromycin (IC50 1.2 +/- 0.4 and 4.3 +/- 2.4 microM, respectively) but not by either thiorphan or captopril. 3. Neither the storing (up to 60 days) nor the freezing and thawing (up to ten times during a 60 days periods) significantly changed the above kinetic parameters, showing the stability of the plasma methionine-enkephalin degrading aminopeptidase.
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