[Hormones and headaches. Epidemiology, physiopathology and drug therapy].
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Analgesics↗
Biomedical subjects
S Evers
Publications and source records attributed to S Evers.
Features, symptoms, and neurophysiological findings in stroke associated with hyperhomocysteinemia.
BACKGROUND: Hyperhomocysteinemia has been shown to be a mild independent risk factor for premature atherosclerosis, and there is evidence of an increased rate of peripheral vascular occlusive disease, myocardial infarction, and stroke. OBJECTIVE: To evaluate clinical, biochemical, and neurophysiological findings in patients with ischemic stroke with and without hyperhomocysteinemia. SUBJECTS: One hundred twenty-five consecutive patients with a history of stroke and 60 healthy control subjects. METHODS: Patients were divided into those with and those without hyperhomocysteinemia, which was defined as blood levels beyond the mean total plasma homocysteine level plus 2 SDs of the healthy control group. History, symptoms, cause, patterns of infarction, biochemical data, continuous and transcranial Doppler sonography, and event-related potentials were recorded in all patients. RESULTS: Twenty-seven patients had hyperhomocysteinemia. Compared with the 98 patients without hyperhomocysteinemia, they had an increased rate of hypertension (odds ratio, 3.5; 95% confidence interval, 1.0-12.6), an increased level of uric acid (P < .007), an increased hematocrit (P < .02), a higher rate of microangiopathy (odds ratio, 2.8; 95% confidence interval, 1.1-7.2), and a trend to a higher rate of multiple infarction. Furthermore, the P3 latency of the event-related potential was significantly increased in hyperhomocysteinemia (P < .004). CONCLUSIONS: Hyperhomocysteinemia is probably an independent risk factor for stroke, with a prevalence of about 20% in all patients with a history of stroke; however, additional factors (eg, hypertension, hyperuricemia) may have an enhancing effect. There are significant differences in stroke patterns between patients with and without hyperhomocysteinemia, with a higher rate of lesions typical of cerebral microangiopathy and a trend to multiple infarctions in the former. Impairment of cognitive processing as measured by visual event-related potential is more pronounced in hyperhomocysteinemia.
Adult↗
Two-dimensional map of Haemophilus influenzae following protein enrichment by heparin chromatography.
Two-dimensional gel electrophoresis separates several hundred protein molecules in one single experiment and is efficiently used to study the products expressed by different genomes. Low-copy-number gene products are invisible on a stained two-dimensional map and must be enriched such that sufficient amounts are present for visualization and identification. We investigated the enrichment of proteins of the bacterium Haemophilus influenzae by chromatography on immobilized heparin which has affinity for growth and protein biosynthesis factors. Total soluble proteins of the microorganism were fractionated on Heparin-Actigel which resulted in enrichment of approximately 160 proteins. The eluates, representing about 40% of the applied proteins, were analyzed by two-dimensional gel electrophoresis and the protein spots were characterized by amino acid composition analysis and matrix-assisted laser desorption ionization mass spectrometry. The proteins enriched by chromatography on the heparin gel were not exclusively low-copy-number gene products and they did not exclusively belong to one single class of proteins. The proteins that bound to the heparin gel are indicated in a two-dimensional protein map which includes more than 110 newly identified proteins.
Bacterial Proteins↗
Energy and nutrient inadequacies in the diets of low-income women who breast-feed.
OBJECTIVE: To assess the energy and nutrient intakes of women who are breast-feeding in relation to the Recommended Dietary Allowances (RDAs) for energy and nutrients during lactation. DESIGN: Survey using a interviewer-administered questionnaire and a 24 dietary recall. SUBJECTS: The subjects were 183 women breast-feeding at 3 months postpartum. All were living in low-income communities in Ontario, Canada, that were participating in the longitudinal prevention initiative, Better Beginnings, Better Futures. STATISTICAL ANALYSES: Mann-Whitney U test to compare energy and nutrient intakes of women with incomes above and below the Statistics Canada poverty line. RESULTS: Median intake of energy (2,148 kcal) was below the RDA of 2,700 kcal. Compared with the RDAs, intakes of calcium (928 vs 1,200 mg), folate (222 vs 280 microns), iron (13 vs 15 mg), thiamin (1.4 vs 1.6 mg), vitamin A (846 vs 1,300 retinol equivalents), and zinc (10 vs 19 mg) were below recommended values for women who are lactating. Although household income for 70% of the women was below the poverty line, differences in energy and nutrient intakes according to income group were not statistically significant. APPLICATIONS: Lactating women are at high risk of energy and nutrient inadequacies. Programs to increase breast-feeding rates, particularly among low-income communities, must include strategies to ensure adequate diets during lactation.
Adolescent↗
Cytomegalovirus encephalomyelomeningoradiculitis in acquired immunodeficiency syndrome (AIDS).
Acute inflammatory polyradiculitis represents an uncommon peripheral nerve complication during HIV infection. The case of an HIV-seropositive patient who was admitted to hospital for a cauda equina syndrome is reported. Despite early application of anticytomegalic medication, a cytomegalovrirus (CMV) infection spread out to the central nervous system (CNS), causing the patient's death. A post-mortem examination confirmed the diagnosis of CMV-encephalomyelomeningoradiculitis. To the authors' knowledge, such a progress of a CMV-related polyradiculitis to an encephalomyelomeningoradiculitis has not yet been described. The clinical features of this case will aid in the recognition of CMV-related neurological complications, and may permit earlier and perhaps more successful treatment.
AIDS-Related Opportunistic Infections↗
Cluster headache after orbital exenteration.
A 37-year-old man developed an ipsilateral headache which fulfilled the criteria for cluster headache after orbital extenteration because of a traumatic lesion of the bulb. The headache could be treated successfully by drugs usually applied in the therapy of cluster headache. Six similar cases of cluster headache after orbital exenteration could be identified in the literature suggesting that the eye itself is not necessarily part of the pathogenesis of cluster headache. We hypothesize that orbital exenteration can cause cluster headache by lesions of sympathetic structures. Possibly, these mechanisms are similar to those of sympathetic reflex dystrophy (Sudeck-Leriche syndrome) causing pain of the limbs.
Adult↗
Progression of distal symmetric polyneuropathy during diabetes mellitus: clinical, neurophysiological, haemorheological changes and self-rating scales of patients.
The complex interrelationships between progression of distal symmetric polyneuropathy (DSP) induced by diabetes mellitus and haemorheological alterations in correlation with the patients' self-rating scales about the progression of DSP were investigated. The study included 42 patients suffering from diabetes mellitus for 15 +/- 10 years. Clinical, neurophysiological and haemorheological follow-ups (platelet reactivity, erythrocyte aggregation, viscosity) were performed initially (A) and repeated 42 +/- 10 months later (B). At point B, clinical signs of DSP were found in 90.2% in the lower extremities, and 41.5% of the patients exhibited for the first time new symptoms and signs of DSP in the upper extremities. Besides conventional neurophysiological investigations (conduction velocity, amplitude) in the sural nerve, paired stimulation (LPSS) was applied. In peroneal nerve, conduction velocity, distal latency and F wave were estimated. These results confirmed the clinical progression of DSP (LPSS; p < 0.05). Platelet reactivity was statistically improved (p < 0.05) at point B predominantly as an effect of treatment (acetylsalicylic acid, Ginkgo biloba), whereas erythrocyte aggregation was increased at point B with and without treatment (p < 0.05). Blood glucose levels were abnormal at both points. Analogue self-rating scales showed that only 27% of the patients realized their progression of DSP. In conclusion, the results prove the clinical and neurophysiological progression of DSP and highlight that haemorheological changes may play a part in the conjectural pathogenesis of DSP. As patients to not realize the dramatic progression of DSP, information of the patients about the correlation between hyperglycaemia and progressive DSP should be reinforced.
Adolescent↗
Cognitive processing in primary headache: a study on event-related potentials.
BACKGROUND: There is experimental evidence for loss of cognitive habituation in migraine but not in other types of headache and not by visual event-related potentials (ERP). OBJECTIVE: Determining the latencies (msec) and amplitudes (microV) of ERP components and the differences of these values in a two-trial analysis representing the amount of cognitive habituation. PARTICIPANTS: Two hundred thirty-three patients with a headache diagnosis according to the criteria of the International Headache Society: migraine without aura (N = 77); migraine with aura (N = 31); cluster headache during period (N = 26); cluster headache during interval (N = 11); chronic paroxysmal hemicrania (N = 8); episodic tension-type headache (N = 33); ergotamine-induced headache (N = 47). Thirty age-matched healthy subjects served as a control group. METHODS: ERPs were evoked by a visual oddball paradigm consisting of 2 x 200 flashes of light (85% white light; 15% red light). Evaluation of ERP components was done separately for the first 200 and the second 200 stimuli as well as for the entire series of stimuli. RESULTS: We found an acceleration of the P3 latency during the second trial in migraine with and without aura, but not in the other headache types, and not in healthy controls. Ergotamine and sumatriptan abolished this loss of habituation in migraine patients. Increased ERP latencies as compared with healthy controls were present in patients with cluster headache, tension-type headache, ergotamine-induced headache, and migraine with aura, but not in migraine without aura. CONCLUSION: There is a loss of cognitive habituation in migraine, which may serve as a specific but not sensitive diagnostic tool. The pathophysiologies of migraine and cluster headache have a specific modifying property on cognitive processing reflected by a loss of cognitive habituation or an increased cognitive processing time. These effects can, in part, be counterbalanced by antimigraine medication.
Adolescent↗
Reproducibility of different nerve conduction velocity measurements in healthy test subjects and patients suffering from diabetic polyneuropathy.
According to literature, repeated nerve conduction velocity measurement may yield differences of up to 10 m/s in the same subject without any need to regard these differences as pathological. In order to get more details about the reproducibility of different nerve conduction velocity parameters, 59 healthy test subjects and 47 patients suffering from diabetic polyneuropathy were investigated. In the sural nerve latency prolongation after paired stimulation, conduction velocity and amplitude of nerve action potential were determined, in the peroneal nerve conduction velocity, distal latency, amplitude of nerve action potential after distal stimulation and F-wave. All investigations were performed using surface electrodes. Measurements were repeated within one day by the same investigator using exactly the same methods. No statistically significant differences between both investigations in test subjects and patients were found. Statistically, results for patients differed significantly from healthy test subjects. Six patients showed discrepancies between both measurements in the individual estimation normal/abnormal in comparison to laboratory norm values. In conclusion, these results demonstrate that strict adherence to technical and methodological parameters-including the same investigator-results in a higher improvement of reproducibility of nerve conduction velocity measurement. Multiple factors are operating in time but strict adherence to technical, methodological, physiological and biological parameters minimises changed results of neurophysiological measurements and improves reproducibility.
Adult↗
Event-related potentials in HIV infection: evidence for impact of antiretroviral treatment.
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Adult↗
Evolution of structure and substrate specificity in D-alanine:D-alanine ligases and related enzymes.
The D-alanine:D-alanine-ligase-related enzymes can have three preferential substrate specificities. Usually, these enzymes synthesize D-alanyl-D-alanine. In vancomycin-resistant Gram-positive bacteria, structurally related enzymes synthesize D-alanyl-D-lactate or d-alanyl-d-serine. The sequence of internal fragments of eight structural d-alanine:d-alanine ligase genes from enterococci has been determined. Alignment of the deduced amino acid sequences with those of other related enzymes from Gram-negative and Gram-positive bacteria revealed the presence of four distinct sequence patterns in the putative substrate-binding sites, each correlating with specificity to a particular substrate (D-alanine:D-lactate ligases exhibited two patterns). Phylogenetic analysis showed different clusters. The enterococcal subtree was largely superimposable on that derived from 16S rRNA sequences. In lactic acid bacteria, structural divergence due to differences in substrate specificity was observed. Glycopeptide resistance proteins VanA and VanB, the VanC-type ligases, and DdlA and DdlB from enteric bacteria and Haemophilus influenzae constituted separate clusters.
Amino Acid Sequence↗
[Genetics of migraine].
Several historical reports focusing on the heredity of migraine, as well as recent studies on its epidemiology and molecular biology, have revealed evidence for a decisive role of genetic factors in the aetiopathogenesis of familial migraine. Indeed, family studies, segregation analyses and twin studies have shown that genetic factors play an important role in disposition towards migraine but could not explain the entire aetiopathogenesis. The influence of extragenetic factors, however, remains mostly unknown. Recent linkage analyses have provided evidence for genetic heterogeneity. A locus for Familial Hemiplegic Migraine (FHM), the only known type of migraine that follows autosomaldominant transmission, has been linked to chromosome 19p13 but genetic heterogeneity has also been shown, i.e., different types of migraine could be excluded from this locus. Further investigations should concentrate on identifying the FHM gene on chromosome 19p13, on linkage analyses with markers for different susceptibility genes, and on genomic analyses of highly informative pedigrees. This would lead to further clues to the pathogenesis underlying migraine and, thus, to therapeutic developments.
Chromosome Aberrations↗
Mechanisms of glycopeptide resistance in enterococci.
Inducible resistance to high levels of glycopeptide antibiotics in clinical isolates of enterococci is mediated by Tn1546 or related transposons. Tn1546 encodes the VanH dehydrogenase which reduces pyruvate to D-lactate (D-Lac) and the VanA ligase which catalyses synthesis of the depsipeptide D-alanyl-D-lactate (D-Ala-D-Lac). The depsipeptide replaces the dipeptide D-Ala-D-Ala leading to production of peptidoglycan precursors which bind glycopeptides with reduced affinity. In addition, Tn1546 encodes the VanX dipeptidase and the VanY D,D-carboxypeptidase that hydrolyse the dipeptide D-Ala-D-Ala and the C-terminal D-Ala residue of the cytoplasmic precursor UDP-MurNAC-L-Ala-gamma-D- Glu-L-Lys-D-Ala-D-Ala, respectively. These two proteins act in series to eliminate D-Ala-D-Ala-containing precursors. VanX is required for resistance whereas VanY only slightly increases the level of resistance mediated by VanH, VanA and VanX.
Amino Acid Sequence↗
Magnesium in the prophylaxis of migraine--a double-blind placebo-controlled study.
The migraine prophylactic effect of 10 mmol magnesium twice-daily has been evaluated in a multicentre, prospective, randomized, double-blind, placebo-controlled study. Patients with two to six migraine attacks per month without aura, and history of migraine of at least 2 years, were included. A 4-week baseline period without medication was followed by 12 weeks of treatment with magnesium or placebo. The primary efficacy end-point was a reduction of at least 50% in intensity or duration of migraine attacks in hours at the end of the 12 weeks of treatment compared to baseline. With a calculated total sample size of 150 patients, an interim analysis was planned after completing treatment of at least 60 patients, which in fact was performed with 69 patients (64F, 5M), aged 18-64 years. Of these, 35 had received magnesium and 34 placebo. The number of responders was 10 in each group (28.6% under magnesium and 29.4% under placebo). As determined in the study protocol, this was a major reason to discontinue the trial. With regard to the number of migraine days or migraine attacks there was no benefit with magnesium compared to placebo. There were no centre-specific differences, and the final assessments of treatment efficacy by the doctor and patient were largely equivocal. With respect to tolerability and safety, 45.7% of patients in the magnesium group reported primarily mild adverse events like soft stool and diarrhoea in contrast to 23.5% in the placebo group.
Adolescent↗
Agraphia as the only symptom of migraine aura: a case report.
A 37-year-old female migraine patient is described, who suffered from episodes with pure lexical agraphia as the only symptom of migraine aura. The MRI showed multiple subcortical white matter lesions. Central inflammatory and demyelinating disorders were excluded. This case suggests that, during a migraine aura, even very circumscribed brain areas involved in complex neuro-psychological processing can be affected.
Adult↗
Georg Friedrich Handel's strokes.
Although there is no definite proof, it seems most likely that Georg Friedrich Handel suffered from cerebrovascular disease, which caused two or three minor strokes and weakness of his eyesight in his last years. His etiologically important risk factors and the symptoms of Handel's strokes are presented and evaluated by primary sources; various diagnoses are discussed. In Handel's musical work, no direct impact from his illness can be found, but there are some indirect outflows of Handel's pathography on his compositions, especially the Messiah.
Cerebrovascular Disorders↗
Genetics of glycopeptide resistance in enterococci.
Glycopeptide resistance in enterococci is phenotypically and genotypically heterogeneous. The genes responsible for inducible resistance to high levels of vancomycin and teicoplanin (VanA phenotype) are carried by the 10,851-bp Tn1546 transposon. Transposition of Tn1546 into self-transferable plasmids and subsequent transfer by conjugation appears to be responsible for the dissemination of this type of resistance. Nine polypeptides are encoded by Tn1546 that belong to five functional groups: transposition functions (ORF1 and ORF2), regulation of resistance gene expression (VanR and VanS), synthesis of depsipeptide D-Ala-D-lactate (VanH and VanA), hydrolysis of D-Ala-D-Ala-containing peptidoglycan precursors (VanX and VanY), and low-level teicoplanin resistance (VanZ). VanB-type resistance (various levels of resistance to vancomycin and susceptibility to teicoplanin) is also due to production of D-Ala-D-Lac. The VanB ligase of VanB-type strains is structurally and functionally similar to VanA. The vanB gene was found on composite transposon Tn1547, which, in turn, was part of larger conjugative chromosomally located elements (90 to 250 kb). In contrast to acquired VanA- and VanB-type resistance, VanC-type resistance (low level of resistance to vancomycin and susceptibility to teicoplanin) is an intrinsic property of motile enterococci. Resistance in these species is due to synthesis of dipeptide D-Ala-D-Ser by VanC ligases leading to production of cell wall precursors with reduced vancomycin affinity.
Anti-Bacterial Agents↗
Regulation of VanB-type vancomycin resistance gene expression by the VanS(B)-VanR (B) two-component regulatory system in Enterococcus faecalis V583.
Acquired VanA- and VanB-type glycopeptide resistance in enterococci is due to synthesis of modified peptidoglycan precursors terminating in D-lactate. As opposed to VanA-type strains which are resistant to both vancomycin and teicoplanin, VanB-type strains remain teicoplanin susceptible. We have determined the sequence of a 7,160-bp DNA fragment associated with VanB-type resistance in Enterococcus faecalis V583 that contains seven open reading frames. The distal part encoded the VanH (B), VanB, and VanX (B) proteins that are highly similar to the putative VanH, VanA, and VanX proteins responsible for VanA-type resistance. Upstream from the structural genes for these proteins were the vanY(B) gene encoding a D,D-carboxypeptidase and an open reading frame vanW with an unknown function. The proximal part of the gene cluster coded for the apparent VanS(B)-VanR (B) two-component regulatory system. VanR (B) was related to response regulators of the OmpR subclass, and VanS (B) was related to membrane-associated histidine protein kinases. Analysis of transcriptional fusions with a reporter gene and promoter mapping indicated that the VanR B-VanS B two-component regulatory system activates a promoter located immediately downstream from the vanS B gene. Vancomycin, but not teicoplanin, was an inducer, which explains teicoplanin susceptibility of VanB-type enterococci.
Amino Acid Sequence↗