Cold Therapy in Migraine Patients: Open-label, Non-controlled, Pilot Study

Some patients with headache report that they have frequently used physical therapies such as application of cold to relieve their headache. There are only a few reported studies related to cold therapies in patients with migraine. In this study, we investigated the effect of cold application on migraine patients. Twenty-eight migraine patients were included. Cold therapy was administered to them by gel cap. Patients used this cap during their two migraine attacks. Before and after the cold therapy, headache severity was recorded by using visual analogue scale (VAS). Patients used this cap for 25 min in each application. They recorded their VAS score just after the therapy and 25 min, 1 h, 2 h and 3 h later. Two patients could not use this therapy due to side effects (one due to cold intolerance and one due to vertigo) in both applications. Therefore, therapeutic efficacy was evaluated in 26 patients. Twenty-five minutes after treatment of the first attack, VAS score was decreased from 7.89 ± 1.93 to 5.54 ± 2.96 (P < 0.01). Twenty-five minutes after treatment of the second attack, VAS score was decreased from 7.7 ± 1.8 to 5.4 ± 3.55 (P < 0.01). Cold application alone may be effective in some patients suffering from migraine attacks. Its combination with conventional drugs should be investigated in future studies

The Impact of Comorbid Diseases on Postoperative Complications in Children after Adenotonsillectomy: Is It a Myth?

Objective: Adenotonsillar surgery remains the second most common surgical practice in pediatric otolaryngology. We aimed to evaluate whether a comorbid disease in children undergoing surgery has any impact on postoperative complication rate.Methods: This study was conducted at a tertiary otolaryngology department with 643 children. The study included children with symptoms of obstructive sleep-disordered breathing and recurrent infection who underwent adenotonsillar surgery. Patients with a comorbid disease constituted the study group and otherwise healthy children constituted the control group. The data were evaluated to find out any association among clinical variables such as gender, age, tonsil grade, type and extent of surgery, indication for surgery, body mass index percentile, comorbid diseases and postoperative complicationsResults: There were 245 (38.1%) patients with a comorbid disease. The most common comorbidity was cardiovascular diseases (n=68) followed by neurological diseases (n=48). We performed adenoidectomy in 319, tonsillectomy in 44, tonsillotomy in nine, adenotonsillectomy (AT) in 190 and adenoidectomy with tonsillotomy (ATT) in 81 patients. The overall rate of postoperative late complication was 17/643 (2.6%) with post-tonsillectomy hemorrhage being the most common (n=10). There was no association between other clinical variables and the complication but older age (p=0.042) and type of surgery (p<0.001) revealed increased risk. The rates of complications in patients with or without comorbid disease were found 5/245 (2%) and 12/389 (3%), respectively, with no difference (p=0.621).Conclusion: The risk of postoperative complications was increased in older children and in patients undergoing AT and ATT, however, the presence of comorbid disease did not increase likelihood of postoperative complications

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Disentangling Content and Motion for Text-Based Neural Video Manipulation

Giving machines the ability to imagine possible new objects or scenes from linguistic descriptions and produce their realistic renderings is arguably one of the most challenging problems in computer vision. Recent advances in deep generative models have led to new approaches that give promising results towards this goal. In this paper, we introduce a new method called DiCoMoGAN for manipulating videos with natural language, aiming to perform local and semantic edits on a video clip to alter the appearances of an object of interest. Our GAN architecture allows for better utilization of multiple observations by disentangling content and motion to enable controllable semantic edits. To this end, we introduce two tightly coupled networks: (i) a representation network for constructing a concise understanding of motion dynamics and temporally invariant content, and (ii) a translation network that exploits the extracted latent content representation to actuate the manipulation according to the target description. Our qualitative and quantitative evaluations demonstrate that DiCoMoGAN significantly outperforms existing frame-based methods, producing temporally coherent and semantically more meaningful results

Comparison of Treatment Outcomes Between Total and Near Total Glossectomy with Larynx Preservation and Flap Reconstruction: A Single Institution Experience with 23 Patients

Objective:The purpose of this study was to evaluate the functional and oncological outcomes of total glossectomy with laryngeal preservation (TGLP) compared to near-total glossectomy with laryngeal preservation (nTGLP).Methods:In this retrospective study, the data of 23 patients who underwent either TGLP or nTGLP between January 2010 and December 2020 in a tertiary university hospital were analyzed. The data including demographic findings, tumor stage, extent of surgery and technique, method of reconstruction, complications, overall survival (OS) and recurrence-free survival (RFS), and tracheostomy and gastric tube dependence during follow-up were assessed.Results:Of the 23 eligible patients, 15 had undergone nTGLP (Group 1) and 8 had undergone TGLP (Group 2). Tracheostomy dependence and gastric tube dependence rates at the sixth month were 3/19 (15.7%) and 12/19 (63.1%), respectively, with no significant differences between the two groups. OS and RFS at one year were 47.6% and 27.8%, respectively, for the study population. OS rate showed significance with nodal positivity and extranodal extension (p=0.004 for both) only, but not within patient groups (p=0.734).Conclusion:Both TGLP and nTGLP are feasible treatment options in patients with advanced tongue cancer with no differences in terms of functional and oncological results. Survival rates are still not satisfactory, and recurrences are high despite appropriate treatments. Proper selection of patients who are highly motivated and willing for long-term postoperative rehabilitation is essential

Advance Access Publication 15

Some patients with headache report that they have frequently used physical therapies such as application of cold to relieve their headache. There are only a few reported studies related to cold therapies in patients with migraine. In this study, we investigated the effect of cold application on migraine patients. Twenty-eight migraine patients were included. Cold therapy was administered to them by gel cap. Patients used this cap during their two migraine attacks. Before and after the cold therapy, headache severity was recorded by using visual analogue scale (VAS). Patients used this cap for 25 min in each application. They recorded their VAS score just after the therapy and 25 min, 1 h, 2 h and 3 h later. Two patients could not use this therapy due to side effects (one due to cold intolerance and one due to vertigo) in both applications. Therefore, therapeutic efficacy was evaluated in 26 patients. Twenty-five minutes after treatment of the first attack, VAS score was decreased from 7.89 ± 1.93 to 5.54 ± 2.96 (P &lt; 0.01). Twenty-five minutes after treatment of the second attack, VAS score was decreased from 7.7 ± 1.8 to 5.4 ± 3.55 (P &lt; 0.01). Cold application alone may be effective in some patients suffering from migraine attacks. Its combination with conventional drugs should be investigated in future studies. Keywords: cold application -cryotherapy -headache -migraine Introduction Migraine headache is generally treated by anti-migraine agents, analgesics and anti-emetic agents. Various nonpharmacological methods including massage, trigger point therapy, reflexology, spinal manipulation, therapeutic heat or cold and exercise therapy have also been investigated in the past for migraine patients (1-3). There are some reports which support the efficacy of acupuncture in the treatment of pediatric pain, including migraine (4). Ancient Greek and Egyptian writings show that physicians of that time were concerned about this disease and bloodletting and craniotomy was used in some patients with headache (2,5). The first cold treatment was done for headache patients in 1849. James Arnott wrote a manuscript on cold therapy in which he used a mixture of salt and ice in patients to treat headache (6). In another study, the efficacy of extra-cranial pressure in combination with cold to treat headaches was supported. They showed that simultaneous pressure of heat and cold reduced the headache&apos;s duration (7). Today, some patients report that they treat their headache using physical therapies, including cold application (5,8-10). Selfadministered pain relief manoeuvres have been investigated in primary headache patients. They reported that application of cold was the most-used manoeuvre in migraine without aura (8). In a small study, Friedman et al. (11) reported the efficacy of a non-invasive technique, intra-oral chilling, for acute migraine headache pain when compared with oral sumatriptan or placebo. Lance (12) reported the results of a new device, which employs cold, pressure and heat around the head. Fifteen out of twenty migraine patients and six out of seven tension headache patients experienced some reduction in headache severity. In another study, 9% of migraine patients reported that a cold wrap was almost completely effective, 26.5% moderately effective and 29.0% mildly effective. However, they did not use an objective method to evaluate headache severity (6). As a result, cold therapy is still not used clinically for migraine patients as an alternative or additive modality. In this study, we investigated the utility of cold therapy for migraine attacks. Materials and Methods All patients in this study were admitted to the Ministry of Health, Ankara Training and Research Hospital Headache Center. Informed consent was obtained from all patients. We obtained an Ethic Committee approval to conduct the study for patients (between 14 and 60 years) who met the criteria outlined below. Inclusion Criteria We proposed that all consecutively admitted patients, who met the following criteria, participate in our study: (i) migraine with aura and migraine without aura; (ii) chronic migraine [migraine headache occurring for 15 or more days per month for more than 3 months in the absence of medication overuse and not attributed to another disorder (other type chronic headache patients excluded)]; and that (iii) diagnosis was made by International Headache Society (IHS) criteria (13). The IHS determined new criteria for headache in 2004 Exclusion Criteria We excluded patients who had more than one type of headache (menstrual migraine was also excluded), took prophylactic treatment and patients with analgesic or ergotamine overuse. We reasoned that menstrual migraine may have different clinical characteristics and it can be more resistant than non-menstrual migraine. Patients using prophylactic treatment were deemed to be the possible cause of confusion when evaluating the responses of migraine patients. Twenty-eight migraine patients were included in this study. All patients were evaluated by a neurologist. Cap Administration All patients kept a diary for two migraine attacks (before and after the treatment). The diary included the time patients used the gel cap, visual analogue scale (VAS) of patients (before the treatment and 25 min, 1 h, 2 h, 3 h post-treatment), associated symptoms (i.e. nausea and vomiting) and side effects. Cold therapy was administered to the patients by gel cap In this study, we did not evaluate the patients beyond 3 h. This is a pilot study to determine the short-term effect of the treatment. Response Evaluation An objective response was defined as a 50% or greater reduction in pretreatment headache severity as measured by VAS. Patients with VAS score (0) were evaluated as having a complete response. A clinical benefit was defined as a reduction in VAS by &gt;25% in pretreatment headache severity. We thought that a 25% decrease in VAS score is an important level of clinical benefit. Therefore, we mentioned a 25% reduction in VAS as a clinical benefit. A patient whose VAS showed increase, no change or &lt;25% decrease was defined as no response. Statistical Analysis Bonferroni corrected Mann-Whitney U-test and Paired Samples t-test were used for statistical analysis. P-values &lt;0.05 were accepted as significant. Results All patients were female and the median age was 29.25 ± 7.92 years (range: minimum 14; maximum 48). Twenty-six patients had migraine without aura and two patients had migraine with aura. The patients&apos; mean number of attacks per month was 3.11 ± 1.2 (minimum 1; maximum 5). Characteristics of patients are shown in 490 Cold therapy in migraine patients Half of the Patients Reported a Clinical Benefit In the first application, 13 patients (50%) reported a clinical benefit 25 min after the cold therapy. Objective response was observed in 10 (38.4%) patients including three (11.5%) patients who had a complete response. However, the other half did not respond and needed to use analgesics 25 min after cold therapy. Mean VAS scores of patients decreased from 7.89 ± 1.93 to 5.54 ± 2.96 in 25 min, 4.62 ± 3.16 in 1 h, 3.92 ± 3.32 in 2 h and 3.42 ± 3.55 in 3 h after cold therapy in first attack. VAS scores at the twenty-fifth minute, first hour, second hour and third hour of treatment were found to be significantly lower compared to VAS scores before treatment (P &lt; 0.01) Benefit Increased with Second Application In the second application, 15 (57.6%) patients reported a clinical benefit 25 min after the cold therapy. Objective response was observed in 9 (34.6%) patients including 2 (7.7%) patients who had a complete response, but 11 (42.4%) did not respond and used analgesics. Mean VAS scores decreased from 7.74 ± 1.81 to 5.40 ± 3.10 in 25 min, 4.76 ± 3.88 in 1 h, 4.60 ± 3.75 in 2 h and 4.04 ± 3.54 in 3 h. VAS scores at the twenty-fifth minute, first hour, second hour and third hour of treatment were found to be significantly lower compared to VAS scores before the treatment (P &lt; 0.01) Median Analgesic Intake Time Increased with the Second Application Median analgesic intake time after onset of cold therapy was 45.0 ± 35.7 min (range: 25-120 min) in the first application and 81.36 ± 118.4 (range: 25-420 min) min in the second. Discussion Migraine is a chronic disease characterized by frequent attacks, high levels of pain and disability during attacks, causing reduced quality of life between attacks (15-18). It is a widespread disorder in the world, affecting $10-15$50% of the patients by cold therapy alone, with significantly decreased VAS scores after the therapy. In addition, we found that the benefit of cold therapy continued progressively over time. VAS scores gradually decreased after the therapy. This shows that the benefits of cold therapy continued after the onset of therapy. Moreover, there was consistency in the cold applications. Seventy-six percent of patients who had a response in their first attack benefited from the cold therapy in the second attack. Similarly, 60% of the patients who did not respond in the first attack had no response in the second attack, either. This study is not a randomized study and there is no control group comparing usual therapeutic approaches such as anti-migraine agents and anti-emetics. Therefore, we cannot conclude that cold therapy is definitely effective in migraine attack and we cannot suggest an evidence-based use of cold therapy in migraine patients. We can say, however, that cold therapy alone warrants investigation in future randomized control studies. In pharmacological trials on migraine drugs, rescue medications are usually allowed after 2 h. In our study, we allowed our patients to take analgesics 25 min after the therapy onset. However, median analgesics intake time after onset of cold therapy was 45.0 min in the first and 81.36 min in the second attack of patients who did not respond to gel cap therapy. In the present study, 13 patients in first application and 11 in second application used analgesic drugs due to inefficacy of cold therapy alone. As seen in The placebo effect in the pharmacological treatment of migraine attacks may influence evaluation of the studies. In a meta-analysis of 31 trials involving acute migraine patients, it has been reported that the mean proportion of subjects who experienced a treatment response to placebo was 28% (24). In our study, the response rate was 50% in the first attack and 57% in the second attack. Moreover, placebo effect may vary in each patient and each attack. Therefore, our results cannot be completely attributed to placebo effect of gel therapy. However, we cannot ignore its possible effect on our results. If we accept the cold treatment as an effective modality in migraine patients, there is still one more question to be resolved: How does cold affect the migraine headache? Local anesthesia is important in the use of cryotherapy. Lowering pain stimuli may be caused by a decrease in contraction. The gate theory suggests that the cold sensations overwhelm and block transmission of the pain stimuli into the cerebral cortex. Ice reduces the release of some substances including histamines, vasoactive substances and enzymes that stimulate nerve endings (6). However, the exact mechanism of cryotherapy is still unclear. In Vijayan&apos;s (1) study, two patients could not apply adequate pressure in cold therapy because of tenderness. In our study three patients showed side effects in both applications. Two patients had cold intolerance and one had vertigo. Two of them discontinued the therapy. The use of gel packs is a safe method of applying cold in adjunct treatment of acute headache

Morgagni-Stewart-Morel syndrome presenting with neurological symptoms: a case report

Morgagni-Stewart-Morel (MSM) syndrome is characterized by the thickening of the frontal bone of the skull (hyperostosis frontalis interna) obesity, neurological symptoms, and hypertrichosis. We present the case of a 76-year-old patient who complained of confusion, extreme irritability, and headache and was diagnosed with MSM based on examination, imaging, and test results

Kawasaki disease: report of two cases

Kawasaki hastalıgı sistemik bir vaskülittir. En çok orta boy arterleri tutar. Gelismis ülkelerde çocuklarda edinsel kalp hastalıklarının en sık nedenidir. Halen etiolojisi ve patogenezi tam aydınlatılmamıstır. Koroner arter etkilenmesine baglı ani ölüm ve kronik hastalık riski intravenöz immünglobulin tedavisi sonrası belirgin azalmaktadır. Bu nedenle erken ve dogru tanı prognoz açısından çok önemlidir. Kawasaki hastalıgı tanısı konan iki olgumuzun birinde ekokardiyogramda sol ana koroner arterde dilatasyon saptandı. Diger olguda kardiyak lezyon yoktu. Koroner arter ektazisi izlemde geriledi. Bu makalede, iki olgu nedeniyle Kawasaki hastalıgı'nın tanısı, tedavi ve izlem ilkeleri tartısılmıstır.Kawasaki disease is a systemic vasculitis. It affects medium-sized arteries most commonly. In developed countries, it is the most common reason for acquired cardiac diseases in children. Etiology and pathogenesis of the disease have not yet been completely clarified. Risk of sudden death or chronic cardiac disease due to coronary artery lesions are highly decreased after intravenous immunoglobulin therapy. Thus, early and correct diagnosis is of utmost importance for favorable outcome. In one of the two cases with Kawasaki disease, left main coronary artery was dilated on the echocardiogram. The other patient had no cardiac lesion. Coronary artery ectasia was observed to be regressed. In this paper, due to the two cases, diagnosis, treatment and follow-up principles of Kawasaki disease were discussed

Retospective analysis of risk factors, etiological factors and treatment options in patients with cerebral venous thrombosis

PURPOSE: Cerebral venous thrombosis (CVT) is not a common disease. It is known to have a varied clinical spectrum. There is too much cause of the etiology of disease. In this manuscript we discussed our patients initial symptoms, cause of CVT and our patients' prognosis. MATERIALS and METHODS: This study was a retrospective database analysis of 29 patients who had CVT followed from 2004 to 2010. All of the patients had cranial magnetic resonans imaging (MR) and Mr /Computarized Tomography (CT) venography. RESULTS: There were 27 female, 2 male in this study. Mean age of the patients was 34.97 ±12.79 years old. Only eight patients had abnormal neurological examination (4 patients papilloedema, 2 patients confusion, 1 patient cerebellar dysfunction, 1 patient homonymous hemianopsia). Initial symptoms of patients were headache(n=19), epileptic seizures (n=6), blurred vision (n=1), diplopia (n=2) and one of the patient had vertigo. Ten patients had only one sinus thrombosis however 19 patients had more than one sinus thrombosis. Thrombotic risk factors were found in 21 patients. Most important risc factor were pregnancy, postpartum condition, oral contraceptive usage and acquired hypercoagulable disease. CONCLUSION: CVT is rare but important condition. Sometimes non specific headache is a herald of this condition. Especially pregnancy and postpartum period are susceptibility of this condition