The role of psychological interventions in chronic headache management: a case report

According to the biopsychosocial model, biological, psychological, and social factors entwine and influence each other bi-directionally concerning health conditions. Therefore, especially in disorders such as chronic headache, where behavioral and environmental factors are prominent risk factors and triggers, psychosocial interventions might contribute to reduce the burden of the health condition and related affective disorders and disability.We present the case of a Medication Overuse Headache patient self-reporting psychosocial and cognitive issues, that prompted further clinical-psychological and neuro-cognitive assessment and eventually psychological interventions targeted at headache management in conjunction with medical treatment. Psychological interventions were tailored to the patient’s features and presentation and were successful in reducing headache attacks in terms of intensity, frequency, and debilitation, thereby resulting also in a better perceived general health

Effects of enzyme-replacement therapy in patients with Anderson-Fabry disease: a prospective long-term cardiac magnetic resonance imaging study

Background. Anderson-Fabry disease is a multisystem X-linked disorder of lipid metabolism frequently associated with cardiac symptoms, including left ventricular (LV) hypertrophy gradually impairing cardiac function. Evidence showing that enzyme replacement therapy (ERT) can be effective in reducing LV hypertrophy and improving myocardial function in the long term is limited. Objective. This study aimed to assess the long term effects of ERT with recombinant agalactosidase A (agalsidase beta, Fabrazyme®) on LV function and myocardial signal intensity in 11 patients with Anderson-Fabry disease. Patients. Eleven patients (8 males, 3 females) with varying stages of genetically confirmed Anderson-Fabry disease were examined by means of physical examination and magnetic resonance imaging before ERT with agalsidase beta at 1 mg/kg every other week (study 1) and after a mean treatment duration of 45 months (study 2). Results. At 45 months of treatment, LV mass and LV wall thickness had significantly reduced: 188±60 g vs 153±47 g, and 16±4 mm vs 14±4 mm, respectively. Furthermore, a significant reduction in myocardial T2 relaxation times was noted in all myocardial regions, i.e., interventricular septum 80±5 msec vs 66±8 msec, apex 79±10 msec vs 64±10 msec, and lateral wall 80±8 msec vs 65±16 msec. Changes in LV ejection fraction were not significant. Amelioration of clinical symptoms was observed in all patients. Conclusions. Long term therapy with agalsidase beta at 1 mg/kg every 2 weeks was effective in significantly reducing LV hypertrophy, improving overall cardiac performance and ameliorating clinical symptoms in patients with Anderson-Fabry disease

Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases

The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level > 1.8 mg/dl and pulmonary shunt > 20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate