Overview of diagnosis and management of paediatric headache. Part I: diagnosis

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life

K-beta/K-alpha X-Ray Intensity Ratios for Co, Ni, Cu, and Zn in Phthalocyanines Complexes

WOS: 000291836700005The K-beta/K-alpha, X-ray intensity ratios of Co, Ni, Cu and Zn in metalophthalocyanines complexes have been studied. Co, Ni, Cu and Zn elements have been excited by using 59.5 keV photons emitted by 50 mCi (241) Am radioactive source. K X-rays emitted by samples have been counted by a Si(Li) detector with resolution 0.16 keV at 5.9 keV. We have found that K-beta/K-alpha X-ray intensity ratios of Co, Ni, Zn, and Cu complexes have changed depending on chemical structures of Co, Ni, Zn and Cu. The measured values have been compared with the theoretical predictions and experimental values of pure elements

Maximum P wave duration and P wave dispersion in adult patients with secundum atrial septal defect: The impact of surgical repair

Background: Patients with atrial septal defect (ASD) have an increased risk for atrial fibrillation (AF). Previously it was shown that maximum P wave duration and P wave dispersion in 12-lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. We studied P maximum and P dispersion in adult patients with ASD during normal sinus rhythm. In addition, the impact of surgical closure of ASD on these variables within 1 year after surgery was evaluated

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. Patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during, physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients. (C) 2003 Elsevier Ireland Ltd. All rights reserved

Metabolic syndrome negatively impacts early patency of saphenous vein grafts

Background Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (<= 5 years)

Aortic pulse pressure and aortic pulsatility in patients with coronary slow flow

Objective: Coronary slow flow (CSF) is an angiographic phenomenon characterized by delayed opacification of coronary arteries in the absence of obstructive coronary disease. Recently, increased aortic pulse pressure (PP) and aortic pulsatility were both linked to the presence of angiographic coronary artery disease. In this study aortic PP and aortic pulsatility, derived from the invasively measured ascending aortic pressure waveform, were analyzed in patients with CSF and otherwise normal epicardial coronary arteries and compared with those with completely normal coronary arteries. Methods: Fifty consecutive patients with CSF (35 men, mean age: 51.7 +/- 10 years) and fifty age and gender- matched controls (34 men, 51.1 +/- 9 years) were included in the study. For determination of coronary flow, the thrombosis in myocardial infarction (TIMI) frame count method was used. Blood pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Results: Study groups were well matched with respect to age, gender and atherosclerotic risk factors. Although systolic, diastolic and mean pressures of the ascending aorta were similar, aortic PP (60.5 +/- 19 vs. 51.7 +/- 14 mm Hg, p = 0.01) and aortic pulsatility (0.63 +/- 0.1 vs. 0.54 +/- 0.1, p = 0.006) were significantly higher in patients with CSF compared with the controls. Besides, in all subjects, corrected TIMI frame counts of all three coronary arteries correlated with both ascending aorta PP and aortic pulsatility values. No association was found between corrected TIMI frame counts of coronary arteries and aortic mean blood pressure or brachial blood pressure parameters. Conclusion: Our findings suggest that CSF is, as with obstructive coronary artery disease, associated with more diffuse vascular disease rather than being an isolated finding

Mean platelet volume and exercise stress test

Background: Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production

The torque reversals of 4U 1626-67

We investigated the detailed torque-reversal behavior of 4U 1626-67 in the framework of the recently developed comprehensive model of the inner disk radius and torque calculations for neutron stars accreting from geometrically thin disks. The model can reproduce the relation between the torque and X-ray luminosity across the torque reversals of 4U 1626-67. Our results imply that: (1) rotational equilibrium is reached when the inner disk radius equals the co-rotation radius, r(co), while the conventional Alfven radius is greater than but close to r(co) ; (2) both spin-up and spin-down torques are operating on either side of torque reversal; and (3) with the increasing accretion rate, the spin-up torque associated with accretion onto the star gradually dominates the spin-down torque exerted by the disk. The torque reversals are the natural outcome of transitions between the well-defined weak-propeller and spin-up phases of the star with a stable, geometrically thin accretion disk.Sabanci University; TUBITAK (The Scientific and Technological Research Council of Turkey) [120F329]; Bundesministerium fur Wirtschaft und Energie through Deutsches Zentrum fur Luft-und Raumfahrt (DLR) [50 OR 1917]We thank the anonymous referee, for very useful comments that have considerably improved our manuscript. We also thank K. Yavuz Eksi for useful comments on the manuscript. We acknowledge research support from Sabanci University, and from TUBITAK (The Scientific and Technological Research Council of Turkey) through grant 120F329. A.V. acknowledges support from the Bundesministerium fur Wirtschaft und Energie through Deutsches Zentrum fur Luft-und Raumfahrt (DLR) under the grant number 50 OR 1917