RESUMO
BioGlue® is an inert, bioadhesive surgical substance commonly used in spinal surgery to aid dural closure. The authors describe two cases in which the use of BioGlue® caused a local reaction culminating in the formation of a granuloma that caused cord compression several years after surgery in one case in which a second operation was required to relieve cord compression and remove the foreign material. In the other case spontaneous resolution occurred. To our knowledge these are the first reports of delayed spinal cord compression secondary to BioGlue®-induced granuloma. We recommend judicious use of this substance.
Assuntos
Granuloma/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Proteínas/efeitos adversos , Compressão da Medula Espinal/etiologia , Adulto , Idoso , Granuloma/diagnóstico , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/diagnóstico , Compressão da Medula Espinal/diagnósticoRESUMO
We report two patients with spinal epithelioid hemangioendothelioma (EH), an uncommon vascular, potentially malignant tumour. Neurological signs, diagnostic images, surgical techniques and complications, histology and the role of adjuvant therapy are discussed. Primary manifestation of EH of the vertebral column is rare. Thorough preoperative clinical and radiological workup, radical surgical excision, and close postoperative follow-up are recommended.
Assuntos
Vértebras Cervicais , Hemangioendotelioma Epitelioide , Neoplasias da Coluna Vertebral/diagnóstico , Adulto , Vértebras Cervicais/cirurgia , Diagnóstico Diferencial , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/cirurgia , Humanos , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
Fas and its ligand (FasL), are a receptor-ligand pair identified as promoting cell death in several tissues. Apoptosis of vascular smooth muscle cells (VSMCs) in human atherosclerotic plaque may contribute to weakening of the fibrous cap, ultimately resulting in plaque rupture. We investigated the ability of monocytes to induce apoptosis of cultured VSMCs through Fas/FasL pathway. In addition, we examined the association of FasL with apoptosis in human coronary plaques. Both activated monocytes and the supernatant obtained from activated monocytes were able to kill cultured VSMCs. The apoptotic response of VSMCs was almost completely blocked by the caspase inhibitor z-VAD-fmk and was partially blocked by incubation with antagonistic anti-Fas IgG1 which suggests that Fas/FasL system was involved in the induction of cell death. An approximate 30 kDa protein, which represents a cleaved, soluble form of FasL, was identified in culture medium from activated monocytes, but not in culture medium from control, unactivated monocytes. Immunohistochemical analysis of human atherosclerotic coronary lesions showed that FasL is expressed by macrophages, and microvessels in the adventitia as well as in the plaque. Finally, double-staining with terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) and FasL antibody showed that FasL enriched lesions always included a number of TUNEL-positive cells. These data suggest that Fas/FasL pathway can be employed by monocytes/macrophages to induce VSMC apoptosis in the atherosclerotic lesions.
Assuntos
Apoptose , Macrófagos/metabolismo , Glicoproteínas de Membrana/farmacologia , Monócitos/metabolismo , Músculo Liso Vascular/citologia , Complexo Antígeno-Anticorpo/farmacologia , Arteriosclerose/metabolismo , Arteriosclerose/patologia , Western Blotting , Células Cultivadas , Cromo/metabolismo , Proteína Ligante Fas , Humanos , Marcação In Situ das Extremidades Cortadas , Pessoa de Meia-Idade , Zimosan/farmacologiaRESUMO
OBJECTIVE AND IMPORTANCE: An arachnoid cyst at the craniocervical junction presenting with obstructive hydrocephalus as a result of blockage of the outflow of the fourth ventricle is described. This is a very rare anatomic site, with only five other cases described in the literature. CLINICAL PRESENTATION: A 37-year-old woman presented with a 9-month history of severe neck pain, persistent vomiting, visual disturbances, and numbness of the nose, cheek, and lips. She had severe bilateral papilledema on ophthalmoscopy. Magnetic resonance imaging revealed a midline cystic lesion extending down to C2. INTERVENTION: The patient underwent posterior fossa craniectomy and excision of the arachnoid cyst. She made a full recovery and was asymptomatic at follow-up examination. CONCLUSION: The symptomatology of these rare craniocervical arachnoid cysts and their development are discussed.
Assuntos
Cistos Aracnóideos/diagnóstico , Cistos Aracnóideos/cirurgia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/cirurgia , Vértebras Cervicais/cirurgia , Crânio/cirurgia , Adulto , Cistos Aracnóideos/complicações , Cistos Aracnóideos/patologia , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Craniotomia , Feminino , Humanos , Hidrocefalia/etiologia , Laminectomia , Imageamento por Ressonância MagnéticaRESUMO
An unusual case with absence and "fusion" of several thoracic and lumbar vertebral bodies leading to a severe thoracolumbar kyphos is presented. Late-onset neurological deterioration occurred due to spinal cord compression, which was treated with anterior decompression. Although several mechanisms for the development of these extensive and rare abnormalities have been proposed, the cause in humans remains unknown. An embryological basis is presented in the light of recent advances in molecular genetics, which show that abnormal notochordal signals and Pax-1 gene expression can produce an experimental phenotype very similar to the one in the patient described here. Thus it is suggested that faults in these early developmental processes may be, at least in part, responsible for the development of such extensive anomalies.
Assuntos
Proteínas de Ligação a DNA/genética , Expressão Gênica , Vértebras Lombares/anormalidades , Vértebras Torácicas/anormalidades , Fatores de Transcrição/genética , Humanos , Cifose/diagnóstico , Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Fatores de Transcrição Box Pareados , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios XRESUMO
This case is believed to be the first reported recurrent intracranial ganglioglioma with purely neuroblastomatous malignant transformation. A complete macroscopic resection of a right frontal lobe tumor in an 18-year-old woman revealed differentiated ganglioglioma. Seven years later a large, well-demarcated recurrent tumor was again macroscopically totally resected in the same patient. Histological analysis showed malignant transformation in only the neuronal component of the original tumor. A review of the literature on recurrent gangliogliomas and their malignant transformation is included.
Assuntos
Neoplasias Encefálicas/patologia , Transformação Celular Neoplásica , Ganglioglioma/patologia , Segunda Neoplasia Primária/patologia , Neuroblastoma/patologia , Adulto , Neoplasias Encefálicas/cirurgia , Feminino , Ganglioglioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Segunda Neoplasia Primária/cirurgia , Neuroblastoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A series of 80 cases of medulloblastomas in children undergoing operation and postoperatively followed between 1980 and 1990 at Great Ormond Street Hospital for Children (GOSH) has been reviewed and compared to an earlier series reported from the same institution by McIntosh. The overall 5-year survival rate for the present series was 50%, although three patients died after surviving 5 years. The operative mortality rate was 5%. Survival analysis revealed that the presence or absence of spinal metastases and the necessity for some form of cerebrospinal fluid diversion within 30 days of the operation independently significantly affected survival in this series. Those patients with no spinal metastasis and total tumor removal had a 5-year survival rate of 73%, making this the most favorable subgroup in the series. Patient age and gender, duration of symptoms, Chang T stages, tumor volume, extent of resection, and postoperative chemotherapy were not significant variables. Although these results are better than those reported in the earlier GOSH series, they are not significantly different from the results of the second 5-year cohort of patients described in that article. Radiotherapy remains the greatest advance in treatment, although it is hoped that further improvement will result from the various chemotherapy protocols now being studied and from increasing knowledge of the biological behavior of these tumors.
Assuntos
Neoplasias Cerebelares/mortalidade , Meduloblastoma/mortalidade , Adolescente , Distribuição por Idade , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/cirurgia , Derivações do Líquido Cefalorraquidiano , Quimioterapia Adjuvante , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lactente , Masculino , Meduloblastoma/diagnóstico , Meduloblastoma/cirurgia , Mielografia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Cuidados Paliativos , Radioterapia Adjuvante , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
Three cases of extensive vertebral fusions with absent clivo-axial angle are presented. The 'bone-within-bone' appearance in two patients with almost complete fusion of the spine suggested ossification of the notochord and perinotochordal sheath. On the basis of the radiological appearances and the results of recent molecular genetic studies on vertebrate embryos, the suggested time of segmentation failure along the axis of the craniovertebral junction and between vertebrae is the third to fifth week of gestation. The possible roles of the Pax-1 gene and of signalling between notochord and sclerotome are discussed, concluding that an early defect of the notochord may be responsible for this type of failure of segmentation. Indications for surgery in these cases included cord compression with brachialgia and 'chin-on-chest' deformity causing severely restricted visual fields. A critical review of clinical lessons learned in the operative treatment is presented.
Assuntos
Osso e Ossos/anormalidades , Proteínas de Ligação a DNA , Coluna Vertebral/anormalidades , Fatores de Transcrição , Adulto , Criança , Feminino , Humanos , Masculino , Notocorda , Fatores de Transcrição Box PareadosAssuntos
Anticoagulantes/farmacocinética , Hidrocarboneto de Aril Hidroxilases/genética , Varfarina/farmacocinética , Fatores Etários , Idoso , Anticoagulantes/química , Povo Asiático/genética , Estudos de Coortes , Citocromo P-450 CYP2C9 , Feminino , Variação Genética , Hong Kong , Humanos , Masculino , Taxa de Depuração Metabólica/genética , Pessoa de Meia-Idade , Estereoisomerismo , Varfarina/químicaRESUMO
A high-speed motorcycle crash is a risk factor for thoracic aortic injury due to the rapid deceleration mechanism. We present a previously healthy 44-year-old man who was involved in a motorcycle accident. Initial spiral computed tomography indicated an intimal flap, which was visualized with evidence of mediastinal hemorrhage. The man was taken emergently to the operating room where a patent ductus arteriosus was seen at the location of the suspected aortic injury. No true aortic injury was appreciated.
Assuntos
Acidentes de Trânsito , Aorta Torácica/lesões , Dissecção Aórtica/diagnóstico , Permeabilidade do Canal Arterial/diagnóstico , Achados Incidentais , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta Torácica/diagnóstico por imagem , Diagnóstico Diferencial , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Transesofagiana , Serviço Hospitalar de Emergência , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Cuidados Intraoperatórios/métodos , Masculino , Motocicletas , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Toracotomia/métodos , Resultado do TratamentoRESUMO
We show, for the first time, the spatiotemporal appearance of Cyp1b1 protein during mouse eye ontogeny. The protein was unambiguously identified in the adult mouse eye and newborn (P0) whole mouse microsomes and was shown to be localized in inner ciliary epithelium, corneal epithelium, retinal inner nuclear cells, and ganglion cells. The enzyme protein was present in the lens epithelium adjacent to the developing ciliary body at 15.5 days postconception (E15.5) and was most strongly expressed during E17.5 to 7 days postnatally (P07). Subsequently, it declined to very low levels. The protein was also expressed in the corneal endothelial cells adjacent to the ciliary body at P07. Cyp1b1 was barely detectable in the inner ciliary epithelium before E17.5 but increased rapidly postnatally, reaching adult levels by P28. Levels of the enzyme protein in the corneal epithelium were seen from E15.5 onward, increasing sharply, and after a decrease at P07, were highest in the adult animal eye. The presence of Cyp1b1 protein in the inner nuclear layer of the retina was very low in the prenatal eye, increasing rapidly postnatally, and was highest in the adult animal eye. In the ganglion cell layer of the retina, it increased slowly from E15.5 to P07 and then rapidly reached adult levels. Interestingly, Cyp1b1 was not detected in the trabecular meshwork at any stage of development or in the adult eye. We conclude that the enzyme may play important roles in normal eye development and function in mice as in humans, and that the mouse may prove to be an excellent model for determination of the roles of CYP1B1 in human eye development and function.
Assuntos
Hidrocarboneto de Aril Hidroxilases/metabolismo , Olho/embriologia , Olho/enzimologia , Animais , Animais Recém-Nascidos , Citocromo P-450 CYP1B1 , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos C57BLRESUMO
Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described. To investigate the risk of LAR (rejection > or = 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation. Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001). Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.
Assuntos
Rejeição de Enxerto/patologia , Rejeição de Enxerto/prevenção & controle , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Doença Aguda , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Rejeição de Enxerto/imunologia , Hepacivirus/efeitos dos fármacos , Hepacivirus/fisiologia , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Hepatite B/cirurgia , Hepatite B/virologia , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/fisiologia , Hepatite C/tratamento farmacológico , Hepatite C/imunologia , Hepatite C/cirurgia , Hepatite C/virologia , Humanos , Transplante de Fígado/imunologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/farmacologia , Fatores de Risco , Fatores de TempoRESUMO
Immunosuppression is often incriminated for the increased risk of post-transplant malignancies. To examine whether triple- (MMF+Tacro+CS) versus dual-drug therapy (Tacro+CS) is associated with an increased incidence of malignancy, or death due to malignancy, data from a large registry of liver transplant recipients were analyzed. Data from adult primary liver recipients reported to the Scientific Registry of Transplant Recipients between June 1, 1995, and April 30, 2004, and recorded at transplant on triple-drug (n = 9180) or dual-drug (n = 10 099) therapy were included. Kaplan-Meier survival analysis showed no significant differences in death due to malignancy 4 years post-transplantation between the treatment groups. Multivariable analysis using Cox proportional hazard models confirmed no differences in risk of death due to malignancy between the groups (HR: 0.83, p = 0.107). Incidence of any post-transplant malignancy was also not significantly different. Older recipient age and cause of liver disease were significantly associated with an increased risk of malignancy-related death. These data utilizing relatively short follow-up suggest the addition of MMF to Tacro+CS at transplant is not associated with death due to malignancy, at least in the short term. Individual recipient factors appear to be important risk factors for malignancy-related death; elucidating these risk factors can assist in identifying who should be monitored most aggressively for post-transplant malignancies.
Assuntos
Corticosteroides/administração & dosagem , Rejeição de Enxerto/tratamento farmacológico , Imunossupressores/administração & dosagem , Transplante de Fígado/mortalidade , Ácido Micofenólico/análogos & derivados , Tacrolimo/administração & dosagem , Adolescente , Adulto , Idoso , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Neoplasias/mortalidade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Análise de SobrevidaRESUMO
Manipulating the expression of a transgene in transient and stable transformed cells is a requirement for many functional analyses. We have investigated the use of the tetracycline-dependent gene expression system developed by Gatz et al. (1992) in tobacco (Nicotiana tabacum L. cv Bright Yellow 2 [BY2]) cells, the most widely used plant cell culture. We have selected a BY2 cell line, named BY2-tetracycline repressor (tetR) 17, which expresses the tetR at a high level, and have evaluated the capacity of this cell line to suppress the expression of a green fluorescent protein reporter gene under the control of the "Triple-Op" promoter in the absence of tetracycline in a large number of independent transformants. The ability to induce the expression of green fluorescent protein after treatment by anhydrotetracycline in the same transformants was also analyzed. BY2-tetR17 cells were demonstrated to be excellent recipient cells for recovery of clonal cell lines with a highly controlled regulation of the introduced transgene.
Assuntos
Glucuronidase/genética , Nicotiana/genética , Plantas Tóxicas , Proteínas Repressoras/genética , Agrobacterium tumefaciens/genética , Linhagem Celular , Glucuronidase/análise , Cinética , Proteínas Recombinantes/análise , Proteínas Recombinantes/biossíntese , Tetraciclina/farmacologia , Nicotiana/citologia , TransfecçãoRESUMO
Tuberculosis of the craniovertebral junction is extremely rare. However, recent evidence suggests that the incidence of this condition may be increasing in the United Kingdom. The diagnosis is often difficult despite advances in imaging using MRI. CT guided biopsy of lesions often yields inconclusive results. The transoral approach to the anterior craniovertebral junction provides excellent access to this region with a low operative morbidity and mortality, enabling biopsy of lesions and decompression of the neuraxis. Management of secondary atlantoaxial instability, regarding both timing and method of stabilization, is controversial. We report two cases of tuberculomas of the craniovertebral junction, that illustrate the role of transoral surgery in both diagnosis and treatment of this condition. Previous management strategies are reviewed and future recommendations are presented.
Assuntos
Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Compressão da Medula Espinal/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnósticoRESUMO
Fibrous dysplasia (FD) is an uncommon benign fibro-osseous abnormality of bone, of unknown aetiology and equal sex incidence, which is most commonly restricted to one bone (monostotic FD: MFD, 70%). Less commonly multiple bones are affected (polyostotic FD: PFD, 27%). Vertebral involvement is uncommon (4%), but more common with PFD (7 - 24%) than MFD (1%). Of 20 cases of FD involving the cervical spine, only three have represented MFD. Unlike cases associated with PFD, all cases presented with acute neck pain without significant neurological impairment after minor trauma. We present the case of a 35-year-old male with MFD who developed a pathological fracture of C3 following minor trauma. Radiographs showed collapse and typical 'ground glass' lucency of C3. CT revealed replacement of C3 cancellous bone by hypodense tissue extending into the right lateral mass. The cortex was thinned and fractured, and encroached upon the right foramen transversarium and spinal canal. Magnetic resonance imaging demonstrated hypo-intensity on both T1 and T2, with uniform contrast enhancement. Subtotal excision was achieved via an anterior C3 corpectomy, with residual FD left within the right lateral mass. Stability was achieved utilizing an iliac crest strut autograft, C2-4 plate-and-screws, and mobilization in a halo frame for 3 months. At 18 months, he remained asymptomatic and without deficit. Radiography, CT and MRI confirmed graft fusion without FD invasion, but with residual right lateral mass FD unchanged in size.
Assuntos
Vértebras Cervicais/lesões , Displasia Fibrosa Monostótica/complicações , Fraturas Espontâneas/etiologia , Fraturas da Coluna Vertebral/etiologia , Adulto , Diagnóstico Diferencial , Displasia Fibrosa Monostótica/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
A cDNA clone encoding an antimicrobial chitin-binding protein from amaranth (Amaranthus caudatus L.) was isolated using a cDNA library constructed from near-mature seed poly(A)+ mRNA. The deduced amino acid sequence of the cDNA clone encodes a predicted polypeptide of 86 amino acids. This polypeptide has three distinct domains: an amino-terminal putative signal peptide (25 amino acids), a domain corresponding to the mature protein (30 amino acids), and a carboxyl-terminal propeptide (31 amino acids) containing a putative N-glycosylation site. The encoded protein differs from all known members of the family of chitin-binding proteins. Transcripts of the expected size (650 bp) are present in developing seeds but not in roots, leaves or stressed leaves.
Assuntos
Anti-Infecciosos , Quitina/metabolismo , Proteínas de Plantas/genética , Plantas/genética , Sequência de Aminoácidos , Sequência de Bases , Northern Blotting , Clonagem Molecular , DNA , Dados de Sequência Molecular , Proteínas de Plantas/metabolismoRESUMO
We report seven cases of rare high cervical split spinal cord associated with extensive vertebral fusions (Klippel-Feil anomaly). In light of previous embryological theories and recent research findings we attempt to explain the origin of split cord and vertebral fusions. Two distinctly separate mechanisms are suggested for the development of split cords observed in our cases: a midline lesion bisecting the neuroepithelium and the notochordal plate could be responsible for complete splitting of the cervical cord with anterior bony defect while a localized disturbance of cervical neural tube closure would account for cases with partial dorsal splitting of the cord with posterior vertebral defect. Vertebral fusion anomalies are likely to be associated with disturbance of Pax-1 gene expression in the developing vertebral column. We confirm with our cases the frequent association of failure of normal segmentation and split cord in the cervical region. Clinically, only three patients had neurological deficit which was mild and has remained stable, and they had no radiological evidence of tethering; the minimal disproportionate growth of the cord and spine and the rarity of a bony spur in the cervical region are the likely reasons. A conservative policy was therefore pursued in these cases with careful long-term follow-up.
Assuntos
Síndrome de Klippel-Feil/diagnóstico , Espinha Bífida Oculta/complicações , Espinha Bífida Oculta/diagnóstico , Adolescente , Adulto , Criança , Proteínas de Ligação a DNA/genética , Feminino , Humanos , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/genética , Pessoa de Meia-Idade , Fatores de Transcrição Box Pareados , Espinha Bífida Oculta/genética , Fatores de Transcrição/genéticaRESUMO
OBJECTIVES: To compare the interviewer-administered Quality of Well-being Scale (QWB) with a self-administered form (QWB-SA) for patients with migraine, and to compare the health status of migraineurs to other medical populations. BACKGROUND: With the increasing need to document the cost-effectiveness of treatment for migraine, limitations with both the Medical Outcomes Study Short Form-36 items and the QWB have been an impediment to research using cost-effectiveness as an outcome. Demonstrating the sensitivity of an alternative instrument which addresses these limitations would facilitate cost-effectiveness analyses on treatments for migraine. METHODS: Eighty-nine adults (87% women) known to suffer from migraine were asked to complete both the interviewer-administered QWB and the self-administered version (QWB-SA) on three occasions. The first occasion was on a day when no migraine was experienced in the previous 7 days. The second and third assessments were completed within 48 hours of the onset of a migraine. RESULTS: While both the QWB and the QWB-SA successfully distinguished migraine from nonmigraine days, more migraines were reported on the QWB-SA. Overall, both instruments showed similar patterns of patient dysfunction during a migraine attack. Each component of the QWB-SA successfully distinguished migraine from nonmigraine days, and the QWB-SA showed a linear sensitivity to pain intensity and disability during a migraine episode. Both instruments are able to detect a migraine's effect on multiple domains of quality of life. Study participants scored significantly lower on the QWB-SA during a migraine episode than several comparison medical populations. CONCLUSIONS: The QWB and the QWB-SA appear to have sensitivity to migraine severity, and the ability to quantitate an effect in multiple quality-of-life domains. Both measures can be used to calculate quality-adjusted life-years, thus facilitating cost-effectiveness and health policy work in this important clinical area.