When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month.

Introduction According to the IHCD-3ß classification, chronic migraine (CM) is headache occurring on 15 or more days/month. Episodic migraine (EM) can be divided into low frequency (LFEM) and high frequency (HFEM) depending on the headache days suffered per month. Methods We performed a clinical comparison of migraine characteristics according to monthly headache days suffered. Patients were divided into three groups: LFEM (1-9 headache days/month), HFEM (10-14 headache days/month) and CM (≥15 headache days/month). Results The analysis included 1109 patients. Previously reported differences between EM and CM were replicated. However, there were three times more clinical differences between LFEM and HFEM than between HFEM and CM (15 vs. 6). A new model that takes 10 headache days as a cut-off value for CM would have a minimally higher predictive capacity (72.8%) and no statistical differences (71.8%) when comparing it to the current classification. Conclusions HFEM patients have few clinical differences compared with CM patients. This includes the poor outcomes regarding headache-related disability and impact on daily life. According to these findings, neurologists and headache specialists should consider that the emotional and functional impact in HFEM patients could be as disabling as in those with CM.

Candidate-gene association study searching for genetic factors involved in migraine chronification.

INTRODUCTION: Chronic migraine (CM) is at the severe end of the clinical migraine spectrum, but its genetic background is unknown. Our study searched for evidence that genetic factors are involved in the chronification process. METHODS: We initially selected 144 single-nucleotide polymorphisms (SNPs) from 48 candidate genes, which we tested for association in two stages: The first stage encompassed 262 CM patients, the second investigated 226 patients with high-frequency migraine (HFM). Subsequently, SNPs with p values < 0.05 were forwarded to the replication stage containing 531 patients with CM or HFM. RESULTS: Eight SNPs were significantly associated with CM and HFM in the two-stage phase. None survived replication in the third stage. DISCUSSION: We present the first comprehensive genetic association study for migraine chronification. There were no significant findings. Future studies may benefit from larger, genome-wide data sets or should use other genetic approaches to identify genetic factors involved in migraine chronification.

Methylmercury decreases cellular excitability by a direct blockade of sodium and calcium channels in bovine chromaffin cells: an integrative study.

Methylmercury, a potent environmental pollutant responsible for fatal food poisoning, blocked calcium channels of bovine chromaffin cells in a time- and concentration-dependent manner with an IC50 of 0.93 µM. This blockade was not reversed upon wash-out and was greater at more depolarising holding potentials (i.e. 21 % at -110 mV and 60 % at -50 mV, after 3 min perfusion with methylmercury). In ω-toxins-sensitive calcium channels, methylmercury caused a higher blockade of I Ba than in ω-toxins-resistant ones, in which a lower blockade was detected. The sodium current was also blocked by acute application of methylmercury in a time- and concentration-dependent manner with an IC50 of 1.05 µM. The blockade was not reversed upon wash-out of the drug. The drug inhibited sodium current at all test potentials and shows a shift of the I-V curve to the left of about 10 mV. Intracellular dialysis with methylmercury caused no blockade of calcium or sodium channels. Voltage-dependent potassium current was not affected by methylmercury. Calcium- and voltage-dependent potassium current was also drastically depressed. This blockade was related to the prevention of Ca(2+) influx through voltage-dependent calcium channels coupled to BK channels. Under current-clamp conditions, the blockade of ionic current present during the generation and termination of action potentials led to a drastic alteration of cellular excitability. The application of methylmercury greatly reduced the shape and the number of electrically evoked action potentials. Taken together, these results point out that the neurotoxic action evoked by methylmercury may be associated to alteration of cellular excitability by blocking ionic currents responsible for the generation and termination of action potentials.

Update on the Serum Biomarkers and Genetic Factors Associated with Safety and Efficacy of rt-PA Treatment in Acute Stroke Patients.

An accurate understanding of the mechanisms underlying an individual's response to rt-PA treatment is critical to improve stroke patients' management. We thus reviewed the literature in order to identify biochemical and genetic factors that have been associated with safety and efficacy of rt-PA administration after stroke.

Enfermedad pilonidal. tratamiento por exéresis en bloque con cierre primario / Pilonidal sinus disease. Treatment by means of en bloc excision with primary closure

Introducción. El objetivo del presente estudio es exponer los resultados obtenidos en el tratamiento de la enfermedad pilonidal crónica por el método de exéresis en bloque con sutura primaria y profilaxis antibiótica preoperatoria. Pacientes y método. Se estudian retrospectivamente 100 pacientes, intervenidos de enfermedad pilonidal sacrococcígea crónica, durante el período comprendido entre enero de 1997 y diciembre de 1998. Se analizan la técnica quirúrgica, la estancia media, la morbilidad y la tasa de recurrencia. El período medio de seguimiento ha sido de 19 meses (rango, 12-34 meses). Resultados. De los 100 pacientes operados, hubo 70 curaciones y en 30 casos aparecieron las siguientes complicaciones: tres hematomas, tres seromas, ocho infecciones de la herida y 11 dehiscencias parciales. Un 6 por ciento de los casos fueron recidivados. La duración media de la hospitalización fue 10 días y el tiempo medio de cicatrización de 12 días. Conclusiones. La resección simple más cierre primario en la enfermedad pilonidal crónica es bien tolerada por los pacientes, tiene un tiempo de cicatrización corto y permite una rápida incorporación al trabajo (AU)

Hernia de spiegel. A propósito de 16 casos / Spigelian hernia. A report of 16 cases

Presentamos una serie de 16 casos de hernia de Spiegel operados en nuestro Servicio, uno de los cuales precisó intervención de urgencia y resección intestinal. Se revisa la anatomía de estas hernias y sus formas clínicas de presentación. Exponemos los procedimientos diagnósticos usados en esta enfermedad, destacando el gran valor de la ecografía y la TC para localizar el defecto parietal y el contenido herniario. En todos los casos, la hernia se localizó infraumbilicalmente y por debajo de la aponeurosis del oblicuo mayor. A todos los pacientes se les realizó herniorrafia con o sin prótesis. La morbilidad, mortalidad y recidiva herniaria fueron nulas (AU)

[Morbidity reduction in preterm newborns fed with milk of their own mothers]. / Disminución de la morbilidad en neonatos pretérmino alimentados con leche de su propia madre.

In order to study the effect of feeding on the morbidity, 118 premature newborn, were followed on successive basis; 59 fed with infant term formula (F) and 59 fed with own mother's milk (LH). The patients were classified in 3 groups according to birth weight: I, < 999 g (n = 4/4); II, 1000-1499 g (n = 37/37) and III, 1500-1999 g (n = 18/18), each group F and LH having equal numbers. Growth, morbidity and clinical management were recorded. Necrotizing enterocolitis (P < 0.001), urinary tract infection (P < 0.01) and infectious diarrhea (P < 0.01) were less frequent in LH infants and as a consequence these infants needed less antimicrobial therapy (P < 0.001), nevertheless the human milk contained flora bacteria. The LH infants of group II need fewer red cell transfusions (P < 0.001) and each group was similar and only the babies < 999 g had increments of approximately 15 g/kg/day. This study highlights the importance of feeding the premature infant with own mother's milk; however, the infant growth increments were less than the expected suggesting that human milk must be fortified with proteins and minerals, considering the mothers as a true human milk bank.