Migraine Headache Treated with Famciclovir and Celecoxib: A Case Report.

INTRODUCTION: Herpes simplex virus (HSV) has been speculated to play a role in migraine headache pathophysiology. We present the first successful migraine headache treatment with therapy specifically targeting HSV infection. CASE PRESENTATION: A previously healthy 21-year-old white woman presented with a severe headache and was diagnosed with severe migraine headache disorder. She initially was treated with standard migraine headache medications without symptomatic improvement. She was then given famciclovir and celecoxib. The patient fully recovered within days and continues to enjoy significant reduction in severity and frequency of symptoms. DISCUSSION: Famciclovir and celecoxib may work synergistically against HSV. The virus may play a role in the pathophysiology of migraine headaches, and this is the first case report of successful migraine headache treatment with these medications. Further studies are needed to elucidate the efficacy of these medications in treating migraine disorder.

Precision and long-term stability of clumped-isotope analysis of CO2 using a small-sector isotope ratio mass spectrometer.

RATIONALE: The ratio of the measured abundance of (13)C-(18)O bonding CO(2) to its stochastic abundance, prescribed by the δ(13)C and δ(18)O values from a carbonate mineral, is sensitive to its growth temperature. Recently, clumped-isotope thermometry, which uses this ratio, has been adopted as a new tool to elucidate paleotemperatures quantitatively. METHODS: Clumped isotopes in CO(2) were measured with a small-sector isotope ratio mass spectrometer. CO(2) samples digested from several kinds of calcium carbonates by phosphoric acid at 25 °C were purified using both cryogenic and gas-chromatographic separations, and their isotopic composition (δ(13)C, δ(18)O, Δ(47), Δ(48) and Δ(49) values) were then determined using a dual-inlet Delta XP mass spectrometer. RESULTS: The internal precisions of the single gas Δ(47) measurements were 0.005 and 0.02‰ (1 SE) for the optimum and the routine analytical conditions, respectively, which are comparable with those obtained using a MAT 253 mass spectrometer. The long-term variations in the Δ(47) values for the in-house working standard and the heated CO(2) gases since 2007 were close to the routine, single gas uncertainty while showing seasonal-like periodicities with a decreasing trend. Unlike the MAT 253, the Delta XP did not show any significant relationship between the Δ(47) and δ(47) values. CONCLUSIONS: The Delta XP gave results that were approximately as precise as those of the MAT 253 for clumped-isotope analysis. The temporal stability of the Delta XP seemed to be lower, although an advantage of the Delta XP was that no dependency of δ(47) on Δ(47) was found.

A 6.5-year continuous record of sea surface salinity and seawater isotopic composition at Harbour of Ishigaki Island, southwest Japan.

We produced continuous records of sea surface salinity and isotopic composition from 1998 to 2004 at Ishigaki Island, southwest Japan, and found clear seasonal variations in salinity and oxygen isotopic composition and increasing trends of them after 1999. These increasing trends could be principally due to the decreasing difference between local precipitation (P) and evaporation (E), as a result of the reduction of horizontal vapour transport from adjacent oceans. When samples collected in heavy rainfall events were excluded, the average Deltadelta(18)O/Delta salinity slope was obtained as 0.31, 0.35 in summer and 0.28 in winter. Estimated E/P ratios based on the isotopic box model are in good agreement with the ratios of independently estimated E to observed P.

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks.

PURPOSE: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks. CLINICAL FEATURES: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia. CONCLUSIONS: Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks.

Anesthesia Residents Have a Negative Opinion on Proposed ACGME Changes to the Curriculum: A Pilot Study.

BACKGROUND: The ACGME has proposed changes to the curriculum for anesthesia residents. These changes include increasing critical care from 2 to 4 months, pain from 1 to 3 months, and obstetrics, pediatric, neuroanesthesia, and cardio thoracic anesthesia from 1 to 2 months. In addition, they have included a preoperative clinic for 1 month. METHODS: With IRB approval, a survey of the anesthesia residents at New York University was distributed. The residents questioned ranged from the CA-1 to the Ca-3 class. The survey questioned the residents on their current curriculum and the proposed changes. RESULTS: 22 Residents completed the questionnaire. Seventy-seven percent of the residents polled felt they had enough experience in critical care with the current requirements and 82% did not want the increase to 4 months (p=0.007). Seventy-three percent of the residents responded that their pain management exposure was sufficient and 82% did not want it increased (p=0.011). Overwhelmingly, 82% of those polled felt an entire month of preoperative clinic was not necessary. Seventy-three percent of those residents polled would not be comfortable on subspecialty rotations as early as August of their CA-1 year. 82% felt that too much of their training would be spent outside of the operating room, and the majority (59%) thought more residents would be on each rotation. Moreover, 55% think that the proposed changes will adversely affect residents in training. DISCUSSION: The results of this survey demonstrate that most residents at New York University do not think the current curriculum should change. The majority opinion is that it will negative impact their education.

Ultrasound-guided lumbar plexus block for open reduction and internal fixation of hip fracture.

PURPOSE: Ultrasound technology has been applied to increase both efficacy and safety of certain peripheral nerve blocks. This case report describes the first successful ultrasound-guided lumber plexus block. CLINICAL FEATURES: We describe a 91-year-old woman with aortic stenosis who successfully underwent open reduction and internal fixation of a fractured right hip with a lumbar plexus block. Ultrasound provided direct visualization to help identify the anatomical structures and guide the block needle during performance of the block. Complete block of the lumbar plexus was attained within 15 min, and the surgical procedure was performed uneventfully. CONCLUSION: The use of ultrasound has gained popularity to perform peripheral nerve blocks. In this case report, a successful lumbar plexus block was performed with ultrasound guidance. By direct visualization, using this technology may potentially reduce complications associated with lumbar plexus blocks.