Abdominal migraine: a cause of abdominal pain in adults?

Eighty-five patients with non-organic abdominal pain, were interviewed with the help of a questionnaire. Those who responded to a high fibre diet were excluded from the study. Twenty-seven patients had multiple pains and 58 described a single pain, which was intermittent in 39. A detailed analysis of the symptoms and family history of the latter group suggested that in 19 patients the symptoms might have been caused by abdominal migraine. Six of these 19 had typical migraine-associated symptoms during the attack, characteristic abdominal pain and a family or personal history of classical migraine. Abdominal migraine should be considered in patients with non-organic abdominal pain where symptoms are not typical of irritable bowel syndrome and when organic disease has been excluded.

Abdominal migraine: does it exist?

Abdominal migraine is well recognised in children, but in spite of anecdotal reports migraine is not well established as a cause of abdominal pain in adults. Functional abdominal pain is usually classified as either irritable bowel syndrome or nonulcer dyspepsia, but some patients have intermittent abdominal pain associated with headache or other migraine accompaniments and, in these, a diagnosis of abdominal migraine should be considered. It is possible that some patients with functional abdominal pain have migraine presenting with few or even no migraine accompaniments. There is no nonclinical objective standard for diagnosing migraine, and research in this area is therefore very difficult. Nevertheless, some patients with functional abdominal pain may respond to antimigraine medication and, if their symptoms are suggestive, a trial of therapy may be desirable.

Recurrent intraoral osseous choristoma. Report of a case.

The osseous choristoma of buccal soft tissue (intraoral soft tissue osteoma) is a rare entity that is reported not to recur after removal. A case involving the first documented recurrence of such a lesion is reported, and a review of the literature is presented.

Prognostic indicators and clinical course in proctosigmoiditis.

The progress and outcome of proctosigmoiditis (PS) varies from a benign self limited illness to severe or continuous disease which may require major surgery. This study identifies certain clinical features in the presenting attack which appear to influence the subsequent course of the disease. Ninety-nine patients with PS were referred to a colitis clinic between 1975 and 1985. Sixty have been followed for at least five years or have required surgery. They have been classified as follows. Group A-asymptomatic after presenting attack (n = 14), group B-symptoms after presenting attack for less than 10% of follow-up (n = 25), group C symptoms for greater than 10% of follow-up (n = 11), group D - patients requiring surgical intervention (n = 10). Data obtained during the initial attack, including sex, age, length of history, disease extent, length of first attack and therapy, were analysed. There was no significant difference in the length of history or extent of disease between groups. The mean ages in groups A-D were 40, 45, 30 and 24 years respectively. The ages of groups A and B were not significantly different, but differed from group C (p less than 0.05) and from group D (p less than 0.005). The length of the first attack was significantly shorter (p less than 0.01) in groups A and B (median 1.0 and 3.0 months respectively) than in groups C and D (median 5.0 and 6.0 months respectively).

Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis.

Sleeping with the bed-head raised is commonly recommended as treatment for patients with troublesome oesophagitis, but its effect has not been objectively tested. Ranitidine therapy is useful in oesophagitis, but it does not often produce complete relief of symptoms. The effects of each of these treatments alone and in combination have been studied in 71 patients with severe (grade III) peptic oesophagitis. Each treatment improved both symptoms and endoscopic appearances significantly more than placebo did. However, the combination of the two treatments was much better than either alone; the reduction in pain score and the area of ulceration healed were about twice those with either treatment alone. Smoking more than five cigarettes per day or drinking more than 30 g alcohol per day significantly reduced the effectiveness of ranitidine therapy, but age, sex, body weight, or the presence of a hiatus hernia had no detectable effect.

N-nitrosodimethylamine precursors in malt.

NDMA is formed in malt because NOx reacts with certain amines in germinated barley when it is kilned. Hordenine is the major precursor of NDMA, although gramine and sarcosine can possibly contribute minor amounts. The hordenine is formed in the developing seedling. The amount of hordenine present in unkilned malts, made using a variety of malting techniques, is always much more than sufficient to account for NDMA formation. Malting techniques which inhibit hordenine breakdown during kilning decrease NDMA formation. Nitrosated intermediates formed from hordenine on treating with NOx at relatively low temperatures (ca 40 degrees C), can be separated by HPLC. They give NDMA on heating with additional NOx. The conditions under which the intermediates are formed and under which they are converted to NDMA correspond to the observed pattern of NDMA formation during kilning. The effects of sulfuring at different times can be explained by the effects on formation and breakdown of the intermediates.