Ruminal motility, reticuloruminal fill, and eating patterns in steers exposed to ergovaline.

Fescue toxicosis is problematic for growing steers, causing lower DMI and productivity when fed endophyte-infected (E+) tall fescue. A complete understanding of underlying mechanisms of how fescue toxicosis affects growing steers is lacking. Therefore, the overall objective of this multiexperiment study was to determine whether ruminally dosed ergovaline (ERV) affects rumen motility, rumen contents, and eating patterns. In Exp. 1, an 8-h period to assess ruminal motility began 4 h after feeding by monitoring pressure changes using a wireless system for 21 d. Eight ruminally cannulated steers (283 kg BW) were pair fed with alfalfa cubes (1.5 × NEm) and assigned to endophyte free (E-; 0 µg ERV/kg BW/d) or E+ treatment (20 µg ERV/kg BW/d). Overall, E+ steers had more frequent rumen contractions (Seed P = 0.05 and day of feeding P = 0.02). On days 7 to 9, both treatments showed lower frequencies and E- steers had greater amplitude of contractions (P < 0.001) that corresponded with decreased DMI. In Exp. 2, steers remained in pairs assigned in Exp. 1 (322 kg BW), but reversed seed treatments while increasing ERV levels (titrated 0, 5, 10, 15, and 20 µg ERV/kg BW/d over 57 d). There were no differences between E- and E+ for frequency (P = 0.137) or amplitude of contractions (P = 0.951), but increasing ERV dosage, decreased frequency (P = 0.018) and amplitude (P = 0.005), coinciding with lower DMI. In Exp. 3, 8 steers (589 kg) were pair fed and ruminally dosed 15 µg ERV/kg BW/d, and rumen motility data were collected for 21 d. E- steers showed higher amplitude and lower frequency of contractions than E+ steers with seed (P < 0.001), day (P < 0.001), and seed × day (P < 0.04) effects, but rumen fill was not different between E- and E+ (P > 0.29). Serum prolactin concentrations were lower in E+ steers in Exp. 1 to 3. Eating patterns of pair-fed E- and E+ steers were relatively slower in E+ than E- (Exp. 4) by measuring every 2 h across 24 h. Number of meals were higher in E+ than E- steers, but meal duration and meal size were not different between treatments. Rumen content (DM%) tended to be higher in E+ than in E- when steers were fed once a day (P = 0.07), but there was no difference for rumen content (DM%) when E- and E+ steers were fed 12 times a day (P = 0.13). These results suggest the changes in rumen fill associated with fescue toxicosis may be driven more by changes in feeding behavior and eating pattern rather than by changes in motility.

Neuropatía úptica isquémica anterior unilateral asociada con ergotismo / Anterior unilateral ischemic optic neuropathy associated to ergotism

Case report of a patient with ergotism. ergotism is a complication of acute intoxication of chronic abuse of ergot derivates. Ergot is a fungus that grows on rye and less commonly on other grases such as wheat. Ergotism is a severe reaction to ergocontaminated food (such as rye bread). Ergot refers to a group of fungi of the genus Claviceps. It is a condition that develops of longterm ingestion of ergotamines. In excess, ergotamine can cause symptos such as hallucinations, severe gastrointestinal upset, a type-of dry gangrene and a pain-ful sensation in the extremities. Our patient is presented with anterior unilateral ischemic optic neuropathy. The studies performed and the clinical evaluatiion, are presented, and the treatment the same as the follow-up, are described in the article.

[Medication overuse headache]. / Abuzusnaia golovnaia bol'.

Rebound headache (RH) is a chronic daily headache which occurs when analgesics, triptans, ergotamines are taken frequently (more than 15 days/month for more than 3 months) to relieve headaches. The prevalence of RH is 1 to 4% in the general population. RH commonly occurs in patients with migraine and tension-type headache. The deficit of central sensitization and psychological factors play an important role in initiating and maintaining of RH. Treatment of noofen for 2 months is effective in 75% of patients with RH.

Adverse cardiovascular events associated with triptans and ergotamines for treatment of migraine: systematic review of observational studies.

BACKGROUND: Apart from the underlying cardiovascular (CV) risk associated with migraine, both triptans and ergotamines can induce vasoconstriction and potentially increase the risk of serious ischemic events. Because of the low frequency of such events in eligible patients, randomized controlled trials are not exhaustive to assess the drug-related CV risk. Observational studies are, therefore, an essential source of information to clarify this matter of concern. AIM: The aim of this study was to systematically review the available published observational studies investigating the risk of serious CV events in triptan or ergotamine users, as compared to unexposed migraineur controls. METHODS: We systematically searched MEDLINE and EMBASE electronic databases for cohort or case-control studies up to December 1, 2013. Studies retrieved from CDSR, DARE and HTA databases of the Cochrane Library were used for snowballing. Studies investigating the risk of any CV outcome in patients with a migraine diagnosis and exposed to triptans or ergotamines were considered for inclusion. Selection of studies, data extraction, and risk of bias assessment were conducted independently by two reviewers. Pooled odds ratios (ORs) with 95% confidence interval (95% CI) were computed using a random-effects model for studies and outcomes judged eligible for quantitative data synthesis. RESULTS: From a total of 3370 citations retrieved, after duplicate removal and screening, only four studies met the inclusion criteria (three nested case-control analyses and one retrospective cohort study). These studies investigated the risk of different CV outcomes associated with either the recency or the intensity of exposure to the studied drugs. As for the intensity of use, the pooled OR of serious ischemic events was 2.28 (95% CI 1.18-4.41; I (2 )= 0%) for ergotamine use (two studies), whereas for triptans (three studies) it was 0.86 (95% CI 0.52-1.43; I (2 )= 24.5%). Recent use of ergotamines was not significantly associated with any CV outcome (only one available study). Two studies investigated the risk of stroke related to recent triptan use: the first study reported an OR of 0.90 (0.64-1.26), and the second one suggested an increased risk of 2.51 (1.10-5.71). In this case, because of the high degree of heterogeneity, results were not pooled. CONCLUSIONS: To date, few comparative observational studies have investigated the CV safety of migraine-specific drugs in clinical practice. Evidence gathered here suggests that intense consumption of ergotamines may be associated with an increased risk of serious ischemic complications. As for triptans, available studies do not suggest strong CV safety issues, although no firm conclusions can be drawn. In particular, evidence on stroke risk is conflicting. However, if an increase of the absolute stroke risk in recently exposed patients does actually exist, it must be small. Overall, residual uncontrolled confounding factors reduce the confidence in the risk estimates collected from the included studies. Further investigations are needed to better define the risk for rare but serious CV events related to triptan and ergotamine use for treatment of migraine.

Medication overuse headache in Europe and Latin America: general demographic and clinical characteristics, referral pathways and national distribution of painkillers in a descriptive, multinational, multicenter study.

BACKGROUND: Medication overuse headache (MOH) is a very disabling and costly disorder due to indirect costs, medication and healthcare utilization. The aim of the study was to describe general demographic and clinical characteristics of MOH, along with the national referral pathways and national painkillers distribution in several European and Latin American (LA) Countries. METHODS: This descriptive cross-sectional observational study included 669 patients with MOH referred to headache-centers in Europe and LA as a part of the COMOESTAS project. Information about acute medication and healthcare utilization were collected by extensive questionnaires, supplemented with structured patient interviews. RESULTS: Triptans were overused by 31 % European patients and by 6 % in LA (p < 0.001), whereas ergotamines were overused by 4 % in Europe and 72 % in LA (p < 0.001). Simple analgesics were overused by 54 % in Europe and by 33 % in LA (p < 0.001), while combination-analgesics were more equally overused (24 % in Europe and 29 % in LA). More European patients (57 %) compared with LA patients (27 %) visited general practitioners (p < 0.001), and 83 % of European patients compared to 38 % in LA consulted headache specialists (p < 0.001). A total of 20 % in Europe and 30 % in LA visited emergency rooms (p = 0.007). CONCLUSION: There are marked variations between LA and Europe in healthcare pathways and in acute medication overuse regarding patients with MOH. This should be considered when planning prevention campaigns against MOH.

Isquemia periférica tras intoxicación crónica por ergóticos / Peripheral ischaemia after chronic ergot poisoning

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Efectos secundarios graves derivados de las interacciones medicamentosas del tratamiento antirretroviral / Serious adverse events derived from the drug interactions of antiretroviral therapy

Fundamento y objetivo. Los fármacosantirretrovirales pueden ser causa de interaccionesmedicamentosas.Material y métodos. Se describen tres casosclínicos de pacientes infectados por VIH en los quedebido a una interacción farmacocinética se produjoun efecto adverso clínicamente relevante.Resultados. Caso 1: mujer de 43 años en tratamientocon tenofovir DF, emtricitabina y lopinavir/ritonavirque presenta isquemia de ambos miembros superioressecundaria a síndrome ergotamínico. Caso 2: varón de54 años en tratamiento con zidovudina, lamivudina ylopinavir/ritonavir que presenta síndrome de Cushingsecundario al uso de fluticasona inhalada. Caso 3:varón de 45 años en tratamiento con tenofovir DF,emtricitabina y atazanavir/ritonavir que presenta unfracaso virológico como consecuencia del consumoconcomitante de omeprazol.Conclusiones. Se deben considerar las potencialesinteracciones medicamentosas de los fármacosantirretrovirales cuando se administra otro fármacoconcomitantemente, especialmente cuando algunode éstos es inductor o inhibidor enzimático delcitocromo P-450

Background and aim. Antiretroviral drugs cancause drug interactions.Material and methods. Three clinical cases aredescribed regarding HIV-infected patients in whicha clinically relevant adverse effect occurred due to apharmacokinetic interaction.Results. Case 1: A 43-year old woman being treatedwith tenofovir DF, emtricitabine andlopinavir/ritonavir who presents ischemia in bothupper extremities following an ergotaminesyndrome. Case 2: A 54-year old man being treatedwith zidovudine, lamivudine and lopinavir/ritonavirwho presents Cushing syndrome following to use ofinhaled fluticasone. Case 3: A 45-year old manbeing treated with tenofovir DF, emtricitabine andatazanavir/ritonavir who presents a virologicalfailure as consequence of concomitant use ofomeprazole.Conclusions. Potential drug interactions must beconsidered when other concomitant drugs are usedwith antiretroviral therapy especially when one ofthese is a P 450 cytochrome enzymatic inductor orinhibitor

[Valvular heart disease associated with the treatment of Parkinson disease]. / Hjerteklapsygdom ved medicinsk behandling af Parkinsons sygdom.

Ergot derivatives (EDs) are used in the treatment of Parkinson's disease, but recent reports indicate induction of valvular heart disease. This survey reviews the documentation and reports on the design of a blinded study of 160 Parkinson's patients treated with either EDs or non-EDs. The present recommendations regarding monitoring of patients treated with ED are also described.

[Ergotism. A case report and review of the literature]. / Ergotismo. Presentación de un caso y revisión de la bibliografía.

INTRODUCTION: Ergotism is characterised by an intensive generalised vasoconstriction of small and large blood vessels. The symptoms derive from the regional ischemia caused by the vasospasm produced by ergotamine. Nowadays, ergotism is almost exclusively due to the excessive ingestion of ergotamine tartrate used in the treatment of migraine. The main treatment consists in withdrawing the medication. CASE REPORT: Our study involves a 53-year-old male with a history of migraine since his youth, who was treated with ergotaminic preparations up until the day before admission to hospital. He was admitted because of a 7-day history of symptoms including bilateral and symmetrical anaesthesia of the fingers and a general feeling of weakness, associated with intense pain and cyanosis of the right thenar eminence. On admission, it was not possible to measure his AT in the upper limbs and his peripheral pulses dropped in a generalised manner. Aetiologies involving vasculitis were ruled out. An angiography study showed segmented stenosis of arteries in the upper and lower limbs. Ergotaminic agents were withdrawn and nifedipine was indicated. The symptoms disappeared, the physical examination was normal and results of a control angiography study were also normal. CONCLUSIONS: Ergotamine intoxication can be detected by a thorough interview and physical examination; it should be suspected when faced with symptoms that are compatible with vasospasms and a history of ingestion of the drug, in the absence of any prothrombotic, liver, kidney or vasculitic pathology. This condition is treated by withdrawing the drug and administration of vasodilators if the symptoms are intense. In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning.

Chronic migraine and medication-overuse headache through the ages.

We set out to review early descriptions of chronic migraine and medication-overuse headache. The International Headache Society (IHS) recently gave criteria for chronic migraine and medication-overuse headache. Chronic migraine was absent from the 1988 IHS criteria. Peters and Horton described ergotamine-overuse headache in 1951. In the 1980s it was more fully appreciated that overuse of other acute headache medications could increase headache frequency. We reviewed published English-language papers and book chapters. Willis (1672), Oppenheim (1900), Collier (1922), Balyeat (1933), and von Storch (1937) all described chronic migraine. Lennox (1934), O'Sullivan (1936), Silfverskiold (1947), Graham (1955), Friedman (1955), and Lippman (1955) wrote about ergotamine-overuse headache. Graham (1955), Friedman (1955), Lippman (1955), and Horton and Peters (1963) outlined withdrawal protocols. Chronic migraine has been mentioned in the literature for centuries, while medication-overuse headache has been written about for decades. Graham, Friedman, and Lippman deserve credit for separately reporting the first ergotamine withdrawal programmes.

Ergotismo. Presentación de un caso y revisión de la bibliografía / Ergotism. A case report and review of the literature

Introducción. El ergotismo se caracteriza por una intensa y generalizada vasoconstricción de los vasos sanguíneos pequeños y grandes. Los síntomas resultan de la isquemia regional causada por el vasoespasmo que produce la ergotamina. En la actualidad, el ergotismo resulta casi exclusivamente de la ingesta excesiva de tartrato de ergotamina para el tratamiento de la migraña. El principal tratamiento es la suspensión del fármaco. Caso clínico. Se trata de un hombre de 53 años con historia de migraña desde su juventud, tratada con ergotamínicos hasta un día antes de su ingreso. Ingresó por manifestaciones de siete días de evolución, con anestesia bilateral y simétrica de los dedos de las manos y sensación de debilidad generalizada, asociados a dolor intenso y cianosis de la eminencia tenar derecha. Cuando ingresó no fue posible medir la tensión arterial en las extremidades superiores, y sus pulsos periféricos estaban disminuidos de manera generalizada. Se descartaron etiologías de vasculitis. Una angiografía mostró estenosis segmentaria de las arterias en las extremidades superiores e inferiores. Se suspendieron los ergotamínicos y se indicó nifedipina. La sintomatología desapareció, la exploración física fue normal y una angiografía de control fue normal. Conclusiones. La intoxicación por ergotamina puede detectarse mediante un interrogatorio y exploración física completos; se debe sospechar ante manifestaciones compatibles con vasoespasmo y el antecedente de ingesta del fármaco, en ausencia de patología protrombótica o vasculítica, hepatopatía o nefropatía. El tratamiento del cuadro es con suspensión del fármaco, y vasodilatadores si las manifestaciones son intensas. En este artículo se revisa la historia, fisiopatología, síntomas y signos de presentación, diagnóstico y tratamiento de la intoxicación por ergotamina

Introduction. Ergotism is characterised by an intensive generalised vasoconstriction of small and large blood vessels. The symptoms derive from the regional ischemia caused by the vasospasm produced by ergotamine. Nowadays, ergotism is almost exclusively due to the excessive ingestion of ergotamine tartrate used in the treatment of migraine. The main treatment consists in withdrawing the medication. Case report. Our study involves a 53-year-old male with a history of migraine since his youth, who was treated with ergotaminic preparations up until the day before admission to hospital. He was admitted because of a 7-day history of symptoms including bilateral and symmetrical anaesthesia of the fingers and a general feeling of weakness, associated with intense pain and cyanosis of the right thenar eminence. On admission, it was not possible to measure his AT in the upper limbs and his peripheral pulses dropped in a generalised manner. Aetiologies involving vasculitis were ruled out. An angiography study showed segmented stenosis of arteries in the upper and lower limbs. Ergotaminic agents were withdrawn and nifedipine was indicated. The symptoms disappeared, the physical examination was normal and results of a control angiography study were also normal. Conclusions. Ergotamine intoxication can be detected by a thorough interview and physical examination; it should be suspected when faced with symptoms that are compatible with vasospasms and a history of ingestion of the drug, in the absence of any prothrombotic, liver, kidney or vasculitic pathology. This condition is treated by withdrawing the drug and administration of vasodilators if the symptoms are intense. In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning

Pleuropulmonary lesions, ergotamines and asbestos exposure.

OBJECTIVES: This study investigated the possibility of pleuropulmonary lesions, which can occur as rare but serious side effects of different ergot drugs, occurring more commonly in persons earlier exposed to asbestos. METHODS: All reports of pleuropulmonary side effects of the ergot drugs used in Sweden in the Swedish side effect registry from 1985 to 2003 were studied. In addition, the literature was reviewed. RESULTS: In the registry, 47 men and 3 women were found. Of the men, 24 were exposed to asbestos, and 2 denied such exposure; 2 of the 3 women were exposed. In the literature, 111 patients were found--32 had confirmed exposure and 15 denied it. For most of the patients, it was not possible to determine exposure. CONCLUSIONS: Enough evidence exists to postulate that earlier asbestos exposure in combination with the intake of ergot drugs can cause pleuropulmonary lesions.

Anticonvulsant hypersensitivity syndrome associated with Bellamine S, a therapy for menopausal symptoms.

Anticonvulsant hypersensitivity syndrome (AHS) is a rare, potentially fatal, idiosyncratic drug reaction characterized by fever, morbilliform rash, lymphadenopathy, hepatitis, and hematologic abnormalities. Aromatic antiepileptic agents, such as phenytoin, carbamazepine, and phenobarbital are the most frequent causes of this syndrome. We report a case of a previously healthy, postmenopausal woman who developed anticonvulsant hypersensitivity syndrome while taking Bellamine S (belladonna alkaloids; ergotamine; phenobarbital) for hot flashes. Although combinations of belladonna, ergotamine, and phenobarbital have been used for medical treatment of menopausal symptoms since the 1960s, this is the first known case report of its association with anticonvulsant hypersensitivity syndrome. Given the current debate about the risks of hormonal replacement therapy, more women are seeking alternative therapies for menopausal symptoms. Dermatologists need to be aware of this potential serious reaction to this phenobarbital-containing therapy for hot flashes.

Association between feeding perennial ryegrass (Lolium perenne cultivar Grasslands impact) containing high concentrations of ergovaline, and health and productivity in a herd of lactating dairy cows.

Perennial ryegrasses are frequently infected with fungal endophyte (Neotyphodium lolii) to increase the resistance of the plant to insect damage. Unfortunately, a side effect of endophyte infection can be the production of alkaloids, including Lolitrem B and ergovaline, that produce toxic effects in animals. A significant 4.6 litre decrease in milk production in a herd of Holstein-Friesian dairy cows was associated with high concentrations of ergovaline in ryegrass silage. Simultaneously, milk SCC increased significantly over a comparable period and reproductive performance declined. Body condition score and coat condition of cows were adversely affected. Unique aspects of this Case report include; very stable production of the herd over a period of years before and after cessation of feeding silage containing high concentrations of ergovaline; the presence of high concentrations of ergovaline in the silage; and a controlled diet that reduced the risks of variation in feed availability and other sources of toxins. Veterinarians and other farm advisors should be aware of the potential for negative effects on animal health and production of fungal endophyte and the potential for Neotyphodium lolii to produce ergovaline.

[Headaches caused by abuse of symptomatic anti-migraine and analgesic treatment]. / Céphalées induites par abus des traitements symptomatiques antalgiques et antimigraineux.

These daily or near-daily headaches result from the chronic overuse of all immediate relief antimigraine drugs: ergotamine, analgesics, and/or more recently triptans. Like for much chronic daily headaches, the International Headache Society diagnostic criteria for drug abuse headaches are difficult to apply. Generally, patients confuse primary headaches (usually migraines) with interparoxysmal tension-type headaches called "rebound headaches". Psychosocial factors may play a role. Insidiously, a compulsive automedication results, often in anticipation of headache. This headache syndrome resists symptomatic and prophylactic treatment. These headaches are frequent, very disabling and socioeconomically costly. They are still largely underdiagnosed. Drug-induced headaches may be restricted to those patients who are already headache sufferers. The pathogenesis is not clearly understood: it may involve a deficience of inhibitory pain modulation, a hyperactivation of nociceptive facilitatory systems, and the peripheral and central effects of the incriminating drugs. The withdrawal of all offending analgesic drugs and a multimodality approach are indispensable, but the therapeutic protocoles are actually very heterogeneous and poorly estimated. Non-drug means could be very helpful. Effective education of headache sufferers and regular follow-up are essential to avoid relapses. Prognosis factors have been evoked, but may not be significant for the long term outcome. The rate successfull of is actually estimated at 60 p. cent at five years. The benefits of an adequate management encourage early recognation of drug-induced headaches. This article has in view to take stock of the literature at the end of 1999, and to help physicians become mora aware of this problem and develp a more preventive attitude.

[Can the biologic pattern of cervicogenic headache change after overuse or withdrawal of ergotamine derivatives?]. / O padrão biológico da cefaléia cervicogênica pode ser alterado pelo uso excessivo de ergotamínicos ou pela sua retirada?

The transformation of a primary headache into a chronic daily headache (CDH) may or may not be related to the overuse of pain-killers, as their influence on the pathophysiological mechanisms remain inconclusive. We describe three patients (female, aged 65 and 39 years, and male, 46) affected by cervicogenic headache (CH) and CDH linked to the overuse of pain-killers (ergotamine derivatives) that were submitted to the infiltration of the greater occipital nerve (GON). At the end of three days of treatment, a total improvement of the pain symptoms was recorded, which allowed for the withdrawal of the ergotamine derivatives. The CH cannot be ranked with the CDHs, since it presents an organic etiology; however, if the pain is daily and the diagnosis is belated, the indiscriminate and excessive use pain-killers may occur. In the cases described, the overuse of pain-killers did not affect the natural evolution of this headache after treatment with the infiltration of the GON, as all the patients who underwent infiltration showed a total improvement of their painful symptoms, without headache resulting from the withdrawal of pain-killers, nor did they show any pharmacological dependence. This is an evidence that the CH presents and organic etiology, not being influenced in its pathophysiology by the overuse of ergotamine derivatives.

O padrão biológico da cefaléia cervicogênica pode ser alterado pelo uso excessivo de ergotamínicos ou pela sua retirada? / Can the biologic pattern of cervicogenic headache change after overuse or withdrawal of the ergotamine derivatives?

A transformação de uma cefaléia primária em cefaléia crônica diária (CCD) pode ou não estar relacionada com o abuso de analgésicos, pois a influência desse abuso sobre os mecanismos fisiopatológicos permanecem inconclusivos. Descrevemos três pacientes (mulher, 65 e 39 anos e homem, 46 anos) com cefaléia cervicogênica (CC) que abusavam de analgésicos (derivados da ergotamina) e foram submetidos a infiltração do nervo occipital maior (NOM). Ao final de três dias do tratamento, melhora total dos sintomas álgicos foram registrados, o que permitiu retirada completa dos derivados da ergotamina. A CC não pode ser classificada dentro das cefaléias crônica diárias visto que apresenta uma etiologia orgânica; entretanto, se a dor for diária e o diagnóstico tardio, o uso indiscriminado e abusivo de analgésicos pode ocorrer. Nos casos descritos o uso abusivo de analgésicos não influenciou a evolução natural desta cefaléia após o tratamento com a infiltração do NOM, uma vez que todos os pacientes submetidos a infiltração apresentaram melhora total de seus sintomas dolorosos sem cefaléia rebote ou tampouco dependência farmacológica. Esta é uma evidência que a CC apresenta uma etiológia orgânica, não sendo influenciada em sua fisiopatologia pelo uso abusivo de derivados da ergotamina.