Intravenous sodium valproate aborts migraine headaches rapidly.

OBJECTIVES: This preliminary study was designed to evaluate the efficacy and safety of intravenous sodium valproate in managing severe migraine headache. DESIGN/METHODS: In a preliminary prospective open-label study, we treated patients with severe migraine headache using intravenous sodium valproate, after obtaining written informed consent. Thirty-six patients, hospitalized with acute established migraine, were infused with sodium valproate. The diagnosis of migraine was based on the International Headache Society classification criteria. Severity of headache was reported on 10-point visual analog. Disability was assessed on a five-point scale. Primary and secondary endpoints were measured as sustained pain relief and symptoms improvement at 2 h, respectively. RESULTS: The study participants had a mean±SD age of 35.7±9.3 years. The loading dose of sodium valproate was 900-1200 mg, and the average time to best response for headache severity was 50 min. A reduction in pain from severe or moderate to mild or no pain in 60 min was reported in 75% of patients [OR=7.187 (95% confidence intervals: 1.32-38.95)]. After treatment with sodium valproate, headache severity was significantly decreased (P<0.0001). No serious adverse events were reported. CONCLUSIONS: Intravenous Sodium Valproate (iVPA) seems to be safe and rapidly effective for intractable migraine attack. Randomized, double-blinded, controlled studies are warranted.

Multiple drug resistance and strength of attachment to surfaces in Pseudomonas aeruginosa isolates.

AIMS: To investigate the presence of a relationship between the strength of attachment of Pseudomonas aeruginosa to stainless steel surfaces and their observed multiple drug resistance. METHODS AND RESULTS: Multiple drug resistance of clinical and environmental isolates of Ps. aeruginosa was evaluated using disc diffusion method. The blot succession technique was used to quantify the strength of attachment of Ps. aeruginosa isolates. Different multiple drug-resistant Ps. aeruginosa isolates exhibited variable attachment strength. Although the highest multiple drug-resistant clinical isolate was shown to have the least attachment strength among clinical isolates, a weak correlation was found between attachment strength and multiple resistance among our investigated Ps. aeruginosa isolates. CONCLUSIONS: There is a weak correlation between multiple drug resistance and strength of attachment to stainless steel surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY: Even low-resistant Ps. aeruginosa could have the potential of attaching firmly to surfaces and forming biofilm.

Treatment of aneurysm of transverse aortic arch.

Although aneurysms involving the aortic arch are usually well localized and amenable to reconstructive operation, the reported results of this form of therapy at this level are not as good as in other portions of the aorta. The difference is due to cerebral and bleeding disturbances associated with cerebral protection techniques. This report describes 30 patients and emphasizes the variability of extent of these lesions and the results of methods employed for cerebral protection, which varied according to extent of disease. The aneurysm involved all but the proximal ascending aorta in one patient and was replaced with a permanent ascending aorta-innominate and left common carotid artery bypass graft. Eight aneurysms were limited to the transverse arch; one was removed with the aid of temporary bypass and seven with cardiopulmonary bypass and separate brachiocephalic normothermic perfusion. Temporary and permanent bypass grafts were used in four patients with lesser involvement. None of these techniques was used in 17 patients who had distal arch involvement. Of the 30 patients, 26 survived and 18 are still alive despite the treatment being spread over a 22 year period. Cerebral complications occurred in 3 patients, two of whom died. These problems were avoided in five patients treated more recently by using lows flows under low pressures. Coagulopathies did not occur. Although the technique of cardiopulmonary bypass, profound hypothermia, and circulatory arrest provides a more convenient and technically simpler method of operation, the disadvantages of coagulopathies with excessive bleeding, pulmonary problems, and lack of consistent cerebral protection argue against its routine use at this time.

Graft replacement of aneurysm in descending thoracic aorta: results without bypass or shunting.

During the 24-year period from 1956 to 1980, 148 patients with aneurysms confined to the thoracic aortic segment, bounded above by the left subclavian artery and below the diaphragm, were treated with replacement therapy. From 1956 to 1967, 36 patients were treated by use of temporary bypass or shunts which carried a 6% incidence of paraplegia and a mortality rate of 22%. From 1962 to 1980, 112 patients were treated without shunts or bypass; this report is concerned with the latter cases. The incidence of paraplegia and the survival rate in this group were 0.9% and 91%, respectively. There were 89 men and 25 women in the series whose ages ranged from 22 to 87 years with an average age of 61. All types of aneurysms were represented; however, arteriosclerosis and dissection were the most common causes. The extent of aneurysm was variable, but most of the descending thoracic aorta was involved in more than half the cases. Associated diseases were present in 77% of cases. Operation consisted of aneurysmal replacement using inclusion technique with cardiac hemodynamics controlled by vasodilators and fluid replacement. During the past 4 years, proximal blood pressure has been controlled with nitroprusside. Cardiovascular hemodynamics, blood gases, electrolytes, and plasma osmolarity were monitored extensively and frequently to achieve the most desirable physiologic response to aortic clamping and operation. During this time 69 patients were treated. There were four (6%) deaths. None developed paraplegia or renal failure. Concomitant subclavian artery clamping was employed in 34 of these patients and in 22 additional patients with distal arch lesions. None in either group developed paraplegia. This indicated the safety of temporary subclavian artery occlusion. Death, both early and late, was due to a number of causes, but rupture of another aneurysm was the most common. This emphasizes the value of concomitant operation in patients with multiple aneurysms and careful follow-up in all patients.

Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a twenty-five-year period.

During a period of slightly over 25 years, 949 new patients with aortoiliac atherosclerotic occlusive disease--409 (43%) with associated distal disease--were submitted to various reconstructive operations for claudication in 719 and rest ischemic problems in 230 patients. The ages ranged from 21 to 91 years with a medial age of 59. Men outnumbered women 2.5 to 1. Associated diseases were present in 695 (75%); heart disease and diabetes were most common. The mortality rate from operation--50% of which was from heart disease--8% in first 5 years and 3% during the last 15 years. Good function, i.e., restoration of femoral pulses, leg salvage, and relief of symptoms, was achieved in 95% of cases early after treatment. Early results were best in patients with claudication and those without associated distal disease. The long-term survival rates were significant--50%, 30%, and 15% at 10, 15, and 20 years, respectively--and successful function was maintained in survivors in 79%, 70%, and 56% at the same intervals. Amputation was performed in only 23 (3%) patients with claudication and 33 (14%) with rest ischemia during the period of study. Survival, functional results, and incidence of amputation varied with the numerous factors described in detail herein.

Viscoelastic measurement of clot formation: a new test of platelet function.

Assessment of platelet function presents a challenge to the investigators in the clinical field. An instrument, Sonoclot, is described which measures changes in the viscoelastic properties (clot impedance on a vibrating probe) of plasma as it is recalcified. Platelet poor plasma (PPP) and platelet rich plasma (PRP) show distinct and characteristic Sonoclot tracings. Tracings of PPP show a lag period and a primary wave. These parameters correspond to recalcification time and fibrin polymerization. Tracings of PRP show, in addition, a secondary wave and a downward wave. These parameters correspond to the incorporation of platelets in the clot and retraction of the clot. The PRP parameters are influenced by the number and quality of the platelets. This instrument was utilized to assess the platelet function in patients after coronary artery bypass surgery (CAB). In 69 patients studied, 20 patients did not have excessive bleeding. The clot impedance tracings in this group were normal. Twenty-four patients had excessive bleeding, normal clot impedance, and coagulation tests indicating the possibility of surgical bleeding. This was confirmed in 22 (92 percent) patients upon exploration to control bleeding. Twenty-five patients had excessive bleeding, normal coagulation tests and abnormal clot impedance suggesting platelet dysfunction. In twenty-one (84 percent) of the patients, transfusion of platelet concentrate controlled the bleeding with corresponding correction of clot impedance. Sonoclot studies are quick and easy to perform, and appear to be a valuable and reliable adjunct in the diagnosis of hemostatic problems after CAB surgery.

A densitometric method for quantitative analysis of the left ventricle performance using i.v. digital subtraction angiography.

In this paper we present a method we used to provide quantitative description of the systolic and diastolic temporal function of the left ventricle (LV). Additional parameters, such as peak filling and ejection rates, times to end systole and end diastole, and temporal changes in slow and fast filling are obtained. The volumes associated with these parameters are also calculated. Correlation between LV volume changes during the cardiac style and corresponding "density" variations was confirmed. Time-density curves were obtained from selected cardiac cycles in each study. We used the polynomial fitting technique to fit the time density curves and developed a computer algorithm for deriving the relevant parameters. Data from a total of 18 patients with ischemic heart or valvular diseases, who underwent I.V. ventriculography was analysed using our method. Some of these patients were forwarded for repeated digital subtraction angiography (DSA) examination before and after intervention therapy to evaluate the effectiveness of treatment. In comparison to the geometric method for the analysis of LV performance, our method is generally faster and simpler to employ. The method was effective in detecting variations in the peak ejection and filling rates in our group of patients before and after interventional therapy.

The role of ultrasound in initial evaluation of renal colic.

Full text is available as a scanned copy of the original print version.

[[Evolution of Egyptian migration]].

PIP: Changing patterns of Egyptian emigration over the past 30 years are reviewed. Four phases are identified: migration among Arab countries up to 1961, migration to the West for professional advancement, migration for political freedom, and migration to oil-producing countries since 1973 for economic reasons. (SUMMARY IN ENG)^ieng

Application of the coupled-mode theory to a specialized graded-index optical fiber coupler.

A specialized coupler formed by two identical multimode graded-index slab fibers is described. This special coupler can be used to examine the tilt or the roughness of a surface through the reflected beam. It may also find applications as a mode filter, an alignment sensor, or a feed component of an optical monopulse tracking radar. Coupled-mode theory is generalized for this application. The coupling length for maximum power transfer of the higher-order modes from the excited to the coupled fiber, leaving as much power of the lowest mode as possible to continue in the excited fiber, is computed. The fields are computed at the output of the system for incident optical beams with different axial displacements and beams launched on axis with tilted wavefronts. This desired coupling length is shown to be substantially independent of characteristics of the incident light beam. To compute the fields propagated through the tapered section introduced to separate the slab fibers, the stairwise approximation is used, and mode matching is used to connect the fields at the junctions between the successive segments. An optimum taper to separate the coupled fibers, with minimal perturbation of the fields, is present at the right-hand end of the coupling section.

Transverse aortic arch aneurysm: improved results of treatment employing new modifications of aortic reconstruction and hypothermic cerebral circulatory arrest.

The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference had been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication.

Production and isolation of milk-clotting enzyme from Aspergillus versicolor.

The production of a milk-clotting enzyme by Aspergillus versicolor in 19 different culture media was investigated. Considerable milk-clotting activity was achieved by supplying corn steep liquor with either glucose of maltose. Dephytinization of corn steep liquor had an adverse effect on the production of milk-clotting enzyme. The results indicated that complex organic compounds favoured the production of the enzyme. Precipitation with acetone or tannin was unsuitable, but ammonium sulphate and ethanol above certain concentration produced active fractions.

The yeast species causing fungemia at a university hospital in Riyadh, Saudi Arabia, during a 10-year period.

This study is a retrospective investigation to determine the species of yeasts causing fungemia in a university hospital in Saudi Arabia during the years 1991-2000. A total of 189 episodes of fungemia were encountered, of which 121 (64%) occurred during 1991-1995, whereas only 68 cases (36%) were found between 1996 and 2000. Overall, 50.3% episodes were due to Candida albicans including five episodes of C. dubliniensis, followed by C. tropicalis (27%), C. parapsilosis (7.9%), C. glabrata (7.4%), C. krusei (3.2%), C. famata (1.0%); 3.2% were due to other species, namely Blastoschizomyces capitatus, Hansenula anomala, Rhodotorula rubra, and Trichosporon beigelii. The percentage of episodes of fungemia caused by C. albicans ranged from 36.4% in 1991 to 71.4% in 2000, revealing an increase in recent years. The incidence of non-C. albicans fungemia decreased from 63 (33.3%) during the first 5 years (1991-1995) to 31 (16.4%) episodes during the second 5 years. Moreover, no fungemia due to C. glabrata and C. krusei were observed during the last 3 years. Overall, during the years of the study, a decreasing incidence of yeast fungemia was observed. Fungemia occurred more frequently in patients with leukemia (24%), prematurity (16%), postsurgery (10.6%), and lymphoma (9.5%). Patients with respiratory infections and preterm infants more often had C. albicans fungemia, whereas C. tropicalis predominated in patients with hepatic disorders and leukemia. The study reports for the first time the involvement of C. dubliniensis in yeast fungemia occurring in Saudi Arabia.

Spectrum and proteinase production of yeasts causing vaginitis in Saudi Arabian women.

BACKGROUND: Yeast vaginitis is a common infection. Data on the identity and prevalence of the etiological species would serve both epidemiological and therapeutic ends. Proteinase secretion by the invading yeast has been implicated in facilitating infection. Hence a prospective study was conducted to determine the species causing vaginitis in women from Saudi Arabia and the yeast's ability to produce proteinase. MATERIAL/METHODS: The subjects were patients with clinical signs of vaginitis. A high vaginal swab specimen from each patient was cultured, and only women yielding heavy yeast growth were enrolled. The isolated yeasts were identified by routine procedures, then evaluated for proteinase production in a medium containing bovine serum albumin. RESULTS: A total of 500 patients were studied. Candida albicans was the major species to cause vaginitis (59%), followed by C. glabrata (31%), C. tropicalis (4%), C. krusei (3.2%), Saccharomyces cerevisiae (1.6%), C. parapsilosis (0.6%), and C. kefyr (0.6%). All isolates of C. albicans and C. parapsilosis and 95% of C. tropicalis produced proteinase, while isolates from the remaining species did not. CONCLUSIONS: These results indicate that 59.6% of yeast vaginitis in women from Saudi Arabia is caused by C. albicans, and 31.6% by C. glabrata. Of relatively low prevalence were C. tropicalis and C. krusei. The study also revealed that both proteinase producers and non-producers were involved in causing vaginitis, indicating that proteinase secretion is not an essential factor in the pathogenesis of yeast vaginitis.

Production and some properties of fibrinolytic enzymes from Fusarium oxysporum N.R.C.1.

A mixture of yeast extract and peptone in the culture medium was the most favourable for the production of active fibrinolytic enzyme by Fusarium oxysporum N.R.C.1. Potassium dihydrogen phosphate had stimulating effect, while glucose, sucrose, lactose, ribose and soluble starch had adverse effect on enzyme productivity. The optimum of the fibrinolytic enzyme activity was at pH 7.0.

Purification and properties of two fibrinolytic enzymes from Fusarium oxysporum N.R.C.1.

The crude fibrinolytic enzyme preparation from Fusarium oxysporum N.R.C.1 was purified into two enzymes by ammonium sulphate precipitation followed by chromatography on Sephadex G-100 and DEAE-cellulose. Both fibrinolytic enzymes were more active on human than on bovine fibrin. The activity of the "major" enzyme component on human fibrin was 72-fold that of the "minor" enzyme component. Both enzymes had the same temperature (37 degrees C) and pH (6.98) optima. The "minor" enzyme component was more stable than the "major" one against heat and pH treatments. Both enzymes were significantly activated with Co2+ and inhibited with EDTA.

Cytophotometric estimation of hepatocytes DNA in chronic liver diseases including schistosomiasis for detection of early preneoplastic changes.

No doubt chronic liver diseases due to schistosomiasis and other causes as virus hepatitis are not uncommon among Egyptian patients. Besides, neoplastic changes in such patients are always seen. So, the aim of this work was to evaluate the estimation of hepatocytes DNA in chronic liver diseases as a diagnostic feature for early preneoplastic changes in different groups of patients. These groups included (a) chronic persistent hepatitis, (b) chronic active hepatitis, (c) liver cirrhosis due to schistosomiasis and other causes & (d) hepatocellular carcinoma. The results were evaluated histochemically and histopathologically. It was concluded that the cytophotometic evidence of hepatocytes DNA in chronic liver diseases is a promising mean in detecting early preneoplastic changes.

Catecholamine release during and after cross clamping of descending thoracic aorta.

During graft replacement of descending thoracic and thoracoabdominal aneurysms, aortic cross clamping without the use of bypass or shunts is accompanied by underperfusion of distal vascular beds. This study, comprising 10 patients, was based on the hypothesis that ischemia of the lower spinal cord and adrenal glands might precipitate release of catecholamines. Arterial blood samples, obtained before (control), during, and after arterial cross clamping, were analyzed for epinephrine (E) and norepinephrine (NE). The E/NE ratio was used as an index of ischemic sympathoadrenal activation. During cross clamping, mean E and E/NE increased by a factor of 4.5 (P = 0.03) and 2.4 (P = 0.001), respectively. The greatest increases were observed in the 5 min postclamp sample: relative to control, mean E increased 22-fold (P = 0.011), NE 3-fold (P = 0.009), and E/NE 8.4-fold (P = 0.013). During the immediate postclamp period, mean E/NE fell exponentially with an average "half-life" of 12.05 +/- 5.83 min (SD). A second-order polynomial related (P = 0.004) log E/NE in first postclamp sample to the ratio between clamp time and mean proximal arterial pressure during clamping (T/AP). Left-ventricular-minute-work-function correlations: (1) positive with log E during clamping (P = 0.043); and (2) none with log E (P = 0.563) or log (E + NE) (P = 0.641) 5 min post-clamp; (3) positive with log (E + NE) 30 min post-clamp (P = 0.016). It is concluded that (1) distal ischemia caused by cross clamping the descending thoracic aorta without bypass or shunts, results in distal regional sympathoadrenal activation, independent of known central reflex mechanisms; (2) this activation leads to marked increases of E/NE and is, in part, dependent upon T/AP during clamping; (3) the activation is probably transitory; (4) by indirect evidence, cardiodepressant factor(s) may transiently be present following declamping; (5) by its magnitude, sympathoadrenal activation is likely to provide compensation for deleterious factors that may affect cardiovascular functions during cross clamping and after declamping; alternatively, it might contribute to postoperative hypertension and cardiac complications such as myocardial ischemia and arrhythmias.

Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period.

This report is concerned with the factors influencing survival in 920 consecutive patients submitted to operation for infrarenal abdominal aortic aneurysm during the past 25 years. Rupture had occurred in 60 patients (6.5%) and survival was 77%, which did not vary during the period of study. Of the 860 patients (93.5%) treated for nonrupture, 819 (95%) survived operation. The mortality rate in this group varied from 18%, in the earlier period to 1.43% , in recent years. Risk factors including heart disease, hypertension, and advanced age accounted for 95% of the deaths that occurred within 30 days however, the mortality rate in patients with these problems decreased from 19.2% to 1.9% during the period of study although the average number of patients treated each year with these risk factors increased tenfold. Improvements in operative techniques and experience were responsible for decreasing mortality up to about 1971. Subsequent decrease in mortality was due to improvements in anesthesia, monitoring, and other supportive measures during operation and the early recovery period. Complete survival information was obtained in 816 (99.6%) patients, 191 of whom had been treated for periods over 15 years. Factors influencing long-term survival were associated disease and age at time of operation. Survival in percentage in patients without associated heart disease of hypertension for 5, 10, and 15 years was 84, 49, and 21; with heart disease, it was 54, 34, and 17. The median age of patients in the series was 65.5 years and survival at above intervals according to quartile was less than or equal to 60; 71, 53, and 24; 60 less than age less than or equal to 71; 66, 38, and 18; less greater than 71; 43, 13, and 11.