Background. Migraine and obesity are highly prevalent and chronic diseases. Evidence has shown that obesity may influence frequency and severity of migraine attacks and is a risk factor for migraine progression. Several studies have suggested that weight loss, achieved via surgical and non-surgical means, may improve migraine. Aim . To perform a meta-analysis on the effect of weight loss obtained by bariatric surgery or behavioral intervention on migraine frequency and indices of severity. Methods. A search through Pubmed/Medline, ISI-web of knowledge and Google Scholar retrieved 10 studies (n=473) that were used for meta-analysis. Selected outcomes were Headache Frequency, Pain Intensity, Disability and Attack Duration while BMI, BMI change, type of intervention (bariatric vs behavioral), type of population (adult vs pediatric) were used for moderators and meta-regression analysis. Results . Random effect meta-analysis shows that weight loss yields significant reductions in Headache Frequency (ES -0.65, 95% C.I. -0.88 to -0.42, p<0.0001), Pain Intensity (ES -0.81, 95% C.I. -1.19 to -0.44, p<0.0001), Disability (ES -0.61, 95% C.I. -0.77 to -0.45, p<0.0001) and Attack Duration (ES -0.35, 95% C.I. -0.62 to -0.08, p=0.01). Moderators and meta-regression analysis showed that improvement in migraine was not correlated either to the degree of obesity at baseline or the degree of weight reduction. In addition, the effect on migraine was similar when weight reduction was obtained with bariatric surgery or behavioral intervention and was comparable in adult and pediatric populations. Conclusions . Weight loss improves parameters of migraine headache in patients who have obesity independently of the type of intervention and the amount of weight loss. The mechanisms underlying the link between obesity, weight loss and migraine headache are still largely unclear although it is possible that alterations in chronic inflammation, adipocytokines, obesity comorbidities (i.e. OSAS), and overlapping behavioral and psychological risk factors may play a role.
Backgroung. Polycystic ovary syndrome (PCOS) is a common disorder affecting reproductive age women and is a cluster of endocrine and metabolic alterations ranging from impaired ovulation and androgen excess to abdominal obesity and metabolic syndrome leading to increased cardiovascular risk profile. Aim. To perform a meta-analysis on the effect of PCOS on surrogate markers of atherosclerosis, namely intima media thickness (IMT), flow-mediated dilation (FMD) and pulse wave velocity (PWV) and to run a meta-regression on the potential determinants of preclinical atherosclerosis. Methods. A search through Pubmed/Medline and ISI-web of knowledge retrieved 90 studies that were used for meta-analysis. Selected outcomes were IMT (n=6199), FMD (n=3090), and PWV (n=2477) while age, BMI, waist circumference, total testosterone, free androgen index (FAI), total-, HDL- and LDL-cholesterol, HOMA-index, systolic and diastolic blood pressure were used for meta-regression analysis. Results. Random effect meta-analysis showed that IMT was significantly increased (ES 0.47, 95% C.I. 0.64 to 0.30, p<0.0001), FMD was significantly impaired (ES -0.92, 95% C.I. -0.69 to -1.15, p<0.0001) and PWV was significantly increased (ES 0.28, 95% C.I. 0.48 to 0.08, p=0.006) in PCOS compared to controls. Meta-regression analysis showed that FMD was positively correlated with FAI (p=0.018) while negative correlations were found between Effect Size (IMT) and BMI (p=0.02), waist circumference (p=0.05) and total cholesterol (p=0.02). Conclusions. This meta-analysis shows a clear effect of PCOS on all markers of preclinical atherosclerosis (IMT, FMD and PWV). Heterogeneity of results is explained in part by the androgen status that was positively linked to impairment of FMD while increasing of anthropometric and metabolic variables (waist, BMI and total cholesterol) seem to overcome PCOS on preclinical atherosclerosis.
A 73-year-old man who had undergone bilateral carotid endarterectomy several years ago presented with an anomalous pulsating mass in the left side of the neck combined with a systolic murmur.His Color Doppler Ultrasound (US) and Angio-CT scan revealed a left carotid pseudoaneurysm. Anti-leukocyte antibody immunoscintigraphy excluded an infectious cause. Digital subtraction angiography revealed two dilations of the extracranial internal carotid, the first, caudal, fusiform that seemed post-surgical dilatation and the second, cranial, eccentric that seemed located at the distal anastomosis site therefore suggesting failure of anastomosis. There was a shrinking between dilations with an arterial substenosis and a kinking immediately above the upper pseudoaneurysm. The carotid artery also had a tortuous shape (figure 1).Because of the high anesthesiologic risk of the patient, the surgeon excluded surgical treatment of the lesion. Therefore, we decided to treat the pseudoaneurysm by placing uncovered stents with or without coil embolization trough the mesh of the stent.An antiaggregant treatment (cardioaspirin 250 mg/die and clopidogrel 75 mg/die) was ad- SummaryPseudoaneurysm treatment with overlapping stents may be a useful technique to reduce flow and enhance thrombosis in the aneurysmal sac. We treated a pseudoaneurysm of the left carotid artery in a patient with a history of bilateral carotid thromboendarterectomy by placing three stents and overlapping them at the level of the aneurysmal neck.Nine month follow-up revealed almost complete pseudoaneurysm exclusion and patency of the carotid artery.
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