Background: Clinical observations of a relationship between unpleasant dreams and migraine headaches have been reported previously. Methods: Due to the anecdotal quality of these case reports, this study empirically investigated the significance of this relationship. Dream content categories were selected corresponding to emotional factors associated with stress that trigger migraine headaches. A total of 37 migraineurs recorded 10 dreams each, 5 that preceded migraines and 5 that did not. Results: Univariate F tests revealed that 4 of the 5 variables contributed significantly to the overall effect, specifically anger, misfortune, apprehension, and aggressive interactions. Conclusions: Recommendations include discussing the predictive value of dreams with regard to nocturnal migraine attacks, and therapeutic implications are suggested.
Extrapyramidal syndromes have been described after administration of phenytoin and primidone. Although asterixis, dystonia, and tremor have been described with carbamazepine (Tegretol), there is no report of orofacial dyskinesia. We report a case in which a dose-related lingual-facial-buccal extrapyramidal reaction occurred in association with carbamazepine intoxication.
Background Low-dose spiral computed tomography (LDCT) may not lead to a clear treatment path when small to intermediate-sized lung nodules are identified. We have combined flow cytometry and machine learning to develop a sputum-based test (CyPath Lung) that can assist physicians in decision-making in such cases. Methods Single cell suspensions prepared from induced sputum samples collected over three consecutive days were labeled with a viability dye to exclude dead cells, antibodies to distinguish cell types, and a porphyrin to label cancer-associated cells. The labeled cell suspension was run on a flow cytometer and the data collected. An analysis pipeline combining automated flow cytometry data processing with machine learning was developed to distinguish cancer from non-cancer samples from 150 patients at high risk of whom 28 had lung cancer. Flow data and patient features were evaluated to identify predictors of lung cancer. Random training and test sets were chosen to evaluate predictive variables iteratively until a robust model was identified. The final model was tested on a second, independent group of 32 samples, including six samples from patients diagnosed with lung cancer. Results Automated analysis combined with machine learning resulted in a predictive model that achieved an area under the ROC curve (AUC) of 0.89 (95% CI 0.83–0.89). The sensitivity and specificity were 82% and 88%, respectively, and the negative and positive predictive values 96% and 61%, respectively. Importantly, the test was 92% sensitive and 87% specific in cases when nodules were < 20 mm (AUC of 0.94; 95% CI 0.89–0.99). Testing of the model on an independent second set of samples showed an AUC of 0.85 (95% CI 0.71–0.98) with an 83% sensitivity, 77% specificity, 95% negative predictive value and 45% positive predictive value. The model is robust to differences in sample processing and disease state. Conclusion CyPath Lung correctly classifies samples as cancer or non-cancer with high accuracy, including from participants at different disease stages and with nodules < 20 mm in diameter. This test is intended for use after lung cancer screening to improve early-stage lung cancer diagnosis. Trial registration ClinicalTrials.gov ID: NCT03457415; March 7, 2018
The authors describe the successful use of maintenance anticonvulsants in 62 children and adolescents with severe migraine. No patient with neurological deficits, active seizures, or behavioral disorders was included in this study. The follow-up period ranged from one month to four years. Of these patients 65 had abnormal or borderline initial electro-encephalograms, family history in parents and siblings was positive for migraine in 62%, and was positive for seizure disorder in 17%. It is the opinion of the authors that maintenance anticonvulsant therapy provided a greater than 75% improvement in severity and duration of headache in 94% of the patients treated. Side-effects necessitating medication change occurred in 10% of patients, but in no instance did this require abandonment of anticonvulsant therapy. The authors advise that maintenance anticonvulsants are safe and effective drugs for the treatment of migraine in the pediatric patient. Sixty-six percent of the patients were treated with phenobarbital and 34% with phenytoin in appropriate dosage, based upon body weight or surface area. Medication changes were necessary in several patients. But the drugs were limited to either barbiturate derivatives or phenytoin. Effects of Onion Extract on Platelet Aggregation and ThromboxaneSynopsis. Makheja AN, Vanderhoek JY and Bailey JM. Prostaglandins and Medicine 2:413-424, 1979.Oral administration of onion and garlic reportedly decreases platelet aggregation in both human and animal subjects. Antiplatelet inhibitors were isolated from an ethanolic extract of onion, by partitioning into petroleum ether and chloroform, and by using standard chromatographic procedures. This inhibiory activity was mainly associated with a non-polar fraction. The antiaggregating activity was heat stable and was not inactivated by either mild acid or alkali treatment.Platelets incubated with onion inhibitor and radio-labled arachidonic acid showed striking changes in the pattern of the radioactive metabolites formed. Most apparent was the almost complete suppression of thromboxane B 2 synthesis and the appearance of a new metabolite identified as a product of the platelet lipoxygenase.Measurements of oxygen consumption of treated platelets indicated that these materials inhibit the platelet cyclooxygenase. Similar inhibition of sheep vasicular gland cyclooxygenase was observed with onion oil but not with garlic oil.Gas chromatographic and mass spectrometric analyses of onion and garlic extracts showed differences in several major components which may relate to the observed differences in biological activity.The results indicate that two members of the allium family commonly used in the diet contain similar compounds which inhibit platelet aggregation by alterations in both the platelet cyclooxygenase and lipoxygenase pathways. Amar N. Makheja, Ph.D. Behar AJ, Deutsch E, Pomerantz E, Pfeifer Y and Sulman FG: Migraine, Serotonin and the Carotid Body. Lancet 1:550, 1979.The carotid bodies are paraganglionic structures of neural crest origin ...
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