To determine the tolerability and efficacy of eletriptan in patients who had discontinued oral sumatriptan due to lack of efficacy or intolerable adverse events (AEs) during previous clinical treatment (not a controlled trial). Eletriptan is a potent, selective 5-HT1B/1D receptor agonist with beneficial pharmacokinetic properties compared with sumatriptan. In a double-blind, parallel group, placebo-controlled multicentre study, patients with and without aura (n = 446) were randomized to 40 mg eletriptan (E40, n = 188), 80 mg eletriptan (E80, n = 171) or placebo (n = 87) for treatment of up to three migraine attacks. Two-hour headache response, based on first-dose, first-attack data, was 59% for eletriptan 40 mg, 70% for eletriptan 80 mg, and 30% for placebo (P < 0.0001 for both doses of eletriptan vs. PBO; P < 0.05 for E80 vs. E40). Onset of action was rapid, with 1-h headache response rates significantly superior for E40 and E80 vs. placebo (40%, 48%, 15%; P < 0.0005). Both E40 and E80 were significantly superior to placebo, based on first-dose, first-attack data, for 2-h pain-free response (35%, 42%, and 7%; P < 0.0001). Both E40 and E80 demonstrated significant consistency of response, with headache relief rates at 2 h on at least two of three attacks in 66% and 72% vs. 15% on placebo (P < 0.001). AEs were mild to moderate in severity and dose related. The most commonly reported AEs included nausea, vomiting, asthenia, and chest symptoms. E40 and E80 produce an effective response in patients who had previously discontinued treatment with sumatriptan due to lack of efficacy or side-effects.

SUMMARY Echocardiographic septal and posterior wall thicknesses and the percent change with systole were measured in 146 patients with the following diagnoses: acute myocardial infarction (40), chronic coronary artery disease (49), congestive cardiomyopathy (8), atrial septal defect (20), and no cardiac disease (29). Mean diastolic thicknesses for the groups of patients with coronary artery disease and congestive cardiomyopathy were not significantly different from normal although there were abnormal values for individual patients within each group. Mean diastolic thickness of the septum was greater than normal for the group with atrial septal defect (P < 0.02). Wall thinning with systole was SEGMENTAL ABNORMALITIES of left ventricular wall motion have been demonstrated echocardiographically in patients with angiographically demonstrated coronary artery obstruction" 2 and in patients with acute myocardial infarction.34 Motion in noninfarcted areas is often greater than normal.3 These studies suggest that the abnormal left ventricular echo motion in these patients is related to segmental differences in myocardial fiber shortening. Echo motion may also be affected by other factors such as 1) motion of the entire heart within the chest; 2) unloading during systole; 3) electrical conduction;5 6 4) relative diastolic volumes of the right and left ventricles;7' 8 and 5) cardiac surgery.9 On the basis of experimental data, Ross and Franklin have suggested that dynamic changes in wall thickness might be used to study regional changes in contractile function caused by ischemia.'0 Because systolic thickening may not be influenced by the variety of factors affecting wall motion, and may therefore be more specifically related to contractility, the present study was undertaken in order 1) to determine whether there are changes in echocardiographic wall thickening in humans with coronary artery disease; 2) to see if these changes might distinguish acute myocardial infarction from chronic coronary artery disease; and 3) to see if changes in systolic thickening are related to changes in wall motion.

No abstract

This current randomized, open-label, crossover study evaluated preference for oral eletriptan 80 mg compared with subcutaneous sumatriptan 6 mg (suma-sc) amongst patients (n = 311) meeting IHS criteria for migraine who had recently used suma-sc, and found it well tolerated. Three attacks were treated on each study medication. Assessment of subjective preference was evaluated, after which patients freely chose which study medication they wished to use to treat each of three additional migraine attacks. A slight majority (50.6%) preferred or greatly preferred eletriptan, whilst 43% preferred suma-sc. When permitted to choose between eletriptan and suma-sc for subsequent treatment, 78% of patients who had preferred eletriptan took eletriptan during the extension phase for all three of their attacks, whilst only 37% of patients who preferred suma-sc took suma-sc for all of their extension-phase attacks (P < 0.05). Secondary efficacy measures showed comparable efficacy for each study medication, except for faster headache response and pain-free rates favor of suma-sc, and a significantly lower recurrence rate on eletriptan (25% vs. 40%; P < 0.05). The results of this study suggest that eletriptan is a strong alternative option for patients who have been prescribed suma-sc.

SUMMARYEchocardiograms of ten patients with congestive cardiomyopathy were compared to those of three groups of patients: (1) 17

In this study, we investigated cerebrospinal fluid of patients with various neurological symptoms for the presence of transforming growth factor alpha (TGF-alpha). 41 samples of cerebrospinal fluid were collected by lumbar puncture performed routinely due to the clinical suspicion of neurological disease from 22 females (age 15-80 years, median 42 years) and from 19 males (age 18-82 years, median 48 years). A highly sensitive and specific radioimmunoassay was used to determine the concentration of TGF-alpha in the samples. The detection limit of the assay was about 200 pg TGF-alpha. There was no cross-reactivity to human EGF. We showed CSF indeed does contain TGFalpha. As TGF-alpha was detected in all 41 samples investigated, this growth factor appears to be a constant component of CSF. The mean concentration was 5.5 ng TGF-alpha (S.D. +/- 2.7 pg/ml, range 1.1 to 13.9 pg/ml). There was no significant correlation between TGF-alpha concentration in CSF and age (r = -0.006) and there was no significant difference between females (mean 5.8+/-3.10 pg/ml) and males (mean 5.2+/-1.96 pg/ml). No diagnosis was over represented in patients with TGF-alpha concentrations above or below 1 S.D. off the mean. However, highest concentrations of TGF-alpha were found in the group of patients with peripheral neurological sensory dysfunctions and polyneuropathy. We conclude that TGF-alpha is not only a constant component of human cerebrospinal fluid in adults but could also be significantly involved in the pathophysiology of various neurological diseases. The earlier hypothesis that TGF-alpha could mainly have a role in brain development needs hence to be re-evaluated.

The purpose of this study was to determine the potential of a clinically adaptable two-dimensional echocardiographic system using computer enhancement and a mathematically defined integrated backscatter ratio for the early detection of ischemic and infarcted myocardium. Fifteen dogs had two-dimensional echocardiograms recorded during either open chest coronary occlusion (n = 5), closed chest occlusion (n = 5), occlusion followed by reperfusion (n = 3) or sham coronary occlusion (n = 2). A serial increase in integrated backscatter ratio, representing differences in returned ultrasound intensities between a reference point and specific myocardial regions, was detected between 7 and 12 minutes of complete occlusion in 9 of 12 animals (p less than 0.05), and at minutes 18, 43 and 67 in the remaining 3 animals. Reperfusion after 20 minutes of occlusion in two studies resulted in normalization of the backscatter ratio. An increase in backscatter ratio was not detected when 5 minute occlusion periods were used or during the 5 hour sham occlusion studies. The computer enhancement techniques utilized in this study provided increased visual detail of intracardiac structures over that provided by routine two-dimensional echocardiograms; myocardial tissue was identifiable in what appeared to be echo-free segments; and boundaries that appeared as noncontiguous horizontal lines on the routine echocardiograms were identifiable as trabeculae. The results indicate that: 1) significant increases in backscatter from nonperfused myocardium are detectable echocardiographically within 12 minutes of coronary occlusion and temporal changes can be assessed in the canine model, and 2) the echocardiographic data acquisition and computer analysis system utilized provide a clinically adaptable approach to identify and map myocardial characteristics in human beings.

No abstract