Age-related headache characteristics

A computerized headache interview was completed by 255 children, adolescents, and adults. Children did not differ from adults in the frequency of auras or prodromes. Young children were more likely than older patients to have brief headaches and headaches that tended to occur on weekdays, and to feel "great" after a headache. They were less likely than older patients to acknowledge multiple kinds of headaches, headaches located on one side of the head or posteriorly, and such concomitant occurrences as blurring, photophobia, irritability, frustration-anger, light-headedness, trouble with concentration, numbness-tingling, and lack of appetite. We do not know how much these differences can be attributed to age-related differences in language, physiology, or medical care selection factors.

Chronic paroxysmal hemicrania. VII. Mechanical precipitation of attacks: new cases and localization of trigger points

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4-C5 vertebrae, or beneath the posterior part of the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4-C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

The effect of ketanserin on blood pressure and biochemical parameters in treated patients with essential hypertension

17 subjects with essential hypertension (14 male, 3 female - ages: 40-69 years), 13 of whom continued their previous anti-hypertensive therapy, completed a double-blind cross-over trial of ketanserin 40 mg twice daily versus placebo tablets twice daily - each treatment phase was six weeks in duration. For the group as a whole, blood pressure (BP) was reduced in the ketanserin phase compared with the placebo phase; supine mean BP decrease: 4 +/- 1 mm Hg (p less than 0.05); standing mean BP decrease: 7 +/- 1 mm Hg (p less than 0.001). Heart rate (HR) was also significantly decreased in the ketanserin phase by 5 +/- 1 beats/minute (p less than 0.001). When individual subgroups were analysed the reductions in BP and HR were greater in subjects already receiving anti-hypertensives, diuretic and/or beta blockers. Changes were observed in 24 hour urine sodium and potassium excretion - sodium (mmol/day): placebo 137 +/- 17, ketanserin 174 +/- 19 (p less than 0.05); potassium (mmol/day): placebo 74 +/- 8, ketanserin 57 +/- 5. For the group as a whole there were no significant adverse effects during the ketanserin phase, although two subjects had a dose reduction of ketanserin because of drowsiness and dizziness. Two additional subjects withdrew from the study due to adverse effects, one in the placebo phase. In conclusion ketanserin in the dose administered has a modest hypotensive effect which is best seen in subjects already receiving other anti-hypertensive agents.

Effects of indomethacin, sulindac, naproxen, aspirin, and paracetamol in treated hypertensive patients

Four placebo controlled, randomised crossover studies were carried out to investigate the effects of non-steroidal anti-inflammatory drugs and analgesics on blood pressure control in treated hypertensive patients. Twelve patients completed one study comparing indomethacin, 25 mg tds, with placebo in 2 six week phases; there were increases in mean blood pressure (p less than 0.01) of 9 mm Hg (casual), 8 mm Hg (supine) and 10 mm Hg (standing) in the indomethacin phase accompanied by a 50% reduction in plasma renin activity (p less than 0.05) and a 47% decrease in plasma aldosterone concentration (p less than 0.05). Similar studies on aspirin-SR, 650 mg daily (19 patients), and paracetamol, 1 g 8th hourly (20 patients), revealed only small changes in blood pressure, with a 2 mm Hg increase in supine diastolic blood pressure during aspirin therapy and a 4 mm Hg increase in supine and standing systolic blood pressure during paracetamol therapy (p less than 0.05 for both). Nineteen patients completed a study with 4 three week phases, taking placebo, naproxen 250 mg mane and 500 mg nocte, sulindac 200 mg bd, and aspirin-SR 1950 mg bd. All three active agents depressed plasma renin activity and plasma aldosterone concentration. Neither sulindac nor aspirin caused any significant increases in blood pressure, and naproxen had little effect, though it did cause a 4 mm Hg increase in standing systolic pressure (p less than 0.05). We conclude that the effects of indomethacin on control of blood pressure in treated hypertensive patients are not exhibited to the same extent by other drugs investigated, and that they are not dependent on the concomitant decreases in plasma renin activity or plasma aldosterone concentration. The importance of inhibition of prostaglandin synthesis remains unclear.

Phycobilisome composition and possible relationship to reaction centers

The photosynthetic apparatus was studied in Anacystis nidulans wild type and in a spontaneous pigment mutant 85Y which had improved growth in far-red light (greater than 650 nm). Two phycobiliproteins, C-phycocyanin (lambda max 625) and allophycocyanin (lambda max 650), were present in a molar ratio of approximately 3:1 in the wild type and approximately 0.4:1 in the mutant. Phycobilisomes of wild type cells were larger (57 X 30 nm) than those of the mutant 85Y (28 X 15 nm). In the mutant they seemed to consist primarily of the allophycocyanin core. Fluorescence emission maxima of wild type and mutant 85Y phycobilisomes were at 680 nm (23 degrees C) and 685 nm (-196 degrees C). Excitation maxima of phycobilisomes were at 630 and 650 nm for the wild type and the mutant 85Y, respectively. The phycobilisomes of wild type cells whether grown in white or far-red light had the same size and pigment composition. A typical wild type cell in white light had a thylakoid area of 22.8 microns 2, but in far-red light the area was reduced to 13.5 microns 2, which was close to that of 85Y at 13.6 microns 2. Chlorophyll molecules per cell decreased in far-red light from 1.1 X 10(7) in wild type (white light) to 4.5 X 10(6) in mutant 85Y (far-red). The number of phycobilisomes per cell (approx 2 X 10(4)), calculated from the phycobiliprotein content and phycobilisome size, was about the same in wild type (white light) and mutant 85Y (far-red light), but the number of phycobilisomes per unit area of thylakoid was significantly greater in mutant 85Y than in wild type. The present results suggest that the phycobilisomes are linked with reaction centers and that the PSII complement (photo-system II and phycobilisome) was fully maintained in far-red light.

Outcome of eclectic psychotherapy in private psychological practice

The outcome of eclectic psychotherapy in a private psychological practice was examined in 69 clients. Target symptoms, life-adjustment ratings, social-adjustment ratings, and therapy expectancy were obtained before and after four months of psychotherapy from clients, therapists, and independent clinical raters. Results indicated that significant change had occurred after four months of psychotherapy for 6 of 10 categories of target complaints, in 9 of 11 areas of life adjustment and in 14 of 22 areas of social adjustment. Overall, 70 percent of clients showed improvement in their symptoms; 14 percent were unchanged and 17 percent deteriorated. The major value of the study is an exploration of psychotherapy outcome under naturalistic conditions in a growing but rarely studied treatment setting.

On the Ratio of Photosynthetic Reaction Centers RC2/RC1 in Chlorella

Chlorella pyrenoidosa (Emerson strain) was grown under high and under low irradiance. Measurements of the O(2) flash yield and the P700 absorption change gave estimates for the ratio of photoreaction centers RC2/RC1 at 1.2 to 1.5. A background light 1 did not increase flash yield.

Marital interaction and adjustment in patients with essential hypertension

Twenty-five men and twenty-six women with essential hypertension, and their spouses, were compared with normotensive control couples on a questionnaire measure of marital adjustment. The marriages of the hypertensive men showed significantly raised levels of marital dissatisfaction in the spouses, and an abnormal degree of reciprocal dissatisfaction between spouses. The marriages of the female patients showed an abnormal lack of reciprocity between spouses' scores. These findings support anecdotal reports of a relationship between marital disharmony and communication problems and elevated blood pressure. It is suggested that clinicians could routinely assess marital adjustment in patients with essential hypertension, and that in some cases conjoint marital therapy might be an adjunct or alternative to anti-hypertensive medications.

Protochlorophyll(ide) in a Blue-Green Alga

During growth under far-red (>650 nm) light, Anacystis nidulans accumulates protochlorophyllide to concentrations about one-tenth of the chlorophyll. From whole cell fluorescence spectra, protochlorophyll(ide) was identified also in another blue-green, and in a red, alga grown in far-red light.

Long-acting and short-acting diuretics in mild essential hypertension

A randomised, placebo-controlled, double-blind crossover study was conducted in 14 patients with mild essential hypertension comparing different regimens of administration of the "short-acting" diuretic, chlorothiazide and the "long-acting" diuretic, chlorthalidone. There were 6 randomised treatment phases each of 5 weeks duration. For blood pressure recorded both at the Clinic and at home the most prominent effects were seen with standing blood pressure, for which significant reductions of mean blood pressure compared to the placebo phase were observed with chlorthalidone 25 mg once daily (-5 +/- 1 (SE) mm Hg - p less than 0.05), chlorthalidone 50 mg once daily (-7 +/- 1 mm Hg - p less than 0.01) and chlorothiazide 500 mg twice daily (-4 +/- 1 mm Hg - p less than 0.05). Blood pressure reductions with chlorothiazide 500 mg once daily and 1000 mg once daily were not significant. About half of the patients completing the trial could be described as "non-responders". The observed biochemical changes (reduced plasma potassium and chloride concentrations and increased plasma bicarbonate and urate concentrations) were most marked in the phases with the most prominent blood pressure effects. The result support the suggestion that a sustained diuretic effect is desirable when diuretics are used in the treatment of hypertension. This can be obtained by selection of the appropriate dosage regimen for a particular diuretic, such as once daily administration for "long-acting" and twice daily for "short-acting" thiazide-type diuretics.

Effects of once daily indapamide and pindolol on blood pressure, plasma aldosterone concentration and plasma renin activity in a general practice setting

Sixteen patients with essential hypertension completed a double blind factorial trial comparing the effects of indapamide (2.5 mg daily) and pindolol (10 mg daily) on blood pressure, heart rate, plasma renin activity and plasma aldosterone concentration. There were four randomised test phases of eight weeks each during which patients received indapamide alone, pindolol alone, indapamide plus pindolol and no active treatment (placebo). Blood pressure and heart rate were measured every two weeks. Supine mean arterial pressure fell from 117 mm Hg in the placebo phase to 111 mm Hg in the indapamide phase, 106 mm Hg in the pindolol phase and 103 mm Hg in the combined indapamide plus pindolol phase. Factorial analysis confirmed that the hypotensive effects of the two drugs were additive, without evidence of potentiation or antagonism. Indapamide caused significant reductions in plasma potassium and chloride, and increases in plasma bicarbonate and urate concentrations; it also caused increases in plasma renin activity and aldosterone concentration. These changes are similar to those observed with thiazide diuretics.

Peridural meperidine in humans: analgesic response, pharmacokinetics, and transmission into CSF

Effective analgesia resulted from the injection of peridural meperidine in two groups of cancer patients, eight with postoperative pain and eight with intractable pain. Peridural meperidine HCl, 100 mg (n = 8), in 10 ml saline administered to patients following surgery was followed by a median duration of analgesia of 6 hours (range 4-20 hours) over periods ranging from 1-4 days. Peridural meperidine HCl, 30-100 mg (n = 8), in 10 ml saline administered to patients with intractable pain gave a median duration of analgesia of 8 hours (range 4-20 hours) over periods ranging from 1-9 days. There was no obvious tendency towards tolerance. In all patients, the onset of analgesia was within 5 min and was complete within 30 min. This analgesia paralleled the rise in CSF meperidine concentrations following peridural administration. Systemic absorption of peridurally administered meperidine occurred with a half-life of 15-30 min and produced blood concentrations high enough to contribute to analgesia after approximately 20 min in the majority of patients. There was no objective evidence in any neurological change nor sympathetic blockade after peridural meperidine. From this evidence the dorsal horn of the spinal cord may be the major site of action as distinct from the axonal blockade produced by local anesthetics, indicating 'selective' spinal analgesia.

The effects of indomethacin in treated hypertensive patients

1. Twelve treated hypertensive patients (ages 58-71 years) who had also been treated for joint disease participated in a randomized double-blind crossover placebo-controlled study to investigate the effects of indomethacin (25 mg three times daily) on blood pressure and biochemical parameters over a 6-week period. 2. Blood pressure was increased in all patients throughout the indomethacin treatment period (P less than 0.001)--average mean blood pressure increases were 9 mmHg (casual), 8 mmHg (supine), 10 mmHg (standing). 3. The blood pressure increase during indomethacin treatment was independent of the particular antihypertensive regimen in use. 4. Plasma aldosterone concentration was reduced by 50% (P less than 0.01), plasma renin activity was reduced by 43% (P = 0.102) and plasma urea concentration was increased by 17% (P less than 0.001) during indomethacin treatment. 5. The findings confirm that indomethacin impairs the blood pressure lowering effect of antihypertensive regimens.

Comparison of indapamide with thiazide diuretics in patients with essential hypertension

The effect of the new diuretic antihypertensive drug, indapamide (2.5 mg a day), was compared with the effect of thiazide diuretics in 24 patients with hypertension (seven of whom were receiving a diuretic alone, six were taking a beta-blocker plus a diuretic, and 11 received other combinations of drugs, including a diuretic in all cases). The randomized crossover study with two six-week phases indicated that indapamide is an effective hypotensive agent with potency similar to that of the thiazide diuretics in lowering the blood pressure and in increasing the excretion of potassium.