Migraine as a deadly disease

The role of estrogen in migraine: a review and hypothesis

The epidemiological, clinical and basic science evidence for a role of estrogen in migraine is reviewed. The hypothesis is put forward that estrogen exerts its influence by modulating sympathetic control of the cerebral vasculature.

The contribution of genetically determined oxidation status to inter-individual variation in phenacetin disposition

The oxidative O-de-ethylation and aromatic 2-hydroxylation of phenacetin have been investigated in panels of extensive (EM, n = 13) and poor (PM, n = 10) metabolizers of debrisoquine. The EM group excreted in the urine significantly more paracetamol (EM: 40.8 +/- 14.9% dose/0-8 h; PM: 29.2 +/- 8.7% dose/0-8 h, 2P less than 0.05) and significantly less 2-hydroxylated metabolites (EM: 4.7 +/- 2.3% dose/0-8 h; PM: 9.7 +/- 3.5% dose/0-8 h, 2P less than 0.005) than the PM group. Apparent first-order rate constants, calculated from pooled phenotype data, for overall elimination of phenacetin (k) and formation of paracetamol (kml) were higher in the EM group (EM: k = 0.191 +/- 0.151 h-1; kml = 0.091 +/- 0.025 h-1; PM: k = 0.098 +/- 0.035 h-1, 2P less than 0.05, kml = 0.052 +/- 0.019 h-1, 2P less than 0.05) than the PM group. The apparent first-order rate constant for 2-hydroxylation displayed no significant inter-phenotype differences. Correlation analysis demonstrated that genetically determined oxidation status accounted for approximately 50% of the inter-individual variability in phenacetin disposition encountered in this study.

The nephrotoxicity of analgesics

IN recent years there has been increasing suspicion that prolonged or excessive use of analgesics may result in progressive renal damage very similar to that produced by chronic pyelonephritis. Phenacetin (acetophenetidin) has been widely incriminated as the offending drug, mainly because it was common to all the analgesic mixtures mentioned in the early reports. Histologically and functionally the renal lesions are predominantly tubular, with interstitial fibrosis, tubular degeneration and atrophy and a high incidence of papillary necrosis and pyelonephritis (Rubenstein, Abrahams, Stables & Levin, 1964).