Objectives: Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and noni...
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Objectives: Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM. Methods: Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 +/- 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age-and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence. Results: Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p < 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was significantly higher than that of subjects without lesions (67 +/- 5 years vs 53 +/- 13, p < 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI findings. In multivariable logistic regression analysis, restrictive type of diastolic filling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4-61.8, p < 0.001). Conclusion: SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic filling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.
Background: Tramadol, an atypical oploid, is a narcotic analgesic used for pain management. A search of the current literature found no studies examining the efficacy of intravenous tramadol on migraine pain. Objectiv...
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Background: Tramadol, an atypical oploid, is a narcotic analgesic used for pain management. A search of the current literature found no studies examining the efficacy of intravenous tramadol on migraine pain. Objective: The aim of this study was to investigate the efficacy and tolerability of a single dose of intravenous tramadol hydrogen chloride 100 mg in comparison with placebo in patients presenting with migraine. Methods: Adult migraineurs admitted consecutively to the emergency department of the Kocaeli University Hospital were enrolled in this single-blind (patients), prospective, randomized, placebo-controlled clinical trial. Patients were randomized to receive a 30-minute infusion of either intravenous tramadol (n = 17;100 mg in 100-mL saline) or placebo (n = 17;100-mL saline). Pain response was defined as a decrease of visual analogue scale (VAS) (0-100 mm) score to <50% of the pretreatment (baseline) value and a decrease of 4-point verbal scale (FPVS) score (0 = none, 1 = mild, 2 = moderate, 3 = severe) to mild or none. Pain-free response was defined as a decrease of both VAS and FPVS scores to 0. Pain was assessed at baseline and at 30 minutes and 1 hour after treatment completion. Migraine symptoms (eg, photophobia, phonophobia, nausea, vomiting) and adverse events (AEs) were assessed at the same time. A follow-up was also conducted by phone 24 hours after treatment. Results: Forty-four migraineurs were screened and 34 (28 women and 6 men;mean [SD] age, 39.5 [10.4] years;all were white) were enrolled in the study. Each group contained 11 patients with severe pain and 6 patients with moderate pain at baseline FPVS. At the end of 1 hour, pain response was reported by significantly more patients in the tramadol group than in the placebo group (12 [70.6%] vs 6 [35.3%];P = 0.040). Pain-free response was reported by 5 (29.4%) patients in the tramadol group and 2 (11.8%) patients in the placebo group, although the difference was not statistically significant.
Due to their localisations and symptoms, interhemispheric subdural haematomas (ISH) compose a distinct category. Altered level of consciousness and hemiparesis are the most frequent symptoms. We report a case of ISH w...
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Isolated abducens nerve palsy is a rare complication of treatment with various drugs. Here, the authors report the case of a 23-year-old female with isolated left abducens nerve palsy after long-term retinoic acid the...
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Isolated abducens nerve palsy is a rare complication of treatment with various drugs. Here, the authors report the case of a 23-year-old female with isolated left abducens nerve palsy after long-term retinoic acid therapy. The association is based on the temporal relationship and the exclusion of other possible etiologic factors following extensive laboratory and imaging diagnostics. The authors suggest that isolated abducens nerve palsy may be a presenting sign of a toxic neuropathy associated with retinoic acid therapy. After the exclusion of other organic lesions, especially idiopathic intracranial hypertension, and an assessment of the risk-benefit ratio, discontinuation of treatment must be considered in such cases.
We wanted to document Turkish migraine sufferers' unconventional therapy methods learnt from their social environment and discuss the historical background and possible action mechanisms of these methods. Unconven...
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The aim of this study was to determine postures adopted by patients during migraine attack. A total of 199 migraine patients were questioned about their postures during the migraine attack. Of these, 92 patients did n...
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The aim of this study was to determine postures adopted by patients during migraine attack. A total of 199 migraine patients were questioned about their postures during the migraine attack. Of these, 92 patients did not choose a specific lying position, 22 could not lie down during the attack because of the increase in pain, while 6 avoided lying due to scalp tenderness. During the attack, 19 patients preferred holding their heads up (compared to painless period) with a few pillows and 41 applied pressure on the aching side;15 lay with their necks extended and 15 lay face downward. Various combinations of these postures were also reported. Pain may arise from extracranial muscles as well as vessels during a migraine attack. The posture chosen during attack is a reflection of vascular and muscle pains that provoke symptoms. The postures that patients chose were aimed to lessen the severity of symptoms of their migraine attacks. Patients know the position they adopt and do not need to be told by a doctor, but they come to consultations to be understood, to learn that others behave in the same way, and in some, to obtain reasons for their posture. The existence of a specific lying posture can be an advantage for the physician in terms of approaching the patient and selecting an appropriate therapy.
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