25. Koopman MW, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N Engl J Med. 1996 Mar 14; 334 11 ; : 682-7. 26. Kusek JW, et al Effect of blood pressure control and antihypertensive drug regimen on quality of life: the African American Study of Kidney Disease and Hypertension AASK ; Pilot Study. Control Clin Trials. 1996 Aug; 17 4 Suppl ; : 40S-46S. 27. Lawrence K, et al. Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results. BMJ. 1995 Oct 14; 311 7011 ; : 981-5. 28. Lonnqvist J, Shivo S, et al. Moclobemide and fluoxetine in the prevention of relapses following acute treatment of depression. Acta Psychiatrica Scandinavica 1995: 91: 189-194 Rampal P, Martin C, Marquis P, Ware JE, Bonfils S. A quality of life study in five hundred and eighty-one duodenal ulcer patients. Scandinavian Journal of Gastroenterology 1994; 29 206 ; : 44-51. 30. Regensteiner JG, Meyer TJ, Krupski WC, Cranford LS, Hiatt WR. Hospital vs homebased exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology 1997; 48 4 ; : 291-300. 31. Regensteiner JG . Exercise in the treatment of claudication: assessment and treatment of functional impairment. Vasc Med. 1997; 2 3 ; : 238-42. Review. 32. Shield CF, McGrath MM, Goss TF. Assessment of health-related quality of life in kidney transplant patients receiving tacrolimus FK506 ; -based versus cyclosporinebased immunosuppression. Transplantation 1997; 64 12 ; : 1738-43. 33. Simon GE, VonKorff M, Heiligenstein JH et al. Initial antidepressant choice in primary care: effectiveness and cost of Fluoxetine vs tricyclic antidepressants. Journal of the American Medical Association 1996; 275: 1897-902. Experimental, unrandomized, comparative trial, no placebo n 7 ; 34. Adelman JU, Sharfman M, Johnson R et al. Impact of oral sumatriptan on workplace productivity, health-related quality of life, healthcare use, and patient satisfaction with medication in nurses with migraine. American Journal of Managed Care 1996; 2 10 ; : 1407-16. 35. Coulter A, et al. Quality of life and patient satisfaction following treatment for menorrhagia. Fam Pract. 1994 Dec; 11 4 ; : 394-401. 36. Currie IC, et al. Treatment of intermittent claudication: the impact on quality of life. Eur J Vasc Endovasc Surg. 1995 Oct; 10 3 ; : 356-61.
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ALDA, Martin GILL, Kathryn J NORMAN, Ross M BARDEN, Nicholas BASSETT, Anne S BELLEVILLE, Sylvie N BRYSON, Susan E DAGHER, Alain GEJMAN, Pablo V GRADY, Cheryl L Dalhousie University McGill University University of Western Ontario Universit Laval University of Toronto Institut universitaire de griatrie de Montral Dalhousie University Montreal Neurological Institute Northwestern University Illinois ; Baycrest Centre for Geriatric Care HEGADOREN, Kathleen M HONER, William G JOOBER, Ridha LE MELLEDO, Jean-Michel LEPAGE, Martin MACQUEEN, Glenda M NORMAN, Ross M YATHAM, Lakshmi N YOUNG, L. T ZIPURSKY, Robert B University of Alberta University of British Columbia Douglas Hospital Research Centre University of Alberta Hospital McGill University Hamilton Psychiatric Hospital University of Western Ontario University Hospital at U.B.C. The Centre for Addiction and Mental Health University of Toronto, for example, sumatriptan otc.
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With treatment of depression, and lack of response to traditional headache therapy all support a diagnosis of headache caused by depression. In this case, the patient's depressive symptoms were attributed to bereavement, and recognition of their significance was delayed. The dose of tricyclic antidepressant used to treat his headache was likely too low to produce a full antidepressant effect. As in case 1, this patient required high doses of nontricyclic antidepressants for a full resolution of his headaches. Case 3 Ms. C, a 52-year-old woman, was seen for complaints of headaches since age 22. She reported headaches occurring on average 20 days a month that were low grade and nondescript, with superimposed exacerbations that met criteria for migraine. She reported a history of overuse of barbiturate-containing medications and had recently been hospitalized for barbiturate withdrawal. Since then, she had used sumatriptan daily. Trials of sumatriptan withdrawal, gabapentin, amitriptyline, and sodium valproate were ineffective. Acupuncture, physical therapy, and massage aggravated her headache. Ms. C was wealthy and traveled extensively to consult well-known physicians. Extensive treatments, both traditional and nontraditional, for headache and her other complaints had proved ineffective or produced unusual, dramatic, or paradoxical effects. Ms. C reported significant distress from headaches but had a score of 1 minimal disability ; on the Migraine Disability Assessment Scale. Her past medical history was significant for depression, anxiety, Raynaud's phenomenon, and fibromyalgia. Upon a review of systems, she endorsed numerous disabling somatic complaints, including weight loss, fatigue, frequent sore throats, sinus infections, palpitations, abdominal pain, menstrual pain and irregularities, alternating diarrhea and constipation, paresthesias, and dizziness. She reported no history of previous physical or sexual trauma. Her physical and neurological examinations were normal; previous neuroimaging studies were without abnormality. This patient met the criteria for a diagnosis of "Headache Attributed to Somatization Disorder" Appendix 2 ; . That her current headaches were attributable to this diagnosis and did not represent a separate primary headache disorder were indicated by their failure to respond to migraine-specific treatment and their worsening and improvement in conjunction with other somatic symptoms. Despite bitter complaints of distress related to headache, this patient suffered no functional impairment from them. RecPsychosomatics 46: 4, July-August 2005 and tadalafil.
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CYTOTOXIC EFFECT OF TETRAHYDROCANNABINOL ON MOUSE NEUROBLASTOMA CELLS Satoshi Yamaori1, Hikari Okada1, Tatsuya Funahashi1, Toshiyuki Kimura1, Kenzo Chiba2, Ikuo Yamamoto3 and Kazuhito Watanabe1, 2 Department of Hygienic Chemistry, Faculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa 920-1181, Japan; 2The Academic Frontier Project, Hokuriku University, Kanazawa 920-1181, Japan; and 3Department of Hygienic Chemistry, School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka 8828508, Japan Tetrahydrocannabinol THC ; , a major psychoactive constituent of marijuana, exerts cytotoxicity in cultured hippocampal and cortical neurons. These neurotoxicities have been suggested to be attributed to generation of free radicals by cyclooxygenase in hippocampal neurons1 and the activation of c-Jun N-terminal kinase JNK ; in cortical neurons2. However, a mechanism underlying THC cytotoxicity in neuroblastoma has not been fully understood. In this study, we examined cytotoxic potential of 8-THC in mouse neuroblastoma C-1300N18 N18 ; cell line. Real-time polymerase chain reaction analysis using primers specific for CB1 or CB2 receptors indicated that N18 cells expressed the mRNA for CB1 receptor 0.464 copies copy of -actin mRNA ; but not CB2 receptor 0.001 copies copy of -actin mRNA ; . 8-THC induced the cell death in a concentration-dependent and exposure time-dependent manner, as assessed by the MTT assay. Fifty % cytotoxic concentrations for 1, 3 and 6 hr exposures to 8-THC were 9.64, 5.12 and 4.25 M, respectively. Fluorescence microscopic analysis by staining with Hoechst 33258 indicated that 8-THC 5 M, 3 hr ; caused the nuclear fragmentation in N18 cells. Furthermore, z-DEVD-fmk 100 M ; , a caspase-3 inhibitor, significantly prevented 8-THC-induced cell death p 0.01 ; , as assessed by the MTT assay. In addition, the cytotoxicity induced by 8-THC 5 M, 3 hr ; was significantly suppressed by the addition of AM251, a CB1 receptor antagonist 2 M, p 0.001 ; , and forskolin, an adenylate cyclase activator 20 M, p 0.001 ; . By contrast, SP600125, a JNK inhibitor 5 M ; , did not affect the cytotoxic effect of 8-THC. These results suggest that the cytotoxicity of 8-THC in neuroblastoma N18 cells may be induced by the activation of CB1 receptor, but its underlying mechanism appears to be different at least in part from that in cortical neurons. Acknowledgements: Mouse neuroblastoma C-1300N18 cell line was provided from Cell Resource Center for Biomedical Research Institute of Development, Aging and Cancer, Tohoku University Sendai, Japan ; . This work was funded by the Academic Frontier Project for Private Universities from the Ministry of Education, Culture, Sports, Science, and Technology of Japan 2005-2009 ; and a Grant-in-Aid for Young Scientists from the Ministry, Education, Science, Sports, and Technology of Japan. 1. Chan G. et al., J. Neurosci., 18, 5322-5332 1998 ; . 2. Downer E. J. et al., Br. J. Pharmacol., 140, 547-557 2003 ; . 150.
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Absence of cutaneous allodynia and central sensitization: clinical and preclinical evidence [abstract]. Headache. 2002; 42: 390-391. Abstract OR15. Burstein R, Yamamura H, Malick A, Strassman AM. Chemical stimulation of the intracranial dura enhances responses to facial stimulation in brain stem trigeminal neurons. J Neurophysiol. 1998; 79: 964-982. Cady RK, Sheftell F, Lipton RB, et al. Effect of early intervention with sumatriptan on migraine pain: retrospective analyses of data from three clinical trials. Clin Ther. 2000; 22: 1035-1048. Lipton RB, Stewart WF. Acute migraine therapy: do doctors understand what patients with migraine want from therapy? Headache. 1999; 39 suppl 2 ; : S20-S26. Tfelt-Hansen P, Block G, Dahlof C, et al. Guidelines for controlled trials of drugs in migraine: second edition. Cephalalgia. 2000; 20: 765-786. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988; 8 suppl 7 ; : 1-96. Ware JE Jr, Bjorner JB, Kosinski M. Practical implications of item response theory and computerized adaptive testing. Med Care. 2000; 38 suppl 2 ; : II-73-II-82. Kwong JW, Putnam GD, Batenhorst AS. Validation of a questionnaire that measures short-term headache disability [abstract]. Neurology. 2001; 56 suppl 3 ; : A140. Abstract PO2.138. Garber WH, Kosinski M, Dahlof C, et al. HIT-6 reliably measures the impact of headache [abstract]. Cephalalgia. 2001; 21: 333. Abstract P1-E16. Ware J, Kosinski M, Dahlof C, et al. Validity of HIT-6, a paperbased short form for measuring headache impact [abstract]. Cephalalgia. 2001; 21: 333. Abstract P1-E17. Pfaffenrath V, Cunin G, Sjonell G, Prendergast S. Efficacy and safety of sumatriptan tablets 25 mg, 50 mg, and 100 mg ; in the acute treatment of migraine: defining the optimum doses of oral sumatriptan. Headache. 1998; 38: 184-190. Cady R, Elkind A, Keywood C. Frovatriptan: patient preference and efficacy in migraine early intervention [abstract]. Headache. 2002; 42: 391. Abstract F50. Klapper J, Charlesworth B, Soisson T, Poole Jergensen A. Treatment of mild migraine with oral zolmitriptan 2.5 mg provides high pain-free response rates and prevents progression to more severe migraine in patients with significant migrainerelated disability [abstract]. Headache. 2002; 42: 395. Abstract F53. Zagami AS, International 311C90 Long-term Study Group. 311C90: long-term efficacy and tolerability profile for the acute treatment of migraine. Neurology. 1997; 48 3, suppl 3 ; : S25S28. Pascual J, Cabarrocas X. Within-patient early versus delayed treatment of migraine attacks with almotriptan: the sooner the better. Headache. 2002; 42: 28-31. Lipton RB. Effects of early treatment of migraine headaches with oral sumatriptan: results from the Sumatdiptan Naratriptan Aggregate Patient SNAP ; database [abstract]. Cephalalgia. 2001; 21: 415. Abstract P2-K24 and temovate.
Useing sumatriptah and ergotamine together can become the reason of prolonged spasm of the blood vessels.
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Probable duration of the stay at the emergency department before the patient is effectively discharged. b ; Predicting the values of Medical Service, given evidence relative to all the remaining variables, except Pathology, Cause of Discharge, and Duration, which would be unknown at the time the patient arrives. If accurate, this prediction could serve to direct the arriving patient to the appropriate emergency unit. c ; Predicting the value of each of the 11 variables, given evidence about all the 10 remaining variables. In this way, we attempt to test the behavior of the network models for different problems. This experiment could serve to assess the robustness of the networks as general classifiers as opposed to having to manage a different model to classify each variable of interest ; . For all the classification problems, we used the previously learned networks and the success percentages were calculated using the independent test set containing 12, 291 cases. Table 6 displays the percentages of success of the different networks for the first two classification problems considered. In the case of predicting the duration of the stay, all the learned networks perform equally well, whereas in the other situation, PC and BE obtain the best results. With respect to predicting the duration of the stay, it should be noted that the results are worse than the ones obtained by the empty network. The reason is that the distribution of the duration of the stay is rather biased towards its first value from 0 to 8 and therefore the default rule, which assigns the `a priori' most probable class to all the cases, obtains a high percentage of correct classifications9. For the problem of predicting the medical service involved, the results remarkably outperform the prediction of the empty network. Table 7 displays the percentages of success of the different networks for the other 11 classification problems. The results are somewhat surprising, because the supposedly best algorithm, LS, performs rather poorly, whereas BE and BNPC obtain the best results. In the light of the poor result obtained by LS from a classificatory point of view, we raise the following question: Is this result due to the specific metric BDeu ; being considered? In other words, could an LS algorithm equipped with another scoring metric outperform the results obtained by BE and BNPC which are algorithms based on independence tests instead on scoring metrics ; ? In order to answer this question, we have considered two and topamax.
Figure 3. Cumulative proportion of patients returning to normal work performance across an 8-hour work shift after treating a migraine in the workplace with either sumatriptan succinate injection 6 mg ; or matching placebo. Patients' time to return to normal work performance has been set to the time to the end of the scheduled work shift for patients not returning to normal work performance.
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Compared to dihydroergotamine, sumatriptan has a faster onset of relief but headache recurs less often with dihydroergotamine and valaciclovir and sumatriptan.
Corresponding Author: Dr. G.F. Ibironke, Department of Physiology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Table 4. Pooled Results of Efficacy and Tolerability of Sumatriptan.
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