We investigated whether polymorphisms of the endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), and GTP cyclohydrolase I (GTPCH) genes are involved in the aggravation of migraine induced by overuse of medications. We studied 47 patients with migraine (six males and 41 females; 36.4 ± 10.3 years of age) and 22 patients with migraine exhibiting medication overuse headache (MOH, one male and 21 females; 39.6 ± 9.9 years of age). The genotypes of polymorphisms of the eNOS (rs1799983), nNOS (rs2682826), and GTPCH (rs841) genes were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotypic distributions of rs2682826 (T/T plus T/C vs. C/C, P = 0.254), rs1799983 (G/G vs. G/T plus T/T, P = 1.000), and rs841 (T/T plus T/C vs. C/C, P = 0.149) were not significantly different between patients with migraine and patients with MOH. The results of this study showed an absence of association between the polymorphisms of eNOS, nNOS, and GTPCH genes and the complication of MOH in patients with migraine.

A 37-year-old man who had suffered right chest pain while mowing weeds was transferred to our hospital. A chest roentgenogram revealed a needle-like foreign body overlying the cardiac silhouette and chest CT confirmed an intracardiac foreign body. The patient underwent emergency operation, and a foreign body was removed under cardiopulmonary bypass and performed cardiac repair. A foreign body penetrated right lung and reached it in the left atrial cavity. The patient recovered uneventfully without any symptoms of infections.

We report a case of tricuspid infective endocarditis with peripheral pulmonary artery aneurysm. A 31-year-old man with a history of intravenous drug abuse was admitted to our institution. Echocardiography showed severe tricuspid valve insufficiency and large vegetation (10 mm) attached to the tricuspid valve. Computed tomography (CT) revealed a right peripheral pulmonary artery aneurysm. We operated because of the large amount of vegetation. Before the operation, we performed coil embolization for peripheral pulmonary aneurysm. During the operation, we removed the posterior leaflet with vegetation, and performed tricuspid valve repair. The postoperative course was uneventful. Postoperative echocardiography did not show any tricuspid valve insufficiency or vegetation.

BACKGROUND AND PURPOSE: Valproate is used as a prophylactic drug for migraine, but it is not be effective in all patients. We used medical records to investigate which clinical factors affected the response to valproate in patients with migraine as an original headache, and established a scoring system for predicting the clinical response to prophylactic therapy. METHODS: We investigated clinical factors from the medical records of 95 consistent responders (CRs) and 24 inconsistent responders (IRs) to valproate. RESULTS: Multivariate stepwise logistic regression analysis revealed that a history of hyperlipidemia and hay fever and the complication of depression or other psychiatric disorder were significant factors that independently contributed to a negative response, with odds ratios of 6.024 [no vs. yes; 95% confidence interval (CI)=1.616–22.222], 2.825 (no vs. yes; 95% CI=1.046–7.634), and 2.825 (no vs. yes; 95% CI=1.052–7.576), respectively. A predictive index (PI) of the clinical response to valproate in patients with migraine was calculated using the regression coefficients of these three factors as an integer, and the index was significantly higher for IRs than for CRs (1.46±1.10 vs. 0.69±0.74, mean±SD, p<0.001). CONCLUSIONS: The obtained PI may represent an appropriate scoring system for predicting the responses in these patients.
Depression ; Headache ; Humans ; Hyperlipidemias ; Logistic Models ; Medical Records ; Migraine Disorders* ; Odds Ratio ; Rhinitis, Allergic, Seasonal ; Risk Factors ; Valproic Acid*

BACKGROUND AND PURPOSE: Migraine patients are particularly prone to the complication of medication-overuse headache (MOH). Although it has been shown that A allele carriers for the tumor necrosis factor (TNF)-beta gene G252A polymorphism are at high risk of the development of migraine without aura, the relationship between the TNF-beta gene G252A polymorphism and MOH is unknown. We investigated whether the TNF-beta gene G252A polymorphism is involved in the aggravation of migraine by overuse of medications. METHODS: Forty-seven migraine patients (6 males and 41 females; age 36.4+/-10.3 years, mean+/-SD) and 22 MOH patients (1 male and 21 females; age 39.6+/-9.9 years) who had migraine were included in this study. The genotype for the TNF-beta gene G252A polymorphism was determined by polymerase-chain-reaction restriction-fragment-length polymorphism analysis. RESULTS: The distribution of TNF-beta gene G252A genotype frequency differed significantly between migraine and MOH patients (p=0.013). The G/G genotype was carried by 23% of the migraine patients but it was absent in MOH patients. CONCLUSIONS: G/G genotype carriers appear to be less susceptible to the aggravation of migraine by overuse of medications. The G252A TNF-beta gene polymorphism may be one of the factors contributing to the complications of MOH in patients with migraine.
Alleles ; Genotype ; Headache ; Humans ; Lymphotoxin-alpha ; Male ; Migraine Disorders ; Migraine without Aura ; Tumor Necrosis Factor-alpha

PURPOSE : The purpose of this study was to clarify the effects of prolonged expiration (PE) on respiratory and cardiovascular responses and autonomic nervous activity during the exercise.METHODS : Twenty-five healthy men (22±1years) were classified according to the breathing mode during the exercise : 2-second inspiration and 4-second expiration in 1 : 2 group, 3-second inspiration and 3-second expiration in 1 : 1 group and normal breathing in control group. The 6-minute exercise was performed at anaerobic threshold (AT) and 60%AT using a cycle ergometer as an exercise protocol. Respiratory rate (RR) and tidal volume (TV) were measured by the expired gas analysis. The power of low- (LF) and high-frequency components (HF) was analyzed from a Holter electrocardiogram to assess the heart rate variability. RESULTS : RR and LF/HF were significantly lower, TV and HF were significantly higher during the exercise of 60%AT and AT in the 1 : 1 and 1 : 2 groups than in the control group (P<0.05 or P<0.01). The increase of HR was significantly lower and that of HF was significantly higher during the exercise at 60%AT in the 1 : 2 group than in the 1 : 1 group (P<0.05). CONCLUSION : PE activated the parasympathetic nervous activity and consequently restrained an excessive increase of HR during the exercise at 60%AT.

The number of heated tobacco product users is increasing rapidly in Japan; thus, smoking prevention education that includes heated tobacco products is necessary. To clarify the current status and issues related to smoking prevention education programs for school pharmacists, a questionnaire survey was conducted among 300 school pharmacists. The response rate was 45.3% (136/300). Smoking prevention education was provided by 42.6% (58/136) of school pharmacists. Among them, 56.9% (33/58) included heated tobacco products in their education programs. Moreover, 75.9% (44/58) of pharmacists also provided support for smoking cessation at pharmacies, and 93.1% (54/58) of pharmacists felt the necessity of providing support for smoking cessation for heated tobacco product users at pharmacies. On the other hand, 21.8% (17/78) of school pharmacists who did not provide smoking prevention education responded that they did not have sufficient information and knowledge about heated tobacco products. In addition, among these pharmacists, 53.8% (42/78) did not provide support for smoking cessation at pharmacies. Although both groups felt the need for the smoking prevention education provided by school pharmacists, the school pharmacists who provided such education felt the need more strongly. Regarding the necessity of including the taking up of heated tobacco products in smoking prevention education, it was found that pharmacists who provided such programs felt the necessity more strongly. It is important to obtain accurate information about heated tobacco products and change the content to unified educational in cooperation with schoolteachers to enhance smoking prevention education by school pharmacists.

A questionnaire survey was conducted to investigate the use of goreisan for headaches caused by weather and atmospheric pressure changes, and to clarify issues in promoting treatment with goreisan. The subjects were men and women in their 20s to 40s who developed headaches due to changes in weather and atmospheric pressure. Medication was used by 58.0% of the migraine group and 42.5% of the other headaches group. Among them, 27.5% of the migraine group and 15.1% of the other headaches group had used goreisan. Regarding the method of use of goreisan, the most common answer for the migraine group was “used after feeling a sign that headache is likely to occur,” whereas for the other headaches group, the most common response was “used after headache has occurred.” In the migraine group, the most frequent premonitory symptom was “stiffness in the shoulders and neck.” More than 80% of both groups were satisfied with the use of goreisan. In addition, 77.8% of migraine group and 59.5% of the other headaches group of those who had never used goreisan answered that they would like to use goreisan for headaches caused by weather or atmospheric pressure changes in the future. As a reason for not wanting to use goreisan, over half of both groups answered that they did not like the taste of herbal medicines. It is necessary to offer tablets to patients that do not like the taste.

A 27-year-old woman who suffered loss of consciousness twice after left femoral pain in the 25th week of gestation was referred to the obstetrics and gynecology department of our hospital. A structure with an attachment on the atrial wall was found in both atria on echocardiography, leading us to suspect impending paradoxical embolism (IPE). Judging from the shape of the thrombus in the atria, we thought that there was a high possibility of further embolism although rescue of the baby was feasible via cesarean section, so we decided to carry out emergency surgery. After delivering the infant by cesarean section, we used a heart-lung machine to incise the right atrium under hypothermia and remove the thrombus. As intraoperative esophageal echocardiography showed embolization in the right pulmonary artery, we cut the right pulmonary artery and removed the emboli. After surgery, a femoral vein thrombus was observed on echocardiography of the lower extremity vein, and we inserted an inferior vena cava filter. The patient was discharged on the 16th postoperative day. The situation whereby a thrombus is trapped in the foramen ovale without embolism of the arterial system is the rare pathological condition known as IPE. As no cases of surgical thrombectomy to treat IPE arising from complications of pregnancy have been reported thus far, the case described herein fittingly augments the literature.

As a screening tool for detecting latent pre-locomotive syndrome (latent pre-LS) in women over the age of 40, measuring handgrip strength with a cut-off value of 26 kg was proposed in a previous report. However, this screening method missed 22% of latent pre-LS. It would be beneficial to screen almost persons with latent pre-LS in community pharmacies. In this study, it was investigated whether screening using the combination of measuring handgrip strength and the questionnaire, “Loco-check,” which was proposed by the Japanese Orthopaedic Association, improved the detection of latent pre-LS in the same group mentioned above. Combining only one of the “Loco-check” questions, “I cannot put on a pair of socks while standing on one leg,” with the measurement of handgrip strength with the cut-off value of 26 kg, the detection of latent pre-LS was increased to 90.2%. The odds ratio was 9.72 in logistic regression analysis. Using the combination of the measurement of handgrip strength and the response to one question is both rapid and convenient. Therefore, in this study, this screening combination is proposed to be a useful tool in community pharmacies for detecting early latent pre-LS.