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Predominant Symptom (predominant + symptom)
Selected AbstractsGastric Stasis in Migraine: More Than Just a Paroxysmal Abnormality During a Migraine AttackHEADACHE, Issue 1 2006Objective.,The aim of this article is to evaluate gastric motility and emptying in the ictal and interictal period in migraine. Background.,Nausea is a predominant symptom of migraine and the basis of it is thought to be gastric stasis. Objective methods to establish this are however lacking. We utilized gastric scintigraphy studies to determine gastric motility in the ictal and interictal period of migraine. Methods.,Ten migraine subjects were compared to equal number of age and sex matched controls. Gastric scintigraphy using a standard meal was performed in all control subjects once and in all 10 migraine subjects in the interictal period and nine studies were performed in the ictal period migraine. Results.,The time to half emptying was delayed in migraine ictally (78%) and interictal period (80%) using normative data at this institution. Gastric stasis was less pronounced ictally (149.9 minutes) compared to interictal period (188.8 minutes). There was a significant delay compared to nonmigrainous controls (migraine 188.8 minutes vs normal controls 111.8 minutes; P < .05). These data were replicated in percentage of radioactive material remaining in the stomach at 2 hours. Conclusions.,Contrary to previous belief, this study has demonstrated that migraineurs suffer from gastric stasis both during and outside an acute migraine attack. This may suggest that migraineurs may have an abnormal autonomic function compared to nonmigrainous controls. The potential role of this in pathophysiology of migraine is discussed and avenues for further investigations are explored. [source] Predictors of the placebo response in functional dyspepsiaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2006N. J. TALLEY Summary Background, Trials in functional dyspepsia report placebo response rates of 30% to 40%. Aim, We aimed to identify predictors of the placebo response. Methods, Patients from primary, secondary and tertiary practices with functional dyspepsia defined by Rome II criteria were enrolled into one of four clinical trials; 220 patients were randomized to receive placebo. Scintigraphic assessment of gastric emptying at baseline was repeated at the end of the treatment in those with delayed emptying. After a 2 week run-in period, patients were followed for 8 weeks on placebo. Response was assessed on a weekly basis and a responder was defined as satisfactory relief of meal-related symptoms on at least 50% of weeks. Results, The mean age was 44 years (range 18,82) and 74% were female; 76 (35%) were placebo responders. The predominant symptom was an unstable measure over the trial. Independent predictors of a lower placebo response were lower body mass index and a more consistent predominant symptom pattern (both P < 0.05). No association was seen with age, gender, centre type, baseline symptom score, baseline or change in gastric emptying, or baseline quality of life. Conclusion, In functional dyspepsia, a consistent predominant symptom pattern and lower body mass index may be associated with a lower placebo response rate. [source] The effect of an empirical trial of high-dose lansoprazole on symptom response of patients with non-cardiac chest pain , a randomized, double-blind, placebo-controlled, crossover trialALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2004J. Bautista Summary Background :,Empirical trial with high-dose omeprazole has been shown to be a sensitive tool for diagnosing patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. Aim :,To determine the clinical value of an empirical trial of high-dose lansoprazole in detecting patients with gastro-oesophageal reflux disease-related non-cardiac chest pain. Methods :,Patients who were referred by a cardiologist after a comprehensive evaluation, with at least three episodes per week of unexplained chest pain as the predominant symptom, were enrolled into the study. Oesophageal mucosal disease was determined by upper endoscopy followed by 24-h oesophageal pH monitoring to assess acid exposure. Patients were then randomized to either placebo or lansoprazole 60 mg am and 30 mg pm for 7 days. After a washout period of 1 week, patients crossed over to the other arm of the study for an additional 7 days. Patients completed a daily diary assessing severity and frequency of chest pain as the predominant symptom throughout the baseline treatment and washout periods. The lansoprazole empirical trial was considered diagnostic if chest pain score improved ,50% than baseline. Results :,Of the 40 patients with non-cardiac chest pain that were enrolled, 18 (45%) had erosive oesophagitis and/or abnormal pH test (gastro-oesophageal reflux disease-positive) and 22 (55%) had both tests negative (gastro-oesophageal reflux disease-negative). Of the gastro-oesophageal reflux disease-positive patients, 14 (78%) had significantly higher symptom improvement on lansoprazole than on placebo (22%) (P = 0.0143). Of the gastro-oesophageal reflux disease-negative group, two (9.1%) markedly improved on the medication and eight (36.3%) on placebo (P = 0.75). The sensitivity and specificity of the lansoprazole empirical trial was 78 and 80%, respectively. By day 2, 12 (85.7%) of the gastro-oesophageal reflux disease-related non-cardiac chest pain responders had either complete or almost complete symptom resolution. Conclusions :,The lansoprazole empirical trial is highly sensitive and specific for diagnosing gastro-oesophageal reflux disease-related non-cardiac chest pain patients. The trial enables diagnosing most of the responders within the first 2 days and thus a shorter duration of therapy may be considered in a subset of non-cardiac chest pain patients. [source] Pain versus discomfort,is differentiation clinically useful?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001V. Stanghellini Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub-groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history-taking will be of pivotal importance in management strategies for functional dyspepsia. [source] Clinical overview of the synucleinopathiesMOVEMENT DISORDERS, Issue S6 2003Maria J. Martí MD Abstract The term synucleinopathies is used to name a group of neurodegenerative disorders characterized by fibrillary aggregates of ,-synuclein protein in the cytoplasm of selective populations of neurons and glia. These disorders include Parkinson's disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF), and multiple system atrophy (MSA). Clinically, they are characterized by a chronic and progressive decline in motor, cognitive, behavioural, and autonomic functions, depending on the distribution of the lesions. Because of clinical overlap, differential diagnosis is sometimes very difficult. Parkinsonism is the predominant symptom of PD, but it can be indistinguishable from the parkinsonism of DLB and MSA. Autonomic dysfunction, which is an isolated finding in PAF, may be present in PD and DLB, but is usually more prominent and appears earlier in MSA. DLB could be the same disease as PD but with widespread cortical pathological states, leading to dementia, fluctuating cognition, and the characteristic visual hallucinations. The deposition of aggregates of synuclein in neurons and glia suggests that a common pathogenic mechanism may exist for these disorders. Even though synuclein may play an important role in disease development in these disorders, in light of the different symptom complex and prognosis and management issues that characterize each disorder, we think that the term synucleinopathy has little practical value as a diagnostic term for the clinician. Clinicians should attempt to reach standard clinical diagnosis on patients, such as PD, PAF, or MSA. © 2003 Movement Disorder Society [source] A new intravaginal device for stress incontinence in womenBJU INTERNATIONAL, Issue 9 2001H. Thyssen Objective To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebćk, Denmark) for treating stress incontinence in women. Patients and methods Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study. Results Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side-effects were few and not serious. The women found both devices easy to prepare, insert and use; two-thirds preferred the CCT to the CCG. Conclusion The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior. [source] At-risk mental state (ARMS) detection in a community service center for early attention to psychosis in BarcelonaEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2010Yanet Quijada Abstract Aim: To describe the strategy and some results in at-risk mental state (ARMS) patient detection as well as some of the ARMS clinical and socio-demographical characteristics. The subjects were selected among the patients visited by an Early Care Equipment for patients at high risk of psychoses, in Barcelona (Spain) during its first year in operation. Methods: Descriptive study of the community,team relations, selection criteria and intervention procedure. Description of patient's socio-demographic and symptomatic characteristics according to the different instruments used in detection and diagnoses, taking account of four principal origins of referrals: mental health services, primary care services, education services and social services. Results: Twenty of 55 referred people fulfilled the at-risk mental state criteria, showing an incidence of 2.4 cases per 10 000 inhabitants. They were mainly adolescent males referred from health, education and social services. Overall, negative symptoms were predominant symptoms and the more frequent specific symptoms were decrease of motivation and poor work and school performance, decreased ability to maintain or initiate social relationships, depressed mood and withdrawal. Conclusions: It is possible to detect and to provide early treatment to patients with prodromal symptoms if the whole matrix of the community , including the social services , contributes to the process. The utilization of a screening instrument and a two-phase strategy , the second carried out by the specialized team , seems to be an appropriate approach for early psychosis and ARMS detection. [source] Pain versus discomfort,is differentiation clinically useful?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2001V. Stanghellini Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub-groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history-taking will be of pivotal importance in management strategies for functional dyspepsia. [source] The Treatment of Cognitive Impairment Associated with Parkinson's DiseaseBRAIN PATHOLOGY, Issue 3 2010David J. Burn FRCP Abstract Cognitive impairment and dementia associated with Parkinson's disease (PD) are common and often have devastating effects upon the patient and their family. Early cognitive impairment in PD is frequent, and the functional impact may be underestimated. Optimal management will rely upon better identification of the predominant symptoms and greater knowledge of their pathophysiological basis. The management of dementia in PD (PD-D) also has to consider the significant neuropsychiatric burden that frequently accompanies the cognitive decline, as well as fluctuations in attention. Atypical anti-psychotics have a limited role at present in treating PD-D, although new drugs are under development. The mainstay of drug management for people with PD-D is cholinesterase inhibitors, although recent trials have suggested that the N-methyl-D aspartate antagonist memantine may also have some benefit. Disease modification remains the ultimate goal for preventing the inexorable decline in PD-D, although effective interventions are still some way off. Limited benefit may, however, be possible through exercise programmes and so-called "medical foods", although randomised trials are required to confirm largely anecdotal observations. [source] Guillain-Barré syndrome in a child with pain: lessons learned from a late diagnosisACTA PAEDIATRICA, Issue 10 2010Danielle B. Pier Abstract Children with Guillain-Barré Syndrome (GBS) often do not present like adults with an ascending paralysis and sensory abnormalities, but typically have pain and gait difficulties as predominant symptoms. We present a case of paediatric GBS that was not diagnosed until late in the course because of limited neurological examination, erroneous interpretation of newly acquired data and insufficient familiarity with the disorder in children. Through this case, essentials of paediatric GBS are reviewed. Conclusion:, pain and gait difficulties can be the main features of paediatric GBS at presentation. In addition, a comprehensive neurological exam in any case of weakness or diffuse pain combined with ongoing critical interpretation of a disease course allows for adjustment of a preliminary diagnosis towards a potentially life-threatening disease. [source] | ||||||||||