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Aim: To outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. Background: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are 'chronic migraine' and 'medication overuse headache'. They are either no better or worse than when their headaches first started despite their efforts. Method: We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients' headache characteristics, the 'burden' of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried. Findings: Most patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care. [ABSTRACT FROM AUTHOR]

OBJECTIVE To report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8-5% of such patients will subsequently develop a new primary tumour in the contralateral testis. PATIENTS AND METHODS From a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified. RESULTS Nineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11-181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinomain situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease-free, with a median follow-up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients. CONCLUSIONS Chemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow-up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the... [ABSTRACT FROM AUTHOR]

Atypical antipsychotic medications are associated with different adverse effects and efficacy profiles compared with conventional antipsychotics (i.e. less extrapyramidal symptoms, improved efficacy against negative symptoms and cognitive deficits, and most often a greater ability to improve patients' quality of life). However, the atypical antipsychotics may be associated with clinically significant bodyweight gain, increasing the risk of medical comorbidity, including diabetes mellitus, hypertension, cardiovascular disease and hyperlipidaemia. This literature review assesses the various bodyweight gain liabilities associated with atypical antipsychotics, as well as the effects of bodyweight gain on quality of life. The issue of prevention and management of this often neglected adverse effect is also examined. Most studies reviewed indicate that clozapine and olanzapine are associated with more bodyweight gain than the other atypical antipsychotics. There are potential factors that place certain patients at greater risk for bodyweight gain, including low pretreatment body mass index, young age and being of female gender. Furthermore, bodyweight gain associated with the use of atypical antipsychotics has been reported to be associated with clinical improvement, although this has not been substantiated widely. It is unclear whether increased medical comorbidity, including diabetes mellitus, coronary artery disease and/or elevated triglyceride levels, is secondary to the bodyweight gain associated with atypical antipsychotics, or the result of the agents themselves. A patient's quality of life may be greatly affected by excessive bodyweight gain; either by increased comorbid medical illness, an increased relapse rate associated with noncompliance, or the social stigma associated with being obese. However, most studies reveal that treatment with atypical antipsychotic medications is associated with improved quality of life compared with that achieved with conventional antipsychotic medications. Because bodyweight is an important health risk associated with atypical antipsychotics, prevention and effective management of bodyweight are paramount in preventing comorbid medical illness, relapse and possible noncompliance. [ABSTRACT FROM AUTHOR]

Examines prognosis of cervical carcinoma among younger patients. treatment of patients with invasive carcinoma of the cervix by radiotherapy; Review on the conclusions of age as a poor indicator of prognosis; Use of age as an indication for adjuvant treatment.

Presents a study in which bibliometric data on research in Mexico was used to show the impact of the special circumstances of science in the developing countries on the application of evaluation criteria. Consideration of the limitations associated with the use of the bibliometric methods; In-depth look at evaluative bibliometrics versus peer review; Conclusions based on the results of the study.

Depression is a common, serious illness that affects millions of individuals, most often in their prime years of productivity. There is strong evidence that depression is as debilitating as most other general medical conditions and results in increased general medical resource utilisation. The economic costs of depression are extremely high. The total cost of depression in the US in 1990 was estimated to be $US53 billion. Of this amount, $US33 billion was estimated to be directly related to the loss of productivity in the workplace. Well-controlled clinical studies have demonstrated that depression can be effectively treated with antidepressant medications. In addition to symptom reduction, these same studies have demonstrated that productivity at work also improves. The economic benefits from this increased productivity far outweigh the cost of appropriately diagnosing and treating depression. [ABSTRACT FROM AUTHOR]

Examines venous blood lactate responses to exercise at a work rate below the anaerobic threshold in relation to psychiatric disorder in patients with chronic fatigue syndrome (CFS). Incidence of increased lactate responses in patients with symptoms that precluded or severely restricted physical activity; Occurrence of impaired muscle energy metabolism for patients with CFS.

Examines the developments of the treatment of motor neuron disease. Analysis of the pathogenesis of the disease; Mechanism of neurotransmitters in neural death and degeneration; Effects of growth factors on the survival and growth of motor neurons.