Repetitive Attacks Research Articles

A Proinflammatory, Antiapoptotic Phenotype Underlies the Susceptibility to Acute Pancreatitis in Cystic Fibrosis Transmembrane Regulator (−/−) Mice

A Proinflammatory, Antiapoptotic Phenotype Underlies the Susceptibility to Acute Pancreatitis in Cystic Fibrosis Transmembrane Regulator (−/−) Mice

An Anatomy of Urban Terror: Lessons from Jerusalem and Elsewhere

This paper examines the increased prevalence of urban terror and its spatial implications. Urban terror concerns territory, space and logistics, and is characterised by low-intensity, ambiguously bounded warfare. It is defined as attacks intentionally directed against non-combatants and key installations located in high-density, continuously developed, diversified environments. The research traces the collective experience of London, Moscow and Istanbul with extended attention paid to Jerusalem. Four patterns of urban terror are identified and used to conduct the analysis. These consist of terrorist attempts to: decontrol urban territory, cause instability and demonstrate vulnerability; launch repetitive attacks on specific spaces in order to create conditions of chaos; achieve proximity and access to targets; and, finally, a response to terror by authorities based on surveillance, partition, closure and shrinkage of urban space. A final section consists of analysing terror's impact on the economy and future of cities.

Adrenal pheochromocytoma associated with dramatic cyclic hemodynamic fluctuations

A 52-year-old woman with a right adrenal pheochromocytoma had repetitive attacks of symptomatic hypotension/shock with systolic blood pressure (SBP)<50 mmHg followed by hypertension/hypertensive crises with SBP>300 mmHg. A non-invasive recording of beat-to-beat SBP, diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) was collected for 346 min. Twenty hemodynamic cycles occurred during this time, lasting 17 min on average, with the most dramatic changes of TPR. The ratio of the highest to the lowest observed values was nearly 12:1 for TPR, over 6:1 for both SBP and DBP, over 4:1 for CO, and nearly 4:1 for SV and 2:1 for HR. The fluctuations of TPR preceded changes of all other hemodynamic variables.

Coronary artery obstruction due to membranous ridge of the right sinus valsalva associated with Tetralogy of Fallot: syncope mimics anoxic spell

We report an infant with Tetralogy of Fallot who had suffered from repetitive attacks of syncope without obvious cyanosis. Careful observation by means of echocardiography and angiography revealed that the attacks resulted from acute coronary artery obstruction due to membranous ridge covering the sinus Valsalva. Surgical resection of the abnormal ridge and repair of Tetralogy of Fallot successfully improved the patient's symptoms. Syncope in children should be extensively investigated to exclude obstruction of the coronary arteries.

Hemicrania continua: diagnostic criteria and nosologic status.

Proposals for the diagnostic criteria for hemicrania continua (HC) and also for the nosological status of HC are set forth. The clinical constellation of symptoms and signs making up HC consists of: unilaterality without side shift; absolute indomethacin effect; and long-lasting repetitive attacks of varying duration, eventually with a chronic pattern, the pain being mild to severe. For the typical clinical picture of HC, including a positive 'indotest', we propose the term hemicrania continua vera. More or less analogous, but 'indotest-negative' clinical pictures have provisionally been termed hemicrania generis incerti (of undetermined nature). At the present level of knowledge, the diagnosis of hemicrania generis incerti should be made mostly by exclusion. HC may possibly best be classified along with chronic paroxysmal hemicrania (CPH) as this is the only other headache absolutely responsive to indomethacin. The bond between these two headaches on the one hand and cluster headache on the other should, at most, be a loose one. Interrelationships of these four classifiable headaches are briefly discussed.

Neuropsychological and psychiatric correlates of intractable pseudoseizures

Psychogenic seizures can mimic convulsive epilepsy and with repetitive attacks, iatrogenic complications from aggressive treatment of status epilepticus can occur. We studied neuropsychiatric features of 20 patients in whom psychogenic seizures were intractable and at times continuous. Nineteen of 20 patients seen were female, and all but one were under 40 years of age. All had convulsive attacks resistant to various medications, normal neurological examinations, and negative imaging studies and electroencephalograms (EEGs). Sixteen had previous evidence of epilepsy and the other four had epileptic relatives. Seizures were atypically prolonged, included back arching and pelvic thrusting, and persisted despite intravenous diazepam and therapeutic phenytoin and phenobarbital levels. Seizures terminated spontaneously in five, were stopped by suggestion in four, and persisted until respiratory arrest or elective intubation in 11. Ten patients had conversion disorder, six borderline or mixed personality disorder and four mental retardation. Fifteen had had some precipitating stressor and the remainder had histories of exhibiting attention-seeking behaviour. Nine of 10 patients with conversion disorder had ‘conversion V’ Minnesota Multiphasic Personality Inventory (MMPI) profiles, while personality disorder patients had elevation of several psychopathological scales. Patients with conversion disorder gradually improved with anticonvulsant discontinuation, while retarded individuals were helped by behaviour modification, situational change or neuroleptics. Personality disorder patients continued to have attacks and eventually discontinued follow-up. Clinical evidence of non-epileptic seizures includes clinical atypicality and long duration, exacerbation by medications and frequent attacks despite normal examination and studies. Such patients often have clinical evidence of mental subnormality, conversion disorder or personality disorder, and can be found to have psychopathology and evidence of cognitive impairment, either focal or general, by neuropsychological testing.

The long-term outcome of patients who suffered and survived an acute myocardial infarction in the midst of recurrent attacks of variant angina.

Twenty-one patients, ranging in age between 28 and 59 years, who survived hospitalization for an acute myocardial infarction in association with repetitive attacks of variant angina, were followed prospectively for 59.1 +/- 5.1 (SEM) (range 17-120) months. Four patients died, one of sudden death 17 months after admission, one of congestive heart failure at 33 months, and two of cancer at 43 and 45 months of follow-up. Three patients had four new myocardial infarctions at 22, 32, 33, and 61 months of follow-up. Six patients were readmitted for angina or other cardiac reasons. Twelve patients remained asymptomatic throughout the follow-up and one more patient was asymptomatic before and after his recurrent myocardial infarction. No relapse of variant angina was documented. Thus, the long-term course of patients with variant angina culminating in acute myocardial infarction is relatively benign, despite the highly unstable features of their initial presentation.

Spontaneous Angina in the Coronary Care Unit: 2. Electrocardiographic Changes during and after Chest Pain

Serial ECGs of 16 patients with repetitive attacks of spontaneous angina in the CCU were studied from admission to the hospital to the follow-up phase at the cardiac clinic. Transient repolarization ECG changes occurring during unprovoked angina included ST-segment elevation and ST-segment depression, alterations of T-wave amplitude and polarity, and pseudonormalization of previously inverted T-waves. In addition, QRS complexes were altered transiently during chest pain. Such changes comprised augmentation or reduction of amplitude of R and S waves, widening of QRS complexes and a merging of R waves with the elevated ST-segments. Occasionally the ECG during attacks of angina did not show any change. During asymptomatic periods, between attacks of spontaneous angina, the ECG either returned to baseline, or displayed minor ST-segment shifts, and/or T-wave alterations of varying durations. However, such changes became either persistent or were replaced in the late course of hospitalization by ECG alterations diagnostic of transmural or nontransmural myocardial infarction. Twelve patients suffered an acute myocardial infarction. Four patients died within one month of admission. During follow-up of the 12 surviving patients in the cardiac clinic, amelioration of T-wave changes was noted in the ECGs of patients who remained asymptomatic, but new ischemic alterations were seen in the ECG of patients who had recurrent angina, or were readmitted to the hospital for evaluation. Increase in the amplitude of R-waves, disappearance of Q-waves, or reduction of Q-wave depth were noted at follow-up, in comparison with the discharge ECG, in some patients who had suffered primarily an anterior myocardial infarction.

Copulation and intermale aggression in rats.

Attack behavior of reliably aggressive male Long-Evans rats against unfamiliar male intruders was observed immediately following copulation to one or more ejaculations. Compulatory series to five ejaculations did not differ from copulation to a single ejaculation or from a noncopulatory control in affecting aggressive behavior. Repetitive biting attacks occurred in all conditions, with comparable wounding. Evidently, the male postejaculatory state of insensitivity to sexual stimuli does not extend to stimuli eliciting intermale aggression. A second experiment determined the attack-eliciting capacity of foreign males placed in the home cage of an actively copulating male. As intromissions increased and the interval to ejaculation decreased, the probability of intermale aggression and interruption of copulation diminished. The results are discussed in reference to sexual and aggressive strategies of the copulating male.

Hyperaldosteronism presenting with repetitive Stokes-Adams attacks.

AN unusual case of primary hyperaldosteronism, associated with longstanding and severe hypertension, which presented with repetitive Stokes-Adams attacks caused by ventricular dysrhythmias, is reported. It was found that when the Q-Tc interval of the electrocardiogram was prolonged by more than fifty per cent ventricular dysrhythmia almost invariably occurred. The close relationship of the onset of dysrhythmias to the increased Q-T interval rather than to the serum potassium levels is pointed out.

The treatment of quinidine-induced ventricular fibrillation by closed-chest resuscitation and external defibrillation

1. 1. Two patients who had numerous repetitive attacks of paroxysmal ventricular flutter and fibrillation due to quinidine are reported upon. 2. 2. The arrhythmia was controlled by external cardiac massage and external electrical defibrillation. 3. 3. One patient survived after at least 14 paroxysms; the other died of cardiac standstill after over 90 paroxysms. 4. 4. The treatment of ventricular fibrillation by external cardiac massage and defibrillation is discussed and reviewed. 5. 5. The incidence of quinidine-induced ventricular tachycardia and fibrillation is reviewed and the treatment discussed.