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The Relationship Between Migraine and Right-to-Left Shunt: Occurrence of Right-to-Left Shunt and Migraine

In patients with migraine, the prevalence of a right-to-left shunt seems to be higher when compared to the general population. Two investigational groups used transcranial Doppler ultrasound to determine right-to-left shunts in patients with migraine. A right-to-left shunt was found in 23% of the patients with migraine without aura. Forty-one to 48% of the patients…

The Relationship Between Migraine and Right-to-Left Shunt: Patent Foramen Ovale

The most common origin of a right-to-left shunt is the patent foramen ovale (PFO). The PFO is an important feature of fetal circulation. The interatrial septum primum on the left side and the interatrial septum secundum on the right side maintain a central communication before birth, so that blood bypasses the pulmonary circulation. After birth,…

The Relationship Between Migraine and Right-to-Left Shunt

Migraine is a very common type of headache, affects the quality of life importantly, and has been ranked among the most disabling medical illnesses in the world. Migraine seems to be a complex disorder in which genetic, environmental, behavioral, and other as-yet unidentified factors interact to trigger the typical migraine attacks. A causal relationship between…

An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar Proteinosis: Conclusion

The other factor that would argue in favor of a treatment effect for the observed clinical response is that many of these patients required frequent WLL for symptom relief before enrolling in our study, suggesting that they did not have many quiescent periods in their disease activity. GM-CSF therapy was well tolerated, with minor side…

An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar Proteinosis: Conclusion

Two plausible mechanisms for this observation in our patients are that both of these patients received escalating doses of GM-CSF for 26 weeks and 48 weeks, respectively, which may have overcome the inhibitory effect of the anti-GM-CSF antibody. The second mechanism could be that these two patients had a relatively lower anti-GM-CSF titer (1:3200 and…

An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar Proteinosis: Long-term Follow-up

The patients were followed up for a mean (± SD) duration of 39 ± 17.3 months. Of the 12 responders, 8 patients (67%) did not require WLL or home oxygen, and 4 patients (33%) required WLL for a mean of two occasions (range, one to five occasions). Of the nine nonresponders, four patients (44%) did…

An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar Proteinosis: Discussion

The improvement in clinical parameters was not apparent until 8 to 12 weeks after initiation of therapy in our study. This was similar to the study by Seymour et al, in which improvement in P(A-a)O2 was not evident until 4 to 6 weeks, with maximal improvement achieved at approximately 6 to 10 weeks of therapy….

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