Biomedical subjects
H A Saadah
Publications and source records attributed to H A Saadah.
Abortive migraine therapy in the office with dexamethasone and prochlorperazine.
Corticosteroids are commonly used in the abortive therapy of status migrainosus. However, this practice is based more on clinical experience than on published data. At my office, over a period of two years, 108 patients (156 migraine episodes) were treated with intravenous dexamethasone. Most of these patients had prolonged migraines that had resisted other forms of abortive therapy. The first 22 patients (32 migraine episodes) were given 10 mg of dexamethasone over 5 minutes, the next 39 patients (55 migraine episodes) were given 20 mg over 10 minutes, and the last 47 patients (69 migraine episodes) were given 3.5 mg of prochlorperazine over 5 minutes followed by 20 mg of dexamethasone over 10 minutes. Adverse effects were minor and patients with episodic migraines responded more favorably than those with intractable migraines. In the episodic migraine groups, response rates ranged from 80-89%, relapse rates from 29-35%, and remission rates from 57-83%. After the intravenous injections, repetitive oral abortive therapy was often required to treat relapses and secure remission. Adding 3.5 mg of prochlorperazine to 20 mg of intravenous dexamethasone significantly shortened the response time.
Post-cholecystectomy biliary pain and dyspepsia (response to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors).
BACKGROUND: The so called post-cholecystectomy syndrome is common, intractable, often progressive, causes prolonged suffering, and has no approved treatment. It usually presents with episodic biliary pains (colics), and postprandial dyspepsia (bloating and indigestion). Because treating a very recalcitrant case with lovastatin provided prolonged remission, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors were given to 12 subsequent patients with similar symptoms. OBJECTIVE: To determine whether HMG-CoA reductase inhibitors are useful in the therapy of post-cholecystectomy biliary pain and dyspepsia. METHODS: Open clinical trial in an internal medicine, private practice setting; data were collected from the patients' charts and from telephone interviews, five years after the index case had been treated. RESULTS: Eight of 12 patients experienced total resolution of their symptoms after many years of suffering; response occurred slowly within the first three months of treatment. Two other patients responded, stopped their medications, relapsed, and continue to be symptomatic. One patient did not take her medication and remains symptomatic; one other patient did not respond, was diagnosed with carcinoma of the pancreas, and died from it. CONCLUSIONS: These preliminary results suggest that HMG-CoA reductase inhibitors may be useful in relieving the symptoms of this common and intractable disorder. Controlled studies are needed.
Vestibular vertigo associated with hyperlipidemia: response to antilipidemic therapy.
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Abortive headache therapy with intramuscular dihydroergotamine.
During a six month period, intramuscular dihydroergotamine mesylate (1 mg.) was given to 43 patients (75 headache episodes) who presented to the office after oral medications failed to abort their headaches. Headaches were successfully aborted in 71%, with most responses occurring between 30-minutes and 4-hours after injection. Side effects were common (61%) but not serious; sedation developed in 25%, nausea in 24%, transient worsening of headaches in 15%, body aches in 11%, diarrhea in 5%, and in 13%, headaches that were successfully aborted relapsed within 24 hours. Intramuscular dihydroergotamine, although under-used, is cost effective, practical, and well suited for busy medical offices. Its appropriate use can reduce the need for narcotic analgesics and emergency room visits.
Abortive migraine therapy with oral naproxen sodium plus metoclopramide plus ergotamine tartrate with caffeine.
The oral tablet combination, (550 mgs. of naproxen sodium plus 10 mgs. of metoclopramide plus 1 mg. of ergotamine tartrate plus 100 mgs. of caffeine), was retrospectively studied in 63 patients who used it to abort migraine headaches. On the average, 84% of the headaches were totally aborted; minor side effects occurred in 40% of the patients, and 87% of the patients considered the combination superior to all prior treatments.
Abortive headache therapy in the office with intravenous dihydroergotamine plus prochlorperazine.
Over two years, 92 patients were treated in the office for 146 severe headache episodes. Headaches were aborted using four different intravenous regimens containing 0.5 or 1 mg. of dihydroergotamine and 3.5, 5, or 10 mg. of prochlorperazine. The speed and rate of response were directly proportional to the prochlorperazine dose used. High prochlorperazine doses (10 mg.) aborted the most headaches (95%) in the shortest time, but caused more sedation and akathesia. Low doses (3.5 mg.) aborted less headaches (89%) and responses were delayed; but, on the other hand, sedation was minimal and akathesia mild and uncommon. Dihydroergotamine given alone caused intolerable side effects; but, when it was given with prochlorperazine, efficacy was enhanced and side effects were greatly reduced. Aborting headaches in the office can be reliably achieved with minimal side effects by administering an intravenous mixture containing 1 mg. of dihydroergotamine and 3.5 mg. of prochlorperazine.
Sustained headache syndrome associated with tender occipital nerve zones.
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A case of panic disorder precipitated by oxymetazoline withdrawal.
Abrupt withdrawal in a healthy man of oxymetazoline nasal spray precipitated a prolonged panic disorder that required hospitalization with extensive evaluations. The pathophysiology of this syndrome is discussed in light of locus ceruleus neuropharmacology. This may be the first report of such a withdrawal syndrome.
The gram stain and culture of vaginal secretions in toxic shock syndrome.
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Petriellidium boydii (Allescheria boydii). Necrotizing pneumonia in a normal host.
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Toxic shock syndrome in Oklahoma.
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Carbenicillin and pseudomembranous enterocolitis.
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Washed sputum gram stain and culture in pneumonia: a practical tool for the clinician.
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Antibiotic-associated colitis treated with oral vancomycin.
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Antibiotic-associated or toxin mediated colitis. A unifying hypothesis.
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Pneumonia caused by Streptococcus pyogenes (group A beta hemolytic streptococcus). A diagnostic and therapeutic challenge.
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Headache fear.
A prospective study of migraine patients seen at the office, over six months, was conducted to ascertain the prevalence and intensity of headache fear. With patients' help a questionnaire, with 14 questions and a maximum score of 50, was developed and refined. A total of 100 patients with episodic migraines (< 15 headache days/month) and another 100 patients with intractable migraines (> or = 15 headache days/month) were inducted. Fifty controls were selected from office patients who, on routine system review, were found to have migraine headaches but had never consulted a physician about them. The average fear score of the control group was 3/50 (range: 0 to 9), and only 2% felt a strong compulsion to take analgesics when headaches began. Based on that, headache fear was defined as a score of 10 or more. The average fear score of the episodic group was 12/50 (range: 0 to 43), 49% had a fear score of > or = 10, and 38% felt a strong compulsion to take analgesics. The average fear score of the intractable group was 19/50 (range: 0 to 46), 73% had a fear score of > or = 10, and 60% felt a strong compulsion to take analgesics. The average number of analgesic tablets taken per month in the control group was 7 (range: 0-150), in the episodic group 22 (range: 0-120), and in the intractable group 139 (range: 0-400). The three groups were comparable as far as age, gender, and migraine years. The frequency of migraines per month was 3 (range: 0-30) in the control group, 6 (range: 0-14) in the episodic group, and 29 (range: 15-30) in the intractable group. As empirically defined, headache fear is common and increases in a statistically significant manner across the three migraine groups (control-episodic-intractable). I theorize that this fear may reinforce analgesic overuse and interfere with withdrawal efforts. Alloying this fear from the outset might provide patients with the support and reassurance needed for analgesic withdrawal, which is often necessary for recovery.