Lijec̆nic̆ki vjesnik
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Central poststroke pain is a type of neuropathic pain which is caused by damage to the central nervous system after a stroke and which is localized to the territory of the neurological deficit which corresponds to the cerebrovascular lesion. Stroke is the commonest cause of central neuropathic pain. ⋯ According to international guidelines for the treatment of central poststroke pain, the first line therapy is tricyclic antidepressants (amytriptilin and nortriptilin) or antiepileptic drugs (lamotrigine, gabapentine, pregabaline, carbamazepine). The second line is tramadol, opioids and fluvoxamin.
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Even though the effects of surgery and anesthesia on sleep have not been completely defined yet, it is an irrefutable fact that the patients with sleep apnea could experience significant perioperative complications, in terms of common difficult airway problems, as well as prolonged emergence from anesthesia. Besides, there are strong evidences of correlation between sleep apnea and hypertension and other cardiovascular diseases. Preoperative questions about sleep, possible snoring, or excessive daytime sleepiness should become a routine part of preanesthesia evaluation, together with airway examination and thorough pulmonary and cardiovacular examination. ⋯ The possible problems may arise during tracheal intubation, extubation, or with postoperative analgesia, since opioids increase the incidence of pharyngeal collapse. Whenever possible, regional anesthesia techniques should be used. On the other hand, by documenting every difficult airway management, difficult intubation or prolonged recovery, the anesthesiologists are in good position to effectively screen for OSA in population.
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Lijec̆nic̆ki vjesnik · Jun 2007
Review[Cervicogenic headache: etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy].
The term "cervicogenic headache" (CH) implies a chronic hemicranial pain syndrome caused by upper cervical spine disorders. According to the clinical researches, in 15-20% of the patients with chronic unilateral headache, it is the case of the headache of cervical origin. The sources of the referred pain manifested as CH are the disorders of anatomical structures innervated by the first three cervical spinal nerves and/or direct irritation/lesion of these nerves (spinal nerves C1-C3, intervertebral/i.v. joints C0-C3, i.v. disc C2-C3 muscles, ligaments, bony structures, dura mater, vertebral arteries). ⋯ It seems that the best results are achieved by a combination of manual therapy, physical therapy and kinezitherapy. Although the CH has been included into International headache classification, this hemicranial pain syndrome has still been unknown to a wider circle of medical practicioners. That is why the purpose of this article is to describe etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy of CH.
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Lijec̆nic̆ki vjesnik · Jan 2007
Review[Vertebrogenic chest pain--"pseudoangina pectoris": etiopathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].
Vertebrogenic pain localised in the anterior thorax can imitate anginal pain ("pseudoangina pectoris"). The most common causes of vertebrogenic chest pain are segmental dysfunction and degenerative changes at the level of the lower cervical and upper middle thoracic spine. Segmental dysfunction is a source of pseudoradicular pain, and degenerative changes, before all disc hernia and dorsal osteophytes which are compressing corresponding nerve roots, are the sources of radicular pain which irradiates in the chest. ⋯ From therapeutic aspect it is very important to distinguish vertebrogenic from anginal pain. That is, the change of cardiological therapy will not eliminate possible attacks of vertebrogenic pain in patients with angina pectoris. From the aspect of most recent understandings, the article describes etiopathogenesis, characteristics, diagnosis and therapy of vertebrogenic chest pain, and also the differences between vertebrogenic and anginal pain.
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Lijec̆nic̆ki vjesnik · Sep 2006
Review[Use of magnetic resonance imaging in the diagnosis and prognosis of multiple sclerosis].
Multiple sclerosis is an autoimmune disease characterized by demyelination and axonal loss. Conventional magnetic resonance imaging allows the demonstration of spatial and temporal dissemination of multiple sclerosis lesions earlier than is possible from clinical assessments. A variety of conventional magnetic resonance imaging protocols, in conjunction with clinical assessment, are now routinely used to increase the accuracy of diagnosis and long-term prognosis of multiple sclerosis. ⋯ Several studies have used brain atrophy, T1-hypointense lesion volume, magnetization transfer imaging, diffusion-weighted imaging and magnetic resonance spectroscopy to test whether the extent and severity of tissue loss in lesions and in normal appearing gray and white matter at the time of clinically isolated syndrome may have diagnostic and prognostic value. These magnetic resonance imaging techniques represent a powerful tool to non-invasively study different pathological substrates of lesions and microscopic tissue changes. Additional short- and long-term prospective studies are requested to establish their value in the diagnosis and prognosis of multiple sclerosis.