Patofizjologia i klasyfikacja bólu

Ból jest nieprzyjemnym doznaniem zmysłowym i emocjonalnym związanym z rzeczywistym lub potencjalnie zagrażającym uszkodzeniem ciała albo opisywanym w kategoriach takiego uszkodzenia. W zależności od źródła uszkodzenia może mieć charakter bólu receptorowego, neuropatycznego lub psychogennego. Biorąc pod uwagę kryteria czasowe, można wyróżnić ból ostry i przewlekły. O bólu przewlekłym mówi się wtedy, gdy trwa dłużej niż 3 miesiące lub utrzymuje się mimo wygojenia tkanek. W prezentowanej pracy przedstawiono patomechanizm i objawy najczęściej występujących zespołów bólu ostrego i przewlekłego, ze szczególnym uwzględnieniem bólu neuropatycznego

Patofizjologia i klasyfikacja bólu

Ból jest nieprzyjemnym doznaniem zmysłowym i emocjonalnym związanym z rzeczywistym lub potencjalnie zagrażającym uszkodzeniem ciała albo opisywanym w kategoriach takiego uszkodzenia. W zależności od źródła uszkodzenia może mieć charakter bólu receptorowego, neuropatycznego lub psychogennego. Biorąc pod uwagę kryteria czasowe, można wyróżnić ból ostry i przewlekły. O bólu przewlekłym mówi się wtedy, gdy trwa dłużej niż 3 miesiące lub utrzymuje się mimo wygojenia tkanek. W prezentowanej pracy przedstawiono patomechanizm i objawy najczęściej występujących zespołów bólu ostrego i przewlekłego, ze szczególnym uwzględnieniem bólu neuropatycznego. Polski Przegląd Neurologiczny 2011; 7 (1): 20–3

Autonomy as a basic determinant of the quality of life in disorders of the musculoskeletal system

The purpose of this article is to draw attention to the basic factor determining a patient’s dignity and quality of life, which is the ability to function autonomously, maintaining self-reliance and independence. In disorders of the locomotor system, and orthopaedic surgeries, such as total hip arthroplasty and total knee arthroplasty, allow the patient – after the rehabilitation period – to carry out life tasks without the help of others. The article discusses ways of understanding patient autonomy as well as quality of life and the determinants of both. Then, it formulates premises for the treatment of orthopaedic patients that allows us to optimize their well-being, satisfaction with surgery, and full use of the resulting improvement in health. The basic assumptions that make up the model of the work of a multidisciplinary team in orthopaedic surgery departments has also been formulated

Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation : incidence, risk factors and results of surgical treatment

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. MATERIAL/METHODS: The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. RESULTS: Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20–30 years), 100% required surgical release procedures, while 66.66% of those treated for 15–19 years, 42.1% of those treated for 10–14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. CONCLUSIONS: Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS

Longitudinal and transversal propagation of excitation along the tubular system of rat fast-twitch muscle fibres studied by high speed confocal microscopy

Mammalian skeletal muscle fibres possess a tubular (t-) system that consists of regularly spaced transverse elements which are also connected in the longitudinal direction. This tubular network provides a pathway for the propagation of action potentials (APs) both radially and longitudinally within the fibre, but little is known about the actual radial and longitudinal AP conduction velocities along the tubular network in mammalian skeletal muscle fibres. The aim of this study was to track AP propagation within the t-system network of fast-twitch rat muscle fibres with high spatio-temporal resolution when the t-system was isolated from the surface membrane. For this we used high speed confocal imaging of AP-induced Ca release in contraction-suppressed mechanically skinned fast-twitch fibres where the t-system can be electrically excited in the absence of the surface membrane. Supramaximal field pulses normally elicited a synchronous AP-induced release of Ca along one side of the fibre axis which propagated uniformly across the fibre. In some cases up to 80 or more adjacent transverse tubules failed to be excited by the field pulse, while adjacent areas responded with normal Ca release. In these cases a continuous front of Ca release with an angle to the scanning line was observed due to APs propagating longitudinally. From these observations the radial/transversal and longitudinal AP conduction velocities along the tubular network deeper in the fibre under our conditions (19 ± 1°C) ranged between 8 and 11 μm ms and 5 to 9 μm ms , respectively, using different methods of estimation. The longitudinal propagation of APs appeared to be markedly faster closer to the edge of the fibre, in agreement with the presence of dense longitudinal connections immediately below the surface of the fibre and more sparse connections at deeper planes within the fibre. During long trains of closely spaced field pulses the AP-elicited Ca releases became non-synchronous along the fibre axis. This is most likely caused by local tubular K accumulation that produces local depolarization and local slowing of AP propagation. Longitudinally propagating APs may reduce such inhomogeneities by exciting areas of delayed AP onset. Clearly, the longitudinal tubular pathways within the fibre for excitation are used as a safety mechanism in situations where a local depolarization obstructs immediate excitation from the sarcolemma. Results obtained from this study also provide an explanation for the pattern of contractures observed in rippling muscle disease. © 2012 The Authors. The Journal of Physiolog