IMPACT OF TRIGEMINAL NERVE DISORDERS ON DIFFERENT TYPES OF HEADACHE

Glavobolja je vrlo česta bolest modernog društva koja dovodi do ozbiljnog smanjenja općih i radnih životnih aktivnosti u pacijenata za vrijeme njenog trajanja sa značajnim utjecajem na kvalitetu života, ali i velikih ekonomskih izdvajanja za njeno liječenje. Iako postoje mnoga istraživanja vezana uz patofiziologiju pojedinih vrsta glavobolja, ostalo je još mnogo nepoznanica. Refleks treptaja je objektivna neurofiziološka metoda za utvrđivanje statusa trigeminalnog sustava, facijalnog živca i lateralnog dijela produžene moždine. Ispitivanja refleksa treptaja u pacijenata s migrenom i kontrolne skupine bez migrene pokazala su dvojbene rezultate. Cilj ovog istraživanja je da se pomoću funkcijskih elektrofizioloških i radioloških metoda prikaza pokuša dokazati povezanost disfunkcije trigeminalnog živca u različitim vrstama glavobolja. Elektrofiziološkom metodom analize refleksa treptaja (blink refleks) provest će se analiza funkcije trigeminalnog živca u pacijenata s glavoboljom. Postojanje trigeminalnog poremećaja ukazivalo bi na još jedan mogući put za ciljano terapijsko djelovanje u pacijenata s glavoboljom s posljedičnim poboljšanjem njihove kvalitete života. Postavlja se hipoteza da je analizom refleksa treptaja u pacijenata s glavoboljom moguće ustanoviti postojanje disfunkcije trigeminalnog živca. Ispitanici i metode: Glavnu skupinu čine pacijenati s glavoboljom kojima je upitnikom o glavobolji potvrđeno postojanje glavobolje. Kontrolnu skupinu čine pacijenti koji nemaju glavobolju i liječe se zbog bolova u kralješnici. Glavna tj. skupina pacijenata s glavoboljom i kontrolna skupina usklađene su po dobi. Rezultati: Istraživanja jasno ukazuju da je patološki nalaz refleksa treptaja utvrđen u 58,3 % pacijenata s glavoboljama, dok je u kontrolnoj skupini osoba bez glavobolje nađen u svega 20 % slučajeva. Izračunavanjem Yatesovog korigiranog χ2 testa utvrđeno da postoji značajna povezanost nalaza patološkog refleksa treptaja i pojave glavobolje (χ2 = 10,354; P = 0,001). Osobe s glavoboljama imaju uredan refleks treptaja u 41,7 %, a osobe kontrolne skupine imaju ga u 80 % slučajeva. Izračunavanje relativnog rizika za pojavu glavobolje pokazalo je da osobe s patološkim nalazom refleksa treptaja imaju 5 do 6 puta veći rizik za pojavu glavobolje od osoba s normalnim nalazom refleksa treptaja. Glavobolje u osoba s patološkim nalazom refleksa treptaja visoko su zastupljene (u 58 % slučajeva). U kontrolnoj skupini normalan nalaz refleksa treptaja dolazi u 80 % slučajeva. Istraživanje je pokazalo da se zaključci doneseni na temelju statističkih testova podudaraju, neovisno o spolu. Zaključak: Postoji jaka povezanost između nalaza patološkog refleksa treptaja i pojavnosti glavobolje, neovisno o dobi i spolu pacijenata, što ukazuje da postoji statistički značajna povezanost između pojavnosti glavobolja i poremećaja funkcije trigeminalnog živca.Headaches are one of the most common ailments in modern society, leading to severe diminishing of patients’ general and work activities during an attack and resulting in a significant impact on the quality of life, as well as causing substantial economic costs for their treatment. Despite numerous research projects on the pathophysiology of specific types of headaches, it still remains insufficiently understood. Blink reflex is an objective neurophysiologic method for determining the status of the trigeminal system, facial nerve and the lateral part of medulla oblongata. Blink reflex tests on patients suffering from migraines and control group consisting of persons not suffering from migraines have shown dubious results. The objective of the research is to try and prove the correlation between trigeminal nerve dysfunction and its causes in various types of headaches by applying functional electrophysiological and radiological methods of display, and to analyse trigeminal nerve functions using blink reflex tests in patients suffering from headaches. The presence of trigeminal nerve dysfunction would point to another potential path for targeted therapies in patients suffering from headaches, resulting in improvements in their quality of life. It is our hypothesis that it is possible to determine trigeminal nerve dysfunction by analysing the blink reflex in patients suffering from headaches. Subjects and methods: The main group consists of subjects in which the occurrence of headache attacks has been determined by a survey. The control group consists of subjects who are free from headaches, but experience pain in cervical and lumbar spine. The main and control groups have been age adjusted. Results: The research clearly shows that pathological findings of blink reflex are found in 58.3 % of patients suffering from headaches and in only 20 % of cases in the control group of headache-free patients. The application of Yates Correction χ2 indicates a significant correlation between the pathological blink reflex and headache occurrence (χ2 = 10.354; P = 0.001). Normal blink reflex was found in 41.7 % of patients suffering from headaches and in 80 % of control group subjects. The calculation of the relative risk of headaches shows that subjects with a pathological blink reflex have 5.6 times higher risk of developing headaches than persons with a normal blink reflex. Headaches occur quite often in persons with a pathological blink reflex (in 58 % of cases), while normal blink reflex findings occur in 80 % of cases in the control group. The research shows that conclusions reached on the basis of statistical tests coincide regardless of sex. Conclusion: There is a strong correlation between the pathological blink reflex and the occurrence of headaches, regardless of age and sex of patients, indicating statistically significant correlation between the occurrence of headaches and trigeminal nerve dysfunction

IMPACT OF TRIGEMINAL NERVE DISORDERS ON DIFFERENT TYPES OF HEADACHE

Glavobolja je vrlo česta bolest modernog društva koja dovodi do ozbiljnog smanjenja općih i radnih životnih aktivnosti u pacijenata za vrijeme njenog trajanja sa značajnim utjecajem na kvalitetu života, ali i velikih ekonomskih izdvajanja za njeno liječenje. Iako postoje mnoga istraživanja vezana uz patofiziologiju pojedinih vrsta glavobolja, ostalo je još mnogo nepoznanica. Refleks treptaja je objektivna neurofiziološka metoda za utvrđivanje statusa trigeminalnog sustava, facijalnog živca i lateralnog dijela produžene moždine. Ispitivanja refleksa treptaja u pacijenata s migrenom i kontrolne skupine bez migrene pokazala su dvojbene rezultate. Cilj ovog istraživanja je da se pomoću funkcijskih elektrofizioloških i radioloških metoda prikaza pokuša dokazati povezanost disfunkcije trigeminalnog živca u različitim vrstama glavobolja. Elektrofiziološkom metodom analize refleksa treptaja (blink refleks) provest će se analiza funkcije trigeminalnog živca u pacijenata s glavoboljom. Postojanje trigeminalnog poremećaja ukazivalo bi na još jedan mogući put za ciljano terapijsko djelovanje u pacijenata s glavoboljom s posljedičnim poboljšanjem njihove kvalitete života. Postavlja se hipoteza da je analizom refleksa treptaja u pacijenata s glavoboljom moguće ustanoviti postojanje disfunkcije trigeminalnog živca. Ispitanici i metode: Glavnu skupinu čine pacijenati s glavoboljom kojima je upitnikom o glavobolji potvrđeno postojanje glavobolje. Kontrolnu skupinu čine pacijenti koji nemaju glavobolju i liječe se zbog bolova u kralješnici. Glavna tj. skupina pacijenata s glavoboljom i kontrolna skupina usklađene su po dobi. Rezultati: Istraživanja jasno ukazuju da je patološki nalaz refleksa treptaja utvrđen u 58,3 % pacijenata s glavoboljama, dok je u kontrolnoj skupini osoba bez glavobolje nađen u svega 20 % slučajeva. Izračunavanjem Yatesovog korigiranog χ2 testa utvrđeno da postoji značajna povezanost nalaza patološkog refleksa treptaja i pojave glavobolje (χ2 = 10,354; P = 0,001). Osobe s glavoboljama imaju uredan refleks treptaja u 41,7 %, a osobe kontrolne skupine imaju ga u 80 % slučajeva. Izračunavanje relativnog rizika za pojavu glavobolje pokazalo je da osobe s patološkim nalazom refleksa treptaja imaju 5 do 6 puta veći rizik za pojavu glavobolje od osoba s normalnim nalazom refleksa treptaja. Glavobolje u osoba s patološkim nalazom refleksa treptaja visoko su zastupljene (u 58 % slučajeva). U kontrolnoj skupini normalan nalaz refleksa treptaja dolazi u 80 % slučajeva. Istraživanje je pokazalo da se zaključci doneseni na temelju statističkih testova podudaraju, neovisno o spolu. Zaključak: Postoji jaka povezanost između nalaza patološkog refleksa treptaja i pojavnosti glavobolje, neovisno o dobi i spolu pacijenata, što ukazuje da postoji statistički značajna povezanost između pojavnosti glavobolja i poremećaja funkcije trigeminalnog živca.Headaches are one of the most common ailments in modern society, leading to severe diminishing of patients’ general and work activities during an attack and resulting in a significant impact on the quality of life, as well as causing substantial economic costs for their treatment. Despite numerous research projects on the pathophysiology of specific types of headaches, it still remains insufficiently understood. Blink reflex is an objective neurophysiologic method for determining the status of the trigeminal system, facial nerve and the lateral part of medulla oblongata. Blink reflex tests on patients suffering from migraines and control group consisting of persons not suffering from migraines have shown dubious results. The objective of the research is to try and prove the correlation between trigeminal nerve dysfunction and its causes in various types of headaches by applying functional electrophysiological and radiological methods of display, and to analyse trigeminal nerve functions using blink reflex tests in patients suffering from headaches. The presence of trigeminal nerve dysfunction would point to another potential path for targeted therapies in patients suffering from headaches, resulting in improvements in their quality of life. It is our hypothesis that it is possible to determine trigeminal nerve dysfunction by analysing the blink reflex in patients suffering from headaches. Subjects and methods: The main group consists of subjects in which the occurrence of headache attacks has been determined by a survey. The control group consists of subjects who are free from headaches, but experience pain in cervical and lumbar spine. The main and control groups have been age adjusted. Results: The research clearly shows that pathological findings of blink reflex are found in 58.3 % of patients suffering from headaches and in only 20 % of cases in the control group of headache-free patients. The application of Yates Correction χ2 indicates a significant correlation between the pathological blink reflex and headache occurrence (χ2 = 10.354; P = 0.001). Normal blink reflex was found in 41.7 % of patients suffering from headaches and in 80 % of control group subjects. The calculation of the relative risk of headaches shows that subjects with a pathological blink reflex have 5.6 times higher risk of developing headaches than persons with a normal blink reflex. Headaches occur quite often in persons with a pathological blink reflex (in 58 % of cases), while normal blink reflex findings occur in 80 % of cases in the control group. The research shows that conclusions reached on the basis of statistical tests coincide regardless of sex. Conclusion: There is a strong correlation between the pathological blink reflex and the occurrence of headaches, regardless of age and sex of patients, indicating statistically significant correlation between the occurrence of headaches and trigeminal nerve dysfunction

History of the first hospice department in Croatia

U proljeće 1991. godine Službi za neurologiju i psihijatriju požeške bolnice pridružen je novi odjel čija je organizacija dijelom inspirirana "St Christopher’s Hospice" pokretom. Namijenjen je prije svega za palijativnu skrb bolesnika u krajnjem stadiju bolesti, te za pružanje pomoći obitelji u ophođenju sa oboljelim u završnom stadiju bolesti. Bio je otvoren za sve stanovnike bez obzira na dob, spol, vjeru i mogućnost plaćanja. Tijekom domovinskog rata teškoće su u financiranju hospicija i osipanje srednjeg medicinskog kadra dostigle kritičnu točku, što je rezultiralo raspuštanjem hospicijskog odjela nakon godinu dana ozbiljnog i humanog rada. Naše iskustvo može biti veoma korisno u analizi problema kako dio hospitala pretvoriti u hospicij u želji da se postigne stručna medicinska i psihološka pomoć bolesnicima i članovima njihove obitelji u krajnjem stadiju bolesti.In the spring of 1991 a new department, inspired by the "St Christopher’s Hospice" movement, was added to the Neuropsychiatric Service of the District General Hospital in Požega. The purpose of this new hospice was palliative care for the patients in terminal stages of illness. It was also intended to help the family communicate with the patient in the last stages of illiness. The department was open to all, regardless of sex, age, religion or ability to pay. During the war in Croatia the Hospital’s financial problems and a lack of nurses reached a critical point, which resulted in the closure of the hospice after a year of dedicated service. Our experience could be helpful in discussing how to transform a part of a hospital into a hospice, in order to provide better medical and psychological care for the patients in terminal stages of illiness and their families

Roman Military Medicine and Croatian Archaeological Perspectives

This article offers a general examination of the sources responsible for understanding Roman military medicine, starting with literal and epigraphical sources all the way to archaeological remains consisting of hospitals, the infrastructure of military garrisons and small medical tools. Given that not one of the literary sources does not directly mention the medical personnel within the various military units, epigraphical discoveries widely represent the main source of our knowledge on the subject. On the other hand, the archaeological exploration of military garrisons offers proof of the medical care of Roman soldiers. If at first it appears that Roman military medicine is perfectly obvious and clear, actually this is not the case as many questions remain to be answered and debated. In all this, Croatia has its own archaeological perspective, where notably, one site stands out, which could hold a key role according to the layout of buildings within the garrison including its hospital

THORACIC LONGUS NERVE LESION IN A PATIENT WITH ANKYLOSING SPONDYLITIS

The paper presents a 33 - year - old patient who has been suffering from ankylosing spondylitis since the age of 28. Pain in his right shoulder and weakness in his right arm developed after more hours of walking with a backpack. The performed procedure diagnosed a lesion of the long thoracic nerve without of sensory damage. Peripheral nerve injuries long thoracic nerve lead to weakness of the muscles -serratus anterior muscle and result in a protrusion of the medial side of the scapula (scapula alata). It is difficult to raise the arm in the shoulder joint above the horizontal line, that is to raise the shoulder from the chest when the arm is extended and pressed against a fixed object in front of the patient. Due to its long, relatively superficial course, long thoracic nerve is susceptible to injury, either through direct trauma or stretching. The long thoracic nerve, also called Charles Bell’s external respiratory nerve, is a rare isolated nerve damage. The nerve is often injured from carrying a load on his shoulder, with supraclavicular and axillary injuries, blows in the neck area. Injury has been reported in almost all sports, usually occurring from a blow to the ribs with an outstretched arm. Long thoracic nerve can be damaged during breast cancer surgery, especially radical mastectomy that involve the removal of axillary lymph nodes. It is a common lesion in spinal surgeries

THORACIC LONGUS NERVE LESION IN A PATIENT WITH ANKYLOSING SPONDYLITIS

The paper presents a 33 - year - old patient who has been suffering from ankylosing spondylitis since the age of 28. Pain in his right shoulder and weakness in his right arm developed after more hours of walking with a backpack. The performed procedure diagnosed a lesion of the long thoracic nerve without of sensory damage. Peripheral nerve injuries long thoracic nerve lead to weakness of the muscles -serratus anterior muscle and result in a protrusion of the medial side of the scapula (scapula alata). It is difficult to raise the arm in the shoulder joint above the horizontal line, that is to raise the shoulder from the chest when the arm is extended and pressed against a fixed object in front of the patient. Due to its long, relatively superficial course, long thoracic nerve is susceptible to injury, either through direct trauma or stretching. The long thoracic nerve, also called Charles Bell’s external respiratory nerve, is a rare isolated nerve damage. The nerve is often injured from carrying a load on his shoulder, with supraclavicular and axillary injuries, blows in the neck area. Injury has been reported in almost all sports, usually occurring from a blow to the ribs with an outstretched arm. Long thoracic nerve can be damaged during breast cancer surgery, especially radical mastectomy that involve the removal of axillary lymph nodes. It is a common lesion in spinal surgeries

Uloga i aktivnosti Kriznog stožera Ministarstva zdravlja na poplavljenim područjima

Uslijed ekstremnih količina oborina te dotad neizmjerenog vodostaja Save kod Županje u visini od 1.194 centimetara, 17. svibnja 2014. godine došlo je do pucanja nasipa kod Račinovaca i Rajevog sela u Vukovarsko-srijemskoj županiji, pri čemu je došlo do silovitog izlijevanja vode iz korita i poplavljanja naselja Gunje, Đurića, Strošinaca, Posavskih Podgajaca i Rajevog Sela. U iduća četiri dana uslijedila je hitna evakuacija stanovnika i preživjele stoke, pri čemu je evakuirano više od 13.000 ljudi te više od 9000 životinja. U nezapamćenoj prirodnoj katastrofi koja je pogodila istočnu Slavoniju dvije osobe iz Rajevog Sela su i smrtno stradal

Uloga i aktivnosti Kriznog stožera Ministarstva zdravlja na poplavljenim područjima

Uslijed ekstremnih količina oborina te dotad neizmjerenog vodostaja Save kod Županje u visini od 1.194 centimetara, 17. svibnja 2014. godine došlo je do pucanja nasipa kod Račinovaca i Rajevog sela u Vukovarsko-srijemskoj županiji, pri čemu je došlo do silovitog izlijevanja vode iz korita i poplavljanja naselja Gunje, Đurića, Strošinaca, Posavskih Podgajaca i Rajevog Sela. U iduća četiri dana uslijedila je hitna evakuacija stanovnika i preživjele stoke, pri čemu je evakuirano više od 13.000 ljudi te više od 9000 životinja. U nezapamćenoj prirodnoj katastrofi koja je pogodila istočnu Slavoniju dvije osobe iz Rajevog Sela su i smrtno stradal

Uporaba piezoelektričnog svojstva u poboljšanju kvalitete instrumenata i sigurnosti bolesnika u laparoskopskoj kirurgiji

The piezoelectric properties of some natural crystals and polymers can also be used in surgery. For this purpose, a prototype of an endoscopic instrument was constructed with piezoelectric material attached to its working end with the aim of recognizing pulsating blood vessels during laparoscopic surgery. To test the properties of the new instrument in laboratory conditions, simulated blood circulation was used with the possibility of changing pressure and frequency. The instrument was tested in the pressure range of 40-180 mm Hg at constant frequency of 72/min and frequency range of 36-130 beats per minute at constant pressure of 120 mm Hg. Test results showed that the instrument with certainty recognized a pulsating “blood vessel” in the expected pressure ranges and at different blood pump frequencies. Given the piezoelectric material’s very small dimensions and flexible form, it can be installed at the working end of most standard laparoscopic instruments and thus significantly increase certainty in the recognition of arteries during surgery, which would reduce the possibility of their injury or accidental ligation.Piezoelektrična svojstva nekih prirodnih kristala i nekih polimera moguće je koristiti i u kirurgiji. U tu svrhu konstruiran je prototip endoskopskog instrumenta na čijem je radnom dijelu ugrađen piezoelektrični materijal s ciljem prepoznavanja pulzirajućih krvnih žila tijekom laparoskopskih operacija. Za ispitivanje svojstava novoga instrumenta u laboratorijskim uvjetima korišten je simulirani krvotok s mogućnošću mijenjanja tlaka i frekvencije. Rad instrumenta je ispitivan u rasponu tlakova 40-180 mm Hg uz konstantnu frekvenciju 72/min, te u rasponu frekvencija 36-130 otkucaja u minuti uz konstantan tlak 120 mm Hg. Rezultati ispitivanja pokazuju da instrument sa sigurnošću prepoznaje pulzirajuću „krvnu žilu“ u očekivanom rasponu tlakova i pri različitim frekvencijama rada krvne pumpe. S obzirom na to da se radi o vrlo malim dimenzijama i prilagodljivim oblicima piezoelektričkog materijala, moguće ga je postaviti na radni dio većine standardnih laparoskopskih instrumenata i time značajno povećati sigurnost prepoznavanja arterija tijekom operacijskog zahvata, što bi smanjilo mogućnost njihove ozljede ili slučajnog podvezivanja

Neuropathic orofacial pain – diagnostic and therapeutic challenges

Chronic neuropathic orofacial pain (OFP) is the leading symptom for a wide range of conditions. It can exist independently of any addition signs, symptoms and radiological or laboratory abnormalities. In addition to physical suffering, OFP causes emotional, psychological and social disturbances and thus significantly influences the quality of life of those affected. Several key factors make OFP a complex diagnostic and therapeutic challenge. These include a lack of diagnostic criteria that are both validated and readily applicable in clinical settings and a lack of sufficient education about pain in undergraduate medical training programs. There is also a need to develop more analgesic therapies offering improved efficacy and side effect profiles. Finally, the provision of analgesic therapies by health insurance programs need to be harmonized with the most current evidence-based treatment protocols. In addition to offering recommendations in these areas, this paper provides an overview of the most common clinical forms of nonodontogenic OFP, epidemiological data, and current diagnostic and therapeutic options