Mehanizmi neuroplastičnosti u patofiziologiji kronične boli

Chronic pain is a widespread healthcare problem with great impact on mental health, professional and family life of the patient. It can be a consequence of many disorders; however, its pathogenesis has not yet been fully understood. Neuroplasticity is the ability of the nervous system to adapt to different changes and it is present throughout life, not only in prenatal period, infancy and childhood. However, in the pathophysiology of chronic pain, neuroplasticity shows its “dark side”. Due to the central sensitization process, noxious stimuli can produce chronic pain or misinterpretation of non-noxious stimuli (secondary hyperalgesia and allodynia). These changes occur at the level of brain cortex as well at peripheral nerves and receptors. This review summarizes a significant portion of literature dealing with neuroplasticity processes in well known chronic pain conditions such as migraine, chronic posttraumatic headache, low back pain, fibromyalgia, and others. The relevance of this topic lies in providing a new insight in the pathophysiology of chronic pain, while also offering a possibility of new therapeutic approaches including not only pharmacological agents.Kronična bol je rašireni zdravstveni problem s velikim utjecajem na mentalno zdravlje, profesionalni i obiteljski život bolesnika. Ona može biti posljedica mnogih bolesti, ali njezina patogeneza još nije u potpunosti razjašnjena. Neuroplastičnost je sposobnost živčanog sustava da se prilagodi različitim promjenama i prisutna je tijekom cijeloga života, a ne samo u prenatalnom i dojenačkom razdoblju i djetinjstvu. Međutim, u patofiziologiji kronične boli neuroplastičnost pokazuje svoju „tamnu stranu“. Uslijed procesa središnje senzitizacije štetni podražaji uzrokuju kroničnu bol, a neštetni podražaji se tumače kao bolni (sekundarna hiperalgezija i alodinija). Ove promjene mogu se događati na razini moždane kore, ali i na razini perifernih živaca i receptora. Ovaj pregledni članak obuhvaća značajan dio literature u kojoj su prikazana istraživanja koja su se bavila procesima neuroplastičnosti u čestim kroničnim bolnim stanjima poput migrene, kronične posttraumatske glavobolje, križobolje, fibromijalgije i drugima. Značenje ove tematike je u novom pristupu patofiziologiji kronične boli, odnosno u mogućnosti pronalaženja novih terapijskih opcija u liječenju kronične boli koje ne moraju sadržavati samo farmakološka sredstva

Noninvasive imaging of craniocervical artery dissection

Craniocervical arterial dissections (CCAD) are being increasingly identified due to growing awareness of diverse clinical picture along with advances in imaging technologies. Although rare, CCADare frequent cause of stroke in young adults. Neurosonological tests serve as an excellent noninvasive screening and monitoring tool, but brainMR andMRA are necessary for confirmation of the diagnosis. Ultrasound examination may show direct or indirect signs. Direct signs are: echolucent intramural hematoma, string sign, double lumen, or stenosis and/or occlusion of an arterial segment usually not affected by atherosclerosis. Indirect signs are: increased or decreased pulsatility index upstream or downstream of the suspected lesion, more than 50% difference in blood flow velocity compared to the unaffected side, or detection of intracranial collateral flow. Since CCAD have been increasingly identified, a whole spectrum of clinical pictures are been recognizes. Neurosonology showed high sensitivity in CCAD detection

Neomicin - čest kontaktni alergen

The incidence of allergic contact dermatitis from neomycin evaluated in relation to 1381 verified cases of allergic contact dermatitis showed a progressive increase (5.00,7.69,10.18%) over a three-year period (1990-1992). Sensitivity to neomycin was investigated with special reference to possible cross-reactions between neomycin and the allergens that are commonly used in the manufacture of cosmetic products. Contact sensitivity to neomycin was found to be present with the other diagnoses, such as atopic dermatitis, seborrhoeic dermatitis, hypostasic dermatitis and psoriasis vulgaris.Pratili smo učestalost kontaktnog alergijskog dermatitisa na neomicin u razdoblju od 1990. do 1992. godine (5,00%; 7,69%, 10,18%) s obzirom na 1381 verificiran kontaktni alergijski dermatitis. Istodobno je prikazan kontaktni alergijski dermatitis s pozitivitetom na neomicin u odnosu na alergene s kojima može imati unakrsne reakcije, a rabe se često u kozmetičkim pripravcima. Prikazali smo kontaktnu senzibilizaciju na neomicin i u drugih dermatoza u kojih se češće javlja: neurodermatitis, seboroički dermatitis, hipostazički dermatitis i vulgarna psorijaza

Umjetnost: neuroznanstveni pristup

Scientists have for centuries tried to localize and define artistic talent. Modern diagnostic techniques that enable visualization and measurement of brain morphology and function are positron emission tomography (PET), magnetic resonance imaging (MRI), functional transcranial Doppler (fTOD) and some biochemical methods. In the majority of people, the left hemisphere is dominant, but the right hemisphere is considered to be creative, visual, imaginative and intuitive. Right hemisphere is associated with musical skills and good three-dimensional orientation. It is also associated with good coordination and athletic skills. Creative people have less marked hemispheric dominance. Using the functional (fMRI) technique, the activation of visual cortex while watching different kinds of compositions was visible; the specific pattern of cortical activation was identified for looking at the landscapes, portraits, abstract compositions or different combination of colors. For music perception, the interplay of activity on both sides of the brain is necessary. In the right side, the centers for perceiving pitch, certain aspects of melody, harmony, timbre and rhythm are placed, and in the left side the processes of rapid changes in frequency and intensity, both in music and words are taking place. Adaptation of the brain, i.e. brain plasticity can arise upon listening or performing music. It is possible to use music, painting and dancing as an aid in the treatment of somatic, neurologic or psychiatric disorders.Stoljećima znanstvenici pokušavaju lokalizirati i definirati umjetnički talent. Pozitronska emisijska tomografja (PET), funkcionalna magnetska rezonanca (fMRI) i funkcionalna dopler sonografija (fTCD) su moderne dijagnostičke metode koje omogućavaju vizualizaciju moždane morfologije i funkcije. U većine osoba dominantna je lijeva hemisfera, dok se za desnu hemisferu smatra da je kreativna, vizualna, intuitivna i zadužena za maštu, dobru trodimenzionalnu orijentaciju, koordinaciju, sportske i glazbene vještine. U kreativnih osoba dominantnost hemisfera je manje izražena. fMRI omogućuje registriranje aktivacije vidne kore za vrijeme promatranja različitih kompozicija poput pejzaža. portreta, apstraktnih kompozicija i kombinacija boja. Za percepciju glazbe potrebna je suradnja obiju hemisfera. U desnoj hemisferi se registrira ton, melodija, ritam i harmonija, dok su centri za brzu promjenu frekvencija u lijevoj hemisferi. Glazba potiče procese neuroplastičnosti. Glazbu, slikarstvo i ples moguće je koristiti kao pomoćno sredstvo u liječenju somatskih, neuroloških i psihijatrijskih poremećaja

Diagnosis and Treatment Issues in Chronic Idiopathic Urticaria

Urtikarija je jedna od najčešćih alergijskih bolesti na koži (do 15% populacije). Otprilike trećina bolesnika ima kroničnu idiopatsku urtikariju (CIU) i autoantitijela usmjerena protiv visoko afi nitetnih IgE-receptora ili rjeđe protiv IgE. U svezi s tim autoantitijelima u CIU postoje neriješeni problemi. Zbog toga nije razjašnjeno može li se CIU s autoantitijelima klasifi cirati kao autoimunosna bolest. Utvrđivanje autoantitijela u bolesnika s CIU je izazov. Metoda in vivo, kožni test autolognim serumom osjetljiv je i specifi čan. U njemu se rabi in vitro otpušten histamin iz bazofi la. Od dijagnostičkih postupaka važno je istaknuti dokaz H. pylori, pozitivnu stolicu na kandidu i pozitivna antitiroidna antitijela. U liječenju CIU važni su eliminacijska ili hipoalergena dijeta, antihistaminici (sedirajući i nesedirajući), triciklički antidepresiv (doksepin), dapson i pentoksifi lin u kombinaciji, azatioprin, metotreksat, leukotrienski antagonisti (npr. montelukast), sulfasalazin, ciklosporin, PUVA-terapija, plazmafereza, imunoglobulini, kumarin, monoklonska antitijela usmjerena na CD20-antigene (rituksimab i omalizumab).Urticaria is one of the most frequent allergic skin diseases (up to 15% of population). Approximately one third of patients with chronic idiopathic urticaria (CIU) have autoantibodies directed against either the high-affi nity IgE receptor or, less frequently, against IgE. However, there are several unsolved problems relating to the role of such autoantibodies in the disease. Additionally, it is not clear whether CIU with autoantibodies can be classifi ed as an autoimmune disease. The detection of patients with autoantibodies also poses challenges. The in vivo method, the autologous serum skin test, is at best 80% sensitive and specifi c using in vitro basophil histamine release assays. The H. pylori assay, Candida-positive stool culture, and antithyroid antibodies are important diagnostic methods. The important elements of the CIU treatment include elimination and hypoallergenic diet, antihistamines (sedative and not sedative), tricyclic antidepressants (doxepin), dapson and pentoxifylline in combination, azathioprine, methotrexate, leukotriene antagonists (e.g. montelukast), sulphasalazine, cyclosporine, PUVA therapy, plasmapheresis, immunoglobulins, coumarin, and monoclonal antibodies against CD 20 antigens (rituximab and omalizumab)

Contact Allergy Caused by Fragrance Mix and Myroxylon pereirae (Balsam Of Peru), a Retrospective Study

Because of their widespread use, fragrances are among the most common causes of contact allergic dermatitis, second only to nickel. During a five-year period 3,065 patients with contact dermatitis were patch tested using a specific mix of fragrances. 509 (16.6%) patients were allergic to the fragrance mix, while 258 (8.4%) patients exhibited an allergic reaction to Myroxylon pereirae (balsam of Peru). Between those 509 patients, 157 were patch tested with eight individual substances contained in the fragrance mix: cinnamal, cinnamyl alcohol, eugenol, isoeugenol, geraniol, hydroxycitronellal, alpha-amyl cinnamal and Evernia prunastri (oak moss). The most frequent allergens were isoeugenol 57.9% (91/157), eugenol 55.4% (87/157), cinnamyl alcohol 34.4% (54/157) and Evernia prunastri (oak moss) 24.2% (38/157). There were 62 patients (39.5%) who exhibited an allergic reaction to both the fragrance mix and Myroxylon pereirae (balsam of Peru). The results prove the importance of avoiding allergens in daily life, especially in industrial and cosmetic products. In order to prevent ACD, better cooperation between industry and dermatologists is needed