Vyšetření senzitivity Dotaz Zobrazit nápovědu
Examining sensorial dysfunction may be difficult for both the doctor and the patient because subjective feelings are misleading and do not reflect the actual severity of a neurological disorder. Sensorial tests provide objective results of measurements, which can be checked against normal values and which allow for determining the severity of neuropathy. Examining sensorial function on feet is necessary in diabetic patients because its loss is the principal risk factor for ulceration. The examination comprises vibration perception tests using a tuner or a biothesiometer, and evaluating surface sensation with the use of monofilaments. A more detailed type of examination is the testing of the electric current perception threshold with the use of different models of neurometer which allows for examining all three main groups of sensorial nerve fibres, i.e. Abeta (large myelinated), Agamma (small myelinated) and C (non-myelinated). The study evaluated the differences between routine diagnosing of polyneuropathy on outpatient basis and biothesiometer and monofilament examination. We discovered that patients with severe neuropathy diagnosed by non-invasive semi-quantitative examination were diagnosed for neuropathy on outpatient basis only in 54% of cases, which points to the need to extend the use of non-invasive examination to outpatient practice. The Neuropathy Disability Score (NDS) assesses neurological functions as a whole, but is more time consuming than simple sensorial tests. Neuropathy self-monitoring by the patient in risk of diabetic foot using the diagnostic test (Neuropad) looks promising. The diabetologist cooperates with a neurologist especially in differential diagnosis of neuropathy, in the treatment of its painful forms and in the classification of its severity.
BACKGROUND: Studies have shown slow healing of peripheral nerve injury in elderly patients. Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly older people and females. Few studies have assessed electrophysiological differences between younger and older patients. We aimed to evaluate age-dependent differences in electrophysiological parameters preoperatively and postoperatively over a 100-day postoperative period. METHOD: This retrospective study included 258 hands of patients who underwent conventional open-technique carpal tunnel syndrome surgery. Patients with paresthesia in the median nerve distribution or with impaired sensation or abnormal findings in sensory and motor median nerve conduction studies were enrolled. The age dependence of the preoperative values of distal motor latency, amplitude of the compound motor action potential and sensory conduction velocity was estimated using regression analysis. RESULTS: Statistically significant age dependence was found for the preoperative distal motor latency, compound motor action potential, amplitude and sensory conduction velocity. The repair of segmental demyelination was nearly twice as slow in the older group, at a 5 % significance level, even when comparing groups with the same preoperative distal motor latency. CONCLUSIONS: Analysis of preoperative nerve conduction parameters indicates that surgery for carpal tunnel syndrome is performed later in older patients.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- motorické evokované potenciály MeSH
- nervové vedení fyziologie MeSH
- nervus medianus patofyziologie MeSH
- neurologické vyšetření MeSH
- obnova funkce * MeSH
- parestezie etiologie MeSH
- poruchy senzitivity etiologie patofyziologie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stárnutí * MeSH
- syndrom karpálního tunelu patofyziologie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests. MATERIALS AND METHODS: Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component. RESULTS: Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS. DISCUSSION: Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated with a reduction in IENFD.
- MeSH
- biopsie MeSH
- dospělí MeSH
- komprese míchy komplikace MeSH
- kůže patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie komplikace diagnóza patologie MeSH
- měření bolesti MeSH
- míšní kořeny patologie MeSH
- mladý dospělý MeSH
- nervová vlákna patologie MeSH
- neuralgie komplikace diagnóza patologie MeSH
- neurologické vyšetření MeSH
- poruchy senzitivity diagnóza etiologie MeSH
- průřezové studie MeSH
- radikulopatie etiologie patologie MeSH
- senioři MeSH
- spinální stenóza komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The aim of the presented study was to evaluate the accuracy of ultrasound staging of early stage endometrial cancer depending on grading, evaluation of ultrasound examination accuracy growing overtime with gained experience of examiners and comparison of subjective versus objective modalities of deep myometrial invasion assessment in the file of patients who were referred in The Oncogyneacologic Center, Department of Gyneacology and Obstetrics in České Budějovice. DESIGN: Retrospective study. SETTINGS: Department of Gyneacology and Obstetrics, Hospital České Budějovice a.s.Methods and the file: In this arcticle we retrospectively evaluate the file of 136 patients with early stage endometrial cancer. The patients underwent diagnostic and therapeutic procedures during the years 2012-2016 in our department. All these patients were able to be compared in different aproaches to deep myometrial invasion assessment using ultrasound examination. RESULTS: Comparing the used methods of deep myometrial invasion assessment with ultrasound examination of early stage endometrial cancer patients the examiner's subjective evaluation seems to be the best approach. After the first year of doing these assessments sensitivity performed 80%, specificity 79% and infiltration of cervix sensitivity 70% and specificity 99%. In case the patients were divided into groups according to the grading, low grade assessed worst sensitivity 64% (high grade l00%), but the best specificity 75% (high grade 56%). The evaluation of objective approaches of ultrasound assement with used cut offs performed the best sensitivity 81% tumour free minimal margin (specificity 67%). On the contrary the best specificity 90% performed the ratio AP (anteroposterior) diameter tumour/AP diameter uterine (senzitivity 54%). CONCLUSION: Generally in oncological therapy the most important things to put stress on the very accurate staging of oncological disease. In oncogyneacology ultrasound becomes more and more required examination. In our file we proved the significance of ultrasound examination in diagnostics and staging of endometrial cancer and we also proved that the accuracy level in early stage depends on the examiner´s experience. After one year practice our results reach the level of the results presented globally, no matter which of the methods - ultrasound MRI or frozen section - was used.
- Klíčová slova
- early stages, endometrial cancer, ultrasound examination staging.,
- MeSH
- invazivní růst nádoru MeSH
- lidé MeSH
- myometrium MeSH
- nádory endometria diagnostické zobrazování patologie MeSH
- prediktivní hodnota testů MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- staging nádorů * metody normy MeSH
- ultrasonografie metody MeSH
- zmrazené řezy MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
