Medicinski pregled
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Fibromyalgia (FM) is a chronic pain condition with spontaneous, chronic, widespread musculoskeletal pain and tenderness accompanied by a number of nonspecific symptoms. The low prevalence of FM is considered an underestimation and results from insufficient knowledge about FM In order to increase the general awareness of the unique nature of pain in fibromyalgia and the right of patients to receive specific attention, EFIC (European Federation of the IASP Chapters) launched the European campaign against pain in fibromyalgia. ⋯ According, to multiple pathophysiological mechanisms, the treatment involves multidisciplinary and multimodal approach, including a combination of pharmacological and non-pharmacological interventions based on EULAR (European League Against Rheumatism) recommendations from 2007. Pharmacological treatment (antidepressants, anticonvulsants and conventional analgesics) is directed toward the control of pain and other symptoms, but nonpharmacological management (aerobic exercise, strength training and cognitive behavioural therapy) is directed to functional consequences of the symptoms. Although the treatment rarely relieves the symptoms completely the active role of an educated FM patient and supportive surrounding are secondary necessary to provide beneficial clinical effects on this complex painful condition.
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A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echocardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. ⋯ Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detection of a patent foramen ovale, with a high level of sensitivity and specificity which is comparable with transesophageal echocardiography. Moreover, it is cheaper and more comfortable than transesophageal echocardiography, and should be used routinely in neurological practice.