Electroacupuncture at Sensitized Acupoints Relieves Somatic Referred Pain in Colitis Rats by Inhibiting Sympathetic-Sensory Coupling to Interfere with 5-HT Signaling Pathway / 中国结合医学杂志

OBJECTIVE@#To investigate whether electroacupuncture (EA) at sensitized acupoints could reduce sympathetic-sensory coupling (SSC) and neurogenic inflammatory response by interfering with 5-hydroxytryptamine (5-HT)ergic neural pathways to relieve colitis and somatic referred pain, and explore the underlying mechanisms.@*METHODS@#Rats were treated with 5% dextran sodium sulfate (DSS) solution for 7 days to establish a colitis model. Twelve rats were randomly divided into the control and model groups according to a random number table (n=6). According to the "Research on Rat Acupoint Atlas", sensitized acupoints and non-sensitized acupoints were determined. Rats were randomly divided into the control, model, Zusanli-EA (ST 36), Dachangshu-EA (BL 25), and Xinshu (BL 15) groups (n=6), as well as the control, model, EA, and EA + GR113808 (a 5-HT inhibitor) groups (n=6). The rats in the control group received no treatment. Acupuncture was administered on 2 days after modeling using the stimulation pavameters: 1 mA, 2 Hz, for 30 min, with sparse and dense waves, for 14 consecutive days. GR113808 was injected into the tail vein at 5 mg/kg before EA for 10 min for 7 consecutive days. Mechanical sensitivity was assessed with von Frey filaments. Body weight and disease activity index (DAI) scores of rats were determined. Hematoxylin and eosin staining was performed to observe colon histopathology. SSC was analyzed by immunofluorescence staining. Immunohistochemical staining was performed to detect 5-HT and substance P (SP) expressions. The calcitonin gene-related peptide (CGRP) in skin tissue and tyrosine hydroxylase (TH) protein levels in DRG were detected by Western blot. The levels of hyaluronic acid (HA), bradykinin (BK), prostaglandin I2 (PGI2) in skin tissue, 5-HT, tryptophan hydroxylase 1 (TPH1), serotonin transporters (SERT), 5-HT 3 receptor (5-HT3R), and 5-HT 4 receptor (5-HT4R) in colon tissue were measured by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#BL 25 and ST 36 acupoints were determined as sensitized acupoints, and BL 15 acupoint was used as a non-sensitized acupoint. EA at sensitized acupoints improved the DAI score, increased mechanical withdrawal thresholds, and alleviated colonic pathological damage of rats. EA at sensitized acupoints reduced SSC structures and decreased TH and CGRP expression levels (P<0.05). Furthermore, EA at sensitized acupoints reduced BK, PGI2, 5-HT, 5-HT3R and TPH1 levels, and increased HA, 5-HT4R and SERT levels in colitis rats (P<0.05). GR113808 treatment diminished the protective effect of EA at sensitized acupoints in colitis rats (P<0.05).@*CONCLUSION@#EA at sensitized acupoints alleviated DSS-induced somatic referred pain in colitis rats by interfering with 5-HTergic neural pathway, and reducing SSC inflammatory response.

Left Basilar Pneumonia Simulating Perforated Appendicitis with Peritonitis in a Child

We present an 8-year-old boy who presented with predominant abdominal symptoms initially to the referring hospital and the initial Chest radiograph being reported as normal. Inflammatory markers being sky high with abdominal symptoms and minimal Chest signs, he was referred to as an atypical case of Perforated Appendicitis. By the time patient was seen in the Tertiary University Teaching Hospital, he had developed classic clinical features of Left Basilar Pneumonia which was clearly evident on good quality repeat Chest radiograph and Ultrasound confirmed it and ruled out any abdominal pathology. The patient responded well to intravenous antibiotics followed by oral one with excellent recovery. Our case is a usual reminder of the fact that a patient is more likely to have a rare presentation of a common disease, than a common presentation of a rare one. Take a careful history and examine the child; consult the appropriate specialist resources and then, if necessary, extend your history and examination with review of available investigations especially being good at reading plain radiographs.

Referred Somatic Hyperalgesia Mediates Cardiac Regulation by the Activation of Sympathetic Nerves in a Rat Model of Myocardial Ischemia / 神经科学通报·英文版

Myocardial ischemia (MI) causes somatic referred pain and sympathetic hyperactivity, and the role of sensory inputs from referred areas in cardiac function and sympathetic hyperactivity remain unclear. Here, in a rat model, we showed that MI not only led to referred mechanical hypersensitivity on the forelimbs and upper back, but also elicited sympathetic sprouting in the skin of the referred area and C8-T6 dorsal root ganglia, and increased cardiac sympathetic tone, indicating sympathetic-sensory coupling. Moreover, intensifying referred hyperalgesic inputs with noxious mechanical, thermal, and electro-stimulation (ES) of the forearm augmented sympathetic hyperactivity and regulated cardiac function, whereas deafferentation of the left brachial plexus diminished sympathoexcitation. Intradermal injection of the α2 adrenoceptor (α2AR) antagonist yohimbine and agonist dexmedetomidine in the forearm attenuated the cardiac adjustment by ES. Overall, these findings suggest that sensory inputs from the referred pain area contribute to cardiac functional adjustment via peripheral α2AR-mediated sympathetic-sensory coupling.

On the acupoint and its specificity / 中国针灸

Although acupuncture has spanned thousands of years in the history of traditional medicine, still some basic questions are not clarified. Acupuncture is the theory based on long time medical practice of the ancient sage, combined with objectivesymptom and medical expertise from diseases, and being applied for the instruction in clinic. In this way, acupoint is discovered by doctors in the practice of disease treatment other than a natural occurrence in the healthy population. And acupoint specificity is attached to the target organ involved in pathological condition. In our opinion, acupoint originates from somatic referred area reactive to visceral disorders. And accordingly, referred hyperesthesia of the somatic area is phenomenon of acupoint sensitization. Acupoint is the situ having health code formed in the biological evolution. Corresponding acupoint of a given organ is the alarmer for the state of health, and also is the trigger for self-healing where acupuncture can work as a gating-button. Therefore, acupoint must be accompanied with diseases in that it is reinforced by, relayed on, responsive to and neutralize by the pathological course. In conclusion, acupoint cannot exist without the disease. In another word, acupoint will be unshown, or be functionally hidden, under physiological condition.

Essence of acupoints and meridians based on the studies of myofascial trigger points / 中国针灸

Based on the modern anatomy and physiology, the referred pain of myofascial trigger points of each muscle is integrated; compared with the twelve meridians as well as conception vessel and governor vessel, the similarity of their position and running course is observed. With the current research progress of myofascial trigger points and fasciology, based on the running course of referred pain of trigger points, combined with fascia mechanics, nerve and vascular, the location of acupoints and meridians, as well as the relationship between acupoints and meridians, are discussed.

Otalgia secundaria o referida, lo que el clínico debe saber

Resumen La otalgia es un motivo de consulta frecuente en otorrinolaringología que se puede clasificar en dos tipos: primaria y secundaria. La otalgia primaria es una consecuencia de una enfermedad otológica mientras que la secundaria o referida, surge de procesos patológicos que se originan en estructuras distintas del oído, pero que comparten vías neuronales comunes. Estas vías la componen los nervios craneales V, VII, IX y X y los nervios cervicales C2 y C3. Las causas más comunes de otalgia secundaria son la patología musculoesquelética como la disfunción de la articulación temporomandibular y el síndrome miofascial, la patología dental y las infecciones orofaríngeas. Para encontrar la etiología de la otalgia secundaria, en la mayoría de los casos, una historia clínica y examen físico acucioso resultarán suficientes, sin embargo, existe un grupo de pacientes con factores de riesgo que pudiesen requerir estudios adicionales. El objetivo de esta revisión es otorgar herramientas al lector para comprender los distintos procesos involucrados en la otalgia secundaria, conocer las patologías más relevantes relacionadas y de esta forma entregar al clínico una pauta para enfrentar este motivo de consulta.

Abstract Otalgia is a common reason for consultation in otolaryngology and can be classified into two types: primary or secondary otalgia. Primary otalgia is a consequence of an otological disease while secondary otalgia arises from pathological processes that originate in other structures different than the ears, but share common neuronal pathways. These pathways involve cranial nerves V, VII, IX and X and cervical nerves C2 and C3. The most common causes of secondary otalgia are musculoskeletal pathology such as temporomandibular joint dysfunction and myofascial syndrome, dental pathology and oropharyngeal infections. To find the etiology of secondary otalgia, in most cases a medical history and physical examination will be sufficient, however there is a group of patients with risk factors that may require additional studies. The objective of this review is to give the reader tools to understand the different processes involved in secondary otalgia, know the most relevant related pathologies and thus give the clinician a guide to deal with this problem.

Trigeminal Schwannoma simulating orofacial pain: differential diagnosis and treatment. Case report / Schwannoma trigeminal simulando dor orofacial: diagnóstico diferencial e tratamento. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Orofacial pain is a major diagnostic challenge for the most experienced clinicians. Due to the complexity regarding the trigeminal-cervical joint, orofacial pain with the same etiology may present different symptoms, and pain with similar symptomatology may have different causes. The objective of this study was to alert health professionals about the importance of differential diagnosis in the hypothesis of trigeminal neuralgia, where the inclusion of the dentist in the medical-hospital team is of paramount importance in establishing the correct diagnosis. CASE REPORT: Twenty-nine-year-old female patient complained of electric shock and pulsatile orofacial pain that covered the third division of the fifth cranial nerve on the right side. Magnetic resonance imaging revealed the presence of trigeminal Schwannoma, causing neuralgia due to its neural compressive nature. Two different neurosurgery departments suggested tumor resection. However, after the evaluation by a third neurosurgery department, in which a dentist, specialized in orofacial pain was part of the team, the complete evaluation established the final diagnosis of right lower first molar odontalgia, with irreversible acute pulpitis as the cause of the symptoms and the expansive lesion was only a radiological finding. CONCLUSION: Interdisciplinary evaluation among physicians and dental surgeons is necessary to obtain the correct diagnosis when considering the hypothesis of trigeminal neuralgia.

RESUMO JUSTIFICATIVA E OBJETIVOS: As dores orofaciais representam grande desafio diagnóstico ao mais experiente clínico. Devido à complexidade do conjunto trigeminocervical, as dores orofaciais com a mesma etiologia podem apresentar sintomas diferentes, e dores com o mesmo sintoma podem ter etiologias diferentes. O objetivo foi alertar o profissional da saúde sobre a importância do diagnóstico diferencial quando aventada a hipótese diagnóstica de neuralgia trigeminal, e a presença do cirurgião-dentista na equipe médico-hospitalar é de suma importância para o estabelecimento do diagnóstico. RELATO DO CASO: Paciente do sexo feminino, 29 anos, apresentou dor orofacial em choque elétrico e pulsátil que percorria o trajeto da terceira divisão do V par craniano, do lado direito. A ressonância nuclear magnética evidenciou Schwannoma trigeminal, sendo diagnosticada neuralgia trigeminal secundária à essa lesão expansiva. Foi sugerida ressecção tumoral em dois serviços de neurocirurgia. Contudo, após a avaliação de um terceiro serviço de neurocirurgia, com a participação de cirurgião-dentista especialista em dor orofacial, foi estabelecido o diagnóstico de odontalgia do primeiro molar inferior direito, com pulpite aguda irreversível, sendo essa a causa do quadro sintomático, e a lesão expansiva, apenas um achado radiológico. CONCLUSÃO: A avaliação interdisciplinar entre médicos e cirurgiões-dentistas é necessária para o diagnóstico correto quando a hipótese diagnóstica for neuralgia trigeminal.

Efectividad de la indometacina vs analgésico habitual en el tratamiento del dolor posthisterectomía / Effectiveness of using indomethacin vs usual analgesic in the management of postoperative pain in hysterectomy

Resumen: OBJETIVO: Determinar la efectividad de la indometacina, por vía rectal, en el tratamiento del dolor posthisterectomía versus paracetamol o metamizol administrados por vía intravenosa. MATERIALES Y MÉTODOS: Estudio experimental, comparativo y prospectivo llevado a cabo en el Hospital Central del Estado de Chihuahua entre noviembre y diciembre de 2019. Criterios de inclusión: pacientes histerectomizadas, con expediente clínico completo y de cualquier edad. Criterios de exclusión: pacientes con alteraciones en el umbral del dolor, inconsistencias en el expediente, histerectomía total no ginecológica. Criterios de eliminación: pacientes con limitantes en la información que no permitieron relacionar la variable dependiente con la independiente. El seguimiento del dolor referido se efectuó con la escala análoga del dolor y valoraciones a las 12 y 24 horas posteriores a la cirugía. RESULTADOS: Se reunieron 141 pacientes, que se dividieron en tres grupos. Grupo 1: metamizol intravenoso e indometacina por vía rectal (n = 24). Grupo 2: paracetamol intravenoso e indometacina por vía rectal (n = 19). Grupo 3: paracetamol y metamizol intravenosos (n = 98). La mayoría de las pacientes de los grupos 1 y 2 reportaron, a las 24 h, una escala visual análoga menor de 3 vs las del grupo 3. Diez de 98 pacientes requirieron tratamiento en el servicio de Anestesiología. CONCLUSIÓN: La administración de indometacina por vía rectal a pacientes histerectomizadas demostró menor dolor que con metamizol y paracetamol, y evolución clínica y alta hospitalaria más temprana.

Abstract: OBJECTIVE: To determine the effectiveness of indomethacin in the treatment of post-hysterectomy pain versus paracetamol or metamizole administered intravenously. MATERIALS AND METHODS: Experimental, comparative and prospective study at the Central Hospital of the State of Chihuahua, period November to December 2019, patients undergoing hysterectomy with complete clinical record, any age. Patients with alterations in the pain threshold, inconsistencies in the file, total non-gynecological hysterectomy were excluded, patients with information limitations were eliminated, which did not allow to relate the dependent variable, with the independent one. RESULTS: 141 patients were collected, which were divided into three groups. Group 1: intravenous metamizole and indomethacin rectally (n = 24). Group 2: intravenous paracetamol and indomethacin rectally (n = 19). Group 3: intravenous paracetamol and metamizole (n = 98). Most of the patients in groups 1 and 2 reported, at 24 hours, a visual analog scale of less than 3 vs those of group 3. Ten of 98 patients required treatment in the Anesthesiology service. CONCLUSION: The administration of indomethacin rectally in postoperative patients of hysterectomy has been shown to reduce pain more effectively than conventional analgesics such as metamizole and paracetamol, relating to clinical evolution and early hospital discharge.

Inter-hospital transfer of referred trauma patients admitted to the trauma centre of King George Medical University

Background: Inter-hospital transfer is a common in trauma victims due to paucity of super-specialty care, lack of specialty beds, and lack of funding. The government of Uttar Pradesh introduced Emergency Medical Response system (EMRS). There is a need to audit and evaluate the transfer process since the introduction of the service. The objectives of this study were to identify critical gaps in the transfer of trauma patients and secondary over triage to the trauma centre of KGMU.Methods: This prospective observational study was conducted on trauma victims referred to the trauma centre. Patients were evaluated for clinical status, Injury Severity Score, protective patient devices present, type of intravenous fluid infusion, mode of transport, and level of referring hospital. Transfer records, transport vehicles and accompanying personal were evaluated.Results: Of the 342 patients enrolled in the study, 91 had a GCS score <8 and 112(32.74%) had a diastolic BP <60 mm Hg at arrival. Twenty patients (5.8%) were referred from tertiary care centers, 74(21.6%) were referred from district hospitals, 136(39.76%) were referred from primary care centers and 112(32.74%) were referred from private hospitals. Date and time of injury was not recorded in any of the patients. Referral time was recorded in 48(14.03%) patients. One hundred seventy-six patients (51.14%) were transferred in EMRS ambulances, 102(29.82%) patients met the criteria for secondary over triage.Conclusions: There is a need to adopt and strictly implement guidelines for transfer of trauma victims to plug the critical gaps in the transfer process.

Efficacy of Injection Ketamine and Injection Dexmedetomidine for Relief of Shoulder Pain in Laparoscopic Appendectomy Under Spinal Anaesthesia

Background: Laparoscopic appendectomy is preferred because of increasing popularity and certain benefits over open method. Laparoscopic surgeries are conventionally done under general anaesthesia with positive pressure ventilation to avoid shoulder pain, respiratory embarrassment and abdominal discomfort caused by pneumoperitoneum. The data regarding use of spinal anaesthesia for laparoscopic appendectomy is limited. This study was designed to evaluate laparoscopic appendectomy under spinal anaesthesia along with the use of intravenous injection ketamine and intravenous injection dexmedetomidine. Objectives of this study were to observe efficacy of both drugs in reducing shoulder pain, need of rescue analgesia, need of conversion to open method due patient discomfort, changes in hemodynamic parameters, postoperative nausea and vomiting. Methods: After approval of ethical committee of institute , 100 patients of age group between 18-60 years with ASA grade I or II undergoing laparoscopic appendectomy with written informed consent were included in this study .All patients were informed about standard spinal anaesthesia technique in detail and also about the risk of conversion to general anaesthesia.Spinal anaesthesia procedure was carried out with hyperbaric injection bupivacaine 0.5% . Patients were randomized in two groups. One is Group K (n=50) patients who received injection Ketamine and other is Group D (n=50) patients who received injection Dexmedetomidine intravenously.Intraoperative hemodynamic parameters,shoulder pain,abdominal discomfort,need of rescue analgesia ,postoperative recovery were monitored and recorded. Results: No patients during study required conversion to general anaesthesia or open method. VDS(verbal descriptive scale) score for referred shoulder pain was statistically lower in group K compared to group D.Group D was associated with statistically significant lower heart rate and blood pressure than Group K. Conclusion:Injection ketamine and injection dexmedetomidine, both drugs are efficacious for reduction of referred shoulder pain with more hemodynamic stability in ketamine group during laparoscopic appendectomy.

The sensitization phenomenon of acupoint and biological significances / 中国针灸

In the pathological conditions, the human body induces somatic sensory exchanges and takes neurogenic inflammatory reactions according to referred visceral organ. Acupoint possesses both diagnosing and treating functions according to the acupuncture theory. The sensitization of acupoint refers to a pathophysiological dynamic change which is manifested predominately as a neurogenic inflammatory reaction in the specific area(s) of the body surface under pathological conditions. Furthermore, the process of acupoint from "silent" (physiological status) to "active" (pathological status) is generally represented by the dynamic changes of acupoint location, size and physicochemical environment. These responses of acupoint sensitization simultaneously activate self-healing system in the body and eventually induce the curative effects.

Maternal and Perinatal Outcome in Hypertension Complicating Pregnancy between Booked and Referred Cases

The present study was conducted in Obstetrics and Gynecology Department in King George Hospital, Andhra Medical College on 300 antenatal women with hypertensive disorders. Patients were categorized according to National Blood Pressure Education Programme Work Group definitions as gestational hypertension, mild preeclampsia and severe preeclampsia. Blood pressure was measured using a mercury sphygmomanometer. Korotkoff sounds were monitored to measure diastolic blood pressure. Korotkoff 5 was taken as diastolic blood pressure. Data collected included socio-demographic details, obstetric history, presenting complaints, gestational age at delivery, mode of delivery, maternal complications, condition of baby and fetal outcome. Results were analyzed based on various parameters such as admission gestational age, gestational age at delivery, mode of delivery, severity of hypertension. Perinatal outcomes like IUGR, prematurity, 5 minute APGAR, etc. were analyzed in both Booked and Referred cases. Comparison between booked and referred cases was made employing chi-square test. P-value < 0.05 was considered as statistical significance.

Pain, click and crepitation as factors associated with temporomandibular dysfunction in Parkinson's disease / Dor, estalido e crepitação como fatores associados à disfunção temporomandibular na doença de Parkinson

ABSTRACT BACKGROUND AND OBJECTIVES: Parkinson's disease leads to mandibular movements that affect the masticatory cycle and induce orofacial pain, one of the main clinical alterations found in temporomandibular dysfunction. Thus, the present study aimed to analyze the possible factors associated with temporomandibular dysfunction and to verify the frequency of the dysfunction in this population. METHODS: This was a cross-sectional study in which the participants were evaluated using the Diagnostic Criteria for Temporomandibular Dysfunction research, used to classify the temporomandibular dysfunction and to obtain by physical examination and self-report the variables studied. RESULTS: A total of 139 people with Parkinson's disease were evaluated. Of these, 77 met the eligibility criteria, with 70% of the sample being male, with an average age of 62±9 years; Parkinson's disease diagnosis time of 6±4 years and with 71% of the sample in the moderate stage of Parkinson's disease. No significant associations were found between age, gender, time and stage of the disease with temporomandibular dysfunction. Of the variables analyzed, the significant results showed that the presence of pain (OR=10.92, 95% CI=2.25-59.93, p<0.001) has a greater chance of developing temporomandibular dysfunction, crepitation (Kappa=0.34, p<0.004) reflects moderate accuracy in the classification of temporomandibular joint disorder and the click (negative predictive value=77%, p<0.032) increases the probability of having temporomandibular dysfunction. CONCLUSION: Therefore, in this study, the frequency of the temporomandibular dysfunction was 30%, and it was observed that the factors associated with the dysfunction in people with Parkinson's disease were: pain, click, and crackle.

RESUMO JUSTIFICATIVA E OBJETIVOS: A doença de Parkinson leva a movimentos mandibulares que afetam o ciclo mastigatório e induzem a dor orofacial, uma das principais alterações clínicas encontradas na disfunção temporomandibular. Sendo assim, o presente estudo objetivou analisar os possíveis fatores associados à disfunção temporomandibular e verificar a frequência da disfunção nessa população. MÉTODOS: Trata-se de um estudo de corte transversal, no qual os participantes foram avaliados com o Critério de Diagnóstico para pesquisa em disfunção temporomandibular, utilizado para classificar a disfunção temporomandibular e obter, através do exame físico e autorrelato, as variáveis estudadas. RESULTADOS: Foram avaliadas 139 pessoas com doença de Parkinson. Dessas, 77 encontraram-se dentro dos critérios de elegibilidade, sendo que 70% da amostra era do sexo masculino, com média de idade de 62±9 anos, tempo de diagnóstico da doença de Parkinson de 6±4 anos e com 71% da amostra no estágio moderado. Não foram encontradas associações significativas entre a idade, sexo, tempo e estágio da doença com a disfunção temporomandibular. Das variáveis analisadas, os resultados significativos mostraram que a presença de dor (OR=10,92; IC95%=2,25-59,93; p<0,001) representa uma maior chance de desenvolver a disfunção temporomandibular, a crepitação (Kappa=0,34; p<0,004) reflete uma precisão moderada na classificação do transtorno da articulação temporomandibular e o estalido (valor preditivo negativo=77%; p<0,032) aumenta a probabilidade de ter a disfunção temporomandibular. CONCLUSÃO: Neste estudo, a frequência de disfunção temporomandibular foi de 30% e verificou-se que os fatores associados à disfunção em pessoas com doença de Parkinson foram dor, estalido e crepitação.

Correlation Between Referred Pain Region and Sensitized Acupoints in Patients with Stable Angina Pectoris and Distribution of Sensitized Spots in Rats with Myocardial Ischemia / 针刺研究

OBJECTIVE: To observe the correlation between the referred pain regions of stable angina pectoris (SAP) and the acupoints in coronary heart disease (CHD) patients and to investigate the rule of regional sensitized point distribution in rats. METHODS: A total of 1 046 CHD patients with SAP from 8 hospitals in China were recruited in the present study. The tenderness was palpated along the left and right chest, back, shoulder, upper limb, etc. by a specially-assigned researcher in each hospital. Among them, 77 patients accepted pain threshold (PT) measurement by using a hand-held esthesiometer. In animal experiments, 14 SD rats were subjected to occlusion of the left anterior descending branch of the left coronary artery for 4 h for establishing myocardial ischemia (MI) model, and other 4 normal rats were used as the sham-operation control group. Four hours after MI, all the rats accepted tail venous injection of 5% Evans blue (50 mg/kg) for examining the distribution of the blue dye exudation spots at the body surface where the mechanical PT was also detected by a von Frey. RESULTS: In 1 046 CHD patients, 987 (94.36%) were found to have at least one tenderness spot. The tenderness spots were found at the left chest (87.47%), right chest (13.67%), left arm (ulnar side, 41.30%), right upper limb (4.68%), left shoulder back (30.21%), right shoulder back (7.07%), etc., accompanied with rash or pigmentation, subcutaneous induration, cord-like tissue contracture, skin sag, etc. The mechanical PT level was significantly lower at the tenderness spots of the left upper limb than at non-tender points of the right upper limb in CHD patients (P<0.001). Tenderness and cutaneous abnormal changes in angor pectoris patients distributed mostly on the left chest, back, shoulder and upper limb, and some also on the right. Tender points scattered on, near or outside acupoints. A similar distribution of the blue exudation spots and lower mechanical PT spots were found in MI rats, but not in sham-MI rats. CONCLUSION: In the case of MI, a regular "referred sensitization" response frequently occurs in the dermatomere area innervated by the corresponding segments (T 1－T 5) in both CHD patients and MI rats, which may be closely associated with the formation of acupoints in ancient China.

Understanding of the trigger points of myalgia: acupuncture and dry needling exploration and modern acupuncture mechanism / 中国针灸

The similarities and differences between trigger points of myalgia and acupoints were explored. Nodules could be detected by B-ultrasound at trigger points of myalgia, but not acupoints. In clinical symptoms, the referred pain pathway of trigger points of myalgia is similar with the pathway of acupuncture meridian. Therefore, the location of trigger points of myalgia should take referred pain as pathway, which is similar with locating acupoints as meridian. Acupuncture at trigger points of myalgia takes jumping feeling as criterion, while acupuncture at acupoints are mainly based on acid swelling and numbness. From clinical observation to basic experimental research, a lot of pathophysiological evidence is provided for trigger point of myalgia. It is believed that the trigger point of myalgia might be the precise acupoint in modern scientific research, and the meridian is the synthesis of the mechanics of nerve, blood vessel and fascia. Although acupuncture and dry needling are different in theory, but the scientific foundation of TCM and western medicine is coherent.

Left Side Otalgia Caused by Acute Myocardial Infarction / 대한이비인후과학회지

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

Bilateral testicular pain as an acute aortic dissection symptom / Dolor testicular bilateral como presentación de disección aórtica aguda

Abstract Acute aortic dissection is a serious cardiovascular event and the most common acute disease of the great vessels. According to the anatomical distribution of the compromised aorta, the Stanford Group classifies it into type A and type B. Its prognosis depends on its early identification and treatment, as the mortality rate in type A increases rapidly with each hour of delay of diagnosis. Clinical manifestations of aortic dissection may be varied, which makes its early diagnosis difficult. Regarding its diagnosis, genital pain is one of the rarest symptoms. In this paper, the case of a patient who initially attended a health care institution due to acute bilateral testicular pain and was eventually diagnosed with acute aortic dissection is presented.

Resumen La disección aórtica aguda es un evento cardiovascular catastrófico que corresponde a la más común de las enfermedades agudas de los grandes vasos. Según la distribución anatómica de la aorta comprometida, el grupo de Stanford la clasifica en dos tipos: A y B. Su pronóstico depende de la identificación y manejo tempranos, siendo la tasa de mortalidad rápidamente creciente en el tipo A con cada hora que se retrasa el diagnóstico. Las manifestaciones clínicas de la disección aórtica pueden ser múltiples, lo que dificulta su diagnóstico precoz. Dentro de las formas de presentación, una de las más infrecuentes es el dolor en los genitales. Se presenta el caso clínico de un paciente que consulta inicialmente por un dolor agudo testicular bilateral y que finalmente es diagnosticado con disección aórtica aguda.

Síndrome miofascial / Myofascial syndrome

El síndrome de dolor miofascial es un complejo de síntomas sensoriales, motores y autonómicos causados por puntos gatillo miofasciales y estos como puntos de exquisita sensibilidad e hiperirritabilidad localizados en una banda tensa palpable, en músculos o su fascia, que producen una respuesta de contracción local de las fibras musculares por un tipo específico de palpación y si es lo suficientemente hiperirritable, da lugar a dolor, sensibilidad y fenómenos autonómicos, así como la disfunción en zonas por lo general distantes de su sitio de origen. Con una alta prevalencia en la población general, y responsable de gran parte de discapacidades y disfunciones en ámbitos laborales y actividades de la vida cotidiana. Presenta factores precipitantes de índole mecánico, estructural, postural, nutricional y endocrino, e involucra una fisiopatología específica, con la participación de múltiples factores proinflamatorios y sustancias neuro-vasoactivas. Su diagnóstico es fundamentalmente clínico, y existen diversos tratamientos para evitar su cronicidad y avance, que usualmente involucra tratamientos accesibles y costoefectivos, los cuales pueden brindar al paciente una solución o manejo a un dolor crónico, muchas veces subdiagnosticado e infratratado, si el médico cuenta con los conocimiento adecuados sobreesta entidad.

Myofascial pain syndrome is compoused by sensory, motor and autonomic symptoms that are generated by myofascial trigger points that are exquisite in sensitivity and irritability. These trigger points are located in a palpable taut band in muscle or fascia, which produce a local twitch response of muscle fibers for a specific type of palpation and if there is enough hyperirritability results in pain, tenderness and autonomic phenomena and dysfunction that appears usually in distant areas from its site of origin. With a high prevalence in the general population, myofascial síndrome is responsible for disability and dysfunction in work areas and daily life activities. It presents precipitating factors, such mechanical, structural, postural, nutritional and endocrine, and involves a specific pathophysiology, involving multiple pro-inflammatory factors and neuro-vasoactive substances. Diagnosis is mainly clinical, and there are various treatments to prevent chronicity and development, which usually involves easy and económica access to treatments, which may give the patient a solution or managing a chronic pain, often underdiagnosed and undertreated, if it has adequate knowledge about this entity.

Diagnosis and treatment of abnormal dental pain

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.