Cannabis has been used for medicinal purposes for thousands of years. The prohibition of cannabis in the middle of the 20th century has arrested cannabis research. In recent years there is a growing debate about the use of cannabis for medical purposes. The term ‘medical cannabis’ refers to physician-recommended use of the cannabis plant and its components, called cannabinoids, to treat disease or improve symptoms. Chronic pain is the most commonly cited reason for using medical cannabis. Cannabinoids act via cannabinoid receptors, but they also affect the activities of many other receptors, ion channels and enzymes. Preclinical studies in animals using both pharmacological and genetic approaches have increased our understanding of the mechanisms of cannabinoid-induced analgesia and provided therapeutical strategies for treating pain in humans. The mechanisms of the analgesic effect of cannabinoids include inhibition of the release of neurotransmitters and neuropeptides from presynaptic nerve endings, modulation of postsynaptic neuron excitability, activation of descending inhibitory pain pathways, and reduction of neural inflammation. Recent meta-analyses of clinical trials that have examined the use of medical cannabis in chronic pain present a moderate amount of evidence that cannabis/cannabinoids exhibit analgesic activity, especially in neuropathic pain. The main limitations of these studies are short treatment duration, small numbers of patients, heterogeneous patient populations, examination of different cannabinoids, different doses, the use of different efficacy endpoints, as well as modest observable effects. Adverse effects in the short-term medical use of cannabis are generally mild to moderate, well tolerated and transient. However, there are scant data regarding the long-term safety of medical cannabis use. Larger well-designed studies of longer duration are mandatory to determine the long-term efficacy and long-term safety of cannabis/cannabinoids and to provide definitive answers to physicians and patients regarding the risk and benefits of its use in the treatment of pain. In conclusion, the evidence from current research supports the use of medical cannabis in the treatment of chronic pain in adults. Careful follow-up and monitoring of patients using cannabis/cannabinoids are mandatory.
This article presents the results of Legg-CalvePerthes (LCP) disease treatment using triple pelvic osteotomy. Thirty patients were analysed. The conditions for inclusion in the study were complete medical documentation and follow-up until the disease was resolved. Postoperatively, no patients were immobilised. Rehabilitation was initiated early in all patients, and full weight bearing was allowed after ten weeks. With this method, an increase of the CE angle of 17.43±4.020°was achieved. Containment was increased from an initial 6.67% to 53.33% of patients at the final check-up. Similar improvement was achieved by using Herring classification of the damage; preoperatively most hips belonged to group C, and postoperatively to group A.Postoperatively, functional results were also considerably improved. The authors recommend triple pelvic osteotomy as the method of choice in the treatment of severe cases of LCP disease.
This research is in line with an important comment from the first amputee who tried the prosthetic hand with tactile feedback developed within the Smarthand project [1]. While trying the system with tactile feedback the patient said: "It's a feeling I have not had in a long time. When I grab something tightly I can feel it in the fingertips. It's strange since I don't have them anymore! It's amazing." We describe here the instrumentation and methods for testing the abilities of humans to discriminate sensations generated by electrical stimulation applied to the skin on the forearm. The instruments allowed testing of electrical stimulation with various properties (pulse duration, intensity, and rate). We tested the perception and pain thresholds, with the emphasis that comfortable sensations are a must. During the tests subjects were asked to locate the point on the skin that was stimulated and describe their perception of the elicited sensation. Results of first tests with small concentric electrodes suggest that non-amputees can distinguish up to seven perceptual qualities (the most common one was vibration, followed by tingling and tickling). Certain sensations had a higher occurrence rate along one axial line of the forearm than another of the forearm. In terms of spatial acuity, the subjects had more difficulties in distinguishing between the positions in the axial direction of the forearm compared with the circumferential direction. These results guided the design of the new array electrode with multiple cathodes and anodes positioned circumferential to the forearm. The results of the tests conducted with this electrode design showed high location discernment accuracy, and demonstrated the ability to memorize and later accurately recall six different electrical “messages” created by delivering electrical stimulation onto three different electrode pads with two different stimulation parameters. [Projekat Ministarstva nauke Republike Srbije, br. TR35040
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