Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology.
ABSTRACT The relationship was investigated between algogenic potential of gallbladder pathology and occurrence/extent of sensory and trophic changes in the referred area. Five groups of subjects were studied, with: symptomatic gallbladder calculosis (3-20 colics); asymptomatic calculosis; symptomatic gallbladder shape abnormality (8-18 colics); asymptomatic shape abnormality; normal gallbladder/no symptoms. At the cystic point (CP) and contralaterally, all underwent measurement of: pain thresholds to electrical stimulation of skin, subcutis and muscle; thickness of subcutis and muscle via ultrasounds. Contralaterally to CP, all thresholds were not significantly different in the five groups. At CP, subcutis and muscle thresholds were significantly lower in symptomatic vs asymptomatic patients and/or normals (0.0001<P< 0.05). In symptomatic cases, at CP compared to contralaterally, subcutis and muscle thresholds were significantly lower (0.0001<P<0.02), subcutis thickness was significantly higher and muscle thickness significantly lower (0.006<P<0.02). Subcutis and muscle thresholds at CP in symptomatic patients were significantly and inversely correlated linearly to the number of colics (P<0.0004; P<0.0001). Patients with symptomatic calculosis were re-evaluated after 6 months; those not presenting further colics showed a significant increase in subcutis and muscle thresholds at CP, while those who continued presenting colics showed a further significant threshold decrease (0.01<P<0.05); tissue thickness did not vary. Referred hyperalgesia and altered trophism from the gallbladder only occur in painful pathology, their extent being modulated by the amount of perceived pain. The results suggest different mechanisms by which visceral nociceptive inputs trigger sensory vs trophic changes in the referred area.
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ABSTRACT: Cholelithiasis leads to 80,000 cholecystectomies being performed every year in France, but its prevalence is still unknown. The aim of this study was to assess the prevalence and risk factors of cholelithiasis in a random population of 1027 women and 727 men over the age of 30 in a small town in the southeast of France. Detailed clinical history, dietary investigation, and gallbladder ultrasound were collected for each subject and assessed by univariate analysis. A regression model was used in the multivariate analysis to detect the relative risk of cholelithiasis. Cholelithiasis was found in 130 individuals (global prevalence 13.9%). The relative risk for lithiasis was higher in women compared to men (1.89). Age (P<0.0001) and body mass index (BMI) >25 (P = 0.013) were also significant risk factors. Neither pregnancy nor oral contraceptive use proved to be risk factors. Typical biliary colic pain was the only symptom significantly associated with cholelithiasis (P<0.0001). These results show that the prevalence of gallstones in France is similar to that in Denmark and Italy.Digestive Diseases and Sciences 08/1999; 44(7):1322-9. · 2.26 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the mechanisms of referred pain observed in female patients with pain from the reproductive organs. We developed a model of inflammatory uterine pain in the rat. Inflammation of the uterus in rats pretreated with Evans Blue Dye resulted in dye extravasation in the skin over the abdomen, groin, lower back, thighs, perineal area and proximal tail, thus providing for the first time evidence for the trophic changes observed in the area of referred visceral pain in an animal model of uterine pain. The neuronal pathways mediating the observed dye extravasation in the skin after uterine inflammation may include dichotomizing afferent fibers, afferent-afferent interactions via a spinal cord pathway or a sympathetic reflex. This model will allow to gain further insight into the mechanisms of referred pain and the trophic changes observed in the area of referred pain in visceral disease.Pain 01/1998; 73(3):309-17. · 5.64 Impact Factor
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ABSTRACT: 1. Previous studies in the rat and other species have shown that neurons in and near the ventrobasal complex (VB) can be activated by various visceral as well as somatic stimuli. 2. This study examined the responses of 84 single neurons in and near the rostral 2/3 of VB in 19 adult female rats in estrus to mechanical stimulation of the skin (brush, pressure, noxious pinch) and 4 different visceral stimuli, as follows: distension of both uterine horns, mechanical probing of the vagina, gentle pressure against the cervix, and distension of the colon. The rats were studied while under moderate gaseous anesthesia (33% O2-67% N2O + 0.5% halothane) and paralyzed (pancuronium bromide). 3. Of 77 neurons tested with both somatic and visceral stimuli, 70 were responsive to one type and/or the other. Responses to somatic stimuli were immediate with brief afterdischarges to the pinch stimuli. In contrast, responses to visceral stimuli were delayed an average of 9 s with long afterdischarges averaging 2 min. Most viscerally responsive neurons (74%) had somatic receptive fields, often (44%) to noxious pinch. 4. Of the 70 responsive neurons, 43 (61%) responded to 1 or more of the 4 visceral stimuli, primarily with excitation. Most of these 43 neurons (71%) were responsive to uterine distension, whereas fewer responded to stimulation of the cervix (45%), vagina (29%), or colon (34%). 5. Viscerally responsive neurons were preferentially located in regions bordering or near VB. Only 6 of 22 neurons within the core of VB (27%) responded to visceral stimuli, in contrast with 37 of 48 neurons bordering or near VB (77%). 6. The six viscerally responsive neurons within VB all had somatic receptive fields located primarily on the caudal part of the body and were responsive to only one or two of the four visceral stimuli, usually the uterus. The 37 viscerally responsive neurons bordering or near VB were of 3 types. Neurons of the first type (n = 15) were scattered throughout the areas bordering VB and responded to both somatic and visceral stimuli much like VB neurons, except that they showed more visceral convergence. Neurons of the second type (n = 11) were concentrated at the rostral and dorsal borders of VB and responded only to visceral stimuli, mainly the uterus. Neurons of the third type (n = 11) were concentrated ventrally and had very complex, long-lasting and history-dependent response characteristics to both visceral and somatic stimuli.(ABSTRACT TRUNCATED AT 400 WORDS)Journal of Neurophysiology 03/1993; 69(2):557-68. · 3.30 Impact Factor