Editor(s)

Dr. Win Myint Oo
Associate Professor, Faculty of Medicine, Sibu Clinical Campus,  SEGi University, Malaysia.

ISBN 978-93-90768-72-1 (Print)
ISBN 978-93-90768-73-8 (eBook)
DOI: 10.9734/bpi/hmmr/v4

This book covers key areas of medicine and medical research. The contribution by the authors include antioxidant activity, melatonin, adrenal incidenteloma, avascular necrosis, Cushing’s syndrome, experimental cardiac lesion, cardio myoblast grafting, ultrasonography investigations, cardiac regenerative surgery, telepractice, speech-language pathology, autism spectrum disorders, autism spectrum disorders, social medicine, social transplantation, self-efficacy theory, physiological risk factors, palpable gonads, microphallus, rheumatoid arthritis, cartilage integrity, zymosan-induced arthritis, pathogenesis, primary immunodeficiency syndrome, pregnancies, estimated blood loss, maternal mortality, perirenal hematoma, noncontrast computed tomography, local analgesic infiltration, analgesic infiltration, Kruskal-Wallis test, hemiplegya, angiography, echocardiography, chronic oxidative stress, chronic vasculopathies, reactive oxygen species, ozone therapy, proinflammatory cytokines, chronic obstructive pulmonary disease, hirschprung disease, central nervous system, organ transplantation, nervous regulation, intestine physiology, humoral regulation, DRESS Syndrome, anti-inflammatory drugs, hematological abnormalities, glucocorticosteroids, lymphadenopathy. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical research.

 

Media Promotion:


Chapters


A Recent Approach: Melatonin Avoids Anatomofunctional Changes Associated to Aging in a Rat Model

Bertha Prieto Gómez, Cruz Reyes-Vázquez, Mireya Velázquez-Paniagua

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 1-10
https://doi.org/10.9734/bpi/hmmr/v4/7238D

Melatonin is a hormone synthesized and released primarily by the pineal gland. Its secretion follows a circadian rhythm with a peak overnight. Melatonin is a natural hormone secreted in humans with a circadian rhythm, its values increase during the darkness. Its secretion is initiated approximately to the three months of age and continues to rise during the childhood. Previous to the puberty there is a decrease of melatonin secretion that continues until the old age. Melatonin has effects in the body and acts through at least four mechanisms: Membrane receptors, orphan nuclear receptors, calmodulin and free radicals. The melatonin amount varies according to age. Infants younger than three months of age secrete very little melatonin. It has been suggested that aging can be a consequence of the oxidation of cells that eventually become vulnerable to injury and die. This work reviews the antioxidant effects of melatonin in a rodent model, on the formation of free radicals, on the MAP2 protein expression and on the electrophysiology of the hippocampus at different ages. The results indicate that melatonin maintains in a “best” state to the experimental animals compared to controls. It suggests the use of melatonin as a therapy to prevent or delay the aging effects on the cells.

A Case of Adrenal Cushing’s Syndrome Presenting as Avascular Necrosis of the Femoral Head

Yu Hee Lee, Soon Hee Lee

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 11-15
https://doi.org/10.9734/bpi/hmmr/v4/7344D

Avascular necrosis of the femoral head is generally caused by excessive use of steroids or alcohol consumption. Avascular necrosis of the femoral head rarely occurs from the overproduction of endogenous cortisol. This report introduces a case of a 37-year-old female who presented with avascular necrosis of the femoral head and adrenal Cushing syndrome. The biochemical & pathologic examination confirmed a cortisol-producing adrenal adenoma. The patient’s persistent complaint of right pelvic pain resulted in further examinations that confirmed the presence of avascular necrosis of the right femoral head. The patient was discharged after left adrenal resection and total right hip arthroplasty and she has been monitored without relapse. This case report shows that avascular necrosis of the femoral head may appear as an early symptom of endogenous cortisol production.

A New (Alternative) Model of Heart Lesion in Rat: A Step to Cardiomyoblast Grafting for Cardiac Tissue Repair

Sébastien Quéron, Véry Coulic, Constantin Stefanidis, Paul Delrée, Carine de Prez, Esmail Najar Saligheh, Pierre Bergmann

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 16-31
https://doi.org/10.9734/bpi/hmmr/v4/7407D

An experiment on 57 rats was performed in order to elaborate an alternative model of cardiac lesion.

The antero-apical area of the heart (i.e. a part of right, septum and left ventricles) was cauterized with a «Cautery high temperature fine tip» (Bovie Medical Corporation-USA) to create an injury of controllable, precise and reproducible dimensions (8x8 mm2 surface, 1 mm depth).

To evaluate functional and morphological characteristics of the lesion, electrocardiography, pulse oximetry, echocardiography and optic microscopy were performed at different times (from day 0 to 230) after the operation.

After technical adjustment a 100% survival of the last 12 operated animals was obtained. A sub epicardial “infarction” was documented (ST-modifications on the ECG in 2 leads, significant decrease of the ejection fraction (37.4% at day 10+/-2 and 27.3% at day 30+/-5), necrotic alterations and fibrosis of the lesion area in the myocardium).

The survival and the evolution of the injury suggest that the proposed model could be used for studies concerning cardiac tissue repair.

Speech Language Therapy for Children with ASD and Their Families during the Covid-19 Pandemic: Considerations about Professional Training and Service Delivery on a Majority Country

Fernanda Dreux M. Fernandes, Ingrid Ya I. Sun, Beatriz Ferreira Rodrigues, Cinthia Parada Cabral, Clarice Tosetto, Letícia Segeren

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 32-38
https://doi.org/10.9734/bpi/hmmr/v4/7594D

The need for health professionals to embrace new technologies and develop competencies to use them is made clear by the increase in the demands for health services available to children with Autism Spectrum Disorders (ASD) and their families. The COVID-19 pandemic highlighted the urgency to consider all possibilities of maintaining and improving the services available to this population. It also became clear that the professional training of speech language pathologists (SLP) should include the use of teleheath technologies in professional practice. This chapter will discuss two studies. The first one deals with the impact of telepractice in different levels of professional education in Speech-Language Pathology. The results indicate that most students reported uncertainty and despair regarding the use of digital technologies in the learning and intervention processes. However, after a brief period they consider that both learning and intervention processes were productive and presented positive results. The second study presents details about a period of intervention that used different technologies available to families of children with ASD. We conclude that telepractice is an important alternative to the professional training of speech-language pathologists and on service delivery but do not exclude face-to-face experiences.  

Study on Social Security and Social Transplantation

Félix Cantarovich

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 39-42
https://doi.org/10.9734/bpi/hmmr/v4/7577D

The primary intention of this study is to discuss about a current social health and economic crisis, generated by the privileged advance of medical sciences. The success in medical action against diseases, plus the progress in population life survival, has conditioned a progressive increase of patients with the so called ‘End stage organ failure’, terminal phase of organic systems indispensable for life. In parallel scientific research and medical engineering, has achieved a significant development of the substitution of vital organs, particularly in the case of extracorporeal dialysis, and as well, by the vertiginous advance of organ transplantation. These positive solutions have conditioned a global and urgent social problem: People’s insufficient organ donation.

Significantly linked with this crisis of public health, globally economic resources and the real possibilities of people’s assistance by social security, have been seriously compromised by the high cost of haemodialysis and as well, by the inexorably annual increase of patients requiring transplantation to stay alive.  The main alternatives to solve this complex socioeconomic crisis tending to unbalance Social Security institution response to the needs of the people, are prevention of end-stage organ failure and also an updated of social and university education about transplantation and organ donation

Falls incidence is a public health issue among older people as it causes morbidity and mortality. Despite the growing evidence in the prevention of falls in older people, however, most interventions were developed based on the perspective of the health care providers and mostly targeting the physiological risk factors. Limited studies have included the perspective of older people and their caregivers in understanding falls and its preventions. It is important to know how older people and their caregivers perceived falls incidence, understand the risk factors and how they should prevent falls as this may empower them to practice the fall prevention strategies. This article briefly examined the current evidence on fall prevention strategies and the model of care for older people at risk of falls. The article then identified the gaps in the previous studies and suggested the conceptual model and theoretical model to guide future studies.

Role of Low Dose Overnight Dexamethasone Supression Test (Lodst) in Management Protocol for Cushing’s Syndrome

Tofail Ahmed, Hajera Mahtab, Tania Tofail, Md. A. H. G. Morshed, Fatema B. Rahman, Shahidul A. Khan

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 49-60
https://doi.org/10.9734/bpi/hmmr/v4/1641C

Introduction: Low dose overnight Dexamethasone Supression Test (LODST) is a diagnostic tool for spontaneous Cushing’s syndrome (CS). A LODST negative excludes CS. But there are 2 exceptions - testing during silent period of Cyclic Cushing’s disease (CD) or a false negative in early or mild CD by one mg dexamethasone.

Methods: We analyzed age and sex data of 154 LOSDT to see there risk association for CS.

Results: The detection rate of CS by LOSDT is 26% and with 95% CI of Cortisol (211.27 to 373.69 nmol/L). Among 154 cases, 45(29.2%) are in pediatric age and 109 (70.8%) are female. The CS group do not differ from the rest in their sex and age group distributions (sig.>.136) but their age of CS group is significantly more with a Mean Difference 2.46 - 13.31 years( sig. 005).

Binary logistic regression equation documented CS population is significantly different (.000) and such deference is influence by their age (sig. .021) but not by sex or age group (sig, > .743). Therefore, age is an independent risk factor for CS.

Conclusion: We opine to use LODST as first tool for CS. And LODST negative cases to be evaluated by newer imaging and biochemical tests. Positive only in imaging are to be managed according to guideline(s) for incidentoloma. Negative cases for both tools need to be enrolled in follow up protocols when age > 30 years or symptoms score suggest CD and rest are to be excluded. Analysis of cumulative diagnostic and outcome data will help us to formulate more cost-effective management policy for CS.

Short Course Androgenisation in Late Reported Cases with Microphallus

Mahmudul Huque, Tania Tofail, Tofail Ahmed

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 61-67
https://doi.org/10.9734/bpi/hmmr/v4/1640C

Background and Objectives: Microphallus is an abnormally short penis and its management should begin in infancy or in early childhood. The present study investigated the response of short term testosterone therapy in late reported cases of microphallus.

Methods: A total of 17 cases of microphallus between the age of 8 and 15 years were studied. Standard criteria for the diagnosis of microphallus were followed among the individual with bilateral palpable gonad. All cases were treated with intramuscular testosterone 50 to 75 mg once every 21 days until their average stretched penile length (SPL) for age is achieved or total dose of 450 mg of testosterone is given. Response to testosterone treatment was measured by the absolute and percent increment in SPL. We also compared the response of treatment of cases reported up-to age of 10 years and thereafter.

Results: A total of 17 cases were included in the study. All of them achieved target SPL. Out of total 17 boys, 7 were between 8 to 10 years (Group 1) and 10 were between 12 to 15 years (Group 2) of age. The pre-treatment SPL of 17 microphallus cases was 3.13±0.15 (2.81 - 3.45 cm). All the cases achieved average phallus for the age with a significant increased post- treatment SPL of 8.94±0.32 (8.27 -9.61 cm); sig. .000. The two groups had similar gain in SPL (3.89 -6.25) vs (5.32 -7.34 cm) & % increment (126.47 -215.31%) vs (145.43 -288.53%) (sig. ? .139) but total testosterone required in older boys (Gr 2) was higher (162.52 –387.48 mg) vs (326.vs 15 – 433.85 mg); sig.0.043.

Conclusion: Microphallus in boys with palpable gonads responded to short term testosterone treatment in late reported cases also and we termed these cases as simple microphallus.

Influence of Depleted Complement Activity on the Development of Zymosan-Induced Arthritis

Lyudmila Belenska-Todorova, Nina Ivanovska

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 68-78
https://doi.org/10.9734/bpi/hmmr/v4/1658C

Zymosan-induced arthritis is an experimental model of rheumatoid arthritis used for analyzing cells and molecules that mediate the pathogenesis of inflammatory joint diseases. Although the alternative pathway of complement activity is involved in the pathogenesis of arthritis, many issues are not well elucidated. The aim of the present study was to evaluate the effect of complement depletion on cartilage integrity, Dectin-1 expression and apoptosis of blood monocytes and lymphocytes. The decomplementation was performed using cobra venom factor (CVF), a peptide fragment analogous to C3 component, which is capable of activating the alternative complement pathway. We established that CVF treatment reduced proteoglycan loss and differentially affected Dectin-1 expression on monocyte and lymphocyte populations along with decreased number of dendritic cells (DCs) in the synovial fluid. Success of complement inhibition in the experimental models encourages novel therapeutic approaches to the treatment of human rheumatoid arthritis.

Systematic Study: The Child with Recurrent Infections

Arnoldo Quezada

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 79-87
https://doi.org/10.9734/bpi/hmmr/v4/7755D

The child with recurrent infections proposes a diagnostic challenge to discard an immunodeficiency. There is no definitive consensus to determine the number of infections that can be considered normal. Children with recurrent infections can be included in four basic types of diagnostic categories: probably normal child, allergic child, children with chronic disease, and immunodeficient child. Different warning signs have been developed to guide the appropriate detection of children with primary immunodeficiency diseases (PID). The value of a detailed clinical history and an exhaustive physical examination, as well as the study with initial laboratory tests are discussed. The last report of the expert committee of the International Union of Immunology Societies has proposed the name of Inborn Errors of Immunity for PIDs. A smartphone application is available for clinicians and students that facilitates the diagnosis of PID. Some PID may be suspected as more probable depending on the infectious agent.  

Background: Caesarean section is the most common major operation performed on women. Although caesarean section is much safe today due to improved techniques, anaesthesia, blood transfusion services and antibiotics, there are still major intra operative and post operative complications. Haemorrhage is one of the short term morbidities following caesarean section and may lead to maternal mortality.

Aim: To determine which method of expansion of uterine incision at caesarean section (sharp and blunt) is associated with a reduction in blood loss.

Methods: A prospective randomized study conducted among booked antenatal women admitted in antenatal ward for elective caesarean section at the University of Port Harcourt Teaching Hospital (UPTH) over a period of nine months. The eligible 354 women (177 for each group) were counseled for participation in the study and informed consent obtained. A profoma was prepared for each participant. Blood loss estimation (EBL) was undertaken using both volumetric and gravimetric methods. The data was collected and analyzed using EPI INFO statistical software.

Results: The mean age of women in blunt group was 31.6 years and 31.7 years in sharp group. All the women had formal education. The mean parity in blunt group was 1.4 and 1.5 in sharp group. The mean gestational age for both groups was 38.1 (SD 1.0) weeks. The mean EBL during the study period was 594.4 (SD 167.0) mls. The mean EBL for sharp group was 602.3 (SD 176.6) mls and 586.4 (SD 157.3) mls for blunt group. The mean EBL for women in blunt group who had uterine extension was 889.3 (SD 100.3) mls while that of sharp was 944.4 (SD190.9) mls.

Conclusion: Caesarean section is a common obstetric operation and needs to be made as safe as possible. Although sharp expansion of the lower segment transverse uterine incision resulted in more blood loss, the difference is not statistically significant. The difference in blood loss following inadvertent extension between the two groups is statistically significant. There was no need for a blood transfusion.

Extensive Perirenal Hematoma Formation Following D-J Stent Insertion in a Solitary Functioning Kidney. Description of an Unusual Complication

Michael S. Nomikos, Sarantis Papanikolaou, George Athanassopoulos, George Koritsiadis

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 98-102
https://doi.org/10.9734/bpi/hmmr/v4/7693D

Double-J ureteral stent insertion is a common urological procedure performed for the relief of renal obstruction either due to stone disease or genitourinary malignancy. A case of a 62-year-old woman who received D-J stent due to hydronephrosis of her solitary functioning left kidney and complicated with renal perforation and significant retroperitoneal hematoma formation is presented. She was managed conservatively with blood transfusion and double-J stent repositioning in the collecting system. Follow-up with noncontrast computed tomography (CT) of the abdomen was performed the first and third months after stent placement which showed stabilization of the hematoma. The hematoma was completely resolved 6 months post D-J reposition. Although a common procedure, ureteral stent placement is not without complications and a high clinical suspicion index is required for early diagnosis and proper management of poststenting renal hematomas. Close follow-up is very important to prevent hematoma-related complications.

Background: A combined adductor canal block (ACB) and sciatic nerve block (SNB) is new different way to achieve an efficient postoperative analgesia after total knee replacement (TKR) that spares the weakness of quadriceps femoris muscle. We compared ultrasound guided combined adductor canal and sciatic nerve blocks that performed by anesthesiologist with surgeon applied local anesthetic infiltration for analgesic efficacy within the first 24 h after TKR. This prospective randomized controlled trial aimed to evaluate the efficiency and safety of the combined adductor canal with sciatic nerve blocks versus local analgesic infiltration alone for pain control after total knee replacement.

Patients and Methods: Forty patients (ASA II, and III), undergoing unilateral total knee replacement, were randomly and allocated to two groups (20 patients each), block group (ACB+SNB): The patient received US- guided adductor canal block combined with sciatic nerve block, local group (LAI): Patient received local analgesic injection (LAI) to entire of the knee joint. The primary outcomes were postoperative visual analogue scale (VAS) at rest and with movement, first request of analgesics and 24 h total consumption of morphine. Secondary outcome measures included sedation score and side effects associated with morphine consumption like nausea, vomiting.

Results: There was a significant reduction in postoperative morphine consumption, VAS, nausea and vomiting and sedation at 12 h in local group. There were no complications attributable to the ACB or SNB blocks.

Conclusion: Combined adductor canal with sciatic nerve blocks could significantly reduce VAS scores, morphine consumption, and first request for analgesia in comparison with local analgesic infiltration alone following TKA. Additionally, there is a lower incidence of sedation, nausea and vomiting in the combined blocks group.

Advanced Study on Pregnancy-Related Low Back Pain Relief after Maximum Static Flexibility Program

Helena Andrade Figueira, Rodrigo Gomes de Souza Vale, Wilma Ferreira Guedes Rodrigues, Alan Andrade Figueira, Joana Andrade Figueira, Estélio Henrique Martin Dantas, Renata Franco Maciel, Ryan Fernando Menezes, Beatriz Martins Carvalho, Christiano Lima De Lucena, Alessandra Isabella Santiago Silva Moura, Ana Maria Ribeiro Fonseca, Luise Oliveira Ribeiro Da Silva, Victoria Guerra Abdias

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 114-122
https://doi.org/10.9734/bpi/hmmr/v4/7513D

Background: Pregnancy-related low back pain (LBP) impacts pregnancy. Pregnancy-related low back pain (LBP) has an impact on daily life for many pregnant women [1] and is characterized by pain in the lower spine responsible for physical and emotional disabilities. Flexibilizing facilitates movements providing posture correction and pain relief.

Objective: To analyze effects of a maximum static flexibility program on pregnancy’s LBP.

Methods: Clinical prospective randomized controlled trial.

Setting: Brazilian Governmental Health Program’s prenatal care.

Participants: 40 volunteer of pregnant women, gestational age between 20 and 31 weeks, with/without LBP randomly assigned to experimental group (EG) or control group (CG): EG n = 20 (E1 with LBP and E2 without LBP) and CG n = 20 (C1 with LBP and C2 without LBP).

Interventions: EG intervention was sessions of static flexion. CG received conventional medical treatment. Pain intensity was measured by visual analog scale (VAS) of pain. Chi-square, Wilcoxon and the Kruskal-Wallis statistical tests were adopted.

Results: Concerning percent variation (?%) E1 presented 56.4% reduction of LBP while E2, C1, C2 increased LBP by 2.9%, 0.1%, 0.5% respectively. Wilcoxon test outcome comparing pre- and post-test of experimental and control groups on pain intensity levels presented significant E1 p < 0.05. Kruskal-Wallis test comparing post-test C1 with E1 with E2 and C2 presented p < 0.05 (C1 post vs. E1 post: p = 0.006; C1 post vs. E2 post: p < 0.0001; C1 post vs. C2 post: p = 0.002), showing significant effect of the experimental treatment.

Conclusion: Gains on LBP for EG show that the static flexibilizing exercises reduce and prevent pregnancy-related LBP. The static exercises contributed to reduction or prevention of LBP in pregnant women attended by this Family Health Program. The conventional treatment, based on drug therapy and resting, did not present significant result for LBP in pregnancy.

Management of Rare Case of Hemiplegya in Emergency Department

Luciana Teodora Rotaru, Mircea-Catalin Fortofoiu, Octavian Istratoaie, Cristian Constantin, Dana Maria Albulescu, Maria Fortofoiu

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 123-134
https://doi.org/10.9734/bpi/hmmr/v4/1655C

Background: Although, loss of consciousness in children and adolescents is produced, in most cases, of neurally mediated hypotension whose clinical expression is vasovagal syncope, a rigorous differential diagnosis is required to eliminate the cardiac, neurological or psychiatric conditions that can cause syncope.

Case Report: An 8-year-old athlete with no significant personal history is brought with an ambulance in the emergency department (ED) for loss of consciousness, vomiting and seizures with sudden onset, without prodromal signs and symptoms while she was in the playground and jumped on an elastic trampoline. Computer tomography revealed a large area of ischemia associated with lack of opacifiation of the entire left middle cerebral artery, magnetic resonance imaging revealed multiple areas of ischemia in the cerebellum, pons and medulla also magnetic resonance angiography including time-of-flight (TOF) sequences showed absence of blood flow in the left middle cerebral artery. The surprise in this case was in echocardiography which revealed a giant left atrial myxoma, multilobulated, with transvalvular protrusion, without symptoms, even in the conditions in which, patient participated in training in a club of athletics, being subjected to intense and prolonged efforts. Subsequently, the patient was sent to intensive care for monitoring and treatment but, unfortunately, died a week after.

Conclusion: The case, presents all the ingredients for fatal evolution, namely: Ignoring or omitting the family history of atrial myxoma, absence of screening echocardiography, absence of symptoms and clinical signs of left atrial myxoma as well as sudden onset with major cardiac and cerebral complications occurring concurrently.

A large series of studies reported that unhealthy lifestyle, such as high fat, heavily salted diet, reduced physical activity and tobacco smoking is a direct or indirect cause of cardiovascular diseases, chronic respiratory diseases, diabetes and neurodegenerative diseases. In all these diseases the main cause of death is a remarkable increase of circulating reactive oxygen species (ROS), proinflammatory cytokines and acute-phase proteins. Consequently, bedsides promoving healthier diets and reducing the use of alcohol and tobacco, it appears indispensable to correct the chronic oxidative stress during the development of the chronic pathology. Thus, the official orthodox treatments of anti-hypertensive, anti-cholesterolemic and antidiabetics drugs need to be integrate with a modulator able to re-establish the oxidant/antioxidant balance in the cells. It has been demonstrated that the judicious application of ozone in the atrophic form of ARMD, chronic vasculopathies, Type II diabetes, chronic obstructive pulmonary disease (COPD), wound healing disorders, orthopedics and dentistry produce a positive biochemical and clinical results that the medical community continue to ignore. The fact that ozone therapy can be used in different pathologies has been derided by skeptical scientists, who do not know that ozone, as soon as it is dissolved in the water of the plasma, reacts immediately with antioxidants and polyunsaturated fatty acids generating two messengers able to activate blood, endothelial and a variety of parenchyma cells, which, having different functions, are responsible for restoring oxidant homeostasis. The systemic indirect ozone therapy is a safe and effective method to solve the problem of chronic oxidative stress and the related pathologies.

Recent Advancements about the Respective Roles of Central and Intraorgan Nervous Systems in Regulation of the Gastrointestinal Tract Physiology and Morphology

V. ` Coulic, C. De Prez, N. Iesuitova, L. F. Makarova, A. Maksimenkova, D. V. Mikhalski, P. J. Delrée

Highlights on Medicine and Medical Research Vol. 4, 5 March 2021, Page 141-165
https://doi.org/10.9734/bpi/hmmr/v4/1695F

The role played by central nervous system in the general regulation and coordination of organ, tissue and even cell activities does not stop to excite the curiosity of investigators. Recently important data were obtained in the field of new neurotransmitters and other active molecules which mechanisms of actions and interactions were clarified. But the function of intra organ, local nervous system, its relations with the main brain and medullar centers remain a little enigmatic though much is known about tiny paths of afferent, efferent and inter neuronal transmission.

In order to isolate the influence of central and intramural nervous system of the intestine, several situations were considered: 1) surgical interruption of nervous reflex links (NRI), which is always present in organ transplantation and often occurs in spinal cord trauma, 2) injury of the intramural nervous system with perfectly conserved links with central nervous system, for instance after intestinal ischemia and in Hirschprung disease. As control a technique of surgical directed re innervation (SDR) of the intestinal graft by suture of the divided mesenteric plexus was elaborated. A model of ontogenetic reconstruction of adult-like organs after syngeneic implantation into an adult organism of a fetal organ containing (intestine) or not (liver, pancreas) an organized intramural nervous system, was also used.

The experiences on 101 dogs, 274 rats and 25 mice were conducted by the same team according to the rules of Bioethics.

Performed investigations concerned testing nervous connection with central nervous system (Recto-enteric reflex presence, normal reaction to anticholinergic substance), evaluation of motility, secretion, membrane digestion of the intestine, as well as optic and electron microscopy of the target organs

The results may be summarized as following.

Disconnection from the CNS does not significantly affect more than a few days (influence of operation trauma) the intrinsic functions and the morphology of the intestine but has an incidence on the own rhythm of the organ activity which becomes “autonomous” and stops to be integrated into the whole regulation of digestive tract function. It creates such disorders as accelerated nutrient transit, hyper secretion, body weight loss. The activity of the remaining linked with central nervous system stomach and colon is modified in such a way that final digestive process is adapted and correctly realized (central nervous coordinating intervention). Restoration of central nervous reflex control of the operated intestine leads to the normalization of its activity and of the whole digestive process.

The destruction of intramural nervous system either by prolonged ischemia, or by congenital dysplasia affects both function and morphology of the intestine. The ontogenetic complete development of a grafted fetal organ is possible only when it presents an intramural nervous system (for instance, intestine). If intra organ neurons are not organized as plexus, the graft development is partial and not coordinated: only isolated weakly organized structures develop (for instance in the ectopically grown fetal liver - bile ducts, hepatocytes column, in pancreas - endocrine cells isolated or in clusters), without any links between each other.

So, if in reconstructive surgery of limbs of face, somatic nerve sutures are a routine procedure, on the other hand surgical or directed reconstruction of nervous links is practically unknown in solid organ grafting. Suturing vegetative nervous plexus surrounding large vessel irrigating the graft is technically simple and seems justified but probably still deserves further investigations for benefit confirmation. These findings may be interesting for the development of organ transplantation, when it may be useful to restore not only the vascular connections of the graft with the host, but also the nervous links of the transplant with the recipient central nervous system (brain and spinal medulla). This conception may be worthwhile in the treatment of such pathology as digestive difficulties in tetra and paraplegia patients on one side, of Hirschprung disease on the other side. It may also help to consider and understand the problems which may be either the consequences of central nervous system alterations for digestion or, on the contrary, the incidence of severe peripheral disorders for the brain activity.

 

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe, potentially life-threatening idiosyncratic drug reaction. It is usually caused by antiepileptics, antibiotics or non-steroidal anti-inflammatory drugs, after a latency period of three weeks to three months. Typical clinical features include mucocutaneous rash, fever, lymphadenopathy and internal organ involvement. We report a patient with systemic sclerosis, rheumatoid arthritis and osteoporosis who developed possible DRESS syndrome to lamotrigine, used for epilepsy. Clinical features suggesting DRESS syndrome included severe rash, fever, hematological abnormalities and time of appearing and disappearing of skin changes. The condition was initially unsuccessfully treated as an acute allergic reaction to ibandronate, without discontinuation of lamotrigine. This report aims to increase the awareness of this rare entity in the rheumatology community.