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Introduction Guillain-Barré syndrome (GBS) is a worldwide demyelinating polyradiculopathy and polyneuropathy. Currently, there is no specific drug for GBS, and established treatment is generally based on immune-modulating treatment with plasma exchange or intravenous immunoglobulin in combination with supportive care. This study aimed to investigate the efficiency of integrated Chinese and Western medicine for acute GBS treatment. Methods We enrolled 73 subjects, and randomly divided them into two groups: 35 cases in the traditional Chinese medicine (TCM) group, and 28 in the Control group. The Control group was treated with the common Western medicine for one month; and the TCM group was administrated with one month of common treatment combined with TCM medication. Results Compared to the controls, TCM significantly enhanced the treatment efficiency in symptom expression, including the TCM syndrome score, the activity of daily living score, Hughes functional score and sensory dysfunction assessment. The total effective rate of the TCM group was 94.29%, significantly better than controls (78.59%). Moreover, TCM provide better improvement in motor nerve conduction functions (distal motor latency and motor conduction velocity) and sensory nerve conduction functions (sensory conduction velocity and sensory nerve action potential) in median nerve, ulnar nerve, and common fibular nerve. Conclusion When combined with TCM administration, the GBS treatment could acquire better outcomes.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease characterized by neurological symptoms and signs of progressive weakness, paresthesias, and sensory dysfunction. Other symptoms include reduced or absent tendon reflexes, cranial nerve involvement, autonomic symptoms, ataxia, and neuropathic pain. Unlike other autoimmune diseases, CIDP generally affects older individuals and has a male predominance. The onset is generally insidious and can take up to 8 weeks with a relapsing-recovery pattern. Like all autoimmune diseases, the etiology is multifactorial, with both genetic and environmental factors contributing to it. Case reports of CIDP have found associations with multiple pathogenic organisms including Hepatitis B and C viruses, Bartonella henselae, Mycoplasma pneumoniae, Human immunodeficiency virus, Cytomegalovirus and Epstein-Barr virus. Possible antigenic self-targets include myelin protein 0, myelin protein 2, peripheral myelin protein 22, Connexin 32, and myelin basic protein. Antibodies targeting the Ranvier node proteins such as contactin-1, contactin-associated protein 1, and neurofascin 155 have been described. CIDP is treated with rehabilitation and pharmacological modalities. Pharmacological treatments target autoimmune dysfunction and include corticosteroids, intravenous immunoglobulin, subcutaneous immunoglobulin, plasma exchange, immunosuppressive and immunomodulatory agents such as methotrexate, cyclophosphamide, rituximab, and mycophenolate mofetil. Although there are few observational studies and randomized clinical trials with limited evidence supporting the use of immunosuppressive drugs, they are widely used in clinical practice. A comprehensive review of CIDP is presented herein in light of the autoimmune tautology. © 2019 Elsevier Ltd

Sensory dysfunction is characterized by difficulty in receiving, processing, and integrating sensory stimuli, resulting in an unusual response to sensory stimulations. An altered sensory reactivity is observed in a large number of people with autism spectrum disorder. The aims of this study were to determine: a) the relationship between the severity of autistic disorder and sensory dysfunctions; b) the relationship between different sensory modalities; c) the relationship between age and functioning on sensory modalities; d) the modalities in which respondents have the most pronounced sensory dysfunctions. The sample included 60 participants with autism spectrum disorder, aged 11 to 26. The adolescent and adult sensory profile (The Adolescent / Adult Sensory Profile, Brown & Dunn, 2002) was used to measure sensory responses of the subjects. For the purposes of determining the severity of autistic disorder, a PDD-MRS scale was used (Pervasive Developmental Disorder Mental Retardation Scale, PDD-MRS, Kraijer & de Bildt, 2005). The results obtained show that in young people with autism spectrum disorder there is no statistically significant relationship between the severity of autistic disorder and the sensory dysfunction. Almost all sensory modalities were mutually correlated significantly. Significant correlations were missing between the participants` age and the altered sensory responses. The results show that subjects achieved significantly higher scores on the Activity Engagement subscale compared with all other subscales, which leads us to conclude that the participants from our sample had the most difficulty in adjusting their activity level to the demands of everyday situations. These findings have significant practical implications, both on the planning and realization of sensory interventions in these individuals, as well as on the need to harmonize the characteristics of the environment in which they reside, the tasks delegated to them, and their sensory specifcities. Senzornu disfunkciju karakterišu poteškoće pri prijemu, obradi i integraciji senzornih stimulusa, koje rezultiraju neobičnom reakcijom na senzorne podražaje. Izmenjena senzorna reaktivnost beleži se kod velikog broja osoba s poremećajem iz spektra autizma. Ciljevi ovog istraživanja su da se utvrde: a) odnos između težine autističkog poremećaja i senzornih disfunkcija; b) odnos između različitih senzornih modaliteta; c) odnos između uzrasta i funkcionisanja na senzornim modalitetima; d) modaliteti u kojima ispitanici imaju najizraženije senzorne disfunkcije. Uzorkom je obuhvaćeno 60 ispitanika s poremećajem iz spektra autizma, uzrasta od 11 do 26 godina. Za merenje senzornih odgovora ispitanika korišćen je Senzorni profl adolescenata i odraslih (Te Adolescent/Adult Sensory Profle, Brown & Dunn, 2002). Za potrebe utvrđivanja težine autističkog poremećaja korišćena je Skala za procenu pervazivnih poremećaja razvoja kod osoba sa intelektualnom ometenošću (Pervasive Developmental Disorder Mental Retardation Scale, PDD-MRS, Kraijer & de Bildt, 2005). Dobijeni rezultati pokazuju da kod mladih osoba s poremećajem iz spektra autizma nema statistički značajnih relacija između težine autističkog poremećaja i senzornih disfunkcija. Skoro svi senzorni modaliteti međusobno koreliraju statistički značajno. Značajne korelacije su izostale između uzrasta ispitanika i izmenjenih senzornih reakcija. Dobijeni rezultati pokazuju da ispitanici ostvaruju značajno viša postignuća na supskali Aktivitet u poređenju sa svim ostalim supskalama, na osnovu čega zaključujemo da ispitanici iz našeg uzorka imaju najviše poteškoća u prilagođavanju svog nivoa aktivnosti zahtevima svakodnevnih situacija. Ovi nalazi imaju značajne praktične implikacije, kako na planiranje i realizaciju senzornih intervencija kod ovih osoba, tako i na potrebu za usklađivanjem karakteristika okruženja u kom borave, zadataka koji im se zadaju i njihovih senzornih specifčnosti.

Modern lifestyles are disrupting the human senses—primarily sight, sound, and smell. Noise-induced hearing loss has been noted for centuries and increasing over time following the industrial era. From the mid-20th century, the numbers of individuals with myopia (the leading visual impairment) have been increasing globally. Historical evidence for olfactory dysfunction is not known but its etiological links to pollution suggest it increased following industrialization. Clinical interventions for sight and sound loss include preventative and corrective measures but none exist for olfactory dysfunction. Further, olfactory loss is linked to multiple negative health outcomes across physical, mental, and social domains. Due to the global rates of exposure to pollution, olfaction is a global health concern. The environmental injustice inherent in human society (locally and globally) results in inequitable risk for sensory loss by the most vulnerable populations and creates an even deeper gradient in health disparity. Situated within the environmental justice and health disparity literature, this paper introduces the term sensory inequity to describe variation in sensory environments based on socio-economic status (which is often entwined with race and education). A key challenge to risk management is awareness of sensory inequity experienced by vulnerable populations and incorporating that awareness into basic research and policy.

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Apuntar. Describir los factores asociados al realce de gadolinio en la RM en pacientes con esclerosis múltiple (EM) y síntomas de recaída. Pacientes y métodos. Estudio transversal retrospectivo de pacientes mayores de 18 años diagnosticados de EM recidivante-remitente, secundaria progresiva y primaria progresiva de 2009 a 2014, que presentaron una recaída clínica y fueron sometidos a resonancia cerebral y espinal con gadolinio durante la fase aguda de los síntomas. Resultados. De los 93 pacientes incluidos, el 70% eran mujeres, la edad media fue de 37 ± 9,6 años. El 90% tenía EM remitente-recidivante y el 50% tenía al menos 5 años desde el diagnóstico. El 56% presentaba afectación medular, siendo las alteraciones sensoriales más frecuentes (44%). La mediana de duración de los síntomas fue de 6 días (rango: 1-89 días). El 93% requirió tratamiento con metilprednisolona intravenosa 3-5 días, que se administró luego de realizar estudios de resonancia magnética. No se evidenció diferencia estadística en la presencia de lesiones que realce con gadolinio en la RM durante la recaída con alguna de las variables clínicas analizadas y solo se observó una tendencia con los síntomas asociados (p = 0,07). Conclusiones. La definición de EM recidivante es clínica. Sin embargo, la mejora de la resonancia magnética en la fase de recaída podría ser útil para confirmar la actividad de la enfermedad. Con esta información, podría ser un punto útil sobre el tratamiento de estos pacientes con fármacos inmunomoduladores. Aim. To describe the factors that are associated with gadolinium enhancement on MRI in patients with multiple sclerosis (MS) and symptoms of relapse. Patients and methods. A retrospective cross-sectional study of patients over 18 years diagnosed with relapsing-remitting MS, secondary progressive and primary progressive from 2009 to 2014, who had a clinical relapse and underwent brain and spinal resonance with gadolinium during the acute phase of the symptoms. Results. Of the 93 patients enrolled, 70% were women, the average age was 37 ± 9.6 years. 90% had relapsing-remitting MS and 50% had at least 5 years since the diagnosis. The 56% had medullar involvement, being the most frequent sensory disturbances (44%). The median duration of symptoms was 6 days (range: 1-89 days). The 93% required treatment with intravenous methylprednisolone 3-5 days, which was administered after performing MRI studies. No evidence statistical difference in the presence of lesions that gadolinium enhancement on MRI during relapse with any of the clinical variables analyzed and only a tendency was observed with associated symptoms (p = 0.07). Conclusions. The definition of relapse MS is clinic. However, the enhancement of the MRI in the phase of relapse could be useful to confirm the disease’s activity. With this information, could be a useful point on the treatment of these patients with immunomodulatory drugs. © 2017 Revista de Neurología

Tactile dysfunction in chronic pain is explained as disruption in somatotopically based processing of stimuli. We hypothesized that people with chronic back pain also demonstrate a spatially defined disruption of tactile processing. In 3 cross-sectional experiments, 26 patients with unilateral low back pain and 12 healthy controls made temporal order judgments of pairs of tactile stimuli. We analyzed the stimulus onset asynchrony at which participants perceived them to be simultaneous (PSS). Stimuli were delivered to either side of the back or to both index fingers. For hand stimuli, the position of the hands were 1) one either side of the back or 2) in front of the body, 3) one behind the back and one in front on the affected side or 4) on the unaffected side. In patients, mean ± SD PSS for stimuli to either side of the lower back occurred when the affected side received the stimulus 25 ± 25 msec before the unaffected side. PSS for stimuli to the hands with one hand held near the affected area was similar when the other hand was behind the back on the opposite side of the midline (17 ± 17 msec) or in front of the body on the affected side (31 ± 21 msec). These PSS values were greater than that for all other conditions and in healthy controls (p < 0.01), which approached zero. Spatial representation of vibrotactile stimuli is disrupted in chronic unilateral back pain. ANOVA: analysis of variance CRPS: complex regional pain syndrome JND: just noticeable difference PSS: perceived to be simultaneous PSS: point of subjective simultaneity SOA: stimulus onset asynchrony TOJ: temporal order judgment. © 2012 Lippincott Williams & Wilkins, Inc.

Neuromyelitis optica (NMO) or Devic's disease is an autoimmune inflammatory demyelinating condition affecting the central nervous system (CNS). It was initially believed to be a variant of multiple sclerosis (MS). However, the discovery of NMO-IgG anti-AQP4 antibodies marked an objective distinction between these conditions. Treatment of acute attacks is generally based on pulsed steroids, followed by long-term immunosuppression with azathioprine, oral steroids, and rituximab as first-line therapies. Plasma exchange therapy is indicated for steroid-resistant relapses. We describe a case report of a pregnant woman with a severe relapse of Devic's disease, initially misdiagnosed as MS, unresponsive to pulsed steroids, and who underwent plasma exchange therapy safely, with excellent clinical response and with no adverse outcome for the fetus. © 2016 Elsevier B.V.

Background: We report a case of stroke due to stenosis caused by a myxoma in the common carotid artery with no evidence of a cardiac origin. Only 1 such case has been reported previously in the literature. Methods: A previously healthy 37-year-old woman presented with repeated episodes of acute focal deficits together with motor, sensory, and language symptoms typical of left internal carotid territory involvement. Brain magnetic resonance imaging showed acute and subacute ischemic lesions in the territory of the left middle cerebral artery and border zone infarcts (middle cerebral artery with anterior and posterior cerebral arteries). Magnetic resonance angiography showed a filling defect in the distal portion of the left common carotid artery causing stenosis over 70%. Transesophageal echocardiography showed no embolic sources. Blood tests ruled out a prothrombotic state. Results: The image was initially interpreted as a possible subacute thrombus and anticoagulation was started. No changes were observed in the follow-up carotid ultrasound examination after 12 days of treatment. A gelatinous mass was removed during carotid surgery. No subjacent lesion was observed in the vessel wall. Pathology examination showed a spindle cell fibromyxoid tissue with fibrinoid material typical of myxoma. Conclusions: We hypothesize that the myxoma originated in the vessel, or alternatively, that a cardiac myxoma embolized without leaving a residual cardiac tumor. Although exceptional, myxoma should be added to the list of unusual causes of carotid artery stenosis causing stroke. © 2015 by National Stroke Association.

Studies were performed on a large number of diabetic patients with three levels of plantar sensation loss by analysing walking foot pressure images in the frequency domain. The feet of diabetic subjects were scanned over ten specified areas using Semmes-Weinstein's nylon monofilaments to determine quantitatively the three levels of neuropathy. A new parameter, the power ratio (PR, ratio of high frequency power to the total power in an image) was used to distinguish discretely between normal and diabetic feet in three levels of sensation loss. Analysis of results showed that the differences in PR values for diabetic feet (in all three levels of sensation loss) compared to normal feet were found to be highly significant (p

Gut homeostasis results from complex neuro-immune interactions aimed at triggering stereotypical and specific programs of coordinated mucosal secretion and powerful motor propulsion. A prominent role in the regulation of this highly integrated network, comprising a variety of immune/inflammatory cells and the enteric nervous system, is played by purinergic mediators. The cells of the digestive tract are literally plunged into a "biological sea" of functionally active nucleotides and nucleosides, which carry out the critical task of driving regulatory interventions on cellular functions through the activation of P1 and P2 receptors. Intensive research efforts are being made to achieve an integrated view of the purinergic system, since it is emerging that the various components of purinergic pathways (i.e., enzymes, transporters, mediators and receptors) are mutually linked entities, deputed to finely modulating the magnitude and the duration of purinergic signaling, and that alterations occurring in this balanced network could be intimately involved in the pathophysiology of several gut disorders. This review article intends to provide a critical appraisal of current knowledge on the purinergic system role in the regulation of gastrointestinal functions, considering these pathways as a whole integrated network, which is capable of finely controlling the levels of bioactive nucleotides and nucleosides in the biophase of their respective receptors. Special attention is paid to the mechanisms through which alterations in the various compartments of the purinergic system could contribute to the pathophysiology of gut disorders, and to the possibility of counteracting such dysfunctions by means of pharmacological interventions on purinergic molecular targets. © 2013 Elsevier Inc.

Background - In this paper, we report a coexistence of multiple sclerosis and an intradural spinal cord tumor. Case report - A 34-year-old woman who had a history of relapsing-remitting multiple sclerosis for the last 15-years presented with acute sensory loss and spasticity in her left lower limb and her spinal magnetic resonance imaging study revealed an intradural spinal cord tumor in the lumbar spine, further diagnosed as ependymoma. Conclusion - We call attention to this rare association of MS and a spinal cord tumor, emphasizing the need for investigation of new symptoms during the evolution of MS.

Purpose of Review: Balamuthia mandrillaris infection of the skin and central nervous system has been increasingly reported in the last decade, making this entity a genuine emerging disease. The ability of the clinician in recognizing the skin lesion early in the course of the disease may lead to a successful therapeutic intervention in an otherwise fatal disease. RECENT FINDINGS: In the past years, advances have been made regarding knowledge about the ubiquity of the ameba in the environment, its worldwide distribution (with higher prevalence in South America), the patients at risk (particularly those of Hispanic origin), the diagnostic methods (including those based on molecular biology) and the different therapeutic strategies that have resulted in survival of patients. A recent report dealing with organ transplant transmission of this infection has made it a subject of interest in transplant medicine. SUMMARY: The present review will allow readers from different fields (clinician, dermatologist, neurologist, infectious disease and transplant specialist) to become familiar with the clinical aspect of the disease, including diagnosis and therapy.

WOS: 000260847300024, PubMed ID: 17965909, Syringomyelia, which is generally related to congenital malformations and tumors, may lead to paresthesia and dysfunctions in thermo-algesic perception. Post-traumatic syringomyelia (PTS) is a rare type of this disease characterised by the development of a cystic formation containing cerebrospinal fluid (CSF), which develops inside the spinal cord after spinal trauma. The description of a case diagnosed as painless burn injury caused by PTS. One case report. Although there are a number of reports regarding the formation of neuropathic ulcers related to syringomyelia, painless burn injury descriptions are very rare. Despite available limited data related to this subject, it is important to warn patients about traumas-especially burns-after a diagnosis of PTS.

Objective: The aim of the study was to assess pain threshold and tolerance in diabetics with/without neuropathy and to compare that in with healthy controls. Methods: In this cross-sectional and comparative study, 79 diabetics (57 without neuropathy and 22 with neuropathy) and 32 healthy controls (63 women and 48 men) with a mean age of 48.11±7.52 years were studied. Seventy-nine diabetics, aged 33 to 74, who met inclusion criteria were evaluated using electrical stimulation (faradic current) to assess pain threshold and tolerance on upper and lower extremities and were compared with healthy controls. They also were evaluated using Michigan Neuropathy Screening Index (MNSI), 5.07 mmg Semmes Weinstein Monofilament, and visual analog scale (VAS). Pain threshold and tolerance were measured experimentally. Results: Of all participants, 32.4% had pain complain. Eighteen diabetics without neuropathy (31.6%) and 9 diabetics with neuropathy (40.9%) reported pain. The result of upper and lower extremities' pain threshold and tolerance showed that there was a significant difference between diabetics and healthy participants (P

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:21:10Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:39:50Z : No. of bitstreams: 1 2-s2.0-10644263663.pdf: 71880 bytes, checksum: 5818b4d38d74a593babc54b276f5c71c (MD5) Made available in DSpace on 2014-05-27T11:21:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-11-01 BACKGROUND AND OBJECTIVES: Before epídural steroids were used in chronic lumbar pain, subarachnoid injection of these agents was the treatment of choice. Although still preconized by some authors, this technique may lead to severe complications with neurological sequelae. This report aimed at describing a case of accidental subarachnoid injection of steroid associated to local anesthetics during epidural puncture to treat lumbar pain. CASE REPORT: Male patient, 46 years old, followed byneuro-surgery for presenting right sciatic pain for 9 month, refractory to clinical treatment due to L 4-L 5 disk protrusion confirmed by CT scan, without neurological deficit. Epidural puncture for pain treatment was performed in L 4-L 5 with 17G needle and 10 mL solution were injected containing 4 mL of 0.25% bupivacaine, 80 mg methylprednisolone and 4 mL of 0.9% saline. Although there has not been CSF reflux, 5 minutes after injection there were sensory block in T 4 and motor block in T 6, associated to blood pressure and heart rate decrease. CONCLUSIONS: Accidental subarachnoid injections with the association of steroids for pain relief may cause adverse effects. There are several risks, varying from mild transient symptoms to nervous injuries, including spinal cord injuries. Our patient had no sequelae from the accidental subarachnoid injection, probably because it has been a single injection. CET/SBA Depto. de Anestesiol. da FM - UNESP Ctro. Paulista de Cir. Plast. de Jau , Rua Jamil Sarkis, 135, Jardim Alvorada 17210-39O Jau, SP CET/SBA Depto. de Anestesiol. da FM - UNESP

This paper presents the results of the study undertaken on diabetic neuropathic subjects to find the relationship between the standing foot pressure parameter, power ratio (PR, ratio of high frequency power to the total power in the power spectrum of standing foot pressure image distribution obtained by optical pedobarograph), the foot sole hardness, and foot sole thicknesses at different levels of sensation loss. Spatial frequency distributions in the standing foot pressure images are analyzed to calculate the PR in each foot sole area for different levels of foot sole sensation loss and mechanical properties of foot sole hardness and thicknesses. The results show that the increase in PR in the upper foot sole hardness or Shore levels (30-40) is 1.4-3.7 times the corresponding increase in lower Shore levels (20-30), implying a higher possibility of development of plantar ulcers when the plantar surface becomes hard, combined with increase in sensation loss. It is observed that plantar ulcers are found to develop (i) for foot sole hardness or Shore values of 30 at sensation level of 4.5 gm and (ii) for Shore values of 40 and above at sensation levels of 10 and >10 gm, PR being high (29, 48 and 58, respectively) and the foot sole thicknesses are also greater than the corresponding normal values. Thus, different degrees of increase of all the three factors, namely, hardness, thickness and foot pressure distribution parameters in different levels of loss of foot sole sensation (or degrees of neuropathy) contribute to formation of foot sole ulcers in diabetic subjects. ? 2003 Elsevier SAS. All rights reserved.

The infiltration of the leptomeninges by malignant cells is not an uncommon complication of cancer and is called carcinomatous meningitis or leptomeningeal carcinomatosis (LC). Carcinomatous meningitis arises from either solid tumours or haematological malignancies. In general, LC represents a devastating metastatic complication of systemic malignant disease with a dismal prognosis and increased mortality. The diagnosis is made by both lumbar puncture and radiological investigation, mainly magnetic resonance imaging (MRI). The most common associated malignancies are breast and lung cancer, melanoma, lymphomas and leukaemias [1, 2]. The therapeutic management of LC includes intrathecal administration of chemotherapy and radiotherapy. The treatment of LC remains controversial and no straighforward guidelines exist in the literature. The present article reviews the incidence, pathogenesis, clinical presentation, diagnosis and treatment of LC in all malignancies.

Aim: In this study we determined the protective role of amifostine against the side effects of the combination of paclitaxel and carboplatin in patients with non-small cell lung cancer (NSCLC). Patients and Methods: Chemo-naive patients with NSCLC were eligible. Thirty-eight patients were randomized to receive paclitaxel 175 mg/m2 and carboplatin AUC=6 with amifostine 910 mg/m2 (group B) or chemotherapy alone (group A). The occurrences of hematologic, neurologic, cardiologic toxicities, and ototoxicity were evaluated. Results: All patients completed the six scheduled cycles of therapy. A total of 114 cycles of chemotherapy was given in both groups. Neutropenia grade 3–4 was observed in 11 cycles (9.6%) in group A and 19 cycles (16.6%) in group B (p=0.16). Paresthesia grade 1 or 2 was observed in 18 of 19 patients of group A and in 8 of 19 patients of group B, following the sixth cycle of chemotherapy (p=0.018). Two patients of group B and nine patients of group A suffered from sensory motor impairment grade 2 (p=0.029). There was no clinical evidence in any patient for deterioration in cardiac function. Asymptomatic and transient sinus bradycardia or ventricular premature beats developed in four patients. None of the patients reported vertigo, tinnitus, or hearing loss. Conclusion: The addition of the amifostine to the combination of paclitaxel and carboplatin may prevent or reduce the incidence of neurotoxicity in the treatment of NSCLC. Amifostine does not appear to have a preventive role in neutropenia.

Gut homeostasis results from complex neuro-immune interactions aimed at triggering stereotypical and specific programs of coordinated mucosal secretion and powerful motor propulsion. A prominent role in the regulation of this highly integrated network, comprising a variety of immune/inflammatory cells and the enteric nervous system, is played by purinergic mediators. The cells of the digestive tract are literally plunged into a "biological sea" of functionally active nucleotides and nucleosides, which carry out the critical task of driving regulatory interventions on cellular functions through the activation of P1 and P2 receptors. Intensive research efforts are being made to achieve an integrated view of the purinergic system, since it is emerging that the various components of purinergic pathways (i.e., enzymes, transporters, mediators and receptors) are mutually linked entities, deputed to finely modulating the magnitude and the duration of purinergic signaling, and that alterations occurring in this balanced network could be intimately involved in the pathophysiology of several gut disorders. This review article intends to provide a critical appraisal of current knowledge on the purinergic system role in the regulation of gastrointestinal functions, considering these pathways as a whole integrated network, which is capable of finely controlling the levels of bioactive nucleotides and nucleosides in the biophase of their respective receptors. Special attention is paid to the mechanisms through which alterations in the various compartments of the purinergic system could contribute to the pathophysiology of gut disorders, and to the possibility of counteracting such dysfunctions by means of pharmacological interventions on purinergic molecular targets. © 2013 Elsevier Inc.

Accumulating evidence over the past decade indicates that synthetic retinoids may be capable of affecting both growth and differentiation of nervous tissue. Our aim was to substantiate possible side-effects of oral isotretinoin therapy on peripheral nerve functions, both neurologically and neurophysiologically. We performed neurological examination and electroneuromyographic studies on 18 patients with various skin diseases before, at the third month, and at the end of isotretinoin treatment. Abnormal neurophysiological findings in this study point towards a typical distal, length-dependent and predominantly sensory polyneuropathy. Clinicians should be aware of possible neurological sensorial symptoms during isotretinoin therapy. In our opinion, electroneuromyographic investigation should be performed on all patients reporting symptoms (e.g. paresthesia, numbness, sensory loss) before and during oral isotretinoin treatment. The precise clinical significance of the isotretinoin-induced neurophysiological alterations reported here remains to be determined in further studies.