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Fibromyalgia (FMS) is a debilitating disorder characterized by chronic diffuse muscle pain, fatigue, sleep disturbance, depression and skin sensitivity. There are no genetic or biochemical markers and patients often present with other comorbid diseases, such as migraines, interstitial cystitis and irritable bowel syndrome. Diagnosis includes the presence of 11/18 trigger points, but many patients with early symptoms might not fit this definition. Pathogenesis is still unknown, but there has been evidence of increased corticotropin-releasing hormone (CRH) and substance P (SP) in the CSF of FMS patients, as well as increased SP, IL-6 and IL-8 in their serum. Increased numbers of activated mast cells were also noted in skin biopsies. The hypothesis is put forward that FMS is a neuro-immunoendocrine disorder where increased release of CRH and SP from neurons in specific muscle sites triggers local mast cells to release proinflammatory and neurosensitizing molecules. There is no curative treatment although low doses of tricyclic antidepressants and the serotonin-3 receptor antagonist tropisetron, are helpful. Recent nutraceutical formulations containing the natural anti-inflammatory and mast cell inhibitory flavonoid quercetin hold promise since they can be used together with other treatment modalities.

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PURPOSE: To asses effectivity of postoperative reinfusion of shed mediastinal blood in reduction of homologous transfusions at cardiac surgery and to study the possibility of side effects. METHODS: Fifteen patients submitted to cardiac surgery that had their shed mediastinal blood reinfused after surgery were compared to another group of 15 patients. The two groups were compared in relation to: volume of shed blood, number of units of blood used in postoperative period, culture of shed blood, postoperative complications, number of days of hospitalization, hematocrit at the end of hospitalization and mortality. RESULTS: The use of whole blood and packed blood cells decreased from 25 to 10 units with reinfusion of shed mediastinal blood (p < 0.01). Volume of shed blood, postoperative complications, period of hospitalization, hematocrit at the end of hospitalization and mortality were not different in both groups. Culture of shed blood, in 8 patients of control group and all patients of study group were negative. CONCLUSION: Reinfusion of shed mediastinal blood in postoperative of cardiac surgery proved to be very efficient in decreasing homologous blood transfusions. This procedure is also safe, with no additional risk to patients.

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The ascending projections from the principal sensory nucleus V (PrV) have been studied by tracing degeneration after lesions in the PrV and by injections of HRP into the projection zone of PrV. The quintofrontal tract arises from PrV, ascends into the forebrain, and terminates in the ipsilateral and the contralateral nucleus basalis (NB). The contralateral fibers decussate in the tegmentum at the level of the trochlear-oculomotor nuclei. NB is a laminar nucleus lying over the rostral part of the paleostriatal complex. Dorsally NB is bounded by the neostriatum. NB consists of small neurons. In the dorsal part of NB, these neurons are arranged in vertical columns; the afferents ascend through these columns, and clusters of degenerated boutons are found around the cells. It is possible to distinguish regions in NB receiving ophthalmic, maxillary, mandibular, or glossopharyngeal afferents. The rostral part of NB receives an exclusive ipsilateral projection; the intermediate part, a bilateral projection; and the caudal part, a contralateral projection, with the exception of the most caudal area, which also receives a bilateral projection. It is not clear whether NB should be considered a thalamic, a telencephalic, or even a pallial structure. The hypothesis that the columnar organization of the NB is a prerequisite to preserve a precise somatotopy of the tactile system of the oral region is discussed. In this respect the organization of NB can be compared to that of layer IV of the somatosensory (SI) cortex of mammals. Knowledge of the structure and functions of the peripheral tactile sense system opens the possibility of subdividing the NB into functional units.

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