Outcomes in Patients Treated with Post-mastectomy Chest Wall Radiotherapy without the Routine Use of Bolus.

AIMS: The use of bolus in post-mastectomy radiotherapy (PMRT) varies significantly between institutions. We report on chest wall recurrence and acute toxicity rates for PMRT patients treated with selective use of bolus. MATERIALS AND METHODS: We analysed PMRT patients who received adjuvant chest wall radiotherapy for invasive breast cancer between 2004 and 2009. Patient, tumour and cancer outcomes were collected from a prospective database, with additional radiotherapy and acute toxicity details supplemented retrospectively. Chest wall bolus was reserved for patients considered at high risk of local recurrence. RESULTS: There were 314 patients suitable for analysis: 52 received bolus, 262 did not. The mean age was 53.2 years. The median follow-up was 4.2 years. The most common T stage was T2 (37%), followed by T3/T4 (33%). There were 229 patients (73%) who had N+ disease; 213 (68%) patients had grade 3 cancer. Oestrogen receptor was positive in 176 (56%) cases, progesterone receptor was positive in 134 (43%) and HER2 receptor was positive in 24 (8%). Lymphovascular space invasion was present in 146 patients (46%), dermal invasion in 30 patients (10%) and positive margin in 14 patients (4%). The 4 year chest wall recurrence rate was 14% (95% confidence interval 5.4-26.8%) in the bolus group and only 3.5% (95% confidence interval 1.6-6.4%) in the non-bolus group. On univariate analysis, use of bolus was associated with a significant difference in chest wall recurrence (hazard ratio 3.09; 1.15-8.33; P = 0.025). However, when taking into account margin status, this significance was lost (hazard ratio = 2.45; 95% confidence interval 0.80-7.50, P = 0.12). There was a higher rate of acute grade 2 skin toxicity in patients receiving bolus compared with those without, 40% versus 21% (P = 0.01). CONCLUSIONS: The selective use of bolus resulted in a small risk of chest wall recurrence rates for low-risk patients. This suggests that the routine use of bolus in PMRT patients may be unnecessary.

Prognostic Significance of Human Papilloma Virus and p16 Expression in Patients with Vulvar Squamous Cell Carcinoma who Received Radiotherapy.

AIMS: Human papilloma virus (HPV) has been identified as an aetiological agent in a subset of patients with vulvar squamous cell carcinoma (VSCC). The prognostic role of HPV status in VSCC patients treated with radiotherapy has not yet been determined. We investigated the associations between HPV, p16 and clinical outcome in these women. MATERIALS AND METHODS: Patients undergoing potentially curative radiation treatment for VSCC at a single institution from 2000 to 2009 were retrospectively identified. Those who received definitive or peri-operative radiotherapy as part of treatment, and who had available pathological specimens, were included for analysis. HPV infection was detected using Roche Linear array hybridisation and p16 by immunohistochemistry. The locoregional relapse (LRR) rate was estimated using a cumulative incidence function to account for competing risks. Disease-free survival (DFS) and overall survival were analysed using the Kaplan-Meier method. The median follow-up was 4.9 years. RESULTS: Forty patients were suitable for analysis, with a median age of 69.5 years. HPV was detected in 14/40 (35%) patients, HPV16 being the most common serotype (79%). Patients with HPV-positive tumours had lower 5 year LRR compared with those with HPV-negative tumours (14.3% versus 79.3%, Gray test P = 0.003). Tumour p16 positivity was also associated with lower 5 year LRR (15.4% versus 81.2%, Gray test P = 0.002). Patients with p16-positive tumours had higher 5 year DFS compared with those with p16-negative tumours (62% versus 7%, Log-rank test P = 0.02). CONCLUSIONS: We have identified a favourable prognostic group in VSCC, with p16-positive patients showing improved outcomes. p16 has the potential to be a predictive marker allowing the identification of women more likely to have a favourable response to radiotherapy.

The role of elective para-aortic lymph node irradiation in patients with locally advanced cervical cancer.

AIMS: Pelvic lymph node positivity in cervical cancer is known to be an adverse prognostic factor and is associated with an elevated risk of clinically occult para-aortic lymph node metastases. The purpose of this study was to examine the benefit of elective para-aortic lymph node radiotherapy (PART) in patients with no clinical or radiographic evidence of para-aortic lymph node metastases receiving concurrent cisplatin chemotherapy. MATERIALS AND METHODS: Patients treated with radiotherapy and concurrent cisplatin for cervical cancer from 1999 to 2009 were identified in two prospective databases. All patients received external beam pelvic radiotherapy (PRT) to a median dose of 50 Gy concurrently with weekly cisplatin 40 mg/m(2). This was followed by pulse dose rate intracavitary brachytherapy to a median dose of 40 Gy. Patients at high risk of occult para-aortic metastases also received PART to a median dose of 40 Gy. RESULTS: There were 228 patients suitable for analysis; the median follow-up was 4.6 years. The addition of PART to PRT was not associated with a significant difference in disease-free survival (hazard ratio 1.1, confidence interval 0.7-1.8, P = 0.75) or overall survival (hazard ratio 1.6, confidence interval 0.9-2.7, P = 0.11) on multivariate analysis. There was no significant difference in the rate of para-aortic relapse with PART versus PRT (hazard ratio 2.01, confidence interval 0.79-5.12, P = 0.14). The 3 year grade 3-4 late toxicities were 11% for the PART group versus 8% for PRT (hazard ratio 1.39, confidence interval 0.58-3.37, P = 0.47). CONCLUSIONS: These results suggest that cervical cancer patients treated with radiotherapy and concurrent cisplatin do not benefit from elective PART.

Ictericia secundaria a cistoadenoma seroso pancreático gigante / Jaundice secondary to giant pancreatic serous cystoadenoma

El cistoadenoma seroso es el segundo tumor quísticomás frecuente del páncreas y representa el 1-2% detodas las neoplasias exocrinas pancreáticas. Recientemente,gracias a las mejoras en las técnicas de imagen,la identificación de las lesiones quísticas pancreáticases cada vez más frecuente. El diagnóstico diferencial hade hacerse con el cistoadenoma mucinoso, debido alpotencial maligno de esta última entidad. En esta notaclínica describimos el caso de una paciente con ictericiaindolora y colestasis, con diagnóstico final de cistoadenomaseroso pancreático (AU)

Serous cystadenoma is the second most frequentpancreatic cystic neoplasm and accounts for 1-2% ofexocrine neoplasms of the pancreas. Recently, theyhave been identified more frequently, due to the improvementin imaging techniques. Differential diagnosisshould be performed with mucinous cystoadenoma,due to the latter´s potential for malignant transformation.We present the case of a female patient whounderwent examination for painless jaundice and cholestasis,with a final diagnosis of pancreatic serous cystoadenoma (AU)

Mujer con hipotensión y fallo renal agudo / No disponible

No disponible

Genetic analysis of Na(+) and K (+) concentrations in leaf and stem as physiological components of salt tolerance in Tomato.

The sodium and potassium concentrations in leaf and stem have been genetically studied as physiological components of the vegetative and reproductive development in two populations of F(8) lines, derived from a salt sensitive genotype of Solanum lycopersicum cv. Cerasiforme, as female parent, and two salt tolerant lines, as male parents, from S. pimpinellifolium, the P population (142 lines), and S. cheesmaniae, the C population (116 lines). Genetic parameters of ten traits under salinity and five of them under control conditions were studied by ANOVA, correlation, principal component and QTL analysis to understand the global response of the plant. Two linkage maps including some tomato flowering time and salt tolerance candidate genes encoding for SlSOS1, SlSOS2, SlSOS3, LeNHX1, LeNHX3, were used for the QTL detection. Thirteen and 20 QTLs were detected under salinity in the P and C populations, respectively, and four under control conditions. Highly significant and contributing QTLs (over 40%) for the concentrations of Na(+) and K(+) in stems and leaves have been detected on chromosome 7 in both the populations. This is the only genomic position where the concentration QTLs for both the cations locate together. The proportion of QTLs significantly affected by salinity was larger in the P population (64.3%, including all QTLs detected under control) than in the C population (21.4%), where the estimated genetic component of variance was larger for most traits. A highly significant association between the leaf area and fruit yield under salinity was found only in the C population, which is supported by the location of QTLs for these traits in a common region of chromososome C1. As far as breeding for salt tolerance is concerned, only two sodium QTLs (lnc1.1 and lnc8.1) map in genomic regions of C1 and C8 where fruit yield QTLs are also located but in both the cases the profitable allele corresponds to the salt sensitive, cultivated species. One of those QTLs, lnc1.1 might involve LeNHX3.

Increasing salt tolerance in the tomato.

In this paper, a number of strategies to overcome the deleterious effects of salinity on plants will be reviewed; these strategies include using molecular markers and genetic transformation as tools to develop salinity-tolerant genotypes, and some cultural techniques. For more than 12 years, QTL analysis has been attempted in order to understand the genetics of salt tolerance and to deal with component traits in breeding programmes. Despite innovations like better marker systems and improved genetic mapping strategies, the success of marker-assisted selection has been very limited because, in part, of inadequate experimental design. Since salinity is variable in time and space, experimental design must allow the study of genotype x environment interaction. Genetic transformation could become a powerful tool in plant breeding, but the growing knowledge from plant physiology must be integrated with molecular breeding techniques. It has been shown that the expression of several transgenes promotes a higher level of salt tolerance in some species. Despite this promising result, the development of a salt-tolerant cultivar by way of transgenesis has still not been achieved. Future directions in order to overcome the present limitations are proposed. Three cultural techniques have proved useful in tomato to overcome, in part, the effects of salinity: treatment of seedlings with drought or NaCl ameliorates the adaptation of adult plants to salinity; mist applied to tomato plants grown in Mediterranean conditions improves vegetative growth and yield in saline conditions; and grafting tomato cultivars onto appropriate rootstocks could reduce the effects of salinity.

Lidocaína endovenosa como coadyuvante en el tratamiento inicial de la neuralgia postherpética. Bases fisiopatológicas del uso de anestésicos locales en el tratamiento del dolor neuropático / Endovenous lidocaine as co-adjuvant in the initial treatment of post-herpetic neuralgia. Physiopathological basis of the use of local anesthetics for the treatment of neuropathic pain

Introducción:La neuralgia postherpética es el cuadro álgico que permanecetras desaparecer las vesículas del episodio agudodel herpes zóster, habiendo pasado un periodo mínimo detiempo de 8-12 semanas. Hasta un 50% de los pacientescon edad superior a 70 años, lo desarrollará tras el episodio agudo de herpes zóster. Sus bases fisiopatológicas nohan sido aclaradas, por lo que su prevención es difícil y sutratamiento sintomático.Material y métodos:Se estudiaron 100 pacientes incluidos de forma aleatoriaen uno de los grupos diseñados (n = 25): grupo A1, pacientesmenores de 70 años, tratados con gabapentina adosis crecientes; grupo A2, pacientes mayores de 70 años,tratados con gabapentina a dosis crecientes; grupo B1, pacientesmenores de 70 años tratados con gabapentina y lidocaínaendovenosa; grupo B2, pacientes mayores de 70años tratados con gabapentina y lidocaína endovenosa. Seevaluó el dolor referido por el paciente en cuatro momentosa lo largo de las cuatro primeras semanas.Resultados:Se observaron diferencias estadísticamente significativas,p < 0,05, en las medias de EVA referido por los pacientes,presentando una EVA menor los grupos tratadoscon lidocaína endovenosa y pacientes menores de 70 añosen ambos grupos.Conclusiones:El tratamiento de la neuralgia postherpética es un tratamientosintomático. Los anestésicos locales han sido utilizadoscon éxito en algunos tipos de dolor neuropático. Lalidocaína endovenosa puede ser útil como coadyuvante enel periodo inicial del tratamiento de la neuralgia posthetpética,al reducir significativamente la EVA referida por lospacientes. Los pacientes de edad avanzada respondieronpeor al uso de lidocaína, aunque presentaron medias deEVA inferiores a los pacientes a los que no se administró lidocaína

Introduction:Post-herpetic neuralgia is the algic condition that remainswhen the vesicles of an acute episode of herpeszoster have disappeared after a minimum period of 8-12weeks. Up to 50% of patients older than 70 years will developthis condition after an acute episode of herpes zoster.Its physiopathological basis is still unclear, so its preventionis difficult and its treatment is aimed to symptoms.Materials and methods:One hundred patients were randomized to one of thestudy groups (n = 25): group A1, patients 70 years of age treated with gabapentin and endovenouslidocaine; group B2, patients > 70 years of agetreated with gabapentin and endovenous lidocaine. Painreported by the patient was assessed at four time pointsduring the first four weeks.Results:Statistically significant differences were observed (p <0,05) in the mean VAS scores reported by the patients,with a lower VAS score within the groups treated with endovenouslidocaine and in patients < 70 years of age inboth groups.Conclusions:The treatment of post-herpetic neuralgia is aimed tosymptoms. Local anesthetics have been successfully usedfor some types of neuropathic pain. Endovenous lidocainecan be useful as co-adjuvant during the initial treatment ofpost-herpetic neuralgia, since it significantly reduces theVAS score reported by patients. Aged patients had a poorerresponse to the use of lidocaine, as well as lower meanVAS scores, compared to patients that did not received lidocaine

Comparative microsatellite linkage analysis and genetic structure of two populations of F6 lines derived from Lycopersicon pimpinellifolium and L. cheesmanii.

A population of recombinant inbred lines (RILs) has several advantages over its F2 population counterpart with respect to quantitative trait loci (QTLs) and genomic studies. The objective of the investigation reported here was the comparative characterization by simple sequence repeat (SSR) and sequence characterized amplified region (SCAR) markers of two populations of F6 lines derived from Lycopersicon pimpinellifolium (P population, consisting of 142 lines) and L. cheesmanii (C population, consisting of 115 lines) and sharing the female parent, L. esculentum var. cerasiforme. Almost the same percentage of polymorphic markers was found for each population although a different set of markers was involved. The proportion of SSR primer pairs (93 in total) that resulted in polymorphism for the main band was larger (55-56%) than for SCAR ones (13-16%). The C population showed the largest proportion of markers with zygotic and gametic segregation distortion, which is in agreement with the larger genetic distance reported between L. esculentum and L. cheesmanii than with the former and L. pimpinellifolium. Zygotic distortion corresponded primarily to an excess of heterozygotes in both populations, suggesting that the increment of homozygosity was the main factor limiting viability/self-fertility of the lines. Despite both populations sharing the female parent, P alleles were slightly favored in the P population while E alleles were the most frequently fixed in the C population. A linkage map for each population was obtained, with the average distances between consecutive markers being 3.8 cM or 3.4 cM depending on the population. Discrepancy between the maps for the location of only four markers on chromosomes 3, 6 and 10 was observed. Two possible causes of this discrepancy were investigated and can not be discarded: (1) the presence of duplicated markers and (2) segregation distortion caused by the selective advantage of gametes carrying one of the two alleles. This marker characterization of both populations will continue and will enable the comparative QTLs and candidate gene analysis of complex traits towards a more efficient utilization of genetic resources and breeding strategies.

Relationship between tomato fruit growth and fruit osmotic potential under salinity.

To investigate the relationship between fruit growth and fruit osmotic potential (Psi(s)) in salty conditions, a sensitive tomato cultivar (Lycopersicon esculentum Mill.) and a tolerant accession of the wild species Lycopersicon pimpinellifolium Mill. were grown in a greenhouse with 0 and 70 mM NaCl, and the growth of the fruit studied from 15 to 70 days after anthesis (DAA). L. pimpinellifolium did not reduce significantly fruit weight in salty conditions throughout the growth period, whereas L. esculentum fruit weights decreased significantly with salinity from 45 DAA. L. esculentum fruit fresh weight reductions resulted from both less dry matter and water accumulation, although the fruit water content was affected by salinity before the fruit weight. In both species, fruit osmotic potential (Psi(s)) decreased significantly with salinity during the rapid fruit growth phase, although the changes were different. Thus, fruits from L. pimpinellifolium salt treated plants showed a Psi(s) reduction at the beginning (15 DAA) twice as high as that found in L. esculentum. As the advanced growth stage (from 15 to 55 DAA), the Psi(s) reduction percentages induced by salinity were quite similar in L. pimpinellifolium fruits, while increased in L. esculentum. Under saline conditions, the solutes contributing to reduce the fruit Psi(s) during the first 55 DAA were the inorganic solutes in both species, while in the ripe fruits they were hexoses. L. esculentum fruits accumulated K(+) as the main osmoticum in salty conditions, while L. pimpinellifolium fruits were able to use not only K(+) but also the Na(+) provided by the salt.

Identification of two loci in tomato reveals distinct mechanisms for salt tolerance.

Salt stress is one of the most serious environmental factors limiting the productivity of crop plants. To understand the molecular basis for salt responses, we used mutagenesis to identify plant genes required for salt tolerance in tomato. As a result, three tomato salt-hypersensitive (tss) mutants were isolated. These mutants defined two loci and were caused by single recessive nuclear mutations. The tss1 mutant is specifically hypersensitive to growth inhibition by Na(+) or Li(+) and is not hypersensitive to general osmotic stress. The tss2 mutant is hypersensitive to growth inhibition by Na(+) or Li(+) but, in contrast to tss1, is also hypersensitive to general osmotic stress. The TSS1 locus is necessary for K(+) nutrition because tss1 mutants are unable to grow on a culture medium containing low concentrations of K(+). Increased Ca(2)+ in the culture medium suppresses the growth defect of tss1 on low K(+). Measurements of membrane potential in apical root cells were made with an intracellular microelectrode to assess the permeability of the membrane to K(+) and Na(+). K(+)-dependent membrane potential measurements indicate impaired K(+) uptake in tss1 but not tss2, whereas no differences in Na(+) uptake were found. The TSS2 locus may be a negative regulator of abscisic acid signaling, because tss2 is hypersensitive to growth inhibition by abscisic acid. Our results demonstrate that the TSS1 locus is essential for K(+) nutrition and NaCl tolerance in tomato. Significantly, the isolation of the tss2 mutant demonstrates that abscisic acid signaling is also important for salt and osmotic tolerance in glycophytic plants.

Tomato plant-water uptake and plant-water relationships under saline growth conditions.

Growth and water uptake both decreases when tomato plants are irrigated with saline water. To determine the relative contribution of physiological traits to these decreases plant fresh and dry weight, leaf area, leaf water (Psi(w)) and osmotic (Psi(Pi)) potentials, gas exchange parameters, stomatal density, leaf chlorophyll and Na content were investigated in the tomato (Lycopersicon esculentum) cultivars, Daniela and Moneymaker. Plants were grown in greenhouse, in sand culture, and irrigated with a complete nutrient solution supplied with 0 (control), 35 and 70 mM NaCl over a period of 2 months. Salinity reduced plant dry weight, height and number of leaves even at 35 mM NaCl. Leaf Psi(w) and Psi(Pi) decreased with salinity but leaf turgor pressures were significantly higher in salinised than in control plants which suggests that bulk tissue turgor did not limit growth under the saline conditions tested. Increasing salinity in the irrigation solution led to both morphological changes [(reduction of plant leaf area and stomatal density) and physiological changes [reduction of stomatal conductance, transpiration, and net CO(2) assimilation (A(CO(2)))] Plant water uptake, measured as the difference between volume of nutrient solution supplied and drainage collected, was closely related to transpiration, stomatal conductance, and stomatal density. Chlorophyll content per unit of leaf area increased with salinity. Reduction of net A(CO(2)) with salinity was explained in higher degree by stomatal conductance and stomatal density than by Na accumulation in the leaves. Although plant water uptake was similar for the two cultivars, Daniela transported, per unit of water uptake, more Na to the leaves than did Moneymaker. However, Daniela reduced leaf area less than did Moneymaker. Water use efficiency, calculated either as the ratio between total plant dry matter and total plant water uptake, or as the ratio between net A(CO(2)) and transpiration, did not change under our saline growth conditions. The contribution of the observed salt-responses to reduction in shoot water loss, plant water uptake and salt loading, while keeping water use efficiency, is discussed in relation to salt tolerance. Because some of these salt-responses take a long time to develop, growing seedlings in seedbeds with saline media could be of interest to better tolerate further salty conditions in the field or greenhouse.

[Multiple sclerosis incidence in the Alcoi Health district. 12-year-long study (1986-1997)]. / Incidencia de la esclerosis múltiple en el área sanitaria de Alcoi. Estudio de 12 años (1986-1997).

INTRODUCTION: To date, epidemiological studies on multiple sclerosis in Spain have been basically prevalence studies, and the data on incidence recorded have been the result of different methodologies, with no definition of the criteria for inclusion. OBJECTIVE: To carry out a study of incidence with prospective collection/review of cases over a prolonged period of time. PATIENTS AND METHODS: Over 12 years, between 1 March 1986 and 31 December 1997, we collected data prospectively for patients with a definite diagnosis of multiple sclerosis. The year of incidence was considered to be when the patient fulfilled clinical criteria for diagnosis of the disease. RESULTS: On 31 December 1997 in the Alcoi Health District there were 54 patients with clinically defined multiple sclerosis (a prevalence of 41.28 cases per 100,000 inhabitants). Of these, 45 patients were diagnosed during the period studied, with an average incidence of 2.82 cases per 100,000 inhabitants per year. Only 15 patients were confirmed before 1986. CONCLUSIONS: This is the most prolonged study of the incidence of multiple sclerosis carried out in Spain. The figures found for incidence are in contrast to those found in previous years for prevalence and incidence. Analysis of the data suggests that the incidence of multiple sclerosis in the Alcoi district has changed and has increased since the second half of the 1980s.

[The prevalence of multiple sclerosis in the Alcoi Health district]. / Prevalencia de la esclerosis múltiple en el área sanitaria de Alcoi.

INTRODUCTION: The epidemiological studies done in Spain in recent years show higher figures for the prevalence of multiple sclerosis than before. Spain is therefore now in the area with a high risk of contracting the disease. OBJECTIVE: We have made a new study to confirm the current prevalence of the disorder in the Alcoi Health District. PATIENTS AND METHODS: Between 1 March 1986 and the prevalence day, 31 December 1997 we recorded the patients with definite or probable multiple sclerosis, as defined on Poser's criteria, after intensive fieldwork and reevaluation of all possible patients by a neurologist from the Neurology Unit. On the prevalence day there were 130,786 inhabitants in the district. RESULTS: On the prevalence day we found 54 patients with definite multiple sclerosis and no patient with probable multiple sclerosis. The rate of prevalence was 41.28 cases per 100,000 inhabitants (95% CI: 31-53.6). During the study we counted an incidence of 45 cases with an average rate of 2.82 cases per 100,000 inhabitants per year. We also describe the clinical characteristics of the patients. CONCLUSIONS: The rate of prevalence found is much higher than that described for the district in studies using similar methodology. This increase, together with the discrepancy between the incidence found and the prevalence, makes us consider that possibly the prevalence has increased in recent years.

Incidencia de la esclerosis múltiple en el área sanitaria de Alcoi. Estudio de 12 años (1986-1997) / The incidence of multiple sclerosis in the Alcoi health district. A 12 year study (1986-1997)

Introducción. Los estudios epidemiológicos sobre esclerosis múltiple en España han sido hasta la fecha estudios fundamentalmente de prevalencia, y los datos de incidencia descritos se han recogido con metodología dispar, sin precisar los criterios de inclusión.Objetivo. Realizar un estudio de incidencia con recogida prospectiva de los casos a lo largo de un período prolongado de tiempo. Pacientes y métodos. A lo largo de 12 años, desde el 1 de marzo de 1986 al 31 de diciembre de 1997, se han recogido de forma prospectiva aquellos enfermos con diagnóstico de esclerosis múltiple definida. Se ha considerado como año de incidencia aquel en el que los pacientes cumplían criterios clínicos de la enfermedad. Resultados. El 31 de diciembre de 1997 había en el área de Alcoi 54 pacientes con esclerosis múltiple clínicamente definida (prevalencia de 41,28 casos por 100.000 habitantes). De ellos, 45 pacientes fueron incidentes a lo largo del período del estudio, con una tasa media de incidencia de 2,82 casos por 100.000 habitantes y año. Únicamente 15 pacientes fueron incidentes con anterioridad a 1986. Conclusiones. Este estudio es el más prolongado de los realizados sobre la incidencia de la esclerosis múltiple en España. Las cifras de incidencia halladas contrastan con los datos de prevalencia y la incidencia de los años anteriores. El análisis de los datos sugiere que la incidencia de la esclerosis múltiple en el área de Alcoi ha variado, incrementándose desde la segunda mitad de los años 80 (AU)

Prevalencia de la esclerosis múltiple en el área sanitaria de Alcoi / The prevalence of multiple sclerosis in the Alcoi health district

Introducción. Los estudios epidemiológicos llevados a cabo los últimos años en España muestran cifras de prevalencia de la esclerosis múltiple superiores a las anteriormente descritas, y sitúan a nuestro país dentro de un área de riesgo elevado de padecer la enfermedad. Objetivo. Se ha realizado un nuevo estudio en el área sanitaria de Alcoi para comprobar la prevalencia actual de la enfermedad. Pacientes y métodos. Desde el 1 de marzo de 1986 hasta el día de prevalencia, el 31 de diciembre de 1997, se han recogido aquellos pacientes con diagnóstico de esclerosis múltiple definida o probable según los criterios de Poser, tras realizar un intensivo trabajo de campo y reevaluar a todos los posibles pacientes por un neurólogo de la Unidad de Neurología. El día de prevalencia el número de habitantes del área era 130.786. Resultados. El día de prevalencia se encontraron 54 pacientes con esclerosis múltiple definida y ningún paciente con esclerosis múltiple probable. La tasa de prevalencia fue de 41,28 casos por 100.000 habitantes (IC del 95 por ciento: 31-53,6). A lo largo del estudio se contabilizaron 45 casos incidentes con una tasa media de 2,82 casos por 100.000 habitantes y año. Se describen asimismo las características clínicas de los pacientes. Conclusiones. La tasa de prevalencia hallada es muy superior a la descrita previamente en la zona con estudios de similar metodología. Este incremento, junto a la discrepancia entre la incidencia encontrada y la prevalencia, hacen pensar en la posibilidad de un aumento de la prevalencia en los últimos años (AU)