Localization and symbiotic status of probiotics in the coral holobiont.

Corals establish symbiotic relationships with microorganisms, especially endosymbiotic photosynthetic algae. Although other microbes have been commonly detected in coral tissues, their identity and beneficial functions for their host are unclear. Here, we confirm the beneficial outcomes of the inoculation of bacteria selected as probiotics and use fluorescence in situ hybridization (FISH) to define their localization in the coral Pocillopora damicornis. Our results show the first evidence of the inherent presence of Halomonas sp. and Cobetia sp. in native coral tissues, even before their inoculation. Furthermore, the relative enrichment of these coral tissue-associated bacteria through their inoculation in corals correlates with health improvements, such as increases in photosynthetic potential, and productivity. Our study suggests the symbiotic status of Halomonas sp. and Cobetia sp. in corals by indicating their localization within coral gastrodermis and epidermis and correlating their increased relative abundance through active inoculation with beneficial outcomes for the holobiont. This knowledge is crucial to facilitate the screening and application of probiotics that may not be transient members of the coral microbiome. IMPORTANCE: Despite the promising results indicating the beneficial outcomes associated with the application of probiotics in corals and some scarce knowledge regarding the identity of bacterial cells found within the coral tissue, the correlation between these two aspects is still missing. This gap limits our understanding of the actual diversity of coral-associated bacteria and whether these symbionts are beneficial. Some researchers, for example, have been suggesting that probiotic screening should only focus on the very few known tissue-associated bacteria, such as Endozoicomonas sp., assuming that the currently tested probiotics are not tissue-associated. Here, we provide specific FISH probes for Halomonas sp. and Cobetia sp., expand our knowledge of the identity of coral-associated bacteria and confirm the probiotic status of the tested probiotics. The presence of these beneficial microorganisms for corals (BMCs) inside host tissues and gastric cavities also supports the notion that direct interactions with the host may underpin their probiotic role. This is a new breakthrough; these results argue against the possibility that the positive effects of BMCs are due to factors that are not related to a direct symbiotic interaction, for example, that the host simply feeds on inoculated bacteria or that the bacteria change the water quality.

Lense-Thirring frame dragging induced by a fast-rotating white dwarf in a binary pulsar system.

Radio pulsars in short-period eccentric binary orbits can be used to study both gravitational dynamics and binary evolution. The binary system containing PSR J1141-6545 includes a massive white dwarf (WD) companion that formed before the gravitationally bound young radio pulsar. We observed a temporal evolution of the orbital inclination of this pulsar that we infer is caused by a combination of a Newtonian quadrupole moment and Lense-Thirring (LT) precession of the orbit resulting from rapid rotation of the WD. LT precession, an effect of relativistic frame dragging, is a prediction of general relativity. This detection is consistent with an evolutionary scenario in which the WD accreted matter from the pulsar progenitor, spinning up the WD to a period of <200 seconds.

PERFIL DE ESTEROIDES SEXUALES DEL CAPITÁN DE LA SABANA (Eremophilus mutisii) DURANTE UN CICLO HIDROLÓGICO COMPLETO

Fueron capturados, mensualmente, adultos de Eremophilus mutisii, en la parte alta del río Bogotá (Municipio de Suesca). Los ejemplares fueron anestesiados, pesados y medidos. Posteriormente, se tomaron muestras de sangre, se extrajeron y se pesaron las gónadas, para cálculo del índice gonadosomático (IGS). Se determinaron testosterona (T) y estradiol (E2), por quimioluminiscencia. La proporción de hembras fue mayor que la de machos, existiendo muestreos en los que solo se obtuvieron hembras. Los niveles de T en hembras permanecieron muy bajos durante todo el ciclo, manteniéndose así o indetectables, con un único pico en octubre. En machos, los niveles fueron superiores, alcanzando valores mayores en abril, septiembre, noviembre y diciembre, con pico en noviembre. El E2 en hembras mostró niveles variables, observándose niveles elevados durante noviembre, diciembre y enero, con pico en diciembre. En machos, solo fue posible determinar E2 en noviembre, diciembre, marzo, abril y mayo, puesto que durante febrero, junio, agosto y septiembre, los valores fueron indetectabes y en los meses restantes, no se capturó ningún macho. El valor máximo fue en noviembre y el mínimo en marzo y abril. En hembras, los picos de E2 coincidieron con los valores más altos de IGS, mientras que la T mantuvo su valor bajo, independientemente de dicho índice. En machos, la relación entre T e IGS también fue coincidente, aunque no de manera tan evidente como en hembras. No se observó una tendencia clara entre la relación de E2 e IGS para machos.

Specimens of Eremophilus mutisii were captured monthly on the upper part of the Bogotá River (municipality of Suesca). The specimens were anesthetized, weighed and measured. Subsequently, a blood sample was taken. The gonads were extracted and weighed to calculate the gonadosomatic index (GSI). Testosterone (T) and estradiol (E2) were determined by chemiluminescence technique. The proportion of females was always greater than that of males, and there were months in which only females were obtained. The T values of the females remained very low during the whole cycle, remaining low or imperceptible levels, with a single peak in October. In males, levels were always higher reaching high values in April, September, November, and December, with a peak in November. E2 in females showed variables values with high levels in November, December and January with a peak in December. In males, it was only possible to determine E2 in November, December, March, April and May, since, during February, June, August, and September the values were imperceptible and in the remaining months no male was captured. The maximum value was obtained in November and the minimum in March and April. In females, the peaks of E2 coincided with the higher values of GSI, while T maintained its low value, independently of this index. In males, the relationship between T and GSI was also coincident, although not as evident as in females. Also, a clear trend was not observed between the E2 and GIS ratio for males.

Mujer de 42 años con pancitopenia / A 42 year-old woman with pancytopenia

No disponible

Limits on Anisotropy in the Nanohertz Stochastic Gravitational Wave Background.

The paucity of observed supermassive black hole binaries (SMBHBs) may imply that the gravitational wave background (GWB) from this population is anisotropic, rendering existing analyses suboptimal. We present the first constraints on the angular distribution of a nanohertz stochastic GWB from circular, inspiral-driven SMBHBs using the 2015 European Pulsar Timing Array data. Our analysis of the GWB in the ~2-90 nHz band shows consistency with isotropy, with the strain amplitude in l>0 spherical harmonic multipoles ≲40% of the monopole value. We expect that these more general techniques will become standard tools to probe the angular distribution of source populations.

Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case-control EpiGEICAM study.

BACKGROUND: Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED). METHODS: We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between 'a priori' and 'a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2-; HER2+; and ER-/PR- and HER2-) was evaluated using logistic and multinomial regression models. RESULTS: Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06-2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14-2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40-0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15-0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between 'a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51-0.94 and aMED=0.74; 95% CI 0.46-1.18)). CONCLUSIONS: Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.

Evolución de la Unidad de Hemano-Oncología y Trasplante Hematopoyético del Hospital Infantil La Paz / Evolution of the Hematology-Oncology and hematopoietic Transplant Unit of the Hospital Infantil la Paz

La Unidad de Hemato-Oncología Pediátrica del Hospital La Paz, fundada en 1965 coincidiendo con la creación del Hospital Infantil, es un centro de referencia a nivel nacional para el diagnóstico y tratamiento de las neoplasias infantiles, así como para la realización de todas las modalidades de Trasplante de Progenitores Hematopoyéticos. Socia fundadora de la Sociedad Internacional de Oncología Pediátrica, así como de las Sociedades Españolas de Hematología y Oncología Pediátricas (SEOP/SEHP, actualmente SEHOP), en las últimas 4 décadas ha formado parte del espectacular avance en calidad de vida y supervivencia del cáncer infantil, alcanzando en la actualidad supervivencias cercanas al 80%. Una parte importante de este éxito ha sido la estrecha colaboración con las demás Unidades y Servicios Médico Quirúrgicos del Hospital Infantil. En la actualidad, la Unidad muestra una actividad creciente tanto del tratamiento oncológico como del trasplante, y sus miembro forman parte activa de las principales sociedades hemato-oncológias pediátricas a nivel nacional e internacional (AU)

The Pediatric Hematology-Oncology Division of La Paz Hospital, founded in 1965 with the whole Children´s Hospital, is a national reference center for diagnosis and treatment of all pediatric malignancies, and for all modalities of Hematopoietic Stem Cell Transplantation. Founding partner of the SIOP (Sociedad Internacional de Oncología Pediátrica) and the Spanish Societies of Hematology and Oncology (formerly SEOP/SEHP), and now SEHOP), it has been part of the spectacular improvement in quality of life and survival of childhood caner in the last four decades reaching today almost 80% survival. An important part of this success is cooperation with other medical and surgical Divisions of the Children´s Hospital. Today, our Division has an increasing activity in both oncologic treatment and transplant and our members are active part of the main national and international pediatric hematologic-oncologic societies (AU)

Aspectos preliminares del manejo reproductivo en cautiverio de la doncella (Ageneiosus pardalis Lütken, 1874) / Preliminary aspects of the reproductive handling in captivity of doncella (Ageneiosus pardalis Lütken, 1874)

Objetivo. Evaluar procedimientos de manejo en cautiverio de ejemplares maduros de doncella Ageneiosus pardalis, con fines de reproducción y presentar una descripción preliminar del desarrollo embrionario y larvario para la especie. Materiales y métodos. Sobre ejemplares mantenidos en cautiverio se adelantaron dos ensayos de reproducción, así: a) inducción con extracto de hipófisis de carpa EHC para la espermiación (4 mg/kg; una dosis intraperitoneal) y para la ovulación (0.5 y 5 mg/kg; intraperitoneales, 0 y 12 horas); b) inducción únicamente sobre hembras mantenidas en piletas, sin machos presentes, recolección y seguimiento de ovas. Resultados. Se comprobó la ovulación y la espermiación, pero no se avanzó en el desarrollo embrionario cuando se mezclaron los gametos y fueron incubados. Los ensayos con hembras inducidas, sin machos presentes, confirman el almacenamiento de esperma en los ovarios y los huevos obtenidos mostraron desarrollo embrionario completo, lográndose eclosión de larvas y el mantenimiento de alevinos. Conclusiones. El protocolo convencional de inducción fue efectivo en hembras y machos, pero la mezcla de los gametos no resultó ser un procedimiento viable para la producción de semilla en la especie. Se comprueba el almacenamiento de esperma en las hembras y la emisión espontánea de huevos fertilizados al medio cuando estas son sometidas a inducción. Tanto la forma y el tiempo de almacenamiento de esperma como los mecanismos fisiológicos que ocurren en la fecundación se desconocen.

Objective. To evaluate handling procedures in captivity of mature specimens, with reproduction purposes, of doncella Ageneiosus pardalis, and to present the first advance in the description of embryonic and larval development for the species. Materials and methods. Several reproduction tests were carried out in specimens maintained in captivity, as follows: a) Spermiation and ovulation were induced with Carp pituitary extract CPE (4 mg/kg; an intraperitoneal dose for spermiation) and (0.5 and 5 mg/kg; intraperitoneal for ovulation, 0 and 12 hours); b) only females maintained in tanks, without males present, were induced. Eggs obtained from tanks were recollected and observed. Results. Ovulation and spermiation were verified, but embryonic development was not advanced when gametes were mixed and incubated. Testing with induced females, without males present, confirms sperm storage in ovaries, and eggs show a complete embryonic development, achieving hatching of larvae and maintenance of young fish. Conclusions. The conventional protocol using induction was effective in females and males, but the mixed products did not prove to be a viable procedure for seed production in the species. Sperm storage in females and spontaneous emission of fertilized eggs in their habitat, when they were subjected to induction, was confirmed. Form and sperm as well as physiological mechanisms occurring in fertilization are unknown.

Fibrosis quística en imágenes. Clasificación de Bhalla para la tomografía computarizada en pacientes pediátricos / Cystic fibrosis in images: the Bhalla scoring system for computed tomography in paediatric patients

Para el seguimiento de la evolución del daño pulmonar en los pacientes con fibrosis quística (FQ) se han desarrollado distintos sistemas de clasificación o puntuación mediante la radiografía de tórax y la tomografía computarizada de alta resolución (TCAR). La TCAR es una técnica más sensible que la radiografía de tórax para evaluar la anatomía, sin embargo, en pacientes pediátricos el uso de la tomografía computarizada (TC) debe reducirse al mínimo necesario y utilizar sistemas de protección radiológica y reducción de dosis. Uno de los sistemas de clasificación mediante TCAR más empleados es el propuesto por Bhalla en 1991, que facilita la evaluación de la gravedad y la evolución de estos pacientes en función de los distintos hallazgos radiológicos. Presentamos diferentes ejemplos de estos criterios para la TCAR, observados al revisar los estudios de un grupo de 48 pacientes (AU)

To monitor the course of lung damage in patients with cystic fibrosis (CF) using the different chest X-ray and high resolution computed tomography (HRCT) scoring systems that have been developed. The HRCT technique is more sensitive than chest radiography to evaluate the anatomy. However, in paediatric patients, the use of CT should be kept to a minimum, and guidelines for radiation protection and dose reduction should be applied. One of the most used classification systems for HRCT is the one proposed by Bhalla in 1991, which helps in the assessment of the severity and course of the disease in these patients depending on the different imaging findings. We present various examples of these criteria for HRCT, observed while reviewing a group of 48 paediatric patients (AU)

[Cystic fibrosis in images: the Bhalla scoring system for computed tomography in paediatric patients]. / Fibrosis quística en imágenes. Clasificación de Bhalla para la tomografía computarizada en pacientes pediátricos.

To monitor the course of lung damage in patients with cystic fibrosis (CF) using the different chest X-ray and high resolution computed tomography (HRCT) scoring systems that have been developed. The HRCT technique is more sensitive than chest radiography to evaluate the anatomy. However, in paediatric patients, the use of CT should be kept to a minimum, and guidelines for radiation protection and dose reduction should be applied. One of the most used classification systems for HRCT is the one proposed by Bhalla in 1991, which helps in the assessment of the severity and course of the disease in these patients depending on the different imaging findings. We present various examples of these criteria for HRCT, observed while reviewing a group of 48 paediatric patients.

Asociación entre tejido graso abdominal y riesgo de morbilidad: efectos positivos del ejercicio físico en la reducción de esta tendencia / Positive effects of physical exercise on reducing the relationship between subcutaneous abdominal fat and morbility risk

Justificación: Las consecuencias derivadas de la acumulación de grasa abdominal por encima de niveles saludables infligen un considerable daño a nivel orgánico. Entre las consecuencias fisiológicas destacan las enfermedades cardiovasculares, hipertensión, diabetes tipo 2, obesidad y síndrome metabólico, que reducen drásticamente la calidad y esperanza de vida. Hay evidencias de que la mejora de la salud es proporcional al incremento de actividad física. No obstante, el ejercicio físico puede ocasionar daño oxidativo en órganos y tejidos musculares más acusado en personas con un elevado porcentaje graso abdominal. En este trabajo se determinan cuáles son las variables fundamentales del programa de ejercicio para optimizar sus beneficios y minimizar el estrés oxidativo. Objetivo principal: Conocer las variables determinantes de una acumulación de masa grasa abdominal por encima de los niveles saludables y el papel que juega el ejercicio en su prevención y mejora. Objetivos específicos: 1) Identificar las variables fundamentales de un programa de ejercicio enfocado a reducir la grasa abdominal; 2) Comprender la relación entre grasa abdominal, salud y ejercicio; 3) Revisar las últimas investigaciones en relación a la práctica de ejercicio físico y su efecto sobre el tejido adiposo abdominal. Metodología: Se llevará a cabo una búsqueda e identificación en artículos originales y de revisión publicados en revistas de impacto indexadas en las principales bases de datos. Discusión: El ejercicio físico habitual, fundamentalmente el de carácter aeróbico, produce una disminución en los depósitos de tejido adiposo corporal y abdominal en las personas obesas y con sobrepeso (AU)

Introduction: The consequences related to the accumulation of abdominal fat above healthy levels create a considerable organic damage. Among the physiological consequences we can highlight heart diseases, hypertension, type-2 diabetes, obesity and metabolic syndrome, which drastically reduce life expectancy and quality. Evidence shows that health improvement is correlated to greater levels of physical activity. However, physical exercise can create oxidative damage on organs and muscular tissue, more relevant in subjects with a high percentage of abdominal fat. This piece of work determines which are the fundamental variables of the exercise program in order to optimize its advantages while minimizing oxidative stress. Main purpose: To know the key variables in the accumulation of abdominal fat above healthy levels, and the role of exercise in prevention and improvement of such issue. Specific purposes: 1) to identify the key variables in an exercise program aimed at reducing abdominal fat; 2) to understand the relationship between abdominal fat, health and exercise; 3) to review the latest research related to physical exercise and its effect on abdominal adipose tissue. Methodology: A search and identification of original and reviewed articles will be carried out in indexed impact journals within the main databases. Discussion: Regular physical exercise, most notably aerobic one, reduces body adipose tissue deposits in general, and abdominal ones in particular, both in obese and overweight subjects (AU)

Carcinoma of the parotid gland: developing prognostic indices.

Prognosis for parotid carcinomas is not-well defined. The authors have developed models that could be useful to define subgroups of patients with differential risks. Clinical and pathological variables, and immunohistochemically studied MMP-7, MMP-9, MT1-MMP, and VEGF proteins were analysed in 42 patients with parotid gland cancer, regarding disease-specific survival and loco-regional recurrence. A prognostic index (PI) was calculated by combining age, disease stage, squamous cell carcinoma histology, and vascular endothelial growth factor immunoexpression. Based on the values of this PI, patients were classified into three groups: 1.89-4.18 (SPI1); 4.2-7 (SPI2), and >7 (SPI3). Corresponding 5-year survival rates for these groups of patients were of 89%, 47%, and 21%, respectively. Regarding loco-regional recurrence three different patient groups were calculated combining three factors: T, N and grade. Differences amongst them were statistically significant and the estimated hazard ratios were 6.4 and 24.2 for intermediate and poor prognosis, respectively, taking the good prognostic group as reference. The authors identified several significant prognostic factors and they propose two PIs for disease-specific survival and for loco-regional recurrence. They allow for the calculation of death risk and recurrence for a given patient, providing a practical system for clinical use.

[Positive effects of physical exercise on reducing the relationship between subcutaneous abdominal fat and morbility risk]. / Asociación entre tejido graso abdominal y riesgo de morbilidad: efectos positivos del ejercicio físico en la reducción de esta tendencia.

INTRODUCTION: The consequences related to the accumulation of abdominal fat above healthy levels create a considerable organic damage. Among the physiological consequences we can highlight heart diseases, hypertension, type-2 diabetes, obesity and metabolic syndrome, which drastically reduce life expectancy and quality. Evidence shows that health improvement is correlated to greater levels of physical activity. However, physical exercise can create oxidative damage on organs and muscular tissue, more relevant in subjects with a high percentage of abdominal fat. This piece of work determines which are the fundamental variables of the exercise program in order to optimize its advantages while minimizing oxidative stress. MAIN PURPOSE: To know the key variables in the accumulation of abdominal fat above healthy levels, and the role of exercise in prevention and improvement of such issue. SPECIFIC PURPOSES: 1) to identify the key variables in an exercise program aimed at reducing abdominal fat; 2) to understand the relationship between abdominal fat, health and exercise; 3) to review the latest research related to physical exercise and its effect on abdominal adipose tissue. METHODOLOGY: A search and identification of original and reviewed articles will be carried out in indexed impact journals within the main databases. DISCUSSION: Regular physical exercise, most notably aerobic one, reduces body adipose tissue deposits in general, and abdominal ones in particular, both in obese and overweight subjects.

Apparent diffusion coefficient mapping of the hippocampus and the amygdala in pharmaco-resistant temporal lobe epilepsy.

BACKGROUND AND PURPOSE: The purpose of this study is to determine whether interictal apparent diffusion coefficients (ADC) provide a robust means for detecting amygdalo-hippocampal abnormalities in adult patients with localization-related chronic temporal lobe epilepsy (TLE) undergoing presurgical evaluation. METHODS: Fifty-five patients and 20 age-matched controls were studied with hippocampal and amygdala ADC maps (HADC and AMYADC), volumes (HCVOL, AMYVOL), T2 relaxometry (HCT2, AMYT2), and hippocampal N-acetylaspartate to choline and creatine/phosphocreatine ratios (HCSI). Mean values and 99% confidence ellipses were computed for the groups. Individual ADC mapping was compared with electroencephalography (EEG) data and further correlated with the quantitative MR measures and with the age at onset and duration of TLE. Moreover, we evaluated the association and the predictive value of HADC and AMYADC with respect to the surgical outcome in a subgroup of patients (n = 21) operated on the side of maximal EEG lateralization and with MR imaging criteria for hippocampal sclerosis, 71% of which became seizure-free. RESULTS: In controls, there was no relation between ADC values and age, sex, or right-left asymmetries. In TLE groups with right (n = 29) or left epileptogenic foci (n = 26), group comparisons showed that ADC mapping detected changes ipsilateral to the focus in the hippocampus (P < .01) and the amygdala (P < .05), accordingly with the volumes, T2 maps, and HCSI. Significant Pearson correlations (2-tailed) were obtained between ADC maps and the volume of the hippocampus (r = -0.64) and of the amygdala (r = -0.55; both P < .01), T2 (r = 0.70, r = 0.29; both P < .01), but not with HCSI. Individual ADC analysis showed ipsilateral pathology in 82% of cases (hippocampus) and 35% (amygdala) and included a moderate association between ipsilateral HADC and AMYADC (r = 0.54; P < .01). Bilateral abnormalities were found in 7% (hippocampus) and 5% (amygdala) of cases. Except for HCSI and the amygdala data, there were significant correlations between the asymmetry indices and the duration of epilepsy (HADC: r = 0.42; HCT2: r = 0.50; HCVOL: r = 0.35; all P < .01). Age at onset was associated only with ipsilateral HADC (r = 0.35; P < .01) and HCVOL and HCT2 (both P < .05). The association with postsurgical successes was characteristic of HADC (Fisher exact test, 2-tailed: P =.031; Spearman correlation: r(s) = -0.75; P = .0002), but not AMYADC. The predictive value regarding a favorable outcome was 0.87 (odds ratio 26; 95% confidence interval 2.33-38.86). As determined by regression models, both larger ipsilateral HADCs and asymmetry indices predicted surgical success. CONCLUSION: Interictal ADC mapping lateralizes efficiently the lesion side in accordance with the EEG data and might be used to study the differential regional aspects of mesio-temporal sclerosis. HADC--not AMYADC--maps discriminate favorably postoperative outcome and can be added to the multidisciplinary evaluation workout of pharmacoresistant TLE patients.

[Malignant disease presenting as rheumatic manifestations]. / Manifestaciones reumáticas como forma de comienzo de enfermedad maligna.

BACKGROUND: Musculoskeletal pain is a frequent complaint in pediatrics in both tertiary and primary care. Although musculoskeletal symptoms are not usually related to severe disease, they can represent the first manifestation of an occult malignancy. OBJECTIVE: To describe the clinical manifestations and complementary findings of the patients referred to a pediatric rheumatology unit with a final diagnosis of malignancy. MATERIAL AND METHODS: We performed a retrospective review of all the children referred to a pediatric rheumatology unit between 1992 and 2002 whose final diagnosis was cancer. RESULTS: Of 3,982 patients referred, 10 had a final diagnosis of neoplasia (0.25 %). Six children were diagnosed with acute lymphoblastic leukemia, two with Langerhans' cell histiocytosis, one with Ewing's sarcoma, and one with metastases from retinoblastoma. The most frequent symptoms were arthralgias, limp, or back pain. Laboratory studies revealed anemia and a significant increase in sedimentation rate and lactate dehydrogenase values. Imaging studies contributed significantly to the diagnosis. The diagnosis was confirmed by bone marrow aspirate in children with leukemia and by bone biopsy in those with bone tumors. CONCLUSIONS: Malignancies should be considered in the differential diagnosis of children with musculoskeletal pain, especially in the presence of organomegalies or abnormal laboratory or imaging studies.

Manifestaciones reumáticas como forma de comienzo de enfermedad maligna / Malignant disease presenting as rheumatic manifestations

Antecedentes Los dolores musculoesqueléticos son un motivo frecuente de consulta tanto en Atención Primaria como en Reumatología Pediátrica. En la mayoría de las ocasiones se trata de síntomas inespecíficos sin relación con enfermedades graves, sin embargo pueden presentarse como síntoma inicial de un proceso neoplásico. Objetivo Describir las manifestaciones clínicas y analíticas de los pacientes vistos en una Unidad de Reumatología Pediátrica cuyo diagnóstico final fue neoplasia. Material y métodos Estudio retrospectivo de los pacientes remitidos a una Unidad de Reumatología Pediátrica durante los años 19922002, y cuyo diagnóstico final fue de malignidad. Resultados De 3.982 pacientes atendidos, 10 tuvieron una enfermedad tumoral (0,25 por ciento). Los diagnósticos finales fueron leucemia linfoblástica aguda en 6 casos, histiocitosis de células de Langerhans en dos, sarcoma de Ewing en uno y metástasis de retinoblastoma en otro. Los síntomas más frecuentes fueron artralgias, cojera y dolor en la columna. Entre las alteraciones analíticas destacaron el aumento de la velocidad de sedimentación globular, la anemia, y un incremento de los niveles de la enzima lactato deshidrogenasa. Las pruebas de imagen contribuyeron de forma significativa al diagnóstico. La confirmación del mismo se realizó mediante medulograma en las leucemias y por biopsia ósea en los tumores sólidos. Conclusiones Las neoplasias deben considerarse en el diagnóstico diferencial de los dolores osteoarticulares, sobre todo si van acompañados de visceromegalia, alteraciones analíticas o radiológicas (AU)

Multiple sclerosis and intrathecal IgA synthesis.

A clinically definite diagnosis of multiple sclerosis was done in a 61 year-old woman who displayed severe cerebellar and pyramidal tract involvement. Symptoms developed 5 years before with unsteadiness of gait and difficulties in walking. Diagnosis was supported by evoked potentials studies and magnetic resonance imaging. However, the cerebrospinal fluid (CSF) analysis was very unusual. CSF albumin and IgG concentrations were normal, as well as the IgG index. In contrast, the IgA level and the IgA index were markedly increased and the local synthesis of IgA was estimated at 31.36 mg/l. Reduction by dithiotreitol did not change the IgA level. On affinity immunoblots, oligoclonal IgA bands were not detected but oligoclonal IgG bands were present. The strong local production of IgA in this patient seems to be therefore polyclonal.

[Neuropathy in Waldenstrom's macroglobulinemia]. / A neuropatia na macroglobulinemia de Waldenström.

The association of a neuropathy and a paraproteinaemia such as Waldenström's macroglobulinaemia is frequent and not fortuitous. This paper reports a slowly progressive, predominantly sensory neuropathy, occurring in a 69-year-old man, as the first sign of a Waldenström's macroglobulinaemia. A saphenous [correction of sural] nerve biopsy revealed a mixed process of primary demyelination and axonal degeneration. Accumulations of immunoglobulin M were observed in the myelin sheets and the perineurium by immunocytochemistry. Infiltrations of inflammatory blood cells and accumulations of amyloid material were absent in the peripheral nerve. The axonal loss was most prominent in central areas of the nerve fascicles. This find supports the hypothesis of an ischemic mechanism for the axonal degeneration plus secondary demyelination, associated to a direct immunological attack against myelin. The various types of peripheral nerve involvement in Waldenström's macroglobulinaemia, as well as the admitted mechanisms of nerve lesion and the therapeutic approaches to this still unclear neuropathy are briefly reviewed.

The sleep of dysthymic patients: a comparison with normal controls.

All-night electroencephalographic (EEG) sleep recordings were compared in dysthymic patients and normal controls. Patients were selected according to DSM-III and underwent 2 weeks of treatment with placebo before the sleep evaluation, which also included self-assessments of sleep quality. As compared with normals, dysthymic patients demonstrated fragmented and superficial sleep with no changes in rapid eye movement (REM) sleep. In addition to sleep continuity disturbances, dysthymics had a higher percentage of stage 1 and a reduction of slow wave sleep (SWS), mainly due to a diminished percentage of stage 4. Other differences were related to a higher incidence of some EEG events, and it is suggested that the analysis of sleep microstructure is a useful approach to study sleep physiology in psychiatric patients. The classification of minor forms of depression is a controversial issue and therefore the nosological implications of our findings are discussed.