Prefrontal cortex activity patterns during taste neophobia habituation in adult and aged rats.

Age-related memory decline has been associated with changes in the medial prefrontal cortex (mPFC) function. In order to explore the role of mPFC in taste recognition memory, we have assessed mPFC c-Fos immunoreactivity in adult (5-month-old) and aged (24-month-old) male Wistar rats during the first (Novel), second (Familiar I), and sixth (Familiar II) exposure to a cider vinegar solution. Adult brains showed higher c-Fos expression in the ventral but not the dorsal region of mPFC during the second taste exposure. Interestingly, old brains exhibited an altered activity pattern selectively in the dorsal peduncular cortex (DP) which can be associated with a delayed attenuation of vinegar neophobia in this group. These results support the involvement of this area in the formation of safe taste memory. Further research is needed for understanding the role of DP in taste recognition memory and the impact of aging on it.

Calidad asistencial en el diagnóstico y la estadificación del cáncer de pulmón en una muestra de hospitales de la Comunidad de Madrid / Quality of care in lung cancer diagnosis and staging in a sample of hospitals in Madrid

OBJETIVO. Estudiar cómo de cuantificables son los indicadores de calidad propuestos por Neumomadrid para el diagnóstico y la estadificación del cáncer de pulmón y analizar mediante su recogida la asistencia recibida por pacientes con cáncer de pulmón en una muestra de hospitales de la Comunidad de Madrid. MATERIAL Y MÉTODO: Estudio retrospectivo en el que se analizaron todos los casos de cáncer de pulmón diagnosticados en 2017 en 5 hospitales pertenecientes al Servicio Madrileño de Salud. Se recogieron el sexo, la edad, la estirpe tumoral y el estadio TNM, y se analizaron siete de los indicadores propuestos por Neumomadrid para el diagnóstico y la estadificación del cáncer de pulmón. RESULTADOS: Se recogieron 302 casos, 80 (26,5%) mujeres y 222 (73,5%) varones, con una mediana de edad de 69 años (rango: 41-89). La estirpe más frecuente fue adenocarcinoma. El 27,5% presentaban un estadio III, y el 56% un estadio IV. Se pudieron recoger 1.004 indicadores de los 1.020 aplicables (98%). Solo se alcanzó el estándar de calidad en el indicador detección de dianas terapéuticas. Se observa variabilidad importante entre hospitales. CONCLUSIONES: Los indicadores de calidad propuestos por Neumomadrid para el diagnóstico y estadificación del cáncer de pulmón son cuantificables. Existe espacio para la mejora en la atención a estos pacientes

OBJECTIVE: Study how measurable are the quality indicators proposed by Neumomadrid for the diagnosis and staging of lung cancer and analyse lung cancer care in a sample of hospitals in Madrid. METHODS: Retrospective study analysing all lung cancer cases diagnosed during 2017 in 5 hospitals from the Servicio Madrileño de Salud. Sex, age, histology and TNM stage were collected, and 7 of the quality indicators proposed by Neumomadrid for the diagnosis and staging of lung cancer were analysed. RESULTS: 302 cases were collected, 80 (26.5%) women and 222 (73.5%) men, with a median age of 69 years (range: 41-89). Adenocarcinoma was the most common histology. Twenty-seven percent had a stage III disease, and 56% a stage IV. One thousand and four indicators out of 1020 were collected (98%). The quality standard was achieved only for the detection of therapeutic targets. Important variability across hospitals is observed. CONCLUSIONS: Quality indicators proposed by Neumomadrid for the diagnosis and staging of lung cancer are measurable. There is room for improvement in the diagnosis and staging of lung cancer

Differential activity pattern of c-Fos in the nucleus accumbens between adult and aged rats during flavor recognition memory.

Previous studies have addressed the role of the nucleus accumbens core (NAcbC) and shell (NAcbSh) in taste aversion learning and in the processing of taste palatability which is affected by aging. However, little is known about its implication in safe taste memory and the aging impact. To explore the role of the NAcb in flavor neophobia and its attenuation during aging, we applied c-Fos immunohistochemistry as an index of neural activity of the NAcbC and NAcbSh. Twenty one adult (5-month-old) and 24 aged (24-month-old) male Wistar rats were exposed to a 3% cider vinegar solution for 1, 2 or 6 consecutive days (n = 7 adult and n = 8 aged rats per group). Aged rats exhibited slower attenuation of flavor neophobia than adult rats. Adult rats showed increased NAcbSh c-Fos activity on day 2 compared to days 1 and 6, while this increase was delayed to day 6 in aged rats. There were no differences in the number of NAcbC c-Fos positive cells. This suggests that changes in the activity of neural circuits of palatability processing during normal aging could contribute to the slower attenuation of flavor neophobia in aged rats.

Indicadores de calidad en patología pleural: consentimiento informado / Quality indicators in pleural pathology: informed consent

Objetivo. Medir el grado de cumplimiento de dos indicadores de calidad en patología pleural: consentimiento informado en toracocentesis (CIT) y consentimiento informado en biopsia pleural cerrada (CIBPC). Material y métodos. Estudio retrospectivo realizado en 6 hospitales de la Comunidad de Madrid. Se seleccionaron todas las toracocentesis y biopsias pleurales cerradas realizadas por un neumólogo desde el 01/12/2016 al 28/02/2017, en pacientes >16 años con derrame pleural. Variables a estudio: edad, sexo, modelo de consentimiento informado, presencia del CIT y CIBPC en la historia clínica o en archivos parciales e informatización del hospital. Se consideró buen cumplimiento cuando el consentimiento informado estaba presente y correctamente cumplimentado en > 90% de las historias clínicas. Las variables se recogieron en una tabla Excel. Análisis mediante Stata v.12. Resultados. Se realizaron 146 toracocentesis (63 mujeres/83 varones, edad media: 69) y 20 biopsias pleurales cerradas (7 mujeres/13 varones, edad media: 64). De forma global el indicador del CIT se cumple en 125/146 (85,6%) de las historias clínicas revisadas y el CIBPC en 18/20 (90%). Por hospitales 3/6 (50%) cumplen el indicador del CIT y 5/6 (83%) el CIBPC. Están informatizados 5 de los hospitales participantes, sólo uno utiliza la firma electrónica y existen archivos parciales en 2/6. No hay homogeneidad en los consentimientos informados. Conclusiones. El 50% de los hospitales cumple el indicador del CIT y el 83% el CIBPC. Existen diversos modelos de consentimiento informado en la Comunidad de Madrid localizados en la historia clínica, en la digital y en archivos parciales, que se deberían homogeneizar y simplificar

Objective. To measure the degree of compliance of two quality indicators in pleural pathology: informed consent in thoracocentesis (ICT) and informed consent in transthoracic needle biopsy (ICTTNB). Material and methods. Retrospective study carried out in 6 hospitals of the Community of Madrid. All thoracocentesis and transthoracic needle biopsy performed by a pneumologist were selected from 12/01/2016 to 02/28/2017, in patients > 16 years with pleural effusion. Variables to study: age, sex, model of informed consent, presence of ICT and ICTTNB in the clinical history or in partial files and computerization of the hospital. Good compliance was considered when the informed consent was present and correctly completed in > 90% of the clinical history. The variables were collected in an Excel table. Analysis by Stata v.12. Results. 146 thoracocentesis was performed (63 women/83 men, average age: 69) and 20 transthoracic needle biopsy (7 women/13 men, mean age: 64). Overall, the ICT indicator is met in 125/146 (85.6%) of the revised clinical history and the ICTTNB in 18/20 (90%). By hospitals 3/6 (50%) meet the ICT indicator and 5/6 (83%) the ICTTNB. They are computerized 5 of the participating hospitals, only one uses the electronic signature and there are partial files in 2/6. There is no homogeneity in the informed consent. Conclusions. 50% of the hospitals meet the ICT indicator and the 83% ICTTNB one. There are several informed consent's models in the Community of Madrid located in the clinical history, in digital and in partial files, which should be standardized and simplified

Flavor recognition memory related activity of the posterior piriform cortex in adult and aged rats.

The relationship between the piriform cortex and flavor recognition memory was investigated in adult and aged rats. By using c-Fos immunohistochemistry, we assessed the piriform cortex activity induced by flavor familiarity. The results indicated increased activity in the rostral region of the posterior piriform cortex elicited by the most familiar cider vinegar solution after six exposures. Aged rats exhibited overall increased activity in the posterior, but not the anterior piriform cortex, which was not related to flavor familiarity. This suggests that the posterior piriform cortex is related to flavor recognition memory and that aging modifies its activity pattern which might underlie their slower attenuation of flavor neophobia.

Flavor and object recognition memory impairment induced by excitotoxic lesions of the perirhinal cortex.

Recognition memory is based on the ability to assess the familiarity of a previously encountered stimulus. It can be approached using tests for different sensorial modalities. Excitotoxic lesions of the perirhinal cortex (Prh) were performed in order to assess the relevance of its integrity for object and flavor recognition memory. Object recognition memory was impaired with a 24h retention interval. Flavor neophobia attenuation was prevented on a second encounter with the tastant. These results support a role of the perirhinal cortex in mediating the transition from novel to familiar, both in object and flavor recognition memory.

Derrame pleural maligno como debut de neoplasia no conocida / No disponible

Objetivo: Conocer el origen de la neoplasia en los pacientes con derrame pleural maligno (DPM) como primera manifestación de enfermedad tumoral. Diseño: Estudio retrospectivo y multicéntrico, desarrollado en 11 hospitales públicos de la Comunidad de Madrid, en el que se incluyeron todos los pacientes consecutivos con DPM, sin antecedentes de neoplasia conocida entre el 1 de abril de 2008 y el 1 de abril de 2013. Resultados: El diagnóstico del tumor primario se realizó mediante muestras citohistológicas en 339 pacientes (84%). El cáncer de pulmón destacó como el origen más frecuente del DPM tanto en hombres (59%) como en mujeres (46%), siendo el adenocarcinoma la estirpe histológica más frecuente. Los tumores pleurales primarios ocuparon el segundo lugar en frecuencia (20%), de los que el 92% fueron mesoteliomas. En tercer lugar se situaron en igual proporción (5,5%), las neoplasias hematológicas y los tumores ováricos. El cáncer mamario, junto con los tumores digestivos, renales y urológicos fueron muy infrecuentes (<2%). En 39 pacientes (9,7%) no fue posible determinar el origen neoplásico. Se hallaron otras metástasis a distancia en 187 pacientes (47%). Conclusión: El pulmón es el órgano que con mayor frecuencia produce DPM como primera manifestación de enfermedad neoplásica, seguido por las neoplasias pleurales. En ausencia de otros síntomas, el clínico debe dirigir sus esfuerzos iniciales a descartar uno de estos órganos como el origen tumoral. En mujeres, nuestro estudio obliga a cambiar la sospecha y enfoque clínico, ya que en esta situación el carcinoma mamario es muy infrecuente

Objective: To determine the origin of neoplasms in patients with malignant pleural effusion (MPE) as the initial manifestation of tumor disease. Material and methods: This is a retrospective, multicenter study. It was developed at 11 public hospitals in the Community of Madrid, and included all consecutive patients with MPE and no history of previously detected neoplasm between April 1, 2008 and April 1, 2013. Results: We studied 402 patients with MPE. We obtained a cytohistological diagnosis of the primary tumor in 339 of them (84%). Lung cancer was the most frequent origin of the MPE in both men (59%) and in women (46%), while adenocarcinoma was the most frequent histological type. Primary pleural tumors were the second most frequent (20%), 92% of which were mesotheliomas. Third were both hematological cancers and ovarian tumors (5,5%). Breast cancer, along with gastrointestinal, renal and urological tumors, were very rare (<2%). It was not possible to determine the origin of the neoplasm in 39 patients (9,7%). Other distant metastases were found in 187 patients (47%). Conclusion: The lungs are the organs that most frequently produce MPE as the initial manifestation of neoplastic disease, which is followed in frequency by pleural neoplasms. Therefore, in the absence of other symptoms, clinicians should aim their initial efforts at ruling out one of these organs as the tumor origin. Our study shows that the clinical suspicion and focus should be changed when diagnosing women, because MPE is uncommon as the first manifestation of breast cancer

Altered perirhinal cortex activity patterns during taste neophobia and their habituation in aged rats.

Perirhinal cortex (PRh) pathology and chemosensory identification dysfunction are early signs of Alzheimer's disease. We have assessed the impact of normal aging on PRh activity during flavor recognition memory using c-Fos immunoreactivity as a marker for neuronal activity. Adult (5-month-old) and aged (24-month-old) Wistar male rats were exposed to a vinegar solution on a daily basis for a period of six days. Behavioral assessment indicated similar performance in both age groups but suggested slower attenuation of neophobia in aged rats. Regarding c-Fos immunoreactivity, an opposite pattern of PRh activity was found in adult and aged groups drinking the flavor solution during the first (Novel), second (Familiar I) or sixth (Familiar II) exposure as the flavor became familiar. While adult rats exhibited a higher number of PRh c-Fos-positive neurons during the presentation of the novel flavor than during the second and sixth presentation, in aged rats the number of PRh c-Fos-positive neurons was higher during the presentation of the familiar flavor in the last session than in the first and second. The results suggest that the role of the PRh changes during aging and can help to dissociate PRh dysfuntions induced by neurodegenerative diseases and normal aging.

Resultados del tratamiento de la escoliosis idiopática del adolescente mediante instrumentación posterior / Results of treatment of idiopathic scoliosis by posterior instrumentation

OBJETIVO: Analizar los resultados clínicos y radiológicos obtenidos tras el tratamiento quirúrgico de la escoliosis idiopática del adolescente mediante artrodesis posterior con diversos sistemas. MATERIAL Y MÉTODOS: Estudio retrospectivo de 25 pacientes intervenidos entre Enero de 2005 y Julio de 2012; con una edad promedio de 15 años. Las curvas se clasificaron según los 6 tipos de Lenke. Se intervino a los sujetos mediante una artrodesis instrumentada posterior. Se realizó una evaluación clínica mediante el cuestionario SRS-22 (Scoliosis Research Society). Así mismo, se realizó una evaluación radiológica prequirúrgica, posquirúrgica inmediata y al final del seguimiento. (Mínimo 1 año, máximo 8 años) RESULTADOS: Mediante el cuestionario SRS-22 se obtuvieron las siguientes puntuaciones medias: 4,84 en dolor; 4,68 en actividad; 4,68 en autoimagen; 4,60 en salud mental, y 4,92 en satisfacción. La corrección radiológica media posquirúrgica en las curvas torácicas fue del 56,4% y en las curvas lumbares fue del 54,4%, con una pérdida media de 7% al 15% al final del seguimiento. CONCLUSIÓN: La instrumentación y fusión posterior es una técnica eficaz y segura, con bajo índice de pseudoartrosis. Los resultados fueron excelentes en cuanto a todos los dominios del cuestionario SRS-22, se encontró asociación estadísticamente significativa entre el género y el dolor, no se evidenció significancia estadística entre el tipo de curva, el grado de corrección, la puntuación del cuestionario SRS-22 y el tipo de implante utilizado(AU)

OBJECTIVE: To analyze the clinical and radiological results obtained after surgical treatment of adolescent idiopathic scoliosis by posterior fusion with various systems. MATERIAL AND METHODS: Retrospective study of 25 subjects who underwent surgery between January 2005 and July 2012, The curves were classified according to the 6 types of Lenke. Subjects were operated by posterior instrumented arthrodesis. Clinical evaluation was performed using the SRS-22 questionnaire (Scoliosis Research Society). Likewise, preoperative radiological evaluation, immediate postoperative and final follow-up. RESULTS: Using the SRS-22 questionnaire obtained the following average scores: 4.84 for pain, 4.68 for activity, 4.68 in self-image, mental health 4.60, and 4.92 in satisfaction. The average postoperative radiological correction in thoracic curves was 56.4% and lumbar curves was 54.4%, with an average loss of 7% to 15% at follow-up. CONCLUSION: The posterior instrumentation and fusion is a safe and effective technique with low rate of nonunion. The results were excellent in all domains of the SRS-22 questionnaire, statistically significant association was found between gender and pain, showed no statistical significance between the type of curve, the degree of correction, SRS questionnaire score-22 and the type of implant used(AU)

Características generales del derrame pleural maligno secundario a neoplasias de diferentes orígenes / No disponible

La presencia de un derrame pleural maligno (DPM) complica la evolución de los pacientes diagnosticados de un cáncer porque implica un estadio más avanzado de la enfermedad, un peor pronóstico y una peor calidad de vida. Aproximadamente el 50% de los pacientes con un cáncer diseminado desarrollará un DPM. El cáncer de pulmón, el cáncer de mama y los linfomas son los tumores que con más frecuencia lo producen. El diagnóstico del DPM se basa en la presencia de células tumorales malignas en la citología del líquido pleural o en la histología de la biopsia pleural. Existen varias opciones terapéuticas: la toracocentesis evacuadora, la pleurodesis, las derivaciones pleuroperitoneales, la colocación de catéteres pleurales tunelizados, la quimioterapia en tumores quimiosensibles y otros en estudio como la instilación intrapleural de agentes antineoplásicos

The presence of malignant pleural effusion (MPE) complicates the course of cancer-diagnosed patients because it implies a more advanced stage of the disease, worse prognosis and worse quality of life. Approximately 50% of the patients with disseminated cancer develop MPE. Lung cancer, breast cancer and lymphomas are the tumors that more frequently cause it. The diagnosis of MPE is based on the presence of malignant tumor cells in the pleural fluid cytology or in the pleural biopsy histology. There are several therapeutic options: evacuating thoracentesis, pleurodesis, pleuroperitoneal shunting, placement of tunnelled pleural catheters, chemotherapy in chemosenstive tumors and others that are under study such as intrapleuralinstillation of antineoplastic drugs

Diagnóstico citoquímico de Leucemia Linfoblástica aguda infantil / Diagnosis cytochemistry of leukemia limfloblastica sharp childlike

Las leucemias constituyen una de las neoplasias más frecuentes en niños, la sobrevida depende de un diagnóstico preciso en el linaje celular comprometido, además de un tratamiento oportuno. Uno de los pilares fundamentales en el diagnóstico laboratorial constituye el perfil citoquímico, que permite identificar enzimas y/o sustancias características de las estirpes celulares, permitiendo así la caracterización de estos procesos. En vista de que en nuestro medio el diagnóstico de estas patologías se realiza principalmente sobre la base de criterios morfológicos se planteó estandarizar las tinciones citoquímicas recomendadas por el British Heamatological Council, a saber, MPO, SBB, esterasa específica, PAS, esterasa inespecífica y su inhibición con fluoruro de sodio, FAG y fosfatasa ácida. Se determinó el perfil citoquímico en médula ósea de niños con diagnóstico de LLA; de esta forma se observó que estos coincidían con los descritos en la literatura y además se pudo definir su diagnóstico

[Clinical and biological evaluation of the response to neoadjuvant hormone therapy before radiotherapy in nonmetastatic cancers of the prostate]. / Evaluation clinique et biologique de la réponse à l'hormonothérapie néoadjuvante avant radiothérapie dans les cancers de la prostate non métastatiques.

PURPOSE: The aim of this study was to evaluate the clinical and biochemical response to neoadjuvant hormonal therapy (NAHT) before radical external radiotherapy (EBRT). MATERIALS AND METHODS: From June 1986 to June 1994, 105 patients with histologically proven and non-metastatic prostate adenocarcinoma (stage B2-C2) received a short induction hormonal therapy (median: 3 months) with a luteinizing hormone releasing hormone (LHRH) analog associated with an anti-androgen followed in all cases by EBRT (66 Gy). All patients underwent a prostate-specific acid (PSA) determination, pelvic computed tomography (CT) scan and bone scan before the combined treatment. Response, treatment toxicity and PSA concentration were analyzed after the NAHT, 3 months after the completion of radiotherapy and every 6 months there after. Relapse was defined by PSA elevations above 4 ng/mL or two consecutive elevation above 1 ng/mL. RESULTS: Median follow-up was 52 months. According to the Withmore-Jewett clinical classification, 85 tumors were stage C. Pre-treatment PSA (PSAi) was above 20 ng/mL in 63.8% of the patients (median PSAi: 26 ng/mL). A clinical evaluation and a PSA determination (PSAPH) were both performed for all patients after NAHT. Most of the time, urinary obstructive symptoms disappeared with androgen ablation; tumor volume regression exceeded 50% in 99 cases and was complete in 50 cases. Median PSAPH was 0.6 ng/mL for the entire group. Clinical and biochemical tumor response were coherent: 84% of patients with clinical total remission had a PSAPH < 1 ng/mL. PSAPH value was significantly correlated with tumor stage and pre-treatment PSAi: among the 11 patients with a PSAPH > 4 ng/mL, ten were stage C and nine had a PSAi > 20 ng/mL. A PSAPH value exceeding 4 ng/mL predicted biochemical relapse (P < 0.0001). CONCLUSION: We conclude that biochemical response to hormonal therapy has a major prognostic value before EBRT can help to identify patients for an adjuvant hormonal therapy.

[Prosthetic breast reconstruction and radiotherapy: analysis of 67 cases)]. / Reconstruction mammaire prothétique et radiothérapie: analyse de 67 cas.

Authors inquire into repercussions of radiotherapy (RT) on prosthetic mammary reconstruction (PMR) by using the retrospective analysis of 67 cases, 59 of which were performed in irradiated areas. The particular aspect of irradiated prosthesis is evoked regarding 8 cases, and with the support of a literature review. Surgical complications and late results are evaluated comparatively to 339 PMR among non irradiated patients. According to available data in our series, harmfulness of RT not appeared statistically demonstrated. From both their experience and the literature, authors clarify indications of PMR following RT. They conclude to the necessity of a high quality RT, and optimal adaptation of surgical technique to tissular conditions.

[Treatment of A2-B2 prostatic cancer: results of a hormonoradiotherapy combination in the PSA era]. / Traitement des cancers prostatiques A2-B2: résultats d'une association hormonoradiothérapique dans l'ère du PSA.

PURPOSE: Prospective analysis of results of combined neoadjuvant hormonetherapy and external beam radiation therapy in A2-B2 prostate adenocarcinoma. PATIENTS AND METHODS: Between 1986 and 1994, 36 patients with clinical stage A2 (five patients), B1 (12 patients) and B2 (19 patients) N0 adenocarcinoma of the prostate declined for radical surgery, underwent a brief neoadjuvant hormonal therapy before external beam radiotherapy at our radiation therapy department. They all had a PSA determination before the combined treatment and no evidence of local extension or metastatic spread. They were followed clinically and with serial PSA levels for a median time of 58 months. Relapse was defined by a PSA level > or = 2.5 ng/mL. RESULTS: Median pre-treatment PSA level was 16.5 ng/mL; 16 patients had less than 15 ng/mL. Combined treatment was very well tolerated. After 3 months of neoadjuvant hormonetherapy, digital rectal examination was normalized in 27 cases with a PSA value < or = 1 ng/mL in 23. Only four tumors have relapsed (one local failure, two metastases and one PSA failure). The single factor that predicted biochemical relapse was pre-treatment PSA level: the 5-year actuarial rate of PSA failure when PSA level < 15 ng/mL was 0% and 27.5% if it was > or = 15 ng/mL (p = 0.05). During follow-up, only two patients suffered grade 2 rectitis and seven complained a total impotency. CONCLUSION: This limited study advocates hormonal neoadjuvant therapy and radiotherapy association in intracapsular prostatic carcinoma in patients declined for surgery or when pre-treatment PSA is above 15 ng/mL, with mild acute and late toxicity.

Place of low-dose total body irradiation in the treatment of localized follicular non-Hodgkin's lymphoma: results of a pilot study.

PURPOSE: In a first prospective nonrandomized trial, 107 patients with Stage III and IV "low-grade" lymphomas have been treated with a combination of chemotherapy and low-dose total body irradiation (LD-TBI). This study shows that this scheme of LD-TBI was very well tolerated, gave a high response rate (83%), and extended RFS. It incited us to start a pilot study on localized follicular lymphomas. METHODS AND MATERIALS: From January 1986 through October 1994, 34 patients with previously untreated localized low-grade non-Hodgkin's lymphomas have been included in a prospective trial with LD-TBI followed by radical involved field radiotherapy (IF-RT). Patients received two courses of whole body irradiation of 0.75 Gy in 5 fractions and 1 week separated by a rest period of 2 weeks. After 1 month, patients were reevaluated, and received 40 Gy in 20 fractions, and 4 weeks on initially pathological lymph node areas. Eight patients have been excluded from the study: 4 after histologic review (2 centrocytic, 1 lymphocytic, 1 centroblastic) and 4 patients with Stage IV because of bone-marrow involvement. The remaining 26 patients were 11 men and 15 women, 50 years old median age (mean: 50.2; range: 35-73.5) with clinical Stage I (10 pts), II1 (8 pts), and II2 (8 pts). All patients received the planned treatment. RESULTS: Clinical tolerance was excellent, and the hematological follow-up shows a mean nadir value of 3.9.10(9)/l (2.1-8.1) for leucocytes, 13.4 g/l (10.8-15.4) for hemoglobin, and 124.10(9)/l (46-216) for platelets, with a median delay of 3.2 months. Of 26 patients, 24 achieved complete remission (CR) after the LD-TBI that was before the IF-RT. All patients, except one, were in complete remission after IF-RT. Nineteen patients remain alive without any evidence of disease, with a median follow-up of 56.2 months. Five patients relapsed; 3 of them died. CONCLUSION: As delivered, this schedule of LD-TBI give a very high rate of CR in localized follicular non-Hodgkin's lymphoma, with a very good tolerance. It remains to prove that this immediate efficacy has an impact on long-term disease-free survival in such patients, and to understand how the LD-TBI works (direct and/or indirect induction of apoptosis; relationship with t(14;18) translocation and overexpression of bcl-2). These will be the two aims of a new EORTC prospective randomized trial comparing LD-TBI followed by IF-RT vs. IF-RT alone.

Magnetic resonance imaging in the treatment planning of radiation therapy in carcinoma of the cervix treated with the four-field pelvic technique.

PURPOSE: To evaluate magnetic resonance imaging (MRI) in the planning of radiation therapy for patients with carcinoma of the cervix treated with a four-field technique. METHODS AND MATERIALS: Between May 1994 and February 1995, 18 patients with carcinoma of the cervix were entered in the study (1 T1 N-; 2 T2a N-; 1 T2b NO; 10 T2b N-; 2 T2b N+; 2 T3b N+). Node status was assessed by a laparoscopic pelvic lymphadenectomy. During the first step, all the patients were simulated with an isocentric four-field pelvic technique. In one group (11 patients) simulation was done based on clinical examination, computed tomography (CT), and standard guidelines. In the second group (seven patients) simulation was based on clinical examination, CT, and with the help of diagnostic MRI, which was available at that time. During the second step, MRI in treatment position with skin markings of the isocenter of the radiation fields was then performed in every patient. During the third step, in each patient, the simulated radiation fields were correlated with the MRI defined target volume by superimposing them on midsagittal and midcoronal MR images. The adequacy of the margins was arbitrarly defined as 1 cm around the MRI defined target volume (tumor of the cervix and its extension, and uterus). RESULTS: In the first group (11 patients), MRI in treatment position led to a change in 7 patients: six inadequate margins in the lateral fields and one in the anterior and lateral field. In almost all the cases, the adjustments were of an increase of 10 mm, equally matched between the anterior and posterior borders of the lateral fields. In the second group (seven patients), MRI in treatment position has led to a change in lateral fields in five patients. The mean adjustment was 10 mm: four increases (two anterior border, one posterior border, one anterior and posterior border), and one decrease of the posterior border. In the two groups, modifications of the anterior border of the lateral fields have allowed adequate margins around the uterine fundus and modifications of the posterior border have allowed adequate coverage of the cervical tumor. CONCLUSION: When treating carcinoma of the cervix with a four-field radiation technique, standard portals do not exist. The design of lateral fields has to be based on individual morbid anatomy, which is given accurately by diagnostic MRI. Magnetic resonance imaging in treatment position assesses the design of simulated lateral fields.

Análisis probabilístico de lluvias intensas en Costa Rica

En este estudio se analizaron las curvas de intensidad, duración y frecuencia y el índice de la erosividad anual "R" para las estaciones pluviográficas de las diferentes regiones climáticas de Costa Rica: Limón para el Caribe, San Carlos para la Zona Norte, Liberia para el Pacífico Norte, Puntarenas para el Pacífico Central, Palmar Sur para el Pacífico Sur y El Coco para el Valle Central. El índice de erosividad varía entre 737 (Palmar Sur) y 173 (El Coco). Las distintas estaciones muestran en diferente grado la influencia de diferentes fenómenos meteorológicos: Limón, San Carlos y Palmar Sur presentan una fuerte influencia de temporales: Liberia y Puntarenas una dominancia de eventos convectivos; El Coco en casi todos los cursos analizados muestra las intensidades menores (AU)