Revolución digital en salud: ¿están los pacientes con accidente cerebrovascular preparados? / Digital revolution in healthcare: are stroke patients ready?

Background: The digital revolution is creating opportunities and challenges in the field of medicine and the Digital Hospital could be a benefit for patients, if they are able to use the Internet. Aim: Identify the barriers that limit Internet use among stroke patients treated in a public hospital in Santiago. Material and Methods: Sociodemographic, clinical and functional variables that could influence the use of the Internet were collected in 107 patients with stroke. Results: Seventy five percent of patients had access to the Internet, but only 29% knew how to use it before their hospitalization. Seventy five percent were older adults, 74% had a low level of education, 78% had an income below the minimum Chilean salary and 56% were discharged with a severe disability (modified Rankin Scale 4 or 5). There was a significant relationship between Internet use and the level of education, income and age. Conclusions: Income levels, age, schooling and stroke related disability limit Internet use in this population.

Phase I study of CC-90010, a reversible, oral BET inhibitor in patients with advanced solid tumors and relapsed/refractory non-Hodgkin's lymphoma.

BACKGROUND: Bromodomain and extra-terminal (BET) proteins are epigenetic readers that regulate expression of genes involved in oncogenesis. CC-90010 is a novel, oral, reversible, small-molecule BET inhibitor. PATIENTS AND METHODS: CC-90010-ST-001 (NCT03220347; 2015-004371-79) is a phase I dose-escalation and expansion study of CC-90010 in patients with advanced or unresectable solid tumors and relapsed/refractory (R/R) non-Hodgkin's lymphoma (NHL). We report results from the dose escalation phase, which explored 11 dose levels and four dosing schedules, two weekly (2 days on/5 days off; 3 days on/4 days off), one biweekly (3 days on/11 days off), and one monthly (4 days on/24 days off). The primary objectives were to determine the safety, maximum tolerated dose (MTD) and/or recommended phase II dose (RP2D) and schedule. Secondary objectives were to evaluate signals of early antitumor activity, pharmacokinetics, and pharmacodynamics. RESULTS: This study enrolled 69 patients, 67 with solid tumors and two with diffuse large B-cell lymphoma (DLBCL). The median age was 57 years (range, 21-80) and the median number of prior regimens was four (range, 1-9). Treatment-related adverse events (TRAEs) were mostly mild and manageable; grade 3/4 TRAEs reported in more than two patients were thrombocytopenia (13%), anemia, and fatigue (4% each). Six patients had dose-limiting toxicities. MTDs were 15 mg (2 days on/5 days off), 30 mg (3 days on/11 days off), and 45 mg (4 days on/24 days off). The RP2D and schedule selected for expansion was 45 mg (4 days on/24 days off). As of 8 October 2019, one patient with grade 2 astrocytoma achieved a complete response, one patient with endometrial carcinoma had a partial response, and six patients had prolonged stable disease ≥11 months. CONCLUSIONS: CC-90010 is well tolerated, with single-agent activity in patients with heavily pretreated, advanced solid tumors.

[Digital revolution in healthcare: are stroke patients ready?] / Revolución digital en salud: ¿están los pacientes con accidente cerebrovascular preparados?

BACKGROUND: The digital revolution is creating opportunities and challenges in the field of medicine and the Digital Hospital could be a benefit for patients, if they are able to use the Internet. AIM: Identify the barriers that limit Internet use among stroke patients treated in a public hospital in Santiago. MATERIAL AND METHODS: Sociodemographic, clinical and functional variables that could influence the use of the Internet were collected in 107 patients with stroke. RESULTS: Seventy five percent of patients had access to the Internet, but only 29% knew how to use it before their hospitalization. Seventy five percent were older adults, 74% had a low level of education, 78% had an income below the minimum Chilean salary and 56% were discharged with a severe disability (modified Rankin Scale 4 or 5). There was a significant relationship between Internet use and the level of education, income and age. CONCLUSIONS: Income levels, age, schooling and stroke related disability limit Internet use in this population.

Cemiplimab for the treatment of advanced cutaneous squamous cell carcinoma.

Cutaneous squamous cell carcinoma (cSCC) is the second most frequent type of malignancy in Caucasians worldwide. Several factors have been correlated with aggressiveness and likelihood of recurrence and distant metastases, which are challenging to control. Metastatic disease has a dismal prognosis, and standard chemotherapy has failed to significantly improve outcomes. Recently, it has been recognized that cSCCs are highly mutated tumors with a denoting potential likelihood of response to immune checkpoint blockade. Cemiplimab is an anti-programmed cell death protein 1 (PD-1) antibody recently approved for the treatment of unresectable locally advanced or metastatic cSCC by the U.S. Food and Drug Administration (FDA) and the European Commission with a compelling response rate and an acceptable safety profile.

Protocolo de actuación en atención primaria en la enfermedad inflamatoria intestinal en la edad pediátrica / Protocol of action in primary care in the pediatric inflammatory bowel disease

Dadas las características de la enfermedad inflamatoria intestinal de los pacientes pediátricos y las diferencias clínicas, es muy importante realizar un diagnóstico y tratamiento lo más precoz posible. El retraso en el inicio del tratamiento implica una menor respuesta al mismo y una evolución hacia una mayor gravedad. El trabajo conjunto desde los centros de salud y los niveles hospitalarios siempre resulta beneficioso para el paciente, a la vez que ayuda y acerca a los profesionales. En la literatura médica no se han documentado muchos protocolos dirigidos al diagnóstico precoz y el manejo de esta patología en pacientes pediátricos en atención primaria en coordinación con la atención hospitalaria

An early diagnosis and treatment in the pediatric inflammatory bowel disease is essential. Pediatric patients have special age-related features that make them different to de adults. Delayed beginning treatment implies a lower response and evolution towards a higher severity. A delayed treatment implies lower response and a worse illness outcome. Coordination between primary health care and tertiary care centers is mandatory to benefit the patients and to get better outcomes. This approach in the pediatric patients is not described in scientific papers

Early Phase Clinical Trial Designs - State of Play and Adapting for the Future.

The process of anti-cancer drug development is complex, with high attrition rates. Factors that may optimise this process include well-constructed and relevant pre-clinical testing and use of biomarkers for patient selection. However, the design of early phase clinical trials will probably play a vital role in both the robust clinical investigation of new targeted therapies and in streamlining drug development. In this overview, we assess current concepts in phase I clinical trials, highlighting issues and opportunities to improve their meaningfulness. The particular challenge of how to design combination trials is addressed, with focus on the potential of new adaptive and model-based designs.

Morphometry-based measurements of the structural response to whole-brain radiation.

PURPOSE: Morphometry techniques were applied to quantify the normal tissue therapy response in patients receiving whole-brain radiation for intracranial malignancies. METHODS: Pre- and Post-irradiation magnetic resonance imaging (MRI) data sets were retrospectively analyzed in N = 15 patients. Volume changes with respect to pre-irradiation were quantitatively measured in the cerebrum and ventricles. Measurements were correlated with the time interval from irradiation. Criteria for inclusion included craniospinal irradiation, pre-irradiation MRI, at least one follow-up MRI, and no disease progression. The brain on each image was segmented to remove the skull and registered to the initial pre-treatment scan. Average volume changes were measured using morphometry analysis of the deformation Jacobian and direct template registration-based segmentation of brain structures. RESULTS: An average cerebral volume atrophy of -0.2 and -3% 3% was measured for the deformation morphometry and direct segmentation methods, respectively. An average ventricle volume dilation of 21 and 20% was measured for the deformation morphometry and direct segmentation methods, respectively. CONCLUSION: The presented study has developed an image processing pipeline for morphometric monitoring of brain tissue volume changes as a response to radiation therapy. Results indicate that quantitative morphometric monitoring is feasible and may provide additional information in assessing response.

Serial haemostatic monitoring of dogs with multicentric lymphoma.

Lymphoma is the most common haematopoietic malignancy in dogs and it has been associated with hypercoagulability and subsequent thromboembolism. The objectives of this study were to serially characterize the haemostatic status of dogs with multicentric lymphoma. Thromboelastography, thrombin-antithrombin complex concentration and routine haematology and coagulation panels were measured. Twenty-seven dogs were included in the study and 15 completed the study in remission. At presentation, 81% (22/27) of dogs with multicentric lymphoma had altered haemostatic profiles consistent with hypercoagulability. Laboratory evidence of hypercoagulability did not resolve during treatment or for up to 1 month following attainment of clinical remission. Accelerated rate of clot formation at the time of chemotherapeutic protocol completion was associated with decreased survival time. We concluded that dogs with multicentric lymphoma were frequently hypercoagulable from presentation through 4 weeks after the completion of chemotherapy. Increased angle and shortened K in dogs that have successfully completed their chemotherapeutic protocol may be associated with shorter survival times.

Incidence of delayed hair re-growth, pruritus, and urinary retention after epidural anaesthesia in dogs.

OBJECTIVE: Delayed hair re-growth, pruritus and urinary retention are known complications after epidural anaesthesia in dogs. The aim of this study was to prospectively evaluate the effect of epidurally administered drugs on the occurrence of these complications in dogs. MATERIAL AND METHODS: Ninety dogs were included in this study. Eighty client-owned dogs undergoing surgery were randomly assigned to one of three epidural treatment groups: either morphine and bupivacaine (MB), bupivacaine (B), or saline solution 0.9% (S) was administered epidurally to these patients. Ten dogs were only clipped in the lumbosacral area (C). Follow-up started 4 weeks after clipping and was performed every 4-5 weeks in cases of delayed hair re-growth or pruritus. Hair re-growth in the lumbosacral area was observed and compared to hair re-growth in the surgical field and the fentanyl patch area. Cytological analysis and a trichogram were performed if hair re-growth was delayed after 6 months. Time interval to first urination postoperatively was recorded (n = 80). RESULTS: Hair re-growth was delayed in 11 dogs (12.2%; B: n = 7, S: n = 2, MB: n = 1, C: n = 1) with no differences between groups. Pruritus was evident in two dogs (2.2%; MB: n = 1, S: n = 1). After 6 months, hair had started to re-grow in all but one dog (B). After 10 months the coat of this dog had re-grown. Time to first urination did not differ between groups. CONCLUSION AND CLINICAL RELEVANCE: No direct correlation between the particular drugs injected epidurally and delayed hair re-growth, pruritus and urinary retention could be shown. Dog owners should be informed that hair re-growth after epidural anaesthesia could be markedly delayed.

Phase I clinical trial of oral rosiglitazone in combination with intravenous carboplatin in cancer-bearing dogs.

Rosiglitazone is an FDA-approved peroxisome proliferator-activated receptor gamma (PPARγ) agonist and antidiabetic agent in humans that has been investigated for its ability to reduce tumor cell growth. The purpose of this study was to determine the maximally tolerated dose, peak plasma concentrations and side effect profile of oral rosiglitazone when combined with carboplatin in dogs with cancer. Rosiglitazone was administered at 6 and 8 mg/m(2) to seven dogs. Carboplatin was administered at 240-300 mg/m(2) in combination with rosiglitazone. For toxicity evaluation, the toxicity data for the seven dogs in this study were combined with the toxicity data from three dogs previously reported in a methodology study. Peak plasma rosiglitazone concentrations varied with dose. The dose-limiting toxicity was hepatic at a dose of 8 mg/m(2). Three dogs had mild to moderate alanine aminotransferase elevations but no changes in total bilirubin, alkaline phosphatase, blood glucose or γ-glutamyltranspeptidase values were noted.

Encefalitis autoinmune reversible y anticuerpos anti-receptores de N-metil-D-aspartato: Report of one case / Limbic encephalitis with positive anti-N-methyl-D-aspartate antibodies

Background: Limbic encephalitis is a subacute syndrome characterized by memory impairment, confusion, seizures, hypothalamic dysfunction and psychiatric symptoms. It has been associated to tumors located outside of the central nervous system. In 2007, anti-N-methyl-D-aspartate receptors (NMDAr) antibodies were found in serum and CSF of patients with this particular type of encephalitis. We report a 25-year-old female who, following upper respiratory tract symptoms, developed serious behavioral and consciousness impairment that progressed to coma. Cerebrospinal fluid (CSF) analysis showed a lymphocyte pleocytosis, the electroencephalogram was altered with a slow encephalopathic rhythm and a brain magnetic resonance imaging was normal. Infectious etiologies were ruled out. CSF and serum anti NMDA receptors antibodies were positive.

Poster - Thur Eve - 16: Four-dimensional x-ray computed tomography and hyperpolarized 3 He magnetic resonance imaging of gas distribution in lung cancer.

Dynamic imaging methods such as four-dimensional computed tomography (4DCT) and static imaging methods such as noble gas magnetic resonance imaging (MRI) deliver direct and regional measurements of lung function even in lung cancer patients in whom global lung function measurements are dominated by tumour burden. The purpose of this study was to directly compare quantitative measurements of gas distribution from static hyperpolarized 3 He MRI and dynamic 4DCT in a small group of lung cancer patients. MRI and 4DCT were performed in 11 subjects prior to radiation therapy. MRI was performed at 3.0T in breath-hold after inhalation 1L of hyperpolarized 3 He gas. Gas distribution in 3 He MRI was quantified using a semi-automated segmentation algorithm to generate percent-ventilated volume (PVV), reflecting the volume of gas in the lung normalized to the thoracic cavity volume. 4DCT pulmonary function maps were generated using deformable image registration of six expiratory phase images. The correspondence between identical tissue elements at inspiratory and expiratory phases was used to estimate regional gas distribution and PVV was quantified from these images. After accounting for differences in lung volumes between 3 He MRI (1.9±0.5L ipsilateral, 2.3±0.7 contralateral) and 4DCT (1.2±0.3L ipsilateral, 1.3±0.4L contralateral) during image acquisition, there was no statistically significant difference in PVV between 3 He MRI (72±11% ipsilateral, 79±12% contralateral) and 4DCT (74±3% ipsilateral, 75±4% contralateral). Our results indicate quantitative agreement in the regional distribution of inhaled gas in both static and dynamic imaging methods. PVV may be considered as a regional surrogate measurement of lung function or ventilation.

Phase I/II clinical trial of 2-difluoromethyl-ornithine (DFMO) and a novel polyamine transport inhibitor (MQT 1426) for feline oral squamous cell carcinoma.

Polyamines are essential for cell proliferation. Their production is dysregulated in many cancers and polyamine depletion leads to tumour regression in mouse models of squamous cell carcinoma (SCC). The purpose of this study was to determine the maximally tolerated dose of the polyamine transport inhibitor, MQT 1426, when combined with the ornithine decarboxylase (ODC) inhibitor, DFMO, and to determine whether this therapy results in reduction in tumour polyamine levels. Thirteen cats with oral SCC received both drugs orally and serial tumour biopsies were obtained for polyamine measurement. Cats were monitored for response to therapy and toxicity. A maximum tolerated dose (MTD) of MQT 1426 when combined with DFMO was determined. Dose-limiting toxicity was vestibular in nature, but was fully reversible. Spermidine and total polyamine levels decreased significantly in tissues, two cats experienced objective tumour regression and six cats had stable disease. These results suggest that further study of polyamine depletion therapies is warranted.

Prospective randomized clinical trial assessing the efficacy of Denamarin for prevention of CCNU-induced hepatopathy in tumor-bearing dogs.

BACKGROUND: Increases in liver enzymes occur in up to 86% of dogs receiving CCNU and can result in treatment delay or early discontinuation of treatment. Denamarin contains S-adenosylmethionine and silybin, both of which have been investigated as treatments for various liver diseases. HYPOTHESIS: Dogs on CCNU receiving Denamarin have lower alanine aminotransferase (ALT) activity than dogs not receiving Denamarin. Dogs on Denamarin are less likely to require treatment delay because of hepatopathy and are more likely to complete their prescribed course of CCNU. ANIMALS: Dogs with lymphoma, mast cell tumor, or histiocytic sarcoma that were prescribed CCNU with or without corticosteroids and with normal ALT activity were eligible for enrollment. METHODS: Dogs were prospectively randomized to receive either concurrent Denamarin during CCNU chemotherapy or to receive CCNU alone. Liver-specific laboratory tests were run before each dose of CCNU. RESULTS: Increased liver enzyme activity occurred in 84% of dogs receiving CCNU alone and in 68% of dogs on concurrent Denamarin. Dogs receiving CCNU alone had significantly greater increases in ALT, aspartate aminotransferase, alkaline phosphatase, and bilirubin and a significantly greater decrease in serum cholesterol concentrations than dogs receiving concurrent Denamarin. Dogs receiving CCNU alone were significantly more likely to have treatment delayed or discontinued because of increased ALT activity. CONCLUSIONS: Increased liver enzyme activity occurs commonly in dogs receiving CCNU chemotherapy. These results support the use of concurrent Denamarin to minimize increased liver enzyme activity in dogs receiving CCNU chemotherapy. Denamarin treatment also increases the likelihood of dogs completing a prescribed CCNU course.

Medial radio-carpal arthrodesis in three cats with a 2.0 mm locking maxillofacial plate system.

The medical records of three cats that were presented with severe carpal injury requiring radiocarpal arthrodesis were reviewed. Medial plating using the Compact 2.0 LOCK™ system was performed in all three cases. Although screw positioning may be difficult because of the large distance between the holes of the plate and the relatively large size of screws, plate loosening or metacarpal fractures did not occur. Long-term clinical and radiographic follow-up (6 months to 4.5 years) revealed excellent outcome in two cats. In the third cat, the radiocarpal joint did not undergo complete fusion. At four and a half years following surgery, recurrence of forelimb lameness was associated with breakage of the plate.

Glioma multifocal multicéntrico / Multifocal multicentric glioma

El glioblastoma multiforme es el más habitual y agresivo de los tumores gliales del sistema nervioso central, sin embargo, infrecuentemente se expresa con lesiones múltiples que pueden definirse como multifocales o multicéntricas, en relación a su origen y capacidad de propagación. Esta presentación intenta analizar las peculiaridades clínicas y los hallazgos imagenológicos de un paciente portador de un glioblastoma multiforme con lesiones supra e infratententoriales, de aparición sincrónica y metacrónica. Llamó la atención en él, que importantes masas tumorales de la protuberancia y mesencéfalo no comprometieran los pares craneales. También fue significativa la visualización en el cuerpo calloso de la propagación selectiva del glioma a través de fibras de conexión. Se concluye que las manifestaciones tanto clínicas como imagenológicas de este paciente son excepcionales por la ausencia de signología esperable por la localización de las múltiples lesiones infra y supratentoriales del tumor, y la visualización del modo de propagación.

Glioblastoma multiforme is the most common and most aggressive glial tumor of central nervous system, however it is infrequently expressed with multiple lesions that can be defined as multifocal or multicentric, relative to their origin, and spread capacity. This presentation makes an effort to analyze clinical peculiarities and radiographic findings of a patient suffering from a glioblastoma multiforme with supra and infratentorial lesions, that appeared synchronic and metachronically. In this case, drew our attention that important tumor masses at pons and midbrain did not compromise cranial nerves. Also, it was significant the visualization at corpus callosum of glioma's selective spreading through connection fibers. It is concluded that both clinical and radiographic manifestations from this patient are exceptional, because of the absence of expected signology from the multiple infra and supratentorial lesions, and the visualization of the way of spreading.

Valoración del estudio alérgico en niños con atopia / Allergic study assessment in atopic children

Introducción: la atopia se define como la tendencia a producir anticuerpos IgE específicosfrente a alérgenos y se expresa clínicamente como dermatitis-eccema, asma y rinoconjuntivitis. En los últimos años se ha documentado el aumento de la prevalencia de atopia en los países desarrollados. La detección de los alérgenos implicados es necesaria para unas medidas terapéuticasóptimas.El objetivo del estudio es describir el perfil de sensibilizaciones en los niños con atopia delmunicipio de Zaragoza. Material y métodos: durante el verano de 2009 se revisaron las historias clínicas de los niñosde 0-14 años, de las consultas de 6 pediatras de Atención Primaria. Se obtuvo una muestrade 194 niños con clínica y estudio alérgico positivo en los últimos 5 años. Resultados: distribución por sexo: 62,9% varones y 37,1% mujeres. Hallazgos clínicos: asma:78%, rinitis: 68%, conjuntivitis: 50% y dermatitis: 29%; con frecuencia se asociaron diferentes diagnósticos. Los alérgenos positivos fueron: gramíneas: 48%, hongos: 35%, árboles: 34%, animales: 26%, alimentos: 24%, ácaros: 19% y malezas: 18%. Conclusiones: las causas más importantes de sensibilización en nuestro estudio son primerolas gramíneas y luego la Alternaria; olivo, animales, ácaros y malezas les siguen por este orden.En nuestra zona geoclimática, si hay síntomas en invierno o al final del verano se debe estudiarel ciprés, plátano de sombra, Chenopodium y Salsola. La alta sensibilización a alimentosencontrada se corresponde con otros estudios. La identificación de las sensibilizaciones permiterelacionarlas con la clínica, tomar las medidas terapéuticas oportunas y mejorar la calidad de vidade los niños (AU)

Introduction: atopy is defined as the tendency to produce allergen-specific IgE antibodiesand is expressed clinically as dermatitis, eczema, bronchial asthma and rhino-conjunctivitis. Inthe last years, an increased prevalence of atopy in developed countries has been documented.The detection of allergens involved is necessary for optimal therapeutic measures. The aim ofthis study is to describe the profiles of sensitizations in children with atopy in the municipalityof Zaragoza.Material and methods: in the summer of 2009 the clinical histories of 0-14 year-old children,of 6 pediatricians’ consultations were reviewed. A sample of 194 children with clinicalfindings and allergic positive study in the last 5 years was collected.Results: distribution between sexes: 62.9% male and 37.1% female. Clinical findings:78% asthma, 68% rhinitis, 50% conjunctivitis and 29% dermatitis; often several diagnoseswere associated. The allergens found were: 48% gramineae, 35% fungi, 34% trees, 26% animals,24% food, 19% dust-mites and 18% weeds.Conclusions: the most important causes of sensitization in our study are gramineae in thefirst place followed by Alternaria. Olive tree, animals, dust-mites and weeds follow them in thisorder. We must study cypress, platanus orientalis and Chenopodium, and Salsola, which areprevalent in our geoclimatic zone, if there are symptoms in winter or in late summer. The high sensitization to food matches other studies. The identification of the sensitizations will allow usto relate them to the clinic, take the appropriate therapeutic measures and to improve the quality of life of these children (AU)

Oftalmoplejia aguda sin ataxia de carácter recurrente / Recurrent acute ophthalmoplegia without ataxia

Pueden mostrar aumento de anticuerpos anti-GQ1b los síndromes de Miller Fisher, Guillain-Barré con Oftalmoplegia, Rombencefalitis de Bickerstaff y Oftalmoplejia Aguda sin Ataxia, llamadas síndromes anti-GQ1b. Presentamos hombre de 72 años que ingresa por diplopía, oftalmoplejia de instalación aguda y dolor retro-ocular. Tuvo un episodio semejante hace cinco años, recuperado. Al ingreso mostraba oftalmoplejia completa bilateral sin ptosis, miosis y leve enoftalmo del ojo derecho. Potencia muscular conservada, arreflexia osteotendinea, sin compromiso cerebeloso ni sensitivo. LCR y electromiografía normales. RM de cerebro mostraba captación e hiperintensidad (T2) de los pares tercero y sexto. RM de medula espinal no mostró cambio de las raíces espinales. Aumento de GQ1b de 46.2/ 25 en el suero. Mejoró sin tratamiento. Treinta días después, quedaba solo paresia de los sextos pares. El anti-GQ1b es un marcador que identifica las neuropatías con compromiso oculomotor. Las oftalmoplejias agudas sin ataxia tienen reflejos conservados, el 30 por ciento tiene arreflexia. Sólo existen reportes de Síndrome de Guillain-Barré y Miller-Fisher recurrentes con anti-GQ1b. Sería el primer caso descrito de Oftalmoplejia aguda sin ataxia anti-GQ1b, recurrente.

They may exhibit increased anti-GQ1b antibodies in Miller Fisher syndrome, Guillain-Barre syndrome with ophthalmoplegia, Bickerstaff Rhombencephalitis, and Acute Ophthalmoplegia without ataxia , the so called anti-GQ1b syndromes. We report a 72 years old man who was admitted because of diplopia, acute onset ophthalmoplegia and retro-ocular pain. He had a similar episode five years ago, fully recovered. At admission he showed complete bilateral ophthalmoplegia without ptosis, miosis and slight enophthalmos of the right eye. Preserved muscle strength, deep tendon areflexia, without sensory or cerebellar commitment. CSF and electromyography were normal. Brain MRI showed uptake and T2 hyperintensity of the third and sixth cranial nerves. Spinal cord MRI showed no change in the spinal roots. Serum anti-GQ1b increase of 46.2 / 25. He improved without treatment. Thirty days later, paresis was only the sixth pair. The anti-GQ1b is a marker that identifies neuropathies with oculomotor commitment. The acute ophthalmoplegia without ataxia have normal reflex, 30 percent had areflexia. There are only Guillain-Barré and Miller-Fisher syndromes recurrent case reports with anti-GQ1b. It would be the first case of recurrent anti-GQ1b-positive acute ophthalmoplegia without ataxia.

Revision of an unstable HELICA endoprosthesis with a Zurich cementless total hip replacement.

A six-year-old, female, spayed Labrador Retriever was evaluated for progressive lameness of one year duration, ending in non-weight-bearing of the right hindlimb. The dog had a history of severe coxarthrosis of both hip joints, and had a HELICA hip prosthesis implanted in the right hip 18 months before. On survey radiographs, the acetabular and femoral components appeared unstable, with a large void in the proximal femur and a lacy periosteal reaction on the trochanter. Arthrocentesis was performed to rule out septic loosening. As culture samples were negative, the dog underwent surgery. We report the successful revision of an unstable HELICA screw hip prosthesis with a Zurich cementless total hip replacement. The patient had a good clinical and radiological outcome seven months postoperatively.