[Acute onset ataxia in infancy: its aetiology, treatment and follow-up]. / Ataxia de aparición aguda en la infancia: etiología, tratamiento y seguimiento.

INTRODUCTION: Acute childhood ataxia is a cause of referency to the pediatric emergency room. AIM. To characterize the etiology, clinical picture, management, and outcome of acute ataxia in our hospital. PATIENTS AND METHODS: A prospective study was undertaken including 39 children with acute ataxia who were admitted between January 1, 2001 and December 31, 2003. RESULTS: During the study period 159,002 episodes were evaluated, 39 children (0.024%) with acute ataxia. The most common diagnoses were post-infectious ataxia (51.2%) and toxic exposure (25.6%). The mean age at presentation in post-infectious ataxia was 55 +/- 27.61 months, 60% females. A prodromal febrile illness was noted in 95%: varicella (10), nonspecific viral infection (6), mycoplasma, enterovirus, and Epstein-Barr virus. The latency from the prodromal illness to the onset of ataxia was 5.86 +/- 3.78 days. Lumbar punctures were altered in 11/17. All computed tomography scans performed were normal. At follow up, one boy presented asymmetric signs of cerebellar dysfunction secondary to hemicerebellitis. The media of the patient who showed full-gait recovery was 18 days, and was complete in all children, except one boy who presented hemophagocytic lymphohistiocytosis. Toxic ingestion was the second most common cause. Boys less than 6 years were more commonly affected. CONCLUSIONS: Acute childhood ataxia are an uncommon cause of presentation to our pediatric emergency room. Postinfectious ataxia and drug ingestion are the most common diagnosis, with a usually benign and self-limited process. A thorough history and neurology examination should be guided to etiology. Neuroimaging studies and hospitalization are needed only if atypical presentation, asymmetric neurologic examination and prolonged ataxia.

Ataxia de aparición aguda en la infancia: etiología, tratamiento y seguimiento / Accute onset ataxia in indancy: its aetiology, treatment and follow-up

Introducción. La ataxia de aparición aguda en la infancia es una causa de referencia al Servicio de Urgencias de Pediatría. Objetivo. Describir la etiología, la actitud diagnóstico-terapéutica y el seguimiento de los niños que consultaron por ataxia aguda en urgencias. Pacientes y métodos. Estudio prospectivo de 39niños diagnosticados de ataxia aguda entre el 1 de enero de 2001y el 31 de diciembre de 2003. Resultados. Durante este período se valoraron 159.002 episodios, 39 niños (0,024%) presentaron una ataxia aguda. Las causas más frecuentes fueron: postinfecciosa (51,28%) e intoxicación (25,64%), seguidas de un grupo heterogéneo de patologías. En la ataxia postinfecciosa, la edad media fue55 ± 27,61 meses, el 60% niñas. El 95% tenía un cuadro infeccioso previo: varicela (10), viral inespecífica (6), micoplasma, enterovirus, y virus de Epstein-Barr. El tiempo de evolución hasta la aparición de ataxia fue 5,86 ± 3,78 días. El líquido cefalorraquídeo fue patológico en 11 de 17. La neuroimagen fue normal. Durante el seguimiento, un niño presentó focalidad hemicerebelosa secundaria a una hemicerebelitis. Todos se recuperaron (media: 18 días), excepto un niño que debutó con una linfohistiocitosis hemofagocítica. La intoxicación fue la segunda causa más frecuente, con predominio en niños (o varones) menores de 6 años. Conclusiones. Las ataxias agudas son un motivo de consulta infrecuente en urgencias. Las ataxias postinfecciosas y tras intoxicación son las más usuales y siguen por lo general un curso benigno y autolimitado. La historia clínica y exploración neurológica nos orientarán hacia la etiología. La neuroimagen y el ingreso hospitalario deberían reservarse para presentaciones atípicas, signos de focalidad neurológica y duración prolongada del cuadro (AU)

Introduction. Acute childhood ataxia is a cause of referency to the pediatric emergency room. Aim. To characterize the etiology, clinical picture, management, and outcome of acute ataxia in our hospital. Patients and methods. A prospective study was undertaken including 39 children with acute ataxia who were admitted between January 1, 2001 and December 31,2003. Results. During the study period 159,002 episodes were evaluated, 39 children (0.024%) with acute ataxia. The most common diagnoses were post-infectious ataxia (51.2%) and toxic exposure (25.6%). The mean age at presentation in postinfectiusataxia was 55 ± 27.61 months, 60% females. A prodromal febrile illness was noted in 95%: varicella (10), nonspecific viral infection (6), mycoplasma, enterovirus, and Epstein-Barr virus. The latency from the prodromal illness to the onset of ataxia was 5.86 ± 3.78 days. Lumbar punctures were altered in 11/17. All computed tomography scans performed were normal. At follow up, one boy presented asymmetric signs of cerebellar dysfunction secondary to hemicerebellitis. The media of the patient who showed full-gait recovery was 18 days, and was complete in all children, except one boy who presented hemophagocyticlymphohistiocytosis. Toxic ingestion was the second most common cause. Boys less than 6 years were more commonly affected. Conclusions. Acute childhood ataxia are an uncommon cause of presentation to our pediatric emergency room. Post infectious ataxia and drug ingestion are the most common diagnosis, with a usually benign and self-limited process. A thorough history and neurology examination should be guided to etiology. Neuroimaging studies and hospitalization are needed only if atypical presentation, asymmetric neurologic examination and prolonged ataxia (AU)

El consejo para dejar de fumar: por qué, cuándo y cómo debemos darlo a nuestros pacientes / Counselling to stop smoking: why, when, and how we should provide our patients with this

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Epilepsia en edad escolar con crisis intratables que empeoran a pesar del tratamiento farmacológico / Epilepsy in a school-aged child with refractory crises worsening despite medica

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Técnicas de desenmascaramiento antigénico e inmunohistoquímica. Estudio dirigido a anticuerpos con especiales dificultades de inmunodetección / Antigenic unmasking techniques in immunohistochemistry

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Differences in the number of micronucleated erythrocytes among young and adult animals including humans. Spontaneous micronuclei in 43 species.

In our previous report we speculated about the possibility that some species had high levels of spontaneous micronucleated erythrocytes (MNE) just in a juvenile stage, this is, that the MNE diminish as the reticuloendothelial system matures. Here we show this effect in species including rat, rabbit, pig, dog, cat, gray squirrel, lion, giraffe, white-tailed deer, opossum and even human. The number of spontaneous MNE that we found in 43 species is shown, and the proportions of polychromatic and normochromatic. This is our third report on spontaneous MNE in different species. We obtained 189 peripheral blood samples of mammals, birds and reptiles. From 12 species we obtained only one sample, and 16 were reported previously, but now the size of the sample has been increased. The species with the highest spontaneous MNE were the Vietnamese potbelly pig (with the highest MNE number), Bengal tiger, capuchin monkey, puma, ferret, owl, hedgehog, squirrel monkey, pig and white-tailed deer. These species could be used as monitors for genotoxic events.

Fine needle aspiration and touch imprint cytology of a malignant fibrous histiocytoma of the spermatic cord. Case report.

BACKGROUND: No cytologic reports on spermatic cord sarcomas have been published. CASE: A 64-year-old man presented with a slowly growing, painless, left spermatic cord enlargement. Fine needle aspiration (FNA) obtained < 1 mL of bloody fluid consisting of solitary, mark-edly anaplastic and pleomorphic tumor giant cells occasionally arranged in small fragments. Rare atypical spindle cells could be observed. Some reactive lymphocytes were observed intermingled with tumor cells. Immunohistochemistry displayed vimentin reactivity and negativity for keratins and leukocytic common antigen. The specimen removed showed a well-circumscribed, 30-mm, yellowish solid tumor. Touch imprints displayed pleomorphic tumor cells showing intense anisonucleosis; a moderate amount of clear, sometimes microvacuolated cytoplasm; and tissue fragments with a storiform pattern. Histologic examination revealed microscopic and immunohistochemical features of malignant fibrous histiocytoma (MFH) arising in soft tissues of the spermatic cord. CONCLUSION: FNA of a spermatic cord lesion may reveal a pleomorphic sarcoma. A pleomorphic appearance together with some spindle elements and compatible immunocytochemistry could help diagnose spermatic cord MFH. This is one of the few reports dealing with FNA cytology of paratesticular tumors and the first report, to the best of our knowledge, showing the cytologic characteristics of a case of spermatic cord MFH.

[Hodgkin's disease. Etiopathogenic role of Epstein-Barr virus in Tarragona]. / Enfermedad de Hodgkin. Papel etiopatogénico del virus de Epstein-Barr en las comarcas de Tarragona.

BACKGROUND: The aim of this study is to assess the proportion of Hodgkin disease (HD) expressing Epstein-Barr virus (EBV) in our area (Tarragona-Spain). PATIENTS AND METHODS: A retrospective study was performed on paraffin embedded HD tissues from 49 patients to examine the presence of latent membrane protein (LMP-1) by immunohistochemistry and for EBER-1 in situ hybridization. RESULTS: Overall, EBV (EBER-1 and/or LMP positive) was expressed in 20 cases (40.8%). This percentage was higher, but not significant, in mixed cellularity, and significant higher in patients over 55 years old. No differences between sexes were observed. CONCLUSIONS: EBV is associated with 40.8% of HD in area of Tarragona.

Fine needle aspiration cytology of a cervical lymph node lymphangioma in an adult. A case report.

BACKGROUND: Although the cytologic features of cervical cystic lesions are well established, no cytology reports on lymphangioma in adults have been published. CASE: A 60-year-old male presented with a slowly growing, upper laterocervical, painless enlargement. Fine needle aspiration (FNA) obtained 15 mL of yellowish fluid, consisting predominantly of a uniform population of small and round lymphocytes without mitosis or atypia and with some histiocytes intermingled with them. Some centrocytes and occasionally centroblasts and plasma cells could also be observed. Immunohistochemistry performed on cell block sections displayed polyclonal B lymphocytes mixed with T cells. The specimen showed a clearly circumscribed, 50-mm, cystic lesion with a multilocular appearance and abundant, yellowish liquid. Microscopic examination demonstrated cystic lymphangioma arising from the medullary portion of a lymph node. CONCLUSION: FNA cytology permits a suggested diagnosis of lymphangioma. This is one of the few reports of FNA cytology of lymphangioma and, to the best of our knowledge, this entity has not previously been found as a neck mass in an adult.

[Monocytoid B-cell lymphoma: clinico-pathologic study of 2 cases]. / Linfoma B monocitoide: estudio clínico-patológico de dos casos.

Monocytoid B-cell lymphoma, considered as a low-grade lymphoma, is seen most frequently in persons of advanced age, chiefly women. It is often diagnosed in lymph-node phase, in low stages (I-II), and peripheral blood, bone-marrow or spleen are seldom involved. The morphologic and immunohistochemical study of two patients with monocytoid B-cell lymphoma is presented. The characteristic cell morphology, with homogeneous nuclei, low number of mitoses, and clear, wide cytoplasm, was present in both. Tumour cells expressed CD45, CD20, HLA-DR and monoclonal IgM-lambda and lambda chains, respectively. Case no. 1 had more irregular nuclei, protruding nucleoli, advanced stage at diagnosis and shorter clinical course. An epithelioid granulomatous reaction was present in case no. 2, which delayed the diagnosis until relapse. The diverse forms of clinical onset of monocytoid B-cell lymphoma, as well as its possibly aggressive course, association with other types of lymphoma and the difficulties for an adequate morphologic identification are commented.