Impacto de las nuevas tecnologías en la neurología en España. Revisión del Comité Ad-Hoc de Nuevas Tecnologías de la Sociedad Española de Neurología / Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology

Introducción: Las nuevas tecnologías (NT) están cada vez más presentes en el ámbito biomédico. Utilizando la definición de consenso de NT del Comité Ad-Hoc de Nuevas Tecnologías de la Sociedad Española de Neurología (SEN), se evalúa su impacto en la neurología española a través de las comunicaciones de las reuniones anuales de la SEN. Material y métodos: Se define el concepto de NT en neurología como una tecnología novedosa o aplicación de una tecnología anterior, caracterizada por un cierto grado de coherencia persistente en el tiempo, con potencial de tener impacto en el presente y futuro de la neurología. Se plantea un estudio descriptivo tomando como fuente las comunicaciones de las reuniones de la SEN desde 2012 hasta 2018 y analizando los tipos de NT empleadas, la subespecialidad, así como su distribución territorial. Resultados: De las 8.139 comunicaciones presentadas, 299 estaban relacionadas con NT (3,7%), incluyendo 120 pósteres y 179 comunicaciones orales, variando desde el 1,6% en 2012 hasta el 6,8% en 2018. Los tipos de tecnología mayormente representados fueron neuroimagen avanzada (24,7%), biosensores (17,1%), electrofisiología y neuroestimulación (14,7%) y telemedicina (13,7%). Las áreas neurológicas con mayor empleo de NT fueron trastornos del movimiento (18,4%), enfermedades cerebrovasculares (15,7%) y demencias (13,4%). Madrid fue la comunidad que presentó más comunicaciones (32,8%), seguida por Cataluña (26,8%) y Andalucía (9,0%). Conclusiones: Las comunicaciones sobre NT siguen una tendencia creciente. El número de NT empleadas ha ido aumentando de manera paralela a la disponibilidad tecnológica. Se encontraron comunicaciones en todas las subespecialidades neurológicas, con una distribución geográfica heterogénea.(AU)

Introduction: New technologies (NT) are increasingly widespread in biomedicine. Using the consensus definition of NT established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. Material and methods: We defined the concept of NT in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of NT, the field of neurology, and the geographical provenance of the studies. Results: We identified 299 communications related with NT from a total of 8,139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where NT were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to NT (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). Conclusions: The number of communications addressing NT follows an upward trend. The number of NT used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.(AU)

Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology.

INTRODUCTION: New technologies are increasingly widespread in biomedicine. Using the consensus definition of new technologies established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. MATERIAL AND METHODS: We defined the concept of new technology in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of technology, the field of neurology, and the geographical provenance of the studies. RESULTS: We identified 299 communications related with new technologies from a total of 8139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where new technologies were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to new technologies (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). CONCLUSIONS: The number of communications addressing new technologies follows an upward trend. The number of technologies used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.

Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology. / Impacto de las nuevas tecnologías en la neurología en España. Revisión del Comité Ad-Hoc de Nuevas Tecnologías de la Sociedad Española de Neurología.

INTRODUCTION: New technologies (NT) are increasingly widespread in biomedicine. Using the consensus definition of NT established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. MATERIAL AND METHODS: We defined the concept of NT in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of NT, the field of neurology, and the geographical provenance of the studies. RESULTS: We identified 299 communications related with NT from a total of 8,139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where NT were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to NT (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). CONCLUSIONS: The number of communications addressing NT follows an upward trend. The number of NT used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.

Effect of different housing systems (single and group penning) on the health and welfare of commercial female rabbits.

In recent decades, concern about rabbit welfare and sustainability has increased. The housing system is a very important factor for animal welfare. However, information about how different available housing types for female rabbits affect their health status is scarce, but this is an important factor for their welfare. Hence, the objective of this study was to evaluate the health status of female rabbits in five common housing systems: three different single-housing systems with distinct available surfaces and heights; a single-housing system with a platform; a collective system. Female rabbits in the collective and platform cages had greater cortisol concentrations in hair than those in the single-housing system with no platform. Haptoglobin concentrations and kit mortality rates during lactation were greater for the collective-cage female rabbits. The collective group had more culled females and more lesions than in the other groups. The main reasons for culling in all the groups were reproduction problems and presence of abscesses, and the collective group of females was the most affected. In conclusion, it appears that keeping females together in collective systems negatively affects their health status and welfare, while single-housing systems imply lower kit mortality rates during lactation and cortisol concentrations, and fewer lesions in female rabbits.

Hemorragia postoperatoria en histerectomía por patología benigna: Estudio unicéntrico / Postsurgical bleeding in hysterectomy due to benign pathoogy unicentric experience

Introducción: la histerectomía es la intervención quirúrgica más frecuente en el ámbito de la ginecología. Si bien se trata de un procedimiento de bajo riesgo, las infecciones y la hemorragia post-operatoria son sus principales complicaciones. Nuestro objetivo ha sido evaluar la hemorragia post-operatoria en nuestro medio durante la realización de histerectomías por patología benigna. Material y métodos: durante 2 años se ha realizado una recogida prospectiva de todos los casos de histerectomía realizados en contexto de patología benigna en único centro. Realizamos un estudio descriptivo de las características de los pacientes y un análisis univariado de la hemorragia post-operatoria significativa (pérdida de hemoglobina mayor a 2g/dl). Resultados: de un total de 256 histerectomías; 125 (48.8%) han sido totales y 131 (51.2%) subtotales. La edad media de los pacientes era de 49.1 ± 8,7 años y la tasa de hemorragia significativa ha sido del 62.5% (n=160). El único predictor de hemorragia significativa ha sido la cirugía abierta (95 vs 87.5%, p=0,05), sin diferencias significativas en el tipo de histerectomía, la realización de anexectomía concomitante o en el tiempo de cirugía. La necesidad de transfusión ha sido mayor (4.4 vs 0%, p=0.048) pero no la necesidad de reintervención (3.8 vs 5.2%, p=0.752). No se han producido exitus. Conclusión: La hemorragia significativa definida por la pérdida de 2 g/dl de hemoglobina es una complicación frecuente de la histerectomía por patología benigna, siendo uno de sus predictores la vía quirúrgica abierta

Introduction: the hysterectomy is the most frequent surgical procedure in gynecology. It is a low risk procedure, but infections and post-operative bleeding are their main complications. Our aim has been to evaluate the post-operative bleeding in our environment in the context of hysterectomies due to benign pathology. Material and methods: during 2 years we have been prospectively recruiting all of the hysterectomies performed in our centre due to benign pathology. We did a descriptive study of the main features of these patients and a univariate analysis of significant post-operative bleeding (lost of hemoglobin more than 2 g/dl). Results: among 256 hysterectomies, 125 (48.8%) have been total hysterectomies and 131(51.2%) subtotal hysterectomies. Mean age of patients was 49.1 ± 8,7 years old and the rate of significant post-operative bleeding was 62.5% (n=160). The unique predictor of significant bleeding was the open operative surgical procedure (95 vs 87.5%, p=0,05), without significant differences among the type of hysterectomy, the concomitant annexectomy or the surgery duration. Need of transfusion was greater (4.4 vs 0%, p=0.048) but not the need of new intervention (3.8 vs 5.2%, p=0.752). There were no deaths. Conclusion: significant postoperative bleeding defined by the lost of haemoglobin greater than 2g/dl is a frequent complication of hysterectomy in the context of benign pathology, being the open operative surgical procedure one of its predictors

Diagnóstico prenatal de tumor de células de la granulosa de tipo juvenil / Prenatal diagnosis of juvenile granulosa cell tumor

Presentamos un caso clínico de diagnóstico prenatal de una masa testicular. Tras el nacimiento, se realizó la exéresis del tumor y el análisis anatomopatológico determinó que se trataba de un tumor de células de la granulosa juvenil. Los tumores testiculares son raros y deben considerarse en el diagnóstico diferencial de las masas escrotales en los neonatos. El tumor de células de la granulosa juvenil es una entidad clínico-patológica poco frecuente, que representa el 5% de los tumores testiculares prepuberales. Se considera una neoplasia benigna y la orquiectomía es una técnica quirúrgica curativa.

We report a case of a prenatally diagnosed testis tumor. After delivery, it was decided to perform right radical orchiectomy which was subsequently diagnosed as a juvenile granulosa cell tumor. Neonatal testicular tumors are rare and should be considered in the differential diagnosis of newborn scrotal masses. Juvenile granulosa cell tumor is a rare benign neoplasm of the testicular stroma that accounts for 5% of all prepuberal testis tumors. As a benign neoplasm, orchiectomy is sufficient for treatment.

Síndrome de Forestier-Rotés-Querol / Forestier-Rotés-Querol's disease

No disponible

Tratamiento de la incontinencia urinaria de esfuerzo femenina mediante cintillas suburetrales: estudio retrospectivo comparativo observacional de 2 técnicas quirúrgicas / Treatment of Female Stress Urinary Incontinence Using Suburethral Slings: Comparative, Retrospective, Observational Study of Two Surgical Techniques

Objetivo: El tratamiento de la incontinencia urinaria femenina ha sufrido una revolución en los últimos años por la aparición en el mercado de las cintillas suburetrales. El objetivo de este estudio es comparar 2 técnicas quirúrgicas para el tratamiento de la incontinencia urinaria de esfuerzo: Monarc™ (cintilla suburetral transobturadora) y MiniArc® (mini-cintilla suburetral de incisión única). Material y métodos: Estudio retrospectivo observacional comparativo desde enero de 2005 hasta diciembre de 2011 con 317 mujeres diagnosticadas de incontinencia urinaria de esfuerzo. Doscientas catorce fueron tratadas con la cintilla suburetral transobturadora Monarc™ y 103 con la mini-cintilla MiniArc®. Los resultados han sido tratados con el programa informático SPSS v 15 y el nivel de significación estadística ha sido p ≤ 0,005. Resultados: Los 2 grupos de pacientes son homogéneos en cuanto a la edad, el número de partos, la presencia de incontinencia urinaria de urgencia o histerectomía previa. Diferencias significativas en estancia hospitalaria, tiempo quirúrgico y complicaciones precoces a favor del Miniarc®, pero no en las tardías donde no hay diferencias significativas globales. El 84% de las pacientes tratadas con la cintilla transobturadora Monarc™ están curadas frente al 72% en las que colocamos un MiniArc® con diferencia significativa. Conclusión: Debemos realizar un mayor número de estudios de alta calidad de carácter prospectivo y aleatorizados, con mayor número de pacientes y tiempo de seguimiento para confirmar o rechazar la diferencia que hemos encontrado en la tasa de éxito a favor de cintilla suburetral transobturador Monarc™ (AU)

Objective: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Material and methods: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P ≤ 0.005. Results: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. Conclusion: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling (AU)

Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques.

OBJECTIVE: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). MATERIAL AND METHODS: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. RESULTS: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. CONCLUSION: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

Effects of group composition on the incidence of respiratory afflictions in group-housed calves after weaning.

A study consisting of 2 experiments was conducted with the aim of determining the effects of previous history of bovine respiratory disease (BRD) on animal performance and health status of transition calves housed in groups. In both experiments, calves were housed in individual hutches until weaning age at 58 d. Before weaning, BRD incidences were individually recorded on a daily basis. Following weaning, calves were moved into super hutches in groups of 8, based on their history of respiratory afflictions, and growth performance and BRD incidences were recorded for 57 d. In experiment 1, 144 female Holstein dairy calves (initial BW=72.6±1.2 kg; age=58.5±0.8 d) were distributed in 6 super hutches composed of 8 calves with no previous history of BRD (HHH), 6 super hutches composed of 6 calves without and 2 calves with a previous episode of BRD (HHR), and 6 super hutches housed 5 calves without a history of BRD and 3 calves with previous respiratory afflictions (HRR). In experiment 2, 144 Holstein female calves [58.0±0.9 d; 72.5±0.9 kg of body weight (BW)] were distributed in 2 treatments consisting of 9 super hutches housing integrally 8 calves with no previous BRD, and 9 super hutches housing integrally calves with a previous BRD case. The number of BRD cases after weaning progressively increased from HHH to HRR as the proportion of calves previously affected by BRD within super hutch increased, mainly due to the fact that both animals affected by BRD before weaning and those with no previous history of BRD had more relapses in HHR and HRR groups than in the HHH group. Odds of incurring BRD after grouping were 3.89 greater in calves that had a previous case of BRD than in those that did not. The average time elapsed between commingling the animals and the appearance of the first BRD case was shorter when calves that had at least one BRD episode prior to weaning were present in a group (10.8±3.3 d) than when the group was formed with calves that had never experienced BRD before weaning (22.5±3.3 d). Final BW (at 115 d of life) and average daily gain tended to decrease as the number of BRD cases incurred increased. In experiment 2, calves in the HHH group reached a greater BW at the end of the study than those in the RRR group and tended to have a greater average daily gain in the HHH group than in the RRR group. It is concluded that forming groups of animals with a previous BRD history should minimize the incidence of respiratory cases in those groups of calves formed by animals without a previous history of respiratory disease.

[Stroke health care plan (ICTUS II. 2010)]. / Plan de asistencia sanitaria al ICTUS II. 2010.

INTRODUCTION: The Spanish Stroke Group published the "Plan for stroke healthcare delivery" in 2006 with the aim that all stroke patients could receive the same degree of specialised healthcare according to the stage of their disease, independently of where they live, their age, gender or ethnicity. This Plan needs to be updated in order to introduce new developments in acute stroke. METHODS: A committee of 19 neurologists specialised in neurovascular diseases representing different regions of Spain evaluated previous experience with this Plan and the available scientific evidence according to published literature. BACKGROUND: The new organised healthcare system must place emphasis on the characteristics of the different care levels with promotion of Reference Stroke Hospitals, set up less restrictive Stroke Code activation criteria that include new therapeutic options, establish new standard measures for endovascular treatment and develop tele-medicine stroke networks.

Gestación ectópica cervical tratada mediante punción ecoguiada intrasacular de metotrexato / Cervical pregnancy treated with local injection of methotrexate guided by transvaginal ultrasonography

El embarazo cervical es una forma infrecuente de gestación ectópica. El examen ecográfico permite el diagnóstico precoz, y una actuación conservadora. Se describe el caso clínico de una gestación ectópica cervical diagnosticada en el Servicio de Urgencias de Obstetricia y Ginecología del Hospital Universitario Miguel Servet (Zaragoza, España). Paciente nulípara de 31 años que consultó por sangrado genital. El diagnóstico se realizó mediante ecografía transvaginal, objetivándose un embarazo ectópico cervical con embrión vivo acorde a 8 semanas de edad gestacional. Se realizó tratamiento conservador con metotrexato mediante inyección local intrasacular asociado a administración sistémica. Seguimiento con determinaciones seriadas de gonodotrópica coriónica humana, objetivándose un descenso progresivo de ésta. Se efectuaron controles ecográfcos periódicos, evidenciando la reabsorción de la gestación confirmándose el éxito del tratamiento.

Cervical ectopic pregnancy is an unusual form of ectopic pregnancy. Ultrasound examination makes early diagnosis possible and permits to perform conservative treatment. We describe a case of cervical ectopic pregnancy diagnosed in the Emergency Section of Miguel Servet University Hospital (Zaragoza, Spain). A 31 year-old nullipara pregnant woman came to our Hospital because of genital bleeding. Ultrasound trans-vaginal examination demonstrated a cervical pregnancy with an 8 weeks embryo. Conservative treatment was prescribed using US-guided injection and systemic methotrexate. After treatment, weekly quantitative human chorionic gonadotrophin levels were determined and decreased progressively. Serial ultrasound exams were performed demonstrating how pregnancy products underwent resorption and confirming therapy success.

Presentación focal única de la leucoencefalopatía multifocal progresiva como inicio de infección por VIH / Focal presentation of progressive multifocal leukoencephalopathy: first manifestation of human immunodeficiency virus infection

Introducción. La leucoencefalopatía multifocal progresiva (LMP) es una enfermedad desmielinizante subaguda del sistema nervioso central causada por la infección de los oligodendrocitospor un papovavirus oportunista, el virus JC. Este virus permanece latente en el huésped (se ha detectadola presencia de anticuerpos contra el virus en cerca de 70% de los sujetos adultos) y es reactivado por algunas enfermedades y tratamientos médicos que afectan a la inmunidad celular. Caso clínico. Hombre de 35 años, fumador, alérgico a la penicilina y derivados, que reconoce consumo de drogas porvía parenteral durante unos meses de su vida. Sin otros antecedentes.Ingresa por parálisis facial y de la mano izquierda de evolución subaguda. Analíticamente se observa unaalteración en la inmunidad celular con cociente CD4/CD8 0,07 y serología positiva para virus de inmunodeficienciahumana, iniciándose tratamiento antirretroviral de gran actividad(TARGA). La resonancia magnética (RM) cerebral muestra una extensa y única lesión hiperintensa subcortical temporoparietal derecha compatible con LMP sin poder descartar astrocitoma de bajo grado. Estudio de líquido cefalorraquídeo dentro de la normalidad con reacción en cadena de la polimerasa (PCR) de virus JC negativa. Dada laedad del paciente y la buena evolución de su estado inmune tras el tratamiento, se decide una biopsia cerebral para intentar filiar el diagnóstico, demostrándose cambios atomopatológicos compatibles con LMP con PCR de JC positiva. Discusión. Presentamos este caso para ilustrar la necesidad, en casos seleccionados como puede ser la presentaciónunifocal de la enfermedad, de técnicas invasivas de diagnóstico dada la dificultad en el diagnóstico diferencialde la LMP y los tumores gliales con diferentes implicaciones pronósticas y de tratamiento (AU)

Introduction. Progressive multifocal leukoencephalopathy(PML) is a subacute demyelinating disorder ofcentral nervous system caused by an opportunistic papovavirusinfection of oligodendroglial cells, the JC virus.This virus remains latent in the human host. Their antibodiesare detectable in 70% of healthy adult subjects. Itis reactivated by different diseases and medical therapiesimpairing cellular immunity.Clinical case. A 35 year-old man, smoker, allergic topenicillin and derivatives, with a history of endovenousdrug abuse, was admitted to Neurology Department dueto a progressive left facial palsy and hand weakness. Analteration in the cellular immune ratio (CD4/CD8 0.07)and a positive human immunodeficiency virus serologywere demonstrated. Highly active antiretroviral therapy(HAART) was started. A unique wide hyperintense subcorticalright temporoparietal lobe lesion was shown bya cerebral magnetic resonance imaging (MRI), suggestinga differential diagnosis between PLM and low grade glialtumor. Cerebrospinal fluid study was normal and thepolymerase chain reaction (PCR) was negative for JC virus.A steroataxic cerebral biopsy was made in order toestablish a correct diagnosis due to patient’s age and thegood response to treatment. The pathology study showedchanges suggestive of PLM and a positive-PCR test forJC virus.Discussion. We report this case to suggest that inva-0 sive diagnosis methods may be useful to differentiate between PLM and low grade glial tumors and to establisha correct prognosis. HAART is becoming a goodtreatment option because it seems to make long termsurvival longer, as is the case of this patient who is practicallyasymptomatic after more than 2 years of evolution (AU)

[Focal presentation of progressive multifocal leukoencephalopathy: first manifestation of human immunodeficiency virus infection]. / Presentación focal única de la leucoencefalopatía multifocal progresiva como inicio de infección por VIH.

INTRODUCTION: Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating disorder of central nervous system caused by an opportunistic papovavirus infection of oligodendroglial cells, the JC virus. This virus remains latent in the human host. Their antibodies are detectable in 70% of healthy adult subjects. It is reactivated by different diseases and medical therapies impairing cellular immunity. CLINICAL CASE: A 35 year-old man, smoker, allergic to penicillin and derivatives, with a history of endovenous drug abuse, was admitted to Neurology Department due to a progressive left facial palsy and hand weakness. An alteration in the cellular immune ratio (CD4/CD8 0.07) and a positive human immunodeficiency virus serology were demonstrated. Highly active antiretroviral therapy (HAART) was started. A unique wide hyperintense subcortical right temporoparietal lobe lesion was shown by a cerebral magnetic resonance imaging (MRI), suggesting a differential diagnosis between PLM and low grade glial tumor. Cerebrospinal fluid study was normal and the polymerase chain reaction (PCR) was negative for JC virus. A steroataxic cerebral biopsy was made in order to establish a correct diagnosis due to patient's age and the good response to treatment. The pathology study showed changes suggestive of PLM and a positive-PCR test for JC virus. DISCUSSION: We report this case to suggest that inva- sive diagnosis methods may be useful to differentiate between PLM and low grade glial tumors and to establish a correct prognosis. HAART is becoming a good treatment option because it seems to make long term survival longer, as is the case of this patient who is practically asymptomatic after more than 2 years of evolution.

Canine stem cell factor augments expression of matrix metalloproteinase-9 by CD34 cells.

BACKGROUND: Canine models have proved to be predictive of clinical findings in human bone marrow (BM) transplantation; consequently, the utilization of dogs is an excellent tool for supporting therapeutic purposes. Considering the role of growth factors in homing and mobilization of hematopoietic progenitors, the aim of this work was to evaluate whether canine stem cell factor (cSCF) contributes to matrix metalloproteinase (MMP)-9 secretion by CD34 cells. METHODS: The study was carried out in a cell population selected by immunomagnetic techniques using the anti-canine CD34 monoclonal antibody (MAb) 3B4 produced by us. Secretion of MMP-9 was evaluated by zymography. RESULTS: Analyzes of canine CD34(+) cells guaranteed that the MAb 3B4 was optimum for selecting a subset population with defined characteristics of primitive hematopoietic cells. The isolated cells were able to proliferate onto irradiated pre-established stroma, giving rise to mature neutrophils. There was also a 20-fold enrichment in the long-term culture-initiating cell content when the isolated population was added to irradiated cultures, with respect to the starting mononuclear cell population. DISCUSSION: We have provided the first evidence that canine BM CD34(+) cells constitutively express MMP-9 and the role of cSCF in up-regulating the secretion of this enzyme. The fact that cSCF augments expression of MMP-9 together with the ability of the isolated CD34(+)cells to proliferate onto irradiated pre-established stroma enables further investigations to determine whether the secretion of MMP-9 mediated by cSCF is one of the factors that enhance migration, homing and repopulation of primitive hemopoietic cells.

Diagnóstico de rabdomioma fetal ecográfico / Ultrasonographic diagnosis of fetal rhabdomyoma

El rabdomioma es una tumoración rara detectada, en la mayor parte de las ocasiones, por ecografía y representa aproximadamente un 1% del total de las anomalías cardíacas halladas intraútero. La evolución intrauterina y su repercusión hemodinámica dependen del crecimiento del tumor. Grandes masas pueden ser causa de obstrucciones y posteriormente de hidropesía y taquiarritmias. A estas complicaciones se añade su asociación a la esclerosis tuberosa, la cual ocupa un lugar importante en el consejo prenatal a los padres, ya que su herencia es autosómica dominante. La frecuencia de la asociación es del 50-70% en las distintas series (AU)

Rhabdomyoma is a rare tumor usually detected by ultrasonography. This neoplasm represents approximately 1% of all intrauterine cardiac abnormalities. Development inside the uterus and the hemodynamic repercussions of this entity depend on tumoral growth. Large masses can cause obstructions and subsequently hydrops and tachyarrhythmias. In addition to these complications, rhabdomyoma is associated with tuberous sclerosis, which occupies an importance place in prenatal counseling since inheritance is autosomal dominant. The frequency of this association is between 50% and 70% in distinct series (AU)

Lamotrigine and epilepsy in the elderly: observational study of low-dose monotherapy.

A one-year prospective, observational study was conducted in 222 elderly patients (>65 years old) with epilepsy. Patients received 25 mg/day lamotrigine for the first 15 days. The dose was then increased to 50 mg/day; further increases were allowed if necessary. Vascular epilepsy was the most frequent diagnosis (56% of patients), and concomitant medication was required by 75% of patients. The mean dose was 72.17 mg/day in the 132 patients who completed the study; the initial dose of 50 mg/day was maintained in 52% of these patients. There was a marked reduction in the number of seizures with 89% of the patients who completed the study continuing to be seizure-free after 1 year. Tolerability was generally good with 15 adverse events in nine patients. Only two patients developed a rash. In conclusion, low-dose lamotrigine is an effective and well tolerated therapy for the control of epilepsy in elderly patients.

Rescaled density expansions and demixing in hard-sphere binary mixtures.

The demixing transition of a binary fluid mixture of additive hard spheres is analyzed for different size asymmetries by starting from the exact low-density expansion of the pressure. Already within the second virial approximation the fluid separates into two phases of different composition with a lower consolute critical point. By successively incorporating the third, fourth, and fifth virial coefficients, the critical consolute point moves to higher values of the pressure and to lower values of the partial number fraction of the large spheres. When the exact low-density expansion of the pressure is rescaled to higher densities as in the Percus-Yevick theory, by adding more exact virial coefficients a different qualitative movement of the critical consolute point in the phase diagram is found. It is argued that the Percus-Yevick factor appearing in many empirical equations of state for the mixture has a deep influence on the location of the critical consolute point, so that the resulting phase diagram for a prescribed equation has to be taken with caution.

Canine long-term bone marrow culture neutrophil production and functionality.

This in vitro study has been conducted to determine the optimal experimental conditions under which to produce canine neutrophils in long-term bone marrow cultures (LTBMC), establish functional parameters of neutrophils obtained from LTBMC and peripheral blood and to ascertain whether these cells display physiological similarities. Our aim is to provide an experimental model, enabling a correlation between hemopoietic injury and neutrophil functionality. The authors demonstrate for the first time that canine neutrophils grown in cultures are able to produce oxyradicals capable of killing bacterial products. Moreover, culture-grown neutrophils contain gelatinase granules, a marker of terminal neutrophil differentiation, and express a specific surface antigen. The results described in this article illustrate the development of a dynamic system that mimics physiological hemopoiesis.