Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery. / Beneficios de los bloqueos analgésicos, PENG (PEricapsular Nerve Group), en la recuperación precoz tras la cirugía de cadera.

INTRODUCTION: Hip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

[Translated article] Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery.

INTRODUCTION: Hip fracture is a frequent orthopaedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anaesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without haemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilisation and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.

Clinical and economic impact of rapid reporting of bacterial identification and antimicrobial susceptibility results of the most frequently processed specimen types.

Inappropriate antibiotic prescriptions are associated with an increase in healthcare costs and a decrease in the quality of care. The aim of this study was to measure the clinical and economic impact of rapid microbiological reporting on the specimens most frequently processed by the Microbiology Laboratory. The Vitek® 2 system (bioMérieux) was used for identification and susceptibility testing. Only hospitalized patients with bacterial infections were included. Two groups were established, a historical control group (results available the day following the analysis) and an intervention group (results available the same day of the analysis). Specimens studied and the median length of time from the introduction of the microorganism in the Vitek® 2 until microbiological report were as follows: wound and abscess (control = 23.5 h, intervention = 9.5 h, p < 0.001), blood (control = 23.5 h, intervention = 9.2 h, p < 0.001), and urine (control = 23.4 h, intervention = 9.3 h, p < 0.001). Outcome parameters were hospital stay and mortality rates. Hospital costs were calculated. The mortality rates did not differ significantly between the two groups. Faster reporting of identification and antimicrobial susceptibility results was associated with a significant reduction in hospital stay and in overall costs for those patients from whom wound, abscess, and urine specimens were analyzed. However, the antimicrobial results of blood culture isolates did not lead to significant clinical or financial benefits.

[Severity of COVID-19 attributable to obesity according to BMI and CUN-BAE]. / Gravedad de COVID-19 atribuible a obesidad según IMC y CUN-BAE.

INTRODUCTION: Obesity is considered a risk factor in severe cases of COVID-19, which has been analysed using body mass index (BMI), an estimator that does not correlate adequately with body fat (BF) percentage. The aim of this study was to analyse the population attributable fraction to BF in severe forms of COVID-19 based on BMI and CUN-BAE. MATERIAL AND METHODS: Multicentre observational prevalence study. Sociodemographic information, personal history, BMI and CUN-BAE were collected in SARS-CoV-2 positive cases from the provinces of León and La Rioja. Logistic regression models were used to calculate odds ratios with their respective 95% confidence intervals adjusting for age and personal history, as well as the population attributable fraction to BF. RESULTS: Seven hundred eighty-five patients participated, 123 (15.7%) were severe. Age, obesity (both by BMI and CUN-BAE) and personal history were detected as risk factors. 51.6% of severe cases could be attributed to excess BMI and 61.4% to excess BF estimated according to CUN-BAE, with a higher underestimation of risk in women. CONCLUSIONS: Excess BF is a risk factor for severe forms of COVID-19 together with advanced age and the presence of cardiovascular, chronic respiratory or oncohematological diseases. BMI underestimates the risk especially in women, being CUN-BAE the predictor selected for its better estimation of the percentage of BF.

Related target enhancers for dorsal and NF-kappa B signaling pathways.

Drosophila dorsoventral (DV) patterning and mammalian hematopoiesis are regulated by related signaling pathways (Toll, interleukin-1) and transcription factors (dorsal, nuclear factor-kappa B). These factors interact with related enhancers, such as the rhomboid NEE and kappa light chain enhancer, that contain similar arrangements of activator and repressor binding sites. It is shown that the kappa enhancer can generate lateral stripes of gene expression in transgenic Drosophila embryos in a pattern similar to that directed by the rhomboid NEE. Drosophila DV determinants direct these stripes through the corresponding mammalian cis regulatory elements in the kappa enhancer, including the kappa B site and kappa E boxes. These results suggest that enhancers can couple conserved signaling pathways to divergent gene functions.

Comparison between rotary and manual instrumentation in primary teeth.

UNLABELLED: The aim of this study was to compare the efficiency in both, preparation time and root canal shape, when using the Nickel Titanium (Ni-Ti) rotary and K-Files hand instrumentation on root canal preparation of single rooted primary teeth. MATERIAL AND METHODS: Sixty single rooted primary teeth were selected and divided into two equal groups: Group (I) 30 teeth instrumented with manual K-files and group (II) 30 teeth instrumented with Ni-Ti rotary files (ProFile 0.04). Instrumentation times were calculated and root canal impressions were taken with light bodied silicone in order to evaluate the shape. The data was analyzed with SPSS program using the t-test and the Chi-square test to compare their means. RESULTS: The preparation time with group (I) K-files was significantly higher than in group (II) rotary files (ProFile 0.04), with a p= .005. The ProFile system showed a significantly more favorable canal taper when compared to the K-files system (P= .002). CONCLUSIONS: The use of rotary files in primary teeth has several advantages when compared with manual K files: the efficiency in both, preparation time and root canal shape. 1. A decreased working time, that helps maintain patient cooperation by diminishing the potential for tiredness. 2. The shape of the root canal is more conical, favoring a higher quality of the root canal filling, and increasing clinical success.

Classification of glucose records from patients at diabetes risk using a combined permutation entropy algorithm.

BACKGROUND AND OBJECTIVES: The adoption in clinical practice of electronic portable blood or interstitial glucose monitors has enabled the collection, storage, and sharing of massive amounts of glucose level readings. This availability of data opened the door to the application of a multitude of mathematical methods to extract clinical information not discernible with conventional visual inspection. The objective of this study is to assess the capability of Permutation Entropy (PE) to find differences between glucose records of healthy and potentially diabetic subjects. METHODS: PE is a mathematical method based on the relative frequency analysis of ordinal patterns in time series that has gained a lot of attention in the last years due to its simplicity, robustness, and performance. We study in this paper the applicability of this method to glucose records of subjects at risk of diabetes in order to assess the predictability value of this metric in this context. RESULTS: PE, along with some of its derivatives, was able to find significant differences between diabetic and non-diabetic patients from records acquired up to 3 years before the diagnosis. The quantitative results for PE were 3.5878 ±â€¯0.3916 for the nondiabetic class, and 3.1564 ±â€¯0.4166 for the diabetic class. With a classification accuracy higher than 70%, and by means of a Cox regression model, PE demonstrated that it is a very promising candidate as a risk stratification tool for continuous glucose monitoring. CONCLUSION: PE can be considered as a prospective tool for the early diagnosis of the glucoregulatory system.

Intrathecal clonidine as an adjuvant for neuraxial anaesthesia during caesarean delivery: a systematic review and meta-analysis of randomised trials.

BACKGROUND: Clonidine is used as adjuvant to local anaesthetics for spinal anaesthesia. Its potential harm and benefits have not been systematically reviewed in obstetrics, and medical regulatory authorities do not recommend its intrathecal administration. The aim of this study was to assess the safety and efficacy of intrathecal clonidine for caesarean delivery. METHODS: We conducted a systematic literature search in Medline, Embase, the Cochrane Library databases and trial registries for randomised trials assessing intrathecal clonidine as an adjuvant to local anaesthetics in patients undergoing caesarean delivery. Studies were assessed for quality, and data were extracted on study characteristics, safety and efficacy. Pooled data analysis using random-effects models was performed. Relative risk (RR) or mean difference with 95% confidence intervals (CI) were used to analyse outcomes. RESULTS: Of 201 reports screened, 12 relevant clinical trials were included. Clonidine prolonged the duration of sensory block by 128.2min (95% CI 81.7 to 174.8) and motor block by 44.7min (95% CI 8.7 to 80.7). Clonidine increased sedation, RR 3.92 (95% CI 1.17 to 13.14), but did not increase the risk of hypotension, pruritus or postoperative nausea and vomiting. Apgar scores at 1 or 5min were not influenced by the addition of intrathecal clonidine. CONCLUSION: Clonidine is an effective and safe adjuvant to local anaesthetics for spinal anaesthesia for caesarean delivery. This opens the debate as to whether intrathecal clonidine as an "off label" prescription should be reconsidered by medical regulatory authorities.

A new technique of pedicle screw placement with the use of sequential multilevel navigation templates based on patient-specific 3D CT reconstruction model: applicability in spine deformity.

INTRODUCTION: The technique of placement of pedicle screws has gradually improved, but even misplacement observed in 1.2 to 20% of cases, have appeared techniques fluoroscopic, tomographic and electromagnetic navigation, which led it to 1.3 to 4.3%, but nevertheless they are expensive and complex technologies. Present technique pedicle screw placement by using templates with a modification in the art, performing tomography and reconstruction in the same surgical position and with the templates of 3 or more levels. METHODS: Five cases of idiopathic scoliosis were performed, with correction and instrumentation with pedicular screws, where a three-dimensional model of the spine was performed with a tomography in a surgical position, whose images were exported to a 3D printer to reconstruct the desired trajectory of the screws in a template using cylinders resting on the inverse surface of the vertebrae. The direction of the screw was planned in the center of the pedicle and parallel to the upper platform of the vertebra. Each template was of several levels and transoperative X-rays were not used. RESULTS: Under electrophysiologic monitoring transoperative «red alerts¼ were not reported, the placement of the screws in postoperative CT scan was evaluated, showing a standard deviation in placement of 1.9 and 2.2 mm on the right and left respectively pedicles, with respect to their planning. DISCUSSION: This technique is simple and safe, besides not requiring great technology, its use is suggested in beginner spine surgeons and in severe deformities, it can be performed in any hospital where spinal surgery is performed.

INTRODUCCIÓN: La técnica de colocación de tornillos transpediculares ha mejorado paulatinamente, a pesar de ello, la mala colocación oscila entre 1.2 al 20% de los casos; han surgido técnicas de navegación asistidas por flouroscopía, tomografía y resonancia magnética mejorando el índice de falla al 1.3-4.3%. La presente técnica de colocación utiliza plantillas con la modificación de que la tomografía y la reconstrucción son realizadas con el paciente en la posición quirúrgica, además que las plantillas abarcan tres o más niveles. MÉTODOS: Se presentan cinco casos de escoliosis idiopática tratados con instrumentación y colocación de tornillos transpediculares donde se generó un modelo tridimensional de la columna en posición quirúrgica; las imágenes fueron exportadas a una impresora 3-D para reconstruir la trayectoria apropiada de los tornillos, la dirección de éstos fue planeada tomando de referencia el centro del pedículo y paralela a la plataforma superior de la vértebra. Cada plantilla consta de diferentes niveles y no se requirió del uso de rayos X trans­operatorios. RESULTADOS: Bajo monitoreo electrofisiológico transquirúrgico no se reportó ninguna «alerta roja¼; la evaluación postoperatoria por tomografía de la colocación de los tornillos mostró una desviación estándar de 1.9 y 2.2 mm tanto a la derecha y a la izquierda, respectivamente, de acuerdo con lo planeado. DISCUSIÓN: La técnica es simple y segura, no requiere de mucho despliegue tecnológico, se sugiere su uso para los cirujanos de columna con poca experiencia y para deformidades severas; consideramos que puede desarrollarse en cualquier hospital donde se realice cirugía de columna.

Differential splicing of the growth hormone-releasing hormone gene in rat placenta generates a novel pre-proGHRH mRNA that encodes a different C-terminal flanking peptide.

We have isolated and characterized a novel rat placental pre-proGHRH mRNA (pre-proGHRH-2 mRNA). This mRNA is generated by an alternative splicing process which results in the presence of an additional exon of 156 bp (designated exon 4.5) located between exons 4 and 5 of the previously reported hypothalamic and placental pre-proGHRH mRNA (pre-proGHRH-1 mRNA). Since the sequences encoding mature GHRH are included within exons 3 and 4, the processing of pre-proGHRH-2 would not affect the synthesis of mature GHRH but would generate a C-terminal peptide (designated GCTP-2) different from that previously reported in the hypothalamus and placenta (GCTP-1). The putative GCTP-2 has 64 amino acids, and the first 18 N-terminal residues are identical to those present in GCTP-1 (30 amino acids long). Pre-proGHRH-2 mRNA has not been detected in the hypothalamus.

Hepatic alterations and induction of micronuclei in rainbow trout (Oncorhynchus mykiss) exposed to a textile industry effluent.

Rainbow trout, Oncorhynchus mykiss, were exposed to a sublethal dose of a wool shrinkproofing effluent for 15, 30, 45 and 60 days. Liver and blood samples were taken after the exposure time together with samples of control handled fish. A light and electron microscope study was carried out to evaluate the histopathological lesions induced in the liver of treated fish. The genotoxic potential of the effluent was assessed by piscine micronucleus test. Vacuolation of liver bile preductular cells was observed in all exposed fish; abnormal lipid accumulation and basophilic foci were seen in the liver of one 30-days- and 45-days-exposed fish, respectively. These specific alterations could be related to a pre-carcinogenic process. On the contrary, other lesions also described in all treated fish such as dilatation, vesiculation and degranulation of the rough endoplasmic reticulum, altered mitochondria, increase in myelin bodies and lysosomes and presence of phagosomes in wandering macrophages might be considered as non-specific alterations, similar to those described in fish exposed to different pollutants. Frequencies of micronucleated peripheral erythrocytes showed a significant increase following 30-days exposure.

Molecular cloning and expression of stromalin protein from Drosophila melanogaster: homologous to mammalian stromalin family of nuclear proteins.

We report the cloning of a new cDNA from Drosophila melanogaster that encodes an open reading frame of 1116 amino acid residues. It is the insect homolog of the previously reported stromalin (SA) family of nuclear proteins in mammals (Carramolino et al. [1997]. Gene 195, 151-159). Taking into account the identical domain present in all the SA family members characterized to date, we have carried out polymerase chain reaction (PCR) using degenerate oligonucleotides from the 5' and 3' ends of one of those regions of the molecule and cDNA from D. melanogaster embryos. We isolated the homologous domain of the putative Drosophila SA molecule (DSA). This cDNA fragment was used as a radiolabeled probe for screening a cDNA library from Drosophila embryos, and we have cloned a full-length cDNA for the SA homolog from an insect. The protein shows a good degree of identity with the mammalian stromalins SA-1 and SA-2, with the N and C ends being the most divergent regions of the molecule. The mRNA coding for this protein shows a molecular size of about 3.7 kb by Northern blot analysis and is essentially expressed in embryonic stage. The in situ hybridization experiments indicate that the DSA messenger is expressed mainly in neurogenic territories in the embryonic development of Drosophila. The DSA protein has been cloned and expressed in a baculovirus system, and polyclonal antibodies were generated against the recombinant molecule. Western blot analysis using these antibodies detected a main band corresponding to about 120 kDa, principally in embryos.

Amperometric glutamate biosensor based on poly(o-phenylenediamine) film electrogenerated onto modified carbon paste electrodes.

A glutamate biosensor was developed by electropolymerizing o-phenylenediamine on a dehydrogenase-NAD+ modified carbon paste electrode. The amperometric response to glutamate was obtained by means of the electrocatalytic oxidation of the enzymatically produced NADH, at an applied potential close to 0 V (Ag/AgCl). After optimizing carbon paste composition, polymer thickness and operating variables, a linear amperometric response to glutamate was obtained within the concentration range 5.0 x 10(-6)-7.8 x 10(-5) M with a detection limit of 3.8 x 10(-6) M. The biosensor was applied to the determination of glutamate in chicken bouillon cubes. Good accuracy was found with respect to a reference enzymatic spectrophotometric method.

Simultaneous in vivo imaging of leukocyte migration: heterogeneity among iris, limbus, and choroid vessels.

PURPOSE: Endothelial cells of different vascular systems may express site-specific adhesion molecules to attract leukocyte subsets. This study describes a method to visualize and compare leukocyte-endothelial interactions in three vascular beds within the same eye in mice. METHODS: Digital in vivo fluorescence microscopy was used to record a trans-corneal iris view, a superficial limbus view, and a trans-scleral anterior choroid view of mouse tissue. Uveitis was induced by intravitreal injection of E. coli endotoxin into BALB/c mice. Leukocytes were labeled systemically with SYTO-16 or rhodamine 6G. Leukocyte rolling and sticking were quantified at baseline and 4, 6, and 24 hours after endotoxin injection. RESULTS: In a normal animal, the limbus had 18 times the number of rolling leukocytes and 6 times the number of sticking leukocytes relative to the iris. All three vascular beds were affected by intravitreal injection of endotoxin. Although they each showed increased numbers of rolling and sticking cells, the levels and kinetics of these increases differed. Rolling peaked at 6 hours in the iris (34-fold increase from baseline) and limbus (7-fold increase) but was maximal in the choroid earlier with a 16-fold increase. Sticking was maximal at 4 hours for iris (96-fold increase) and choroid (19-fold increase) but peaked in the limbus at 6 hours (47-fold increase from baseline). CONCLUSIONS: This study demonstrates that leukocyte-endothelial dynamics are not the same in different vascular beds in the normal mouse eye. Furthermore, site-specific differences in responses to intravitreally injected endotoxin, beyond what can be readily explained by differential distribution of endotoxin, were observed. The methodology can be used to test the hypothesis that endothelial cells within the eye have site-specific patterns of adhesion molecule expression.

Histopathology of cultured sea bream Sparus aurata infected with sanguinicolid trematodes.

The present study is the first report of a sanguinicolid infection affecting sea bream Sparus aurata cultured in net cages in the NE of Spain. The disease was associated with trickling mortalities during the cold season (1999 and 2000). Examination of gill wet mounts of the affected population revealed that sanguinicolid infection was present in 82.6 and 100% of the fish sampled in 1999 and 2000, respectively. Adult flukes, which were located in the kidney, were tentatively identified as members of the family Sanguinicolidae, subfamily Cardicolinae. Eggs and miracidia were found in the gill vascular structures. The inflammatory response triggered by the parasites was moderate and the lesions caused by either eggs and miracidia in the gills or adult flukes in the kidney were not extremely severe, possibly because of the moderate intensity of the parasitosis. Histological observations of sanguinicolid infected sea bream presented here are compared with those reported in other fish species. The role played on sea bream morbility and mortality by other factors (occurrence of a simultaneous moderate monogenean infection, immunological impairement related to low water temperatures) is discussed.

Epitheliocystis agents in sea bream Sparus aurata: morphological evidence for two distinct chlamydia-like developmental cycles.

The morphology of membrane-bound intracellular inclusions, or 'cysts', of epitheliocystis from sea bream Sparus aurata is described. Inclusions under the light microscope appear either granular or amorphous. Granular inclusions do not elicit a proliferative host reaction and contain the 3 distinctive developmental stages of chlamydial organisms: the highly pleomorphic reproductive form or reticulate body, the condensing form or intermediate body and the infective non-dividing rather uniform elementary body. Amorphous inclusions may elicit a proliferative host reaction and contain prokaryotic organisms which differ morphologically from those reported within granular cysts. More or less elongated electron-lucent organisms divide by fission to give rise to electron-dense non-dividing small cells with a dense nucleoid. Vacuolated and non-vacuolated small cells are reported. The morphology and developmental cycle of sea bream epitheliocystis agents would support their chlamydial nature; however, the immunohistochemical study conducted on gill samples which carried both inclusions failed to demonstrate the expression of lipopolysaccharide (LPS) chlamydial antigen. The different stages of the 2 distinct developmental cycles described in the present study are compared with electron microscope observations of epitheliocystis organisms reported from different host species. The hypothesis that epitheliocystis infection in the sea bream might be caused by a unique highly pleomorphic chlamydia-like agent, the life history of which includes 2 entirely different developmental cycles, is discussed.

Myxidium leei (Myxozoa) infections in aquarium-reared Mediterranean fish species.

An episode of parasitic enteritis causing trickling mortalities at an exhibition aquarium reproducing Mediterranean ecosystems was found to be caused by the myxozoan parasite Myxidium leei Diamant, Lom & Dykova 1994. The myxozoan was recorded in 25 different fish species belonging to 16 Genera, 10 Families and 4 Orders. It was mainly detected in the intestine of affected fish, and was responsible for severe chronic enteritis. The parasite was probably introduced into the facilities with infected wild fish, and transmitted directly from fish to fish by cohabitation, transfer of infected material and necrophagia. Fish belonging to the Families Labridae and Blenniidae appeared as most susceptible, and the incidence of infections in members of the Sparidae was low. This study significantly widens the host spectrum for this virulent parasite and now includes many ubiquitous coastal Mediterranean species. Wild fish may have a significant role in the transmission of myxidiosis of cultured sparid fish.

Histopathological events throughout the development of turbot (Scophthalmus maximus L.) larvae.

Histopathological observations in cultured turbot (Scopthalmus maximus L.) larvae are described in varying developmental stages. No striking changes were found during the endogenous feeding period. After the introduction of live food, the main lesions encountered were atrophy and degeneration of the digestive system, but these lesions were not associated with high mortality rates in the culture system during the early stages. Subsequently, during the stages of organogenesis, progressive bacterial colonization of the digestive tract was observed, accompanied by severe enteritis, especially in the more mature larvae. High mortality rates were detected in the rearing system at this time. In severe cases, necrosis of pancreatic acini and hepatocytes were observed also. Swimbladder alterations such as non-inflation, malformation and bacterial invasion via the pneumatic duct were frequently observed at all stages of development. It is suggested that infectious agents may play an important role in the high mortality often encountered in cultured turbot larvae.

[C-reactive protein in differential diagnosis of primary thrombocytosis]. / La proteína C reactiva en el diagnóstico diferencial de la trombocitosis primaria.

BACKGROUND: The most potent stimulator for the hepatic synthesis of C-reactive protein is the interleukin-6. Also interleukin-6 is endowed with thrombopoietic activity, and its seric levels increases in most of secondary thrombocytosis whereas they remain normal in chronic myeloproliferative diseases or primary thrombocytosis. The aims of the study were verify the ability of quantitation of serum C-reactive protein in the differential diagnosis of primary thrombocytosis. METHODS: Serum samples from 89 patients with thrombocytosis (> 400 x 10(9)/1) and 54 normal controls were assayed for C-reactive protein. Patients with thrombocytosis were classified in primary thrombocytosis with 27 patients (chronic myeloproliferative disease with thrombocytosis) and secondary thrombocytosis (62 cases). RESULTS: The mean C-reactive protein serum levels observed in the 27 patients with primary thrombocytosis were 13 +/- 10 mg/l, superior to normal controls (7 +/- 5 mg/l; p < 0.01). In the secondary thrombocytosis group, C-reactive protein serum levels reached a mean value of 59 +/- 34 mg/l, clearly superior to control group and the primary thrombocytosis group (p < 0.0001). No patients in primary thrombocytosis group reached a C-reactive protein value > 40 mg/l, versus 65% of patients in secondary thrombocytosis group. A normal value occurred in 67% cases of primary thrombocytosis group, but also in 17% cases of secondary thrombocytosis group. CONCLUSIONS: Quantitation of C-reactive protein could thus prove useful in the differential diagnosis between primary and secondary thrombocytosis.