Outcome without any adjuvant systemic treatment in stage I ER+/HER2- breast cancer patients included in the MINDACT trial.

BACKGROUND: Adjuvant systemic treatments (AST) reduce mortality, but have associated short- and long-term toxicities. Careful selection of patients likely to benefit from AST is needed. We evaluated outcome of low-risk breast cancer patients of the EORTC 10041/BIG 3-04 MINDACT trial who received no AST. PATIENTS AND METHODS: Patients with estrogen receptor-positive, HER2-negative, lymph node-negative tumors ≤2 cm who received no AST were matched 1 : 1 to patients with similar tumor characteristics treated with adjuvant endocrine therapy (ET), using propensity score matching and exact matching on age, genomic risk (70-gene signature) and grade. In a post hoc analysis, distant metastasis-free interval (DMFI) and overall survival (OS) were assessed by Kaplan-Meier analysis and hazard ratios (HR) by Cox regression. Cumulative incidences of locoregional recurrence (LRR) and contralateral breast cancer (CBC) were assessed with competing risk analyses. RESULTS: At 8 years, DMFI rates were 94.8% [95% confidence interval (CI) 92.7% to 96.9%] in 509 patients receiving no AST, and 97.3% (95% CI 95.8% to 98.8%) in 509 matched patients who received only ET [absolute difference: 2.5%, HR 0.56 (95% CI 0.30-1.03)]. No statistically significant difference was seen in 8-year OS rates, 95.4% (95% CI 93.5% to 97.4%) in patients receiving no AST and 95.6% (95% CI 93.8% to 97.5%) in patients receiving only ET [absolute difference: 0.2%, HR 0.86 (95% CI 0.53-1.41)]. Cumulative incidence rates of LRR and CBC were 4.7% (95% CI 3.0% to 7.0%) and 4.6% (95% CI 2.9% to 6.9%) in patients receiving no AST versus 1.4% (95% CI 0.6% to 2.9%) and 1.5% (95% CI 0.6% to 3.1%) in patients receiving only ET. CONCLUSIONS: In patients with stage I low-risk breast cancer, the effect of ET on DMFI was limited, but overall significantly fewer breast cancer events were observed in patients who received ET, after the relatively short follow-up of 8 years. These benefits and side-effects of ET should be discussed with all patients, even those at a very low risk of distant metastasis.

Combining method of detection and 70-gene signature for enhanced prognostication of breast cancer.

PURPOSE: Studies have shown that screen detection by national screening programs is independently associated with better prognosis of breast cancer. The aim of this study is to evaluate the association between tumor biology according to the 70-gene signature (70-GS) and survival of patients with screen-detected and interval breast cancers. METHODS: All Dutch breast cancer patients enrolled in the MINDACT trial (EORTC-10041/BIG3-04) accrued 2007-2011, who participated in the national screening program (biennial screening, ages 50-75) were included (n = 1102). Distant Metastasis-Free Interval (DMFI) was evaluated according to the 70-GS for patients with screen-detected (n = 754) and interval cancers (n = 348). RESULTS: Patients with screen-detected cancers had 8-year DMFI rates of 98.2% for 70-GS ultralow-, 94.6% for low-, and 93.8% for high-risk tumors (p = 0.4). For interval cancers, there was a significantly lower 8-year DMFI rate for patients with 70-GS high-risk tumors (85.2%) compared to low- (92.2%) and ultralow-risk tumors (97.4%, p = 0.0023). Among patients with 70-GS high-risk tumors, a significant difference in 8-year DMFI rate was observed between interval (85.2%, n = 166) versus screen-detected cancers (93.8%, n = 238; p = 0.002) with a HR of 2.3 (95%CI 1.2-4.4, p = 0.010) adjusted for clinical-pathological characteristics and adjuvant systemic treatment. CONCLUSION: Among patients with 70-GS high-risk tumors, a significant difference in DMFI was observed between screen-detected and interval cancers, suggesting that method of detection is an additional prognostic factor in this subgroup and should be taken into account when deciding on adjuvant treatment strategies.

Analysis of health habits, vices and interpersonal relationships of Spanish adolescents, using SEM statistical model.

The objective of this article is to know the state of health of a sample of adolescents and how it relates to toxic habits and personal relationships. Likewise, it is presented how can influence eating habits, sports practice and interpersonal relationships in their general health status. The research has carried out through a survey of 56 questions to 470 adolescents, between 13 and 18 years old, of both sexes, of different schools in the province of Cordoba, Spain. These results have been subjected to a statistical model widely used in health and social sciences in general, called Structural Equations Model (SEM), through the SPSS program, v. 23 and AMOS. SEM is widely used in the social sciences to estimate regression models (usually multi-equational). The estimated model shows a significant global acceptability based on the usual statistical tests and goodness-of-fit measures. In this regard, these results are: CMIN = 17.554 with 33 degrees of freedom (DF) and a probability level, p = 0.987, which is higher than any reasonable level of significance (α = 0.05, 0.10, even 0.20). Likewise, FMIN = 0.038, CFI = 1.000 and RMSEA = 0.000. The main recommendation of this research aimed at improving good eating and healthy habits, and to avoid toxic habits of adolescents, is to begin the education in the family, in coordination with their school and high school.

Surface of Half-Neutralized Diamine Triflate Ionic Liquids. A Molecular Dynamics Study of Structure, Thermodynamics, and Kinetics of Water Absorption and Evaporation.

Surface properties of room temperature ionic liquids (RTILs) consisting of half neutralized diamine cations (H2N-(CH2)n-NH3+, n = 2, 4) and triflate anions have been investigated by molecular dynamics simulations, based on an empirical atomistic force field. Planar slabs periodically repeated in 2D have been considered, and the temperature range 260 ≤ T ≤ 360 K has been covered, extending from below the melting and glass point to the equilibrium liquid range of the diamine compounds under investigation. Addition of water at 1% weight concentration allowed us to investigate the kinetics of water absorption through the RTIL surface, and to characterize the structural and dynamical properties of subsurface water. Animations of the simulation trajectory highlight the quick absorption of water molecules, progressing downhill in free energy and taking place without apparent intermediate kinetic stages. To verify and quantify these observations, a variant of the umbrella sampling algorithm has been applied to compute the variation of excess free energy upon displacing a water molecule along the normal to the surface, from the center of the slab to the vapor phase. The results provide a comprehensive picture of the thermodynamic properties underlying the kinetics of water absorption and evaporation through the surface, and they also provide the ratio of the equilibrium density of water in the vapor and liquid phase at the average concentration considered by simulations. A variety of properties such as the surface energy, the 90-10% width of the profile, the layering of different species at the interface, and the electrostatic double layer at the surface are computed and discussed, focusing on the effect of water contamination on all of them.

Primary cerebral fibrosarcoma in a child.

OBJECTIVE: To describe the case of a primary cerebral fibrosarcoma in a child. CLINICAL CASE: A 6-year-old boy presented with a history of headache, drowsiness, vomiting and seizures. He was referred to our institution and died shortly upon arrival to the ER. The autopsy revealed a large left frontoparietal mass with histopathologic features characteristic of fibrosarcoma. Immunohistochemical and ultrastructural studies allowed the exclusion of other mimickers such as meningiomas, and neoplasms of glial or neuronal origin. No other growths were found in the CNS or in other parts of the body. CONCLUSIONS: Brain fibrosarcoma is an exceedingly uncommon tumor. Only 41 cases have been reported to date. The diagnosis of fibrosarcoma must be based on the identification of a predominant herringbone architectural pattern, and immunohistochemical features, although the latter are of limited diagnostic value, its importance being that they facilitate the exclusion of other entities considered in the differential diagnosis.

Monthly variations in ovine seminal plasma proteins analyzed by two-dimensional polyacrylamide gel electrophoresis.

This study was conducted to evaluate monthly changes in the ram seminal plasma protein profile using two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) with a polyacrylamide linear gradient gel. Likewise, comparative analyses of the protein composition of ovine seminal plasma (SP) from ejaculates obtained along the year, and its relationship with sperm motility, viability and concentration of ejaculate were carried out. Western-blot analysis was performed to specifically detect P14, a ram SP protein postulated to be involved in sperm capacitation and gamete interaction [Barrios B, Fernández-Juan M, Muiño-Blanco T, Cebrián-Pérez JA. Immunocytochemical localization and biochemical characterization of two seminal plasma proteins which protect ram spermatozoa against cold-shock. J Androl 2005;26:539-49], and its variations along the year have also been established. The experiment was carried out from May 2003 to April 2004, with nine Rasa Aragonesa rams. Ejaculates obtained every 2 days were pooled and used for each assay, to avoid individual differences, and three two-dimensional SDS-PAGE gels were run for each month. The high resolution of the gradient gel allowed the image analysis software to detect around 252 protein spots, with pIs ranging from 4.2 to 7.6, and molecular weight (M(r)) from 12.5 to 83.9 kDa. Four protein spots (1, 2, 3 and 4) of low M(r) (15.1, 15.7, 15.9 and 21.0 kDa) and acidic pI (5.9, 5.3, 5.7 and 6.6), respectively, had the highest relative intensity in the SP map (11.2, 9.3, 4.7 and 7.7%, respectively). Spot 3 was more abundant (P<0.05) from May to December, and negatively correlated (P<0.05, r=-0.34) with sperm viability and concentration (P<0.05, r=0.36). Another 12 protein spots also had significant quantitative differences (P<0.05) along the year, and 17 protein spots, which correlated with some seminal quality parameter, did not show quantitative monthly changes. Western-blot analysis indicated that spots 1 and 2 reacted with the anti-P14 antibody, raised against the P14 band (approximate M(r) 14 kDa) of ram SP. This indicates that spots 1 and 2 are similar to RSP15 [Bergeron A, Villemure M, Lazure C, Manjunath P. Isolation and characterization of the major proteins of ram seminal plasma. Mol Reprod Dev 2005;71:461-70], bovine PDC-109 [Esch FS, Ling NC, Bohlen P, Ying S, Guillemin R. Primary structure of PDC-109, a major protein constituent of bovine seminal plasma. Biochem Biophys Res Commun 1983;113:861-7] (also called BSP A1/A2 [Manjunath P, Sairam MR. Purification and biochemical characterization of three major acidic proteins (BSP-A1, BSP-A2 and BSP-A3) from bovine seminal plasma. Biochem J 1987;241:685-92]) and goat GSP-14/15 kDa [Villemure M, Lazure C, Manjunath P. Isolation and characterization of gelatine-binding proteins from goat seminal plasma. Reprod Biol Endocrinol 2003;1:39], based on our previous results on the P14 amino acid sequence [Barrios B, Fernández-Juan M, Muiño-Blanco T, Cebrián-Pérez JA. Immunocytochemical localization and biochemical characterization of two seminal plasma proteins which protect ram spermatozoa against cold-shock. J Androl 2005;26:539-49].

Penile cancer associated with so-called low-risk human papilloma virus. Report of five cases from rural Venezuela.

Penile cancer is uncommon in western countries. It has been related to human papilloma virus (HPV) types 16 and 18. We describe five cases of carcinoma of the penis in men from a rural Venezuelan town that were related to HPV types 6, 11, 53, which represent a rather low risk for cancer.

GABA immuno-electron microscopic study of the nucleus of the optic tract in the rabbit.

The pretectal nucleus of the optic tract (NOT) was investigated immunocytochemically with an antiserum against gamma aminobutyric acid (GABA) employing the pre-embedding peroxidase antiperoxidase technique at the light microscopic level and the postembedding colloidal gold technique at the electron microscopic level. GABA immunoreactivity was observed in cell bodies of different sizes and as punctate structures in the neuropil. In the electron microscope, besides immunoreactive dendrites, four different types of terminals were found to be GABA-immunopositive; three types of terminals with clustered and flattened vesicles (F-profile) and a fourth type with pleomorphic vesicles, presumably of dendritic origin (P-profile). Both P- and F-profiles formed symmetrical synapses with dendritic profiles arranged in clusters ensheathed by glial elements. GABA-immunopositive terminals were observed in synaptic contact with somata and retinal terminals (R-profiles) that were always GABA-immunonegative. Some GABA-immunopositive somata showed presynaptic contacts with dendrites. The presence of GABA in numerous distinct elements in the NOT and the diversity in labeled somata and terminals demonstrate the importance of the inhibitor neurotransmitter in the NOT and suggest that its function is not limited to interneurons.

GABAergic neurons and circuits in the pretectal nuclei and the accessory optic system of mammals.

Two classes of GABAergic cell bodies have been described. They probably can be divided into GABAergic local interneurons and GABAergic projection neurons. GABAergic cell bodies receive few terminals which is in contrast to non-GABAergic somata, which receive many synaptic contacts. GABAergic dendrites that originate from GABAergic cell bodies, however, receive numerous terminals, both GABAergic and nonGABAergic. It can therefore be concluded that somatic inhibition is not present on GABAergic neurons, but does occur on nonGABAergic neurons. Furthermore, dendrites traverse large parts of the NOT/DTN forming a complex network that enables sampling and integration from a wide area. The projection to the IO is not GABAergic itself, but cells projecting to the IO receive a substantial GABAergic input, that probably originates in part from the MTN. Further investigation on the distribution of this input over a completely identified neuron would provide the quantitative data that are required to verify the above mentioned hypothesis. A GABAergic projection that originates in the pretectal nuclei is directed towards the superficial layers of the SC in the cat (Appell and Behan, 1990) and rat (Van der Want et al., 1991). A second GABAergic projection derives from the pretectum and reaches the LGN (Cucchiaro et al., 1991). Whether this projection originates from the same GABAergic cell bodies that project to the SC and the LGN or is derived from different populations remains to be determined. The ultrastructural studies of the NOT/DTN complex have shown that GABAergic terminals with different morphological characteristics are present and that the GABA positive F and P terminals are widely distributed over somata and the adjacent neuropil. The P terminals probably originate from dendrites of GABAergic interneurons while the F types originate from GABAergic projection and interneurons (Van der Want and Nunes Cardozo, 1988). One of these sources is located in the MTN differ from the intrinsic GABAergic terminals with respect to their relation to R terminals. GABAergic MTN terminals were never observed to receive R terminal input. This is in contrast with other GABAergic terminals which frequently do receive direct contact from R terminals. Within glomeruli triadic arrangements, formed by a single retinal terminal, a dendritic profile and second axonal profile dendritic profile and second axonal profile synapsing with the dendrite, were frequently encountered in the OPN (Campbell and Lieberman, 1985), but only occasionally in the NOT/DTN (Nunes Cardozo and Van der Want, 1987).(ABSTRACT TRUNCATED AT 400 WORDS)

Variations in presynaptic grid size in the granular and molecular layer of the cerebellar cortex of the cat. I. A quantitative ultrastructural study on semithin E-PTA sections.

The size distribution of synapses in the cerebellar cortex of the cat was defined on 0.5-micron semithin sections stained with ethanolic phosphotungstic acid (E-PTA). The surface area (SA) of synaptic grids was measured and the number of dense projections per grid (NDP) was counted. The results show large differences in mean values between molecular and granular layer. Within the molecular layer the differences in mean values at different levels below the pial surface were small; however, the frequency distributions differed significantly. In the granular layer a confined unimodal frequency distribution of SA and NDP was observed (mean NDP, 7.02 +/- 0.10), in the molecular layer a considerable variation in the size of the synaptic discs was observed (mean NDP, 20.40 +/- 0.43). Only a small percentage of the synaptic discs have less than 5 or more than 47 DPs. The sharply defined differences in synaptic size between the granular and molecular layer and the smaller differences within the granular and molecular layer are discussed in the context of the congruity hypothesis of Chan-Palay.

The presynaptic grid: a new approach.

A new electron microscopic facility is described which enables systematic visualization of E-PTA-stained presynaptic grids in full en face position. This EM-facility is used to analyze the size and the number of dense projections of synaptic grids in different brain areas of the rabbit. The observations support the view that dense projections form an intrinsic part of all central synapses and are organized in a hexagonal or triangular pattern. The observation of annulate and horseshoe-shaped synaptic grids is in agreement with previous observations on synaptic connections with subsynaptic plate perforations. A non-normal frequency distribution of dense projections per synaptic grid with distinct peaks is suggestive for the existence of distinct size classes of synaptic contacts. Analyses of the frequency distribution of dense projections in different areas and at different levels below the pial surface in adult animals point to a specificity of the distinct size classes related to the afferent origin or the target cell they are projecting on. Investigation of grid size and number of dense projections during a period of rapid synaptogenesis reveals that newly formed synapses also have a specific size. The complementarity of dense projections and vesicle attachment sites implicit in the model of Akert et al. has been used to calculate the number of vesicle attachment sites per sq. micrometer on account of the density of projections per grid. The agreement between our values and those of Akert and Peper, based on the analyses of vesicle attachment sites in freeze-etch specimen, is striking. The possible implications of these observations in relation to synaptic efficacy and neuronal microcicuitry are discussed.

Hallervorden-Spatz disease: two new early childhood onset cases.

Hallervorden-Spatz disease is a rare, autosomal-recessive hereditary condition characterized by early onset of progressive movement alterations such as dystonia, rigidity, and choreoathetosis, which is usually associated with pyramidal signs and mental deterioration. The authors report two cases for which diagnosis of Hallervorden-Spatz disease was based on clinical manifestations that appeared during the first year of life, illness progression, and late-stage magnetic resonance imaging findings. The possibility that these two cases, along with other previously described rare instances with similar clinical features, be considered as a variant of subtype of the early-onset type of Hallervorden-Spatz disease is suggested. The need to differentiate these cases from cases of static encephalopathy with mental retardation and motor impairment is also stressed.

Serial MRI findings in the Costa Rican variant of neuronal ceroid-lipofuscinosis.

Widespread cerebral atrophy and basal ganglia involvement are highly suggestive imaging features of the variants of late infantile type neuronal ceroid-lipofuscinosis. In the presence of clinical findings indicative of neuronal ceroid-lipofuscinosis, neuroimaging procedures are highly recommended to differentiate the variants from classic late infantile neuronal ceroid-lipofuscinosis. The clinical features and follow-up magnetic resonance imaging studies in a patient with the Costa Rican variant of late infantile neuronal ceroid-lipofuscinosis is presented. These procedures were of the utmost importance to observe the progression of the neurologic ailment and the extent of the cerebral and cerebellar abnormalities.

Solitary fibrous tumor of the meninges.

Intracranial fibrous tumors are unusual growths that occur almost exclusively in young individuals. Most of these lesions are intra-axial, however, on extremely rare occasions they arise from the leptomeninges and compress the adjacent brain. The authors report the case of a benign solitary fibrous tumor of the meninges in a 14-year-old girl who presented with a 5-month history of generalized headaches. NMR imaging displayed a left parietal mass, which mimicked a meningioma.

Extraventricular cerebral anaplastic ependymomas.

BACKGROUND: Anaplastic ependymomas are considered to be uncommon cerebral tumors by most authors. We have had the opportunity to study 34 cases of such lesions in 13 years. METHODS: 34 cases of anaplastic ependymoma operated in different hospitals of Maracaibo, Venezuela, during the period of 1983-1995 were analyzed. Cases of ependymoblastoma were excluded. RESULTS: Adult patients made up most of the present series. All patients harbored supratentorial growths in locations distant from the ventricular system. The microscopic pattern was of limited value to establish prognosis, for there was no constant correlation between the histologic features and tumor relapse; only in sporadic cases in which high cell density and conspicuous mitotic activity were maximally expressed, did tumor relapse occur shortly after removal of the lesion. CONCLUSION: This type of paradoxical behavior being the rule makes all attempts at predicting prognosis in these entities a disappointing task.

[Single diverticulum of perforated cecum. Report of 5 cases]. / Divertículo único de ciego perforado. Reporte de cinco casos.

Cecal diverticulitis is a relatively rare disease, which closely mimics the picture of acute appendicitis. At times it is difficult to differentiate from carcinoma. Five cases of cecal diverticulitis are reported, with a discussion of some salient features of this condition. Although two cases were treated with a right hemicolectomy, a plea for conservatism in the treatment of this disease is made.

[Causes of dementia in Maracaibo, Venezuela: a re-evaluation]. / Reevaluación de las causas de demencia en Maracaibo, Venezuela.

INTRODUCTION AND OBJECTIVES: In a previous report we analyzed the causes of dementia in an autopsy population from four hospitals of Maracaibo, Venezuela. Our results showed that vascular dementia (VD) accounted for 86.7% of all clinically diagnosed demented patients, whereas no cases of Alzheimer's disease (AD) were neuropathologically demonstrated. Six years later, we undertook a similar study, in order to re-evaluate the frequency of the different causes of dementia in our country. MATERIAL AND METHODS: We studied 611 adult brains obtained from autopsies performed during the period 1992-1998; 39 of these came from clinically demented patients. RESULTS: Vascular dementia was disclosed in 33 cases (84.6%), five cases (12.82%) showed evidence of specific causes for dementia other than VD or AD, and in one of the cases (2.56%) the neuropathological changes were specific for AD. CONCLUSIONS: Our current results confirm the conclusions of our previous study and contrast with the vast majority of reports in the medical literature regarding the frequency of the different causes of dementia, except for studies from China, Japan and Russia that yielded similar findings as ours. At present, further investigations are being undertaken in order to come up with possible explanations for these differences.

[Neurological aspects of ceroid-lipofuscinoses]. / Aspectos neurológicos de la ceroidolipofuscinosis.

OBJECTIVE: We discuss the historical, epidemiological, clinical, complementary tests and neuropathological details of ceroid-lipofuscinoses in children. DEVELOPMENT: Initially, we review the basic concepts and historical details of the disorders, and the frequency and distribution of the different clinical forms. Subsequently, we review the subtypes and variants most commonly found in children, together with the elements necessary for diagnosis. Finally we analyze the neuropathological studies and their clinical correlation. CONCLUSIONS: The clinical diagnosis of ceroid-lipofuscinoses should be based on a clinical history showing disorders of vision, convulsions and regression of psychomotor functions. Neuroimaging findings, neurophysiological changes and ultrastructural studies confirm the diagnosis.

[Idiopathic hypertrophic pachymeningitis: a diagnostic dilemma]. / Paquimeningitis hipertrófica idiopática: un dilema diagnóstico.

INTRODUCTION: Idiopathic hypertrophic pachymeningitis (IHP) is a rare fibrosing inflammatory process of unknown pathogenesis that causes diffuse thickening of the duramater. In spite of the fact that this pathological entity has been linked to specific etiological agents such as syphilis, tuberculosis, mycosis and sarcoidosis, In recent years there has been an increase in the number of patients with IHP of undetermined cause. CASE REPORT: 58 year-old female with a long date history of oppressive headaches, frontally located at first, and later generalized, accompanied by weakness and asthenia; urinary incontinence, dizziness, vomiting, and gait ataxia. Physical examination revealed bilateral cerebellar signs, and optic atrophy. Magnetic resonance displayed a diffuse thickening of the falx cerebrii, and cerebellar tentorium, hypointense in T1 and T2- weighted images, and markedly enhanced following administration of intravenous Gd-DTPA. A biopsy obtained from the falx revealed conspicuous fibrosis, and focal chronic inflammatory mononuclear infiltrate. Complementary exams carried out in order to reveal a specific etiologic agent were negative. CONCLUSION: Due to the variable clinical presentation, and the difficulty to establish the etiology of the pathological process, to make the diagnosis of IHP usually represents a true dilemma. This diagnosis is often made by exclusion.

[Central nervous system infection by free-living amebas: report of 3 Venezuelan cases]. / Infección del sistema nervioso central por amebas de vida libre: comunicación de tres nuevos casos venezolanos.

INTRODUCTION: Infection of the Central Nervous System by free living amebas is an unusual event, 344 cases have been reported to date. The disease becomes evident in two different clinical fashions: Primary Amebic Meningoencephalitis (PAM) caused by Naegleria fowleri and Granulomatous Amebic Encephalitis (GAE) induced by Spp. of Acanthamoeba and Balamuthia. CLINICAL CASES: The authors report three new cases from Venezuela. Case 1. 34 years old man, with a chief complaint of general malaise, headache and fever, a diagnosis of common cold was made and the patient was treated as such, he did not improve and was admitted to the hospital with deterioration of his clinical status; the patient died 10 days after the onset of his illness which was determined to be GAE produced by Balamuthia mandrillaris. Case 2. 8 years old female admitted to the hospital because of fever, headache and generalized seizures of sudden onset; neurocysticercosis was diagnosed and following improvement the patient was discharged and readmitted on two occasions because of relapse and worsening of her illness, she died 2 months after the onset of her disease that was diagnosed by autopsy as GAE due to Balamuthia mandrillaris. Case 3. 16 years old male, previously healthy, who following immersion in a water tank was admitted to the hospital because of meningeal irritation that progressed to coma and death in a 7 day lapse; autopsy revealed PAM by Naegleria fowleri. The two cases of GAE due to Balamuthia mandrillaris occurred in apparently immunocompetent individuals, contrary to the statement that these microorganisms are opportunistic. CONCLUSION: We believe that neurological infection by amphizoic amebas is being underdiagnosed, probably due to ignorance regarding this pathology or because of a very low autopsy rate in most countries.