Spectroscopic examination of Red Queen's funerary mask and her green stone offering from the Mayan site of Palenque, Mexico.

This work presents a non-invasive material study of the Red Queen's funerary offering via in situ infrared (FTIR) and Raman spectroscopies for mineral identification, and X-ray fluorescence spectroscopy (XRF) for elemental characterization. A second non-destructive laboratory stage on the main mask of the offering only was carried out by particle induced X-ray emission (PIXE) for further elemental analysis. The main FTIR results indicate that all of the tesserae of the main mask are composed of malachite, identified by their ν(CuO), ν(CuOH), ν1-ν4(CO32-) and δ(CO32-) infrared and T(CO32-) Raman vibrational modes. Moreover, the pupils are composed of obsidian (δ(SiOSi) and ν(SiO) infrared vibrational modes), and remarkably, jadeite was identified in the sclera of the eyes. Most of the accompanying mask's tesserae are green quartz and chalcedony (δ(SiOSi) and ν(SiO) infrared and Raman vibrational modes). The pendants are made of jadeite, while the headdress´ tesserae were identified as omphacite. The diadem and necklace's green beads were mostly jadeite, omphacite and albite. Jadeite, albite and omphacite were identified through their characteristic infrared and Raman vibrational modes: ν(SiOSi), δ(SiOSi), τ(SiO4) and AlSiO4 interactions. Yellow-orange beads in the diadem and in the pectoral are quartz. Green and blue pectoral beads are jadeite, omphacite and quartz. Limestones and shells identified in the figurine, valve and in some of the headdress and accompanying mask's tesserae, were properly classified by Raman spectroscopy, using their characteristic ν1 and ν4 (CO32-) vibrational modes for aragonite and beta-carotenes characteristic Raman shifts for Spondylus valves. These results indicate a special selection and the use of unique raw materials for the royal burial of the Red Queen, different to those used for other rulers of Palenque and other contemporary Mayan sites.

Opsoclonus-myoclonus-ataxia syndrome associated with central nervous system HIV-1 escape phenomenon. / Síndrome opsoclono-mioclono-ataxia asociado a fenómeno de escape viral por virus de la inmunodeficiencia humana en el sistema nervioso central.

INTRODUCTION: Opsoclonus-myoclonus-ataxia (OMA) syndrome is a rare neurological disorder characterized by involuntary conjugate saccadic eye movements, myoclonus, and ataxia. Few reports exist on patients with HIV and OMA. CASE REPORT: A 41-year-old man diagnosed with HIV-1 infection in 1997 coursed with multiple anti-retroviral schemes as a consequence of poor adherence. In 2008 he presented an HIV-1 viral load of 100,000 copies/mL and a CD4+ T cell count of 10 cells/mm3. In 2013 our patient arrived with an 11-month history of progressive opsoclonus and ataxia. He had undetectable plasma HIV-1 RNA load and CD4+ of 606 cells/mm3. No opportunistic infections were found. Cerebrospinal fluid analysis showed mildly elevated protein concentration and HIV-1 viral load of 534 copies/mL. Cerebrospinal fluid co-receptor tropism test showed selective CCR5 usage. A brain magnetic resonance imaging showed hippocampal atrophy and T2-weighted hyperintensities. Our patient exhibited a dramatic recovery and cerebrospinal fluid HIV clearance after adjustment of anti-retroviral treatment based on genotyping resistance and tropism analyses. CONCLUSIONS: In patients with HIV presenting cengral nervous system dysfunction without opportunistic infections, cerebro-spinal fluid and plasma HIV-1 viral load, resistance and tropism tests should be performed to assess a potential viral escape and to design the appropriate anti-retroviral therapy in an individual patient basis.

TITLE: Síndrome opsoclono-mioclono-ataxia asociado a fenómeno de escape viral por virus de la inmunodeficiencia humana en el sistema nervioso central.Introducción. El síndrome opsoclono-mioclono-ataxia (OMA) es un trastorno neurológico infrecuente caracterizado por movimientos oculares conjugados sacádicos involuntarios, mioclonías y ataxia. Existen pocos casos en la bibliografía de pacientes con virus de la inmunodeficiencia humana (VIH) y OMA. Caso clínico. Varón de 41 años y diagnóstico de infección por el VIH-1 desde 1997, que cursó con múltiples esquemas antirretrovirales debido a una pobre adhesión al tratamiento. En 2008 presentó una carga viral de 100.000 copias/mL y una cuenta linfocitaria CD4+ de 10 células/mm3. En 2013 sufrió un cuadro progresivo de 11 meses de evolución caracterizado por opsoclonía y ataxia. En ese momento, su carga viral era indetectable, y la cuenta de CD4+, de 606 células/mm3. Se descartaron infecciones oportunistas. El examen del líquido cefalorraquídeo demostró hiperproteinorraquia leve y una carga viral de 534 copias/mL. El examen del tropismo de correceptor en el líquido cefalorraquídeo demostró un uso selectivo de CCR5. La resonancia magnética cerebral objetivó atrofia hipocámpica e hiperintensidades en las secuencias ponderadas en T2. El paciente mostró una recuperación clínica franca y un aclaramiento de la carga viral en el líquido cefalorraquídeo tras el ajuste de antirretrovirales basado en la resistencia de genotipo y el análisis de tropismo. Conclusiones. En pacientes con infección por el VIH y disfunción del sistema nervioso central sin infecciones oportunistas, debería llevarse a cabo una determinación de la carga viral en el plasma y el líquido cefalorraquídeo para descartar un potencial fenómeno de escape viral, así como exámenes de resistencia y tropismo para diseñar el tratamiento antirretroviral adecuado.

Methodology for the non-destructive characterization of jadeite-jade for archaeological studies.

The present paper proposes a methodology that complies with the requirements of identifying and characterizing jadeite (and its associated minerals) for archaeological studies, avoiding the acquisition of samples and ensuring the integrity of the object. The methodology exploits a carefully selected array of techniques (optical microscopy, UV fluorescence photography, X-Ray digital radiography, infrared and Raman spectroscopies, X-Ray fluorescence and particle induced X-ray emission spectroscopies) that, despite not definitively replacing laboratory procedures, provides a first mineral and elemental evaluation of jadeite archaeological objects. The proposed methodology was applied in the characterization of twelve different jade tones, allowing the identification of major - jadeite, albite and omphacite - and minor - pumpellyite, actinolite, analcime, rutile, grossular and titanite - mineral phases. To display its advantages and limitations, this methodology was also compared with a characterization employing specific gravity measurements and with an invasive methodology based on petrography and scanning electron microscopy with energy dispersive spectroscopy.

Localization and expression of spermadhesin PSP-I/PSP-II subunits in the reproductive organs of the boar.

The epithelial localization and expression of the spermadhesin PSP-I and PSP-II subunits were determined in the testis, ductus epididymes (caput, corpus and cauda), seminal vesicles and bulbourethral glands of mature boars, using immunohistochemical, western blotting and RT-PCR methods. Immunohistochemistry showed positive labelling for PSP-I and PSP-II antibodies in the epithelium of seminal vesicles in all males tested. Positive immunolabelling, but with variable intensity, was also present in the epididymal epithelium (caput, corpus and cauda), although varying largely among segments and boars. Immunoreactivity was nearly or completely absent in the seminiferous epithelium and the bulbourethral gland, although SDS-PAGE and western blotting revealed the presence of PSP-I and PSP-II immunoreactive bands in all the tissue extracts, including the testis and the bulbourethral gland. mRNA amplification by RT-PCR using primers specific for PSP-I and PSP-II showed a trend similar to that observed for western blotting, i.e. intensity variation between tissues (even between segments of the same epididymis) and among boars. Our results indicate that the seminal vesicles are the main source of PSP-I and PSP-II spermadhesins, although epididymal segments, testis and the bulbourethral gland also participate in the expression of both proteins.

Venezuelan equine encephalomyelitis and African horse sickness. Current status and review.

The arthropod-borne virus (arbovirus) diseases of livestock have worldwide impact. The prevention of an introduction of an exotic disease and the control of one subsequent to an introduction will require the attention, cooperation, and support of the livestock industry, regulatory agencies, and researchers. The most effective protection of our livestock industries is to prevent the introduction of an exotic disease agent. This implies complete restriction of animal imports and exports. However, "zero risk" is an unacceptable option in today's world of internationally integrated and interdependent agriculture. Scientifically sound and factually based regulatory decisions must be combined with continued vigilance and preparedness, as well as appropriately directed surveillance and research, to protect the world agricultural marketplace. Two exotic arbovirus diseases that are of current concern to the livestock industries and regulatory officials of the North American and Caribbean Basin countries are VEE and AHS. Devastating epizootics of VEE in equines have occurred frequently in the Western Hemisphere, but no recent epizootic activity has been documented. Naturally occurring foci of sylvatic, equine nonpathogenic VEE virus subtypes, however, do exist in the tropical countries of the hemisphere. The relationship of these sylvatic virus foci to the origin of equine virulent epizootic VEE virus subtypes is unknown. AHS epizootics had been confined to Africa, the Middle East, and the Indian subcontinent until recent outbreaks in 1966 and 1987-1990 in Spain. With the recurrence of AHS in Spain for the past four years, concern about the possible introduction into potential vector species and equines in the Western Hemisphere has increased. This review addresses the current VEE and AHS virus activity and the potential for outbreaks in the Western Hemisphere.

The seasonal and geographical distribution of Culicoides imicola, C. pulicaris group and C. obsoletus group biting midges in central and southern Spain.

Pirbright-type light traps were used to collect Culicoides biting midges (Diptera: Ceratopogonidae) at fifteen sites in twelve provinces of central Spain and Andalusia. A total of 293,625 Culicoides were collected in 1,387 samples over a two year period. These comprised approximately 9.2% Culicoides imicola, 11.4% C. pulicaris group, 1.6% C. obsoletus group and 12.2% C. circumscriptus. Culicoides imicola was present at ten of the fifteen sites; the five sites from which it was absent were the most eastern of the fifteen. The greatest abundance of this species was at Navalmoral in Caceres Province. Culicoides pulicaris group were present at all sites; C. obsoletus group were present at twelve sites. The annual peaks in abundance were: C. imicola, August-October; C. pulicaris group, May-June; and C. obsoletus group, March-June. The geographical and seasonal distributions of C. imicola are consistent with those of the outbreaks of African horse sickness (AHS) and bluetongue (BT) during epizootics in Spain, and support the contention that C. imicola was the major vector of AHS and BT viruses.

The relationship between climate and the distribution of Culicoides imicola in Iberia.

The biting midge Culicoides imicola was captured at 17 of 27 farms in Spain and Portugal during a survey of its distribution following outbreaks of African horse sickness in Iberia that occurred between 1987 and 1990. Farms were sampled approximately twice weekly from October 1992 to February 1995. Farms were widely spaced apart (maximum 850 km) and had considerable variation in climate. Across sites, summer temperatures ranged from 18.3 degrees C-27.2 degrees C; in winter the range was 4.4 degrees C-11.6 degrees C. Relative humidities in summer ranged from 37.2% to 90.1%. Proximity to southern Spain (Seville) was the most significant predictor of the presence/absence of C. imicola, but high summer temperatures and possibly dry summer conditions, were also important. Vila Nova de Milfontes in Portugal, where C. imicola was abundant and the climate is relatively cool, was an exception to the climatic trends at the other 26 sites. This exception points to a lack of knowledge of climatic requirements for immature development of C. imicola. The absence of C. imicola from the three most easterly sites, which have apparently favourable climates, suggests a relatively recent invasion by this species into Iberia.

Concordance between serum and cytosolic levels of CEA, CA125 and SCC antigens in patients with non-small cell lung cancer.

The relationship between serum and cytosolic levels of carcinoembryonic (CEA), squamous-cell carcinoma (SCC) and CA125 antigens was determined in 122 patients with non-small cell lung cancer. A pronounced serum-cytosol gradient and a high degree of dispersion in the distribution of serum and cytosol marker concentrations was detected. In addition, the degree of concordance between TM levels in the two compartments, determined by the intraclass correlation coefficient (ICC) index, was low (ICC = 0.42 for CEA; 0.35 for CA 125; and 0.27 for SCC). Tumour stage and histological type both played a limited role in the serum-cytosol relationship. As tumour stage advanced, the concordance between serum and cytosolic TM level became more pronounced. In addition, each histological type showed a distinctive pattern of expression of serum and cytosolic tumour markers, and a specific degree of concordance between levels in serum and cytosol. However, the ICC indices were always under 0.51, indicating that the importance of these factors is minor. The data obtained indicate that the relationship between serum and cytosolic concentration is moderate. The differences found according to stage grouping and histological subtype are so small that no clear-cut message for clinical practice can be drawn.

Prognostic significance of preoperative serum CA 19.9 assay in patients with colorectal carcinoma.

The prognostic information provided by preoperative serum CEA and CA 19.9 antigen assay on the postoperative outcome of 150 patients with colorectal cancer was analysed. The influence of both markers was studied by Cox's proportional-hazard regression analysis. In the univariate analysis, patients whose initial CA 19.9 level was higher than 37 U/ml had a 4.32-fold greater risk of death due to the cancer (95% CI: 1.72-10.84) (p < 0.001) than patients with lower values. The 36-month survival rate posttreatment was lower for patients with CA 19.9 serum levels over 37 U/ml (61% versus 90%) (p < 0.001). Patients whose initial CEA level was higher than 5 ng/ml had a 2.9-fold greater risk of death (95% CI: 1.05-7.99) (p = 0.04) than patients with lower values. The 36-month survival rate posttreatment was lower for patients with CEA serum levels over 5 ng/ml (84% versus 76%) (p = 0.04). After adjustment for Dukes' stage, CEA, CA 19.9, tumor site, sex and age, only Dukes' stage and CA 19.9 continued to provide independent predictive information on survival. The risk of death increases by 1.008 for every 10 U/ml rise in the level of the marker (95% CI: 1.002-1.014) (p = 0.009). With respect to analysis of disease-free survival, only Dukes' stage provided independent predictive value. CA 19.9 is an independent prognostic factor of survival in colorectal cancer. The authors suggest including CA 19.9 in a future multifactorial analysis of survival.

Serum CEA, CA125, and SCC antigens and tumor recurrence in resectable non-small cell lung cancer.

Carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and CA125 were determined pre- and postoperatively in non-small cell lung cancer patients (NSCLC) to assess the relationship between serum levels and postoperative recurrent disease. Ninety-five patients who underwent curative surgical resection were included (TNM stages I, II, IIIa). CEA and CA125 were determined by solid-phase enzyme-immunoassay, SCC by radio-immunoassay. Tumor relapse was detected in 41 patients (43%): 16 (39%) with locoregional disease and 25 (61%) with disseminated disease. The overall 36-month disease-free survival rate was 42%. The sensitivity for recurrence was 58% for CEA, 53.6% for CA125, and 51.2% for SCC; 87.8% of patients showed at least one elevated marker. The sensitivity of CEA and CA125 increased significantly in patients with preoperative serum concentrations above the cut-off: 86.6% versus 42.3% (p < 0.01), and 93% versus 18% (p < 0.01), respectively. Preoperative CA125 above 15 U/ml identified a high-risk group of patients: a lower 36-month disease-free survival rate (0% versus 56%) (p < 0.001), a 3.02-fold higher risk of recurrence (p < 0.05), and a 6.22-fold higher risk of disseminated failure (p < 0.001). The identification of CEA and CA125 producer-tumors, based on preoperative serum values, enhances the clinical performance of a postoperative surveillance program in surgically treated NSCLC. Preoperative serum CA125 is a prognostic factor to identify patients at high risk of postoperative tumor recurrence.

Tumor markers in pancreatic cancer: a comparative clinical study between CEA, CA 19-9 and CA 50.

Seventy-eight patients were evaluated to ascertain the usefulness of markers CA 19-9 and CA 50 in diagnosing pancreatic cancer, using a less specific marker (CEA) as reference. Three groups were considered: a) 36 controls; b) 22 patients with benign obstructive jaundice; c) 20 patients with pancreatic cancer. Preoperative blood samples were obtained to ascertain CEA (E.I.A.), CA 19-9 (R.I.A.) and CA 50 (T.R.-F.I.A.). Serum concentrations of the various markers were significantly higher for patients with pancreatic cancer in comparison with the other groups, at cut-offs of 10 ng/ml (CEA), 100 ng/ml (CA 19-9) and 170 U/ml (CA 50). The sensitivity of CA 19-9 (94%) and CA 50 (88%) was much greater than that of CEA (30%). The specificity of the three markers in patients with pancreatic cancer, with respect to the control group, was 100% and this figure is reduced with respect to the group suffering from benign obstructive jaundice (CEA: 90%; CA 19-9: 88% and CA 50: 87%). Diagnostic results (sensitivity, specificity, positive predictive value (P.P.V.) and negative predictive value (N.P.V.] did not significantly increase with respect to CA 19-9 and CA 50 when considered individually. It is concluded that the serum concentrations of CA 19-9 and CA 50 showed high sensitivity and specificity as markers of pancreatic cancer with respect to the other groups, pointing towards clinical routine clinical use of both markers. In addition, a comparative study of the literature has been made and prospects for short-term development and concrete applications for early and reliable diagnosis have been highlighted.

[Epidermal growth factor receptor in non-small cell cancer of the lung]. / Receptor para el factor de crecimiento epidérmico en el cáncer de pulmón no microcítico.

In this study we determined the concentration of epidermic growth factor receptors (EGFr) in non-small cell carcinoma of the lung (NSCCL) and analyzed its relation to the anatomical, pathological and clinical factors of these neoplasms. The concentration of EGFr in 62 tumor tissue samples was 9.9 +/- 14 fmol/mg, higher than that found in 14 tissue samples from cases of spontaneous pneumothorax (3.9 +/- 3.6 fmol/mg) (p = 0.005). EGFr concentration in lung tissue with no signs of neoplasm was 6.5 +/- 10 fmol/mg. In 21 (33%) cases of NSCCL the concentration exceeded the normal threshold of 10 fmol/mg. EGFr concentration was higher in cases of epidermoid carcinoma than in other tissue samples (p = 0.042). No significant association was found between EGFr levels and status of tumor node metastasis, degree of differentiation and mitotic index. The probability of remaining free of tumor recurrence and of survival after 24 months among patients whose tumoral EGFr concentration was below 10 fmol/mg was 34 and 40%, respectively. The rates for patients with concentrations that exceeded the threshold were 20% (p = 0.32) and 25% (p = 0.26), respectively. The results seem to indicate that the study of EGFr concentration alone does not yield practically important information for the management of patients with NSCCL who have undergone surgery. The concentration of EGFr marks degree of differentiation in NSCCL and has prognostic implications derived from its association with other factors.

Presence of Culicoides imicola (Diptera: Ceratopogonidae) in Jaen, Spain.

Culicoides imicola Kieffer is reported from 2 locations in the province of Jaen, Spain. The locations are outside the area where African horse sickness epizootics occurred from 1988 to 1990. The absence of African horse sickness in Jaen during this period may have been due to the low abundance of this species.

Seasonal and geographical distribution of Culicoides imicola Kieffer (Diptera: Ceratopogonidae) in southwestern Spain.

Culicoides imicola Kieffer adults were collected in light traps weekly between August 1990 and October 1991. The species was collected at all 62 sites located in 5 provinces of the Autonomous Region of Andalucía (Spain). Culicoides imicola represented 31.7% of the total collection of Culicoides. The highest numbers of C. imicola were collected from September through November 1990 and September and October 1991. The lowest numbers were collected from December 1990 through April 1991. The presence or absence of C. imicola was related to the mean monthly minimum and maximum air temperature. Greatest numbers of C. imicola were collected at daily minimum and maximum temperatures of 18 degrees C and 38 degrees C, respectively. The relevance of this information to previous outbreaks of African horse sickness is discussed.

Seasonal distribution and relationship to temperature and precipitation of the most abundant species of Culicoides in five provinces of Andalusia, Spain.

A total of 177,344 Culicoides specimens were collected from 3,109 light trap collections made weekly from August 1990 to October 1991 at 62 sites in the provinces of Cádiz, Córdoba, Huelva, Seville, and Málaga, Spain. Reported for the 1st time are Culicoides agathensis, Culicoides bahrainensis, Culicoides marcleti, and Culicoides odiatus in the Iberian Peninsula, and Culicoides scoticus in Andalusia, Spain. As a group, Culicoides were active throughout the year. The 3 most common species were Culicoides imicola (56,254), Culicoides newsteadi (24,359), and Culicoides circumscriptus (16,720). Numbers of C. imicola peaked in October, C. newsteadi peaked in May, and C. circumscriptus peaked in June. Based on regression analyses, the optimal minimum and maximum air temperatures, respectively, for adult insect activity were approximately > or = 18 degrees C and > or = 38 degrees C for C. imicola, 12 degrees C for C. newsteadi, 14 degrees C for C. circumscriptus (minimum temperature only), 16 degrees C and > or = 38 degrees C for "other" Culicoides, and 14 degrees C and 32 degrees C for total Culicoides. Optimal minimum and maximum temperatures could not be determined for Culicoides pulicaris, Culicoides punctatus, subgenus Monoculicoides, and the Culicoides obsoletus group. During August and September, the months when African horse sickness outbreaks occurred, C. imicola was the predominant species in the coastal Mediterranean zone. If the "other" Culicoides spp. group was not considered, the predominant species were C. imicola in the Guadalquivir River valley zone, C. newsteadi in the Subbética mountainous range zone, and subgenus Monoculicoides in the coastal Atlantic zone.

[Tumor markers in liver metastases of colorectal carcinoma]. / Marcadores tumorales en metástasis hepáticas del carcinoma colorrectal.

Colorectal cancer is a potentially curable tumour when diagnosed in the early stages. In order to improve the results obtained up to now, we propose application of a diagnostic program among patients who undergo curative resection for colorectal adenocarcinoma, which would consist of using a panel of tumor markers, in combination with endoscopic, histologic and ultrasonographic diagnostic methods. For this study we studied 105 patients, divided into two groups: A) Group 1: 30 control patients. B) Group 2: 75 patients diagnosed as having colorectal cancer. We performed the preoperative determination of a series of tumor markers (CEA, CA 19.9, GGT and PHI), endoscopy/biopsy and hepatic ultrasonography on these patients. Our results suggest that the design of the preoperative diagnostic program makes early detection of hepatic metastases possible. The tumor marker panel combination provided a visible increase in sensitivity for detecting hepatic metastases.

Serum and tissue CEA in colorectal cancer: clinical relevance.

PURPOSE: This article is an analysis of the information derived from the determination of tumor-tissue concentration of CEA in patients with colorectal cancer. To ascertain the relationship between tumor marker content with the histologic aspects and serologic levels of CEA of this neoplam. MATERIALS AND METHODS: 136 patients with colorectal adenocarcinoma and 41 with colorectal benign processes are analyzed and followed during an average time of 27 months. The CEA of the serum were obtained preoperatively and postoperatively and measured by radioimmunoassay (RIA). Tissular CEA levels were determined with RIA. The histological characteristics are analyzed (Dukes classification, grade of differentiation, index of atypia, microscopic vascular and lymphatic involvement. RESULTS: 1) The cut off point of the tissular CEA with the best sensitivity and specificity for the diagnosis of normal mucosa is 386 ng/mg and for tumoral tissue is 1160 ng/mg. 2) There is no correlation between tissue and serologic CEA value. 3) The tissular level of CEA have a significant statistical correlation with Dukes stage (p < 0.003); other histological characteristics were no significative. 4) There are significant statistical correlations between serologic CEA and relapse but no with survival rates. CONCLUSIONS: 1) Serologic CEA levels depend on numerous factors. 2) There aren't correlations between preoperative serologic levels and tissular CEA levels. 3) Tissular CEA do not predict what patients will have an elevated serologic CEA level in relapse.

[Advances in the treatment of epilepsy: status epilepticus]. / Avances en el tratamiento de la epilepsia: estado de mal epiléptico.

OBJECTIVE: The complexity of the treatment of status epilepticus (SE) is due to the wide variety of forms of clinical presentation. In this review we wish to emphasize that satisfactory management of SE requires a system which takes account of the successive phases of the gravity of the electroclinical course of SE and the different types of SE according to the electroclinical semiology of the seizure. DEVELOPMENT: The concepts and classifications which, in current epileptology, are used in SE are mainly based on criteria developed at three international symposia: in Marseilles in 1962 and Santa Monica, California, in 1979 and 1997. Current knowledge permits distinction of different therapeutic periods depending on the chronology of each SE and to classify the SE according to the type of seizures, age of the patient and underlying pathology. CONCLUSIONS: The classifications described permit the standardization of treatment: preventive measure in high-risk patients; immediate and in situ treatment during the prodromal phase; three parallel lines of action--differential diagnosis, general measures and antiepileptic treatment--during the initial phase; measures in hospital emergencies and in the Intensive Care Unit when the SE is at a fully established phase; special measures, including induction of anaesthesia in the refractory phase; transition to long-term treatment, recovery of autonomy by the patient and long-term management in the phases following remission of the SE. The standardization proposed may perhaps serve as a basis for the future development of guidelines.

[Intracranial involvement in neurosarcoidosis: a report of 4 cases as initial manifestation of the disease]. / Afectación intracraneal en la neurosarcoidosis: descripción de cuatro casos como manifestación inicial de la enfermedad.

INTRODUCTION: The incidence of sarcoidosis in our country is one of the lowest in Europe. Neurosarcoidosis affects only 5% on patients with sarcoidosis. Clinical cases. We describe four patients in which neurologic disfunction was the presenting finding. Initial neurological symptoms include status epilepticus, headache, fever and nerve cranial palsies. MRI showed a spectrum of protean central nervous abnormalities: 1. Hypotalamic infiltrating lesion; 2. Brain parenchyme enhanced masses; 3. Leptomeningeal enhancement, and 4. Focal white-matter lesions. Thoracic CT scan, bronchoscopy, Gallium scintigraphy and pulmonary biopsy yielded to diagnosis in three patients. Biopsy of the meninges was required in one patient because systemic involvement was not found. Histological examination of an intracranial mass was also performed in another patient to rule out tumoral lesions. ACE in serum was normal in all patients. CSF ACE was determine in only one patient and was also normal. Three patients started treatment with corticosteroids but one of them required adjuvant treatment with immunosuppressor. Cranial nerve palsy resolved spontaneously in the last patient. CONCLUSIONS: Clinical and radiological polymorphism explained the delay before diagnosis and the problems in ruling out other diseases. MRI is highly useful for the diagnosis and follow up treatment.

[Aetiological diagnosis of cerebral infarction in a county hospital]. / Diagnóstico etiológico del infarto cerebral en el hospital comarcal.

INTRODUCTION: Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. PATIENTS AND METHODS: We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN 98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. RESULTS: Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN 98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of incomplete studies was the absence of carotid Doppler. CONCLUSIONS: The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI.