The striatal cholinergic system in L-dopa-induced dyskinesias.

Cholinergic signaling plays a key role in regulating striatal function. The principal source of acetylcholine in the striatum is the cholinergic interneurons which, although low in number, densely arborize to modulate striatal neurotransmission. This modulation occurs via strategically positioned nicotinic and muscarinic acetylcholine receptors that influence striatal dopamine, GABA and other neurotransmitter release. Cholinergic interneurons integrate multiple striatal synaptic inputs and outputs to regulate motor activity under normal physiological conditions. Consequently, an imbalance between these systems is associated with basal ganglia disorders. Here, we provide an overview of how striatal cholinergic interneurons modulate striatal activity under normal and pathological conditions. Numerous studies show that nigrostriatal damage such as that occurs with Parkinson's disease affects cholinergic receptor-mediated striatal activity. This altered cholinergic signaling is an important contributor to Parkinson's disease as well as to the dyskinesias that develop with L-dopa therapy, the gold standard for treatment. Indeed, multiple preclinical studies show that cholinergic receptor drugs may be beneficial for the treatment of L-dopa-induced dyskinesias. In this review, we discuss the evidence indicating that therapeutic modulation of the cholinergic system, particularly targeting of nicotinic cholinergic receptors, may offer a novel approach to manage this debilitating side effect of dopamine replacement therapy for Parkinson's disease.

Cell-cycle arrest biomarkers in urine to predict acute kidney injury in septic and non-septic critically ill patients.

PURPOSE: To analyse the usefulness of the composite index of the tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) as urinary biomarkers for the early prediction of AKI in septic and non-septic patients. METHODS: This is a prospective, observational study including patients admitted to ICU from acute care departments and hospital length of stay <48 h. The main exclusion criteria were pre-existing eGFR <30 mL/min/1.73 m2 and hospitalisation 2 months prior to current admission. The [TIMP-2]·[IGFBP7] index was analysed twice, within the first 12 h of ICU admission. RESULTS: The sample included 98 patients. AKI incidence during ICU stay was 50%. Sepsis was diagnosed in 40.8%. Baseline renal variables were comparable between subgroups except for a higher baseline eGFR in non-septic patients. Patients were stratified based on the presence of AKI and their highest level of [TIMP-2]·[IGFBP7] within the first 12 h of stay. [TIMP-2]·[IGFBP7] index values were dependent on the incidence of AKI but not of sepsis. [TIMP-2]·[IGFBP7] values were significantly related to AKI severity according to AKIN criteria (p < 0.0001). The AUROC curve to predict AKI of the worst [TIMP-2]·[IGFBP7] index value was 0.798 (sensitivity 73.5%, specificity 71.4%, p < 0.0001). Index values below 0.8 ruled out any need for renal replacement (NPV 100%), whereas an index >0.8 predicted a rate of AKI of 71% and AKIN ≥ 2 of 62.9%. CONCLUSIONS: In our study, urinary [TIMP-2]·[IGFBP7] was an early predictor of AKI in ICU patients regardless of sepsis. Besides, index values <0.8(ng/mL)2/1000 ruled out the need for renal replacement.

Validación, adaptación y traducción al castellano del MacCAT-T: herramienta para evaluar la capacidad en la toma de decisiones sanitarias / Validation, adaptation and translation of the MacCAT-T into Spanish: a tool to assess the ability to make health decisions

Introducción. La valoración de la capacidad es elemento esencial del proceso de consentimiento informado y un deber del médico. Una herramienta ampliamente desarrollada es el MacCAT-T que explora cuatro habilidades para consentir un tratamiento. No se dispone versión en español y el objetivo principal de este trabajo es validar, adaptar y traducir el MacCAT-T al castellano. Material y métodos. Se tradujo al español e inversamente al inglés. Se validó en su apariencia y contenido (a través de 15 expertos), en constructo (confiabilidad interevaluador y consistencia interna) y en criterio (la validez de un instrumento comparándola con algún criterio externo, en este caso el rendimiento cognoscitivo evaluado por el mini examen cognoscitivo de Lobo). Se incluyeron noventa pacientes ambulatorios médico-quirúrgicos, mayores de 18 años sin déficits de expresión y/o con graves alteraciones de conciencia que no permitieran la realización de la entrevista. Resultados. Los resultados han permitido valorar los diferentes tipos de validez. Su media de aplicación ha sido entre 9 y 13 minutos. Discusión. Los datos son coherentes con los obtenidos en otras aplicaciones del MacCAT-T en lengua inglesa y facilitan la disposición de una herramienta en castellano para valorar la capacidad en la toma de decisiones sanitarias(AU)

Introduction. Capacity assessment is an essential element of the informed consent process and is the duty of the physician. The MacCAT-T instrument explores four skills needed to consent a treatment. There is no Spanish version, and the main objective of this work is to validate, adapt and translate the MacCAT-T into Spanish. Material and methods. The MacCAT-T was translated into Spanish and then back-translated into English. It was validated as regards its appearance and content (by 15 experts), construct (inter-rater reliability and internal consistency) and criteria (the validity of an instrument by comparing it to some external criterion, in this case the Mini Examen Cognoscitivo de Lobo). Ninety medical and surgical outpatients over 18 years were included with no deficits of expression and/or severe disorders of consciousness that did not allow them to be interviewed. Results. They have been optimal considering different types of validity. The average application time was between 9 and 13minutes. Discussion. Data are consistent with those obtained in other applications of MacCAT-T in the English language and facilitate the provision of a Spanish tool for assessing capacity(AU)

[Validation, adaptation and translation of the MacCAT-T into Spanish: a tool to assess the ability to make health decisions]. / Validación, adaptación y traducción al castellano del MacCAT-T: herramienta para evaluar la capacidad en la toma de decisiones sanitarias.

INTRODUCTION: Capacity assessment is an essential element of the informed consent process and is the duty of the physician. The MacCAT-T instrument explores four skills needed to consent a treatment. There is no Spanish version, and the main objective of this work is to validate, adapt and translate the MacCAT-T into Spanish. MATERIAL AND METHODS: The MacCAT-T was translated into Spanish and then back-translated into English. It was validated as regards its appearance and content (by 15 experts), construct (inter-rater reliability and internal consistency) and criteria (the validity of an instrument by comparing it to some external criterion, in this case the Mini Examen Cognoscitivo de Lobo). Ninety medical and surgical outpatients over 18 years were included with no deficits of expression and/or severe disorders of consciousness that did not allow them to be interviewed. RESULTS: They have been optimal considering different types of validity. The average application time was between 9 and 13minutes. DISCUSSION: Data are consistent with those obtained in other applications of MacCAT-T in the English language and facilitate the provision of a Spanish tool for assessing capacity.

[GEITDAH consensus on attention deficit hyperactivity disorder]. / Consenso del GEITDAH sobre el trastorno por deficit de atencion/hiperactividad.

In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects.

[PET/CT with (11)C-choline and (18)F-FDG in patients with elevated PSA after radical treatment of a prostate cancer]. / PET/TAC con (11)C-colina y (18)F-FDG en pacientes con elevación de PSA tras tratamiento radical de un cáncer de próstata.

OBJECTIVE: To compare the diagnostic accuracy of PET/CT with (18)F-FDG and (11)C-choline for early detection and localization of recurrent prostate cancer. MATERIAL AND METHODS: Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with (11)C-choline and (18)F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7). RESULTS: Focal uptake of (11)C-choline was detected in 26 patients (68%), and focal uptake of (18)F-FDG was detected in 13 patients (34%). The (11)C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with (18)F-FDG. Pelvic lymph nodes were detected with (11)C-choline PET/CT in 8 patients and only in 4 patients (50%) with (18)F-FDG. Mediastinal involvement was detected in 5 patients with (11)C-choline and 3 patients (60%) with (18)F-FDG. Focal bone involvement was detected in 3 patients with (11)C-choline and (18)F-FDG. (11)C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of (11)C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. CONCLUSIONS: (11)C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to (18)F-FDG. (11)C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with (11)C-choline showed direct impact for the selection of the most appropriate therapeutic approach.

PET/TAC con 11C-colina y 18F-FDG en pacientes con elevación de PSA tras tratamiento radical de un cáncer de próstata / PET/CT with 11C-choline and 18F-FDG in patients with elevated PSA after radical treatment of a prostate cancer

Objetivo: Comparar el rendimiento diagnóstico de la PET/TAC con 18F-FDG y 11C-colina en la detección precoz y localización de la recurrencia del cáncer de próstata. Material y métodos: Se incluyeron 38 pacientes con elevación de PSA (0,8-9,5 ng/ml) tras terapia radical de cáncer de próstata (cirugía n = 20/radioterapia n = 18). Diez pacientes estaban en terapia antiandrogénica. A todos se les realizó el mismo día una PET/TAC con 11C-colina y 18F-FDG. Los hallazgos se compararon con la histología (n = 10), monitorización del PSA (n = 21) y/u otras técnicas (n = 7). Objetivo: Comparar el rendimiento diagnóstico de la PET/TAC con 18F-FDG y 11C-colina en la detección precoz y localización de la recurrencia del cáncer de próstata. Material y métodos: Se incluyeron 38 pacientes con elevación de PSA (0,8-9,5 ng/ml) tras terapia radical de cáncer de próstata (cirugía n = 20/radioterapia n = 18). Diez pacientes estaban en terapia antiandrogénica. A todos se les realizó el mismo día una PET/TAC con 11C-colina y 18F-FDG. Los hallazgos se compararon con la histología (n = 10), monitorización del PSA (n = 21) y/u otras técnicas (n = 7). Resultados: El 68% de los pacientes (n = 26) mostraron depósitos de 11C-colina y un 34% (n = 13) focos con 18FFDG. Catorce pacientes mostraron captación de 11C-colina sugestiva de recidiva local, y sólo 6 (48%) de 18F-FDG. La 11C-colina mostró adenopatías pélvicas en 8 pacientes y sólo 4 (50%) con 18F-FDG. La afectación mediastínica se observó en 5 pacientes con 11C-colina y en 3 (60%) con 18F-FDG. Se detectaron depósitos de 18F-FDG y 11C-colina en el esqueleto de 3 pacientes. En el grupo de pacientes con PSA < 1 ng/ml la 11C-colina detectó el 40% de recidivas, con PSA entre 1-4 ng/ml, el 50% y con PSA > 4 ng/ml, el 87%. La sensibilidad de la 11C-colina fue más elevada en los pacientes operados, sin diferencias entre los pacientes con o sin terapia antiandrogénica...(AU)

Objective: To compare the diagnostic accuracy of PET/CT with 18F-FDG and 11C-choline for early detection and localization of recurrent prostate cancer. Material and methods: Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with 11C-choline and 18F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7). Results: Focal uptake of 11C-choline was detected in 26 patients (68%), and focal uptake of 18F-FDG was detected in 13 patients (34%). The 11C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with 18F-FDG. Pelvic lymph nodes were detected with 11C-choline PET/CT in 8 patients and only in 4 patients (50%) with 18FFDG. Mediastinal involvement was detected in 5 patients with 11C-choline and 3 patients (60%) with 18F-FDG. Focal bone involvement was detected in 3 patients with 11C-choline and 18F-FDG. 11C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of 11C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. Conclusions: 11C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to 18F-FDG. 11C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with 11C-choline showed direct impact for the selection of the most appropriate therapeutic approach(AU)

Compensation in pre-synaptic dopaminergic function following nigrostriatal damage in primates.

Clinical symptoms of Parkinson's disease only become evident after 70-80% reductions in striatal dopamine. To investigate the importance of pre-synaptic dopaminergic mechanisms in this compensation, we determined the effect of nigrostriatal damage on dopaminergic markers and function in primates. MPTP treatment resulted in a graded dopamine loss with moderate to severe declines in ventromedial striatum (approximately 60-95%) and the greatest reductions (approximately 95-99%) in dorsolateral striatum. A somewhat less severe pattern of loss was observed for striatal nicotinic receptor, tyrosine hydroxylase and vesicular monoamine transporter expression. Declines in striatal dopamine uptake and transporter sites were also less severe than the reduction in dopamine levels, with enhanced dopamine turnover in the dorsolateral striatum after lesioning. The greatest degree of adaptation occurred for nicotine-evoked [(3)H]dopamine release from striatal synaptosomes, which was relatively intact in ventromedial striatum after lesioning, despite > 50% declines in dopamine. This maintenance of evoked release was not due to compensatory alterations in nicotinic receptor characteristics. Rather, there appeared to be a generalized preservation of release processes in ventromedial striatum, with K(+)-evoked release also near control levels after lesioning. These combined compensatory mechanisms help explain the finding that Parkinson's disease symptomatology develops only with major losses of striatal dopamine.

[Brain metastasis and the carcinoembryonic antigen]. / Metástasis cerebrales y antígeno carcinoembrionario.

INTRODUCTION: Neurological complications have a notable repercussion on the quality of life of patients with systemic cancer, and can even become the direct cause of death. The complication that causes most concern is undoubtedly brain metastasis, because of its difficult management and because there has been an upward tendency in its incidence in the last few years. AIMS: The aim of this study is to provide a review of the literature about brain metastases and, more particularly, about the carcinoembryonic antigen (CEA) as a marker of these pathologies. DEVELOPMENT: In general it is reckoned that 60% of all brain metastases start from the lung and most of them are multiple when they are diagnosed, which suggests a possibly mistaken staging of these patients. The carcinoembryonic antigen is the prototypical tumour marker, and it is usually found in higher concentrations in the cerebrospinal fluid of patients with metastatic tumours in the central nervous system. As the CEA goes through the blood brain barrier, it behaves in a similar way to IgA due to their having homologous molecular weights. This allows us to employ the same hyperbolic distribution curve that is used as a reference for lgA to distinguish between intrathecally synthesized CEA and that which diffuses from the systemic circulation. CONCLUSIONS: In spite of the progress that has been obtained with the new therapies, brain metastases continue to have a poor prognosis. Hence, there is a need to identify new tumour markers that allow a diagnosis to be established before the clinical methods and presentations.

Metástasis cerebrales y antígeno carcinoembrionario / Brain metastasis and the carcinoembryonic antigen

Introducción. Las complicaciones neurológicas repercuten notablemente en la calidad de vida de los pacientes con cáncer sistémico, y llega a ser incluso la causa directa de muerte. Entre estas complicaciones, la más preocupante es la metástasis cerebral, por su difícil tratamiento y porque su incidencia tiende a aumentar en los últimos años. Objetivos. Aportar una revisión bibliográfica acerca de las metástasis cerebrales y en particular del antígeno carcinoembrionario (CEA) como marcador de estas patologías. Desarrollo. En general, se plantea que el 60 por ciento de las metástasis cerebrales provienen del pulmón, y la mayoría son múltiples en el momento del diagnóstico, lo que nos sugiere una posible estadificación incorrecta de estos pacientes. El antígeno carcinoembrionario constituye el prototipo de marcador tumoral, y sus concentraciones suelen elevarse en el líquido cefalorraquídeo de los pacientes con tumores metastáticos en el sistema nervioso central. El CEA se comporta en su paso por la barrera hematoencefálica de forma similar a la IgA, pues tienen pesos moleculares homólogos, lo que permite que lamisma curva de distribución hiperbólica de referencia que se usa para la IgA pueda emplearse para discernir entre el CEA sintetizado intratecalmente del que se difunde de la circulación sistémica. Conclusiones. A pesar de los progresos que se han obtenido con las nuevas terapias, las metástasis cerebrales continúan teniendo un mal pronóstico, por lo que es necesario identificar nuevos marcadores tumorales que permitan establecer el diagnóstico antes que los métodos establecidos y las manifestaciones clínica (AU)

Introduction. Neurological complications have a notable repercussion on the quality of life of patients with systemic cancer, and can even become the direct cause of death. The complication that causes most concern is undoubtedly brain metastasis, because of its difficult management and because there has been an upward tendency in its incidence in the last few years. Aims. The aim of this study is to provide a review of the literature about brain metastases and, more particularly, about the carcinoembryonic antigen (CEA) as a marker of these pathologies. Development. In general it is reckoned that 60% of all brain metastases start from the lung and most of them are multiple when they are diagnosed, which suggests a possibly mistaken staging of these patients. The carcinoembryonic antigen is the prototypical tumour marker, and it is usually found in higher concentrations in the cerebrospinal fluid of patients with metastatic tumours in the central nervous system. As the CEA goes through the blood-brain barrier, it behaves in a similar way to IgA due to their having homologous molecular weights. This allows us to employ the same hyperbolic distribution curve that is used as a reference for lgA to distinguish between intrathecally synthesized CEA and that which diffuses from the systemic circulation. Conclusions. In spite of the progress that has been obtained with the new therapies, brain metastases continue to have a poor prognosis. Hence, there is a need to identify new tumour markers that allow a diagnosis to be established before the clinical methods and presentations (AU)

[IgG subclasses intrathecal synthesis patterns in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis]. / Patrones de síntesis intratecal de subclases de IgG en meningoencefalitis eosinofílica por Angiostrongylus cantonensis.

INTRODUCTION: There is a growing interest to know the characteristics of meningoencephalitis due to Angiostrongylus cantonensis because of it is an emergent disease. OBJECTIVE: To describe the intrathecal synthesis pattern of IgG subclasses in pediatric patients suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis. PATIENTS AND METHODS: Ten pediatric patients with the disease were studied. During the firs diagnostic lumbar puncture an eosinophilic pleocitosis was found. Simultaneously a serum sample was taken. Eight days later, a second lumbar and venous puncture was performed. To every serum and cerebrospinal fluid sample IgA, IgM, IgG, albumin and the four subclasses of IgG were quantified by immunodiffusion and a differential cell count. RESULTS: During the first diagnostic lumbar puncture, all the cases had blood cerebrospinal fluid barrier dysfunction with absence of immunoglobulins intrathecal synthesis with a mean of 450 106cells/L and 48% of eosinophils average. In the second lumbar punction there was a 40% patients with dysfunction of the blood cerebrospinal fluid barrier and with a synthesis pattern IgA+IgM+IgG in the 50% o patients and with IgA+IgG in four patients. The synthesis pattern of IgG subclasses was IgG1+IgG2 in six patients, IgG1+IgG2+IgG3 in one patient, IgG1+IgG2+IgG4 in one more patient and two patients without intrathecal synthesis. CONCLUSION: The intrathecal synthesis pattern of IgG subclasses can contribute to eosinophilic meningoencephalitis diagnosis due to Angiostrongylus cantonensis.

Patrones de síntesis intratecal de subclases de IgG en meningoencefalitis eosinofílica por Angiostrongylus cantonensis / Igg subclasses intrathecal synthesis patterns in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis

Introducción. Es de interés creciente conocer las características de las meningoencefalitis por Angiostrongylus cantonensis, pues se trata de una enfermedad emergente. Objetivo. Describir el patrón de síntesis de subclases de IgG en pacientes pediátricos con meningoencefalitis eosinofílica por Angiostrongylus cantonensis. Pacientes y métodos. Se estudiaron 10 pacientes pediátricos con la enfermedad. En la punción lumbar diagnóstica se encontró pleocitosis eosinofílica. Se tomó una muestra simultánea de suero. A los ocho días se realizó una segunda punción lumbar y venosa. En cada muestra de suero y líquido cefalorraquídeo (LCR) se cuantificó IgA, IgM, IgG, albúmina y las cuatro subclases de IgG por inmunodifusión. Además, se realizó un conteo celular diferencial. Resultados. En la primera punción lumbar diagnóstica, todos los casos tenían disfunción de la barrera sangre-LCR, con ausencia de síntesis intratecal de inmunoglobulinas, con un promedio 450 × 106 células/L y un 48 por ciento de eosinófilos. En la segunda punción lumbar, el 40 por ciento permanecía con disfunción de barrera sangre-LCR, con patrón de síntesis IgA+IgM+IgG en el 50 por ciento de los casos e IgA+IgG en otros cuatro pacientes. El patrón de síntesis de subclases fue de IgG1+IgG2 en seis pacientes, de IgG1+IgG2+IgG3 en otro paciente y de IgG1+IgG2+IgG4 en otro. Hubo dos pacientes que no sintetizaron ninguna subclase a nivel intratecal. Conclusiones. El patrón de síntesis intratecal de subclases de IgG puede contribuir al diagnóstico de las meningoencefalitis eosinofílicas por Angiostrongylus cantonensis (AU)

Introduction. There is a growing interest to know the characteristics of meningoencephalitis due to Angiostrongylus cantonensis because of it is an emergent disease. Objective. To describe the intrathecal synthesis pattern of IgG subclasses in pediatric patients suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis. Patients and methods. Ten pediatric patients with the disease were studied. During the firs diagnostic lumbar puncture an eosinophilic pleocitosis was found. Simultaneously a serum sample was taken. Eight days later, a second lumbar and venous puncture was performed. To every serum and cerebrospinal fluid sample IgA, IgM, IgG, albumin and the four subclasses of IgG were quantified by immunodiffusion and a differential cell count. Results. During the first diagnostic lumbar puncture, all the cases had blood-cerebrospinal fluid barrier dysfunction with absence of immunoglobulins intrathecal synthesis with a mean of 450 × 106 cells/L and 48% of eosinophils average. In the second lumbar punction there was a 40% patients with dysfunction of the blood-cerebrospinal fluid barrier and with a synthesis pattern IgA+IgM+IgG in the 50% o patients and with IgA+IgG in four patients. The synthesis pattern of IgG subclasses was IgG1+IgG2 in six patients, IgG1+IgG2+IgG3 in one patient, IgG1+IgG2+IgG4 in one more patient and two patients without intrathecal synthesis. Conclusion. The intrathecal synthesis pattern of IgG subclasses can contribute to eosinophilic meningoencephalitis diagnosis due to Angiostrongylus cantonensis (AU)

Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer Group (GG).

OBJECTIVE: To describe the clinical characteristics and treatment results obtained with the application of a homogeneous treatment protocol in 1490 patients with germ-cell tumours (GCT) registered in the 55 hospitals belonging to the Spanish Germ-Cell Cancer Group (GG) during the period between January 1994 and April 2001. METHODS: In general, surveillance was the common policy for stage I patients without local poor prognosis factors, whereas they received adjuvant chemotherapy in case those factor were present. Chemotherapy schedules used in advanced cases were cisplatin and etoposide (EP) for seminoma and BEP or BOMP-EPI in non-seminoma, according to whether the patient was in the good or poor prognosis IGCCCG (International Germ-Cell Cancer Collaborative Group) group. Excision of residual masses was mandatory in non-seminomatous germ-cell tumour (NSGCT). RESULTS: Initial local symptomatology was increased testis size in 90% of cases. Sonography was an excellent diagnostic tool to suggest tumour. Non-seminoma (64.2%) was more frequent than seminoma (35.8%). Approximately 10% had the antecedent of cryptorchidism. Non-seminoma patients were 7 years younger than seminoma. Right testis was involved predominantly. Pre-orchidectomy tumour markers were elevated in 21% of seminoma (betaHGC) and 79% in non-seminoma (alphaFP and/or betaHGC). Scrotum violation occurred in only 1.8%. There were significant differences among stage I and the IGCCCG prognosis groups related to a longer interval between the first symptom and orchiectomy. Eighteen percent of non-seminomatous germ-cell tumour belonged to the poor prognosis IGCCCG group. With a median follow-up to 33 months, this series has achieved a 3 year overall survival of 98% for seminoma and 94% for non-seminoma. Only 10% of excised residual masses present after chemotherapy contained malignant cells. CONCLUSION: Spanish GCT have a similar clinical pattern to that described in the other occidental countries except for a slight increased proportion of non-seminoma upon seminoma. Co-operative groups as GG are unique structures to obtain quick and wide experience on the treatment of testis tumours, contributing to achieve a high cure rate.

[Intrathecal synthesis pattern of immunoglobulins in meningoencephalitis epidemic due to echovirus 9]. / Patrones de síntesis intratecal de inmunoglobulinas en epidemia de meningoencefalitis por echovirus 9.

INTRODUCTION: Epidemics of meningoencephalitis due to echovirus 9 were commonly occurred when a children population become susceptible for the first time in front the virus. OBJECTIVE: To present the intrathecal synthesis pattern of immunoglobulins of the epidemic that affected Cuba in 1999 and to probe the usefulness of reibergram and antibody index in the diagnostic and characterization of the outbreak. PATIENTS AND METHODS: 23 pediatric patients suffering from viral meningoencephalitis due to echovirus 9 were studied in the income moment. Serum and cerebrospinal fluid IgA, IgM, IgG, albumin and glucose were quantified. Cerebrospinal fluid total protein content and lactate were quantified. Titles of antibodies against echo 9 and Coxsackie A9 and differential cell count were performed. RESULTS: A mean of 555 cells/10 6 L mainly lymphocytes were obtained. Glucose in cerebrospinal fluid was over 50%, serum glucose and lactate levels below 2.1 mmol/L. In the reibergram an absence of intrathecal synthesis was predominant (15/23), IgM synthesis (6/23) and IgM+IgA (2/23). Blood cerebrospinal fluid dysfunction was observed in 15 patients. The mean antibody index was 1,8 for echo 9 and 0,9 for Coxsackie A9. CONCLUSIONS: The intrathecal synthesis pattern of immunoglobulins was different from other enterovirus and from echovirus 9 in non epidemic situations before this epidemic, probably with alteration of viral genome.

Patrones de síntesis intratecal de inmunoglobulinas en epidemia de meningoencefalitis por echovirus 9 / Intrathecal synthesis pattern of immunoglobulins in meningoencephalitis epidemic due to echovirus 9

Introducción. Las epidemias producidas por echovirus 9 son comunes cuando existe una población infantil susceptible que se enfrenta al virus por primera vez. Objetivo. Presentar el patrón de síntesis intratecal (SI) de inmunoglobulinas de la epidemia que afectó a Cuba en 1999 y comprobar la utilidad del reibergrama y del índice de anticuerpo en el diagnóstico y caracterización del brote. Pacientes y métodos. Se estudiaron 23 pacientes con meningoencefalitis vírica por echovirus 9 en el momento del ingreso. Se cuantificaron IgA, IgM, IgG, albúmina, glucosa en suero y líquido cefalorraquídeo (LCR), y proteínas totales y lactato en LCR. Se realizaron los títulos de anticuerpos antiechovirus 9 y Coxsackie A9 y recuento celular diferencial. Resultados. Se obtuvo un recuento celular medio de 555 células/10-6 L con predominio de linfocitos. Los valores de glucosa en LCR estuvieron por encima del 50 por ciento de la glucosa en suero y lactato menor de 2,1 mmol/L. En el reibergrama predominó la ausencia de síntesis (15/23), IgM (6/23) e IgM+IgA (2/23). Hubo disfunción de la barrera sangre-LCR en 15 pacientes. El índice de anticuerpo específico medio fue de 1,8 para echovirus 9 y 0,9 para Coxsackie A9. Conclusión. El patrón de SI de inmunoglobulinas se diferencia del de otros enterovirus y el propio echovirus 9 en situaciones no epidémicas anteriores con probable alteración del genoma vírico (AU)