Primary central nervous system vasculitis: A diagnostic and therapeutic challenge. A series of 7 patients.

INTRODUCTION: Primary central nervous system vasculitis (PCNSV) is a rare disease affecting medium- and small-calibre blood vessels of the central nervous system. OBJECTIVE: The aim of this study was to analyse clinical findings and diagnostic aspects, with special attention to histopathological findings, as well as the treatments used and treatment response in patients diagnosed with PCNSV at our hospital. PATIENTS AND METHODS: We conducted a retrospective descriptive analysis of patients with a diagnosis of PCNSV at discharge from our centre and meeting the 1988 Calabrese criteria. To this end, we analysed the hospital discharge records of Hospital General Universitario de Castellón between January 2000 and May 2020. RESULTS: We analysed a series of 7 patients who were admitted with transient focal alterations and other less specific symptoms such as headache or dizziness; diagnosis was based on histological findings in 5 cases and on suggestive arteriographic findings in the remaining 2. Neuroimaging results were pathological in all cases, and CSF analysis detected alterations in 3 of the 5 patients who underwent lumbar puncture. All patients received initial treatment with megadoses of corticosteroids followed by immunosuppressive treatment. Progression was unfavourable in 6 cases, with fatal outcomes in 4. CONCLUSIONS: Despite the diagnostic challenge of PCNSV, it is essential to attempt to reach a definitive diagnosis using such tools as histopathology and/or arteriography studies, in order to promptly establish appropriate treatment and thus reduce the morbidity and mortality of this condition.

Benquerencia (La Serena - Spain) rock art: An integrated spectroscopy analysis with FTIR and Raman.

La Serena region is a large plateau with open landscapes bounded in the south by a mountain chain formed by the Benquerencia, Tiros and La Rinconada Sierras. There are more than 300 painted and engraved sites in the region. Cueva Grande, Cueva de En medio and Cueva Pequeña are three Schematic rock art shelters located in the municipality of Benquerencia de la Serena, Badajoz, Spain. Over their panels have been documented more than a hundred of painted schematic figures (anthropomorphic figures, eye-shape figures and symbols) (Neolithic - Copper Age). Paintings are monochromatic with red or black coloration. A total of 13 samples (10 red and 3 black samples) from different panels were collected and analyzed using micro-Raman spectroscopy and ATR-FTIR. Micro-Raman spectroscopy was able to characterize the main mineral component, respectively hematite for the red figures and charcoal for the black paintings. ATR-FTIR was useful to possible ochre and possible organic identification. These latest results are particularly important for understanding manufacturing processes and addressing conservation problems.

Response to Comment on "U-Th dating of carbonate crusts reveals Neandertal origin of Iberian cave art".

Slimak et al challenge the reliability of our oldest (>65,000 years) U-Th dates on carbonates associated with cave paintings in Spain. They cite a supposed lack of parietal art for the 25,000 years following this date, along with potential methodological issues relating to open-system behavior and corrections to detrital or source water 230Th. We show that their criticisms are unfounded.

U-Th dating of carbonate crusts reveals Neandertal origin of Iberian cave art.

The extent and nature of symbolic behavior among Neandertals are obscure. Although evidence for Neandertal body ornamentation has been proposed, all cave painting has been attributed to modern humans. Here we present dating results for three sites in Spain that show that cave art emerged in Iberia substantially earlier than previously thought. Uranium-thorium (U-Th) dates on carbonate crusts overlying paintings provide minimum ages for a red linear motif in La Pasiega (Cantabria), a hand stencil in Maltravieso (Extremadura), and red-painted speleothems in Ardales (Andalucía). Collectively, these results show that cave art in Iberia is older than 64.8 thousand years (ka). This cave art is the earliest dated so far and predates, by at least 20 ka, the arrival of modern humans in Europe, which implies Neandertal authorship.

Utilidad del coeficiente de difusión aparente en resonancia magnética como método auxiliar para la diferenciación entre meduloblastomas y ependimomas de la fosa craneal posterior en niños y adultos tratados en el Hospital Carlos Van Buren de Valparaíso: Una experiencia preliminar / Usefulness of apparent diffusion coefficient in magnetic resonance as an auxiliary method for the differentiation between medulloblastomas and ependymomas of the posterior cranial fossa in children and adults treated at the Carlos Van Buren Hospital in Valparaíso: A preliminary experience

The use of the apparent diffusion coefficient (ADC) in magnetic resonance imaging (MRI) has been shown to be useful in the task of differentiating primary brain tumors. Our objective is to evaluate its use to differentiate between medulloblastomas and ependymomas. We analyzed 37 cases: 21 medulloblastomas (average age 12 years) and 16 ependymomas (average age 5 years) of the posterior fossa treated at the Carlos Van Buren Hospital in Valparaíso between december 2005 and June 2015. There were 15 and 5 males in each group respectively. In addition to age and gender, ADC values of tumors (ADCt) and healthy tissue were collected. The ADCt values for medulloblastoma and ependymoma averaged 0.64 and 0.92 [x10-3 mm²/s] respectively (p< 0.001). The multivariate model included gender and ADCt, with a sensitivity of 0.95 and a specificity of 0.87 to predict medulloblastoma. We can conclude that ADC measurement helps differentiate tumors of different cellularity such as medulloblastoma and ependymoma.

El uso del coeficiente de difusión aparente (ADC) en resonancia magnética (RM) ha demostrado ser útil en la tarea de diferenciar tumores cerebrales primarios. Nuestro objetivo es evaluar su uso para diferenciar entre meduloblastomas y ependimomas. Se analizaron 37 casos: 21 meduloblastomas (edad promedio 12 años) y 16 ependimomas (edad promedio 5 años) de fosa posterior tratados en el hospital Carlos Van Buren de Valparaíso, entre diciembre de 2005 y junio de 2015. Hubo 15 y 5 hombres en cada grupo respectivamente. Además de edad y sexo se recolectaron valores ADC tumorales (ADCt) y de tejido sano. Los valores ADCt para meduloblastoma y ependimoma promediaron 0,64 y 0,92 [x 10-3 mm²/s] respectivamente (p<0,001). El modelo multivariado incluyó sexo y ADCt, con sensibilidad de 0,95 y especificidad 0,87 para predecir meduloblastoma. Podemos concluir que la medición de ADC ayuda a diferenciar tumores de distinta celularidad como el meduloblastoma y el ependimoma.

Actualización en sobrecrecimiento bacteriano intestinal y dificultades en su diagnóstico / Update in intestinal bacterial overgrowth and difficulties in their diagnosis

This is a short review related with the current concepts and controversies in the diagnosis of intestinal bacterial overgrowth. This is a relatively complex entity present in diverse pathologies. Its adequate diagnosis has impact in the therapy and management of the patients with this condition. (AU)

Peroneus quartus and functional ankle instability.

INTRODUCTION: Physical and rehabilitation medicine physicians commonly see patients with chronic functional ankle instability. The main anatomical structures involved in ankle stability are the peroneus (fibularis) brevis and peroneus longus muscles. Several anatomical muscle-tendon variations have been described in the literature as being sometimes responsible for this instability, the peroneus quartus muscle being the most frequent. The objective of this clinical study is to discuss the implication of the bilateral peroneus quartus muscle in functional ankle instability. CLINICAL CASE: This 26-year-old patient was seen in PM&R consultation for recurrent episodes of lateral ankle sprains. The clinical examination found a moderate hyperlaxity on the right side in bilateral ankle varus. We also noted a bilateral weakness of the peroneus muscles. Additional imaging examinations showed a supernumerary bilateral peroneus quartus. The electroneuromyogram of the peroneus muscles was normal. DISCUSSION: In the literature the incidence of a supernumerary peroneus quartus muscle varies from 0 to 21.7%. Most times this muscle is asymptomatic and is only fortuitously discovered. However some cases of chronic ankle pain or instability have been reported in the literature. It seems relevant to discuss, around the clinical case of this patient, the impact of this muscle on ankle instability especially when faced with lingering weakness of the peroneus brevis and longus muscles in spite of eccentric strength training and in the absence of any neurological impairment. One of the hypotheses, previously described in the literature, would be the overcrowding effect resulting in a true conflict by reducing the available space for the peroneal muscles in the peroneal sheath.

An assessment of patient satisfaction for a short-stay program in a physical and rehabilitation medicine day hospital.

INTRODUCTION: The aim of the Physical and Rehabilitation Medicine (PRM) day hospital's short-stay program is to propose a one- or two-day medical and psychosocial assessment to patients with disabilities. The day hospital is run by an interprofessional team, using interdisciplinary cooperation and a hospital/community network. OBJECTIVES: To describe a tool for assessing patient satisfaction and to present the results of our survey. PATIENTS AND METHODS: A self-administered questionnaire about patient satisfaction was created and given to patients coming to the PRM day hospital. The questionnaire included 27 multiple-choice questions, two visual analogic scales, and one free-response question. The survey was conducted over two months. For the 603 annual day hospital sessions, 143 questionnaires on 143 sessions were filled out. RESULTS: Patients found the questionnaire easy to use, but a few needed help to fill it out. It permitted us to highlight the places where the short-stay program performed unsatisfactorily. CONCLUSIONS: The self-administered questionnaire seems to be appropriate for assessing patient satisfaction. The highest scores helped to emphasize where the program was functioning correctly, and the lowest scores allowed us to identify the points that needed to be improved.

Eccentric reinforcement of the ankle evertor muscles after lateral ankle sprain.

To compare two methods of ankle evertor muscle reinforcement after ankle sprain: concentric vs eccentric reinforcement. Eighteen subjects practising sport with first episode of ankle sprain. The first randomized group underwent conventional physical therapy including concentric reinforcement of the evertor ankle muscles [concentric group (CG)]. The second randomized group underwent eccentric reinforcement [eccentric group (EG)]. At the end of the physical therapy, the strength of the evertor muscles was tested using an isokinetic dynamometer. The measurements were peak torques in the concentric and eccentric modes; ankle strength deficits, expressed as percentages of the healthy ankle values recorded in the concentric and eccentric modes; ratios between concentric/eccentric values. After the concentric reinforcement, in the CG group, there is both significant concentric strength deficit and an eccentric strength deficit on the injured side in comparison with the healthy side. After the eccentric reinforcement in the EG group, the muscle strength was significantly greater during concentric movements. Eccentric rehabilitation therefore restored the strength of the injured evertor muscles. These results show the value of this method, especially as the weakness of these muscles after sprains is one of the main risk factors contributing to instability and the recurrence of sprains.

Should European PRM residents be taught in English? The experience of the European school Marseille.

OBJECTIVE: To assess the level of comprehension of the courses taught in English at the annual European school on Physical and Rehabilitation Medicine (PRM) (European School Marseille). MATERIALS AND METHODS: The English level of 37 students, mainly from European countries, was tested using three written questionnaires: an initial test of English grammar, a questionnaire about comprehension at the end of a basic PRM class taught in English by a French specialist and a final multiple-choice test (MCT) on the contents of the course. RESULTS: We found a difference between the level of English given by the residents and the level shown by the initial test. The overall level of English comprehension of the group was good, an average of 8.2/10 (S.D.: 2.1) on a Visual Analogue Scale. The mean MCT score on the contents of the course was good, an average of 6.1/10 (S.D.: 2.2). For residents with lower levels of English, the level of comprehension for courses taught in English by the French specialist was greater than the level of comprehension for courses taught by native English speakers (p=0.033). CONCLUSION: The level of comprehension of most European PRM residents for courses taught in English by French PRM specialists and by English-speaking specialists is good. The level of comprehension is, of course, influenced by the English level of European residents. It thus appears worthwhile to organize programmes taught in English for European PRM residents. Nonetheless, it is important to assess the language skills of the residents and to use specific tools to help the small number of trainees whose English level is to low.

Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle.

AIM: Clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The aim of this study was to compare the assessment of clinical signs and the ultrasonographic findings in recent LCL sprain of the ankle. METHODS: This was a retrospective cross-sectional study. Spearman's rank correlation test and multiple regression analysis were used to assess correlations between clinical signs and type of ligament injury. Fisher's linear discriminant analysis was used to determine most contributive signs in ligament tear diagnosis. RESULTS: No single clinical sign was correlated with the severity of ligament injury as revealed by ultrasonography in the 34 patients analyzed. Careful assessment of all the usual clinical signs of severity seems to better guide the diagnosis of the presence or absence of ligament tearing. CONCLUSIONS: These results confirm the lack of correlation between clinical examination and the anatomic injury in distension or partial tearing of the anterior talofibular ligament. They raise questions about the usefulness of clinical classifications and suggest a broadening of the indications for ultrasonographic exam in ambiguous situations, particularly for athletes showing few signs of severe injury, in order to ensure optimal treatment and a faster recovery.

[Eyberg inventory of child behavior. Standardization of the Spanish version and its usefulness in ambulatory pediatrics]. / Inventario Eyberg del comportamiento en niños. Normalización de la versión española y su utilidad para el pediatra extrahospitalario.

OBJECTIVE: Taking into account the high prevalence of behavioral problems in the pediatric outpatient clinic, a need for a useful and easy to administer tool for the evaluation of this problem arises. The psychometric characteristics of the Spanish version of the Eyberg Behavioral Child Inventory (EBCI), [in Spanish Inventario de Eyberg para el Comportamiento de Niño (IECN)], a 36-item questionnaire were established. PATIENTS AND METHODS: The ECBI inventory/questionnaire was translated into Spanish. The basis of the ECBI is the evaluation of the child's behavior through the parents' answers to the questionnaire. Healthy children between 2 and 12 years of age were included and were taken from pediatric outpatient clinics from urban and suburban areas of Barcelona and from our hospital's own ambulatory clinic. RESULTS: The final sample included 518 subjects. The mean score on the intensity scale was 96.8 and on the problem scale 3.9. Internal consistency (Cronbach's alpha) was 0.73 and the test-retest had an r of 0.89 (p < 0.001) for the intensity scale and r = 0.93 (p < 0.001) for the problem scale. Interrater reliability for the intensity scale was r = 0.58 (p < 0.001) and r = 0.32 (p < 0.001) for the problem scale. Concurrent validity between both scales was r = 0.343 (p < 0.001). CONCLUSIONS: The IECN is a useful and easy tool to apply in the pediatrician's office as a method for early detection of behavior problems.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4%7) and six in Group B(35.2%) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoinmune hepatitis (CAH)

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoinmmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([a]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fullfilled criteria for PBC diagnosis (clinical and humoral and liver biopsy). Group B: 17 patients who fullfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody tiles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded form the study. Ability to acidify urine was evaluated by gradient between pCO2 in urine and blood (U-BpC02) after alkali infusion. Five patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 ñ 33.8, versus 50.8 ñ 8.1 mEq/l, in Group B. (p=0.00016). We concluded that the prevalence of dRTA was similar en patiens with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did whit the latter

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4

7) and six in Group B(35.2

) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoinmune hepatitis (CAH)

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoinmmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([a]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fullfilled criteria for PBC diagnosis (clinical and humoral and liver biopsy). Group B: 17 patients who fullfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody tiles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded form the study. Ability to acidify urine was evaluated by gradient between pCO2 in urine and blood (U-BpC02) after alkali infusion. Five patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 ñ 33.8, versus 50.8 ñ 8.1 mEq/l, in Group B. (p=0.00016). We concluded that the prevalence of dRTA was similar en patiens with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did whit the latter (AU)