[The use of biological markers in the diagnosis and follow-up of patients with multiple sclerosis. Test of five fluids]. / Utilidad de los marcadores biológicos en el diagnóstico y seguimiento de los pacientes con esclerosis múltiple. Test de los cinco humores.

PATIENTS AND METHODS: We studied five biological fluids which were easily accessible to immunological examination (cerebrospinal fluid, plasma, tears, saliva and urine) in 25 patients with multiple sclerosis, clinically definite according to the criteria of Cleveland, Ohio (1991) and tabulated according to the Kurztke's expanded disability status scale. The samples were obtained simultaneously during a clinical bout of the disease before any pharmacological or immunosuppressive treatment had been given. RESULTS: The soluble interleukin-2 levels were significantly raised in at least three of these fluids--always absent from the urine--when compared with normal controls. The sensitivity and specificity of this determination for diagnosis of the condition was greater than that of other immunochemical parameters--oligoclonal distribution of immunoglobulins (specifically of IgG), imbalance of the light Kappa and Lambda chains--and physiological studies (evoked potentials). The dosification and quantification of basic myelin protein of the central nervous system, rich in citruline in the urine, may be a parameter of progressiveness. CONCLUSION: This methodology (five humours test) may be used to establish an earlier, more certain diagnosis of multiple sclerosis and also monitor its biological activity together with nuclear magnetic resonance with intravenous contrast.

Test de los cinco humores / The use of biological markers in the diagnosis and follow-up of patients with multiple sclerosis. Test of the five humours

Pacientes y métodos. Se estudiaron cinco fluidos biológicos de fácil acceso a la exploración inmune (líquido cefalorraquídeo, suero, lágrimas, saliva y orina) en 25 pacientes con esclerosis múltiple clínicamente definida, de acuerdo con los criterios de Cleveland, Ohio (1991), y tabulados según la escala del estado de incapacidad ampliada de Kurtzke. Las muestras se obtuvieron simultáneamente durante un brote de la enfermedad y previo a todo tratamiento farmacológico e inmunosupresor. Resultados. El nivel de receptor soluble de interleucina-2 se encontró significativamente aumentado en, por lo menos, tres de estos fluidos -ausente siempre en la orina- en comparación con el de los controles normales. La sensibilidad y especificidad de su determinación para el diagnóstico de la afección fue mayor que la de otros parámetros inmunoquímicos -distribución oligoclonal de inmunoglobulinas (específicamente de IgG), desequilibrio de cadenas livianas kappa y lambda- y estudios electrofisiológicos (potenciales evocados). La dosificación y cuantificación de proteína básica de mielina del sistema nervioso central, rica en citrulina en orina, puede ser un parámetro de progresividad. Conclusión. Esta metodología (test de los cinco humores) podría utilizarse para establecer un diagnóstico más certero y precoz de la esclerosis múltiple así como también para monitorizar su actividad biológica junto con la resonancia magnética nuclear con contraste intravenoso (AU)

Indicaciones neuroquirurgicas en el C.B.P. / Neurosurgical indications in bronchopulmonary neoplasms

Los autores analizan la incidencia de las metastasis cerebrales unicas y multiples en el CBP. Se subraya la importancia actual de la tomografia computada en su diagnostico y el valor del metodo para las indicaciones terapeuticas. Las indicaciones quirurgicas y de tratamiento paliativo con telecobaltoterapia son precisadas, destacandose el buen resultado funcional y vital en las lesiones unicas. En segundo termino se comentan los mecanismos de produccion, asi como las indicaciones actuales de la cirugia y radioterapia en las compresiones metastaticas extradurales de la medula

[Report of a new case of Cobb syndrome. Meningo-spinal cutaneous angiomatosis]. / Aporte de un nuevo caso de síndrome de Cobb. Angiomatosis cutáneo meningoespinal.

The authors present a 47 years old female patient with cutaneomeningospinal angiomatosis or Cobb's syndrome of thoracic location. This entity, included in the primarily mesodermic phacomatose, is extremely rare, and only 17 cases have been sufficiently documented in the literature on the subject. The rare association with vertebral haemangioma of the same metameric level was present in this patient. The diagnostic criteria, possible associations, pathophysiology and nosological situation are discussed. The telangiectasic type of angioma and the principally extradural location are stressed. The authors concluded on the importance of clinical suspicion of this diagnosis based on a spinal cord syndrome in the presence of a cutaneous angioma of the same metameric level. The necessity of a complete paraclinical studies which includes selective spinal angiography and linear tomography of the spine are also stressed. With this methodology the real incidence of this syndrome will be revealed, permitting a planned surgical treatment which will diminish the high mortality and morbidity of the cases published up to the present.

[Actinomycotic cerebral abscess. Apropos of a case]. / Absceso actinomicótico cerebral. A propósito de un caso.

A case of an actinomycotic brain abscess in an adult patient apparently free of systemic infection is presented. The rarity of this etiology of brain abscess is underlined. The patient was treated by complete surgical excision and prolonged antibiotic therapy with penicillin. The authors stress the importance of taking into account this infrequent cause of brain abscess, the necessity of radical surgical treatment followed by intensive, prolonged and adequate antibiotic therapy, as the only means of reducing the high mortality rate.