[Endophenotypes of the biorhythms and the sleep in depression]. / Endophénotypes des rythmes biologiques et du sommeil dans la dépression.

Chronobiological markers of depression display a biological desynchronization which participates in the pathogenesis of depression. Mood disorders and clock genes have shown significant associations suggesting a possible pathogenetic link between them, providing a privileged base for exploring biorhythmic endophenotypes. They would be useful indicators of vulnerability mechanisms, giving rise to new therapies and prevention programs. Two ways of research are of interest: the study of the genetic determinants of cholinergic hypersensitivity generating REM sleep pressure in depression, and the analysis of clinical response to sleep deprivation suggesting an exploration of links between genomic function of arousal and mood regulation. To date, the empirical principle of behavioral stimulus control reaches the level of the available eco-instrumental synchronization procedures.

[Combination of external irradiation and androgen suppression for prostate cancer: facts and questions]. / Radiothérapie et hormonothérapie pour le cancer de la prostate: acquis et interrogations.

The combination of radiotherapy and androgen suppression with luteinizing hormone releasing hormone agonist is mainly devoted to locally advanced prostate cancer and intermediate or poor risk localized prostate cancer. They are based on phase III randomized trials which have shown that for locally advanced prostate cancer, a four-month complete androgen blockade initiated two months prior radiotherapy and stopped at the completion of radiotherapy increased overall survival in patients with Gleason scores 2-6, meanwhile, an adjuvant long-term androgen suppression (2.5 to three years) improved significantly the overall survival. Complete androgen blockade with a four to six months duration, combined with external irradiation, enhanced the overall survival in patients with intermediate or poor risk localized prostate cancer.

Absceso en pabellón auricular tras inicio efectivo de TARGA (tratamiento antirretroviral de gran actividad) / Abscess in ear after effective onset of high activity antiretroviral treatment

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Possible azithromycin-associated hiccups.

OBJECTIVE: To report a case of persistent hiccups associated by azithromycin therapy. CASE SUMMARY: A 76-year-old man presented with persistent hiccups after beginning azithromycin for the treatment of pharyngitis. Hiccups were persistent and exhausting. Discontinuation of azithromycin and therapy with baclofen finally resolved hiccups. No organic cause of hiccups was identified despite extensive investigation. DISCUSSION: Pharmacotherapeutic agents have been uncommonly associated with hiccups. Corticosteroids (dexamethasone and methylprednisolone), benzodiazepines (midazolam) and general anaesthesia have been the specific agents mentioned most frequently in the literature as being associated with the development of hiccups. Few cases of drug-induced hiccups have been reported related to macrolide antimicrobials. Using the Naranjo adverse effect reaction probability scale this event could be classified as possible (score 5 points), mostly because of the close temporal sequence, previous reports on this reaction with other macrolides and the absence of any alternative explanation for hiccups. Our hypothesis is that a vagal mechanism mediated by azithromycin could be the pathogenesis of hiccups in our patient. CONCLUSIONS: Diagnosis of drug-induced hiccups is difficult and often achieved only by a process of elimination. However, macrolide antimicrobials have been reported to be associated with hiccups and vagal mechanism could explain the development of this side-effect.

Sacral myeloradiculitis complicating genital herpes in a HIV-infected patient.

Myeloradiculitis is a rare neurological complication of herpes simplex type 2 (HSV-2) infection, frequently associated with a fatal outcome. Among patients with HIV infection, HSV-2 myeloradiculitis has occasionally been reported, always associated with advanced immunosuppression and AIDS. We report a patient with HIV infection but no history of previous opportunistic infections, who developed sacral myeloradiculitis immediately after an episode of genital herpes. Magnetic resonance imaging with gadolinium showed necrotizing myelitis in the conus medullaris and enhancement of sacral roots. CD4 lymphocyte count was 530/mm3. Other possible causes of myeloradiculitis in HIV-infected patients were appropriately excluded. Acyclovir therapy resulted in partial clinical improvement. This report shows that myeloradiculitis as a complication of genital herpes may occur in the early stages of HIV infection and may have a favourable outcome with antiviral treatment.

Utilidad del SPECT cerebral en el diagnóstico de la encefalopatía de Wernicke-Korsakoff / Use of brain SPECT imaging in the diagnosis of Wernicke-Korsakoff´s encephalopathy

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[Acute respiratory insufficiency as onset form of Lambert-Eaton's syndrome associated with pulmonary small cell carcinoma]. / Insuficiencia respiratoria aguda como forma de debut de síndrome de Lambert-Eaton asociado a carcinoma pulmonar de células pequeñas.

The Lambert-Eaton myasthenic syndrome is a rare disorder of neuromuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failure as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first manifestation of Lambert-Eaton myasthenic syndrome associated with small cell lung cancer and discuss the main features of this disease, including its treatment. The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplasic disease. We thought that electromyographic studies could reveal the real involvement of respiratory muscles, including diaphragm, in this condition.

Insuficiencia respiratoria aguda como forma de debut de síndrome de Lambert-Eaton asociado a carcinoma pulmonar de células pequeñas / Lambert-Eaton myasthenic syndrome presenting as acute respiratory failure in a patient with small cell lung cancer

El síndrome de Lambert-Eaton (SLE) es un trastorno raro de la transmisión neuromuscular que se presenta habitualmente como un proceso paraneoplásico frecuentemente asociado al carcinoma pulmonar de células pequeñas. Varios estudios han demostrado la existencia de disfunción de la musculatura respiratoria en estos pacientes. La insuficiencia respiratoria aguda como presentación del SLE ha sido descrita de forma excepcional. Se describe un caso de insuficiencia respiratoria aguda como forma de debut de SLE asociado a un carcinoma microcítico de pulmón, repasando las principales características del cuadro y su tratamiento. El SLE debería ser considerado en casos de insuficiencia respiratoria aguda sin causa aparente y sospecha de enfermedad neoplásica de base. Proponemos la realización de estudios electromiográficos que detecten alteraciones en la función muscular respiratoria, incluyendo el diafragma, para descartar su existencia (AU)

Sepsis neumocócica en una paciente con infección por el virus de la inmunodeficiencia humana esplenectomizada vacunada

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[Acute iron poisoning. A case report]. / Intoxicación aguda por hierro en un caso.

The ingestion of iron-containing products is a potential toxicological emergency. It is a leading cause of pediatric unintentional ingestion fatalities because some iron-containing compounds are readily available (vitamin mixtures, iron pills). Among adults, it has been described as accidental overdoses (mainly in pregnancy) and as suicidal attempts. We report a 42 years old woman, admitted due to the intentional ingestion of iron pills with suicidal purposes. A plain abdominal X ray showed at least 20 pills in the gastric fundus and antrum. She was successfully treated with intravenous desferroxamine chelation. Plain abdominal X ray examination can be very useful in the diagnosis of acute iron poisoning.

Meningitis meningocócica sin reacción inflamatoria en líquido cefalorraquídeo / Meningococcal meningitis with no signs of inflammatory reaction in the cerebrospinal fluis

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