Short Term Effect of Salt Shock on Ethylene and Polyamines Depends on Plant Salt Sensitivity.

In the present manuscript the short term effect (3-24 h) of a saline shock (NaCl 100 mM) on fresh weight, water content, respiration rate, ethylene production and Na+, Cl-, ACC and polyamine concentration was studied in four plant species with different salt sensitivity, pepper, lettuce, spinach, and beetroot. Higher reduction in fresh weight and water content as a consequence of saline shock was found in pepper and lettuce plants than in spinach and beetroot, the latter behaving as more salinity tolerant. In general, salinity led to rapid increases in respiration rate, ethylene production and ACC and polyamine (putrescine, spermidine, and spermine) concentrations in shoot and root. These increases were related to plant salinity sensitivity, since they were higher in the most sensitive species and vice versa. However, ethylene and respiration rates in salt stressed plants recovered similar values to controls after 24 h of treatment in salt tolerant plants, while still remaining high in the most sensitive. On the other hand, sudden increases in putrescine, spermidine, and spermine concentration were higher and occurred earlier in pepper and lettuce, the most sensitive species, than in spinach and beetroot, the less sensitive ones. These increases tended to disappear after 24 h, except in lettuce. These changes would support the conclusion that ethylene and polyamine increases could be considered as a plant response to saline shock and related to the plant species sensitivity to this stress. In addition, no competition between polyamines and ethylene biosynthesis for their common precursor was observed.

Etnobotánica farmacéutica en la Sierra de Grazalema / Etnobotânica farmacêutica em Grazalema / Pharmaceutical Ethnobotany in Grazalema

La pérdida de los saberes tradicionales acumulados durante miles de años, que han servido para garantizar la supervivencia de las comunidades, supone un impacto cultural que provoca el plantearse la importancia y necesidad de recopilar éstos conocimientos antes de su desaparición. Por otra parte, el Parque Natural Sierra de Grazalema (Cádiz) es un territorio protegido (Reserva de la Biosfera desde 1977 y Parque Natural desde 1984) que cuenta con una amplia variedad de especies vegetales y cuya poblacion está estrechamente ligada al medio. El aprovechamiento que tradicionalmente se ha realizado de sus recursos vegetales y animales ha sido el sustento económico y social de la zona, favoreciendo la conservacion de la misma y, sin embargo, no existen trabajos etnobotánicos especificos previos. Este trabajo pretende contribuir a la recuperacion del patrimonio cultural tradicional sobre el uso de las plantas que los habitantes de la Sierra de Grazalema han desarrollado durante largo tiempo (AU)

A perda do conhecimento tradicional, que tem sido acumulado durante milhares de anos e que tem contribuido para a sobrevivencia das comunidades, pode originar um impacto cultural que faz com que se reconsidere a importancia e a necessidade de reunir esse conhecimento antes do seu desaparecimento total. Alem disso, o Parque Natural Serra de Grazalema (Cádiz) e uma área protegida (Reserva da Biosfera desde 1977 e Parque Natural desde 1984), que apresenta uma grande variedade de especies vegetais, e cuja populagáo está intimamente ligada ao meio ambiente. O aproveitamento que tradicionalmente se tem realizado com os seus recursos vegetais e animais tem sido o sustento economico e social da regiáo, favorecendo a preservagáo dos mesmos, porem, sem haver trabalho etnobotenico especifico anterior. Este trabalho tem o objetivo de contribuir para a recuperagáo do patrimonio cultural tradicional sobre o uso de plantas que os habitantes da Serra de Grazalema desenvolveram durante muito tempo (AU)

The loss of the traditional knowledge, that has been accumulated during thousands of years and that has contributed to the survival of the communities, implies a cultural impact that causes the reconsideration of the significance and the need of gathering this knowledge before its total disappearance. On the other side, the Natur l Park Sierra de Grazalema (Cádiz, Spain) is a protected area (Biosphere Reserve since 1977 and Natural Park since 1984) with a wide variety of plant species that are closely linked to the environment. The traditional utilisation of its plant and animal resources has been the economic and social support of the area, a fact contributing to its preservation but, however, there are not previous specific ethnobotanical works. This work tries to contribute to the recovery of the traditional cultural heritage related to the use of plants that the inhabitants of the Sierra de Grazalema have developed during a long time (AU)

Lupus eritematoso inducido por fármacos / Drug-Induced Lupus Erythematosus

El término lupus eritematoso inducido por fármacos (LEIF) hace referencia a una entidad caracterizada por la aparición de manifestaciones clínicas, histopatológicas e inmunológicas similares a aquellas que aparecen en el lupus eritematoso idiopático, pero que cronológicamente coinciden con la toma de ciertos fármacos y que se resuelven tras la retirada de los mismos. Más de 90 fármacos se han asociado con la aparición de LEIF. Esta lista de fármacos implicados sigue aumentando. Al igual que el lupus eritematoso idiopático, el LEIF se puede subclasificar en lupus eritematoso sistémico inducido por fármacos, lupus eritematoso cutáneo subagudo inducido por fármacos y lupus eritematoso cutáneo crónico inducido por fármacos. Reconocer estas entidades es de gran interés, ya que este cuadro suele revertir tras la retirada del fármaco implicado

Drug-induced lupus erythematosus (DILE) refers to a condition whose clinical, histological, and immunological features are similar to those seen in idiopathic lupus erythematosus but that occurs when certain drugs are taken and resolves after their withdrawal. Over 90 drugs have been linked to DILE to date and the list is growing. Like idiopathic lupus erythematosus, DILE has systemic, subacute cutaneous, and chronic cutaneous forms. A correct diagnosis is very important, as this condition usually resolves after withdrawal of the offending drug

Drug-induced lupus erythematosus.

Drug-induced lupus erythematosus (DILE) refers to a condition whose clinical, histological, and immunological features are similar to those seen in idiopathic lupus erythematosus but that occurs when certain drugs are taken and resolves after their withdrawal. Over 90 drugs have been linked to DILE to date and the list is growing. Like idiopathic lupus erythematosus, DILE has systemic, subacute cutaneous, and chronic cutaneous forms. A correct diagnosis is very important, as this condition usually resolves after withdrawal of the offending drug.

Dermatomiositis del adulto asociada a lipodistrofia / Adult Dermatomyositis Associated With Lipodystrophy

No disponible

Obtaining and storage of ready-to-use segments from traditional orange obtained by enzymatic peeling.

The aim of this study was to optimize all parameters implied in the process of obtaining orange segments as minimally processed product by enzymatic peeling, from the method of segment obtaining to the storage conditions, and also to evaluate two films with different permeability. Enzymatic peeling was carried out by fruit infusion under vacuum conditions in a commercial preparation of pectinases and cellulases (Peelzym II). The best condition to obtain Cadenera segments by enzymatic peeling was 1 mL/L of Peelzym II applied at 53 kPa with three vacuum pulses of 2 min and a subsequent period of 30 min in the enzymatic solution at atmospheric pressure. The segments were packaged in two films with different permeability and they were stored for 10 days at 4 °C. Samplings were carried out after 4, 7 and 10 days of storage. The results showed that the concentration of CO(2) in the less permeable film (PA 120) ranged between 0.7 and 1.2 mL/100 mL, while in the most permeable one (PA 240) was around 0.2 mL/100 mL. Under these conditions, the weight loss was kept at low levels until day 7 of storage, showing a significant increase after 10 days. Colour (a/b) increased with the peeling process and it remained without significant changes during the whole storage period for both films. The antioxidant capacity slightly decreased after 10 days of storage. The microbial flora was reduced after the enzymatic peeling. Both the sensory and the microbiological quality were kept in adequate levels for consumption during 7 days. From this moment, they lost sweetness and aroma and the microbial development increased. Thus, the use of the most permeable film and a maximum storage time of 7 days are recommended to maintain the most quality of the segments.

Roasting and packaging in nitrogen atmosphere protect almond var. Guara against lipid oxidation.

The effect of packaging in nitrogen (N2) atmosphere or in air on the quality of peeled and roasted almond var. Guara during storage for 20 weeks at 20 °C ± 1 °C and 65-70% relative humidity (RH) was studied. No changes in the sugar, fat, protein or fiber contents were observed during the storage period nor in color. Only the lipid fraction showed significant changes with the kind of packaging atmosphere. The composition of fatty acids remained unchanged during the 5 month storage in all the samples. Packaging in N2 atmosphere was seen to have a protective effect against the accumulation of conjugated dienes (CD) in peeled almonds, while in roasted almonds, the protective effect was lower and even nil by the end of storage. The contrary effect was observed for the ultraviolet (UV; K270) index which increased more slowly in the roasted samples packaged in N2, while in peeled samples it reached the same levels at the end of storage regardless of the packaging atmosphere. No effect of the packaging atmosphere was observed on the evolution of the peroxide value in the tested samples (peeled or roasted almonds). None of these changes in the lipid fraction was reflected in the final sensory quality of the samples and the taster panel found no changes in the sensory quality in any case.

[Prolonged complete clinical remission in patients with severe pemphigus vulgaris after cycles of intravenous cyclophosphamide]. / Remisión clínica completa prolongada en pacientes con pénfigo vulgar grave después del tratamiento con ciclos intravenosos de ciclofosfamida.

BACKGROUND: Corticosteroids are the systemic treatment of choice in patients with pemphigus vulgaris, but chronic administration is associated with side effects. Intravenous treatment with cyclophosphamide can improve the clinical signs of pemphigus vulgaris. MATERIAL AND METHODS: We prospectively studied 8 patients diagnosed with pemphigus vulgaris. Six of these had mucocutaneous pemphigus vulgaris and 2 had mucosal pemphigus vulgaris. Treatment consisted of 10 cycles of cyclophosphamide at a dose of 10-15 mg/kg separated by 15 days, while maintaining the initial corticosteroid and immunosuppressant dose. Clinical efficacy was assessed and the anti-epidermal intercellular substance (EIS) and anti-desmoglein (DSG) 3 and 1 antibody titers were monitored (by indirect immunofluorescence and enzyme-linked immunosorbent assay, respectively). RESULTS: All patients with pemphigus vulgaris responded excellently to treatment. Five of the 8 patients achieved complete remission of pemphigus lesions after 10 cycles of cyclophosphamide. In the other 3 patients, the skin lesions disappeared a few weeks after the last cycle of cyclophosphamide. A substantial reduction in immuno suppressant dose was possible in all patients. Furthermore, an improved immunologic response was observed in all cases after cyclophosphamide treatment, with decreased anti-DSG1 and anti-DSG3 antibody titers and well as decreased circulating anti-EIS antibody titers. During the mean 15.1 month follow-up (range, 1-25 months), no new lesions appeared and no side effects of cyclophosphamide therapy were reported. CONCLUSIONS: Fortnightly cycles of intravenous cyclophosphamide may be a useful therapeutic option in patients with severe pemphigus vulgaris. A reduction of corticosteroid dose was possible with this therapeutic approach and the cumulative cyclophosphamide dose was lower than with daily oral administration. Our findings also show that the therapeutic approach induces clinical and immunologic remission in most patients.

Remisión clínica completa prolongada en pacientes con pénfigo vulgar grave después del tratamiento con ciclos intravenosos de ciclofosfamida / Prolonged Complete Clinical Remission in Patients With Severe Pemphigus Vulgaris After Cycles of Intravenous Cyclophosphamide

Introducción: Los corticosteroides son el tratamiento sistémico de elección en los pacientes con pénfigo vulgar (PV). Su administración crónica produce efectos secundarios. La administración de ciclofosfamida (CF) intravenosa puede mejorar las manifestaciones clínicas del PV. Material y método: Estudiamos prospectivamente 8 pacientes diagnosticados de PV. Seis de los pacientes presentaban PV cutáneo-mucoso (PVCM) y 2 casos PV mucoso (PVM). El tratamiento consistió en 10 ciclos quincenales de CF en dosis de 10-15 mg/kg, manteniendo la dosis inicial de corticosteroides y de inmunosupresor. Se evaluó la eficacia clínica y la evolución del título de anticuerpos anti-sustancia intercelular epidérmica (SIE) (inmunofluorescencia indirecta) y específicamente anti-desmogleína (Dsg) 1 y 3 (ELISA). Resultados: Todos los pacientes con PV presentaron una excelente respuesta al tratamiento. Cinco de los 8 pacientes presentaron una remisión completa de las lesiones de PV después de los 10 ciclos de CF. En los otros 3 pacientes las lesiones cutáneas desparecieron unas semanas después del último ciclo de CF. En todos los pacientes se redujo de forma importante la dosis de inmunosupresores. Además, en todos los casos se observó una mejoría en la respuesta inmunológica después del tratamiento con CF, con disminución en el título de anticuerpos frente a las Dsg 1 y 3, así como del título de anticuerpos circulantes frente a la SIE. Tras un seguimiento medio de 15,1 meses (1-25 meses) ningún paciente ha presentado nuevas lesiones de PV. A su vez, no se han observado efectos secundarios por la CF. Conclusiones: La administración de pulsos quincenales de CF intravenosa puede ser una opción terapéutica útil en pacientes con PV grave. Este esquema terapéutico permite disminuir la dosis de corticosteroides con una menor dosis acumulada de CF que en la administración oral diaria. Además, nuestros resultados muestran que este esquema terapéutico se acompaña de una remisión clínica e inmunológica en la mayoría de los pacientes (AU)

Background: Corticosteroids are the systemic treatment of choice in patients with pemphigus vulgaris, but chronic administration is associated with side effects. Intravenous treatment with cyclophosphamide can improve the clinical signs of pemphigus vulgaris. Material and methods: We prospectively studied 8 patients diagnosed with pemphigus vulgaris. Six of these had mucocutaneous pemphigus vulgaris and 2 had mucosal pemphigus vulgaris. Treatment consisted of 10 cycles of cyclophosphamide at a dose of 10-15 mg/kg separated by 15 days, while maintaining the initial corticosteroid and immunosuppressant dose. Clinical efficacy was assessed and the anti-epidermal intercellular substance (EIS) and anti-desmoglein (DSG) 3 and 1 antibody titers were monitored (by indirect immunofluorescence and enzyme-linked immunosorbent assay, respectively). Results: All patients with pemphigus vulgaris responded excellently to treatment. Five of the 8 patients achieved complete remission of pemphigus lesions after 10 cycles of cyclophosphamide. In the other 3 patients, the skin lesions disappeared a few weeks after the last cycle of cyclophosphamide. A substantial reduction in immunosuppressant dose was possible in all patients. Furthermore, an improved immunologic response was observed in all cases after cyclophosphamide treatment, with decreased anti-DSG1 and anti-DSG3 antibody titers and well as decreased circulating anti-EIS antibody titers. During the mean 15.1 month follow-up (range, 1-25 months), no new lesions appeared and no side effects of cyclophosphamide therapy were reported. Conclusions: Fortnightly cycles of intravenous cyclophosphamide may be a useful therapeutic option in patients with severe pemphigus vulgaris. A reduction of corticosteroid dose was possible with this therapeutic approach and the cumulative cyclophosphamide dose was lower than with daily oral administration. Our findings also show that the therapeutic approach induces clinical and immunologic remission in most patients (AU)

Lesions of pemphigus vulgaris on irradiated skin.

Summary Pemphigus vulgaris (PV) is an autoimmune blistering disease produced by IgG autoantibodies against desmoglein (Dsg)3. Lesions on the skin and mucosa can, in rare cases, be induced by radiotherapy. We report a patient with a history of microprolactinoma and PV, who had only oral lesions from the beginning of her illness but 2 months after treatment with radiotherapy for a breast neoplasia, developed skin lesions limited to the irradiated area. Over the following few months, she also developed autoantibodies against Dsg1.

[Brachial plexus block for minimally invasive parathyroidectomy: report of 3 cases]. / Bloqueo del plexo cervical en paratiroidectomía mínimamente invasiva. A propósito de tres casos.

The brachial plexus block, either deep or superficial, is one of the anesthetic techniques used in parathyroidectomy. The block is easy to perform and has few hemodynamic side effects. Surgery can be carried out in an awake patient. We describe 3 cases of patients with primary hyperparathyroidism (parathyroid adenoma) who underwent unilateral minimally invasive parathyroidectomy under regional anesthesia and sedation with 2 mg of midazolam plus remifentanil at dosages ranging from 0.6 to 0.1 microg kg(-1) min(-1). To provide a deep cervical block, we administered 15 mL of 0.75% ropivacaine. For a superficial block, 15 mL of 0.2% ropivacaine was used. The procedure could be completed in all 3 patients under regional anesthesia. The latency time for the block ranged from 21 to 30 minutes, and remifentanil dosages from 0.05 to 0.09 microg kg(-1) min(-1) were administered for procedures that lasted 30 to 45 minutes. No patient required postoperative opioids or antiemetics, although a local anesthetic had to be used at the moment of incision for 1 patient. All 3 patients were discharged the same day. We wish to underline the utility of the brachial plexus block for parathyroid surgery. The technique is easy to perform, safe, and effective; as a result, surgery can be carried out on an outpatient basis.

Bloqueo del plexo cervical en paratiroidectomia minimamente invasiva. A proposito de tres casos / Brachial plexus block for minimally invasive parathyroidectomy: report of 3 cases

El bloqueo del plexo cervical profundo y superficial,es una de las tecnicas anestesicas para el manejo depacientes sometidos a cirugia de paratiroides. Es facil derealizar, con pocos efectos hemodinamicos, y permite llevara cabo la cirugia con el paciente despierto. Presentamostres casos clinicos, en pacientes con hiperparatiroidismo(HPT) primario (adenoma de paratiroides) en losque se les practica una paratiroidectomia unilateral minimamenteinvasiva. Para ello, se realiza una anestesiaregional mas sedacion con midazolam 2 mg y remifentaniloen un rango de 0,06-0,1 ug kg-1min-1. Para el bloqueocervical profundo se administra ropivacaina 0,75% untotal de 15 mL, y para el bloqueo cervical superficial ropivacaina0,2%15 mL. En los tres pacientes se pudo realizarla tecnica quirurgica mediante anestesia regional, conun tiempo de latencia del bloqueo que oscilo entre 21-30min, y unas dosis de remifentanilo 0,05-0,09 ug kg-1min-1durante el tiempo que duro la cirugia (30-45 min). Ningun paciente preciso opioides ni antiemeticos postoperatorios,aunque uno requirio en el momento de la incision la infiltracio nde la piel con anestesico local. Los tres pacientesfueron dados de alta en el dia. Con estos casos clinicos queremos mostrar la utilidad del bloqueo del plexo cervicalpara la cirugia de paratiroides, que ademss de su facil realizacion, es seguro y efectivo, lo que permite queeste tipo de cirugia sea ambulatoria (AU)

The brachial plexus block, either deep or superficial,is one of the anesthetic techniques used inparathyroidectomy. The block is easy to perform andhas few hemodynamic side effects. Surgery can becarried out in an awake patient. We describe 3 cases ofpatients with primary hyperparathyroidism(parathyroid adenoma) who underwent unilateralminimally invasive parathyroidectomy under regionalanesthesia and sedation with 2 mg of midazolam plusremifentanil at dosages ranging from 0.6 to 0.1 ¦Ìg kg-1min-1.To provide a deep cervical block, we administered 15mL of 0.75% ropivacaine. For a superficial block, 15 mLof 0.2% ropivacaine was used. The procedure could becompleted in all 3 patients under regional anesthesia.The latency time for the block ranged from 21 to 30minutes, and remifentanil dosages from 0.05 to 0.09¦Ìg kg-1min-1 were administered for procedures that lasted30 to 45 minutes. No patient required postoperativeopioids or antiemetics, although a local anesthetic had tobe used at the moment of incision for 1 patient. All 3patients were discharged the same day. We wish tounderline the utility of the brachial plexus block forparathyroid surgery. The technique is easy to perform,safe, and effective; as a result, surgery can be carriedout on an outpatient basis (AU)

Repigmentación del pelo canoso tras tratamiento con hormona tiroidea / Repigmentation of gray hair after thyroid hormone treatment

Introducción y objetivos. Basándonos en dos pacientes con oscurecimiento de sus canas que sufrieron una elevación exógena de T3, debida a un coma mixedematoso y a una descompensación de su enfermedad, sugerimos que la hormona tiroidea puede tener un efecto en la homeostasis del folículo piloso. Para ello se utilizan un modelo animal de ratón y un modelo de cultivo in vitro de unidades foliculares, con el objeto de valorar la influencia de la hormona tiroidea en el ciclo capilar. Métodos. Sobre un modelo de ratón estandarizado para el estudio del ciclo capilar (C57BL/6), aplicamos tópicamente T3 (0,5 g) disuelta en etanol una vez al día durante 10 días en el dorso de ratones depilados en fase de telogen. Cultivamos in vitro unidades foliculares, obtenidas de cirugía capilar, con diferentes concentraciones de T3. Resultados. In vivo, al quinto día del tratamiento el 100 % de los ratones estudiados entraron en anagen, mientras que en el grupo control se apreció un inicio del anagen el día 9, que no se completó en todos los ratones hasta el día 15. In vitro, las unidades foliculares tratadas con 100 nM de T3 crecieron de forma significativa respecto al grupo control. Conclusiones. Estos datos sugieren que los folículos en telogen pueden estimularse para entrar en anagen tras la aplicación tópica de T3. Esta hormona puede revertir el encanecimiento del pelo terminal. En cultivo, la administración de T3 estimula el crecimiento del tallo piloso. Los melanocitos foliculares podrían ser la célula diana para estas acciones

Background and objectives. Darkening of gray and white hairs occurred in 2 patients with increased exogenous triiodothyronine (T3) due to treatment of myxedema coma in one case and iatrogenic hyperthyroidism in the other. We hypothesized that thyroid hormone may affect the homeostasis of hair follicles. To test our hypothesis and investigate the influence of thyroid hormone on the hair cycle, we used an in vivo murine model and an in vitro model based on culture of follicular units. Methods.We used the standard C57BL/6 murine model of the hair cycle. T3 (0.5 g) dissolved in ethanol was applied topically once daily for 10 days to a depilated area in the telogen phase on the backs of the mice. Follicular units, obtained from hair transplant interventions, were cultured in vitro with different concentrations of T3. Results. On day 5, all T3-treated mice entered the anagen phase, whereas the anagen phase started spontaneously in control mice on day 9, and not until day 15 had all controls entered this phase. In the in vitro experiment, follicular units treated with 100 nmol/L T3 grew significantly larger compared to the control group. Conclusions. These data suggest that follicles in the telogen phase can be induced to enter the anagen phase by the topical application of T3. This thyroid hormone may reverse graying of the terminal hair. In the in vitro experiments, T3 stimulated hair shaft growth. Follicular melanocytes may be the target cell for these actions

[Repigmentation of gray hair after thyroid hormone treatment]. / Repigmentación del pelo canoso tras tratamiento con hormona tiroidea.

BACKGROUND AND OBJECTIVES: Darkening of gray and white hairs occurred in 2 patients with increased exogenous triiodothyronine (T3) due to treatment of myxedema coma in one case and iatrogenic hyperthyroidism in the other. We hypothesized that thyroid hormone may affect the homeostasis of hair follicles. To test our hypothesis and investigate the influence of thyroid hormone on the hair cycle, we used an in vivo murine model and an in vitro model based on culture of follicular units. METHODS: We used the standard C57BL/6 murine model of the hair cycle. T3 (0.5 microg) dissolved in ethanol was applied topically once daily for 10 days to a depilated area in the telogen phase on the backs of the mice. Follicular units, obtained from hair transplant interventions, were cultured in vitro with different concentrations of T3. RESULTS: On day 5, all T3-treated mice entered the anagen phase, whereas the anagen phase started spontaneously in control mice on day 9, and not until day 15 had all controls entered this phase. In the in vitro experiment, follicular units treated with 100 nmol/L T3 grew significantly larger compared to the control group. CONCLUSIONS: These data suggest that follicles in the telogen phase can be induced to enter the anagen phase by the topical application of T3. This thyroid hormone may reverse graying of the terminal hair. In the in vitro experiments, T3 stimulated hair shaft growth. Follicular melanocytes may be the target cell for these actions.

Ear, nose and throat manifestations in pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are two clinical forms: mucosal (MPV) and mucocutaneous (MCPV). The frequency of ear, nose and throat (ENT) involvement in PV is not clearly defined. Only a few isolated individual cases have been reported. OBJECTIVES: The objective of our study was to determine the incidence of ENT involvement in patients with PV. PATIENTS: We studied prospectively all 16 patients diagnosed with PV and treated in the Department of Dermatology of the University Clinic of Navarra between 2001 and 2005. They were 10 cases of MPV and six cases of MCPV. All patients were evaluated for ENT manifestations by endoscopic examination. RESULTS: Of the 16 patients, 13 presented with throat symptoms (81%), 12 pharyngeal (75%) and seven laryngeal symptoms (44%). Fourteen patients (88%) had active PV lesions on endoscopic evaluation (eight patients had active lesions on both pharyngeal and laryngeal mucosa, four had PV lesions only on laryngeal mucosa and two had PV lesions on pharyngeal mucosa). Laryngeal lesions were most commonly present in MPV patients. The frequency of nasal symptoms (38%) was lower than active PV lesions (62%) found on ENT examination. Oral symptoms and oral active PV lesions were the most frequent findings (94%). Only three patients with MCPV showed erosions on the external auditory canal. CONCLUSIONS: As ENT endoscopy allows more extensive areas of mucosa to be examined than simple visual inspection, we recommend that it be included in the examination of all patients with PV. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved.