Calcitonin gene-related peptide in migraine: from pathophysiology to treatment.

INTRODUCTION: It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT: The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS: The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.

Short-course radiotherapy in stage IV rectal cancer with resectable disease

Introduction Stage IV rectal cancer with resectable disease presents challenging issues, as the radical treatment of the whole disease is difficult. Surgery and chemotherapy (CT) play an unquestionable role, but the contribution of pelvic radiotherapy (RT) is not very clear. Methods In 2009, we established a prospective treatment protocol that included CT, short-course preoperative radiotherapy (SCRT) with surgery of the primary tumour and all metastatic locations. Results Forty patients were included. Eight (20%) patients did not receive CT due to significant comorbidities. Radical surgery treatment was possible in 22 (55%) patients. The mean follow-up was 42.81 months (3.63–105.97). Overall survival at 24 and 36 months was 71.4% and 58.2%, respectively. There was good local control of the disease, as 97.2% of pelvic surgeries were R0 and there were no local recurrences. Conclusion In stage IV with resectable metastatic disease, the proposed therapeutic regimen seems very appropriate in well selected patients able to tolerate the treatment. We bet on the role of pelvic RT, due to the good local control of the disease in our series (AU)

Short-course radiotherapy in stage IV rectal cancer with resectable disease.

INTRODUCTION: Stage IV rectal cancer with resectable disease presents challenging issues, as the radical treatment of the whole disease is difficult. Surgery and chemotherapy (CT) play an unquestionable role, but the contribution of pelvic radiotherapy (RT) is not very clear. METHODS: In 2009, we established a prospective treatment protocol that included CT, short-course preoperative radiotherapy (SCRT) with surgery of the primary tumour and all metastatic locations. RESULTS: Forty patients were included. Eight (20%) patients did not receive CT due to significant comorbidities. Radical surgery treatment was possible in 22 (55%) patients. The mean follow-up was 42.81 months (3.63-105.97). Overall survival at 24 and 36 months was 71.4% and 58.2%, respectively. There was good local control of the disease, as 97.2% of pelvic surgeries were R0 and there were no local recurrences. CONCLUSION: In stage IV with resectable metastatic disease, the proposed therapeutic regimen seems very appropriate in well selected patients able to tolerate the treatment. We bet on the role of pelvic RT, due to the good local control of the disease in our series.

Evaluation of the concomitant use of oral preventive treatments and onabotulinumtoxinA in chronic migraine: the PREVENBOX study.

BACKGROUND AND PURPOSE: OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. METHODS: This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. RESULTS: We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%; P < 0.001). CONCLUSIONS: Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.

Evidencia y experiencia de bótox en migraña crónica: Recomendaciones para la práctica clínica diaria / Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice

OnabotulinumtoxinA ha demostrado ser eficaz como tratamiento preventivo en pacientes con migraña crónica (MC). El Grupo de Estudio de Cefalea de la Sociedad Española de Neurología ha considerado que sería de interés, a los 5 años de la aprobación en España de la onabotulinumtoxinA, reunir a un grupo de expertos en el tratamiento de pacientes con MC para elaborar con la evidencia actual y nuestra experiencia unas recomendaciones dirigidas a facilitar su uso en la práctica clínica diaria. Con este fin planteamos 12 preguntas que nos hacemos como médicos y que también nos realizan nuestros pacientes. Cada autor ha contestado una pregunta y luego el documento ha sido revisado por todos. Esperamos que esta revisión constituya una herramienta práctica para ayudar a los neurólogos que tratan a pacientes con MC

OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM

Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. / CGRP en migraña: de la fisiopatología a la terapéutica.

INTRODUCTION: It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT: The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS: The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.

Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. / Evidencia y experiencia de bótox en migraña crónica: Recomendaciones para la práctica clínica diaria.

OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.

Effect of exposure to light on physico-chemical quality attributes of sliced dry-cured Iberian ham under different packaging systems.

Dry-cured Iberian ham slices were stored under vacuum and under two different atmospheres (N(2)=70% N(2)+30% CO(2); Ar=70% Ar+30% CO(2)) and exposed to lightness or darkness. Physico-chemical, sensory and microbial analysis was carried out throughout 60 days storage. Vacuum samples showed the highest a*-value compared to N(2) and Ar after 30 (P<0.05) and 60 days (P<0.05). The influence of illumination during storage was evident after 60 days of storage, L* and a*-values being lower (P<0.01) in hams exposed to light than those kept in darkness, which can be ascribed to the lower nitrosylmioglobin content in samples exposed to light after 60 days (P=0.001). Ham slices stored in darkness showed the lowest TBARS values (P<0.05) and hexanal content (P<0.05) after 60 days. Slices of ham packed in vacuum showed lower TBARS values than N(2) and Ar batches (P=0.001), these samples being perceived as more rancid (P<0.05). The rest of the sensory attributes were not generally affected by gas mixture or illumination (P>0.05).

Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests.

BACKGROUND: In about 16-85% of subjects with goiter, upper airway obstruction (UAO) is observed. This percentage is higher in patients affected by goiter with endothoracic enlargement. UAO is an indication for surgery. Visual analysis of flow-volume loops (FVL) are the best indicators for UAO, although various studies using clinical and radiological parameters have observed no correlation. OBJECTIVE: To evaluate the presence of UAO in patients with endothoracic goiter enlargement and the relationship between the FVL with the observed symptoms and the measurements obtained by computed tomography (CT). SUBJECTS: Subjects with endothoracic goiter enlargement participated in the study. DESIGN: i) Symptom questionnaire (dysphagia, dyspnea, cough, oppression, dysphonia, and worsened symptoms when prone); ii) analysis: TSH and free thyroxine; iii) cervical ultrasound; iv) cervical-thoracic CT (measurements of area and diameter in the area of maximum stenosis and at 2 cm from the carina); v) chest radiography and vi) forced spirometry: visual analysis of FVL morphology and the maximum forced expiratory volume in 1 s (FEV(1)), forced expiratory flow at 50% vital capacity/forced inspiratory flow at 50% vital capacity and FEV(1)/peak expiratory flow parameters. RESULTS: Fifty subjects participated in the study: 11 men/39 women, median age 73.8 years (43.76-88.43). UAO was diagnosed in 13 cases (26%, confidence interval: 14.6-40.3%) and 27 subjects (54%) presented symptoms suggesting goiter compression. No clinical or radiological variables showed the presence of UAO. CONCLUSIONS: The frequency of UAO in subjects affected by goiter with endothoracic enlargement was lower than that described for goiter patients, and there were no clinical or radiological indicators to establish its presence.

Modified atmosphere packaging and vacuum packaging for long period chilled storage of dry-cured Iberian ham.

Dry-cured Iberian ham slices were stored under vacuum and under four different modified atmospheres (60/40=60%N(2)+40%CO(2); 70/30=70%N(2)+30%CO(2); 80/20=80%N(2)+20%CO(2); argon=70%argon+30%CO(2)) at 4+/-1 degrees C during 120 days. Gas composition, moisture content, pH, colour, pigment content, and lipid stability were measured, as well as sensory and microbial analysis were carried out throughout storage. A loss of intensity of red colour (a(*)-values) was observed during storage in ham slices (P<0.05). Consistently, MbFe(II)NO content also decreased throughout storage (P>0.05). Slices of ham packed in 40%CO(2) (60/40) and 30%CO(2) (70/30) showed lower a(*)-values than the rest of the batches after 60 days (P<0.05), though differences were not evident after 120 days (P>0.05). TBARs values showed an upward trend during the storage of packaged slices (P<0.05). Vacuum-packed slices showed the lowest TBARs values and those packed with 40%CO(2), the highest. Sensory attributes did not vary significantly (P>0.05) throughout storage under refrigeration and packed either in vacuum or in modified atmospheres. No safety problems were detected in relation to the microbial quality in any case.

Investigation of uniformity in pig carcass and meat quality traits.

The study was carried out to provide information on uniformity of commercial pigs on some of the most important traits determining pork quality: carcass, loin, ham and shoulder weights, fatness, drip loss, pH and colour. Three batches of pigs raised at the same farm and slaughtered at four different dates in the same commercial abattoir were considered. Batches included halothane-free females and castrated males, Duroc and Pietrain sire lines and two slaughter weights, but a common maternal line. The first batch was obtained using commercial Duroc sire boars, and included a total of 112 animals (56 castrated males and 56 females). The second batch used Duroc and Pietrain sire boars with the target to achieve two different final weights (105 and 115 kg live weight); 128 animals were controlled (64 castrated males and 64 females), 16 for each combination of sire boar, sex and final weight. The last batch used only Pietrain sire boars with 96 controlled pigs (48 castrated males and 48 females). The uniformity was measured by the coefficient of variation (CV) and the coefficient of dispersion (CD) for all data available, and for groups of common sex, sire breed and slaughter weight. Differences in uniformity were tested among traits and groups by using confidence intervals (CIs) at 95% confidence level (CI95%) for the CV and CD. Results showed a significantly lower uniformity for drip loss (CV = 40.4%, CI95% 36.9% to 44.7%; CD = 32.1%, CI95% 28.7% to 35.4%) and backfat (CV = 22.8%, CI95% 21.1% to 24.8%; CD = 18.3%, CI95% 17.1% to 20.2%) the pH being the most uniform trait (CV = 3.2%, CI95% 3.0% to 3.5%; CD = 2.6%, CI95% 2.4% to 2.9%). When comparing different 'sire breed-sex-slaughter weight' groups, no consistent sex and slaughter weight differences in uniformity were found, but animals from Pietrain sire breed showed a tendency to be less uniform for carcass traits than animals from Duroc sire breed. Nevertheless, variability within those groups was very high and often similar to that observed when considering all the animals from all the groups. Small differences were found comparing uniformity when using the CV or the CD. CIs of these coefficients have proved to be a simple and useful tool for testing differences in uniformity.

Valoración del riesgo quirúrgico. Índices de riesgo en cirugía torácica / No disponible

No disponible

Carcinoma arising in the pleural cavity following pneumonectomy for hydatid disease.

We report a case of carcinoma following 42 years of chronic empyema in a patient who underwent surgery for a hydatid cyst at the age of 3. At the time of diagnosis, an esophageal fistula was observed and treated with cyanoacrylate. We hypothesize that chronic inflammation of the pleura, caused by decades of empyema, associated with the presence of heterotopic squamous epithelium due to a long-standing esophago-pleural fistula, led to neoplastic transformation.

[HIV related Foix-Chavany-Marie syndrome]. / Síndrome de Foix-Chavany-Marie asociado a VIH.

Automatic-voluntary motor dissociation of the face and lower cranial nerves of brainstem is the hallmark of Foix-Chavany-Marie syndrome (biopercular syndrome). It is commonly caused by ischemic strokes. We present a biopercular syndrome associated with HIV. A 41 year old female who presents a progressive automatic- voluntary motor dissociation of face and lower cranial nerves with later involvement of limbs. She was immunodepressed as a result of HIV. MRI showed bilateral lesions in opercular areas and ventrolateral thalamic nucleus, likely as a result of retrograde neuronal degeneration. Automatic-voluntary dissociation occur after biopercular lesions with sparing of motor pathway proceeding from the cingulate cortex.

Síndrome de Foix-Chavany-Marie asociado a VIH / HIV related Foix-Chavany-Marie syndrome

El síndrome de Foix-Chavany-Marie (síndrome biopercular) se caracteriza por la disociación automático-voluntaria de la motilidad de la cara y los pares craneales bajos del tronco de encéfalo. Habitualmente está causado por accidentes cerebrovasculares isquémicos. Presentamos un caso de síndrome biopercular asociado a infección por el VIH. Mujer de 41 años que presenta un cuadro progresivo de disociación automático-voluntaria facial y de los pares bajos con posterior extensión a los miembros. La paciente estaba inmunodeprimida como consecuencia de infección por el VIH. En la RM se observaban lesiones bilaterales en el opérculo rolándico y en los núcleos ventrolaterales del tálamo, probablemente como consecuencia de una degeneración neuronal retrógrada. La disociación automático-voluntaria de la motilidad facial acontece tras la lesión de las áreas o fibras bioperculares con indemnidad de las vías motoras procedentes del cíngulo (AU)