[Non-secretory myeloma. Report of a case with negative immunofluorescence in the tumor cells (author's transl)]. / Mieloma no secretor. Exposición de un caso con inmunofluorescencia negativa en las células tumorales.

A 39-year-old patient with bilateral paralysis of the VI cranial nerve was studied. Numerous foci of intracranial osteolysis were discovered as well as on the right calvicle and several ribs. Two bone marrow aspirates gave results within normal limits. A biopsy of the lesion on the right calvicle led to the diagnosis of myelomatosis. Immunoelectrophoresis showed that paraprotein was not present in serum and urine. Immunofluorescence with antisera marked with fluorescein was negative in the diseased bone marrow. Treatment with melphalan and prednisone given alternately produced an improvement in all of the lytic lesions within several months; 20 months after treatment was started no new destructive bony lesions have appeared. There have been very few reported cases of non-secretory myeloma. In most of these cases the presence of immunoglobulins in the tumoral cells has been shown by immunofluorescence. The absence of the immunoglobulins, as described in our case, is extremely rare. Unlike most cases of non-secretory myeloma published to date, our patient has a favorable clinical course after treatment was administered.

[Acute intermittent porphyria versus porphyria variegata: a diagnostic uncertainty (author's transl)]. / Porfiria aguda intermitente versus porfiria variegata: una incertidumbre diagnóstica.

The authors study a case of acute porphyria in a young woman who was taking oral contraceptives and who began having abdominal pain and bilateral radial paralysis with neuropsychic disorders. The quantitative and chromatographic analyses of urine, feces, and liver porphyrins revealed a pattern of excretion compatible but not definite of porphyria variegata, making this an example of porphyria of difficult noslogic placement. The problems of classification, the action of the contraceptive drugs as probable triggering agents (of the clinical picture) by means of their action on the ALA-synthetase, the rare form of neuropathy, and the rarity of these types of porphyrias in our country are analyzed and discussed. The patient did not present the endocrine-metabolic disorders that are commonly evidenced in these cases.

PIP: The article reports on the case of a 27 year old woman on oral contraceptives who developed abdominal pain, bilateral radial paralysis, and neuropsychic disorders, the classic symptoms of acute, intermittent porphyria. Complete laboratory analyses and tests revealed a pattern of disease similar but not equal to that of porphyria variegata; also, the endocrin and metabolic disorders were not those common in porphyria variegata. Both types of porphyria are very infrequent cases in Spain; the problem of diagnosis, and of the possible influence of oral contraceptives are discussed.

[Disease in Velázquez' painting]. / La patología en la pintura de Velázquez.

A short biographical abstract of Painter Velázquez and his artistical and cultural background with relation to this own time is given. His whole work and of the court and official jobs he had has, been analysed. Together with his artistical vocation and great capacity and aptitude for painting, he felt the ambition to seek a position of nobility. A peculiar research of the pathological aspects appearing in his pictures has been made, regardless of the technical characteristics of his painting and style. For this purpose, his paintings have been classified in still lives, religious pictures, mythological pictures, portraits of royal male and female family members, portraits of ordinary people, big peoples such as Las Lanzas, Las Hilanderas and Las Meninas, etc., to conclude with the really singular group of buffoons, dwarfs, jesters and mad people. The pathological issues have been commented. A list of bibliographical references is also added.

[The heme oxygenase system and its physiopathology]. / El sistema hemooxigenasa y su fisiopatología.

The HENE-OX system (isoforms 1, 2 and 3) is the key enzyme in the oxygen dependent HEME catabolism pathway and cleavage to HEME into biliverdin IX alfa, iron and carbon-monoxide (CO). The biliverdin reductase catalyzes biliverdin into bilirubin unconjugated what is converted in bilirubin conjugated, mono and biglucuronized for the activity of hepatic Uridindifosfo-glucuronil-transferase (UDFGT). The hyperbilirubinemias unconjugated can produce kernicterus. This should be treated with metalloporphyrins (Zn-Proto IX, Zn-Mesoporphyrin, Sn-Proto-IX, Sn-Mesoporphyrin). Relations between HEM-OX/CO and NOS/NO systems. The induction of the HEME-OX system is a protective cellular mechanism against oxidative damage. Studies about the relations of the HEME-OX system with functions of various tissues (liver, kidney, cardiovascular and respiratory and hematological system, etc.).