Interobserver variability in the histopathological evaluation of melanoma: analysis of 60 case reports.

INTRODUCTION: Since the field of dermatopathology is not an exact science, it is prone to personal subjectivity, which sometimes causes disagreements on the diagnosis and assessment of some histological features. In the case of melanoma, some variables such as regression are associated with low interobserver agreement. On the contrary, other variables such as the measurement of Breslow thickness show high reproducibility. OBJECTIVE: The main objective of our study was to investigate multiple features of 60 consecutive cases of melanoma to establish interobserver reproducibility. METHODS AND MAIN RESULTS: We conducted an observational and descriptive study at Hospital de Manises, Valencia, Spain, IVO Foundation, Valencia, Spain, and Hospital 12 de Octubre, Madrid, Spain. The mean level of agreement of all study variables was moderate (Cohen's kappa coefficient statistic = 0.5). The highest agreement corresponded to polypoid morphology, pigmentation, ulceration, and solar elastosis. On the other hand, the lowest level agreement was reached for the presence of cellular pleomorphism and tumor necrosis. CONCLUSIONS: Our mean level of agreement was moderate, which reflects that some of the measured characteristics such as cellular pleomorphism or the presence of necrosis cannot be used for future studies or must be redefined and their reproducibility, reestablished. When conducting a research study, it is necessary to analyze the study variables to demonstrate their validity to measure or classify a certain feature. It is also advisable to warrant that that the variables are reproducible to be able to use them for other studies or in the routine clinical practice.

Six-Year Follow-up of Slaughterhouse Surveillance (2008-2013): The Catalan Slaughterhouse Support Network (SESC).

Meat inspection has the ultimate objective of declaring the meat and offal obtained from carcasses of slaughtered animals fit or unfit for human consumption. This safeguards the health of consumers by ensuring that the food coming from these establishments poses no risk to public health. Concomitantly, it contributes to animal disease surveillance. The Catalan Public Health Protection Agency (Generalitat de Catalunya) identified the need to provide its meat inspectors with a support structure to improve diagnostic capacity: the Slaughterhouse Support Network (SESC). The main goal of the SESC was to offer continuing education to meat inspectors to improve the diagnostic capacity for lesions observed in slaughterhouses. With this aim, a web-based application was designed that allowed meat inspectors to submit their inquiries, images of the lesions, and samples for laboratory analysis. This commentary reviews the cases from the first 6 years of SESC operation (2008-2013). The program not only provides continuing education to inspectors but also contributes to the collection of useful information on animal health and welfare. Therefore, SESC complements animal disease surveillance programs, such as those for tuberculosis, bovine cysticercosis, and porcine trichinellosis, and is a powerful tool for early detection of emerging animal diseases and zoonoses.

Performances of preoperative CT scan to predict the pTN stage for MSI/dMMR localized colon cancers.

BACKGROUND: Neoadjuvant immunotherapy emerges as a promising strategy for patients with localized colon cancer (CC) harboring microsatellite instability/mismatch repair deficiency (MSI/dMMR). The aim of this study is to evaluate the concordance between clinical cTN stage assessed by preoperative computed tomography (CT) scan and pTN stage of MSI/dMMR CC. PATIENTS AND METHODS: Consecutive patients diagnosed for localized MSI/dMMR CC and treated with upfront surgery between 2013 and 2022 in two French centers were eligible. Two independent radiologists, blinded to pathological findings, reviewed all preoperative CT scans and assessed cTN stage, with a third radiologist reviewing discordant cases. Radiological predictive diagnostic accuracy for pT4 and pN+ (N+ = N1 or N2) were calculated. RESULTS: One hundred and thirteen patients were included (right CCs = 79%). CT scan diagnostic performances for pT4 were sensitivity (Se) = 33.3%; specificity (Sp) = 94.0%; positive predictive value (PPV) = 66.7%; and negative predictive value (NPV) = 79.6% and for pN+ were Se = 70.3%; Sp = 59.2%; PPV = 45.6%; and NPV = 80.4%. When pT-pN were combined, 37.5% of tumors identified as cT4 and/or cN+ were actually pT1-3 and pN0, and 23.1% of the pT4 and pN+ population was not identified as such radiologically. CONCLUSION: The ability of preoperative CT scan to predict pT and pN stages is limited for localized MSI/dMMR CCs. Reassessing neoadjuvant strategies' benefit-risk balance in this population is needed.

Sensory optimization of gluten-free hazelnut omelette and sugar-modified chestnut pudding: A free choice profiling approach for enhanced traditional recipe formulations.

The Mediterranean region is distinguished by its gastronomic diversity and a wide variety of indigenous nut crops. In line with changing global food consumers' preferences, a noteworthy aspect is the increasing demand to the use of local varieties in recipe formulation. The aim of the present study was to incorporate the Terra Fria chestnut (Portugal) and Negreta hazelnut from Reus (Spain) in traditional Mediterranean recipes. The sensory, technofunctional, nutritional, and shelf-life characterization were investigated in hazelnut omelette (gluten and gluten-free) and chestnut pudding (sugar and sugar-free) formulations. Results conducted by trained assessors using the free choice profiling (FCP) showed that hazelnut omelette samples were described as "creamy," "smooth," and "handmade." In addition, the texture obtained with the hazelnut omelette gluten-free version showed the softest textural profile analysis attributes, with lower values for hardness (2.43 ± 0.36 N), adhesiveness (-0.38 ± 0.00 g s) and gumminess (2.12 ± 0.14). Furthermore, the shelf-life studies revealed a more golden color (>14.43 of a* CIELAB coordinate) and a lower moisture content (25.36%-43.59%) in the hazelnut flour formulation, in addition to the enrichment in terms of protein (8.36 g/100 g), fiber, and healthy fats. In the case of chestnut pudding, it was observed that the study parameters did not differ significantly from its sweetened analogue with positive attributes in FCP ("toasted," "fluffy," and "sweet"), positioning it as a viable alternative to sugar in this application. Therefore, both hazelnut flour in hazelnut omelette and oligofructose in chestnut pudding proved to be promising ingredients in the formulation of gluten-free and sugar-free developed products, offering attractive organoleptic and textural characteristics.

Trop-2 is a ubiquitous and promising target in pancreatic adenocarcinoma.

BACKGROUND: Trop-2 is overexpressed in tumor cells of various cancers, including pancreatic ductal adenocarcinoma (PDAC), and has emerged as a potent therapeutic target. We evaluated Trop-2 expression both at the transcriptomic and protein levels, and its correlation with tumor features and patients' outcomes in a large cohort of PDAC. METHODS: We included patients undergoing pancreatic resection for PDAC in 5 academic hospitals in France and Belgium. Transcriptomic profiles were obtained from FFPE tissue samples, with paired primary -25and metastatic lesions when available. Protein expression was evaluated by immunohistochemistry (IHC) using tissue micro-arrays. RESULTS: 495 patients (male 54%, median age 63 years) were included between 1996 and 2012. Trop-2 mRNA expression was significantly associated to tumor cellularity, but no association with survival nor with any clinical or pathological features was observed, with tumor cells showing an overall high expression among every subgroup. Trop-2 mRNA expression was maintained between primary and metastatic lesion in all 26 paired samples evaluated. In 50 tumors assessed by IHC, 30%, 68% and 2% harbored a high, medium, or low Trop-2 expression score, respectively. Trop-2 staining was significantly associated to mRNA expression, but not to survival or any pathological features. CONCLUSIONS: Our results suggest Trop-2 overexpression as a ubiquitous marker of PDAC tumor cells and thus a promising therapeutic target to evaluate in these patients.

The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France.

BACKGROUND: Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma. OBJECTIVES: To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants. MATERIALS AND METHODS: A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness. RESULTS: Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs. CONCLUSIONS: GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma.

[Randomised controlled study of inter-hemispheric electroencephalographic coherence following assisted therapy with dolphins in children with autism spectrum disorders]. / Estudio aleatorizado controlado de la coherencia interhemisferica del electroencefalograma tras terapia asistida con delfines en niños con trastorno del espectro autista.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with impairments in executive function, language, emotional function, and social function. Its anatomofunctional substrate is related to a disorganization of the brain's functional connections. The aim is to investigate the cerebral connections in subjects with ASD through the analysis of the interhemispheric coherence (IHC) of the quantified electroencephalogram and its changes after dolphin assisted therapy (DAT) versus therapeutical intervention without dolphins (TIWD). PATIENTS AND METHODS: The IHC was determined in 44 subjects with ASD before randomly assigning them to two therapeutic groups: DAT (n = 22) and TIWD (n = 22). The results were statistically analyzed through the multi-measure ANOVA test for within-subject (time) and between-subject (DAT vs TIWD) factors. RESULTS: The IHC showed a significant reduction (p < 0.05) for both groups in the delta, theta, beta, and alpha frequencies (p < 0.001) in the anterior frontal region (F3-F4), alpha in the central region (C3-C4) (p < 0.05), and alpha (p < 0.05) and beta (p < 0.001) in the temporal region (T3-T4). In the intersection with the specific treatment (DAT), the coherence in the alpha band increased in Fp1-Fp2 (p < 0.05), and the delta did not decline in F3-F4 (p < 0.05). CONCLUSION: In 5-year-old children with ASD, DAT increases the IHC in the anterior frontal region and stabilizes the tendency to reduce the delta band in the posterior frontal region.

TITLE: Estudio aleatorizado controlado de la coherencia interhemisferica del electroencefalograma tras terapia asistida con delfines en niños con trastorno del espectro autista.Introduccion. El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo asociado con trastornos de la funcion ejecutiva, el lenguaje, la funcion emocional y la funcion social, cuyo sustrato anatomofuncional se relaciona con una desorganizacion de las conexiones funcionales cerebrales. El objetivo es investigar las conexiones cerebrales en sujetos con TEA mediante analisis de la coherencia interhemisferica (CIH) del electroencefalograma cuantificado y sus cambios tras la terapia asistida con delfines (TAD) frente a la intervencion terapeutica sin delfines (ITSD). Pacientes y metodos. Se determino la CIH en 44 sujetos con TEA antes de asignarse aleatoriamente a dos grupos de tratamiento: TAD (n = 22) e ITSD (n = 22). Los resultados se analizaron estadisticamente mediante el test de la ANOVA multimedida para los factores intrasujeto (tiempo) e intersujeto (TAD frente a ITSD). Resultados. La CIH mostro una reduccion significativa (p < 0,05) para ambos grupos en las frecuencias delta, theta, beta y alfa (p < 0,001) en la region frontal anterior (F3-F4). Se hallo tambien una reduccion en la frecuencia alfa en la region central (C3-C4) (p < 0,05), y alfa (p < 0,05) y beta (p < 0,001) en la region temporal (T3-T4). En la interseccion con el tratamiento especifico (TAD), la coherencia en la banda alfa aumento en Fp1-Fp2 (p < 0,05) y no descendio la delta en F3-F4 (p < 0,05). Conclusion. En niños de 5 años con TEA, la TAD aumenta la CIH en la region frontal anterior y estabiliza la tendencia a la reduccion de la banda delta en la region frontal posterior.

[Sensory integration: benefits and effectiveness of therapeutic management in sensory processing disorders]. / Integracion sensorial: beneficios y efectividad del abordaje terapeutico en los trastornos del procesamiento sensorial.

Today, the fact that sensory integration difficulties with a neurological basis exist and that they seriously condition the development of those individuals who suffer from them is widely accepted and acknowledged as being obvious by the vast majority of professionals working in the field of community healthcare. However, less is known and there is more controversy about effective treatments that can be applied to them. This is because many professionals criticise the fact that there is not enough scientific evidence to prove, both quantitatively and empirically, the outcomes of the interventions implemented as alternatives to pharmacological therapy. Consequently, when the symptoms and repercussions on the quality of life deriving from a distorted sensory integration are really disabling for the person, pharmacological treatment is used as the only possible approach, with the side effects that this entails. The reason for this is largely the fact that little is known about other effective therapeutic approaches, such as occupational therapy based on sensory integration.

TITLE: Integracion sensorial: beneficios y efectividad del abordaje terapeutico en los trastornos del procesamiento sensorial.En la actualidad, el hecho de que existen dificultades de integracion sensorial de base neurologica y que estas condicionan gravemente el desarrollo de las personas que las sufren, esta aceptado y reconocido como evidente por la gran mayoria de profesionales del campo sociosanitario. No obstante, en cuanto a tratamientos efectivos para abordarlas, hay mas controversia y desconocimiento, ya que existe la critica generalizada de que las intervenciones alternativas a la farmacologica no constan con la suficiente evidencia cientifica que demuestre de forma cuantitativa y empirica los resultados obtenidos a traves de ella. Consecuentemente, cuando los sintomas y repercusion en la calidad de vida derivados de una integracion sensorial distorsionada son realmente limitantes para la persona, se acaba recurriendo al tratamiento farmacologico como unico abordaje posible, con los efectos secundarios que ello conlleva, debido al desconocimiento de enfoques terapeuticos efectivos, como la terapia ocupacional basada en el enfoque de la integracion sensorial.

[Comparison between the diagnosis of attention deficit hyperactivity disorder with the DSM-5 and neuropsychological evaluation of the executive functions]. / Comparacion entre el diagnostico del trastorno por deficit de atencion/hiperactividad con el DSM-5 y la valoracion neuropsicologica de las funciones ejecutivas.

INTRODUCTION: The attention deficit-hyperactivity disorder (ADHD) has a prevalence among 3-7% in scholar population and it is associated with learning disabilities and executive dysfunctions. AIM: To study the relationship between the ADHD diagnostic through DSM-5 criteria and the neuropshychology evaluation of executive functions. SUBJECTS AND METHODS: The sample of this study consisted in 50 subjects, 12 females and 38 males, with an age between 8 and 10 years old. To evaluate the inhibitory control, we used the Stroop Test and the Continuous Performance Test (CPT), to evaluate intelligence and working memory we use the Wechsler Intelligence Scale WISC-IV, to evaluate attention we used the CPT and Selective Attention Test. RESULTS: There weren't significant differences between both subtypes of ADHD regarding working memory, on the other hand the female group had better abilities in cognitive flexibility task than males and subjects diagnosed with combined ADHD had more difficulties in inhibitory control. CONCLUSIONS: We can confirm that the definition of ADHD in DSM-5 isn't enough as them are imprecise. Therefore, the disease definition it's performed by a specific evaluation of attention and inhibitory control mechanisms and its necessary a neuropshychological evaluation of these brain functions.

TITLE: Comparacion entre el diagnostico del trastorno por deficit de atencion/hiperactividad con el DSM-5 y la valoracion neuropsicologica de las funciones ejecutivas.Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) tiene una prevalencia del 3-7% de la poblacion en edad escolar y cursa con problemas academicos y disfunciones ejecutivas. Objetivo. Estudiar la relacion entre el diagnostico del TDAH por medio de los criterios del Manual diagnostico y estadistico de los trastornos mentales, quinta edicion (DSM-5), y la evaluacion neuropsicologica de las funciones ejecutivas. Sujetos y metodos. Se evaluo a 50 sujetos, 12 mujeres y 38 varones, entre 8 y 10 años. Para evaluar el control inhibitorio se utilizo el Continuous Performance Test (CPT) y el test de Stroop; para la inteligencia y la memoria de trabajo, la escala de inteligencia de Wechsler para niños-IV; y para la atencion, el CPT y el Selective Attention Test. Resultados. No habia diferencias significativas entre ambos subtipos de TDAH en cuanto a la memoria de trabajo. Las niñas presentaban mejores habilidades en la tarea de flexibilidad cognitiva que los niños, y los sujetos diagnosticados de TDAH combinado presentaban mayores dificultades en el control inhibitorio. Conclusiones. Confirmamos que las definiciones del TDAH en el DSM-5 son imprecisas. Son una escasa enumeracion de sintomas clinicos del trastorno, sin definir con claridad criterios propios de el. Por lo tanto, la definicion del trastorno se realiza por la evaluacion especifica de la atencion y de los mecanismos de control inhibitorio y, por ello, es necesaria una evaluacion neuropsicologica de las funciones cerebrales superiores.

[Papillary carcinoma after 13 years of correct function of renal graft]. / Carcinoma papilar hallado en injerto renal tras 13 años de correcto funcionamiento.

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft's control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation.

[Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (part 1)]. / Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (parte 1).

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

Elderly patients with aggressive non-Hodgkin's lymphoma treated with CHOP chemotherapy plus granulocyte-macrophage colony-stimulating factor: identification of two age subgroups with differing hematologic toxicity.

PURPOSE: Standard cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy repeated at 3-week intervals is difficult to deliver in elderly patients with non-Hodgkin's lymphoma (NHL). The use of hemopoietic growth factors may decrease the hematologic toxicity of chemotherapy and allow the delivery of full-dose CHOP. PATIENTS AND METHODS: We conducted a phase II trial with the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) to CHOP chemotherapy in NHL patients older than 60 years of age. Twenty-six previously untreated patients were assessable; median age was 67 years (range, 61 to 84 years). CHOP included cyclophosphamide 750 mg/m2 intravenously day 1; doxorubicin 50 mg/m2 intravenously day 1; vincristine 1.4 mg/m2 (2 mg total dose) intravenously day 1; and prednisone 100 mg orally days 1 through 5. GM-CSF 5 microg/kg was administered subcutaneously on days 4 through 13. Cycles were repeated every 21 days for six cycles. Results were analyzed for the total group and for two age subgroups: 61 to 69 years (n = 15) and 70 years or older (n = 11). RESULTS: Sixteen patients (62%) achieved a complete response (CR), four patients (15%) achieved a partial response (PR), and six patients (23%) did not respond to therapy. After a median follow-up of 41 months, the median progression-free and overall survival were 19 and 30 months, respectively. Twenty patients completed six cycles. One hundred thirty-eight of the 156 planned cycles were delivered (88%). The relative dose-intensity was 95%. The chemotherapy-induced toxicity was important. Absolute neutrophil count was less than 500/mL in 43% of the cycles, platelet nadir was less than 20,000/mL in 19%, and febrile neutropenia occurred in 21%. There were no grades 3 to 4 mucositis. Treatment-related death occurred in two patients, and was associated with neutropenic septic shock. The toxicity related to GM-CSF was mild hypotension after the cytokine was administered in 7% of cycles. When the results of the study were analyzed by age subgroups, we observed that whereas response and median survival were similar in patients aged 61 to 69 years or 70 years or older, there were significant differences in dose delivery and toxicity. Chemotherapy was delivered in 86 of 90 planned cycles in patients aged 61 to 69 years, but in only 52 of 72 planned cycles in patients aged 70 to 84 years (P = .00008). Absolute neutrophil count was less than 500/mL in 24% of cycles in patients aged 61 to 69 years and 73% of cycles in patients aged 70 years or older (P = .00001). The platelet nadir of less than 20,000/mL occurred in 5% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P < .0001). Fever and neutropenia occurred in 8% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P < .0001). Mucositis (grades 1 to 2) occurred in 21% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P = .006). CONCLUSION: CHOP chemotherapy plus GM-CSF is an active regimen in elderly patients with NHL. Despite cytokine support, the toxicity of the regimen is elevated. We have identified two age subgroups (61 to 69 and > or = 70 years) that do not differ in treatment efficacy but show large differences in treatment-related toxicity.

[Psychopedagogical management of attention deficit hyperactivity disorder with the model of executive function training]. / Abordaje psicopedagogico del trastorno por deficit de atencion con hiperactividad con el modelo de entrenamiento de las funciones ejecutivas.

Different therapeutic models have been presented with which to treat the condition of attention deficit hyperactivity disorder (ADHD) and the scientific literature speaks of the benefits linked to multimodal approaches. The National Institute of Mental Health report grants combined treatments an essential role. Throughout the literature authors agree that the executive functions are intrinsically related to the functions of the frontal lobe. We consider executive function training (EFT) to be another resource available within the different approaches used to treat ADHD and which is oriented towards developing and reinforcing the neuropsychological functions so as to give rise to new cognitive resources. Working memory is responsible for storage for a minimum amount of time while the information needed to resolve higher cognitive processes is manipulated. Some authors consider executive dysfunction to be a distinguishing element of ADHD. This type of dysfunction would make it more difficult for the higher cognitive processes to be carried out and is therefore a disorder that conditions the problems observed in the formal academic learning processes. The EFT programme consists of specific work modules and is aimed at favouring the appearance, development and operation of the affected functions.

[The neuropaediatric and pathogenic clinical bases of autistic spectrum disorder]. / Bases clinicas neuropediatricas y patogenicas del trastorno del espectro autista.

INTRODUCTION: The dimension of the autistic spectrum embraces a considerable degree of clinical complexity which is, in turn, an expression of the numerous systems involved in the functioning of the central nervous system. Every day different biological factors are revealed which put in doubt other factors that, in a more objective way, appear to be involved in a particular aetiology. DEVELOPMENT AND CONCLUSIONS: It is clear that exactly what causes autistic spectrum disorder is still unknown and it may be useful to analyse cases with a known aetiology and correlate them with other similar cases, as it is likely to be this association between findings and studies in the future that will probably enable us to better define the bases and the underlying causes of the complex and manifold origin of the autistic spectrum. This will enable a more efficient therapeutic approach to be developed, which, when all is said and done, is what is primarily sought in the management of children with autistic spectrum disorder.

[Multisensory stimulation]. / Estimulación multisensorial.

INTRODUCTION: Diagnosis in early care (EC) involves a global study that covers the child's development, their personal history, family and surroundings. The specific aims of an intervention programme in EC could be summed up in four areas: the prevention of deficits or difficulties, the detection of problems linked with a socio-family deficiency or shortages, the stimulation of development, and help and assistance for families. Multisensory stimulation (MSS) of small children is essential for their future existence. The presentation of stimuli must follow a strict schedule; indeed, this observation is so important that if the critical moment for incorporating a stimulus is missed, providing the stimulus at another time will not have the same effect. METHOD: Intellectual development during early childhood was taken into account when defining the fundamental aims of a therapeutic intervention programme in EC. To develop suitable therapy according to these concepts, an EMS (Snoezelen) room with certain special characteristics is required. This room must allow the stimuli offered in each moment and under each sensory modality to be controlled. CONCLUSION: Applying intervention programmes in a proper, specific and timely manner will enable us to accompany each child, as far as is possible in each case, in the development of his or her abilities and capabilities.

[Prostatic rebiopsy. Prognosis factors of the anatomopathologic result]. / Rebiopsia de próstata. Factores pronósticos del resultado anatomopatológico.

The indications for repeat prostate needle biopsy after a previous biopsy are not defined. We examined 107 prostate biopsies (in 98 patients) without a diagnosis of malignancy, which we repeat. Carcinoma was detected in 31 patients (31.6%). We didn't find statistic relationship between the repeat biopsy's outcome and: interval between biopsy and repeat biopsy, PSA value, PSA density (biopsy), PSAD of the transitional area (PSAD ad., on repeat biopsy). We found relationship with: prostatic weight (p = 0.002 on the biopsy, p = 0.0002 on the repeat biopsy), volume of the transitional area (p = 0.02 on the biopsy, p = 0.0001 on the repeat biopsy), PSA value (p = 0.02, on the repeat biopsy), PSAD ad. (p = 0.002, on the repeat biopsy), and with PSA velocity (p = 0.008). We only found clinic usefulness for the PSA velocity: patients with PSA velocity greater than 1 ng/ml/year are at high risk for prostate carcinoma on the repeat biopsy, specially in small prostates.

[Parotid metastasis of renal adenocarcinoma: report of a case]. / Metástasis parotidea de adenocarcinoma renal: a propósito de un caso.

Renal adenocarcinomas are tumours which sometimes tend to remain clinically silent, and initially become evident through distant metastasis. This paper presents the case of a 54 year-old patient whose initial clinical evidence was parotid metastasis from kidney clear cells adenocarcinoma. The patient had a metastasis and renal tumour exeresis with application of supplementary chemotherapy and immunotherapy, presenting early pulmonary metastasis which remains currently unchangeable. Some comments apropos of distant metastasis, its prognosis and regression in renal tumours are made.