[Multifocal cavernous hemangioma of the skull. Case report]. / Hemangioma cavernoso multifocal en cráneo. Revisión de un caso.

A 39 year old female presented with a multifocal lesions in the skull, at the frontal right and parietal left. We performed bilateral craniectomies guided with navigation, and the bone defects were repaired with titanium mesh. The pathological examination reported intraosseous cavernous hemangioma in both lesions. Follow up of six months without any complication or recurrence and good cosmetic outcome.

The role of immunotherapy in small cell lung cancer.

Despite decades of research, prognosis for SCLC patients remains poor, and treatment options limited. SCLC is an immunogenic tumor with high somatic mutation rates due to tobacco exposure resulting in potential neo-antigens, the presence of suppressed immune responses, and occurrence of paraneoplastic disorders. The use of T cell immune-checkpoint inhibitors (anti-PD1: nivolumab, pembrolizumab; anti-PD-L1: atezolizumab, durvalumab; anti-CTLA-4: ipilimumab, tremelimumab) have shown promising antitumor activity with the potential to prolong survival in SCLC patients. In fact, atezolizumab when combined with chemotherapy has achieved the milestone of being the first drug to improve survival in patients with newly diagnosed extensive-stage SCLC. Other immunotherapeutic approaches evaluated in clinical trials for SCLC include the use of cytokines, cancer vaccines, antiganglioside therapies, TLR9 inhibition, anti-Notch signaling, and anti-CD47. This review discusses the rationale and clinical evidence of immunotherapy in SCLC, the conflictive clinical results of novel immunotherapeutic agents and combinatorial therapies under evaluation in SCLC patients.

Dissociation of semantic and phonological errors in naming.

We report the naming performance of a fluent aphasic, DP, who shows a striking dissociation between semantic and phonological (nonword) errors: he produced numerous semantic errors but virtually no phonological errors. DP's pattern of performance is the reverse of that reported for patient DM (Caramazza, Papagno, & Ruml, 2000), who only made phonological errors in a naming task. These patterns of performance are inconsistent with the proposal by Dell, Schwartz, Martin, Saffran, and Gagnon (1997) that the naming deficit in fluent aphasia is the result of global damage to all levels of the lexical access system and support instead the hypothesis that brain damage can selectively disrupt distinct subcomponents of the lexical processing system.

[The recommendations regarding non-ST segment elevation acute coronary syndrome have been reviewed. SEMICYUC. Spanish Society for Intensive Medicine, Critical Care and Coronary Units]. / Recomendaciones para el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. SEMICYUC. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine.

[Repetition of pseudo-words in Spanish children with specific language disorder: a psycholinguistic marker]. / Repetición de pseudopalabras en niños españoles con trastorno específico del lenguaje: marcador psicolingüístico.

AIMS: To analyze whether repetition of nonwords (NWR) is a good method to differentiate between Spanish-speaking children with specific language impairment (SLI), children with normal language development (NL), and children with articulation disorder (AD), and to study whether phonological and syllabical characteristics, which are present in nonwords used in this task, are compatible with a SLI explanation on the basis of the temporal auditory limitation. PATIENTS AND METHODS: Eighteen 5- and 6-year-old children with NL, 19 with SLI, and 19 with AD, performed verbal tasks (principally, lexical and verbal memory tasks), and two NWR tasks: one is formed by four nonwords series with frequent syllables, in accordance with the analysis of syllable frequency in Spanish, and the other task is formed by nonwords with infrequent syllables. RESULTS: Like in English, NWR is the best method to differentiate children with SLI and children with NL; yet children with a minor impairment, like AD, show deficits in this task. Therefore, this disorder could be considered as an 'intermediate zone' between NL and SLI. Then it seems that AD is not an unmixed impairment of production only, since in its origin there are difficulties linked with the formation of the phonological representations of the words. CONCLUSIONS: With regard to syllable frequency, results do not support the explanation on the basis of temporal auditory limitation in Spanish. Results are discussed in relation to other explanations: general limitation of processing, with special incidence of the phonological working memory, and connectionist perspectives.

Divergent routes to chiral cyclobutane synthons from (-)-alpha-pinene and their use in the stereoselective synthesis of dehydro amino acids.

Several polyfunctionalized cyclobutane derivatives have been synthesized using commercial (-)-alpha-pinene and (-)-verbenone as chiral precursors. Thus, oxidative cleavage of these compounds by using ruthenium trichloride afforded quantitatively (-)-cis-pinonic and (-)-cis-pinononic acids, respectively, without epimerization. These products were converted into several types of aldehydes, which are the key intermediates in the synthesis of cyclobutane dehydro amino acids via Wittig-Horner condensations with suitable phosphonates. These reactions are highly stereoselective, affording exclusively (Z) isomers, stereochemistry being assessed by NMR experiments. The obtained dehydro amino acids are polyfunctionalized molecules useful for the synthesis of other alpha-amino acids, with additional chiral centers, whose configuration must be induced by the chirality of the terpene employed as a precursor.

[Tuberculous myocarditis. Presentation of a case and review of the literature]. / Miocarditis tuberculosa. Presentación de un caso y revisión de la literatura.

We report a case of a 22 year-old drug addict man with overt heart failure and cardiomegaly. The patient had no prior history of tuberculosis and not clinical features to suggest this diagnosis. Tuberculosis myocarditis was found at the necropsy. It is important to point out the frequency of this pathology, the uncommon clinical presentation of this case; as well as the lack of immunologic response to the tuberculous bacillus.