[SUNCT type headache. A report of a new case. Short-lasting, unilateral, neuralgiform, headache attacks with conjuctival injection and tearing]

We report a new case of short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). This rare headache, described in 1978, shares clinical traits with trigeminal neuralgia and cluster headache and its diagnostic classification as a unilateral headache with autonomic involvement has been the subject of considerable debate. The etiology of SUNCT is unknown, although it is considered a highly difficult pain to treat. We discuss our patient's symptoms and response to treatment with carbamazepine.

[Parry-Romberg syndrome: a form of focal vasculitis]

The Parry-Romberg syndrome (PRS), which was described many years ago, is a process of unknown etiology which evolves with invalidating lesions in one half of the face to which different neurologic, cutaneous or analytical abnormalities may be associated. A clinical, analytical and radiologic study of 5 patients in whom intracranial lesions were shown are herein presented. These findings, together with alterations in the cutaneous biopsies reported in the literature lead to the hypothesis that PRS may be due to a neurovascular alteration of immunologic basis, indicating antiinflammatory or immunosuppressive treatment.

Treatment of relapsing-remitting multiple sclerosis with natural interferon beta: a multicenter, randomized clinical trial

Preliminary results of a multicenter, randomized study on the effect of natural interferon beta (n-INFN-beta) in relapsing-remitting MS are reported. Sixty patients received either no treatment or n-IFN-beta (9 MIU three times a week, subcutaneously). After 6 months, the n-IFN-beta-treated group showed a 58% median reduction in the number of active lesions detected on monthly magnetic resonance imaging scans as well as a 38% reduction in the exacerbation rate as compared with the control group. Side-effects were mild and self-limiting. The study continues according to the protocol.

[Reversible cortical blindness associated with bilateral occipital lesions caused by cyclosporin A: report of two cases]

We report two cases of encephalopathy with cortical blindness associated with reversible bioccipital lesions in transplanted patients (of the kidney and bone marrow) who were being treated with cyclosporin A. We briefly discuss the pathogenesis of symptoms and review the literature.

[Frontal dementia-motor neuron disease: a case report and literature review]

The association between frontal dementia and motor neurone disease has been known for years now although its existence as a nosologic entity in its own right is still subject to debate. Lack of strict histological criteria and inspecificity in complementary tests which might otherwise lend weight to such a diagnosis prevent our considering it as much more than a mere clinical syndrome. We present here the case of a 56 year old female patient who developed a type of dementia with frontal characteristics associated with motor neurone disease. We discuss the clinical picture and review the relevant literature.

[Neurological manifestations of fat embolism syndrome]

Fat embolism is a frequent complication of long bone trauma. Although neurological signs are key elements in the diagnosis of this syndrome, little attention to them has been paid in the spanish literature. We present a retrospective study of 13 patients with fat embolism syndrome in which we focused on neurological manifestations and alterations in computerized tomography (CT) of the head. The most frequent symptom was impairment of consciousness of varying degrees. Three patients out of the 13 also presented focal signs (hemiparesis and partial seizures). CT revealed edema (4/7) and multiple low density foci (1/7). All but one patient recovered without sequelae. Our study does not allow us to establish either the physiopathology of fat embolism syndrome or the most effective treatment.

[Carotid artery dissection at the cervical level presenting as unilateral paresis of lower cranial nerves]

Internal carotid artery dissection at the cervical level is a known cause of stroke in young patients. The usual clinical presentation is strong ipsilateral cephalea and oculosympathetic paresis or ischemic symptoms in the affected artery. Paresis of the lower cranial nerves due to local compression in the space behind the parotid is rarely found and may complicate the diagnosis by leading physicians to look for anomalies in the vertebro-basilar territory. We present a patient with internal carotid artery dissection at the cervical level diagnosed by angiography. Symptoms at presentation were hemicranial cephalea accompanied by Villaret's syndrome. We point out the importance of keeping this diagnostic possibility in mind when looking for the etiology of subacute paresis of the lower cranial nerves.

The prevalence of multiple sclerosis in the Sanitary District of Vélez-Málaga, southern Spain

Since little is known about the prevalence of multiple sclerosis (MS) in Spain, we undertook an epidemiologic study to ascertain the prevalence of MS in the Sanitary District of Vélez-Málaga, close to the city of Málaga, in southern Spain. The crude prevalence rate of MS in Vélez-Málaga was 53 per 100,000, twice as high as the prevalence previously reported in both the city and province of Málaga. The MS prevalence in the Sanitary District of Vélez-Málaga is similar to that in Sicily and in Cyprus.

[Neurophthalmological alterations in multiple sclerosis]

With the aim of defining the neuro-ophthalmological alterations in multiple sclerosis, both with respect to visual and oculomotor aspects, we have studied a sample of 100 clinically definite multiple sclerosis patients, all in the remittent phase of the disease. We compared them with a sample of 100 unrelated healthy controls, matched for age and sex. Visuomotor alterations were found in 99%, purely visual alterations in 38%, purely oculomotor alterations in 3%, and mixed alterations in 58% of the MS patients. Comparisons with controls showed significant statistical differences in all the tests used in the study. The neuro-ophthalmological examination in multiple sclerosis permits us to detect subclinical lesions and arrive at a better comprehension of central nervous system involvement in this disease, thereby contributing collaborating to better patient care.

[Neurologic complications induced by the treatment of the acute renal allograft rejection with the monoclonal antibody OKT3]

The treatment of the acute renal allograft rejection with the monoclonal antibody orthoclone OKT3 produces both systemic and neurologic alterations. In a series of 21 patients with an acute renal allograft rejection treated with this monoclonal antibody, 20 with a renal allograft transplantation and one with a renal and pancreatic allograft transplantation, 29% referred headache associated with fever and vomiting, and 14.2% presented severe neurological alterations induced by the treatment. We stress the need to know these secondary effects to differentiate them from other central nervous system disorders, particularly those of infectious origin.

Effect of transfer factor on myelosuppression and related morbidity induced by chemotherapy in acute leukaemias

The aim of this study is to determine the safety and efficacy of Transfer Factor (TF) in accelerating the haematopoietic recovery in patients with acute leukaemias (AL), following intensive therapy to induce remission of the disease. Twenty-two patients with different types of AL (16 AML, three BC-CML and three ALL) were studied. The patients were divided in two groups. Group 1 (eight AML, two BC-CML and one ALL) received, after myelosuppression induced by chemotherapy, TF (1 unit daily, subcutaneous) until leucocyte count was > 2.5 x 10(9)/l and platelet count > 80 x 10(9)/l. Group 2 was considered the control group and did not receive TF. Treatment with TF accelerated the recovery of neutrophils, leucocytes, platelets (P < 0.001) and haemoglobin (P < 0.01). As a logical consequence, incidence and severity of infection and haemorrhage were lesser in the TF group than in the control group. There was no evidence that TF accelerated the re-growth of leukaemic cells. It seems that TF is safe in AL, accelerating haematopoietic recovery. However, it should be used with caution until results of additional trials become available.

[Treatment of acute lymphoid leukemia (ALL) in the child]

PURPOSE

To analyse the results of the therapy administered to children with ALL in Cuba.

PATIENTS AND METHODS

Four-hundred and twenty-five children (aged below 15 years), diagnosed of ALL in 8 different Cuban hospitals between 1973 and 1991, were evaluated. Five different therapeutic regimes were used: three "classic" GLATHEM protocols in the first period (1973-1981) and two intensive BFM-like protocols in the second period (1982-1991). The Kaplan-Meier method was applied for survival analysis, and the differences were evaluated by the log-rank and Mantel-Cox methods.

RESULTS

Two-hundred and sixty-five patients were included in the first period, 81 with low-risk disease, 133 with standard risk and 51 with poor-risk leukaemia. The second period comprised 160 cases, 50 of low-risk, 83 with standard risk and 27 with poor-risk leukaemia. The disease-free survival probability at 60 months was 35% for the first group and 55% for the second (p < 0.0001). The 60-month survival (SV) as a whole was 45% for the "classic" treatments and 60% for the BFM-like protocols (p < 0.01). The disease-free survival (DFS) probability for each prognostic group was as follows: 50% for low-risk, 43% for standard risk, and 25% for poor-risk (p < 0.001) and the probability of survival as a whole was, respectively, 65%, 49% and 28% (p < 0.001). as for this compilation, 172 patients were out of any treatment for periods ranging between 14 and 168 months.

CONCLUSIONS

1) The percentage of remissions was similar for both groups of treatments. 2) The results attained with BFM-like protocols were better than those of the "classic" therapy with regard to the SV and DFS differences. 3) Significant differences can be appreciated between good- and poor-prognosis groups for both types of treatment.

p53 gene rearrangements in chronic myelocytic leukemia

We performed Southern-blot analysis of the p53 gene in 41 consecutive patients with typical chronic myelocytic leukemia (CML). In two of them, we were able to study cells during both the chronic and the accelerated phases. Only one of the 29 chronic-phase samples had rearrangement of the p53 gene, whereas three of the nine accelerated-phase samples and one of the five patients in blast crisis exhibited rearrangements. Gene deletion was observed in two patients, one in accelerated phase and the other in blast crisis. One patient with a nonrearranged p53 gene in chronic phase showed rearrangement after progression to the accelerated phase. On the other hand, one patient in accelerated phase exhibited rearrangements which disappeared after reversion to chronic phase with successful treatment. Our findings support the opinion that alterations of the p53 gene may play an important role in CML evolution.

Chemiluminescence production by neutrophils and immune complex levels in cancer patients

We studied the production of chemiluminescence (CL) by peripheral blood neutrophils from 24 normal subjects, 13 lung cancer patients with clinical stages (CS) III and IV, and 27 breast cancer patients with CS II, III, and IV. Evaluations were made before chemo- and radiotherapy treatments. CL was expressed as: baseline of the record background activity; area under the curve (AUC) of opsonized zymosan response; maximum peak (MP) response; time to MP (TMP); and total time (TT). Simultaneously, circulating immune complexes (CIC) in sera were evaluated by polyethylene glycol precipitation technique. The results demonstrated that lung cancer patients with CS III had an increase of TMP and TT values, while breast cancer patients with CS IV showed the lowest values of AUC and MP compared with the control group. The CIC levels were increased in all the cancer patients. There was no correlation between the baseline CL activity and the levels of immune complexes.

[Rearrangement of the bcl1 and bcl2 oncogenes in chronic lymphoid leukemia]

Oncogenes bcl1 and bcl2 are located in the rupture site of t(11;14) and t(14; 18), respectively. They have been found to rearrange in different B-cell malignancies. A molecular study of oncogenes bcl1 and bcl2 was carried out in 42 patients diagnosed of B-cell chronic lymphoid leukaemia. In 14.3% of the patients the rearrangement affected bcl1, but no differences were found with regard to stage and clinical course between these patients and those without any oncogen rearrangement. In all the patients studied bc12 was in a germinal configuration.