• The Human Entorhinal Cortex: A Cytoarchitectonic Analysis
• Plasma Levels o Substance P in Liver Cirrhosis: Relationship to the Activation of Vasopressor Systems and Urinary Sodium Excretion
• Recidivas en la enfermedad de Graves-Basedow: influencia de la pauta de tratamiento
• Detección precoz del cáncer de mama en Navarra. Conducta diagnóstica en las mujeres enviadas a un hospital de referencia
• Schizophrenic syndrome and Wisconsin Card Sorting Test dimensions
• Truth-telling to the patient in advanced cancer: family information filtering and prospects for change
• Is Poor Insight in Psychotic Disorders Associated With Poor Performance on the Wisconsin Card Sorting Test?
• Estimación de la prevalencia de la Enfermedad de Parkinson en Navarra. Estudio Farmacoepidemiológico del consumo de Antiparkinsonianos

The Human Entorhinal Cortex: A Cytoarchitectonic Analysis

R. Insausti, T. Tuñón, T. Sobreviela, A.M. Insausti and L.M. Gonzalo

Department of Anatomy, University of Navarra, Apdo. 273, 31080 Pamplona, Spain (R.I., T.S., A.M.I., L.M.G.), and Department of Pathology, Hospital of Navarra, Irunlarrea s/n 31007 Pamplona, Spain (T.T.)

ABSTRACT
The entorhinal cortex of man is in the medial aspect of the temporal lobe. As in other mammalian species, it constitutes an essential component of the hippocampal formation and the route through which the neocortex interacts with the hippocampus. The importance of knowing its architecture in detail arises from the possibility of extrapolating it to experimental findings, notably in the nonhuman primate. We have investigated the cytoarchitectonic features of the human entorhinal cortex by using as a base our previous study (D.G. Amaral, R. Insausti, and W.M. Cowan [1987] J. Comp. Neurol, 264:326-355) of the nonhuman primate entorhinal cortex. We prepared serial sections of the temporal lobe from 35 normal brains. Thionin- and myelin-stained series were made of all cases. Sections spaced 500 µm apart through the full rostrocaudal extent of the entorhinal cortex were analyzed. The human entorhinal cortex is made up of six layers, of which layer IV does not apeear throughout all subfields of the entorhinal cortex. The overall appearance resembles that of the adjacent neocortex in lateral and caudal portions. In harmony with general structural principles in the nonhuman primate entorhinal cortex, our analysis supports the partitioning of the human entorhinal cortex into eight different subfields. (1) The olfactory subfield (EO), the rostralmost field, is little laminated. (2) The lateral rostral subfield (ELr), laterally located, merges with the laterally adjacent perirhinal cortex. (3) The rostral subfield (ER) is between EO and ELr, with better differentiation of layers II and III than EO. (4) The medial intermediate subfield (EMI) is located at the medial border. (5) The intermediate field (EI) is a lateral continuation of EMI; lamina dissecans (layer IV) can be best appreciated in this field. (6) The lateral caudal subfield (ELc) laterally borders on EI as a continuation of ELr. (7) The caudal subfield (EC) lies caudal to the beginning of the hippocampal fissure, with a distinctive, clear space (Vc) between layers V and VI. (8) The caudal limiting field (ECL) forms the caudal termination of the entorhinal cortex. Thus our parcellation of the entorhinal cortex in man is largely parallel to that arrived at in the monkey. This close homology provides a rational basis for the application to clinical problems of anatomical and functional information obtained in experimental work in nonhuman primates. (The Journal of comparative neurology 355: 171-198 (1995).

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Plasma Levels o Substance P in Liver Cirrhosis: Relationship to the Activation of Vasopressor Systems and Urinary Sodium Excretion

Conrado M. Fernández-Rodríguez (1), Jesús Prieto (2), Jorge Quiroga (2), José Manuel Zozoya (2), Amalia Andrade (1), Marina Núez (2), Bruno Sangro (2) and José Penas (1)

From the (1) Services of Gastroenterology, Cardiology and Laboratory of Hormones, Hospital Xeral de Vigo; and (2) Department of Internal Medicine and Liver Unit, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain.

ABSTRACT
The mediators of the hyperdynamic circulation of liver cirrhosis are not well characterized. Substance P is a potent vasodilatory peptide produced by the enteric nervous system and partly cleared by the liver. In this work we have investigated the plasma levels of substante P and their relationship to the hemodynamic, neurohormonal, and renal function changes occurring in patients with cirrhosis. Seven healthy subjects (control group), 7 cirrhotic patients without ascites (group I), and 24 cirrhotic patients with ascites (group II) were studied. Cardiac output (CO), femoral blood flow (FBF), blood volume (BV), femoral arteriovenous difference of oxygen content (Ca-v O2), plasma renin activity (PRA), plasma aldosterone concentration (PAC), and plasma norepinephrine (NE) were determined. Five patients underwent trans-jugular intrahepatic porto-systemic stent shunt (TIPSS) because of refractory ascites. Immunoreactive substance P (irSP) was measured by radioimmunoassay after plasma extraction. irSP was higher in ascitic patients than in healthy controls (P < .01) and directly correlated with PRA, PAC, plasma NE, and Pugh's score and inversely correlated with urinary sodium excretion, glomerular filtration rate, and Ca-v O2. No differences were observed between portal and peripheral vein irSP concentration. TIPSS placement induced a decrease in portal pressure and an increase in CO but circulatin irSP remained unchanged. Our data show that circulating irSP is increased in decompensated cirrhotic patients and may be involved in the pathogenesis of the hemodynamic changes of cirrhosis, Alleviation of portal hypertension did not result in decreased plasma levels of this vasodilatory substance. (HEPATOLOGY 1995;1:35-40.)

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Recidivas en la enfermedad de Graves-Basedow: influencia de la pauta de tratamiento

María José Goñi Iriarte, Luis Forga Llenas, Ana Iriarte Beroiz, Emma Anda Apiñániz, Rosa Rodríguez Erdozain y Edelmiro Menéndez Torre

Sección de Endocrinología. Hospital de Navarra. Pamplona.

RESUMEN

FUNDAMENTO Valorar la posible influencia, sobre el número de recidivas en la enfermedad de Graves-Basedow, de dos modalidades diferentes de tratamiento (antitiroideos y antitiroideos más levotiroxina) y estudiar los posibles factores pronósticos de la evolución de la enfermedad.

METODOS Se estudiaron 76 pacientes distribuidos al azar en 2 grupos de tratamiento, grupo A, tratado con carbimazol a dosis decrecientes, y grupo B, con carbimazol a dosis altas asociado con levotiroxina. El seguimiento de estos pacientes se realizó durante un mínimo de 36 meses tras la suspensión del tratamiento.

RESULTADOS No hubo diferencias significativas en las características clínicas ni en los valores hormonales o de anticuerpos entre ambos grupos al inicio y al final del tratamiento. Durante los primeros 12 meses de seguimiento, el tanto por ciento de recidivas del grupo A fue significativamente mayor (65% frente al 23%; p<0,001 que en el B. Al prolongar el periodo de seguimiento hasta 36 meses, el tanto por ciento de recidivas se igualó (62,8% frente al 60,7%; p = NS). La aparición de recidivas no se correlacionó con los parámetros clínicos ni bioquímicos evaluados, sino únicamente con el tamaño del bocio; se detectó recidiva en el 100% de los pacientes con bocio de grado mayor o igual a II.

CONCLUSIONES La asociación de levotiroxina al tratamiento con carbimazol en la enfermedad de Graves-Basedow retrasa la aparición de las recididas, pero no las reduce de forma significativa, en comparación con el tratamiento con carbimazol en dosis decreciente. Unicamente el tamaño del bocio al inicio del tratamiento podría constituir un factor pronóstico de la evolución de la enfermedad. (Med Clin (Barc) 1995; 104: 11-14.)

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Detección precoz del cáncer de mama en Navarra. Conducta diagnóstica en las mujeres enviadas a un hospital de referencia

Luis Apesteguía Ciriza (1), Ana Osa Labrador (1), Estrella Extramiana Cameno (2), Concepción de Miguel Medina (3), Begoña Repáraz Romero (3), Fernando Domínguez Cunchillos (4), Ramón Trujillo Ascanio (4) y Miguel Aizcorbe Garralda (4)

Servicios de: 1 Radiología, 3 Anatomía Patológica y 4 Cirugía General. Hospital Virgen del Camino. Pamplona. 2 Sección de Epidemiología. Instituto de Salud Pública.

FUNDAMENTO: La implantación de programas de detección de cáncer mamario supone, para el hospital de referencia, un importante aumento del número de pacientes a evaluar y el diagnóstico de una mayor proporción de lesiones subclínicas. Se presenta la experiencia relacionada con un programa de detección precoz, de tipo poblacional, instaurado en Navarra (PDPCM).

SUJETOS Y METODOS: Se han revisado las actuaciones diagnósticas realizadas en el Hospital Virgen del Camino de Pamplona a 319 mujeres enviadas desde el PDPCM, por presentar sospecha mamográfica de malignidad. Se practicó biopsia quirúrgica dirigida, sin previa citología, en 89 mujeres (27,9%). Se realizó punción-aspiración con agua aguja fina y citología (PAAF-citología), como primera prueba diagnóstica, a 216 lesiones (67,7%), 53 de ellas palpables y 163 no palpables. En 14 casos no se indicaron técnicas agresivas (4,4%).

RESULTADOS: Se diagnosticaron en total 136 carcinomas (42,6%), y otras 112 mujeres fueron biopsiadas con resultado de benignidad (35,1%). Cincuenta y siete lesiones (17,9%) no sospechosas de malignidad en la PAAF-citología finalmente no se biopsiaron por considerarse insuficiente el grado de sospecha. Pasados de 27 a 48 meses desde la primera consulta, solamente ha aparecido un falso negativo en este grupo, lo cual supone una fiabilidad diagnóstica global del 99,68%.

CONCLUSIONES: La biopsia quirúrgica dirigida es la técnica más fiable para diagnosticar lesiones no palpables y en estadio precoz, y es necesario siempre que la sospecha radiológica sea media o alta. La PAAF-citología es una técnica muy útil para confirmar malignidad y para evitar biopsias innecesarias en lesiones de baja sospecha. (Med Clin (Barc) 1996; 106: 126-130).

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Schizophrenic syndrome and Wisconsin Card Sorting Test dimensions

Manuel J. Cuesta* (a), Víctor Peralta (a), Francisco Caro (a), José de León (b)

a Psychiatric Unit I, "Virgen del Camino" Hospital, Irunlarrea 4, 31008 Pamplona, Spain
b Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenua, Philadelphia, PA 19129, USA

ABSTRACT
A principal component analysis of Wisconsin Card Sorting Test (WCST) scores has recently shown three factors. Only the Perseveration factor may measure the activity of the dorsolateral prefrontal cortex in schizophrenic patients. Liddle has hypothesized that a dysfunction in this area is specifically related to the negative syndrome and not to other schizophrenic syndromes (positive and disorganization). The factor analysis of the WCST was replicated with similar results in 38 schizophrenic or schizoaffective patients. In the total group, the correlation between the negative syndrome and the Perseveration factor did not reach signifcant levels. In the patients with a DSM-III-R diagnosis of schizophrenia (n = 30), the correlations did reach significant levels. (Psychiatry Research 58 (1995) 45-51).

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Truth-telling to the patient in advanced cancer: family information filtering and prospects for change

Juan Ignacio Arraras (1), José Juan Illarramendi (2), Juan José Valerdi (3) and Stephen James Wright (4)

(1) Clinical Psychologist (2) Consultant Physician and (3) Head of Department, Servicio de Oncologia, Hospital de Navarra, Irunlarrea s/n, 31008 Pamplona, Spain; (4) Clinical Psychologist, Department of Medical Psychology, Clinical Support Services Directorate, Leicester General Hospital, Leicester LE5 4PW, UK

SUMMARY
This study investigated 'truth telling' to the patient in Navarre, Spain. Knowledge of diagnosis amongst a group of 89 advanced cancer patients was compared with the hypothetical desire for information of a convenience sample of 78 non-patients. The views of patients' families were also assessed. Of the patient sample, 46% reported complete or partial knowledge of the diagnosis, whereas over 90% of the general population sample indicated that they would want complete or partial knowledge of the diagnosis. Two factors were found to be predictive of knowledge status amongst the patient group-including primary tumour site (lung/larynx vs breast) and the family's wish for the diagnosis to be withheld. Age and educational level were found to be predictive of attitudes towards 'truth telling' amongst the general population sample. The results indicate a clear wish for greater knowledge amongst (potential) patients. Although the family will almost certainly continue to play a central role in health care, it is concluded that there are already early signs of the desired trend towards greater diagnostic disclosure by families. (Psycho-Oncology, Vol. 4: 191-196 (1995)).

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Is Poor Insight in Psychotic Disorders Associated With Poor Performance on the Wisconsin Card Sorting Test?

Manuel J. Cuesta, M.D., Víctor Peralta, M.D., Francisco Caro, M.D. and Jose de Leon, M.D.

Psychiatric Unit, Virgen del Camino Hospital; the Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia; and Norristown State Hospital, Norristown, Pa.

ABSTRACT
Objective: The purpose of this study was to test whether poor insight in patients with psychotic disorders is correlated with their performance on the Wisconsin Card Sorting Test.

Method: The subjects included 52 psychotic patients (35 of whom had schizophrenia) given diagnoses according to DSM-III-R criteria. Their scores on the Wisconsin Card Sorting Test (number of categories and perserverative responses) were compared with those on three items measuring poor insight: lack of feeling ill, lack of insight, and uncooperativeness.

Results: None of the six correlations between scores on the two measures of the neuropsychological test and the three items measuring insight was significant. Conclusions: In spite of its limitations, this study suggests that poor insight may not be associated with poor performance on the Wisconsin Card Sorting Test. (Am J Psychiatry 1995; 152:1380-1382)

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Estimación de la prevalencia de la Enfermedad de Parkinson en Navarra. Estudio Farmacoepidemiológico del consumo de Antiparkinsonianos

M.ª Teresa Artázcoz Sanz (1) y José Javier Viñes Rueda (2)
(1) Servicio Navarro de Salud-Osasunbidea
(2) Departamento de Salud Gobierno de Navarra

RESUMEN
Fundamento: Los estudios sobre la prevalencia de la enfermedad de Parkinson son escasos y con metología diferente, lo que impide conocer su impacto como problema de salud pública en nuestra Comunidad. El consumo de fármacos específicos y obligados como la levodopa en la enfermedad de Parkinson nos va a permitir de forma fiable conocer su prevalencia.
Métodos: Se determina en Navarra la prevalencia de la enfermedad de Parkinson (332.0 y 332.1 de la CIE, 9.ª revisión) por el consumo de fármacos antiparkisonianos N04A) durante los años 1993 y 1994, a través del cálculo de las dosis diarias definidas (DDD) por 100.000 habitantes (105) para cada uno de los fármacos prescritos). Se ha dispuesto de los datos de las prescripciones indicadas del Servicio de Prestaciones Farmacéuticas del Servicio Navarro de Salud, que cubre la asistencia del 93,5% de la población de Navarra.
Resultados: Por medio de la determinación de la dosis diaria definida (DDD) de levopoda por 105 habitantes, se estima una prevalencia de 161,5 x 105 (IC 95% 172,4-150,6) para el conjunto de la población de 8 x 105 (IC 95% 10,4-5,6) para los menores de 65 años y de 1.001,1 x 105 (IC 95% 1.069,6-932.4) para los 65 y más años de edad. El consumo de levodopa por zonas básicas de salud (Distritos sanitarios) permite determinar la distribución geográfica de la Enfermedad de Parkinson en Navarra, que registra variaciones entre una prevalencia en mayores de 65 años de 1.602,77 x 105 en Alsasua y de 517,61 x 105 en Lodosa.
Conclusiones: Las cifras obtenidas permiten situar a Navarra en una prevalencia media respecto a otras áreas europeas, aunque las diferencias metodológicas no permiten conclusiones definitivas al respecto. (Rev Esp Salud Pública 1995:69:479-485)