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In recent years, prehabilitation has generated high expectations as an innovative preoperative strategy to enhance clinical outcomes following surgery. Several studies have demonstrated that multimodal programs are effective in improving patients' health status and cardiopulmonary reserve, allowing them to undergo surgery in better conditions and, consequently, reducing the incidence of postoperative complications. Most publications describe proof-of-concept studies, and literature about their implementation is more limited. The implementation of these programs requires new resources and significant organizational effort. In this paper, we share our experience implementing a multimodal prehabilitation program as a mainstream service at a tertiary hospital. Although there are still many unknowns regarding the optimal selection of patients, as well as the duration and components of the program, this article describes our journey in this field, aiming to provide insight for teams interested in developing a similar project., (Copyright © 2024 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Voiding urosonography (VUS) is a dynamic imaging technique which evaluates the lower urinary tract by introducing sonographic contrast into the bladder, preferably used in the diagnosis of vesicoureteral reflux (VUR). Our goals were to describe the clinical indications for performing a VUS for VUR's diagnosis and analyse its diagnostic reliability., Material and Methods: Cross-sectional study carried on patients under 15 years old with a VUS taken between November 2013-2020. Sex, age, indications (lower urinary tract infection-LUTI; dilatated lower urinary tract-DLUT; duplex collecting system-DCS), results (presence/absence of VUR, score and side) and complications were analysed. U Mann-Whitney and Chi-squared tests were used and 2 predictive capacity models for the indications used to detect VUR were employed (logistic binomial regression and multilayer perceptron neural network). Statistical significance p < 0.05., Results: 415 VUS were completed correctly (male 51.8%, median age 7.3 (3.1-15.3) months). Indications were: LUTI (67.5%), DLUT (33.5%) and DCS (10.2%); presenting 1, 2 and 3 indications in 86.5%, 12.8% and 0.7% respectively. VUR was diagnosed in 34.7% cases. A tendency towards statistically significance was showed related to male sex ( p = 0.052) and the only significative clinical indication for VUR was DCS ( p = 0.007). Patients with 2 simultaneous indications had higher probability of VUR ( p = 0.012). DCS presence or male sex were the only predictive variables of VUR: DCS = OR 1.89 (1.54-6.52) ( p = 0.006) and male sex = OR 1.56 (1.03-2.35) ( p = 0.035)., Conclusions: VUS is a thriving technique, radiation free and with a low complications rate. Presence of DCS, male sex or 2 simultaneous indications for VUS increase the probability of presenting VUR.

Objective: Wolf-Hirschhorn syndrome is a rare disease of genetic origin caused by the deletion of the distal end of chromosome 4, including at least the region p16.3. The objectives of this work were to determine the prevalence of the disease in the Spanish population, as well as to establish the geographical distribution of the syndrome throughout the Spanish geography, elucidating the age range in which there are more patients., Methods: Patients diagnosed with the disease for nine years (2013-2021) throughout the Spanish territory were recruited for the research, thanks to agreements with the Spanish Association of Wolf-Hirschhorn Syndrome (AESWH). The clinical information of the patients was obtained from referring physicians using two standardized questionnaires completed with data from medical reports and the parent interview. The molecular characterization of the disease was made using SNP (single nucleotide polymorphism) microarrays (cytoSNP850K, Illumina, USA). The data were statistically processed using Microsoft Excel (Microsoft Corporation) and SPSS (IBM) software, using comparisons between two groups s with Student's t-test (for continuous variables) or with Chi-square tests (for categorical ones). For more than two groups, ANOVA analyses were performed (followed by Bonferroni or T3-Dunnett post hoc tests) for continuous variables and z-tests between column proportions for categorical variables., Results: In Spain (until 2021) eighty people are diagnosed with this syndrome, estimating its prevalence at 1.69x10-4 per 10,000 inhabitants and / or 1/172,904 for each live newborn. This paper remarks the existence of important differences in prevalence between the different regions in Spain. The region with the most diagnosed patients was Madrid, although the highest prevalence was observed in Asturias. Significant differences have been established in terms of sex and disease (ratio of women to men of 2:1), and the mean age at diagnosis has been established at 7.20 years., Conclusions: The prevalence of this syndrome in Spain has been estimated well below the prevalence that is handled in scientific texts (1/50,000 newborns). In addition, we have determined that this prevalence shows large geographical differences, which allows us to affirm that this syndrome could be under-diagnosed in our country. Most of the patients included in this cohort are of paediatric age. It has not been possible to corroborate that mortality in this syndrome, in our population, occurs preferably during the first two years of life, as has been claimed., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: To analyse the clinical evolution, the therapeutic strategies and the characteristics of the patients presenting enuresis attended at our outpatient clinic., Material and Methods: Retrospective study of patients <14 years old(yo) diagnosed of enuresis attended at our outpatient clinic (2011-2019) and completed their follow-up (remission or aged 15). Urotherapy was offered to all patients as initial management. The therapeutic strategies were classified as: first line (desmopressin or clock alarm), second line (desmo-pressin+alarm) and third line(anticholinergics). The remission rate during follow-up, the number of consultations needed until remission and the treatments used were calculated. Statistical tests used:Kaplan-Meier, actuarial survival. Multivariate analysis:Cox regression.Statistical significance:p<0.05., Results: Data were collected from 125 patients (mean age: 8.6±2.45yo). Family history of enuresis was present in 38.9%. The mean follow-up was 2.37±1.55yo and the average number of consultations was 7.54±5.06. The remission rate (RE) was 84%(n=105), with a median remission interval:2.66 years (2.34-2.991[95%CI]). The average number of treatments required for remission was 2.74±1.27. RE with urotherapy alone was 20%(n=25); RE with first line:19.3%(n=17) and second line:16.7(n=11). In the remaining patients, a RE of 78.18%(n=43) was achieved by adding an anticholinergic. Patients aged > 8.7 years at the beginning of the follow-up required less time to achieve remission (p=.025). These patients had a higher RE (hazard ratio 1.15 (1.05-1.25))(p=.004). No other variables were significant., Conclusion: Staged therapeutic strategies are necessary to achieve remission. Only 25% remitted with urotherapy as single treatment. RE are higher when patients are >8.7 yo once they initiate their follow up.

Introduction: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014., Objective: To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established., Material and Methods: A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05., Results: 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed., Conclusion: Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

Introduction: Graft-versus-host disease (GVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with high morbidity and mortality rates. Intestinal clinical signs are unspecific, which means differential diagnosis with infections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standard technique, there is no consensus as to which sampling method is best., Objective: To assess the results of the biopsy techniques used in patients with suspected intestinal GVHD., Material and Methods: A retrospective study of patients with suspected intestinal GVHD undergoing allo-HSCT from 2010 to 2019 was carried out. They were assessed through digestive biopsy - esophagogastroduodenal biopsy (upper GI endoscopy - UGIE) or rectal biopsy (colonoscopy or direct biopsy). Quantitative variables, expressed as median and interquartile range, and qualitative variables, expressed as absolute frequency and percentage, were collected., Results: 23 patients were studied, 60.9% of whom were male. Median age at biopsy was 9 years (7-14 years). UGIE was used in 47.8% of patients (n=11), colonoscopy was used in 26.1% of patients (n=6), and direct biopsy was used in 34.8% of patients (n=8), with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%) patients, respectively., Conclusions: Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.

Introduction: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994., Material and Methods: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed., Results: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%)., Conclusions: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.

Introduction: Panayiotopoulos syndrome (PS) is a common form of epilepsy in childhood that is classified as one of the benign idiopathic focal epilepsies. There is no consensus on the indication of neuroimaging in the presence of an electroclinical picture consistent with this disorder. Two cases are presented that began with an electroclinical pattern compatible with PS and in which alterations in the occipital structure were finally detected., Case Reports: Two girls aged 5 and 6 years who began with episodes consistent with PS. In both cases neuroimaging showed structural lesions (cortical dysplasia and pleomorphic xanthoastrocytoma), and hence the final diagnosis was occipital symptomatic focal epilepsy, with the ensuing change in the prognosis and treatment., Conclusions: The literature describes abnormalities in cranial magnetic resonance imaging in 10-20% of diagnosed cases of PS in which a scan is performed, although the diagnosis of PS is not always changed (matching lesions). Both cases exemplify the importance of reaching a correct diagnosis through a detailed study that must include neuroimaging, since, in some patients, causal brain injuries will be detected and as a result the diagnosis, treatment and evolution will be significantly different.

Introduction: Tumours of the central nervous system (CNS) are one of the most common causes of child mortality, second only to accidents. In the last few decades we have witnessed an increase in the incidence of these tumours, which now stands at 2.5-3.2 cases/100,000 children/year in the population under 15 years of age., Aims: To determine the real incidence of tumours affecting the CNS in Asturias and to describe their characteristics., Patients and Methods: Data were collected on patients under 15 years of age who had been diagnosed with a CNS tumour in any of the hospitals in the Community during the ten-year period 1999-2008., Results: The mean annual incidence of CNS tumours was 4.4 cases/100,000 children/year (range: 3.1-5.7). The mean time elapsed before a diagnosis was reached was 2.03 months. The clinical features at onset were focal neurological deficit in 58% of cases, followed by cerebellar symptoms (42%), headache (32%) and behavioural disorders (32%)., Conclusions: The incidence of tumours affecting the CNS found in children in Asturias is the highest of those recorded for this age bracket, the clinical features of these patients being similar to those in other studies. We seem to be before new data that confirms the claims of a growing incidence of these tumours.

SCIWORA is an uncommon syndrome affecting mainly children and is defined as the occurrence of acute spinal cord injury despite normal plain radiography and normal computed tomography (CT). Lumbar SCIWORA is very rare in children, and to our knowledge, there is only one report of lumbar SCIWORA in the literature. We present the case of a 5 year-old boy who suffered acute bilateral lower limbs paralysis, associated to urinary and bowel incontinence following a 1.5 meter fall. Lumbar cord contusion could be demonstrated on MRI without other radiologic abnormalities, which confirmed SCIWORA diagnosis. Our case report illustrates the potential seriousness of this disease and the importance of a thorough and accurate clinical history for diagnosis.

Introduction: Congenital metabolic diseases are considered as rare diseases because of their low incidence and their clinical symptoms at onset. Sometimes they can just begin in the neonatal period. Their progressive knowledge and the availability of specific and sensitive biochemical procedures allow us to diagnose many congenital metabolic diseases, which were not recognized some years ago., Patients and Methods: We reviewed the 52 patients with congenital metabolic diseases diagnosed for the last 25 years in our centre, evaluating the clinical presentation, neurological symptoms, complementary exams and clinical evolution., Results: The mean age at onset of symptoms was 5 days and the mean age at diagnosis was 88 days of age. We considered a first group of 36 patients with inborn errors of intermediary metabolism, in whom hypotonia, weight loss and seizures are the main symptoms. The second group was composed of 8 patients with defective energy metabolism, who showed abnormal respiratory rhythm and hypotonia. Finally, we considered 8 patients with diseases of the complex molecules, who presented with hypotonia and cataracts as common symptoms at onset. The more common neurological symptoms in this period were hypotonia (60%), sensorial deficit (35%) and refractory seizures (23%). The complementary laboratory tests in the first phases of the diseases allowed us to suspect a congenital metabolic disease especially among intermediary and energy defects. EEG registration and CSF samples were important to diagnose some inborn errors of intermediary metabolism. In the first steps, the neuroimaging was less orientative, even if it allow the exclusion of other diseases. More than half of the patients with inborn errors of metabolism with onset in the neonatal period died within the first year of life., Conclusion: It is really important to suspect these diseases in the neonatal period so as to achieve an early diagnosis and therapy which may reduce the morbimortality.

In this paper we study the reliability of the basophil activation test (BAT) in the "in-vitro" diagnosis of allergy to betalactams and to metamizol, and the sensitivity and specificity of the technique are analyzed. To this end, we studied 58 patients allergic to betalactam antibiotics with a positive cutaneous test facing any derivative of penicillin and 30 healthy controls who tolerated betalactams, and 26 patients allergic to metamizol with an immediate reaction and 30 healthy controls who tolerated the medicine. Sensitivity to BAT in allergy to betalactams was 52.8%, and specificity was 92.6%. For metamizol, sensitivity was 42.3% and specificity was 100%. The positive predictive value of BAT in allergy to betalactams was 18.9% and the negative predictive value was 98.4%. For metamizol, the positive predictive value of the technique was 100% and the negative predictive value was 99.4%. The joint use of BAT and CAP (specific IgE) makes it possible to diagnose some 65% of patients allergic to betalactams. The combined use of cutaneous tests and BAT in allergy to metamizol detects 70% of the cases. BAT is a useful, non-invasive technique in the "in-vitro" diagnosis of allergy to betalactams and metamizol.

Flow cytometry is a technique enabling the analysis of physical and biological characteristics of cells or other biological particles when labeled with antibodies coupled to fluorochromes or other dyes. The basophil activation test (BAT), also called flow-cytometric allergen stimulation test (FAST) [commercially available under the name of Flow CAST (Bühlmann Laboratories) or BASOTEST (Beckton-Dickinson)] is based on the in vitro allergen-induced specific activation of basophils. This assay rests on the demonstration of some membrane protein markers that appear after exposure to the allergen. This paper reviews some of the literature about the use of this technique in the investigation of immediate-type allergies to inhalant allergens, drugs, and foods, as well as our own experience with this diagnostic technique. Flow cytometry is a reliable method for the quantification of basophil activation after allergenic stimulus in vitro and in vivo. It also enables us to detect allergic and pseudoallergic reactions because of other mechanisms than allergen-specific IgE antibodies. Further clinical evaluation of this technique will allow validation and better establishment of its diagnostic value in allergy.

Objective and Design: To study in vitro sulphidoleukotriene (sLT) production by food allergic patients using cellular allergen stimulation test (CAST)-ELISA and to evaluate the reliability of this technique for diagnosing food allergic reactions., Subjects: Forty patients with adverse reactions after food intake, 20 healthy controls, and 15 individuals sensitized to inhalant allergens as atopic controls., Methods: Skin tests, serum-specific IgE, histamine release test (HRT), CAST-ELISA and food challenges. One-way ANOVA was used to compare tests results between patients and controls and to study mediator release and specific IgE, related to the severity of clinical pictures. Sensitivity and specificity were analyzed by ROC curves., Results: Food allergic patients showed higher (p < 0.05) Ag-dependent sLT production (836.2 +/- 664.1 pg/ml) (mean +/- standard deviation) than both control groups. After stimulus with anti-IgE antibodies, sLT production was higher (p < 0.05) by atopic controls (1630.8 +/- 696.5 pg/ml) compared to patients and healthy controls. Patients with anaphylactic reactions showed higher Ag-specific and anti-IgE sLT and histamine production than patients with less severe manifestations. Mean serum-specific IgE was significantly lower (p < 0.05) in patients presenting oral allergy syndrome compared to patients with more severe clinical pictures. CAST-ELISA was the most sensitive method. Prick by prick test was the most specific., Conclusions: CAST-ELISA may provide a useful tool for diagnosing food allergy. Enhanced cell releasability may be linked to the severity of the clinical response to foods.

Serum sickness consists of a systemic reaction resulting from the formation of soluble circulating immunocomplexes after the introduction of a foreign substance into the body We studied a 38-year-old woman diagnosed with anxiety, depression and right sacroileitis who was treated with phenylbutazone, ranitidine, clomipramine and levomepromazine. After taking this treatment for 1 month, she presented with fever, diarrhea, localized edemas, generalized pruritic papular and erythematous rash and lymphadenopathies. She presented the same symptoms after oral intake of metamizole. The diagnosis was confirmed following a single-blind, placebo-controlled provocation test with phenylbutazone and a biopsy of the affected skin.

Schnitzler syndrome is a clinical entity of unknown etiopathogenesis and is an unusual cause of chronic urticaria. It is characterized by the presentation of a monoclonal band, especially IgM, as well as fever, asthenia and arthralgia. We present the case of a 48-year-old man with 5 years of recurrent urticarial lesions, slight itching, as well as lip, face and occasional pharyngeal edema. The patient had also suffered from fever and right hip and left knee arthralgia. The protein electrophoresis and the immunoelectrophoresis presented an IgG band and a slight lambda band, which is suggestive of a monoclonal gammopathy. The bone marrow examination showed a slight increase in the lymphoplasmatic cells. The marrow biopsy was negative. In order to rule out tumorous, infectious and rheumatic processes as well as collagen diseases, other complementary examinations were performed with negative results. The diagnosis of Schnitzler syndrome as a cause of chronic urticaria requires a thorough study in order to rule out other systemic processes provoking the same symptoms.

In the last years, latex has frequently been found to be involved in immediate hypersensitivity reactions. The first case mentioned with recurrent urticaria and laryngoedema was reported by Stern (1) in 1927. Since then, latex has also been implicated in generalized urticaria, rhinoconjunctivitis, asthma and anaphylaxis. Associated sensitization to several fruits is frequently seen in latex-allergic patients with the symptoms described above. This study was performed in seven patients (six females and one male) with hypersensitivity to latex and concomitant fruit sensitization. Six of them were healthcare personnel. The age of the patients ranged from 25-39 years, with a mean of 30 years. Prick tests and intracutaneous tests with latex (10% w/v in PBS), banana, chestnut, avocado, kiwi and melon were carried out. A specific histamine release test (HRT) was performed according to the fluorometric assay. Antigen-specific IgE was also performed. Latex CAP inhibition with banana and SDS-PAGE immunoblotting were carried out in one patient. Although in latex-allergic patients multiple sensitization to fruits may be observed, banana and avocado are those most frequently involved, followed by chestnut and melon. This is likely to be due to the presence of common antigens in these fruits and latex, as demonstrated in our study only for banana and avocado. We consider that further investigation is needed on the possible sensitization to latex in sanitary personnel reporting symptoms after fruit ingestion.

A 48-year-old male patient had arrest due to rupture of a dissecting aneurysm of the thoracic aorta into the pericardial cavity with tamponade; he received treatment in a general hospital lacking the facilities to practice heart surgery. The patient was treated by means of intermittent pericardial drainage while being transferred to another hospital at 100-km distance for surgical treatment.

In this study, we assessed the effect of antigen-specific stimulation on beta-adrenoceptors of human lymphocytes in order to study the beta-receptor atopy theory of Szentivanyi. Determination of these receptors was basically carried out as described by Brodde et al., utilizing [125I]-cyanopindolol as ligand in control and allergic patients before and after stimulation with specific antigen. We found that in vitro the specific antigen-antibody reaction induces a decrease in beta-adrenoceptors. This alteration takes place in patients with rhinitis and asthma with sensitization to Dermatophagoides and grass pollen, regardless of their baseline clinical status. Therefore, in view of the results, we question the validity of Szentivanyi's atopy theory. We hypothesize that the modification in the beta-adrenoceptor system is a consequence rather than the cause of the activity of atopic diseases.

Specific immunotherapy in pollen-allergic patients leads to a significant time-dependent decrease in the seasonal differences in IgE values, that is, the shorter the duration of immunotherapy, the smaller the difference. Immunotherapy leads to a maximum specific histamine release during the first year, with higher values during the pollen season. Later, the amount of histamine released from basophils decreases gradually in relation to the duration of immunotherapy and the clinical recovery, indicating that this would be a useful parameter in the follow-up of the efficacy of this type of treatment. Inversely, total histamine, which may be considered a parameter indicating the histamine stored in basophil granules, decreases significantly, reaching its lowest values at the end of the first year, with eventual recovery to initial values. From these results we may conclude that hyposensitizing treatment should not be interrupted before 3 years, since the immunological variations of the immediate hypersensitivity parameters take place during the first 2 years, and then stabilize. On the other hand, the correlation between the degree of recovery after hyposensitizing treatment and the duration of the treatment leads us to recommend immunotherapy for periods longer than 2 years.

Many authors have described an increase in total serum IgE values during the first few months of immunotherapy (IT), followed by a subsequent decrease. In previous studies in patients undergoing medium-term IT, we detected an IgE synthesis suppressor factor (SF), which was modified during the course of IT. In this study, we investigated the influence of long-term IT on the production of SF and the lymphocyte response to its stimulus. Mixed bidirectional cultures of lymphocytes isolated from healthy individuals (n = 62) and allergic patients (n = 98) were carried out after different periods of IT. The resulting supernatants were subjected to affinity chromatography, from which two fractions were obtained: the first one, likely to contain SF, was added to lymphocyte cultures from 13 allergic patients undergoing no IT (LyG1) and 6 allergic patients with > 3 years of IT (LyG5), in order to assess its inhibitory effect on IgE synthesis. We found that patients undergoing IT for > 3 years presented a significant increase in SF production and an important lymphocyte response to exogenous SF from most of the groups studied, but little response to their own SF. These results could be ascribed to an alteration in the quantity and/or structure of the lymphocyte receptors likely to be sensitive to these factors induced by IT.

In this study, we evaluated the evolution of IgG subclasses in the course of immunotherapy, and related this to the clinical evolution. We selected 226 adult patients with sensitivity to grass pollen alone, undergoing immunotherapy for 0-26 months. The following results may be highlighted: 1) IgG1 increased with immunotherapy and reached its peak at 6 months; 2) IgG2 increased significantly, reaching its peak after 24 months of treatment; 3) IgG3, however, did not present significant modifications in the course of immunotherapy; and 4) IgG4 was high in all patients undergoing immunotherapy compared to patients without hyposensitizing treatment, the peak being reached in the group of patients with the longest course of immunotherapy. Only IgG4 showed a positive and significant (p < 0.05) correlation with the degree of clinical recovery reached with immunotherapy.

The isotype-specific mechanisms involved in IgE synthesis are a sophisticated system about which very little is known. Several research groups have demonstrated that there is an enhancing factor (EF) in lymphocyte supernatants which is related to the regulation of the synthesis of IgE, and the influence medium-long-term immunotherapy (IT) exerts on it. Following this line of research, we studied the influence of long-term IT (> 3 years) and the presence of interleukin-4 (IL-4), not only in the different fractions where EF is contained, but also in lymphocyte supernatants after stimulation. Bidirectional mixed lymphocyte cultures were performed between lymphocytes from healthy controls (n = 62) and allergic patients (n = 98) after different periods of IT. The supernatants obtained were submitted to affinity chromatography and the second fractions, containing EF, were added to healthy control lymphocytes (n = 11) in order to test their enhancing effect on IgE synthesis. Modifications in EF production were observed, depending on the duration of IT. There were no detectable levels of IL-4 either in EF fractions or supernatants from stimulated lymphocytes.

We studied IgG subclasses in pollinosis in order to determine the possible immunopathological role of these antibodies, especially antigen-specific IgG4. The selection of pollinosic patients allowed us to observe the influence natural antigenic exposure exerts upon antibodies. On the other hand, we intended to study the possible modifications immunotherapy produces on IgG subclasses. For this purpose, we selected 266 patients who were classified into the following groups: Group I, 65 patients without immunotherapy, 35 of whom were studied during the pollen season and 30 outside the pollen season; Group II, 40 nonpollinosic patients with hypersensitization to Dermatophagoides pteronyssinus were taken as atopic controls; Group III, 161 pollinosic patients with from 3 to 42 months of immunotherapy. For every patient, IgG1, IgG2 and IgG3 against Phleum pratense were determined by means of ELAST (Leti), and IgG4 against the same allergen by means of the ELISA technique developed by us. Our results confirm, first, that untreated pollinosic patients present higher concentrations of IgG4 against Phleum than nonpollinosic patients, and second, that immunotherapy produces significant modifications in the production of antigen-specific IgG.

We studied the histories of patients who had visited our Department during the last 5 years, presenting food allergy with exclusively respiratory symptoms (18.5%). We studied the correlation between IgE levels and the histamine release test and the type of food implicated. Seventy-seven percent of patients presented sensitization to one food, and 23% presented polysensitization. We found that foods such as snails and eggs have a strong predilection for the bronchial tree as the shock organ. High total IgE was found in 85.2% of patients. The histamine release test was positive in 66% of cases. We conclude that this is a highly sensitive method for the in vitro diagnosis of food allergy.

Transvenous traction for the removal of retained pacemaker electrodes is common practice with few reported complications. This case reports a patient with a DDD pacemaker with extruded electrodes, who died of a myocardial rupture at the atrial lead site after prolonged (i.e., after 24 hours) traction was applied.

One hundred and fifty-six pollen-sensitive patients with sensitization to grass pollen only were chosen for this study; 65 patients were allergic to Dermatophagoides, while 45 were non-allergic subjects with no atopic history. The following tests were carried out on all patients: histamine release of total blood, basal histamine, total histamine, determination of total IgE and specific IgE (RAST) serum levels, serum hemagglutinating antibodies and skin tests. Seasonal increase of IgE was observed, with post-seasonal fall; 50% of the cases reached normal values. However, RAST as a semiquantitative method did not prove to be useful in the detection of variations in specific IgE levels. During pollination, an increase in titers in pollen-sensitive subjects was seen. This was attributed to a humoral immune response epiphenomenon which was independent of IgE. The histamine release test was significantly greater during pollination in pollen-sensitive subjects. The total of stored histamine increased during the months of allergenic exposure.