ObjectivesTo review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection.DesignA search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.”SettingOnly papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included.SampleWe included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine-related neurological events from our neurological care center, arising during the period of study, were also included.Main outcome measuresDemographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection.ResultsThe retrieved cases were divided into two groups: the post-vaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain-Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed.ConclusionsFatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post-vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long-term clinical and imaging follow-up of infection and post-vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.

Background: Ependymoma is a tumor that formed from the ependyma. Usually, in paediatric cases the location is intracranial, while in adults it is spinal. Methods: We study the prognostic implications of the current grading system, of histological and immunohistochemical features of GFAP, GFAP-δ, EMA, neurofilament and E-cadherin expression and Ki-67 in ependymomas. Results: 60 cases were included in this study of which 32 were female and 28 were male, aging ranged from 18 to 65 years old (mean age of 34.18±11.35 yr). 17 were supratentorial, 25 infratentorial and 18 cases were spinal location. Histologically 15 were grade 1, 36 were grade II and 9 grade III. 23 cases recurrence (4, 13 and 6 stage III respectively), with mean age 34.52±12.23 years vs 33.97±97.94 that not recurrence. The expression of GFAP-δ was negative in 38 cases and positive in 21(p=0.359). GFAP-δ expression was correlated with anaplastic type (grade III). Tumor grade and tumor size, brain invasion, atypia, and mitosis features and also were correlated with higher expression of neurofilament, higher ki-67-Li, as well as loss of immnunoexpression of E-Cadherina and EMA. Conclusions: PGAF, S-100, and GFAP-δ expression in ependymomas varied and depends of the histologic grade likewise the value of proliferation index. The expression of GFAP-δ was in directly relationship with presence of neurofilament and loss of E-Cadherins and EMA expression. Studies have suggested that human ependimomas arise from regionally distinct populations of radial glial cells.

Rojas L, et al. Síndrome de fuga aérea torácica por enfermedad de injerto contra huésped posterior a trasplante alogénico de médula ósea.