Subclinical form of the American visceral leishmaniasis

The subclinical form of visceral leishmaniasis (VL) shows nonspecific clinical manifestations, with difficulties being frequently met in its clinical characterization and diagnostic confirmation. Thus, the objective of the present study was to define the clinical-laboratory profile of this clinical form. A cohort study was conducted in the state of Maranhão, Brazil, from January/1998 to December/2000, with monthly follow-up of 784 children aged 0-5 years. Based on the clinical-laboratory parameters reported in the literature, four categories were established, with the children being classified (according to their clinical-evolutive behavior) as asymptomatic (N = 144), as having the subclinical form (N = 33) or the acute form (N = 12) or as subjects "without VL" (N = 595). Multiple discriminant analysis demonstrated that the combination of fever, hepatomegaly, hyperglobulinemia, and increased blood sedimentation rate (BSR) can predict the subclinical form of VL as long as it is not associated with splenomegaly or leukopenia. Subjects with the subclinical form did not show prolonged or intermittent evolution or progression to the acute form of VL. Subclinical cases have a profile differing from the remaining clinical forms of VL, being best characterized by the combination of fever, hepatomegaly, hyperglobulinemia, and increased BSR.

Le myélome à chaînes légères ou les pièges du diagnostic du myélome [Light chain myeloma or the pitfalls of myeloma diagnosis]

The diagnosis of multiple myeloma is often suggested by disturbances found in routine laboratory tests such as sedimentation rate, electrophoresis of serum proteins and search for proteinuria. In light chain myeloma these tests are nonspecific and therefore misleading. We present 8 cases of light chain myeloma and discuss the diagnosis of multiple myeloma with its associated pitfalls.

Discriminating irritable bowel syndrome from inflammatory bowel disease: what is the role of biomarkers in daily practice?

Background and Aims: Discriminating irritable bowel syndrome (IBS) from inflammatorybowel disease (IBD) can be a clinical challenge as symptoms can overlap. We and othershave recently shown that fecal calprotectin (FC) is more accurate for discriminating IBSfrom IBD compared to C-reactive protein (CRP) and blood leukocytes. Data on the biomarkersused in daily gastroenterological practice are lacking. We therefore aimed to assess whichbiomarkers are used by gastroenterologists in their daily practice for discriminating IBSfrom IBD.Methods: A questionnaire was sent to all board certified gastroenterologists inSwitzerland focusing on demographic informations, number of IBS patients treated in thetime period from May 2009 to April 2010, and the specific biomarkers evaluated fordiscriminating IBS from IBD.Results: Response rate was 57% (153/270). Mean physician'sage was 50±9years, mean duration of gastroenterologic practice 14±8years, 52% of themwere working in private practice and 48% in hospitals. Thirty-nine percent had taken careof more than 100 IBS patients in the last 12 months, 37% had seen 41-100 and 24% hadseen 1-40 IBS patients. Gastroenterologists in private practice more frequently took care ofat least 40 IBS patients in a year compared to hospital-based gastroenterologists (P<0.001).The following biomarkers were determined for discriminating IBS from IBD: CRP 100%,FC 79%, hematogram (red blood cells and leukocytes) 70%, iron status (ferritin, transferrinsaturation) 59%, erythrocyte sedimentation rate 2.7%, protein electrophoresis 0.7%, andalpha-1 antitrypsin clearance 0.7%. There was a trend for using FC more often in privatepractice than in hospital (P = 0.08). Twenty-four percent of gastroenterologists had usedFC in the workup of more than 70% of patients classified as IBS, 22% had used FC in 30-70% of IBS patients, 39% in less than 30%, and 15% had never used FC for the work-upof suspected IBS. Eighty-nine percent of gastroenterologists considered FC to be superiorto CRP for discriminating IBS from IBD, 87% thought that patient's compliance for fecalsampling is high, and 51% judged the fee of USD 60 for a FC test as appropriate.Conclusions:FC is widely used in clinical practice to discriminate IBS from IBD. In accordance with thescientific evidence, the majority of gastroenterologists consider FC to be more accurate thanCRP for discriminating IBS from IBD. Gastroenterologists in private practice take care ofsignificantly more IBS patients than colleagues in hospital.

Estabilitat i diagènesis dels fitòlits de silici en els jaciments arqueològics

Estudi realitzat a partir d’una estada al Kimmel Center for Archaeological Research, Israel, entre 2010 i 2012. Els fitòlits són un dels components principals dels sediments arqueològics. Són relativament estables i menys propensos a la degradació biològica que altres restes vegetals, però també poden ser afectats per la diagènesis. Per entendre com la diagènesis afecta als fitòlits hem desenvolupat una aproximació experimental utilitzant solucions alcalines per determinar l’estabilitat individual de fitòlits fòssils i moderns. L’experimentació ha estat completada amb un estudi de camp a Izbet Sartah. Els resultats mostren com la diagènesis canvia la composició dels conjunts de fitòlits, i per tant afecta la interpretació arqueològica. Conseqüentment, hem desenvolupat un mètode per determinar l’estat de preservació dels fitòlits en els jaciments arqueològics. L’experimentació mostra com els fitòlits moderns són més solubles que els fitòlits fòssils. Tant els fitòlits fòssils com els moderns són menys estables si són cremats. No totes les morfologies es preserven igual, indicant així que hi ha unes morfologies més estables que unes altres. Els fitòlits amb decoracions delicades, especialment aquells formats a la inflorescència de gramínies, són més propensos a la dissolució que els de les fulles. L’avaluació de l’estat de preservació dels fitòlits en jaciments arqueològics es pot realitzar utilitzant un conjunt de tècniques com ara: l’Index de Variació de Fitòlits, el mètode de dissolució ràpida, la identificació de morfologies delicades i la utilització del FTIR. Proposem que la diagènesis dels fitòlits depèn directament de la quantitat inicial de fitòlits en els sediments, la velocitat de sedimentació, i la presència o absència de fitòlits i plantes modernes en l’àrea estudiada. Els resultats d’aquesta investigació han estat publicats en dos articles afegits al final de l’informe (Cabanes et al., 2011 i Cabanes et al., in press), presentats en congressos internacionals i utilitzats indirectament en altres investigacions.

Sedimentos superficiales y morfología de la plataforma y talud continental superior entre 3°30’S y 15°30’S, Perú

Basados en la compilación de resultados de análisis sedimentológicos (granulometría, contenido orgánico) de 1191 estaciones realizadas por IMARPE, de 1975 a 2001, la compilación de información sobre el tema entre los 3°30’S y los 15°30’S y con el conocimiento de la morfología del fondo marino de esta región, se definen tres grandes áreas: al norte de los 6°15’S, de 6°15’S a 9°30’S y entre 9°30’ y 15°30’S. Entre los 3°30’ y los 6°15’S los contenidos de materia orgánica son mayores a 5% y menores a 10%, el carbono orgánico predomina con valores <1% a 2%. Los sedimentos corresponden a facies de fango y arenas, de origen terrígeno. El ancho de la plataforma es variable aproximadamente de 3 a 30 mn (14 mn promedio), la pendiente del talud superior es bastante pronunciada, presenta caídas bruscas. El relieve es disparejo, con fuertes desmembramientos en el borde exterior de la plataforma y el talud superior debido a que se encuentra surcado por cañones submarinos. En el extremo noroccidental de esta zona, se halla el Banco de Máncora cuyo fondo es rocoso e irregular. Entre los 6°30’S y los 9°30’S los contenidos de materia orgánica se incrementan de 5% a 15%, los contenidos de carbono orgánico son >2% y llegan a 5%, en algunos casos localmente superan este valor casi en tres puntos más. En los sedimentos del sector norte de esta zona predominan facies texturales de arenas y fango de origen terrígeno y también biógenos (foraminíferos), hacia el sur de esta zona predominan sedimentos de origen biogénico y autigénico (principalmente fosforita). El ancho de la plataforma se incrementa hasta alcanzar su máxima magnitud, esta es variable, aproximadamente de 22 a 70 mn. El talud superior tiene un declive moderado. El relieve del fondo marino en el borde exterior de la plataforma y talud superior se hallan surcados por cañones submarinos (7° - 9°S). Frente a Punta Chao aproximadamente a 65 mn se encuentra el Banco de Chimbote cuyo fondo es rocoso e irregular. La granulometría de los sedimentos y sus estadígrafos muestran un cambio definido desde los 10°30’S. Desde los 9°30’ a los 15°45’S los valores de materia orgánica por lo general sobrepasan el 15% y pueden alcanzar hasta 32,12%, los contenidos de carbono orgánico varían de 5% a 11,14%. En esta zona se encuentra presente, principalmente fango limoso y fango arcilloso terrígeno y biógeno (diatoméico). El ancho de la plataforma varía de modo general entre 10 y 50 mn (24 mn promedio aproximadamente). La pendiente del talud superior es suave en casi toda su extensión, el relieve del fondo marino es bastante uniforme, surcado por algunos pequeños cañones submarinos que no afectan la regularidad del relieve. De la interpretación de la data, análisis de parámetros estadísticos generados y condiciones de los sedimentos, se encontró coincidencia en la zona de la plataforma y talud superior de más de uno de los factores medio ambiente deposicional que permiten la preservación del contenido de materia orgánica tales como: Tipo y condiciones geoquímicas del sedimento y fondo marino, morfología del fondo marino, hidrodinámica, fuente de suministro, tasa de sedimentación, bioturbación.

Monitoring inflammatory bowel disease activity: clinical activity is judged to be more relevant than endoscopic severity or biomarkers.

BACKGROUND: There is increasing evidence for the clinical relevance of mucosal healing (MH) as therapeutic treatment goal in inflammatory bowel disease (IBD). We aimed to investigate by which method gastroenterologists monitor IBD activity in daily practice. METHODS: A questionnaire was sent to all board-certified gastroenterologists in Switzerland to specifically address their strategy to monitor IBD between May 2009 and April 2010. RESULTS: The response rate was 57% (153/270). Fifty-two percent of gastroenterologists worked in private practice and 48% worked in hospitals. Seventy-eight percent judged clinical activity to be the most relevant criterion for monitoring IBD activity, 15% chose endoscopic severity, and 7% chose biomarkers. Seventy percent of gastroenterologists based their therapeutic decisions on clinical activity, 24% on endoscopic severity, and 6% on biomarkers. The following biomarkers were used for IBD activity monitoring: CRP, 94%; differential blood count, 78%; fecal calprotectin (FC), 74%; iron status, 63%; blood sedimentation rate, 3%; protein electrophoresis, 0.7%; fecal neutrophils, 0.7%; and vitamin B12, 0.7%. Gastroenterologists in hospitals and those with ≤ 10 years of professional experience used FC more frequently compared with colleagues in private practice (P=0.035) and those with > 10 years of experience (P<0.001). CONCLUSIONS: Clinical activity is judged to be more relevant for monitoring IBD activity and guiding therapeutic decisions than endoscopic severity and biomarkers. As such, the accumulating scientific evidence on the clinical impact of mucosal healing does not yet seem to influence the management of IBD in daily gastroenterologic practice.

Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.

Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score ¿¿2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.

Syndrome de Cogan : à propos d'un cas et brève revue de la littérature [Cogan's Syndrome]

We report the case of a 20-year-old woman, with no medical history, who in a short period of time developed the association of a bilateral vestibulocochlear deficit and a nonsyphilitic interstitial keratitis, the usual clinical presentation of Cogan's syndrome. This rare disease was named after David Cogan, the ophthalmologist to whom we owe the description of the first series of cases. The precise aetiology of Cogan's syndrome has yet to be defined, but clinical and biological evidence point toward an immunopathological process. Some authors distinguish between a typical and an atypical form of Cogan's syndrome, the former being associated with interstitial keratitis, the latter with other forms of ocular involvement. The diagnosis of Cogan's syndrome is mainly a clinical one, the association of a bilateral vestibulocochlear deficit and a non-syphilitic keratitis being almost specific. Cogan's syndrome is frequently associated with general signs and cardiovascular, neurological, rheumathological and digestive involvement. Laboratory data usually show nonspecific inflammatory signs (elevation of the white cell count and of the erythrocyte sedimentation rate). The mortality of the disease is essentially determined by its cardiovascular involvement, mostly aortic insufficiency, which should therefore actively be sought for in every patient. It is useful to emphasise that the typical form of Cogan's syndrome carries a higher risk regarding the development of aortic insufficiency, whereas the atypical form is more often associated with a systemic vasculitis. Treatment is mandatory, based upon corticosteroids, and must sometimes be intensified by the administration of a steroid-sparing immunosuppressive drug. Although our patient perfectly met the diagnostic criteria of Cogan's syndrome, the vestibular symptoms preceded the visual complaints, the reverse temporal sequence being more often reported in the literature. Systemic signs and cardiovascular involvement are frequently seen in Cogan's syndrome, but were notably absent in our patient. Blood samples showed inflammatory signs, whereas both lumbar puncture and cerebral MRI were normal, which is the usual pattern encountered in Cogan's syndrome. Following the rapid initiation of immunosuppressive therapy (Prednisone), the visual symptoms due to the bilateral keratitis resolved in a matter of days, whereas the vestibulocochlear deficit was only partly - but dramatically - reduced. This is in accordance with literature data, showing that a severe and permanent auditory deficit occurs at some time in the majority of patients suffering from Cogan's syndrome. Tapering off Prednisone unfortunately reactivated the audiovestibular and ocular symptoms of the disease in our patient so that a steroid-sparing immunosuppressive drug had to be added (azathioprine, followed by mycophenolate mofetil because the patient developed hepatic intolerance). Only after these therapeutic measures could the disease be stabilised. With this case report, we would like to emphasise the importance of rapidly identifying the clinical picture of Cogan's syndrome, so that immunosuppressive therapy can be started without delay, which may significantly reduce both morbidity and mortality of this disease.

La fibrose rétropéritonéale, une maladie inflammatoire méconnue. Observations cliniques et revue de la littérature [Retroperitoneal fibrosis, an unrecognized inflammatory disease. Clinical observations and review of the literature]

Retroperitoneal fibrosis (RF) is a rare disease, typically with an insidious clinical course. The peak incidence is seen in patients 40 to 60 years of age and mostly in man. The characteristic finding in this disease is a periaortic fibrous mass that often surrounds the ureters. Although usually regarded as an obstructive uropathy, there has been growing recognition of the condition as a generalized disease. It may have a wide variety of manifestations including mediastinitis, thyroiditis and sclerosing cholangitis. The most common mode of presentation remains abdominal or flank pain with uremia, anemia and a high sedimentation rate. Although ultrasound and renal scintigraphy may contribute to the general evaluation of patients with RF, CT-scanner is the preferred imaging method. The multiplanar imaging capability of magnetic resonance may facilitate assessment of disease extent. The pathogenesis of the disease remains unknown. Steroids and, more recently tamoxifen, appear to be effective in the treatment of the RF. In most instances, RF does not lead to long-term morbidity or affect survival. The three cases of RF reported herein illustrate the varied mode of presentation and the response to the treatment.

Prospective study on procalcitonin and other systemic infection markers in patients with leukocytosis.

OBJECTIVE: To better assess the diagnosis of an infection in patients presenting at an emergency department with peripheral blood leukocytosis (>10 x 10(9) cells/l) on laboratory testing. METHODS: We prospectively evaluated serum procalcitonin concentration (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Patients were divided into two groups according to their final diagnosis: patients with infection and those without infection. PCT, CRP, and ESR were compared between these groups. Sensitivity, specificity, positive predictive values, negative predictive values, receiver operating characteristic curves, and areas under the curves were calculated for each biological measurement. RESULTS: Out of 173 patients, 99 (57%) had a final diagnosis of systemic infection. If a cutoff point of 0.5 ng/ml is considered, procalcitonin concentration had a sensitivity of 0.57, a specificity of 0.85, a negative predictive value of 0.59, and a positive predictive value of 0.84 for the diagnosis of a systemic infection. Adding CRP or ESR to PCT gave no more information (p=0.84). CONCLUSIONS: Only about half of the patients attending the emergency department with leukocytosis were suffering from an infection. Determination of the procalcitonin level may be useful for these patients, particularly in the case of a value higher than 0.5 ng/ml.

Parésie trochléaire transitoire comme signe neurologique inaugural d'une panartérite noueuse [Transient trochlear nerve palsy as the presenting neurological sign of panarteritis nodosa]

INTRODUCTION: Panarteritis nodosa (PAN) is a systemic vasculitis affecting small and medium-sized arteries. Neuro-ophthalmological complications of PAN are rare but numerous, and may affect the eye, the visual and the oculomotor pathways. Such complications occur mainly in patients previously diagnosed with PAN. OBSERVATION: A 51-year-old woman presented with an isolated right trochlear (IV) palsy, in the setting of headaches and fluctuating fever of unknown etiology. Erythrocyte sedimentation rate was 13 mm and full blood cell count was normal. Previous chest X-ray and blood studies were negative for an infection or inflammation. Orbital and cerebral CT scan was normal. Spontaneous recovery of diplopia ensued over four days. Two days later, paresthesia and sensory paresis of the dorsal portion of the left foot were present. Lumbar puncture revealed 14 leucocytes (76 percent lymphocytes) with elevated proteins, but blood studies and serologies were negative. A diagnosis of undetermined meningo-myelo-radiculoneuritis was made. Because of a possible tick bite six weeks previously the patient was empirically treated with 2 g intravenous ceftriaxone for 3 weeks. Fever rapidly dropped. Six weeks after the onset of diplopia, acute onset of blindness in her right eye, diffuse arthralgias and fever motivated a new hospitalization. There was a central retinal artery occlusion of the right eye. Blood studies now revealed signs of systemic inflammation (ESR 30 mm, CRP 12 mg/L, ANA 1/80, pANCA 1/40, leucocytosis 12.4 G/L, Hb 111 g/L, Ht 33 percent). Biopsy of the left sural nerve revealed arterial fibrinoid necrosis. A diagnosis of PAN was made. CONCLUSIONS: Transient diplopia can be the heralding symptom of a systemic vasculitis such as PAN, giant cell arteritis and Wegener granulomatosis. In this patient the presence of accompanying systemic symptoms raised a suspicion of systemic inflammation, but the absence of serologic and imaging abnormalities precluded a specific diagnosis initially. A few weeks later, the presence of a second ischemic event (retinal) and positive blood studies led to a further diagnostic procedure. Oculomotor and abducens palsies have rarely been reported in association with PAN. We report the first case of trochlear nerve paresis as the inaugural neurological sign of PAN. This case highlights the importance of considering inflammatory systemic disorders in patients with acute diplopia particularly when they are young, lack vascular risk factors or cause, and complain of associated systemic symptoms.

Giant cell arteritis: A rare cause of posterior vasculitis.

PURPOSE: To report three cases of posterior vasculitis associated with subacute giant cell arteritis (GCA). METHODS: Three patients with decreased vision underwent complete ophthalmologic examination and fluorescein angiography. RESULTS: All patients presented posterior vasculitis. Patient 1 had an erythrocyte sedimentation rate (ESR) of 38 mm/hr and a C-reactive protein (CRP) of 28mg/L. Patient 2 and 3 had an ESR of 104 and 95 mm/hr and a CRP of 42 and 195 mg/L accordingly. Diagnosis was established by temporal artery biopsy. Resolution was observed after systemic prednisolone therapy. CONCLUSION: GCA should be suspected when posterior vasculitis and relatively high ESR and CRP are present.

Recent human-induced trophic change in the large and deep perialpine Lake Lucerne (Switzerland) compared to historical geochemical variations

This study investigates the sedimentological and geochemical changes that occurred during the last 2200 years in the meromictic Lake Lucerne (Switzerland), one of the largest freshwater lakes of Central Europe. The stable isotope composition (delta C-13 and delta O-18 values) of bulk carbonates is compared to changes in grain-size distribution (clay and silt fraction), natural trace element input (titanium and thorium concentrations), and organic material abundance (C-org, nitrogen and phosphorus) and composition (C/N ratios and hydrogen and oxygen indexes). A drop in carbonate accumulation and in the delta O-18 values of sediments between ca. AD 500 and 700 followed a large and consistent rise in chemical weathering, marked by increases in the silicate-clay fraction and in crustal element concentrations. During the following millennium, there was a long-term decreasing trend in the lithogenic trace element input and in the phosphorus loading, suggesting decreasing terrigeneous input from runoff water. The major sedimentological change over the studied period occurred after ca. AD 1800 with a significant increase in the erosion-driven silt-fraction and in the sedimentation rate. During the last century, human-induced increase in nutrient input to the lake highly enhanced the accumulation of organic matter in sediment. Changes in nutrients and oxygen conditions in the hypolimnion of Lake Lucerne during the eutrophication period (i.e., the last 40 years) highly modified the geochemical fluxes compared to the relatively stable oligotrophic conditions that prevailed during the previous 2000 years. Before the 19th century, climate driven meromixis had a limited impact on the organic matter flux to the sediments, but the accumulation of carbonate considerably decreased during periods of lower mechanical erosion rates and high chemical weathering rates. (C) 2012 Elsevier B.V. All rights reserved.

What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series.

PURPOSE: Controversy still exists as to the best surgical treatment for periprosthetic shoulder infections. The aim of this multi-institutional study was to review a continuous retrospective series of patients treated in four European centres and to assess the respective eradication rate of various treatment approaches. METHODS: Forty-four patients were available for this retrospective follow-up evaluation. Functional and clinical evaluation of treatment for infection was performed using the Constant-Murley score, visual analogue scale and patient satisfaction Neer score. Erythrocyte sedimentation rate, serum leucocyte count and C-reactive protein were measured and shoulder X-ray examination performed prior to surgery and at the latest follow-up. RESULTS: At a mean follow-up of 41 months (range 24-98), 42 of 44 patients (95.5%) showed no signs of infection recurrence/persistence. Comparable eradication rates were observed after resection arthroplasty (100%; 6/6), two-stage revision (17/17) or permanent antibiotic-loaded spacer implant (93.3%; 14/15). No patient was treated by one-stage revision. On average, both functional and pain scores improved significantly; the worst joint function was observed after resection arthroplasty. CONCLUSIONS: This retrospective analysis conducted on the largest published series of patients to date shows comparable infection eradication rates after two-stage revision, resection arthroplasty or permanent spacer implant for the treatment of septic shoulder prosthesis.

Magnetoestratigrafía de las sucesiones del Mioceno medio y superior del Vallés occidental (Depresión del Vallés-Penedés, NE España): Implicaciones biocronológicas y cronoestratigráficas.

The magnetostratigraphic analysis of the middle to late Miocene continental deposits from the Valles-Penedes basin, combined with its well-documented fossil mammal record, provides a well-resoluted chronology for the upper basin infill. It is based on the biostratigraphic and magnetostratigraphic cross-correlation of 18 sections throughout the alluvial and transitional/shallow marine sequences in the Western Valles area. The biostratigraphic framework consists of 24 mammal localities of upper Aragonian and Vallesian age. Correlation of the studied sections to the geomagnetic polarity time scale (GPTS) is based on the distinctive pattern of local magnetozones, as well as the radiometric age of the late Vallesian fauna from the Bicorp Basin (9.6 + 0.3 Ma) and the known relationship of the late Vallesian assemblages with marine beds belonging to the planktonic forarninifera N16 zone. It has led to an absolute dating of the fauna1 events and a precise chronostratigraphy of the Vallesian marnrnal stage in its type area. The Hipparion First Appearance Datum (FAD) defines the lower Vallesian boundary and is dated at 11.1 Ma, at the base of chron C5r. ln. It is in good agreement with radiometric ages from the early Hipparion bearing sites in the Vienna Basin (1 1.1 * 0.5 Ma) and the classic Howenegg locality in Germany (10.8 * 0.3 Ma). It also agrees with the age of the turkish localities of Yailacilar (1 1.6 + 0.25 Ma) and Yenieskihisar-2 (1 1.1 * 0.2 Ma) with absence of Hipparion. Al1 these support the isochrony of the dispersa1 of Hipparion throughout the Mediterranean region. A possible isochrony at a larger geographical scale (Old World, Mesogea) must await more reliable ages of the Hipparion FAD in Asia and Africa. The Cricetulodon FAD that defines the MN9a/MN9b boundary occurs at the middle part of C5n. Assuming an on average constant sedimentation rate, this datum has an age of approximately 10.4 Ma. The earlyllate Vallesian boundary is marked by one of the most distinct fauna1 events of the late Neogene: the dispersa1 of the muridae Progonomys into Europe and North Africa, which coincides with an important macromarnmal turnover. The first extensive appearance of Progonomys in Europe (MN9íMN10 boundary) is dated at 9.7 Ma (C4Ar3r), showing a remarkable diachrony with the Himalayan region. F9i d lly, the FAD of Rotundomys bressnnus occurs in the upper part of C4Ar.ln (9.2-9.3 Ma). The Vallesian spans 2.4 Myr, from 11.1 Ma (CSr.ln) to 8.7 Ma (C4An), and correlates to the early Tortonian.