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Antecedentes: La púrpura trombocitopénica inmune es un trastorno autoinmune caracterizado por un descenso de la cifra de plaquetas acompañado habitualmente de diátesis hemorrágica. Las formas crónicas son aquellas en las que la trombocitopenia persiste a los 6 meses del diagnóstico y las formas recurrentes son las que, tras un período de normalidad, experimentan un descenso en la cifra de plaquetas Objetivos: Valorar la evolución, así como la respuesta al tratamiento, de los pacientes afectados de púrpura trombocitopénica inmune crónica persistente y recurrente Métodos: Estudio retrospectivo y descriptivo de los pacientes asistidos en consultas externas en un período de 3 años, desde enero de 1999 hasta diciembre de 2001 Resultados: De 38 pacientes afectados de púrpura trombocitopénica inmune crónica, 16 (42 %) correspondieron a formas crónicas y 22 (58 %) se consideraron formas recurrentes. No se encontraron diferencias significativas entre ambos grupos en cuanto a sexo, edad al diagnóstico, tiempo de seguimiento, infección viral previa, así como presencia de anticuerpos antiplaquetarios. En las formas recurrentes, el tratamiento médico más eficaz fue la gammaglobulina por vía intravenosa (77 % de respuestas favorables), pero la duración de la respuesta fue corta (media, 22,1 semanas). El 63 % de las formas crónicas persistentes obtuvieron una remisión completa mediante esplenectomía. Seis pacientes de ambos grupos, tratados con gammaglobulina anti-D, obtuvieron resultados favorables. El 4,5 % de las formas recurrentes y el 31,5 % de las persistentes remitieron de forma espontánea durante el período de estudio Conclusiones: Con los resultados obtenidos y en nuestra experiencia, el tratamiento más eficaz en las formas recurrentes fue la gammaglobulina intravenosa, pero ningún tratamiento consiguió respuestas duraderas a largo plazo. En las formas persistentes la esplenectomía sería una alternativa eficaz en situaciones de riesgo hemorrágico, mientras que una conducta expectante parece la mejor opción cuando éste no exista. Aunque el número de pacientes tratados es limitado es de señalar el elevado número de respuestas favorables obtenidas con la gammaglobulina anti-D : Background: Immune thrombocytopenic purpura (ITP) is characterized by a drop in platelet count usually accompanied by hemorrhagic diathesis. In chronic forms the platelet count remains low for six months after diagnosis and in recurrent forms the drop in platelet count appears after a period of normality Objectives: To asses outcome and treatment response in patients with chronic or recurrent ITP Methods: We performed a retrospective, descriptive study of patients attended in the pediatric hematology outpatient clinic between January 1999 and December 2001 Results: Of 38 patients with chronic ITP, 16 (42 %) presented chronic forms and 22 (58%) presented recurrent forms. No significant differences were found between the two groups in age, sex, diagnosis, duration of follow-up, previous viral infection, or antiplatelet antibodies. In recurrent forms, the most effective treatment was intravenous immune gamma-globulin (77 % favorable responses) but response time was short (mean: 22.1 weeks). Splenectomy produced complete remission in 63 % of the chronic forms. Good results were obtained in six patients from both groups treated with intravenous anti-D immune globulin. During the study period, 4.5% of patients with recurrent forms and 31.5% of those with chronic forms showed spontaneous remission without treatment Conclusions: In our experience, the most effective treatment for recurrent forms of ITP was intravenous immune globulin, but none of the treatments achieved long-term responses. In chronic forms, splenectomy is an effective alternative when the risk of hemorrhage is high, while a watchful attitude seems to be the best option when this risk is absent. Although the number of patients treated with intravenous anti-D immune globulin was low, good results were achieved

El seudoquiste pulmonar traumático es una complicación poco frecuente que se presenta después de un tratamiento torácico cerrado. Está producido por fuerzas de estallido o cizallamiento generadas por el impacto sobre una caja torácica elástica.Presentamos el caso de un adolescente de 14 años que, tras un accidente de motocicleta presentó un seudoquiste pulmonar traumático único localizado en hemitórax derecho con una evolución favorable. El antecedente traumático acompañado de la radiología, así como la tendencia a la resolución espontánea nos orientan hacia el diagnóstico de esta entidad y nos permite adoptar una actitud conservadora en la mayoría de los casos pediátricos. El reconocimiento de esta entidad poco frecuente, evitaría procedimientos diagnósticos y terapéuticos innecesarios. : Traumatic pulmonary pseudocyst is an unusual complication that appears after a closed thoracic trauma. It is produced as a consequence of outburst and shear forces released by the impact on the elastic thoracic wall.We present a 14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary pseudocyst, isolated on the right hemithorax. The patient's evolution was good. The antecedent of trauma, together with radiological examination and the tendency toward spontaneous resolution, suggested the diagnosis as well as the advisability of a conservative approach in most pediatric cases. Recognition of this unusual disorder would help to avoid unnecessary diagnostic and therapeutic procedures.

Immune thrombocytopenic purpura (ITP) is characterized by a drop in platelet count usually accompanied by hemorrhagic diathesis. In chronic forms the platelet count remains low for six months after diagnosis and in recurrent forms the drop in platelet count appears after a period of normality.To asses outcome and treatment response in patients with chronic or recurrent ITP.We performed a retrospective, descriptive study of patients attended in the pediatric hematology outpatient clinic between January 1999 and December 2001.Of 38 patients with chronic ITP, 16 (42 %) presented chronic forms and 22 (58 %) presented recurrent forms. No significant differences were found between the two groups in age, sex, diagnosis, duration of follow-up, previous viral infection, or antiplatelet antibodies. In recurrent forms, the most effective treatment was intravenous immune gamma-globulin (77 % favorable responses) but response time was short (mean: 22.1 weeks). Splenectomy produced complete remission in 63 % of the chronic forms. Good results were obtained in six patients from both groups treated with intravenous anti-D immune globulin. During the study period, 4.5 % of patients with recurrent forms and 31.5 % of those with chronic forms showed spontaneous remission without treatment.In our experience, the most effective treatment for recurrent forms of ITP was intravenous immune globulin, but none of the treatments achieved long-term responses. In chronic forms, splenectomy is an effective alternative when the risk of hemorrhage is high, while a watchful attitude seems to be the best option when this risk is absent. Although the number of patients treated with intravenous anti-D immune globulin was low, good results were achieved.

Traumatic pulmonary pseudocyst is an unusual complication that appears after a closed thoracic trauma. It is produced as a consequence of outburst and shear forces released by the impact on the elastic thoracic wall. We present a 14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary pseudocyst, isolated on the right hemithorax. The patient's evolution was good. The antecedent of trauma, together with radiological examination and the tendency toward spontaneous resolution, suggested the diagnosis as well as the advisability of a conservative approach in most pediatric cases. Recognition of this unusual disorder would help to avoid unnecessary diagnostic and therapeutic procedures.

OBSERVACION CLINICA Nina de 9 anos de edad con tumoracion en el brazo derecho de 9 meses de evolucion que iba aumentando. Exploracion fisica. Buen estado general. Afebril. Sin lesiones cutaneas. Se aprecia una masa dura, indolora, adherida a planos profundos en la cara anterointerna de la diafisis humeral derecha a nivel del tercio medio. No se palpan adenopatias. El resto de la exploracion fisica es normal. Exploraciones complementarias. Hemograma, proteina C reactiva (PCR), VSG, ionograma, funcionalismo hepatico y renal dentro de la normalidad; hemocultivo y prueba de tuberculina a las 72 h, negativos; radiografia de torax, normal; serie esqueletica, normal; serologia a Salmonella y Brucella, negativas; radiografia simple, en dos proyecciones, del brazo derecho (figs. 1A y B), y ecografia bidimensional de la lesion (fig. 2).

A case of communicating hydrocephalus with excessive amount of choroid plexus confirmed by computerized tomography scan in a five-year-old girl is reported. The child exhibited hypovolemic shock and cerebrospinal fluid (CSF) ascites after ventriculo-peritoneal shunting and relief after ventriculoatrial shunting. Some features suggest overproduction of CSF, with the so-called "third-space" fluid losses, due to sequestration of fluids in the body (peritoneum) that might explain shock. They review 22 cases of CSF ascites reported in the literature.

Here we review nine cases of children with herpetic encephalitis (EH) admitted to the "San Juan de Dios" Hospital in Barcelona from 1976 to 1983. Of particular significance is the average age of 3,2 years, initial respiratory symptoms, fever and seizures in the majority of the cases. The EEG showed in every case short focal periodic activity from the 3rd to the 8th day of the illness, with normal CT-scan in 5 patients from the 5th to the 9th day. All the patients showed deterioration in the course of the illness, with serious sequels or death. We support an early herpetic encephalitis diagnosis and its treatment (ARA-A or Acyclovir) based on the clinical symptoms, the characteristic EEG, and a normal initial CT-scan. Antibodies levels and evolution will confirm or deny the diagnosis, without the need for a cerebral biopsy.