[Chronic and recurrent immune thrombocytopenic purpura]. / Púrpura trombocitopénica inmune crónica y recurrente.

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.

[Traumatic pulmonary pseudocyst]. / Seudoquiste pulmonar traumático.

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.

[Herpetic encephalitis in children. Study of 9 cases]. / Encefalitis herpética en el niño. Estudio de nueve casos.

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.

[Ventriculo-peritoneal shunt, hypovolemic shock and cerebrospinal fluid ascites]. / Derivación ventrículo-peritoneal, "shock" hipovolémico y ascitis por líquido cefalorraquídeo.

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.