Neurofilament light chain levels in pregnant multiple sclerosis patients: a prospective cohort study.

BACKGROUND AND PURPOSE: Neurofilament light chain is a cytoskeletal protein of neurons. Its levels are increasingly recognized as measures of neuroaxonal damage. The aim of this study was to explore serum neurofilament light chain (sNfL) levels in multiple sclerosis (MS) patients and healthy controls during pregnancy and puerperium. METHODS: This was a prospective, longitudinal, single-center study. sNfL concentration was assessed using a highly sensitive single-molecule array during pregnancy and in puerperium, in a cohort of 39 pregnant patients with relapsing multiple sclerosis (P-MS). Twenty-one healthy pregnant women (HPW) served as a control group. Eight P-MS suffered relapses during pregnancy (P-MS-R) in the first or second trimesters. RESULTS: No differences in pregnancy and delivery data were observed between P-MS and HPW. P-MS showed higher sNfL values than HPW in the first trimester, independently of the presence (P = 0.002) or not (P = 0.02) of relapses during pregnancy. However, in the third trimester, only P-MS-R showed higher sNfL values than HPW (P = 0.001). These differences extended to the puerperium, where P-MS-R showed higher sNfL values than those with no relapses during gestation (P = 0.02). CONCLUSION: These data strongly suggest that sNfL levels reflect MS activity during pregnancy. Additionally, the absence of relapses during pregnancy may have a beneficial effect on neurodegeneration during puerperium.

Genes differentially expressed by methylprednisolone in vivo in CD4 T lymphocytes from multiple sclerosis patients: potential biomarkers.

Intravenous methylprednisolone (IVMP) is the gold standard treatment in acute relapses of multiple sclerosis. Knowing the response to IVMP in advance could facilitate earlier selection of patients for subsequent courses of therapy. However, molecular mechanisms and changes in gene expression induced by methylprednisolone remain unknown. The aim of the study was to identify in vivo differentially expressed genes in relapsing-remitting multiple sclerosis patients after 3-6 days of treatment with IVMP. For this purpose, whole-genome transcription profiling of CD4+ T lymphocytes was performed before and after treatment with IVMP in 8 relapsing-remitting multiple sclerosis patients during relapse using Human GE 4x44K v2 microarrays. Differentially expressed genes were identified using a paired t test on GeneSpring v13.0 software. A P-value <0.001 and a twofold change were considered significant. Microarray data were confirmed using real-time PCR. Microarray revealed changes in gene expression: four genes were downregulated (B3GNT3, ZNF683, IFNG and TNF) and seven upregulated (DEFA4, CTSG, DEFA8P, AZU1, MPO, ELANE and PRTN3). Pathway analysis revealed the transforming growth factor-ß signaling pathway to be affected. Comparison with previously published data on in vitro methylprednisolone-regulated genes showed that SMAD7, TNF and CHI3L1 were also downregulated in vivo in relapsing-remitting multiple sclerosis patients. In summary, we performed the first in vivo transcriptome analysis in CD4+ T lymphocytes before and after the treatment with IVMP in patients with multiple sclerosis. Identification of differentially expressed genes in patients receiving IVMP could improve our understanding of the molecular mechanisms underlying the therapeutic effects of IVMP and highlight potential biomarkers of the response to IVMP.

Multiple sclerosis and pregnancy: a single-centre prospective comparative study. / Esclerosis múltiple y embarazo: estudio unicéntrico prospectivo y comparativo.

INTRODUCTION: Multiple sclerosis (MS) is a autoimmune disorder which preferentially affects young women of childbearing age. During pregnancy, the annualized relapse rate (AAR) is modified, but pregnancy has no harm effect on the long-term course of the disease. We aimed to study the clinical course of our MS patients during pregnancy, and compare their obstetrics outcomes with a control group of non-MS patients. METHODS: A single centre prospective observational study was conducted. We assessed the reproductive history, MS history, pregnancy course and new-born outcome of a cohort of MS patients who had had a pregnancy between january 2007 and july 2012. We compared the global outcomes with a control cohort of 58 age-matched healthy pregnancies. RESULTS: Complete data from 35 consecutive women were analyzed, 40 deliveries. Control groups: 58 patients, 60 deliveries. EDSS at pregnancy 0,7. ARR before pregnancy 0,5. During pregnancy 0,3, after pregnancy 0,4. Twelve patients were on disease-modifying drugs (DMD) before pregnancy, 4 prenatal exposure occurs. The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference. In addition, compared to control group, there were also no differences in the obstetric outcomes. In MS cohort, we found a higher incidence of assisted reproductive treatments and lower breastfeeding rate, both statistically significant. CONCLUSIONS: Our series confirms that pregnancy has no negative long term impact on the progression of MS and also suggest that there is no additional morbidity in the pregnancy, comparing to the rest of the population.

Changes in B and T-cell subsets and NMO-IgG levels after immunoglobulins and rituximab treatment for an acute attack of neuromyelitis optica.

BACKGROUND: There is increasing evidence supporting that neuromyelitis optica (NMO) is an inflammatory humoral mediated disorder associated with NMO-IgG/AQP-4 antibodies. However, little is known about the subsets of B cells and T cells that contribute to the pathogenesis or therapy response. OBJECTIVES: To describe the clinical and immunological changes associated with intravenous immunoglobulins (IV-Igs) plus rituximab (RTX) in a patient with a severe acute attack of NMO and intrathecal synthesis of NMO-IgG/AQP-4, who previously did not respond to intravenous methylprednisolone and plasma exchange. METHODS: We sequentially analysed the levels of NMO-IgG/AQP-4 by immunohistochemistry, and B and T cells subsets by multiparametric flow-cytometry, in the CSF and peripheral blood (PB), before and alter IV-Igs plus RTX therapy. RESULTS: In the CSF before treatment, and compared with PB, there was a higher percentage of CD4(+) T cells and a lower percentage of CD8(+) T cells and CD19(+) B cells. After therapy, the percentage of CD4(+) T cells remained high, and that of CD8(+) T cells increased. The observed decrease in the percentage of CD19(+) B cells was lower than in the PB. When the CSF was compared, it was found that the percentage of effector-memory and effector CD8(+) T cells had increased after therapy, and that of IgM memory B cells and switched-memory B cells decreased. The observed changes paralleled the decrease of NMO-IgG/AQP-4 results to negative and the clinical improvement. CONCLUSIONS: Our findings confirm that, besides intrathecal humoral immune response against AQP4, B and T cell subsets are involved in the modulation of inflammation within and outside the central nervous system.

Histologic evaluation of organ preservation injury and correlation with cold ischemia time in 13 intestinal grafts.

Lesions produced in the graft mucosa due to harvesting, storage, and implantation must be graduated to assess the subsequent protocolized biopsy specimens. The aim is to identify type and intensity of graft mucosal lesions observed immediately after implantation. Congestion, hemorrhage, microthrombi, neutrophilic infiltrates, shortening of villi, epithelial detachment, erosion, and crypt loss were separately evaluated by two pathologists in mucosal biopsy specimens from 13 grafts. Each change was assessed as normal, mild, moderate, or severe and by splintering the summation of points a global score was designed. Cold ischemia time was registered. Correlation between the pathologists' evaluations and between final preservation injury degree and cold ischemia time was determined using the "index of correlation rho (ρ)" (Spearman's test). The same changes were assessed in 19 biopsy specimens from day 2 to day 6 (3.6 ± 1.1) to determine their evolution. Congestion was found in 7 biopsy specimens, microthrombi in 2, hemorrhage in 4, neutrophils in 6, villous atrophy in 8, epithelial detachment in 9, erosions in 2 and/or crypt loss in 2. The maximum degree of preservation injury was expressed as intense congestion and hemorrhage associated with epithelial detachment and villous atrophy. The global preservation score was grade 3 in 2 cases, grade 2 in 5, grade 1 in 2, and grade 0 in 4. There was positive correlation (ρ = 0.915) in the evaluation between pathologists (P < .01), total agreement in 9 biopsy specimens, and partial agreement (only 1 point disagreement) in 4. Mean cold ischemia time was 327 ± 101 min. (135-480). There was positive correlation (ρ = 0.694) between preservation score and cold ischemia time (P < .01). In the follow-up biopsy procedures, histological injury decreased by at least one grade in every case. Additionally, karyorrhexis was observed in 3 grafts and very occasional apoptosis in 2 others. This scale achieves good reproducibility and allows graduate preservation injury in intestinal transplantation.

Histologic evaluation of post-implantation immediate C4d deposition in 13 intestinal grafts: correlation with cell-based crossmatching, cold ischemia time, and preservation injury.

C4d deposits are predictive of humoral rejection in kidney and heart transplantation. The aim of this study was to identify C4d deposit patterns in intestinal mucosa of the grafts on biopsy specimens obtained immediately after implantation and to detect if it could be a valuable tool to predict humoral or acute rejection. A second objective was to search for a statistically significant relationship between positive C4d deposition and other collected variables. Thirteen immediately post-transplantation mucosal graft biopsy specimens, formalin fixed, underwent immunohistochemical stain for C4d deposits. Diffuse intense staining of capillary endothelium was considered positive and absent, focal or weak stains as negative. Preservation injury grade and cold ischemia times were registered for each case. Donor-specific preformed antibodies were detected by complement dependent cytotoxicity serologic technique (crossmatching). Another 19 endoscopic follow-up biopsy specimens from days 2 to 6 were also evaluated. Statistical studies were made using the index of correlation ρ (Spearman's test). Diffuse intense C4d deposits were observed in 2 grafts, focal and weak in 5, and completely negative in 6. The mean cold ischemia time was 327 ± 101 minutes. Two cases showed diffuse positive deposits, 1 had a positive crossmatch and the cold ischemia time was 360 minutes whereas the other had not preformed antibodies and its cold ischemia time was 475 minutes. Humoral or acute rejection was not observed in follow-up mucosal biopsy specimens. There was no statistically significant relationship between the C4d deposition, cold ischemia time, crossmatching results, and preservation injury degree. In conclusion, C4d deposition was not a helpful tool for diagnosis of humoral rejection and prediction of acute rejection during the early post-transplantation period.

Consensus Statement on medication use in multiple sclerosis by the Spanish Society of Neurology's study group for demyelinating diseases.

Treatments for multiple sclerosis therapy are rapidly evolving. It is believed that new drugs will be approved in the near future, thereby changing current indications for treatment. In this context, the Spanish Society of Neurology's study group on demyelinating diseases, which evaluates medication use in MS, has decided to draw up a consensus statement on the current indications and guidelines for multiple sclerosis treatment.

Utility of oligoclonal IgG band detection for MS diagnosis in daily clinical practice.

An early and accurate diagnosis of multiple sclerosis (MS) is very important, since it allows early treatment initiation, which reduces the activity of the disease. Oligoclonal IgG band (OCGB) detection is a good ancillary tool for MS diagnosis. However, it was argued that its usefulness was limited by the high interlaboratory variability. In the last years, different techniques for OCGB detection have appeared. We performed a blinded aleatorized multicenter study in 19 Spanish hospitals to assess the accuracy and reproducibility of OCGB detection in this new scenario. We studied cerebrospinal fluid (CSF) and serum samples from 114 neurological patients. Every hospital contributed to the study with triplicated pairs of CSF and serum samples of six patients and analyzed 18 different samples. Global analysis rendered a sensitivity of 92.1%, a specificity of 95.1% and a Kappa value of 0.81. This shows that current techniques for OCGB detection have good accuracy and a high interlaboratory reproducibility and thus, represent a good tool for MS diagnosis. When we analyzed separately the different techniques used for OCGB detection, the highest concordance was observed in western blot with alkaline phosphatase detection (kappa=0.91). This indicates that high sensitivity techniques improve the reproducibility of this assay.

[Spanish Neurology Society consensus document on the use of drugs in multiple sclerosis: escalating therapy]. / Documento de consenso de la Sociedad Española de Neurología sobre el uso de medicamentos en esclerosis múltiple: escalado terapéutico.

INTRODUCTION: Treatment of multiple sclerosis has advanced considerably in the last few years, at the same time as its complexity has increased. The purpose of this consensus document is to provide specific recommendations and rules on the strategy to follow in the treatment of multiple sclerosis in order to modify its course. MATERIAL AND METHODS: Experts on the treatment and clinical research on multiple sclerosis proposed by the Demyelinating Diseases Group of the Spanish Neurology Society (SEN) prepared an initial document with recommendations for the treatment of this disease. The final version of this document was submitted to members of the Demyelinating Diseases Group of the SEN, who were able to make modifications and suggest changes to the final manuscript. RESULTS AND CONCLUSIONS: A review has been made of the evidence levels and indications for the treatment of the different clinical forms of multiple sclerosis, and recommendations made for the use of drugs. As well as authorised drugs, a review has also been made of other occasionally used products, as well as combined therapy, therapeutic response criteria, levels of treatment changes, and finally a proposal is made on therapeutic escalation.

Implementation of a comprehensive cancer plan. A health planning experience

Here we describe the working method used to implement an Integrated Cancer Health Plan in Andalusia (Spain) and to set out some of the lines of work for improving quality of care and health network planning. Four main initial considerations were made: (1) work must be centred on patients and respect for their autonomy; (2) cancer requires action at every healthcare level; (3) integration of expert professionals is to be encouraged; and (4) relevant information and data should be systematically used for planning. Two operative approaches were also established: structured participation and evidence-based healthcare. This methodology was used in various planning programmes, largely in relation to healthcare resources. In this article, as examples, we describe the development of two types of programmes: one for radiotherapy equipment and another for the management of lymphoedema in breast cancer patients. Analysis of results obtained against cancer is always controversial. It is necessary to review the healthcare structure used in terms of effectiveness and excellence. Comprehensive or integrated health plans are a useful model for a wide-ranging and multi-level approach to cancer. The structured and real participation of experts and an evidence- based healthcare strategy proved very useful in this public health planning experience (AU)

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[Portal and mesenteric thrombosis associated with protein S deficiency]. / Trombosis portal y mesentérica asociada al déficit de la proteína S.

INTRODUCTION: liver cirrhosis is the main cause of portal thrombosis (PT), while hypercoagulability syndromes are rarely found as the etiology of PT. We report a case of portal and mesenteric thrombosis secondary to protein S deficiency. CASE REPORT: a 74-year-old woman was admitted with melena secondary to upper gastrointestinal bleeding. She reported mild, diffuse abdominal pain in the last 2 weeks. Endoscopy revealed ruptured esophageal varices. Doppler ultrasonography and CT demonstrated a heterogeneous liver, splenomegaly and ascites, and complete non-occlusive PT involving the hilum and portal branches, as well as the superior mesenteric vein, with portosystemic collaterals. At this point a complete study for cirrhosis etiologies was negative, including a liver biopsy that showed nonspecific architectural changes secondary to diminished blood flow, which suggested non-cirrhotic portal hypertension. The search for hypercoagulability states determined a deficiency of S protein, with total pS = 107% and free pS = 56%. The patient was started on anticoagulant treatment and no other thrombotic events occurred. DISCUSSION: PT usually manifests without specific symptoms. The most common presentation is upper gastrointestinal bleeding, as occurred in our patient. Liver cirrhosis is one of the most frequent cause of PT. Up to 65% of these patients present an associated prothrombotic state, including protein S deficiency. Our case reminds us of the importance of a systematic search for hipercoagulability syndromes in patients with TP, even when the etiology can be conferred to liver cirrhosis.

Trombosis portal y mesentérica asociada al déficit de la proteína S / No disponible

Introducción: la causa más frecuente de trombosis portal (TP)es la cirrosis hepática, mientras que los estados hipercoagulables sonraramente identificados como etiología de la TP. Presentamos uncaso de TP y mesentérica secundaria al déficit de la proteína S (pS).Caso clínico: paciente mujer de 74 años, que debuta con dolorabdominal difuso de 2 semanas de evolución y hemorragia digestivaalta tipo melena secundaria a varices esofágicas. En el estudiose objetiva un hígado heterogéneo, esplenomegalia y ascitis,así como una trombosis portal completa no oclusiva del hilio hepáticoy de sus ramas y de la vena mesentérica superior con circulacióncolateral. El estudio etiológico de hepatopatía fue negativo,incluyendo una biopsia hepática que mostraba cambios arquitecturalessecundarios al flujo hemático disminuido compatible conhipertensión portal no cirrótica. El estudio de hipercoagulabilidadfue positivo para un déficit de proteína S. pS libre 56%, pS total107%. Desde entonces se inició tratamiento anticoagulante sinpresentar descompensaciones posteriores.Discusión: la trombosis portal suele manifestarse con síntomasinespecíficos, siendo la forma de presentación más frecuentela hemorragia digestiva alta como el caso que nos ocupa. La cirrosises una de las causas más frecuentes de trombosis portal, sinembargo existe hasta un 65% de estos pacientes que tienen unaenfermedad protrombótica asociada, como es el déficit de proteínaS. Nuestro caso remarca la importancia de realizar estudios defactores trombogénicos en pacientes con TP, incluso cuando laetiología se puede atribuir a una cirrosis

Introduction: liver cirrhosis is the main cause of portalthrombosis (PT), while hypercoagulability syndromes are rarelyfound as the etiology of PT. We report a case of portal andmesenteric thrombosis secondary to protein S deficiency.Case report: a 74-year-old woman was admitted with melenasecondary to upper gastrointestinal bleeding. She reported mild, diffuseabdominal pain in the last 2 weeks. Endoscopy revealed rupturedesophageal varices. Doppler ultrasonography and CT demonstrateda heterogeneous liver, splenomegaly and ascites, andcomplete non-occlusive PT involving the hilum and portal branches,as well as the superior mesenteric vein, with portosystemic collaterals.At this point a complete study for cirrhosis etiologies was negative,including a liver biopsy that showed nonspecific architecturalchanges secondary to diminished blood flow, which suggested noncirrhoticportal hypertension. The search for hypercoagulabilitystates determined a deficiency of S protein, with total pS = 107%and free pS = 56%. The patient was started on anticoagulant treatmentand no other thrombotic events occurred.Discussion: PT usually manifests without specific symptoms.The most common presentation is upper gastrointestinal bleeding,as occurred in our patient. Liver cirrhosis is one of the mostfrequent cause of PT. Up to 65% of these patients present an associatedprothrombotic state, including protein S deficiency. Ourcase reminds us of the importance of a systematic search forhipercoagulability syndromes in patients with TP, even when theetiology can be conferred to liver cirrhosis (AU)

Pregnancy in multiple sclerosis patients treated with immunomodulators prior to or during part of the pregnancy: a descriptive study in the Spanish population.

OBJECTIVES: To study the management of pregnancy in multiple sclerosis (MS) patients on immunomodulatory therapy (IMT) in routine clinical practice and to analyze pregnancy outcomes and the clinical course of MS around pregnancy. METHODS: Retrospective, multicentric study in Spain in MS patients receiving IMT before conception and followed for at least three months post-partum. RESULTS: A total of 1286 medical records were reviewed. Eighty-eight pregnancies were identified in 74 (6%) women, 66% of which were unexposed and 34% exposed pregnancies. In most cases, IMT was discontinued before conception and resumed shortly after delivery. Accidental exposure to IMT did not lead to higher rates of abortions (P = 0.76) or malformations. The relapse rate was decreased during pregnancy (0.31 versus 0.61 in the pre-pregnancy year) and increased after delivery (0.87 on month 3), returning to pre-conception values on month 12. The median EDSS score was not increased during the study. CONCLUSIONS: Discontinuation of IMT before conception, and resumption shortly after delivery was the most frequent clinical practice procedure. Accidental exposure to IMT did not affect pregnancy outcomes or increased malformation rates. Pregnancy was associated with a reduced relapse rate. No factor was found to predict the risk of relapses during or after pregnancy.

Impact of fatigue in multiple sclerosis: the Fatigue Impact Scale for Daily Use (D-FIS).

OBJECTIVE: The Fatigue Impact Scale for Daily Use (D-FIS) is an eight-item instrument designed to measure subjective daily experience of fatigue. This study sought to determine the metric properties of the D-FIS in multiple sclerosis (MS) patients. METHODS: Sixty-eight patients with operationally-defined MS and fatigue (54.8% of the sample) underwent the D-FIS. Usual clinical measures for MS, the Montgomery-Asberg Depression Rating Scale (MADRS) and the Functional Assessment of Multiple Sclerosis (FAMS) were also applied. In addition, patients with fatigue completed the Fatigue Descriptive Scale, the Multidimensional Fatigue Inventory (MFI), a Visual Analogue Scale for Fatigue (VAS-F), and a Global Perception of Fatigue Scale (GPF). RESULTS: Full computable data, 95.6%; both floor and ceiling effect=1.54%; item-total correlation=0.62 (item 1) to 0.84 (item 6); Cronbach's alpha=0.91; item homogeneity =0.55; standard error of measurement=3.18; convergent validity with other fatigue measures=-0.57 (VAS-F); 0.52 (GPF); and 0.46 (MFI-general fatigue). Test-retest reliability (ICC)=0.81. There was a strong association between health-related quality of life (HRQoL) (FAMS) and D-FIS (rS=0.70). CONCLUSIONS: In this study, D-FIS proved to be a feasible and valid instrument for measuring MSrelated fatigue, a frequent symptom associated with deterioration of patients' HRQoL.

[Peritonsillar and retropharyngeal abscesses: study of 13 years]. / Abscesos periamigdalino y retrofaríngeo: estudio de 13 años.

INTRODUCTION: Peritonsillar and retropharyngeal abscesses are the most common deep head and neck infections. We present a series of patients with these infections. MATERIAL AND METHODS: We performed a retrospective study of peritonsillar and retropharyngeal abscesses in children admitted to the Infectious Diseases Unit of our hospital between January 1991 and January 2004. Diagnosis was based mainly on clinical and laboratory findings. RESULTS: We studied 54 patients, 10 with retropharyngeal abscess and 44 with peritonsillar abscess. The mean age was 6.7 and 7.5 years respectively. There was a slight predominance of boys (1.45:1). The number of cases diagnosed increased from 1997, with a maximum (nine cases) in 2002. Twenty-nine children had received previous antibiotic therapy. The main symptoms and signs were: fever, odynophagia, cervical lymphadenitis, and asymmetric tonsillar hypertrophy. All children received intravenous antibiotic therapy. Puncture-aspiration was carried out in seven patients. Eleven children underwent tonsillectomy, two with retropharyngeal abscess and nine with peritonsillar abscess. Of these 11 patients, five had had several episodes of tonsillitis and three had previously had a peritonsillar abscess. Three children who developed an abscess had previously undergone tonsillectomy. In most patients, outcome was favorable. CONCLUSIONS: In the last few years the frequency of peritonsillar and retropharyngeal abscesses has increased in the pediatric population. Most of the children have a good response to conservative treatment. The main risk factor for abscess recurrence is a previous history of repeated tonsillitis. Consequently, these patients are candidates for tonsillectomy.

Abscesos periamigdalino y retrofaríngeo: estudio de 13 años / Peritonsillar and retropharyngeal abscesses: study of 13 years

Introducción Los abscesos periamigdalino y retrofaríngeo son las infecciones más frecuentes de tejidos profundos de cabeza y cuello. Se presenta una casuística sobre estas entidades. Material y métodos Estudio retrospectivo de los abscesos periamigdalino y retrofaríngeo en niños ingresados en la Unidad de Enfermedades Infecciosas de nuestro hospital entre enero de 1991 y enero de 2004. El diagnóstico se realizó fundamentalmente según criterios clínico-analíticos. Resultados Se estudian 54 casos, 10 con absceso retrofaríngeo y 44 con absceso periamigdalino, con edad media de 6,7 y 7,5 años, respectivamente. Se observa un discreto predominio en varones (1,45:1). Hay un aumento de casos diagnosticados desde 1997, con un máximo (9) en 2002. Un total de 29 niños habían recibido antibioterapia previa. Los principales síntomas y signos fueron: fiebre, odinofagia, adenopatías cervicales e hipertrofia amigdalar asimétrica. Todos los niños recibieron antibioterapia intravenosa. Se realizó punción-aspiración en 7 casos. Se practicó amigdalectomía en 11 niños, dos de ellos con absceso retrofaríngeo y nueve periamigdalino. De estos 11 pacientes, cinco tenían antecedentes de faringoamigdalitis de repetición y tres de absceso periamigdalino previo. Habían sido amigdalectomizados con anterioridad al desarrollo del absceso 3 niños. La mayoría de los casos presentaron una evolución favorable. Conclusiones En los últimos años se ha observado un aumento de la frecuencia de los abscesos periamigdalino y retrofaríngeo en la edad infantil. La mayor parte de los niños responden favorablemente al tratamiento conservador. La historia previa de amigdalitis de repetición constituye el principal factor de riesgo de recurrencia del absceso, y son estos pacientes los candidatos a amigdalectomía

Introduction Peritonsillar and retropharyngeal abscesses are the most common deep head and neck infections. We present a series of patients with these infections. Material and methods We performed a retrospective study of peritonsillar and retropharyngeal abscesses in children admitted to the Infectious Diseases Unit of our hospital between January 1991 and January 2004. Diagnosis was based mainly on clinical and laboratory findings. Results We studied 54 patients, 10 with retropharyngeal abscess and 44 with peritonsillar abscess. The mean age was 6.7 and 7.5 years respectively. There was a slight predominance of boys (1.45:1). The number of cases diagnosed increased from 1997, with a maximum (nine cases) in 2002. Twenty-nine children had received previous antibiotic therapy. The main symptoms and signs were: fever, odynophagia, cervical lymphadenitis, and asymmetric tonsillar hypertrophy. All children received intravenous antibiotic therapy. Puncture-aspiration was carried out in seven patients. Eleven children underwent tonsillectomy, two with retropharyngeal abscess and nine with peritonsillar abscess. Of these 11 patients, five had had several episodes of tonsillitis and three had previously had a peritonsillar abscess. Three children who developed an abscess had previously undergone tonsillectomy. In most patients, outcome was favorable. Conclusions In the last few years the frequency of peritonsillar and retropharyngeal abscesses has increased in the pediatric population. Most of the children have a good response to conservative treatment. The main risk factor for abscess recurrence is a previous history of repeated tonsillitis. Consequently, these patients are candidates for tonsillectomy