Linfoma no Hodgkin: excelentes resultados a expensas de elevada toxicidad del tratamiento / Non-Hodgkin lymphoma: Excellent results at the expense of the high toxicity of the treatment

Introducción : Los linfomas son la tercera neoplasia maligna en los niños y, dentro de ellos, los linfomas no Hodgkin (LNH) representan tan solo el 7% del cáncer en menores de 15 años. La quimioterapia constituye actualmente el tratamiento de elección. El objetivo de este estudio es analizar la toxicidad secundaria al tratamiento en pacientes pediátricos diagnosticados de LNH. Material y métodos: Estudio retrospectivo de pacientes diagnosticados de LNH de células B maduras tratados según el protocolo LMB 2001, desde enero del 2007 hasta febrero del 2014. Se recogieron los datos referentes al diagnóstico, el tratamiento y las toxicidades que desarrollaron durante el mismo. Resultados: Se diagnosticaron 20 LNH de células B maduras: 16 linfomas Burkitt, 2 linfomas difusos de células grandes y 2 leucemias maduras. Un 65% de los pacientes se clasificó al diagnóstico en un estadio de alto grado (III-IV). Los procesos infecciosos graves, la mielosupresión severa, las alteraciones hepáticas y la mucositis fueron las toxicidades más frecuentes. La supervivencia global fue del 95% (19/20). Un paciente falleció por causas no relacionadas con su enfermedad. Conclusión: La mayoría de los pacientes diagnosticados de LNH de células B maduras experimentan toxicidades grado III y IV durante el tratamiento, a pesar de lo cual la supervivencia es excelente (AU)

Introduction: Lymphomas are the third malignancy in children, and within them non-Hodgkin lymphoma (NHL) accounts for just 7% of cancers in children under 15 years old. Chemotherapy is currently the treatment of choice. The objective of this study is to analyze the toxicity caused by the treatment in pediatric patients diagnosed with NHL. Material and methods: A retrospective study was conducted on patients diagnosed with mature B-cell NHL, treated according to the LMB protocol 2001, from January 2007 to February 2014. Data concerning the diagnosis, treatment and toxicities that developed in the patients during the same period were collected. Results: A total of 20 mature B-cell NHL cases were diagnosed: 16 Burkitt lymphomas, 2 diffuse large cell lymphomas and 2 mature leukemias. Almost two-thirds (65%) of patients were classified in a high grade stage (III-IV) at diagnosis. Serious infectious processes, severe myelosuppression, liver abnormalities, and mucositis were the most frequent toxicities. Overall survival was 95% (19/20). One patient died of causes unrelated to the illness. Conclusion: Despite the excellent survival rate, most patients diagnosed with NHL mature B cells experience grade III and IV toxicities during treatment (AU)

Gliomas de bajo grado: revisión de 10 años / Low-grade gliomas: Review of 10 years

INTRODUCCIÓN: Los tumores del SNC son los tumores sólidos más frecuentes en la edad pediátrica. Dentro de ellos los gliomas de bajo grado constituyen el tipo más común de tumor del SNC en niños, representando hasta el 30-50% de los mismos. PACIENTES Y MÉTODOS: Análisis retrospectivo de las características epidemiológicas, manifestaciones clínicas, localización del tumor, histología, tipo de tratamiento si lo ha recibido, evolución y secuelas a largo plazo de 111 pacientes diagnosticados de glioma de bajo grado en el Hospital Infantil Universitario Niño Jesús de Madrid entre enero de 2002 y diciembre de 2011. RESULTADOS: De los 111 pacientes 57 eran niños y 54 niñas. La edad media fue de 7,26 años (intervalo 2 meses-19 anos). Los síntomas de presentación más frecuentes fueron la cefalea (27%) y los vómitos (19%). Las localizaciones más frecuentes fueron los hemisferios cerebrales (38%), seguido del tronco cerebral (27,4%) y del cerebelo (18,5%). Se realizó estudio histológico en 89 pacientes (80,18%), siendo el astrocitoma pilocítico el tipo histológico más frecuente. Se realizó biopsia diagnóstica en 20 pacientes (22,5%), resección parcial en 38 pacientes (42,7%) y resección total en 31 pacientes (34,8%). Recibieron quimioterapia 16 pacientes (14%) y radioterapia 18 pacientes (16%). La supervivencia global fue del 88,3%. Un paciente presentó secuelas auditivas, 5 pacientes presentaron secuelas visuales y 4 pacientes secuelas endocrinas. CONCLUSIONES: El tipo histológico más frecuente es el astrocitoma pilocítico. La supervivencia global fue del 88,3%. Solo el 9% de los pacientes presentaron algún tipo de secuela auditiva, visual o endocrinológica

INTRODUCTION: Central nervous system (CNS) tumors are the most common solid tumors in children. Among these, the low-grade gliomas are the most common type, accounting for up to 30-50% of them. PATIENTS AND METHODS: A retrospective analysis was carried out on the epidemiology, clinical characteristics, tumor location, histology, treatment, outcome and long-term sequelae of 111 patients diagnosed with low-grade glioma in the Nino˜ Jesús Children's Hospital of Madrid from January 2002 to December 2011. RESULTS: Of the 111 patients, there were 57 boys and 54 girls. The mean age was 7.26 years (range, 2 months - 19 years). The most common symptoms of presentation were headache (27%) and vomiting (19%). The most common locations were the cerebral hemispheres (38%), followed by the brainstem (27.4%), and cerebellum (18.5%). Histological examination was performed in 89 patients (80.18%). Pilocytic astrocytoma was the most common histological type. Diagnostic biopsy was performed in 20 patients (22.5%), partial resection in 38 patients (42.7%), and total resection in 31 patients (34.8%). Sixteen patients received chemotherapy (14%), and eighteen patients received radiotherapy (16%). Overall survival was 88.3%. Long term hearing, visual and endocrine sequelae were note in 1, 5, and 4 patients, respectively. CONCLUSIONS: The most common histological type is pilocytic astrocytoma. Overall survival was 88.3%. Only 9% of patients had some kind or auditory, visual or endocrine sequelae

[Non-Hodgkin lymphoma: Excellent results at the expense of the high toxicity of the treatment]. / Linfoma no Hodgkin: excelentes resultados a expensas de elevada toxicidad del tratamiento.

INTRODUCTION: Lymphomas are the third malignancy in children, and within them non-Hodgkin lymphoma (NHL) accounts for just 7% of cancers in children under 15 years old. Chemotherapy is currently the treatment of choice. The objective of this study is to analyze the toxicity caused by the treatment in pediatric patients diagnosed with NHL. MATERIAL AND METHODS: A retrospective study was conducted on patients diagnosed with mature B-cell NHL, treated according to the LMB protocol 2001, from January 2007 to February 2014. Data concerning the diagnosis, treatment and toxicities that developed in the patients during the same period were collected. RESULTS: A total of 20 mature B-cell NHL cases were diagnosed: 16 Burkitt lymphomas, 2 diffuse large cell lymphomas and 2 mature leukemias. Almost two-thirds (65%) of patients were classified in a high grade stage (iii-iv) at diagnosis. Serious infectious processes, severe myelosuppression, liver abnormalities, and mucositis were the most frequent toxicities. Overall survival was 95% (19/20). One patient died of causes unrelated to the illness. CONCLUSION: Despite the excellent survival rate, most patients diagnosed with NHL mature B cells experience grade iii and iv toxicities during treatment.

[Low-grade gliomas: review of 10 years]. / Gliomas de bajo grado: revisión de 10 años.

INTRODUCTION: Central nervous system (CNS) tumors are the most common solid tumors in children. Among these, the low-grade gliomas are the most common type, accounting for up to 30-50% of them. PATIENTS AND METHODS: A retrospective analysis was carried out on the epidemiology, clinical characteristics, tumor location, histology, treatment, outcome and long-term sequelae of 111 patients diagnosed with low-grade glioma in the Niño Jesús Children's Hospital of Madrid from January 2002 to December 2011. RESULTS: Of the 111 patients, there were 57 boys and 54 girls. The mean age was 7.26 years (range, 2 months - 19 years). The most common symptoms of presentation were headache (27%) and vomiting (19%). The most common locations were the cerebral hemispheres (38%), followed by the brainstem (27.4%), and cerebellum (18.5%). Histological examination was performed in 89 patients (80.18%). Pilocytic astrocytoma was the most common histological type. Diagnostic biopsy was performed in 20 patients (22.5%), partial resection in 38 patients (42.7%), and total resection in 31 patients (34.8%). Sixteen patients received chemotherapy (14%), and eighteen patients received radiotherapy (16%). Overall survival was 88.3%. Long term hearing, visual and endocrine sequelae were note in 1, 5, and 4 patients, respectively. CONCLUSIONS: The most common histological type is pilocytic astrocytoma. Overall survival was 88.3%. Only 9% of patients had some kind or auditory, visual or endocrine sequelae.

Irinotecán y temozolomida en tumores sólidos pediátricos en recaída o refractarios / Irinotecan plus temozolomide in refractory or relapsed pediatric solid tumors

Introducción: El pronóstico de los tumores sólidos pediátricos refractarios o en recaída es infausto, y actualmente no existen tratamientos estandarizados para este tipo de situaciones. La combinación irinotecán y temozolomida ha demostrado su utilidad en adultos como segunda línea de tratamiento en distintos tumores sólidos. En pacientes pediátricos ya ha demostrado su eficacia en sarcoma de Ewing, neuroblastoma o rabdomiosarcoma en recaída o refractario. Pacientes y métodos: Se ha realizado un estudio retrospectivo de 32 pacientes pediátricos con tumores sólidos en recaída o refractarios que fueron tratados con irinotecán y temozolomida desde septiembre de 2005 hasta junio de 2012 en el Servicio de Oncología del Hospital Infantil Niño Jesús. Se analizaron las características clínicas, el tratamiento realizado, la toxicidad presentada y la respuesta obtenida. Resultados: Treinta y dos pacientes recibieron un total de 180 ciclos. De 30 pacientes valorables, 10 (33%) presentaron respuesta positiva (2 remisión completa y 8 remisión parcial) y 8 (27%) mantuvieron enfermedad estable. El 94% de los pacientes que obtuvo respuesta lo hicieron en los 4 primeros ciclos. De los 180 ciclos analizados, solo 50 (28%) presentaron toxicidad y, de ellos, solo 15 (8%) fueron de grado III-IV . La toxicidad más frecuente fue la diarrea que apareció en 18 pacientes. Todos los pacientes recibieron el tratamiento de forma ambulatoria, excepto 3 que precisaron ingreso por síntomas relacionados con su enfermedad de base. Conclusión: La combinación irinotecán y temozolomida es bien tolerada y activa frente a tumores sólidos pediátricos refractarios al tratamiento o en recaída (AU)

Introduction: The prognosis of refractory or relapsed pediatric solid tumors is very poor, and there is no standard treatment for this condition. The combination of irinotecan and temozolomide has proved useful in adults as a second-line treatment of different solid tumors. In pediatric patients, this combination has been effective in Ewing's sarcoma, neuroblastoma, and relapsed or refractory rhabdomyosarcoma. Patients and methods: A retrospective study was conducted on 32 pediatric patients with refractory or relapsed solid tumors, who were treated with irinotecan and temozolomide in the Oncology Department at Children's Hospital Niño Jesus from September 2005 to June 2012. The clinical characteristics, treatment performed, toxicity and outcome, were analyzed. Results: Thirty-two patients received a total of 180 cycles. Of the 30 evaluable patients, 10 (33%) had a positive response (2 complete remission and 8 partial remission), and in 8 (27%) the disease remained stable. Almost all (94%) of the patients achieved a response in the first four cycles. Of the 180 cycles analyzed, only 50 (28%) had toxicity, and of these only 15 (8%) were grade III-IV . The most common toxicity was diarrhea appearing in 18 patients. All patients received ambulatory treatment, except three of them who required hospitalization due to symptoms of their underlying disease. Conclusion: The combination of irinotecan and temozolomide is well tolerated and active against pediatric refractory or relapsed solid tumors (AU)

[Irinotecan plus temozolomide in refractory or relapsed pediatric solid tumors]. / Irinotecán y temozolomida en tumores sólidos pediátricos en recaída o refractarios.

INTRODUCTION: The prognosis of refractory or relapsed pediatric solid tumors is very poor, and there is no standard treatment for this condition. The combination of irinotecan and temozolomide has proved useful in adults as a second-line treatment of different solid tumors. In pediatric patients, this combination has been effective in Ewing's sarcoma, neuroblastoma, and relapsed or refractory rhabdomyosarcoma. PATIENTS AND METHODS: A retrospective study was conducted on 32 pediatric patients with refractory or relapsed solid tumors, who were treated with irinotecan and temozolomide in the Oncology Department at Children's Hospital Niño Jesus from September 2005 to June 2012. The clinical characteristics, treatment performed, toxicity and outcome, were analyzed. RESULTS: Thirty-two patients received a total of 180 cycles. Of the 30 evaluable patients, 10 (33%) had a positive response (2 complete remission and 8 partial remission), and in 8 (27%) the disease remained stable. Almost all (94%) of the patients achieved a response in the first four cycles. Of the 180 cycles analyzed, only 50 (28%) had toxicity, and of these only 15 (8%) were grade iii-iv. The most common toxicity was diarrhea appearing in 18 patients. All patients received ambulatory treatment, except three of them who required hospitalization due to symptoms of their underlying disease. CONCLUSION: The combination of irinotecan and temozolomide is well tolerated and active against pediatric refractory or relapsed solid tumors.

Leucemia linfoblástica aguda diagnosticada y tratada inicialmente como artritis crónica juvenil / Acute lymphoblastic leukaemia initially diagnosed and treated as chronic juvenile arthritis

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Candidiasis hepatoesplénica en pacientes hemato-oncológicos pediátricos / Hepatosplenic candidiasis in paediatric haematology-oncology patients

Introducción: En las últimas décadas, la supervivencia en las enfermedades hemato-oncológicas infantiles ha aumentado gracias a la mejora de los tratamientos, con regímenes quimioterápicos más agresivos. Esto ha conducido a un aumento en la incidencia de infecciones graves, con la consecuente morbimortalidad. La candidiasis hepatoesplénica es una infección diseminada por Candida que suele afectar más frecuentemente al hígado y bazo, aunque pueden verse involucrados otros órganos. Pacientes y métodos: Se ha realizado un estudio retrospectivo de 13 pacientes pediátricos diagnosticados de candidiasis hepatoesplénica desde enero de 2002 a febrero de 2010 en el Servicio de Hemato-Oncología pediátrica del Hospital Niño Jesús de Madrid siguiendo los criterios propuestos por la EORTC/MSG (European Organization for Research and Treatment of Cancer and Mycoses Study Group) revisados en el 2008. Se analizaron las características clínicas, los métodos diagnósticos, el tratamiento realizado y la evolución posterior. Resultados: El síntoma más frecuente de presentación de la candidiasis hepatoesplénica en nuestra serie fue la fiebre persistente, hasta en un 84,6% de los casos, en casi todos, asociada a algún otro síntoma. Los factores de riesgo para desarrollarla son bastante inespecíficos y estaban presentes hasta en un 92,3% de nuestros pacientes. El diagnóstico de infección probada, que se realiza mediante histología o cultivos, normalmente es difícil de obtener y sólo se logró obtener en nuestro caso en un 23,1%. La mayoría de las veces, como en nuestra serie, sólo se llega a un diagnóstico de sospecha. Las pruebas de laboratorio no tienen utilidad en la población pediátrica y tan sólo en un paciente se apreció aumento de la fosfatasa alcalina al diagnóstico. Este resultado difiere del comportamiento de este marcador biológico en los adultos. Aunque suelen ser necesarios tratamientos prolongados para la resolución de las lesiones, la supervivencia es muy alta, en nuestra serie un 100%, con un tratamiento adecuado. Conclusión: La mortalidad de la candidiasis hepatoesplénica es baja si se realiza un tratamiento precoz y adecuado (AU)

Introduction: In the last few decades, the survival of children with haematology-oncological malignancies has increased due to more aggressive chemotherapy regimens. This has led to an increase of fungal infections causing significant morbidity and mortality in these patients. Hepatosplenic candidiasis is a disseminated candida infection that affects most commonly the liver and spleen, although other organs may be involved. Patients and methods: We performed a retrospective study of 13 paediatric patients diagnosed with hepatosplenic candidiasis from January 2002 to February 2010 in our paediatric haematology-oncology department following the criteria proposed by the EORTC/MSG (European Organization for Research and Treatment of Cancer and Mycoses study group) updated in2008. We analysed the clinical characteristics, diagnostic methods, treatment and outcome. Results: The most common symptom of presentation of hepatosplenic candidiasis in our series was persistent fever, up 84.6% of cases, almost all associated with other symptoms. Risk factors for development are non-specific and were present in 92.3% of our patients. The diagnosis of proven infection, which is made by histology or culture, is usually difficult to obtain and in our series it was obtained only in 23.1% of cases. As in our series, diagnosis is often presumptive. Laboratory tests are not useful in the paediatric population and only in one patient we observed an increase in alkaline phosphatase at diagnosis. This result differs from the behaviour of this biological marker in adults. Although prolonged treatment is often necessary for the resolution of the lesions, survival is high with appropriate treatment, 100% in our series. Conclusions: The mortality of hepatosplenic candidiasis is low with early and adequate treatment (AU)

[Hepatosplenic candidiasis in paediatric haematology-oncology patients]. / Candidiasis hepatoesplénica en pacientes hemato-oncológicos pediátricos.

INTRODUCTION: In the last few decades, the survival of children with haematology-oncological malignancies has increased due to more aggressive chemotherapy regimens. This has led to an increase of fungal infections causing significant morbidity and mortality in these patients. Hepatosplenic candidiasis is a disseminated candida infection that affects most commonly the liver and spleen, although other organs may be involved. PATIENTS AND METHODS: We performed a retrospective study of 13 paediatric patients diagnosed with hepatosplenic candidiasis from January 2002 to February 2010 in our paediatric haematology-oncology department following the criteria proposed by the EORTC/MSG (European Organization for Research and Treatment of Cancer and Mycoses study group) updated in 2008. We analysed the clinical characteristics, diagnostic methods, treatment and outcome. RESULTS: The most common symptom of presentation of hepatosplenic candidiasis in our series was persistent fever, up 84.6% of cases, almost all associated with other symptoms. Risk factors for development are non-specific and were present in 92.3% of our patients. The diagnosis of proven infection, which is made by histology or culture, is usually difficult to obtain and in our series it was obtained only in 23.1% of cases. As in our series, diagnosis is often presumptive. Laboratory tests are not useful in the paediatric population and only in one patient we observed an increase in alkaline phosphatase at diagnosis. This result differs from the behaviour of this biological marker in adults. Although prolonged treatment is often necessary for the resolution of the lesions, survival is high with appropriate treatment, 100% in our series. CONCLUSIONS: The mortality of hepatosplenic candidiasis is low with early and adequate treatment.

[Arsenic trioxide treatment in a patient with recurrent acute promyelocytic leukemia (APL)]. / Tratamiento con trióxido de arsénico en paciente con recaída de leucemia promielocítica aguda.

Acute promyelocytic leukemia (APL) is a special subtype of acute myeloid leukemia (AML) with M3 morphology and specific chromosomal translocation t(15;17) with resultant leukemogenic PML-RARalpha fusion gene. Its main characteristics are therapy response using all-trans-retinoic acid (ATRA) and its high rate of recovery; higher than other subtypes of acute myeloid leukemia. Arsenic trioxide induces a high complete remission rate in patients having an APL relapse. Experience in the use of this drug is still limited in the field of Paediatrics.

Tratamiento con trióxido de arsénico en paciente con recaída de leucemia promielocítica aguda / Arsenic trioxide treatment in a patient with recurrent acute promyelocytic leukemia (APL)

La leucemia promielocítica aguda (LPA) es un subtipo de leucemia aguda mieloblástica (LMA) con morfología M3 y una traslocación específica, t(15;17) que origina la fusión de los genes PML del cromosoma 15 con RARα del 17. Su característica más importante es su respuesta terapéutica al ácido retinoico (ATRA) y su alta tasa de curación, superior a otros subtipos de LMA. Para los pacientes que recaen las posibilidades de tratamiento se han visto incrementadas en los últimos años con la aparición del trióxido de Arsénio (ATO). La experiencia en el campo de la pediatría con este fármaco es todavía escasa (AU)

Acute promyelocytic leukemia (APL) is a special subtype of acute myeloid leukemia (AML) with M3 morphology and specific chromosomal translocation t(15;17) with resultant leukemogenic PML-RARα fusion gene. Its main characteristics are therapy response using all-trans-retinoic acid (ATRA) and its high rate of recovery; higher than other subtypes of acute myeloid leukemia. Arsenic trioxide induces a high complete remission rate in patients having an APL relapse. Experience in the use of this drug is still limited in the field of Paediatrics (AU)

[Neuroblastoma presenting as obstructive jaundice]. / Ictericia obstructiva como forma de presentación de neuroblastoma.

Obstructive jaundice as a presentation of abdominal tumors in childhood is extremely rare. To date, only 4 cases of neuroblastoma causing obstructive jaundice at diagnosis have been reported in children. We report a 4-year-old boy who presented to the emergency department with abdominal pain, jaundice, choluria and acholia. A diagnosis of unresectable, nonmetastatic neuroblastoma was made. Chemotherapy reduced the size of the tumor and relieved the symptoms of obstructive jaundice without the need for decompressive surgery. Abdominal tumors should be included in the differential diagnoses of obstructive jaundice in childhood.

Ictericia obstructiva como forma de presentación de neuroblastoma / Neuroblastoma presenting as obstructive jaundice

La presentación de los tumores abdominales en forma de ictericia obstructiva en la infancia es excepcional. Hasta la fecha, tan sólo existen descritos 4 casos de pacientes pediátricos con neuroblastoma que debutaron con ictericia obstructiva. Presentamos a un varón de 4 años que acudió a urgencias con dolor abdominal, ictericia, coluria y acolia. Fue diagnosticado de neuroblastoma irresecable no metastásico. Tras iniciar el tratamiento con quimioterapia disminuyó el tamaño del tumor, resolviéndose la sintomatología obstructiva de la vía biliar sin precisar tratamiento quirúrgico descompresivo. En el diagnóstico diferencial de la ictericia obstructiva en la edad pediátrica debe incluirse la patología tumoral

Obstructive jaundice as a presentation of abdominal tumors in childhood is extremely rare. To date, only 4 cases of neuroblastoma causing obstructive jaundice at diagnosis have been reported in children. We report a 4-year-old boy who presented to the emergency department with abdominal pain, jaundice, choluria and acholia. A diagnosis of unresectable, nonmetastatic neuroblastoma was made. Chemotherapy reduced the size of the tumor and relieved the symptoms of obstructive jaundice without the need for decompressive surgery. Abdominal tumors should be included in the differential diagnoses of obstructive jaundice in childhood

Ingresos por varicela: estudio retrospectivo / Hospital admission due to varicella: a retrospective study

Objetivo: Describir las características de los pacientes ingresados por varicela en el Hospital «Príncipe de Asturias» y analizar las complicaciones que motivan su ingreso. Material y métodos: Estudio retrospectivo de los pacientes ingresados por varicela entre enero de 1996 y diciembre de 2002. Resultados: Se encontraron 61 pacientes ingresados por varicela. El 7,6% de los casos que consultaron en el Servicio de Urgencias fueron ingresados. La media de edad de estos pacientes fue de 3,1 ± 3,37 años. Fueron hospitalizados, fundamentalmente, para el tratamiento de complicaciones, terapia antiviral u observación. El tiempo medio de estancia fue de 5,32 días. Las complicaciones neurológicas y cutáneas fueron las más frecuentes (21,3%), seguidas de las respiratorias (16,9%). Otras complicaciones fueron: la escarlatina (8,2%), complicaciones hematológicas, vómitos, casos neonatales, amigdalitis y varicela hemorrágica. El 11,4% de los casos se produjeron por estreptococo betahemolítico del grupo A (5 pacientes con escarlatina, un caso de infección cutánea con hemocultivo positivo y otro caso en el que se aisló Streptococcus pyogenes de las lesiones cutáneas). Las complicaciones por varicela supusieron el 0,5% de los motivos de consulta en el Servicio de Urgencias, y un 7,6% de éstas precisó ingreso hospitalario. Conclusión: La introducción de la vacuna de la varicela en el calendario vacunal podría disminuir el número de ingresos debidos a complicaciones

Objective. To describe the features of the patients admitted to our hospital with varicella and analyze the complications that lead to hospital admission. Material and methods: We carried out a retrospective study of the children admitted with varicella between January 1996 and December 2002. Results: We identified 61 children who had been hospitalized for varicella during the study period. They represented 7.65% of the patients that were brought to the emergency room. The mean age was 3.1 ± 3.37 years. The children were admitted mainly for treatment of complications, for antiviral therapy or for observation. The mean length of the hospital stay was 5.32 days. The most prevalent reasons for admission were neurological and cutaneous complications (21.3%), followed by respiratory complications. Other complications were scarlet fever (8.2%), hematological disorders, vomiting, neonatal patient, tonsillitis and hemorrhagic varicella. Group A streptococcus was the cause in 11.4% of the cases (5 cases of scarlet fever, one case of skin infection with positive blood culture and another case in which beta hemolytic streptococcus was isolated from varicella skin lesions). Conclusion: Complications of varicella were the cause of 0.5% of emergency room visits; 7.65% of the patients with complications were admitted to the hospital. The introduction of a varicella vaccination program could decrease the number of hospital admissions produced by complications

Incapacidad para iniciar la deambulación tras el reposo prolongado en una adolescente / Inhability to begin ambulation after prolonged bed rest in a teenaged girl

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[Subacute sclerosing panencephalitis: a still existing disease]. / Panencefalitis esclerosante subaguda: una enfermedad que todavía existe.

Subacute sclerosing panencephalitis (SSPE) is a rare entity with an invariably fatal course that progressively affects the central nervous system. It is caused by persistent infection with the wild-type measles virus. While rare in industrial countries, it is not infrequent in developing countries, where there are still areas of endemic measles infection and immunization is not yet generalized. We describe an eight-year-old Spanish girl who presented rhythmic and symmetric myoclonus. She contracted measles at 13 months and required hospitalization. No cognitive deterioration was found. Neuroimaging and the initial electroencephalogram were normal. Oligoclonal bands and high titers of measles antibodies were found in serum and cerebrospinal fluid. She was treated with oral metisoprinol and intraventricular alpha-interferon (IFN-) and showed no further progression of her symptoms. The importance of including SSPE in the differential diagnosis of patients consulting for school failure, neurological deterioration or movement disorders is highlighted. Special attention should be paid to the immigrant population from countries where the incidence of SSPE is greater than in Spain.

Panencefalitis esclerosante subaguda:una enfermedad que todavía existe / Subacute sclerosing panencephalitis: a still existing disease

La panencefalitis esclerosante subaguda (PEES) es una enfermedad rara y de curso fatal, que afecta de forma progresiva al sistema nervioso central. Está causada por la infección persistente de una forma mutante del virus del sarampión. En países desarrollados la incidencia de PEES es muy baja; no ocurre lo mismo en países menos favorecidos, donde existen todavía zonas endémicas de sarampión y la vacunación no está al alcance de la mayoría de la población. Se presenta una niña española de 8 años con mioclonías rítmicas y simétricas. Como antecedentes tan sólo destacaba un ingreso hospitalario por sarampión a los 13 meses de edad. No presentaba deterioro cognitivo ni intelectual. Las técnicas de neuroimagen fueron normales, así como los electroencefalogramas iniciales. En la electroforesis en suero y líquido cefalorraquídeo (LCR) se detectaron bandas oligoclonales. Los niveles de anticuerpos antisarampión en suero y LCR eran muy elevados. Se inició tratamiento con metisoprinol oral e interferón alfa por vía intraventricular con lo que se ha detenido la progresión de la enfermedad. Se subraya la importancia que tiene incluir la PEES en el diagnóstico diferencial de pacientes que consultan por deterioro cognitivo, disminución del rendimiento escolar o trastornos del movimiento. Se debe prestar especial atención a la población inmigrante procedente de países donde la PEES presenta una mayor incidencia que en España (AU)