The role of the European Swimming Federations in the protection of athletes' health and the promotion of health in the general population / El papel de las federaciones europeas de natación en la protección de la salud de atletas y de la promoción de la salud en la población general / O papel das federações europeias de natação na proteção da saúde dos atletas e na promoção da saúde da população em geral

Objective: To determine the profile of the medical personnel, priorities and activities/researches of the European National Swimming Federations respect to the protection of their athletes' health and their role in the promotion of health in the general population. Method: A cross-sectional descriptive survey was circulated among the 51 European National Swimming Federations requesting information regarding the profile of the medical personnel of the federations, the importance they place on the health of their athletes, the promotion of health in their societies and about the activities/research programmes that they engage in to promote health. Results: The results show that 58.9% of the European National Swimming Federations have doctors and 64.1% have physiotherapists. For 51.2% of federations the top priority is the performance of their elite athletes and only 10.2% of them have as a priority to improve the health of the general population. Conclusions: Overall, European National Swimming Federations have appropriate medical personal within their federation or National teams. However, they have reported that health promotion is not a top priority for them. There is a need to improve their general health promotion programmes. Plans and strategies could be implemented in order to promote health in the general population

Objetivo: Determinar el perfil del personal médico, las prioridades y las actividades/investigaciones de las federaciones nacionales de natación europeas respecto a la protección de la salud de sus atletas y su papel en la promoción de la salud en la población general. Método: Un estudio descriptivo transversal se distribuyó entre las 51 federaciones nacionales de natación europeas solicitando información en relación con el perfil del personal médico de las federaciones, la importancia que estas daban a la salud de sus atletas, la promoción de la salud en sus sociedades y sobre los programas de actividades/investigación que dedican a la promoción de la salud. Resultados: Los resultados muestran que el 58.9% de las federaciones nacionales de natación europeas tienen médicos y el 64.1% tienen fisioterapeutas. Para el 51.2% de las federaciones la principal prioridad es el rendimiento de sus deportistas de élite y solo el 10.2% de ellas tienen como prioridad mejorar la salud de la población general. Conclusiones: En general, las federaciones nacionales de natación europeas tienen personal médico adecuado dentro de sus federaciones o de sus equipos nacionales. Sin embargo, han informado que la promoción de la salud no es una prioridad para ellas. Hay una necesidad de mejorar sus programas de promoción de la salud general. Planes y estrategias podrían ser implementados con el fin de promover la salud en la población general

Objetivo: Determinar o perfil da equipe médica, as prioridades e as atividades/pesquisas das federações nacionais de natação europeias a respeito da proteção da saúde dos seus atletas e seu papel na promoção da saúde na população em geral. Método: Um estudo descritivo transversal foi distribuído entre as 51 federações nacionais de natação europeias, solicitando informações sobre o perfil da equipe médica das federações, a importância que davam para a saúde de seus atletas, a promoção da saúde em suas sociedades e sobre os programas de atividades/pesquisas dedicados à promoção da saúde. Resultados: Os resultados mostram que 58.9% das federações nacionais de natação europeu têm uma equipe médica e 64.1% têm fisioterapeutas. Para 51.2% das federações, a principal prioridade é o desempenho de seus atletas e apenas 10.2% têm como prioridade melhorar a saúde da população em geral. Conclusões: Em geral, as federações nacionais de natação europeias têm uma equipe médica adequada dentro de suas federações ou equipes nacionais. No entanto, relataram que a promoção da saúde não é uma prioridade para elas. Há uma necessidade de melhorar os seus programas de promoção da saúde em geral. Planos e estratégias poderiam ser implementadas, a fim de promover a saúde da população em geral

[Tumours in the pineal region in the paediatric age. Reports of 23 cases and a review of the literature]. / Tumores de la region pineal en la edad pediatrica. Presentacion de 23 casos y revision de la bibliografia.

INTRODUCTION: Tumours in the pineal region are located at a meeting point of several neurovascular structures that are difficult to reach surgically and for which the possibility of resection is limited; as a result the management of these lesions usually requires associated adjunctive treatment with radiotherapy and/or chemotherapy. PATIENTS AND METHODS: This study is a retrospective analysis of the epidemiological, clinical, neuroimaging and pathological characteristics of 23 patients with tumours in the pineal region who were treated between the years 1997 and 2010 in the Hospital Infantil Niño Jesús. The factors involved in the prognosis of this cohort following surgical or adjunctive treatment are also discussed. RESULTS: Subjects included in the study were 6 girls and 17 boys with ages ranging from 4 months to 18 years. It was found that the initial symptoms in 95% of the patients were signs of acute or subacute hydrocephalus, which required the placement of a ventriculoperitoneal shunt (82%). A histological sample of the tumour tissue was collected in all cases. Biopsy samples were taken in the case of five patients and 18 underwent surgery involving a craniotomy. Germinoma (eight cases) and mature teratoma (one case) were the tumours with the longest survival times; non-germinomatous tumours (three cases), those of the pineal parenchyma (four cases) and gliomas (five cases) presented the highest rates of recurrence and a poorer prognosis. CONCLUSIONS: The study of tumour markers can be used to guide the diagnosis of certain tumours of the pineal region. At present, the recommended procedure involves taking a histological sample of the tumour in order to establish an accurate diagnosis and a specific oncological treatment.

[New evidence in the susceptibility to dengue infection associated to HH polymorphism of FcgammaRIIa receptor]. / Nuevas evidencias en la susceptibilidad a la infección por dengue asociadas al polimorfismo HH del receptor FcgammaRIIa.

INTRODUCTION: polymorphic variants of FcgammaRIIa receptor have been associated to susceptibility to develop several infectious diseases. The relationship between the polymorphism of this receptor and the susceptibility to dengue hemorrhagic fever was recently reported. OBJECTIVES: to explore whether the association of the homocygotic variants of the receptor to susceptibility to or protection from a disease could be also related with the IgG antibody titters and the exposure to a number of infections. METHODS: a retrospective analytical study was performed on individuals who had been infected with the dengue virus 4 during the 2006 epidemic in the City of Havana and were tracked down in 2008. A total number of 97 individuals were recruited of whom 68 had suffered dengue fever and 29 had had dengue hemorrhagic fever. A 10-mL blood sample was taken from each of them and then placed in EDTA anticoagulant for DNA isolation and 5 mL placed in dry tubes to obtain serum. The genetic polymorphism of FcgammaRIIa receptor, the total anti-dengue IgG antibody titers and the antecedent of dengue infection were determined. RESULTS: it was interesting to note that there was very significant direct relation (p< 0.0001) between high anti-dengue IgG antibodies titers and the number of infections suffered by these people. This behaviour was present in those individuals with the HH homocygotic variant. CONCLUSION: it seems that those individuals with polymorphism in FCgammaRIIa-H/H receptor would tend to non-elimination of IgG antibodies through this receptor, which is associated to the number of infections suffered by the individual.

[Use of antifungal combination therapy]. / Uso de la terapia antifungica combinada.

The growing use of antifungal agents in patients with febrile neutropenia points at combination therapy as a strategy to face the increasing incidence of fungal infections in this population. Likewise, the low efficacy of single-drug therapies calls for research on this approach. Combination therapies should focus on extending their activity to a wider range of microorganisms, considering the mechanisms of action of major known antifungal agents, and also on enhancing the individual effect of each drug alone. In vitro and in vivo findings suggest that combination therapy may be better than single-drug therapy with amphotericin B for the treatment of emergent pathogens in immunosuppressed patients. In order to implement combination treatments, knowledge of the sensitivity profile of most prevalent species is required.

[Cranial lesions due to forceps delivery]. / Lesiones craneales secundarias a parto asistido con forceps.

Deliveries with forceps or vacuum-extraction increase the incidence of perinatal craneoencephalic lesions, for which reason cesarean sections are performed more frequently. We report 3 cases of cranial lesions due to forceps deliveries, 2 with depressed skull fractures and 1 with a depressed fracture and an associated epidural hematoma. Diagnosis is made on clinical and radiological founds with CT scan or MRI. Treatment is surgical and consists of elevation of the depressed fracture and evacuation of the hematoma. The correct use of forceps is very important to avoid this kind of lesions in the newborn, especially in cases of difficult delivery.

Lesiones craneales secundarias a parto asistido con forceps / Cranial lesions due to forceps delivery

Los partos asistidos con forceps o vacuum aumentanla incidencia de lesiones craneoencefálicas fetales,siendo la tendencia actual a realizar cesáreas en partosque se prevén difíciles.Presentamos una serie de tres casos de lesionescraneales secundarias a parto asistido con forceps, doscasos de fracturas deprimidas y una fractura deprimidacon hematoma epidural subyacente. El diagnóstico serealiza con la clínica y técnicas de imagen como TACo IRM. El tratamiento es quirúrgico en la mayoría decasos, con elevación de la fractura y evacuación delhematoma.La forma correcta de aplicar los forceps resultaesencial para prevenir lesiones craneales fetales, especialmenteen partos difíciles (AU)

Deliveries with forceps or vacuum-extractionincrease the incidence of perinatal craneoencephaliclesions, for which reason cesarean sections are performedmore frequently. We report 3 cases of craniallesions due to forceps deliveries, 2 with depressedskull fractures and 1 with a depressed fracture and anassociated epidural hematoma. Diagnosis is made onclinical and radiological founds with CT scan or MRI.Treatment is surgical and consists of elevation of thedepressed fracture and evacuation of the hematoma.The correct use of forceps is very important to avoidthis kind of lesions in the newborn, especially in cases ofdifficult delivery (AU)

[Brain-stem tumors in children]. / Tumores de tronco cerebral en la población pediátrica.

We report a large series of brain-stem tumors seen during 18 years of at our hospital. We diagnosed and treated a total of 42 patients between 1988 and 2006; 36 of them were operated with partial resection in most cases. Brain-stem tumors constitute a rare condition with very bad prognosis. A surgical complete resection of the mass is not possible in most cases, so the principal surgical objective is reduction and decompression. The best prognosis is seen in patients with low grade tumors with minimal neurologic deficit. Most of these tumors cause death in a short period, usually one year or less.

Tumores de tronco cerebral en la población pediátrica / Brain-stem tumors in children

Presentamos una serie de tumores de tronco cerebraldiagnosticados y tratados en nuestro centro duranteun período de 18 años. Se han revisado un total de 42pacientes entre los años 1982 y 2006; 36 de ellos fueronintervenidos, realizándose una resección parcial en lamayoría de los casos.Los tumores de tronco cerebral suponen una raraentidad patológica con muy mal pronóstico. En lamayoría de los casos no resulta posible una reseccióncompleta de la lesión, por lo que el principal objetivode la cirugía es la reducción de masa tumoral y ladescompresión. El mejor pronóstico se obtiene en lostumores de bajo grado de malignidad con mínimo déficitneurológico. La mayoría de estos tumores provocanla muerte en un breve período, habitualmente un año omenos desde el diagnóstico (AU)

We report a large series of brain-stem tumors seenduring 18 years of at our hospital. We diagnosed andtreated a total of 42 patients between 1988 and 2006;36 of them were operated with partial resection in mostcases.Brain-stem tumors constitute a rare condition withvery bad prognosis. A surgical complete resection of themass is not possible in most cases, so the principal surgicalobjetive is reduction and descompression. The bestprognosis is seen in patients with low grade tumors withminimal neurologic deficit. Most of these tumors causedeath in a short period, usually one year or less. (AU)

Tratamiento quirúrgico de los quistes aracnoideos sintomáticos en niños / Surgical treatment of symptomatic arachnoid cysts in children

Introducción. Los quistes aracnoideos (QA) deben tratarse quirúrgicamente cuando son sintomáticos. Actualmente persiste todavía la controversia sobre la mejor técnica quirúrgica: derivación cistoperitoneal (CPS) o fenestración del quiste, bien mediante craneotomía o por técnicas endoscópicas. Pacientes y métodos. Se presentan los resultados de una serie de 18 pacientes con edad inferior a los 10 años que se han tratado de QA sintomáticos. 12 pacientes presentaron aumento del perímetro craneal, 4 cefaleas y 2 niños crisis comiciales. La localización ha sido supratentorial en 11 casos y 7 intratentorial. Resultados. En 12 casos el tratamiento realizado ha sido la derivación cistoperitoneal o ventriculoperitoneal. En 5 pacientes se ha realizado tratamiento endoscópico del quiste y en 1 caso desbridamiento mediante craneotomía. De los 18 niños, 7 han precisado una segunda intervención para resolver la clínica, bien por mal funcionamiento valvular o por insuficiencia del tratamiento endoscópico. Como complicaciones se han producido 2 hematomas subdurales, que han precisado tratamiento quirúrgico. No se ha producido mortalidad ni morbilidad. Conclusiones. Los avances en técnicas endoscópicas pueden ser el tratamiento ideal frente al desbridamiento por craneotomía, aunque hay que tener en cuenta el alto porcentaje de no resolución en niños de menos de 15 meses. La CPS soluciona el problema de estos quistes con menor riesgo quirúrgico, pero tiene un alto índice de reintervenciones, además de la dependencia del shunt. En la revisión bibliográfica realizada se comprueba que se publican todavía series tratadas tanto con fenestración del quiste como mediante derivación (AU)

Introduction. When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy –implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques. Patients and methods. This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial. Results. Treatment involved a cyst-peritoneal or ventriculo peritoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred. Conclusions. The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts (AU)

[Surgical treatment of symptomatic arachnoid cysts in children]. / Tratamiento quirúrgico de los quistes aracnoideos sintomáticos en niños.

INTRODUCTION: When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy -implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques. PATIENTS AND METHODS: This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial. RESULTS: Treatment involved a cyst-peritoneal or ventriculoperitoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred. CONCLUSIONS: The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts.

Cerebral fluid edema: an unusual complication of ventriculoperitoneal shunts.

INTRODUCTION: A case of accumulation of CSF into the brain parenchyma simulating a brain tumor, secondary to an obstructed ventriculoperitoneal shunt, is presented. Until now, only seven cases of this rare complication have been described. CASE REPORT: Magnetic resonance showed an expansive, low-density intracranial lesion on the right frontal and parietal lobe. This mass was biopsied, but no tumor was found and the diagnosis was brain edema. CONCLUSION: The mistake in the diagnosis was due to the clinical symptoms and to the MR images.

[Intrathecal baclofen therapy: the selection of patients and short term results in five patients]. / Terapia con baclofén intratecal: selección de pacientes y resultados a corto plazo en cinco pacientes.

INTRODUCTION: Intrathecal baclofen therapy (ITB) is a new tool in the integrated treatment of childhood spasticity. AIMS. We describe the eligibility and exclusion criteria used in the study and short term results of ITB therapy in our first five patients are also reported. PATIENTS AND METHODS: Our sample of patients consisted of three females and two males aged between 14 and 17 years. Two of them were ambulant (one without help and the other with crutches), two were serious non ambulant tetraparetics and the other was in a wheelchair but minimally ambulant. All of them satisfied our eligibility criteria. The main aims set out were to improve walking in the three patients with less serious involvement and to reduce or eliminate the pain and enhance quality of life (QOL) in the two more seriously affected patients. In all cases, the Baclofen test was positive. RESULTS: Follow up time was between 2 and 5 months. The objectives appear to have been accomplished, for the time being, in three patients: the two ambulant patients improved their capacity to walk and one male with serious spastic tetraparesis and pain no longer suffers from that pain and his QOL has improved. There were mild transient side effects in three patients. CONCLUSION: The selection of patients, including the definition of realistic tailor made objectives, is an essential step in ITB therapy. Results in our series, in the short term, indicate that ITB therapy can be efficient in ambulant and non ambulant patients, and offers few side effects.

Terapia con baclofén intratecal: selección de pacientes y resultados a corto plazo en cinco pacientes / Intrathecal baclofen therapy: the selection of patients and short-term results in five patients

Introducción. La terapia con baclofén intratecal (ITB) es una nueva herramienta en el tratamiento integral de la espasticidad en la infancia. Objetivo. Se exponen los criterios de inclusión y de exclusión que utilizamos. Además, se revisan los resultados a corto plazo del tratamiento con ITB en nuestros cinco primeros pacientes. Pacientes y métodos. Se trata de tres mujeres y dos hombres de entre 14 y 17 años de edad. Dos eran pacientes ambulatorios (uno sin ayuda y otro con muletas), dos tetraparéticos graves no ambulatorios y uno, en silla de ruedas, mínimamente ambulatorio. Todos cumplían los criterios de selección. Los objetivos principales planteados fueron: mejorar la marcha en los tres pacientes con afectación menos grave y disminuir o eliminar el dolor y mejorar la calidad de vida (CDV) en los dos pacientes más graves. En todos, la prueba de baclofén fue positiva. Resultados. El tiempo de seguimiento fue de entre 2 y 5 meses. Los objetivos parecen, por el momento, cumplidos en tres pacientes: los dos deambulantes -mejoraron su deambulación- y un varón con tetraparesia espástica grave y dolor -ha desaparecido el dolor y ha mejorado su CDV-. En tres pacientes hubo efectos adversos de intensidad ligera y transitorios. Conclusión. La selección de pacientes, con una definición de objetivos realista e individualizada, es un paso esencial en la terapia con ITB. Los resultados en nuestra serie, a corto plazo, indican que la terapia con ITB puede ser eficaz en pacientes deambulantes y no deambulantes, y presenta pocos efectos adversos (AU)

Introduction. Intrathecal baclofen therapy (ITB) is a new tool in the integrated treatment of childhood spasticity. Aims. We describe the eligibility and exclusion criteria used in the study and short-term results of ITB therapy in our first five patients are also reported. Patients and methods. Our sample of patients consisted of three females and two males aged between 14 and 17 years. Two of them were ambulant (one without help and the other with crutches), two were serious non-ambulant tetraparetics and the other was in a wheelchair but minimally ambulant. All of them satisfied our eligibility criteria. The main aims set out were to improve walking in the three patients with less serious involvement and to reduce or eliminate the pain and enhance quality of life (QOL) in the two more seriously affected patients. In all cases, the Baclofen test was positive. Results. Follow-up time was between 2 and 5 months. The objectives appear to have been accomplished, for the time being, in three patients: the two ambulant patients improved their capacity to walk and one male with serious spastic tetraparesis and pain no longer suffers from that pain and his QOL has improved. There were mild transient side-effects in three patients. Conclusion. The selection of patients, including the definition of realistic tailor-made objectives, is an essential step in ITB therapy. Results in our series, in the short term, indicate that ITB therapy can be efficient in ambulant and non-ambulant patients, and offers few side-effects (AU)

[Lumbar disc disease in adolescents]. / Hernia discal lumbar en adolescentes.

INTRODUCTION: Intervertebral disc herniation is a very common neurosurgical pathology. Most commonly disc disease occurs in adults and series published in children are only few and each reports only few cases. A genetic factor has been considered but in none of our patients there was a family history of disc disease. PATIENTS AND METHODS: We report ten patients with disc herniations in adolescents occurring among 1920 patients operated of herniated discs between 1988 and 1998. These herniations in adolescents were all related to some sport activities, and they occurred in the age range of 12 to 16 years. Symptoms were back pain and lower extremities pains of roots L5 or S1. All were studied with magnetic resonance imaging and in all patients the herniated disc was either in L4 L5 or L5 S1 intervertebral spaces. All disc were subligamental and 81.5% were posterolateral in position. Pathological studies of the herniated discs showed elastic consistency with high water content without degenerative changes. RESULTS: After microscopic removal of the herniated discs pain disappeared and remained so in the follow up. It was not necessary to reoperate in any of these patients and the postoperative follow up was between 2 and 5 years. CONCLUSIONS: Herniated disc disease is very infrequent in adolescents and all recovered completely after surgery, and the localization is posterolateral and subligamental.

Hernia discal lumbar en adolescentes / Lumbar disc disease in adolescents

Introducción. Las hernias discales son una patología habitual dentro de la Neurocirugía, pero la presentación suele producirse en la edad adulta y las series publicadas en niños son pocas y con un número de casos pequeño. Se ha invocado un factor genético, pero en ninguno de nuestros casos existía antecedente familiar de hernia de disco. Pacientes y métodos. Se presentan 10 hernias discales lumbares (HDL) en adolescentes en una serie de 1.920 HDL, que abarca desde 1988 hasta 1998. Todos los casos de la serie se presentaron asociados a la realización de algún tipo de deporte. Las edades estaban comprendidas entre los 12 y los 16 años. La clínica fue un cuadro de dolor lumbar con irradiación por el territorio radicular asociado (L5 o S1). Todos los casos se estudiaron con resonancia magnética y su localización fue, en el 100 por ciento, entre L4-L5 y L5-S1; todas eran hernias subligamentosas y el 81,5 por ciento aparecieron en posición posterolateral. La anatomía patológica demostró una consistencia elástica y alto contenido en agua, sin fenómenos degenerativos. Resultados. En todos los casos desaparecía el cuadro doloroso y se hacían asintomáticas tras la realización de extirpación por el procedimiento de microdisectomía. No se precisó reintervención en ningún caso, y el control postoperatorio fue de entre 2 y 5 años. Conclusiones. La HDL del adolescente es una patología poco frecuente y en todos los casos los resultados fueron buenos después de la intervención quirúrgica. La localización generalmente es subligamentosa posterolateral (AU)

Introduction. Intervertebral disc herniation is a very common neurosurgical pathology. Most commonly disc disease occurs in adults and series published in children are only few and each reports only few cases. A genetic factor has been considered but in none of our patients there was a family history of disc disease. Patients and methods. We report ten patients with disc herniations in adolescents occurring among 1920 patients operated of herniated discs between 1988 and 1998. These herniations in adolescents were all related to some sport activities, and they occurred in the age range of 12 to 16 years. Symptoms were back pain and lower extremities pains of roots L5 or S1. All were studied with magnetic resonance imaging and in all patients the herniated disc was either in L4-L5 or L5-S1 intervertebral spaces. All disc were subligamental and 81.5% were posterolateral in position. Pathological studies of the herniated discs showed elastic consistency with high water content without degenerative changes. Results. After microscopic removal of the herniated discs pain disappeared and remained so in the follow up. It was not necessary to reoperate in any of these patients and the postoperative follow up was between 2 and 5 years. Conclusions. Herniated disc disease is very infrequent in adolescents and all recovered completely after surgery, and the localization is posterolateral and subligamental (AU)

Subdural empyema with extension to vertebral canal secondary to salmonellosis in a patient with systemic lupus erythematosus.

CASE REPORT: A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection. DISCUSSION: We review the neurological and neurosurgical complications in systemic lupus erythematosus.

[Dysembrioplastic neuroepithelial tumors]. / Tumores neuroepiteliales disembrioplásicos.

INTRODUCTION: The dysembryoplastic neuroepithelial tumours, first defined by Dumas-Duport in 1988, are characterized histologically by being found in the cerebral cortex and having a histological pattern of multinodular architecture, foci of cortical dysplasia and a specific glioneuronal element. The clinical condition is characterized by seizures with a long evolution. These seizures are usually simple or complex partial seizures, but occasionally become generalized tonic-clonic seizures. Radiological findings on CAT or MR are cystic images localized to the cortex, with a solid component and do not cause displacement. The surgical operation required involves excision of the lesion or lesionectomy. This may be done so as to include 1 cm of the periphery of the lesion. The evolution is excellent and in most cases the seizures disappear. CLINICAL CASES: We present 4 cases of a series of 470 patients with tumours of the nervous system, operated on over the past 10 years in the Hospital del Niño Jesús. The evolution of these 4 cases has been from 1 to 5 years. In all 4 cases lesionectomy was carried out, and the evolution has been excellent (grade I of Engel's classification). CONCLUSIONS: 1. Dysembryoplastic neuroepithelial tumours are solid and cystic, situated in the cerebral cortex, with foci of cortical dysplasia. They are characterized by having a specific glioneuronal element. 2. Clinically they are characterized by crises with a long evolution. 3. The surgical operation involves lesionectomy or excision of the lesion. The evolution is excellent.

Pneumocephalus after shunting for hydrocephalus.

A case of tension pneumocephalus that occurred after ventriculoperitoneal shunting is presented. We have reviewed 12 cases of pneumocephalus in association with ventriculoperitoneal shunt placement. This phenomenon occurs when air is forced through the shunt or enters through the cranial base because of: iatrogenic postsurgical connection, congenital fistula, trauma, or thinning of the cranial base. Ways of preventing and treating this problem are outlined.

Trigeminal neurinomas in infants: report of two cases.

Two cases of trigeminal neurinoma in two infant girls aged 3 and 6 months are reported. Both presented with temporal cranial vault bulging at birth. The 6-month-old patient suffered onset of focal fits 1 month before admission and her neurological examination revealed no abnormalities. The 3-month-old patient had right exophthalmus and a subcutaneous fronto-orbital plexiform neurofibroma at birth. Neurological examination disclosed a sensory deficit of the first trigeminal nerve division. She also had a family medical history of von Reckling-hausen's disease. The incidence of trigeminal neurinomas in children is reviewed. The patients in these two cases are the youngest recorded; the cases are the only ones reported in infants. Clinical, radiological, and therapeutic aspects are discussed.