[Staphylococcal scalded skin syndrome]. / Síndrome de escaldadura estafilocócica.

INTRODUCTION: Staphylococcal scalded skin syndrome is a rare disease caused by Staphylococcus aureus that produces exfoliative toxins. There are few epidemiological data in our environment. PATIENTS AND METHODS: We present an observational cohort study. We review the cases of staphylococcal scalded skin syndrome monitored at La Paz Children Hospital during the last ten years (January 1997 to December 2006). RESULTS: We obtained 26 patients, 7 in the first 5 years and 19 more in the following years. The mean age at diagnosis was 19 months. Four cases (15%) occurred during the neonatal period. Sixty-seven percent of the cases were diagnosed during spring and summer. Main clinical signs were: erythroderma with blisters and posterior desquamation (100%), perioral fissures (54%), fever (46%), conjunctivitis (42%) and palpebral edema (31%). No significant increases in leukocytes (mean: 11,341/.l) or C-reactive protein (mean: 9 mg/l) were found on blood analysis. Diagnosis was made by clinical findings. S. aureus was isolated in nasal or conjunctival samples on 59% of cases. All strains were sensitive to cloxacillin, clindamycin and vancomycin. The patients were treated with cloxacillin with good progress. CONCLUSIONS: Staphylococcal scalded skin syndrome seems to be more common in the last few years. It must be suspected in children with acute erythroderma and perioral or conjunctival lesions. Treatment with cloxacillin leads to healing without sequelae.

[Treatment of infantile acute lymphoblastic leukemia with protocol ALL-BFM 83]. / Tratamiento de la leucemia aguda linfoblástica infantil con el protocolo ALL-BFM 83.

The outcome of 63 children with non-B acute lymphoblastic leukemia treated with ALL-BFM 83 protocol is analyzed. 95% achieved complete remission with the initial treatment. For the entire group the event free survival (EFS) was 66% (+/- 9%) at 48 months. These results were close to those obtained by the BFM group. Haematological toxicity was the main adverse effect, but there where no therapy related deaths. Persistence of more than 1,000 blast cells per microl in peripheral blood after 7th days of prednisone monotherapy, and spleen size greater than or equal to 5 cm under the costal margin, were identified as independent risk factors of high significance. The EFS in patients with poor clinical response to steroids (greater than or equal to 1,000 blast/microl at day 8) was 22% (+/- 18%), instead of 69% (+/- 12%) in those with adequate response.