Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

[Ambulatory phlebectomy: our experience]. / La flebectomia ambulatoriale: nostra esperienza.

The Authors report their experience of out-patient phlebectomy. Over a period of 5 years they have examined 186 patients (156 females, 30 males): 166 had micro- and extra-saphenic varicosities, while 20 had recurrent varices. Patients with ostium failure were excluded. Muller's out-patient phlebectomy implies an accurate mapping of varicosities, local anaesthesia, microincisions which are only exceptionally sutured. The Authors consider that an accurate elastic pressure bandage is indispensable and useful in order to improve the dynamics of the PVC and to avoid haemorrhages. Such a surgical technique bears aesthetic, economic and haemodynamic advantages.

[Peroperative endoscopic papillotomy in a patient with an abdominal aortic aneurysm and biliary calculi]. / Papillotomia endoscopica peroperatoria in paziente con aneurisma dell'aorta addominale e calcolosi biliare.

The authors report a case of abdominal aortic aneurysm associated with biliary tract lithiasis. The need to simultaneously treat both diseases is stressed. A technique which involves endoscopy during open surgery in order to prevent contamination is illustrated. The technique used together with other manoeuvres is part of a methodology aiming to broaden indications to the treatment of abdominal diseases associated with vascular diseases, limiting at the same time the risks of prosthetic infection.

[Posttraumatic pseudoaneurysms of the anterior tibial artery: a review of the literature and a clinical case report]. / Pseudoaneurismi post-traumatici dell'arteria tibiale anteriore: revisione della letteratura e presentazione di un caso clinico.

The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.

[Juvenile vascular pathology due to homocystinuria. A clinical case report]. / Patologia vascolare giovanile da omocistinuria. Presentazione di un caso clinico.

The authors report a case of juvenile vasculopathy in a homocystinuria patient. They point out that thromboembolism may be the only symptomatic expression of this genetically determined metabolic disease. Diagnostic approach and surgical therapy of the vascular lesions as well as medical therapy to prevent further complications are analysed. The opportunity to perform clinical tests for the diagnosis of homocystinuria in all those young patients presenting vascular lesions without other risk factors is finally stressed.

[Brachial plexus block by the axillary route. Cannulation of the neurovascular sheath with a G22 spinal needle. Our experience with 100 cases]. / Il blocco del plesso brachiale per via ascellare. Incannulamento della guaina del fascio neuro-vascolare mediante ago da spinale G22. Nostra esperienza su 100 casi.

The aim of this study was to evaluate the utility of the brachial plexus block using an axillary route employing the technique in which the needle is inserted into the sheath at an angle parallel to the neuro-vascular bundle with a sole modification: using a G22 spinal needle and without evoking paresthesia. The results obtained show that this method ensures an improved and more widespread analgesia. The flexibility and small size of the G22 spinal needle allow traumas to the axillary guaina and brachial plexus to be reduced to a minimum. In addition its length enables the anesthetic solution to be diffused around the first rib, including the axillary and musculo-cutaneous nerves, thus ensuring e total sensory and motor block of the upper limb.

[Risk factors and multicentricity of vascular atherosclerotic disease. Our experience]. / Fattori di rischio e polidistrettualità nella malattia vascolare aterosclerotica. Nostra esperienza.

The objective of this study is the identification of the most important risk factors of atherosclerosis and the determination of its multicentricity, the goal being an efficient primary and secondary prevention of this disease. Over the course of eight years, at the Department of Diagnosis and Surgical Physiopathology of Peripheral Vascular Diseases, 829 subjects with atherosclerosis were examined, of whom 513 males and 316 females between 18 and 85 years old, as well as to 200 healthy control subjects. The risk factors in consideration were: age, sex, hypertension, diabetes, lipoidoproteinosis, smoking, alcohol and coffee intake. From the data obtained it was revealed that smoking represents the most important risk factor for atherosclerosis (65% of the cases, 40% of the controls), followed in decreasing order by hypertension (31% of the cases, 6% of the controls), diabetes (26% of the cases, 2% of the controls), lipoidoproteinosis (15% of the cases, 6% of the controls). Furthermore 21% of the subjects drank coffee and 28% ingested alcoholic beverages, compared with, respectively 19% and 24% of the controls. In 70% of the cases the presence of atherosclerotic lesions were found in more than one vascular region. Atherosclerosis has a multifactorial etiology as there exists a correlation between the predisposition of the patient to acquire the disease and environmental factors. It is difficult to distinguish the determining effects of a single risk factor, because often many risk factors are tightly interrelated in the same individual; a nearly direct relationship clearly exists between the number and entity of the risk factors and the clinical picture of the patient examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[An anaphylactic reaction to succinylcholine. A clinical case]. / Reazione anafilattica da succinilcolina. Caso clinico.

A case of severe anaphylactic reaction provoked by suxamethonium during the induction of general anaesthesia is reported. Diagnosis of reaction and the trigger effect of suxamethonium was identified by intradermal testing. Diagnosis of anaphylactic reaction was confirmed on serial blood estimations of IgE and C3-C4 of complement fractions.