Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial.

OBJECTIVE: Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide (TA) is equivalent to that of triamcinolone hexacetonide (TH), if used at double the dosage. In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints, in children with juvenile idiopathic arthritis (JIA). METHOD: Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study. The symmetry was assessed by both clinical examination and synovial fluid analysis. The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA. The identity of injected compound was blinded to the patient and to the physician. RESULTS: Thirty-seven patients, 30 female, seven male, with JIA, entered the study. A total of 86 joints were injected. Twenty-one (53.8%) of the joints injected with TA relapsed first compared with only six (15.4%) of the joints injected with TH. In three (7.7%) relapse occurred simultaneously. Nine (23%) were still in remission after 24-month follow-up. The percentage of joints with lasting remission was higher with TH than with TA (80 vs 47.5% after 12 months and 63.6 vs 32.4% after 24 months, respectively; log rank test P = 0.003). CONCLUSION: Even when TA is given at higher doses, TH is more effective and should be considered the drug of choice for intra-articular treatment of JIA.

Behavioural and physiological reactivity to noise in the newborn.

OBJECTIVE: To assess the electromyographic (EMG) and behavioural reactivity of a group of newborn infants exposed to noisy stimulation of various intensity recorded in the Paediatric intensive care Unit (PICU). METHODS: The study was performed at the nursery of the Paediatrics Department (University of Padova) on a group of 21 healthy newborns (mean 39 weeks of gestation), assessed between 24 and 72 h after birth. The study involved taking EMG recordings of the corrugator supercilii muscle and assessing the infant's behaviour at the baseline (15 seconds before stimulation), during noisy stimulation (for 1-2 seconds) and during recovery (15 seconds in three subphases). The noises, previously recorded in PICU, had four different intensities and were administered in random order to all infants. Descriptive analysis and repeated-measures analysis of variance (anova) were performed on the EMG and behavioural data. RESULTS: The infants demonstrated a significant reaction to the noises both in the EMG recordings and in behavioural changes, especially during intense noisy stimulation. The reaction lasted longer than the stimulation period, preventing the infants from returning to the baseline condition. CONCLUSIONS: Exposure to high-intensity noise produced in PICU causes evident behavioural and physiological effects (EMG). This is a field of study that could have important repercussions, given the medium- and long-term effects of repeated noise stimulation.

Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis.

OBJECTIVE: To compare the efficacy and safety of intra-articular triamcinolone hexacetonide (TH) and triamcinolone acetonide (TA) in children with oligoarticular juvenile idiopathic arthritis (JIA). METHODS: One hundred and thirty joints of 85 patients undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. The efficacy of both treatments was evaluated prospectively in a blinded fashion. A good response was defined as a decrease in the articular score of > or =60% from baseline. Clinical, laboratory and immunological variables were noted in order to examine possible factors, other than treatment, predictive of the result. RESULTS: Seventy injections were performed using TH and 60 with TA. The two groups were comparable for clinical, immunological and laboratory characteristics. The rate of response was significantly higher with TH than with TA: 81.4% vs 53.3% (P = 0.001) at 6 months, 67.1 vs 43.3% (P = 0.006) at 12 months, and 60 vs 33.3% (P = 0.002) at 24 months. CONCLUSION: At comparable doses TH appeared to be much more effective than TA for intra-articular use, in both short- and long-term follow-up. This result was not affected by disease duration or degree of local and systemic inflammation.

Self-report assessment of recurrent abdominal pain.

UNLABELLED: Pain is the principal, and often the only symptom in cases of recurrent abdominal pain (RAP). The purpose of this study was to analyze the clinical background behind the pain symptom and the pain's capacity for differentiation in the diagnostic assessment of a group of 86 children suffering from RAP and observed at a pediatric gastroenterology service. The self-rating methods applied to the children included a verbal scale and a Visual Analogue Scale (VAS) for scoring the pain, and the Eland method, which is based on a graphic representation of the pain to enable its quantification and localization. Regardless of the pain assessment emerging from this study, the children were divided into 3 groups on the basis of a standardized diagnostic procedure, i.e. G1--upper gastrointestinal tract disease; G2--RAP with no apparent organic cause; G3--intestinal disease. RESULTS: The intensity of the pain fails to distinguish between the three groups, while other features seem more useful, e.g. variability in the pain's intensity, the number and location of painful sites, and the how the pain is graphically represented. Drawings typical of RAP with no apparent organic cause characteristically represent the pain more accurately and in greater detail, using more colors and a certain refinement in the performance of the drawing, with varying types of pain in subsequent episodes, and involving several abdominal and even extra-abdominal sites. In our experience, this method might contribute towards the completion and standardization of the child's clinical history and clinical evaluation. Such methods would have to be validated by further clinical studies, however.

Comparison between echocardiographic subtraction method and first-pass radionuclide ventriculography for measuring right ventricular volume after operative "repair" of patients with tetralogy of Fallot.

In the long-term follow-up of patients after repair of tetralogy of Fallot, monitoring right ventricular function is mandatory. The echocardiographic subtraction method proposed by Tomita seems to be easily applicable to a pediatric age population and accurate enough to be included in the longitudinal surveillance of such a group of patients.

Pain management of arteriovenous fistula cannulation in haemodialysis children: efficacy of EMLA anaesthetic cream.

The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mixture of local anaesthetics) in controlling pain due to arteriovenous fistula cannulation in teenagers undergoing chronic haemodialysis. The study was conducted in two phases, one prospective, the other a blind randomized trial, at the Paediatric Haemodialysis service of the Paediatrics Department of Padua University, Italy. It involved six teenagers, aged 12-18 years. Pain was measured using the visual analogue scale, indirect evaluation by nurses and a four-category verbal rating scale. Results showed that: (1) the visual analogue scale calls for an adequate training period; and (2) the EMLA cream might be effective in controlling cannulation-related pain but emotional factors, such as uncontrolled fear and stress, can interfere with the global efficacy of the analgesic approach. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

[Silent celiac disease: results of a study in secondary schools of Padua]. / La celiachia silente: risultati di uno studio nelle scuole medie di Padova.

Aim of this study was the assessment of the prevalence of coeliac disease (CD) in children attending the secondary school in the city of Padua. 939 students, aged 10-15 years (mean age: 12 years, 7 months), 35% eligible population, were accepted to undergo a study process which included three stages: a) in all students venous sample was taken for measurement of the IgG and IgA anti-gliadin antibodies (AGA); b) measurement of serum immunoglobulins and anti-endomysium antibodies (AEA) if AGA IgA was resulted positive; c) intestinal biopsy was performed in 3 students; two of them had pathologic levels of AGA IgG and IgA and AEA. These patients were females and had decreased rates of statural growth, anemia with iron deficiency, anorexia, abdominal pain, asthenia. The third girl had positive AGA IgG and IgA but absence of AEA and normal biopsy. She also had symptoms of abdominal pain, reduced height. Follow-up studies have been planned to establish a latent phase of CD. In conclusion, the prevalence of CD was 2.13/1000 (0.37-8.55, 95% CI), if we consider the patients with established diagnosis of CD in the same urban area and of the same age, the overall incidence increases to 2.6/1000. This prevalence, therefore, is higher, than that of 0.5/1000 previously reported in the general population, with a ratio of 1/4 between patients already known and the cases detected in this study.

[Abdominal pain syndrome recurring after 40 years: critical revision]. / La sindrome del dolore addominale ricorrente 40 anni dopo: revisione critica.

Recurrent abdominal pain (RAP) syndrome is described by Apley 40 years ago. The definition of condition, still generally accepted, is at least three episodes of abdominal pain over a period of three months, with pain of intensity which affects the behaviour of the child. The prevalence of condition among school children is 10-15%. Apley's classic studies demonstrated organic disease in only 10% of the children. Apley's conclusions have dominated pediatric writing through present era. In recent years, however, a number of reports have appeared in the medical literature that have suggested that careful investigation of children with RAP may reveal previously unsuspected functional or morphologic abnormalities of the gastrointestinal tract. These have included reports of peptic disease and Helicobacter Pylori infection, abnormal antro-duodenal motility, lactase malabsorption, gastro-esophageal reflux. Nevertheless these abnormalities cannot be correlated always with specific complaints. Therefore pathogenetic background is not clarified. Despite greater understanding of these disorders the enigme remains. There is a need for controlled studies in non selected patients.

Childhood obesity treatment: double blinded trial on dietary fibres (glucomannan) versus placebo.

Dietary fibres are frequently used for the treatment of paediatric obesity. The aim of this clinical trial is to evaluate the efficacy of glucomannan in the child obesity management. This experimental design was double blinded with a block randomisation, alpha = 0.05, beta = 0.2 and delta = 50%. The study involved 60 children under 15 years of age (mean age 11.2 years, mean overweight 46%), 30 of them under glucomannan treatment (1 g twice a day for two months) and 30 under placebo and the same schedule. The drug and the placebo were indistinguishable both for the family and the physician. During the two months study period the children followed a normocaloric diet evaluated every two weeks by a dietetic record book. At the beginning of the study the drug and the placebo groups were comparable in regards to anthropometric data. At the end, the mean overweight of the drug group was decreased from 49.5% to 41% and that of the placebo group from 43.9% to 41.7%. Both decreases were significant (p < 0.01), but no significant difference was observed between the drug and the placebo groups. The only significant difference concerned the lipid metabolism. The children under glucomannan treatment manifested a significant decrease of alpha-lipoprotein and an increase of pre-beta-lipoprotein and triglycerides; the children under placebo manifested only a decrease of triglycerides and apo beta-lipoprotein. We suggest that this metabolic alteration may derive from a primary decrease of alpha-lipoprotein, most likely because of an inadequate water intake.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assistance to the healthy newborn infant. II. The current situation in Veneto]. / L'assistenza al neonato sano. II. La situazione attuale nel Veneto.

We report the results of a research carried out giving all head physicians of the paediatrics departments in Veneto or of the neonatal sections a questionnaire in order to know how the lying-in woman and the healthy newborn are assisted. The principle information requested by the questionnaire are reported in Table n. 1. The structures of the labour and delivery rooms, regarding their present use, allow the continuous presence of the father during the delivery and the accomplishment of the rooming-in. On the contrary the assistance given to the mothers and the newborns is traditional in 80% of the cases, and they hard take measures able to favour suckling and a mother-child contact in the first hours of the delivery (fig. 2). The tendency to admit in the paediatrics department the newborn who presents problems even slight is not influenced by the apparatus equipped in the neonatal section, but it seems to be in proportion to the structure (number of the deliveries a year) and to the staff of the hospital. In conclusion we think that in our district not just logistical and structural limits but cultural and administrative obstacles slacken the accomplishment of a new neonatal assistance. Particularly we consider very important the administrative recognition of the activity carried out by the paediatricians in the neonatal section and in the puerpery, even if it is not linked to hospitalizations in the department.