Indications to upper gastrointestinal endoscopy in children with dyspepsia.

OBJECTIVES: The objective of the study was to ascertain the appropriateness of indications for upper gastrointestinal (UGI) endoscopy in children with dyspepsia. METHODS: We used the RAND/University of California at Los Angeles method to investigate the appropriateness of the opinions of a panel of experts. The panel judged 2304 theoretical patient scenarios defined by a combination of demographic and clinical variables. Descriptive and multivariate logistic regression analyses were performed. RESULTS: The panel rated UGI endoscopy as appropriate in 27.2% of cases, inappropriate in 14.3%, and dubious in 58.5%. Disagreement emerged for 21% of cases. UGI endoscopy was considered increasingly appropriate in cases with a positive family history of peptic ulcer and/or Helicobacter pylori infection (odds ratio [OR] 8.518, P < 0.0001), when dyspepsia interfered with activities of daily living ("sleep" OR 7.540, P < 0.0001; "normal activities" OR 5.725, P < 0.0001), and when patients were older than 10 years ("

[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.

[The herniated disk in childhood: a case report and review of the literature]. / L'ernia discale in età evolutiva: presentazione di un caso e revisione della letteratura.

A 12-years-old female subject, without previous history of trauma, complained of mild low-back pain and right sciatic pain. At physical examination the ankle jerk was absent on the right and severe leg pain was elicited by the Lasègue test. No sensory or motor deficits were detectable. Computed tomography and nuclear magnetic resonance examinations showed a right paramedian L5/S1 disc prolapse, exerting a compressive action on the dural sac. Nonoperative, medical treatment was successful and a complete disappearance of symptoms was observed after 6 weeks, without recurrence during a 36-months follow-up.

[Abetalipoproteinemia: case report]. / Abetalipoproteinemia: descrizione di un caso.

The abetalipoproteinemia is a recessively inherited defect in the formation of the proteins coating chylomicrons. Their absence compromises the transport of absorbed fats out of the enterocytes into the lymphatic system and the general circulation. Clinical features include steatorrhea, retarded growth, acanthocytosis of erythrocytes, retinitis pigmentosa and a chronic progressive neurological disorder with ataxia. We describe here the case of a 3 year old girl.