[Sensitivity and specificity of antigliadine antibodies in the diagnosis of celiac disease in a population of children in Toscana]. / Sensibilità e specificità degli anticorpi antigliadina nella diagnosi di celiachia in una popolazione toscana in età pediatrica.

The aim of this study was to determine the value of IgA and IgG antigliadin antibody test (AGA) for screening, diagnosis and follow-up of coeliac disease. A rapid, simple, sensitive and accurate immunosorbent assay (ELISA) was used to determine AGA IgA and IgG in the sera of patients with untreated coeliac disease (I stage), coeliac patients in gluten withdrawal, healthy controls, children with gastroenterological disorders other than coeliac disease and children with constitutional short stature. In the I stage of coeliac disease the AGA IgA gave a sensitivity of 90.9% and a specificity of 97.9%, the IgG assay resulted in a sensitivity of 100% and a specificity of 82.3%. AGA IgG resulted positive in 17.7% of control disease group, but it's interesting to remark that they had a mean level significantly lower than in coeliac patients. On gluten free diet the titres of AGA IgA returned to normal value in three months, while the AGA IgG showed a slower decrease.

[Mixed connective tissue disease in childhood. Report of a case]. / La malattia mista del connettivo in età pediatrica. Segnalazione di un caso.

The Authors report a case of MCTD in a 11 years old girl. Initially the disease presented the classical clinical picture of IDM. Successively its evolution was marked by the appearance of the typical clinical features of JRA, SS and of serum antibodies anti-RNP and by absence of antibodies anti-dsDNA and anti-Sm. These data are characteristic of MCTD. The occurrence of this disease in children is extremely rare and the prognosis is related to a possible renal and/or haemopoietic involvement.

[Articular manifestations of 11 cases of Kawasaki syndrome observed in Toscana]. / Manifestations articulaires de 11 cas de syndrome de Kawasaki observés en Toscane.

11 cases of Kawasaki's disease were studied: the patients originated from Toscana and had at least 5 to 6 of the major criteria established by the Japanese Committee for Research to diagnose Kawasaki's disease. No toxic or infectious agents could be identified. We believe, like many other authors, that the responsible agent must be searched for in the patient's environment. Genetic predisposition also plays an important role, as demonstrated in the Japanese population. Our study of 9 patients yielded no conclusive results concerning the role of genetic factors. Only a study involving a much greater number of patients could establish whether genetics plays a major role in the development of the disease.

[A case of systemic sclerosis in childhood complicated by severe digital ulcers]. / Un caso di sclerosi sistemica in età pediatrica complicato da gravi ulcere digitali.

Systemic sclerosis is a diffuse disorder of connective tissue in which there are inflammatory, fibrotic and degenerative changes in the skin and many internal organs. We describe a case of systemic sclerosis type "acrosclerosis" in a six years old child with Raynaud's phenomenon and gastrointestinal involvement. In the course of illness he presented severe digital ulcerations in the hands and in the feet, responsive to a calcium channel blocking agent nifedipine treatment.

[Our experience with antibiotic therapy in children hospitalized between 1979 and 1981]. / Esperienze sull'antibioticoterapia nel bambino ricoverato 1979-1981.

The use of antibiotics in the Children Hospital of Florence has been studied considering the whole hospital for 1979 and only one department for 1980-81. 7832 clinical records of children admitted to the Hospital have been analyzed in order to get more informations about the quality of antibiotic treatment and to understand the causes of use and misuse of this kind of drugs in pediatric practice.

[Mucocutaneous lymph node syndrome]. / La sindrome linfomucocutanea.

Authors describe two new cases of mucocutaneus lymphonode syndrome (MCLS). These are the tenth and eleventh in Italy since 1977, confirming that this syndrome, known also as Kawasaki disease, is world-wide spread. More attention is therefore required to diagnosis particularly for possible coronary artery involvement. Echocardiography may be useful in doing that. A survey of recent literature indicates that salicylate therapy may be useful not only for symptoms relief but also in preventing life threatening of coronary artery vasculitis.

[Osteodystrophy in children with chronic renal insufficiency in dialysis therapy]. / Osteodistrofia nel bambino con insufficienza renale cronica in trattamento dialitico.

One of the most important complication of patients with chronic renal failure is osteodystrophy. This causes skeletal deformities, growth failure, bone pain and decreased physical activity. Osteodystrophy is more frequent among children than uraemic adults. In fact, 50-80% of children with chronic renal failure may occur in metabolic bone disease and the incidence tends to be higher in those children who have been in uraemic state for a long time before starting chronic haemodialysis. Osteodystrophy is a result of: 1) lesions of rickets; 2) lesions of osteitis fibrosa: 3) osteosclerosis. In contrast to adult, metastatic calcifications are virtually never observed in uraemic children. Hyperphosphoraemia, that is secondary to the reduction of G.F.R., may be the principal responsible of hyperparathyroidism that is the main cause of osteodystrophy. Hyperparathyroidism is also maintained and increased by deficit of 1,25(OH)2D3 which is responsible for lesions of rickets. Haemodialysis may markedly improve osteitis fibrosa and it is efficacious in reversing the mineral defect. Dialysate calcium concentration should be maintained at approximately 3,5 mEq/l. In this case we can raise serum calcium. On the contrary dialysate has to be lacking in phosphorus to correct hyperphosphoraemia. It must be noted that we have to prepare a dialysate with deionized water lacking in aluminum to avoid encephalopathy compliance.