[The pediatric emergency department: assessment of clinical activity and interaction with local health authorities]. / Il pronto soccorso pediatrico: valutazione dell'attività e interazione con i servizi territoriali.

A perspective study was carried out at the Emergency Department of the Gaslini Institute on a sample of the children admitted from May to September 1990. The study aimed to describe types and modalities of admission. "G. Gaslini" Institute is a multidisciplinary children's hospital: 45% of patients admitted in the hospital come from the southern regions of Italy, while the admission at the Emergency Department were local in 82%. Among all children considered, 2080 (71.9% were admitted on request of their parents, who did not ask previously any physician; of those cases, 356 (17%) were hospitalized, 474 (25%) were either examined by specialist or treated and then discharged. In the remaining cases, no intervention was necessary. As a consequence, 58% of children were admitted without any clinically plausible reason. Parents' anxiety clearly played an important role in most cases. 840 children were addressed to the Emergency Department by a physician, 652 (22.3%) by the doctor in charge, 213 (32.7%) of which were sent back home by the doctor on duty, who did not think it necessary any treatment. Of the 120 (4.1%) children sent by different Emergency Departments, 95 (79.1%) were hospitalized. The reason why physicians addressed quite a large number of children to the Emergency Department, when they didn't need any intervention remain nucleo. Their diagnosis, in fact, agreed with those of the doctor on duty in 83% of cases. In conclusion, it is difficult to imagine a diagnostic or therapeutic problem which needs specific structures. Cooperative programs with physicians working in our region will be carried out in order to control, where possible, admission to Emergency Departments.

[The activities of a pediatric emergency department. The emergency problems]. / L'attività di un pronto soccorso pediatrico. Problemi emergenti.

The authors reviewed records of admission at the Fist Ais-Emergency Service of "G. Gaslini" Children's Hospital, data referring both to in and outpatients. First of all we took into account epidemiological data analysing occurrence and types of diseases; at the same time a demographic study, which aimed to show a decrease in the child population in Genova, was performed. Secondly we compared these data with the real number of admitted patients: collected data showed that this service has been used excessively.

[The effects of lactitol in the treatment of intestinal stasis in childhood]. / Effetti del lattitolo nel trattamento della stasi intestinale in età pediatrica.

Thirty-nine children (18 males, 21 females) suffering from intestinal stasis were treated with lactitol or a reference drug (lactulose in crystalline form), according to a balanced randomization, for 15 days. The first group of children included 19 subjects treated with lactitol, the second group included 20 subjects treated with lactulose. The dosages of lactitol and lactulose were, respectively, of 150-350 mg/kg and of 150-300 mg/kg daily per os with a single administration in the morning. During the trial, the children did not take any concomitant drug. For each patient the tested parameters were: number of intestinal evacuations, consistency of stool and adverse reactions (abdominal swelling, abdominal pain, nausea, vomiting, meteorism) daily; routine laboratory tests at the beginning and at the end of the trials. The results showed that the subjects treated with lactitol have manifested, besides a proved therapeutic efficacy, a better tolerability and compliance than the subjects treated with lactulose.

Discharge report accuracy.

The clinical report is one of the most useful ways of cooperation between the hospital doctors and general practitioners. This paper is aimed at checking the accuracy of clinical reports in an Italian children's hospital. The authors examined 200 clinical reports after establishing some criteria to be fulfilled in order to write a good clinical report. Only 18 reports were considered good; the results were discussed with the physicians who had written the reports. At a second evaluation, the authors checked the efficacy of the proposed changes: 97 clinical reports were considered good.

[Theophylline poisoning in childhood: depurative therapy using a combination of activated charcoal and a saline cathartic]. / L'avvelenamento da teofillina in età pediatrica: terapia depurativa con associazione di carbone vegetale attivato e catartico salino.

The Authors describe two cases of theophylline poisoning and discuss advantages of activated charcoal and magnesium hydroxide therapy. This treatment seems to be better in patients for whom hemoperfusion could be delayed. In fact, activated charcoal can determine a real decrease in serum theophylline as experimental data show. Patients who overdose with slow release theophylline preparation should receive multiple oral doses of activated charcoal; they should also receive multiple oral doses of cathartic, both saline or sorbitol like. There is a lack of references about the activated charcoal plus magnesium hydroxide regimen particularly in childhood. The Authors discuss their own experience.

[Cerebral gigantism or Sotos' syndrome]. / Gigantismo cerebrale o sindrome di Sotos.

The paper describes a case of Sotos syndrome and reviews the world literature on the subject. Inheritance may be dominant autosomal as well as recessive, although the latter is quite rare. The pathophysiology is not well known but a common underlying basis between various syndromes (Sotos; Beckwith-Wiedemann; Klippel-Trenaunay) is hypothesised.