Difficult diagnosis of atypical kawasaki disease in an infant younger than six months: a case report.

BACKGROUND: Kawasaki disease (KD) is an acute inflammatory vasculitis of unknown origin. CASE PRESENTATION: We report the case of a 5-month-old child with an atypical form of KD, characterized by undulating symptoms, who developed an aneurysm of the right coronary artery and an ectasia of the left anterior descending coronary artery. CONCLUSION: This case report underlines the difficulties in recognizing incomplete forms of the illness in young infants, who are at higher risk of cardiac complications.

3-min step test and treadmill exercise for evaluating exercise-induced asthma.

A simple exercise test would be useful for detecting exercise-induced asthma, a common problem in asthmatic children. The current study compared the 3-min step test with treadmill exercise for evaluating exercise-induced asthma in asthmatic children and assessed whether responses to both tests are influenced by baseline lung function and habitual physical activity. A series of 154 asthmatic children (84 male children; mean age 12.9 +/- 0.9 yrs) underwent a 3-min step-test and treadmill testing on different days within a week at least 24 h apart. Before both tests each subject did spirometry to obtain the baseline forced expiratory volume in one second (FEV1). After both exercise challenges all subjects did serial spirometry and the lowest FEV1 recorded over time was used to calculate the fall in FEV1 expressed as a percentage of the measured pre-exercise (baseline) value (% fall in FEV1) and the area above the FEV1 curve (AAC0-30 min) expressed as a percentage of the pre-exercise value. Changes in both exercise variables were also analysed in percentile subgroups defined by questionnaire answers on habitual physical activity in hours. The mean % fall in FEV1 was significantly higher for treadmill exercise than for the step test (15.0 +/- 7.5 versus 11.7 +/- 5.9); and the AAC0-30 min was larger for treadmill than for the step test (-261.6 +/- 139.9% versus -197.3 +/- 105.0% min). In all subgroups defined by habitual physical activity the mean % fall in FEV1 decreased more after treadmill exercise than after the step test. After step test and treadmill exercise no significant correlation was found between % fall in FEV1 and baseline lung function, or between % fall in FEV1 among groups defined by habitual physical activity. Although the 3-min step test yields a lower % fall in forced expiratory volume in one second (FEV1) and a lower value of the area above the FEV1 curve than treadmill testing, it is a quick, economical, reproducible and portable alternative procedure for identifying exercise-induced asthma in outpatients and epidemiological studies. Baseline lung function and habitual physical activity have no influence on the amount or duration of exercise-induced asthma.

[Bilateral intravesical ureteroceles associated with hydroureteronephrosis and hyperechogenic spots in kidneys. Report of a neonatal case]. / Ureterocele intravescicale bilaterale associato ad idroureteronefrosi e spots iperecogeni renali. Descrizione di un caso ad esordio neonatale.

Ureterocele is a cystic dilatation of the terminal ureter. In children it is most commonly ectopic and associated with the duplex collecting system, less frequently it is intravesical and associated with the single collecting system. We present the radiological and ultrasound findings in a male newborn with bilateral intravesical ureterocele associated with hydroureteronephrosis and hyperechogenic spots in both kidneys. In the literature this association has never been reported in neonatal age.

[Jejunal enteral feeding in a severe case of reflux esophagitis in an infant with Pierre-Robin syndrome]. / Trattamento con nutrizione enterale perdigiunale di un grave caso di esofagite da reflusso in un lattante con sindrome di Pierre-Robin.

A case of Pierre-Robin syndrome associated with gastroesophageal reflux and oesophagitis is described. The infant was firstly fed with a hydrolysed-casein formula by gastrostomy, but there was not any improvement of his clinical status, in spite of an appropriate nutrient intake. For this reason, a jejunal enteral feeding, with a semi-elemental formula and then with a hydrolysed-casein formula was started. During this nutritional treatment, the infant showed an adequate weight gain and after 52 days the weight increased from 2880 g to 4580 g.

Crossed renal ectopia with fusion.

The case of three-year old girl with right to left crossed renal ectopia with fusion is described. This malformation presented only microhematuria and urinary tract infections. The diagnosis was established by means of biochemical and radiographic investigations.

[Single umbilical artery (SUA) and congenital eye abnormalities. 2 case reports]. / Arteria ombelicale singola (SUA) e malformazioni congenite oculari. Descrizione di due casi clinici.

Two cases of single umbilical artery (SUA) are reported, associated respectively with unilateral microphthalmia the first case, with bilateral congenital glaucoma (buphthalmos) the second one. While the association between single umbilical artery and microphthalmia is reported in international literature, the association between single umbilical artery and congenital glaucoma (buphthalmos) described for the first time.

[Evaluation of N-acetyl-beta glucosaminidase in upper and lower urinary tract infections in childhood. Clinical study of 168 children]. / Valutazione della N-acetyl-beta-glucosaminidasi (NAG) nelle infezioni delle alte e delle basse vie urinarie in età pediatrica. Studio clinico su 168 bambini.

BACKGROUND: Urinary N-acetyl-beta-glucosaminidase (NAG) is a renal tubular enzyme that may be used as a marker of tubular damage. METHODS: We studied 96 patients 1 to 8 years old and considered NAG excretion to distinguish cystitis from pyelonephritis. Whenever urinary NAG values were expressed in relation to urinary creatinine concentration and compared with urinary NAG values in 72 normal controls 1 to 14 years old grouped by age. RESULTS: Our results demonstrate that urinary NAG levels are elevated in children with pyelonephritis in the presence or absence of urinary tract abnormality. CONCLUSIONS: Therefore, we conclude that NAG may be considered as a further criteria in the diagnosis of upper urinary tract infection and interstitial tubular damage.