Haemodynamic modifications after unilateral subarachnoid anaesthesia evaluated with transthoracic echocardiography.

AIM: The aim of the study is the evaluation through transthoracic echocardiography of the haemodynamic modifications due to unilateral subarachnoid anaesthesia with bupivacaine 0.5% given for orthopaedic surgery. METHODS: In this prospective study, at the University Hospital Orthopedics surgical theater, 20 patients underwent orthopaedic surgery on the lower limbs. Unilateral spinal block was performed with hyperbaric bupivacaine 0.5%, 8 mg after a fluid challenge with saline solution 0.9%. Transthoracic echocardiography was performed and cardiac output was calculated from the left ventricular outflow tract (LVOT) with a recently validated technique. Cardiac output, stroke volume, ejection fraction, heart rate, mean arterial pressure were evaluated. These parameters were obtained before anaesthesia (t1), 5 minutes after anaesthesia (t2) and 16 minutes after anaesthesia (t3). RESULTS: Systolic, mean and diastolic arterial pressures after 5 min and 16 min from anaesthesia significantly decreased if compared to basal time (p<0.05 and p<0.001 respectively) while cardiac index (p<0.001) and ejection fraction (p<0.05) decreased only after 16 min from subarachnoid anaesthesia. CONCLUSION: Despite the fluid challenge we can not prevent a significant fall in the blood pressure and a decrease of the left ventricular function calculated with the decrease of cardiac output and of the left ventricular ejection fraction.

[Catch-up growth and final height in celiac disease].

BACKGROUND: Growth retardation resulting from celiac disease diagnosed in infancy or in early childhood is remediable after introduction of a gluten-free diet. The aim of this study was to evaluate long-term growth, catch-up growth and final height in a group of treated patients with celiac disease. METHODS: The study population consisted of 35 patients (13 M, 22 F) with typical celiac disease. Age at diagnosis was 1.17 (+/- 0.69) years. For each patient, the standard deviation score (SDS) and centile of height at diagnosis, target height and final height were elaborated, and linear regression and correlations between SDS of final height and age at diagnosis, SDS of height at diagnosis and SDS of target height, respectively, were calculated. RESULTS: At diagnosis patients had a general tendency to short stature: mean height was 81.8 cm +/- 22.9 cm (SDS -0.75 +/- 1.61), while target height was 164.3 cm +/- 13.5 cm (SDS -0.14 +/- 1.04) and final height 169.2 cm +/- 7.7 cm (SDS 0.41 +/- 1.04). Linear regression and correlations between SDS of final height and age at diagnosis, SDS of height at diagnosis and SDS of target height, respectively, proved nonsignificant. CONCLUSIONS: Irrespective of age and height at diagnosis, catch-up growth was complete in this group of patients, with satisfactory achievement of final height. Only one patient (age at diagnosis 13 years) failed to reach the target height.

[Hepatic and splenic micro-abscess in cat scratch disease. Report of a case]. / Microascessi epatici e splenici nella malattia da graffio di gatto. Caso clinico.

Cat-scratch disease (CSD) is an infection caused by a gram-negative bacillus known as Bartonella Henselae. Hepatosplenic disease occurs in only 0.3-0.7% of patients. In this report we describe a 7-year-old male presented with a 4-week history of fever, after diagnosis of CSD with regional lymphoadenitis. Ultrasonography and tomography identified hepatic and splenic abscesses. Antibiotic treatment for three months was associated with resolution of lesions. In Patients affected by CSD, ultrasonography and tomography permit to identify hepatic and/or splenic lesions, indicating systemic CSD.

Psychological problems connected to the dietary restrictions in the adolescent with coeliac disease.

AIMS: To assess the influence of dietary restrictions on psychological development in adolescents with coeliac disease. DESIGN: Statistical analysis on coeliac patients on gluten-free diet who agreed to answer the questionnaire. SETTING: Children with coeliac disease on gluten-free diet followed by the Department of the Pediatric Division of the City Mayor Hospital, Chair of Paediatrics, Verona University. SUBJECT: 39 patients (15 male and 24 female) from 10 years old to 21 who chose to answer a questionnaire of 25 questions dealing with the psychological implications of coeliac disease and with the need of following a particular dietary regime, in the presence of a psychologist. The questionnaire was made up of 6 SIGNALLING questions, 15 EVALUATING questions, 4 FILTER questions. They also filled up an information sheet on the composition and social position of the family. RESULTS: Fathers were on average 45.5 years old, mothers 43. Only 2 parents had no educational qualifications. Father's professions were of various kinds, 22 mothers were housewives. Only 4 patients were only children, 22 had one brother or sister. 13 patients only out of 39 claimed not to have been admonished by their parents, though, showed a conflictual relationship with food. The awareness of their difference from friends was: a) lack in children 10 to 12, b) uneasiness in adolescents 13 to 17, c) maturation and consensus in older patients. A significant number of patients feel different from their friends and these patients showed a latent envy to friends on free diet. A sense of latent envy towards the condition of independence was exhibited by patients who felt different from friends. CONCLUSIONS: The acceptance of a gluten-free diet is problematic for the majority of coeliac children and adolescents, particularly for those between 12 and 17. In this group the search of an individual personality is disturbed. Difficulties connected with gluten-free diet seem to be absent in the family environment, whereas difficulties emerge significantly when relating with friends. The number of cases of our study was limited but we consider these conclusions quite significant. DESCRIPTORS: Gluten-free diet, adolescents and children, relationship with parents, relationship with friends.

[Hypertrophic pyloric stenosis. A unique familial case]. / Stenosi ipertrofica del piloro. Un particolare caso di familiarità.

The paper reports the case of family in which the mother and sons were affected by hypertrophic pyloric stenosis. Epidemiological, etiopathogenetic and diagnostic aspects of the disease are taken into account.