Azithromycin compared with clarithromycin for the treatment of streptococcal pharyngitis in children.

The treatment of streptococcal pharyngitis with azithromycin (10 mg/kg orally once daily for 3 days) or clarithromycin (7.5 mg/kg orally twice daily for 10 days) was compared in a randomized observer-blind study carried out in 174 children with documented Streptococcus pyogenes infection. The observed cure rate 10 days after the beginning of treatment was 61/63 (96.8%) in the clarithromycin group and 71/74 (95.9%) in the azithromycin group. At days 17-20 the bacteriological eradication rate was 95.2% for clarithromycin and 94.6% for azithromycin. When children who did not complete treatment were included in the analysis the eradication rate was higher for azithromycin (93.6% compared with 82.9%; P < 0.05); the difference was due to better compliance with the azithromycin regimen.

[Migrant polyarthritis and EBV infection]. / Poliartrite migrante ed infezione da EBV.

A twelve-years-old boy developed fever, pharyngitis and acute migrant polyarthralgia. An increasing ASO titre was observed, so that rheumatic fever was firstly diagnosed. Finally splenomegaly and positive IgG and IgM against Epstein Barr virus led to the diagnosis of acute EBV infection with polyarthritis. EBV infection should be considered into the differential diagnosis of migrant polyarthritis.

[Head injuries in the pediatric emergency department: a 5-year experience at the Pediatric Clinic of Modena]. / Il trauma cranico in accettazione pediatrica: esperienza di cinque anni nella clinica pediatrica di Modena.

We re-evaluated the cases of 436 children with minor head injury admitted in the paediatric department of Modena University Hospital in the years 1991-1995 in order to revise diagnostic and therapeutic protocols. The external lesions, the presence of loss consciousness, vomiting, vegetative reactions, late complications, skull X ray, TC scan and EEG were considered. Signs and symptoms at admission have been faced with instrumental findings and eventual late complications to evaluate the prognostic significance. External lesions and vomiting did not correspond to TC scan and EEG positivity or significant sequelae. A more close connection to these parameters was found when an history of immediate loss of consciousness after trauma, or presence of vegetative reactions. Skull X ray appeared useless both to judge the seriousness of the lesion and to formulate a prognosis. EEG appeared a sensible tool to evaluate the gravity of the trauma and its late consequences. TC has confirmed to be the unique instrument able to solve any diagnostic or prognostic doubt. When symptoms suggest a bad prognosis, diagnostic procedures should be limited to TC and EEG. By our point of view, patients that at admission have a normal neurological examination at the Glasgow Coma Scale, no significant symptoms and signs, an history of a minor impact dynamic and no signs of child abuse, can be discharged from the emergency department; in this case parents should be instructed how to do an observation at home in order to evaluate eventual complications.

Essential fatty acids: the effects of dietary supplementation among children with recurrent respiratory infections.

The impact of dietary supplementation with essential fatty acids (EFA) on recurrent respiratory infections (RRI) in children was evaluated by means of a randomized cross-over double-blind study. Linoleic acid (596 mg/day) and alpha-linolenic acid [855 mg/day] as a commercial preparation or placebo (olive oil) were administered for two consecutive winter seasons (November to February, T0-T120) to 20 children affected by RRI, aged between 36 and 49 months. Plasma levels of n-3 and n-6 metabolites increased after the administration of EFA. The number of infective episodes, days' fever and days' absence from school were reduced significantly during the observation period (extended from T120 to T180) in children receiving EFA supplementation. Our results suggest that n-3 and n-6 polyunsaturated fatty acids may play a favourable role in the defence mechanism of these subjects.

Influence of urinary calcium concentration on erythrocyte morphology.

The effect of the urinary calcium concentration (CaU) on erythrocyte morphology was studied by incubating erythrocytes in urine with prefixed CaUs of 5, 10, 20 and 40 mmol/l by addition of CaCl2. The same experiment was carried out on erythrocytes preincubated with levo-verapamil (l-V) at 10, 100 and 200 mumol/l. Phase contrast microscopy observations were performed at 0, 30, 60, 120, and 240 min by 2 experienced investigators. At 0 min the erythrocytes showed a clear extraglomerular pattern. At 60 min marked morphological and volumetric alterations were evident when the CaU was > or = 10 mmol/l. On the contrary, no change was found when red cells were treated with > or = 100 mumol/l l-V, independent of the CaU. Dysmorphic erythrocyturia has been related to transglomerular passage even if it was sporadically observed in hypercalciuric or lithiasic patients. This work suggests a role for a high CaU in causing the formation of microcytic and warped erythrocytes. In our opinion, in hypercalciuric urine the appearance of dysmorphic or mixed hematuria does not necessarily indicate transglomerular passage.

Acute post-streptococcal polymyalgia: two new cases with a review of the literature.

UNLABELLED: Two patients with acute post-streptococcal polymyalgia are described with a review of the seven cases previously reported cases. The common features are sudden onset of muscular pain with fever usually after an acute upper respiratory tract infection. Antistreptolysin O titre and inflammatory indexes are increased and muscle enzymes are normal. CONCLUSION: Acute post-streptococcal polymyalgia should be considered as a possible diagnosis in every child complaining acute polymyalgia.

[Rheumatic fever: a retrospective study of a case series of the last 20 years]. / La malattia reumatica: studio retrospettivo di una casistica degli ultimi 20 anni.

The incidence of rheumatic fever in the last twenty years in our ward is reviewed. A substantial decrease is noted; anyway a peak in the years '80-'86 is reported, accordingly literature. Carditis is a frequent manifestation, but its clinical impact is less severe than in the past. Arthritis may have an unusual feature. A good compliance to prophylaxis has been obtained by a strict follow-up.

[The multiple exostoses syndrome. 3 cases in one family]. / La sindrome da esostosi multiple. Tre casi in una famiglia.

Multiple exostoses syndrome is a rare autosomal dominant disorder that affects the enchondral skeleton during growth. The formation of numerous exostoses causes deformities of bones and joints. Degenerative malignant changes are described. A careful follow up during paediatric age is required. Three new cases in the same family are reported in this paper.