[LHRH and cryptorchism. The results in a selected group of patients]. / LHRH e criptorchidismo. Risultati in una casistica selezionata.

The authors report their experience on treatment or cryptorchidism with synthetic LHRH intranasally sprayed in a selected group of prepubertal boys (58 cases with 75 undescended testes). The success rate of the present study, in the patients with pretreatment testicular position at or below the external annulus, was 36% (24/66 testes). Indications for hormonal therapy are related to the position of the testis before treatment.

Bone metabolism in juvenile rheumatoid arthritis.

Plasma and urinary indexes of bone metabolism were studied in 36 children affected by juvenile rheumatoid arthritis (JRA) during 1 year, in order to evaluate the calciotropic hormone levels and bone mass. Children were divided in three groups according to the subtype of JRA: pauciarticular, polyarticular, systemic. Patients of the latter two groups were on corticosteroid treatment. A control group of healthy children (matched for age and sex) was compared. Children affected by pauciarticular disease did not show any difference with respect to controls. In the polyarticular and systemic groups, basal observation revealed decreased levels of 25(OH)D, significantly lower (P less than 0.01) with respect to the control and pauciarticular groups. After one year, 25(OH)D showed a further decrease in the systemic group, while PTH levels were increased. Moreover, bone mineral density values in systemic JRA were significantly lower than values of a matched control group and did not increase as expected during the year. It seems thus possible that severe JRA has an influence on bone mass, perhaps mediated by a decrease in active vitamin D metabolites.

[Congenital multiple arthrogryposis. Report of a case]. / L'artrogriposi multipla congenita. Contributo casistico.

Six patients affected by arthrogriposis multiplex congenita (AMC) are studied and the detected alterations, the adopted treatment and the obtained results are described and discussed. Notwithstanding the limited number of considered cases, it is underlined that a precocious, constant and protracted treatment can considerably help these patients to gain a certain degree of self-sufficiency though it can not heal serious deformations. This result is also supported by the cases published by the literature.

Clinical and microbiological evaluation of miocamycin activity against group A beta-hemolytic streptococci in pediatric patients. Three years' incidence of erythromycin-resistant group A streptococci.

The authors have evaluated the incidence of Group A streptococci, and the prevalence of erythromycin-resistant strains in the years 1985/86/87 at the I.C.P. of Milan. The minimum inhibitory concentrations (MICs) for erythromycin, penicillin and miocamycin of 40 erythromycin-resistant strains were also studied (MIC50-MIC90 = 4.5-8, 0.015-0.015, 0.041-0.186 micrograms/ml respectively). A clinical trial with miocamycin vs. erythromycin in the elimination of Group A streptococci (67 patients) showed good and comparable efficacy for both the antibiotics.

[Amoxicillin-clavulanic acid combination in bacterial infections of the upper respiratory tract in childhood. Controlled clinical study]. / L'associazione amoxicillina-acido clavulanico nelle infezioni batteriche delle vie respiratorie superiori in età pediatrica. Studio clinico controllato.

A comparative clinical trial of amoxycillin - clavulanic acid combination versus erythromycin was carried out in a case series of 20 pediatric patients, suffering from upper respiratory tract infections with a proven bacterial etiology and different localization (tonsils, nasal and paranasal sinuses and ear). The results have confirmed the highly innovative efficacy of amoxycillin - clavulanic acid combination: the clinical judgement was in fact favourable, with eradication of the pathogenic agent in 90% of cases. The tolerability of the combination was globally good from both the general and local point of view.

Treatment of lower urinary tract infections in children: single dose fosfomycin trometamol versus pipemidic acid.

Fifty-one children suffering from symptomatic and asymptomatic recurrent urinary tract infections were treated at random in a comparative study. A single dose of 2 g fosfomycin trometamol was administered to 24 children (2 males and 22 females, mean age 6.7 +/- 3.3 yr) and two 200 mg doses of pipemidic acid (400 mg in children weighing more than 25 kg) were administered daily to 27 children (3 males and 24 females, mean age 6.6 +/- 3 yr) for 7 days. Bacteriological results showed that at the end of followup (1 month) urine was sterile in 17 out of 24 children treated with fosfomycin trometamol (70.8%) and in 19 out of the 27 children treated with pipemidic acid (70.3%). One persistant infection and six reinfections were observed in the follow-up period in the fosfomycin group and 8 reinfections in the pipemidic acid group, usually in patients with urinary complications. No side effects were reported. The microbiological study of feces showed that neither of the drugs caused the emergence of resistant bacteria.

[Giardiasis in children. Ultrastructural study of the parasite]. / Giardiasi in etá pediatrica. Studio ultrastrutturale del parassita.

Giardia lamblia is the first protozoan to be identified and recognized as an important pathogen in human disease. We studied 8 pediatric patients with giardiasis in order to examine the clinical spectrum, the structural changes of the small intestinal mucosa and mainly the protozoan's ultrastructural features. The most common clinical manifestations were diarrhea, abdominal pain, anorexia, vomiting, failure to thrive. Infection was confirmed by excreted cysts in the stools in one patient, by the presence of trophozoites in duodenal aspirate and on jejunal mucosa. Giardiasis was not associated with hypogammaglobulinemia in our patients and no or only slight mucosal abnormalities were present in jejunal biopsies, except one which showed a flat mucosa. Specimens for transmissions and scanning electron microscopy were taken. We could establish the protozoan's features, its normal distribution, its relationship to intestinal mucosa and structural indications of the normal reaction of intestine with the use of ultrastructural techniques. The trophozoites colonized the proximal intestine, adhered to microvilli of columnar cells near the bases of villi, wedged or lodged in mucus. The sticky mucus producing an effective diffusion barrier to nutrients could explain malabsorption phenomena. Numerous intraluminal lymphocytes were seen, suggesting an immune response. These observations indicate that in giardiasis the clinical spectrum and structural changes of the small intestinal mucosa vary widely, suggesting a different reaction of immune system and/or a different degree of infection.

[Comparative study of 3 different prophylactic programs in hemophiliac children]. / Studio comparativo su 3 differenti programmi di profilassi in bambini emofilici.

Prophylaxis continues to be an area for discussion in the therapy of the hemophilic child. In fact, standard parameters are still not used in the evaluation of the efficacy of this treatment. At the Milan University Pediatric Clinic we have begun three different prophylactic programs with 52 children with ages ranging from 12 months to 14 years 7 months. We have evaluated the efficacy of these regimes comparing the data obtained in the 12 months following the start of the program with those obtained in the 12 months prior to it. Our data, even though they pertain to a limited number of children, show that continuous prophylaxis is truly efficacious if it is begun early before the onset of an arthopathy. Therapeutic prophylaxis however for the stabilizing of a target joint is usually better accepted by the children and their parents. The high cost of the prophylactic programs can nevertheless be justified by the better quality of life of the patients.

[Validity of the H2 breath test and limits of blood xylose in the evaluation of malabsorption in children]. / Validità del breath H2 test e limiti della xilosemia nella valutazione del malassorbimento in età pediatrica.

Many authors have recently discussed the real value of the xylose test in the evaluation of intestinal malabsorption, especially its correlation with the morphological damage of the duodenal-jejunal mucosa. In our study we have performed in 48 pediatric patients one-hour blood xylose test and breath H2 test, method used for the diagnosis of sugar malabsorption, in order to value small bowel function and to know indirectly small intestinal mucosal structure. We have compared the values of the xylose test with those of the breath H2 test and both with hystological findings. The D-xylose absorption test was performed using the technique described by Roe and Rice. A serum concentration of more than 25 mg/dl was considered normal. For the breath H2 test the technique described by Douwes was used. A hydrogen concentration lower than 20 p.p.m. in expired air was considered normal. All of the patients in whose breath hydrogen was not detected after lactose oral load (2g/Kg body-weight, maximum 50 g), underwent a second test with lactulose (0,8 - 1 g/Kg body-weight), is not absorbed. We performed this test to rule out a false negative result (2% of the normal population). On histologic criteria, the patients were assigned to one of three study groups. Group I: normal duodenal-jejunal mucosal structure (11 patients). Group II: structural abnormalities not diagnostic of celiac diseases (7 patients). Group III: mucosal structural abnormalities typical of celiac disease (30 patients). In the first group the one-hour blood xylose test was normal in 9 patients (81.81%), whilst the breath H2 test was normal in 11 patients (100%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastrointestinal fiber endoscopy in children: diagnostic and therapeutic contribution]. / La fibroendoscopia digestiva in età pediatrica: contributo diagnostico e terapeutico.

The diagnostic and therapeutic value of gastrointestinal endoscopy in adults is well established. Our study, performed in pediatric patients confirms its usefulness and emphasises its easy execution and little risk in children. The availability of small caliber fiberendoscopes and the simple medication permit its wide and sure use. The direct visualization of mucosal surface allows to see even small alteration always not found by roentgenological examination and to pick up aimed bioptic specimens. The therapeutic contribution revealed itself affective in our experience, permitting polipectomy and consequently rectal bleeding removal. It was possible at last by this technique to make the follow-up of patients with ulcerative colitis avoiding them repeated irradiations. We can thus conclude that gastrointestinal endoscopy has an important diagnostic and therapeutic value also in pediatric patients for the study of gastrointestinal diseases.

[Non-rachitic hypophosphatemic osteopathy]. / Osteopatia ipofosfatemica non rachitica.

We have identified a patient with a condition called Hypophosphatemic Bone Disease (HBD). This disorder of phosphate metabolism is unrecorded by Dent in his final classification of metabolic bone diseases and has been described by Scriver C.R. and coll. Although the condition is in same ways analogous to X-Linked Hyophosphatemia (XLH), there are important differences between the two diseases. For example, there is selective impairment in the tubular reabsorption of phosphate in HBD but the defect is less severe and it is clearly different from that described in XLH. Clinical manifestations of HBD appear in infancy, but the dwarfism and the bone changes are less severe than in XLH at comparable concentrations of plasmatic phosphorus in the two diseases. While in both conditions there is osteomalacia of endostal trabecular bone, only in XLH is florid rickets present, affecting the epiphyses and compromising linear growth. The phosphaturic response to PTH infusion is abnormal in qualitative aspects, but it is present in HBD, and this differs considerably from that described in XLH. The treatment with oral load of phosphates and 1,25(OH)2D3 in every patient with HBD, and so in our patient, is accompanied by increase in serum phosphorus, with improved tubular reabsorption of phosphate anion and a fall of hydrossiprolinuria with bone healing; this combination of responses is not present in XLH.