Recurrent pneumococcal meningitis in a child with transethmoidal encephalocele: a case report and review of literature.

Bacterial meningitis is a life-threatening infection with a low recurrence rate. However, this possibility has always to be considered and avoided. This case report concerns a 5-year-old girl who was admitted in our Emergency Pediatric Unit for symptoms of bacterial meningitis and signs of disseminated intra-vascular coagulopathy. After a successful treatment the girl was discharged in good health. She was admitted to our hospital after one year with the same symptoms of meningitis. Laboratory examinations confirm the admittance suspect. An accurate research allowed to find out immunological deficiencies and showed an occult malformation, transethmoidal encephalocele, responsible for the recurrent meningitis. The present case suggests that the opportunity to perform an accurate cerebral imaging study (with special attention to the ethmoidal region and inner ear) in all cases of meningitis to detect occult anatomical alterations, thus preventing infectious recurrence, should always be taken into account.

[The short-stay observation unit: an experience of the Pediatric Department in Modena]. / Osservazione breve intensiva (OBI) in pediatria: l'esperienza del Policlinico di Modena.

The use of a short-stay observation unit (OBI) in a pediatric department has reduced the number of admissions. Significant cost savings and a better care for children and their families have been also achieved. During the year 2003 in our department 1759 children received OBI. 226 (12.8%) were then admitted. 1553 (87.2%) were discharged after a nine-hour mean stay. Descriptive statistics are used to outline the sample of patients and used treatments.

[Unusual cause of ileal occlusion: a coconut bezoar]. / Una causa insolita di occlusione ileale: un bezoario da noce di cocco.

A coconut phytobezoar was detected in the distal ileum of a 4-year-old boy, admitted for suspected appendicitis. While persimmon or citrus fruit ingestion has been previously reported as cause of phytobezoar intestinal occlusion, it is the first time that coconut pulp is described to cause ileal obstruction in children. No predisposing factor as previous gastric surgery or Meckel's diverticulum was present. The bezoar was successfully milked past the ileocecal valve into the right colon.

[Coexistence of cystic fibrosis and celiac disease. Description of a clinical case and review of the literature]. / Compresenza di fibrosi cistica e malattia celiaca. Descrizione di un caso clinico e revisione della letteratura.

A 14-month-old female infant with chronic diarrhea, recurrent respiratory infections and stunted growth was diagnosed as celiac disease with AGA detection and a positive intestinal biopsy. A gluten-free diet was introduced with a poor response. A sweat test was positive and heterozygosis for mutation of CFTR gene (both F508 and G542X) was found, demonstrating an association in the infant between cystic fibrosis and celiac disease. Fifteen cases of such association have been previously described in literature, but only three have been genetically studied. The co-existence of cystic fibrosis and celiac disease in the same subject has to be considered till now a casual finding, but are also discussed hypothesis of a non-casual linkage, formulated by some authors.