C-reactive protein in viral and bacterial gastroenteritis in childhood.

To differentiate bacterial from viral infections the level of C-reactive protein in serum samples was studied in three groups of children under 5 years of age with gastroenteritis. Of the 53 children with bacterial infection, 41 (77%) had C-reactive protein levels > or = 12 mg1 -1, 32 (66%) > or = 20 mgl-1 and 24 (45%) > or = 35 mgl-1. Of the 35 patients with viral infection, 4 (11%) had C-reactive protein levels > or = 12 mgl-1, 3 (9%) > or = 20 mgl-1 and 1 (3%) > or = 35 mgl-1. The best balance between sensitivity and specificity of C-reactive protein was obtained for a cut-off level > or = 12 mgl-1 (sensitivity 77%, specificity 89%) as compared to > or = 20 mgl-1 (sensitivity 58%, specificity 97%) and > or = 35 mgl-1 (sensitivity 44%, specificity 97%). Our results suggest that the determination of C-reactive protein values may be a useful tool for predicting bacterial gastroenteritis in children.

[Cholelithiasis in children: observations on a further case and the technique of laparoscopic cholecystectomy in a child]. / Colelitiasi in età pediatrica: osservazioni su un nuovo caso e sulla tecnica di colecistectomia laparoscopica nel bambino.

A new case of gallstone in a child, with non apparent predisposing condition, who underwent laparoscopic cholecystectomy is reported. The importance of considering cholelithiasis in children with abdominal pain as well as the value of ultrasonography in diagnosis is stressed. The technique of laparoscopic cholecystectomy modified for pediatric patients and its benefits (decreased pain and ileus after surgery, shortened hospitalization and improved cosmesis) are discussed.

[Aplasia cutis congenita: report of 4 additional cases and review of the literature]. / Aplasia cutis congenita: segnalazione di quattro nuovi casi e revisione della letteratura.

Aplasia cutis congenita is a heterogeneous group of disorders characterized by focal absence of skin at birth. In the majority of cases, the involved area is limited to the scalp. These disorders are relatively rare. As a result of misinterpretation, medicolegal advice can be sought by parents who believed that their child's scalp had been injured during surgical induction of labour or fetal monitoring. We report four additional patients (two familiar and two sporadic cases) and discuss, in the light of a comprehensive review of the literature, the probable pathogenesis, the clinical variability and the treatment.

[Clinico-epidemiological observations of 77 pediatric cases of infection with non-typhi salmonellae]. / Osservazioni clinico-epidemiologiche su 77 casi pediatrici di infezione da Salmonelle non tifiche.

Non-typhoid salmonellosis remains a common infective illness. We studied 77 consecutively admitted children aged 1 month to 15 years in order to determine frequency of antecedents, the strain of the isolated organisms, clinical findings, frequency of complications and the adequacy of management. The presentation and severity of the illness were compared between younger than two and older children. Salmonella typhimurium was isolated in 65% of the cases. Two thirds of the tested strains were multiresistant to antibiotics. Non-typhoid salmonellosis usually occurred in the form of acute gastroenteritis: in only 4% of the cases it presented as pyrexia of unknown origin without gastrointestinal symptoms. 30% of the cases had been exposed to one or more antimicrobial agents within four weeks before the date of their stool culture. Only 30% had been breast fed. Previously diagnosed cow's milk protein intolerance resulted to be present in 14% of the less than two years old children (p < 0.02). Abdominal pain and headache were found more frequently in older children (p < 0.02). Protein C reactive values were significantly higher in this age group (p < 0.05). 25% of the children were mildly or moderately dehydrated. Hypernatremia was uncommon. 31% of the cases were treated with antibiotics: the antimicrobial treated children presented diarrhoea for longer period (p < 0.05) and they remained admitted for longer time (p < 0.00).(ABSTRACT TRUNCATED AT 250 WORDS)

[Spontaneous pneumomediastinum in an adolescent]. / Pneumomediastino spontaneo in un adolescente.

Spontaneous pneumomediastinum is defined as nontraumatic mediastinal air leak in patients without underlying lung disease. In children and adolescents it is rarely described and is likely to be underdiagnosed. We describe a case. The aetiopathogenesis, clinical findings, diagnosis and treatment are discussed.

A two-year survey of mucocutaneous lymph node syndrome in northeastern Italy. Epidemiological and clinical findings.

A two-year retrospective survey of cases of mucocutaneous lymph node syndrome (MLNS, Kawasaki disease) was conducted by a collaborative research group in Northeastern Italy (Friuli Venezia-Giulia) by reviewing the records of all patients admitted in the paediatric wards of this area from January 1, 1981 to December 31, 1982. 19 cases of MLNS were identified representing an overall incidence in the two-year period of 14.7 cases per 100,000 children younger than 5 years of age. Seasonal clustering of cases was observed, 17 out of 19 cases occurring either in spring or autumn (P = 0.0004, binomial distribution) and 11 out of 19 cases occurring in spring alone (P = 0.0023). No evidence for direct contact between cases or common source exposure emerged, and no risk factors were identified. The clinical spectrum of the disease was similar to that described elsewhere, carditis, uveitis, arthritis and urethritis being the most frequent complications. One infant died, and in this case coronary artery aneurysms were demonstrated by two-dimensional echocardiography. In the remaining cases recovery was complete without sequelae. This study suggests that MLNS is more frequent than expected and that the real incidence of the disease is probably underestimated. The evidence of seasonal clustering of cases strongly suggests the presence of a yet unidentified exogenous factor playing a role in the etiology of the disease.

Home treatment of seizures as a strategy for the long-term management of febrile convulsions in children.

A cooperative study evaluating compliance and efficacy of Diazepam clisma in home treatment of febrile seizures in children was conducted from January 1979 to June 1981. Parents of 601 children admitted to hospital for a febrile convulsion were taught to use Diazepam clisma in the eventuality of a new seizure and asked to record the length of the episode. Complete follow-up was possible in 564 cases for an average time of 16.7 months. During the research period 109 convulsive episodes were registered in 76 children. Four of these children presented a seizure without fever. Diazepam clisma was administered correctly in 70 episodes (64.2%). In 26 of the remaining 39 cases, therapy was not administered because the seizure ended before the treatment was started. Prolonged seizures (greater than 15 min) have been reported in 8 cases. Six were in the non-treated group and 2 in the treated group. In both these last cases Diazepam was expelled immediately after being administered. The results of the study suggest that home treatment of febrile convulsions by Diazepam clisma represents a well accepted and useful strategy for prevention of prolonged seizures, provided that continuous contact and complete understanding between family and physician can be ensured.