[Activity of pediatric acceptance in the Polyclinic of Modena: 1999 to 2003]. / Attività di accettazione pediatrica nel Policlinico di Modena: 1999-2003.

The activity of the pediatric emergency ward in 1999-2003 period is described. An increasing number of contacts was recorded. Most of them should be considered improper. An extra health-care information is required, specially directed to the foreign families, who recently settled in our town. A pediatric outpatient clinic for non-critical patient could cover Sundays and holidays, as in other italian centers.

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.

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.

Efficacy and tolerability of nimesulide and lysine-acetylsalicylate in the treatment of paediatric acute upper respiratory tract inflammation.

In a single-blind study that recruited 70 children aged 5 to 12 years with acute upper respiratory tract infection and fever (in- or outpatients), the effectiveness and tolerability of nimesulide 50 mg/dose were compared with those of lysine-acetylsalicylate 720 mg/dose (equivalent to 200mg of salicylate). Each agent was administered to 35 children, and both groups were simultaneously treated with antibiotics. General and respiratory symptoms were evaluated daily. Nimesulide treatment was associated with a more rapid and greater antipyretic effect than lysine-acetylsalicylate: 94% of nimesulide recipients and 77% of lysine-acetylsalicylate recipients were considered by physicians to have a good or very good response to therapy (p < 0.05). Furthermore, fewer doses of nimesulide than lysine-acetylsalicylate were required for resolution of fever and associated symptoms (nausea, vomiting, headache). The 2 drugs had similar global efficacy. Tolerability was good or very good in all patients.

[Contribution of echography in the diagnosis of gastro-esophageal reflux in children]. / Apporto dell'ecografia nella diagnosi del reflusso gastro-esofageo nel bambino.

56 children, aged between 0-13 month, affected by chronic vomiting were evaluated both with ultrasound and radiological methods, in a double blind study. 22/56 children resulted to be affected by gastro-oesophageal reflux (GER) with upper GI series versus 18/56 with ultrasound. Four cases, ultrasound negative and X-ray positive, represented a borderline situation in which a mild gastro-oesophageal reflux is to be considered paraphysiological phenomenon. The accuracy and handleness of ultrasound evaluation in GER are emphasized.

[Gastroesophageal reflux in children. A combined radiologic and scintigraphic study]. / Il reflusso gastroesofageo nel bambino. Studio combinato radiologico e scintigrafico.

Thirty-one children examined for gastroesophageal (GE) reflux were studied with both barium meal X-ray and gastroesophageal scintigraphy. The study was performed with a double-blind method. The children with negative findings at both tests were submitted to intraluminal esophageal pH probe test. Barium X-ray detected GE reflux in 17/27 patients, whereas radionuclide scintigraphy was positive in 24/27 (positivity: 63% versus 89%; p less than 0.05). Their combined use provided positive findings in 26/27 cases. Scintigraphy appeared to be a safe and reliable screening test to detect GE reflux. Moreover, scintigraphy was superior to barium X-ray study for it had higher diagnostic accuracy, it could be easily performed on young patients, and delivered smaller radiation doses.

[Sympathetic reflex dystrophy. Description of a pediatric case]. / La distrofia simpatica riflessa. Descrizione di un caso pediatrico.

Reflex sympathetic dystrophy is a well known syndrome in adults, but often misdiagnosed in children. We describe a case occurred in a 12 years old girl. Psychological factors played a major role in the mechanism of the disease. Early recognition and prompt management allow complete recovery without sequelae.

[Hypochromic hyposideremic anemia as the first symptom of gastroesophageal reflux]. / Anemia ipocromica iposideremica come primo sintomo di reflusso gastroesofageo.

In a five months infant is described by authors iron deficiency anaemia as early symptom of gastroesophageal reflux undiagnosed previously. Laboratory evaluation excluded any haematological pathology; thereafter clinical suspicion was confirmed by radiological exams and oesophageal PH-monitoring.

[Agenesis of the gallbladder. Description of 2 cases in 2 siblings]. / L'agenesia della colecisti. Descrizione di due casi in due fratelli.

Gallbladder and cystic duct agenesis is a rare malformation with frequent familial occurrence. We report a case in a girl, diagnosed by nonoperative means, and a second case in her brother, discovered with a screening in the same family, operated with ultrasonography.

[Clinical considerations on cases of pneumonia caused by mycoplasma]. / Considerazioni cliniche su una casistica di polmoniti da mycoplasma.

Personal experience of a series of mycoplasma-induced pneumoniae is reported. The importance of early diagnosis for the purpose of speedy target antibiotic therapy is reiterated. Stress is laid on the absence of complications in all patients studied.

[Echographic examination in the screening of hip dysplasia in newborn infants and infants]. / L'indagine ecografica nello screening della displasia dell'anca del neonato e del lattante.

Sonography was employed to evaluate the accuracy of congenital hip dysplasia in 1014 cases, using Graf's methodology and classification in neonatal and infant age. Sonography appears useful to detect and monitor this disease. In fact all the acetabular development can be better revealed than by radiography.