Study on 480 hospitalized febrile children: evaluation of the septic risk and results of the antibiotic and corticosteroid combined therapy.

The febrile child, previously healthy, represents a frequent diagnosis and management problem for pediatricians who work in private offices and those in hospital emergency departments. We are specifically interested in the identification, for the febrile child with septic risk, of severity parameters permitting to assess the likelihood of a serious bacterial infection. In the retrospective study we present, carried out on children admitted for febrile illness, two factors were mainly evaluated: 1. identification of the septic risk on the basis of some laboratory and clinical parameters; 2. effectiveness of an early antibiotic plus corticosteroid treatment in a sub-group of children with septic risk. The parameters we considered have been the degree of temperature upon admission, the clinical appearance and the C-reactive protein (C-RP) values. A significant correlation resulted for levels of temperature over 39 degrees C, toxic-appearing child and very positive C-RP values. We have defined this condition as a "threatening" fever requiring an immediate hospitalization in order to administer appropriate blood tests and cultures, and also, according to our rationale, to start an early antibiotic plus corticosteroid therapy (within 6-12 hours from the disease onset).

[Severe inflammatory disease in children. Rationale for corticosteroid immunomodulating therapy: pathogenic therapy]. / La patologia infiammatoria grave in pediatria. II razionale della terapia immunomodulatrice corticosteroidea: terapia patogenetica.

At the moment it is assumed that each strongly aggressive pathogenic agent, such as bacteria, viruses, toins, trauma, burns, grave asphyxia, allergic agents, and so on, could trigger serious and uncontrollable inflammatory response. That is due to an excessive response of subject's immune system, through the dysregulation of pro-inflammatory cytokines release. The initial physiopathological event of inflammatory response consists in the production of "primary cytokines", TNF-alpha, IL-1 and IL-6 by macrophages. These and other cytokines trigger the progress and amplification of inflammatory process involving secondary mediators and inflammatory cells (Th1/Th2-type cytokines). When the amplification of inflammatory process is excessive ("cytokines storm") a "pro-inflammatory cytokines pathology" can occur and that can determine: 1) systemic inflammatory response syndrome (S.I.R.S.); 2) inflammatory damage of restricted areas (organ pathology). TNF-alpha, IL-1 and IL-6 can act on hypothalamus-hypophisis-surrenal axis and, through cortisol release, can determine a negative feedback on the cytokines gene expression and a physiological anti-inflammatory mechanism. According to our experience we believe that a praecox corticosteroid treatment (Desametasone, Betametasone), in small doses and for a short period, associated with an antibiotic therapy (Ceftazidime, Ceftriaxone, Cefixima, Ceftibuten), could compensate the relative and transitory deficiency of hypothalamus-hypophisis-surrenal axis, and reestablish the physiological control mechanism of cytokines release.

[An update on the treatment of otitis media with effusion in children. The indications for transtympanic drainage]. / Attualità in tema di trattamento dell'otite media con effusione del bambino. Indicazioni al drenaggio transtimpanico.

Otitis media with effusion (O.M.E.) is a frequent child's condition, with generally spontaneous recovery. Only a few cases, with some complications and chronic-O.M.E., present hearing loss and later verbal and academic delayed performances. We report our experience on treatment by tympanostomy tubes for O.M.E., at the Clinic of otolaryngology of the University of Pisa, since 1981 to 1993, resulting a progressively reduced number of these operations in the last period. We believe that both the inflamed upper airways care, and first choice adenoidectomy can explain the trend. Ventilation tubes must be placed only for persistent picture of O.M.E. and possibility of invalidity.

[Acute eosinophilic pneumonia: a case in an adolescent and a review of the literature]. / Polmonite eosinofila acuta: un caso in adolescente e revisione della letteratura.

A previously healthy young girl presented with acute respiratory disease, high fever, increased number of eosinophils in peripheral white blood cells and diffuse bilateral infiltrates on chest radiograph. There was no evidence of an infectious etiology. The illness resolved rapidly after treatment with erythromycin and corticosteroids. Bronchoalveolar lavage was not performed. We believe that we are describing an acute form of eosinophilic pneumonia in adolescent.

[Nutrition errors in children]. / Errori alimentari nel bambino.

Errors in the childhood feeding administration are commonly met, particularly during the first and second year of life, according to the poor or vague knowledge among paediatricians. A first proof of this assumption is given when, as a consequence of digestive disturbance, caused by a wrong nourishment, the paediatrician suggests remedies that, substantially, make the same primitive mistakes. A second proof is given when a particular diet, due to the presence of intestinal disturbance and already seen to be inefficacious, is reproposed, even more than once, with industrial aliments which differ from the ones used in the name and the brand but not in the composition. Finally, another proof is given when in the exclusion therapy due to an intolerance towards gluten, towards cow's milk, towards disaccharides, the paediatrician inserts, in the diet, products containing, respectively, the above mentioned components. These and other mistakes are reported in the present casuistry (121 cases), the majority of which (75 cases) is accompanied by specific examples. Between the cases that mostly stand out we find the so called "precocious weaning" as cause of digestive disturbance and, frequently, as initial moment of a chain of errors responsible, in their turn for the protraction and the chronicization of the aforementioned intestinal pathology.