Multiple pathologies and drug consumption in a group of centenarians from Eastern Sicily.

Multiple pathologies are characteristic for the elderly. We evaluated the prevalence of multiple pathologies in 28 randomly selected centenarians living in Eastern Sicily and compared the data with those obtained in another random group of 28 control subjects over 80 years of age. It has been revealed that 25% of the centenarians suffered from 0-3 pathologies, while the remaining 75% displayed more than 3 pathologies. The control subjects had 0-3 pathologies in 50% of over 80 years, while 50% were affected by more than 3 pathologies. In centenarians the most prevalent pathologies involved the sensorial apparatus (sight and hearing), followed by the digestive, urogenital and cardiovascular systems. In the control group the rank of occurrence was as follows: cardiovascular system, osteoarticular and respiratory apparatuses, and sensorium. We compared drug consumption in the two age groups. In the centenarians, 71.43% took 0-3 drugs, while 28.57% took more than 3 drugs. In the control group, 53.57% took 0-3 drugs, whereas 46.43% took more than 3 drugs.

Increasing incidence of childhood celiac disease in Sicily: results of a multicenter study.

By screening the patient list of four Sicilian centers of gastroenterology and those with gluten-free product consumption, 1074 patients (607 females and 467 males) with celiac disease, diagnosed between 1975 and 1989, were identified. A maximum cumulative incidence rate by birth cohort was reached in 1986 (1.65/1000). When the incidence rate was adjusted for the years of follow-up, the actual standardized rate was 3 cases per 1000 live births. Growth failure and chronic diarrhea were the most common symptoms, but a diminishing trend for chronic diarrhea was observed when symptoms were distributed by year of diagnosis. Even though 61.1% of all cases were diagnosed within six months from the onset of symptoms, mean age at diagnosis showed an increasing trend, from less than two years to approximately four years of age. The results of our study showed an increasing incidence of celiac disease due to diagnosis of less typical cases at an older age and also to a steady increase in the rate of diagnosis of cases with a classic clinical picture.

[Importance of antigliadin antibodies determination during the follow-up of childhood coeliac disease]. / Importanza del dosaggio degli anticorpi antigliadina nel follow-up della malattia celiaca del bambino.

Since their introduction in clinical practice, antigliadin antibodies (AGA) have simplified the diagnostic iter of coeliac disease. In addition they have allowed us to recognize an even high number of new cases and also to identify new clinical forms. While AGA are widely used in the diagnostic phase, their determination during follow-up of the disease has been always limited. With the present work we observe the behaviour of AGA during the various phases of coeliac disease. The study was carried out on 288 coeliac children divided as follows: 96 at diagnosis, 136 on gluten-free-diet (75 diet adherent and 61 non adherent) and 56 on gluten-challenge. 145 healthy children were also studied as a control group. In all children AGA (IgA and IgG) were determined, with a micro-ELISA method, every two months in the children on gluten-free-diet and monthly in the children on gluten-challenge. Data obtained showed AGA behaviour strictly related to the diet. In fact while children with good compliance to the diet had AGA normalization within the 2nd and 6th month, respectively for IgA and IgG, children with poor adherence to diet had constantly positive AGA. Noteworthy was the AGA behaviour during challenge. Gluten introduction determined a rapid increase of IgA and a slow increase of IgG. Our results confirm the usefulness of AGA determination during the follow-up of coeliac children giving us the possibility to avoid one or more biopsies included in the ESPGAN protocol.

Changes in coeliac disease behaviour over the years.

We performed a retrospective study of 325 coeliac children (179 females and 146 males, F/M ratio 1:2), diagnosed from 1984 to 1989. The children were divided into two groups; group A were diagnosed between 1984 and 1986 and group B were diagnosed between 1987 and 1989, when the antigliadin antibody test had been introduced in our routine. The data showed a difference between the number of diagnoses in the two groups, 117 in group A versus 208 in group B, with a yearly increment of new cases. In both groups, the onset of the disease occurred within the 2nd year of life, in most cases (group A, 88.9%; group B 89.4%) showing a mode at approximately the 9th month. Diagnosis was made within the 2nd year of life in the majority of cases (group A, 80.3%; group B, 87.4%), showing a mode of approximately the 12th month. In both groups, chronic diarrhoea was the most frequent symptom (75.2% in group A and 70.2% in group B), while minor symptoms, such as isolated short stature, pallor, delayed puberty and others, did not show any important change. We conclude that in Sicily, in recent years, the incidence of coeliac disease has been increasing. The most representative clinical form is the classic one, with onset within the 2nd year of life, and chronic diarrhoea, growth failure and abdominal distention as key symptoms.

[Cisapride efficacy in gastroesophageal reflux in children]. / Efficacia della cisapride nella malattia da reflusso gastroesofageo del bambino.

In the last years gastroesophageal reflux disease received more attentions, due to an improving in diagnostic techniques. Motility disorders, such as reduced competence of lower esophageal sphincter, motor esophageal disorders, delayed gastric emptying are important factors in the pathogenesis of the disease. Therefore therapy using prokinetic agents has been considered useful. A variety of drugs such as bethanecol, metoclopramide and domperidone have been used. There are conflicting report on the effects of these drugs and it should also be emphasized that they are not devoid of side effects related to dopamine antagonism. Recently cisapride, prokinetic agent which acts through facilitation of acetylcholine release, has been considered effective and well tolerate drug for the treatment of gastroesophageal reflux disease. In this view we investigated the effects of oral administration of cisapride in 12 children (age range 3-40 months), 7 females and 5 males, suffering from gastroesophageal reflux disease diagnosed on the bases of: clinic criteria, barium swallow radiological examination, 24-hour intraesophageal pH monitoring. After diagnosis a treatment with cisapride (1 mg/kg/die) before feedings for 8 weeks was started in all children. At the end of the trial clinical assessment and 24-hour intraesophageal pH test were performed. Clinical assessment was determined through weight, length and a clinical score calculated using the following parameters: regurgitation, vomiting, irritability, nocturnal weeping, meteorism, respiratory complaints. The total score was evaluated at diagnosis and during the follow-up (1st, 2nd, 4th and 8th week).(ABSTRACT TRUNCATED AT 250 WORDS)

[The predictive value of antigliadin antibodies (AGA) in the diagnosis of non-celiac gastrointestinal disease in children]. / Il valore predittivo degli anticorpi antigliadina (AGA) nella diagnosi di malattia gastrointestinale non celiaca del bambino.

Recent antigliadin antibody (AGA) determination has become an important diagnostic tool in coeliac disease (CD). Although this test has high sensibility for the disease, it is less specific, especially for IgG class, because of its having been found in some acute and chronic common intestinal childhood diseases. We studied the behaviour of AGA, IgA and IgG, in 234 children affected by various gastrointestinal diseases, comparing the results with those obtained in 125 coeliac children and 788 normal children. The intestinal diseases were as follows: irritable bowel syndrome, cow's milk protein intolerance, acute infectious diarrhoea, parasitosis, lactase deficiency, recurrent abdominal pain, cystic fibrosis, chronic constipation, gastroesophageal reflux, intestinal lymphangiectasia, chronic intractable diarrhoea and nodular lymphoid hyperplasia. Our results showed that while AGA-IgA were absent in all children studied, with the exception of 3 cases of acute diarrhoea, a moderate percentage of AGA-IgG was observed in subjects with cow's milk protein intolerance, acute diarrhoea, irritable bowel syndrome, lactase deficiency, chronic intractable diarrhoea and in a low percentage of children with parasitosis, intestinal lymphangiectasia and nodular lymphoid hyperplasia. There was no antibody movement in subjects with cystic fibrosis, gastroesophageal reflux, recurrent abdominal pains and chronic constipation. The different behaviour of the two antibody classes could be explained by the fact that AGA-IgG were detected in diseases where scattered areas of mucosal damage could allow the permeability of the macromolecules inducing passage of gliadin through the mucosal barrier and immune system-induced antibody stimulation.

[The diagnostic approach to and clinical study of 23 children with an obstructive sleep apnea syndrome]. / Approccio diagnostico e studio clinico di 23 bambini affetti da "sindrome di apnea ostruttiva nel sonno".

23 children, aging from 3 to 13 years, affected by chronic upper airway obstruction, were studied. The clinical suspicion was "obstructive sleep apnea" (O.S.A.). In this study was found a significantly different frequency, in O.S.A. group, if compared with controls, of the following symptoms: nocturnal snoring (100%), mouth breathing when awake (69%), and during sleep (91%), abnormal restless movements (69%), behavioral disturbances (60%). Clinical evaluation revealed: pectus excavatum (82%), enlarged tonsils and adenoids (82%), failure to thrive (39%). Chest index was 0.72 +/- 0.07 significantly higher (p < 0.001) than controls. The authors also carried out in all patients and controls pCO2 venous blood determination during sleep, to screen subjects with high risk of cardiopulmonary dysfunction. Data obtained showed that threshold value of pCO2 was 45.6 mmHg.

[Blood beta-carotene after oral administration of carotenoids. A dynamic test of lipid absorption]. / Beta-carotenemia da carico orale di carotinoidi. Prova dinamica di assorbimento dei lipidi.

Authors report a method on the functional investigation of intestinal epithelium, based upon the dosage of serum carotene levels after administration of carotenoids. This test takes advantage of the modality of beta-carotene absorption that it behaves like a lipid. The "beta-carotene test" has demonstrated, as regards to T.A.R.T., great sensibility and specificity over 90%. It doesn't show value overlapping between normal and coeliac children and also it shows good compliance of children and simplicity in laboratory determination. For all these characteristics the Authors suggest the utilization of "beta-carotene test" as screening tool of malabsorption.

[Significance of milk antibodies in cow's milk protein intolerance]. / Significato degli anticorpi antilatte nella intolleranza alle proteine del latte vaccino.

Cow's Milk Protein Intolerance (CMPI) is the most common food intolerance in childhood. The I, III and IV type of the immunological mechanisms are involved in the pathogenesis. Nowadays there are no diagnostic tests with good reliability excluding the IgE-mediated clinical pictures. Recently the evaluation of antibodies (IgA and IgG classes) versus milk proteins has been proposed as reliable test. In order to establish the pattern of antibody response against milk proteins we studied 37 children (17 males and 20 females), aged from 3 months to 6 years, divided as follows: 23 with CMPI of which 16 suffering from gastrointestinal complaints (GI) and 7 from cutaneous ones (CT); 5 children with coeliac disease; 9 normal healthy children without any clinical manifestation. All children at the time of the assessment assuming a diet containing cow's milk proteins. IgA, IgG and IgM antibody classes against cow's milk proteins such as alpha-lactoalbumin (alpha LA), beta-lactoglobulin (beta LG), casein (CAS) and pooled proteins (PPL) were measured using an ELISA method. The results obtained in the various groups were as follows: CMPI-GI group: the percentage of positivity for alpha LA-IgA was 43.8% and alpha LA-IgG 68.7%, for beta LG-IgA was 50% and beta LG-IgG 75%, for CAS-IgA was 43.8% and CAS-IgG 68.7%, for PPL-IgA was 37.5% and PPL-IgG 62.5%. CMPI-CT group: the percentage of positivity for alpha LA-IgA was 42.8% and alpha LA-IgG 57.1%, for beta LG-IgA was 71.4% and beta LG-IgG 42.8%, for CAS-IgA and CAS-IgG was 85.7%, for PPL-IgA was 71.4% and PPL-IgG 57.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of two methods to determine beta-lactoglobulin antibodies in children with cow's milk protein intolerance]. / Comparazione tra due metodiche di determinazione degli anticorpi anti-beta-lattoglobulina in bambini affetti da intolleranza alle proteine del latte vaccino.

In the last years the evaluation of IgG against beta-lactoglobulin (beta LG-IgG) has been proposed as reliable test to diagnose Cow's Milk Protein Intolerance (CMPI). This test, associated with other diagnostic tools (such as eosinophilia, hemoccult, RAST, challenge, etc.) showed a good sensibility, but less specificity. In fact antibodies against beta-lactoglobulin were found in other gastrointestinal diseases (coeliac disease, inflammatory bowel diseases, cystic fibrosis, etc.). To determine the specificity of the test some Authors attributed great importance to the laboratory method (IFL, ELISA). They retained IFL more specific. In order to verify the behaviour of the two methods and their concordance we carried out a double bind determination of IgG against beta-lactoglobulin (beta LG-IgG) on serum samples from children affected by CMPI. For this study we chose 16 children, aged from 3 months and 6 years, suffering from CMPI of which 11 with gastrointestinal complaints and 5 from extraintestinal ones. All children were diagnosed on the basis of the following criteria: clinical picture, blood eosinophilia, positivity of hemoccult, amelioration after the withdrawal of cow's milk proteins from the diet, positivity of challenge test. All children at the time of the assessment assuming a diet containing cow's milk proteins. beta LG-IgG were measured using simultaneously immunofluorescent and micro-ELISA methods. The obtained data showed that 12 children (75%) had IgG versus beta-lactoglobulin in the serum. This result was obtained both with IFL and ELISA methods, showing a 100% of concordance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Megaloblastic anemia: a unusual complication in an infant with double allergy to both cow's milk protein and soy]. / Anemia megaloblastica: singolare complicanza in lattante con doppia allergia alle proteine del latte vaccino ed alla soja.

The authors reported a case of a child suffering from Cow's milk protein allergy, in which a soybean milk was administered for one month. The incorrect preparation of the formula determined a megaloblastic anaemia due to folate deficiency. The observation of very high levels of seric aminoacids during the acute phase of the disease was noteworthy. The therapy with folic acid and the introduction of protein hydrolysated formula milk determined a rapid normalization of the haematological picture. During the follow-up the administration of soybean protein caused anaphylaxis showing the contemporary presence of soybean allergy. The challenge test with cow's milk performed afterwards showed the restoration of the tolerance towards cow's milk protein.

Hypertransaminasemia as the first symptom in infant celiac disease.

Two infants admitted for evaluation of hypertransaminasemia had high levels of anti-gliadin IgA and IgG antibodies and histological changes of the duodenal mucosa typical of celiac disease. Although the cause of the liver involvement could not be exactly identified, both the hypertransaminasemia and the histological changes of the mucosa disappeared after a short period of gluten-free diet. Even though two cases are not enough for definite conclusions, the authors suggest that an unexplained increase in transaminases would require an evaluation for celiac disease.

[The clinical pictures of rotavirus infection in childhood. Studies on the admissions to the Clinica Pediatrica di Catania in 1984-1988]. / Quadri clinici dell'infezione da rotavirus in età pediatrica. Indagine sui ricoverati della Clinica Pediatrica di Catania negli anni 1984-1988.

The Authors carried out a Rotavirus investigation on the stools of 6057 children admitted in the Department of Pediatric and Pediatric Gastroenterology of Catania University, during the years 1984-1988. The stool samples of 264 children were found positive for Rotavirus. While 204 children presented gastrointestinal symptoms with diarrhoea, 12 had subclinical signs, 26 presented only respiratory symptoms and 22 had no clinical symptomatology. Moreover 122 children with diarrhoea had associated respiratory manifestations. In this study the authors punctualized that: 1) the most interested age was the first year of life; 2) there was no evidence in seasonal variations; 3) the respiratory tract was involved in high percentage of children (59.8%); 4) a transient lactase deficiency was supposed in every children with watery diarrhoea, but it was demonstrated only in 21 (10.3%).

["Qualitative test of fecal fat" and "steatocrit", simple complementary methods for the evaluation of steatorrhea in childhood]. / L'"esame qualitativo dei grassi fecali" e lo "steatocrito", semplici metodi complementari di valutazione della steatorrea nell'infanzia.

The evaluation of fecal fat elimination (steatorrhoea) is of primary importance for diagnosis of gastroenterological disorders. In childhood it is quite difficult to apply the ordinary methods of evaluation, on the other hand it is necessary to make use of them to screen and diagnose maldigestion and/or malabsorption syndromes. In this work "Steatocrit" method by Phuapradit and "Fecal fat qualitative test" (FFQT) on glass, by Jacobson, have been used in a parallel study on stool samples from subjects with suspected gastrointestinal disease. While Steatocrit was determined on 200 samples, FFQT was determined on 1574 samples. Our data show that steatocrit is fully able to detect quantitative steatorrhoea with high significance when compared to controls. Likewise FFQT shows a sensibility of 100% compared to controls and it is able to predict coeliac disease and cystic fibrosis in 85.5% of cases and in 89.9% of cases respectively. We conclude that these two tests are sure and auxiliary each other. They allow, when performed on the same sample, to go toward diagnosis of both malabsorption and maldigestion, furthermore they allow to monitor steatorrhoea under therapy.

[Antigliadin antibodies (AGA) in the various stages of celiac disease in children]. / Gli anticorpi antigliadina (AGA) nelle varie fasi della malattia celiaca del bambino.

Antigliadin antibodies (AGA), both IgA and IgG, were studied in the serum of 84 coeliac children during the various stage (Diagnosis, GFD, Challenge) and in 29 healthy children, with a micro-ELISA technique. The results demonstrated the presence of AGA in the serum of coeliac children and a different behaviour between the two Ig-classes in the various stages of the disease. During acute phase both classes were present at high titre. When gluten was withdrawal from the diet, while the titre of IgA fell rapidly since the first month, the IgG titre decreased slowly and raised the normal limits after six months. If the children didn't observe a corrected GFD, the serum AGA titres remained at high levels. During challenge, while IgG raised since the early days, IgA titres raised later, when the intestinal damage became important. The explanation of this different behaviour could be that AGA-IgA are derived from gut mucosa, on the contrary AGA-IgG are not synthesised in the intestine. We believe that serum AGA seem to be good markers of the immune reaction in the intestine triggered by gluten. Furthermore we conclude that the assay of AGA in the serum of coeliac patients is: 1) high sensible and specific method; 2) the most important screening test for intestinal biopsy; 3) the most important test for diagnosis and follow-up of CD; 4) the test which could substitute 1 or 2 intestinal biopsies of the ESPGAN protocol.

Ichthyosis and neutral lipid storage disease.

A boy with a lipid storage disease characterized by lamellar ichthyosis, cataracts, hepatosplenomegaly, and leukocyte vacuoles has been identified in a Sicilian family. This patient shows all the characteristics of ichthyosis and neutral lipid storage disease (Chanarin-Dorfman syndrome). Family data confirm an autosomal recessive inheritance; the heterozygotes may be detected by the presence of vacuoles in circulating eosinophils.

[Effect of the therapy with vitamin K on coagulation factors in celiac disease in children]. / Effetto della terapia con vitamina K sui fattori della coagulazione nella malattia celiaca del bambino.

The Authors carried out a study on 37 untreated coeliac children to investigate the behaviour of K-dependent factors after vitamin K administration. The children were randomized into two groups: 22 children receiving a single dose of 10 mg i.m. of Phytonadione (Konakion, Roche) on the initial day of GFD and 15 children who did not receive vitamin K administration. PT, PTT and clotting activity of Factors II, VII, IX, X were determined before the treatment and/or GFD, and after 24 hours, 7 and 15 days. The results demonstrated that vitamin K administration determined a rapid increase in clotting activity of all K-dependent factors after 24 hours. These values remained normal after 7 and 15 days, except for Factor II, which slightly decreased on the 7th day. On the contrary, the children not treated, had levels similar to those of acute stage. After 7 days these values showed a slight increase and reached normal limits on the 15th day. No significant changes were seen in either PT or PTT in the two groups. They were constantly prolonged, reaching normal limits on the 15th day. These results indicate that the vitamin K deficiency, not only seems constant in children with CD, but also seems responsible for the haemocoagulative deficit of the K-dependent factors. After GFD when intestinal absorption is regained, all parameters returned to normal. The Authors concluded that K-dependent factors can be used as short-term indexes of improved intestinal absorption and that the coeliac children with severely compromised nutritional status can be treated with vitamin K (10 mg bolus).

[Acute ulcer of the stomach caused by the concurrent administration of the antipyretic-intended betamethasone and a non-steroid anti-inflammatory drug]. / Ulcera acuta dello stomaco da somministrazione contemporanea a scopo antipiretico di betametasone e di un farmaco antiinfiammatorio non steroideo (fans).

The authors report a case of acute gastric ulceration in a 4 year-old-child after contemporary administration of Betametason and Dypiron as antipyretic. A pathogenetic interpretation of the rapid formation of gastric ulceration it is briefly noticed. The Authors concluded with some considerations on the side effects of Betametason and Anti inflammatory Non-Steroidal Drugs.

[Cushing's ulcer in childhood. Description of a case]. / L'ulcera di Cushing in età pediatrica. Descrizione di un caso.

The authors describe a case of Cushing's duodenal ulcer associated with Encephalitis. Diagnosis was made as the following criteria: neurological manifestations (fever, seizures, coma) and clinical manifestations of ulcer (hematemesis and melena); endoscopic evidence of ulcer and demonstration of increased gastric acid secretion; direct correlation between neurological lesion and duodenal ulcer. The good therapeutic result obtained with Ranitidine was noteworthy. The high dosage (20 mg/kg/die) allowed the control of the bleeding and the ulcer cicatrization.