Role of the gluten-free diet on neurological-EEG findings and sleep disordered breathing in children with celiac disease.

PURPOSE: To determine whether celiac children are at risk for EEG-neurological features and sleep disordered breathing (SDB), and whether an appropriate gluten-free diet (GFD) influences these disorders. METHODS: We consecutively enrolled 19 children with a new biopsy-proven celiac disease (CD) diagnosis. At CD diagnosis and after 6 months of GFD, each patient underwent a general and neurological examination, an electroencephalogram, a questionnaire about neurological features, and a validated questionnaire about SDB: OSA (obstructive sleep apnea) scores<0 predict normality; values>0 predict OSA. RESULTS: At CD diagnosis, 37% of patients complained headache that affected daily activities and 32% showed positive OSA score. The EEG examinations revealed abnormal finding in 48% of children. After 6 months of GFD headache disappeared in 72% of children and EEG abnormalities in 78%; all children showed negative OSA score. CONCLUSION: According to our preliminary data, in the presence of unexplained EEG abnormalities and/or other neurological disorders/SDB an atypical or silent CD should also be taken into account.

[Bilateral intravesical ureteroceles associated with hydroureteronephrosis and hyperechogenic spots in kidneys. Report of a neonatal case]. / Ureterocele intravescicale bilaterale associato ad idroureteronefrosi e spots iperecogeni renali. Descrizione di un caso ad esordio neonatale.

Ureterocele is a cystic dilatation of the terminal ureter. In children it is most commonly ectopic and associated with the duplex collecting system, less frequently it is intravesical and associated with the single collecting system. We present the radiological and ultrasound findings in a male newborn with bilateral intravesical ureterocele associated with hydroureteronephrosis and hyperechogenic spots in both kidneys. In the literature this association has never been reported in neonatal age.

[Jejunal enteral feeding in a severe case of reflux esophagitis in an infant with Pierre-Robin syndrome]. / Trattamento con nutrizione enterale perdigiunale di un grave caso di esofagite da reflusso in un lattante con sindrome di Pierre-Robin.

A case of Pierre-Robin syndrome associated with gastroesophageal reflux and oesophagitis is described. The infant was firstly fed with a hydrolysed-casein formula by gastrostomy, but there was not any improvement of his clinical status, in spite of an appropriate nutrient intake. For this reason, a jejunal enteral feeding, with a semi-elemental formula and then with a hydrolysed-casein formula was started. During this nutritional treatment, the infant showed an adequate weight gain and after 52 days the weight increased from 2880 g to 4580 g.

Crossed renal ectopia with fusion.

The case of three-year old girl with right to left crossed renal ectopia with fusion is described. This malformation presented only microhematuria and urinary tract infections. The diagnosis was established by means of biochemical and radiographic investigations.

[An anomaly in Poland. A description of a clinical case of a three years and four months-old boy]. / Anomalia di Poland. Descrizione di un caso clinico in un bambino di tre anni e quattro mesi.

The authors describe Poland's anomaly in a boy aged three years and four months, characterised by a depression in the right hemithorax caused by the absence of the medial extremity of the large pectoral muscle with hypoplasia of the remaining venter musculi. Moreover, the scan showed the absence of the small homolateral pectoral muscle. The vascular alteration of the subclavian artery and/or its branches during embryogenesis might be related, in this case, to the fact that the mother took sex hormones during the 6th and 7th week of gestation.

[A comparison between antigliadin antibodies and blood xylose in celiac disease]. / Comparazione tra anticorpi antigliadina e xilosemia nella malattia celiaca.

We have compared serum antigliadin antibodies (AGA) with xylose absorption test in diagnosis and follow-up of pediatric celiac disease. Three groups of children were investigated: celiacs, affected by other gastrointestinal disease, healthy controls. On gluten diet AGA IgA, IgG and xylose test were abnormal in all celiac children. After only three months of gluten-free diet, abnormal AGA IgA values were found in 3%, AGA IgG in 63%, xylose test in 28% of children. Normal values for AGA IgA and IgG and for xylose test were found between 7 and 20 months. On challenge, after 1-4 months of gluten diet, abnormal AGA IgA and IgG values were found in 90% of cases, xylose test only in 27%. As far as the children with other gastrointestinal disease are concerned, 2% had abnormal values for AGA IgA, 22% for AGA IgG and 42% for xylose test. All healthy children had normal AGA IgA, IgG values and xylose test. Our date show AGA IgA the most specific laboratory test, among these investigated, for diagnosis and follow-up of celiac disease.