[Diagnosis of gastro-esophageal reflux in children. Ultrasonography versus pH monitoring]. / Diagnosi del reflusso gastro-esofageo nell'età pediatrica. Ecografia versus pH-metria.

The reliability of ultrasonography (US) was investigated in the diagnosis of gastroesophageal reflux in the pediatric patient. Therefore, specificity and sensitivity of US were compared with those of a 24-hour pH monitoring. A hundred and twenty-nine patients were examined; their age ranged 38 days to 14 years (56 were under and 73 over 2 years old). Since these patients presented with gastroesophageal symptoms, they underwent both pH monitoring and US. The results of the two methods were in agreement in 79.8% of the cases. Notably, in the age group ranging 0 to 2 years, US exhibited greater sensitivity (87% vs. 78.8%) and slightly lower specificity (76.5% vs. 81.1%) than in the age group ranging 2 to 14 years. The greater sensitivity in the 0-2 age group can be explained by physiological factors (which are typical of the first months of life) as well as by technical factors. Therefore, in infants, US should be combined with pH monitoring to identify the cases which are unquestionably pathological. The high specificity in the children over 2 years of age could justify the use of US alone in this group of patients for both diagnosis and follow-up, while pH monitoring might be used only in the most severe and/or complicated cases. The results suggest that, in the two age groups considered, abdominal US can be used not only as the diagnostic method of choice in the study of gastroesophageal reflux, but also as an extremely useful tool during follow-up when therapeutic monitoring is also needed.

[Conservative treatment of post-traumatic periduodenal hematoma: presentation of a clinical case and review of the literature]. / Trattamento conservativo di ematoma periduodenale post-traumatico: presentazione di un caso clinico e revisione della letteratura.

The authors describe a case of post-traumatic hematoma of the duodenum in a two years old child. This is a very rare condition in paediatric age, but with the increasing incidence of traumatic pathology it can be predicted an increase of this condition. The duodenal hematoma can be treated either with surgical approach or with conservative treatment. The authors discuss the characteristics of the pathology, the etiopathogenetic mechanism, and propose the same classification adopted by some french authors. The type of lesion indicates the adequate therapy; in particular in the case report (type 1) a conservative treatment is adopted. The laboratory parametres are significative but none is diagnostic. In the present case the amylasemia is not elevated until two weeks after the trauma. Very important for diagnosis are T.C., roentgenography and echotomography, the last one can be easily used for the control of the resolution of the hematoma. The conservative treatment is based on nasogastric suction and parenteral nutrition; although the role of nonoperative treatment is emphasized, the importance of careful assessment for signs of peritonitis or enlarging tender mass cannot be overlooked.

[Papillary nephrocarcinoma: radiographic and echographic aspects]. / Nefrocarcinoma papillifero. Aspetti radiografici ed ecografici.

Between 1976 and 1987, 395 patients with kidney tumors were studied with radiological techniques and sonography. In 37 cases (9.4%) histopathology diagnosed pure papillary renal cell carcinoma. Analyzing the radiographic patterns of these neoplasms, the authors observed constantly diminished vascularity (100%), frequent calcifications (35.1%) and necrotic areas (51.3%). Such X-ray features are not specific: nevertheless, their coexistence is strongly suggestive of papillary renal cell cancer. No consistent US pattern was found; however, necrotic areas were easily demonstrated in most cases. It must be stressed how patients with papillary carcinoma experienced a longer postoperative survival; it has not yet been established whether such favorable behavior is due to low biological aggressiveness or to earlier diagnosis.