[Sequelae of bacterial meningitis in childhood: a study of hearing impairment]. / Sequele della meningite batterica in età pediatrica: studio dell'interessamento audiologico.

Bacterial meningitis is an infection of the central nervous system involving quite a number of neurological sequelae the most common of which is hearing impairment. To assess the incidence of audiological deficit the authors evaluated retrospectively 20 patients, between 4 months and 11 years of age, observed at the Pediatric Clinic at the University of Pisa between 1988 and 1993. A clinical-neurological examination and a complete auditory assessment (using BAEPs and impedence audiometry) has been performed in every patient between 1 and 18 months after they left hospital. 4 children had persisting neurological sequelae, 3 patients developed sensorineural hearing loss and one child visual impairment and seizures. Haemophilus Influenzae was responsible for 2 cases of sequelae and Streptococcus Pneumoniae for the other 2 cases. The number of days of illness before hospitalization and the institution of an antibacterial treatment, persistence of fever and deviation from the normal level of consciousness and persistence of neck rigidity were not correlated with the presence of sequelae. No correlation has been found between sensorineural hearing loss and the kind of antibacterial therapy. It's advisable that every child, following bacterial meningitis, should undergo a complete and repeated audiological assessment to detect any lesser impairments and/or unilateral losses that may damage the development of speech and language in any way.

[Gardner syndrome]. / La sindrome di Gardner.

The observation of Gardner's syndrome case, in a six year old girl, referred to the hospital for seizures, provides the Authors with the opportunity of reviewing that important subject of the medical and surgical clinical pathology. The diagnostic features and differential diagnosis are described. The current criteria for diagnosis and surveillance of the affected or at risk subjects are outlined. Today the molecular, and, thereafter, the prenatal, neonatal and preclinical diagnosis of the disease, is possible.

[Peutz-Jeghers syndrome]. / La sindrome di Peutz-Jeghers.

An observation of Peutz-Jeghers syndrome, in a 13 year old girl, provides the Authors with the opportunity of reviewing the clinical features, the natural history and the complications of the disease, mainly the malignancies. In recent reviews the occurrence of cancer was further on investigated: gastrointestinal and non gastrointestinal tumors occurred in 22-48% of the patients examined. The surveillance protocols of the subjects at risk and genetic counseling are discussed.

[Bacterial meningitis. Review of literature and retrospective study of 208 cases observed]. / Le meningiti batteriche. Revisione della letteratura e studio retrospettivo in 208 casi osservati.

Bacterial meningitis is a particularly dangerous infection of the central nervous system involving quite a number of mortal cases and frequent neurological sequelae. Etiology varies in relation to the patient's age. In the first 2 months of life Streptococcus B, Listeria monocytogenes, Escherichia coli and other Gram negative enteric bacilli are more frequently isolated while in older children Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae are more common. Clinical symptoms take a different form according to the patient's age: symptoms of a general kind prevail in the first 2 months of life while in older children signs of meningeal irritation predominate. In a review of the survey of cases of bacterial meningitis observed at the Clinica Pediatrica in Pisa from 1970 to July 1993, with a retrospective research, 208 patients have been examined, considering age, etiology, clinical course especially observing the course of temperature, liquor characteristics, normalisation of the index of phlogosis, mortality and neurological sequelae. In the last ten years the availability of 3rd generation cephalosporin has provided the possibility of comparing two groups of patients of an age ranging between 1 month and 14 years. Twenty cases were treated with ampicillin and chloramphenicol and 30 cases with cephalosporins the evaluation made considering the course of temperature, the normalization of the liquor index has revealed a more favourable clinical course in the second group of patients.

[Acute osteoarthritis in the newborn and infants]. / Osteoartrite acuta del neonato e del lattante.

The Authors report two cases of acute osteomyelitis, in a newborn and in an infant. Bone and joint sepsis in the first years of life is rare. The metaphases of long bones are the most common sites of hematogenous osteomyelitis. The hip and the knee are especially at risk. The patients were treated with pharmacologic and orthopedic therapy. The Authors describe the clinical features, radiographic changes, the diagnosis and management of this disease.

[Hypertrophic pyloric stenosis in infants. A retrospective study of cases observed in the years 1970-1990]. / La stenosi pilorica ipertrofica del lattante. Studio retrospettivo dei casi osservati negli anni 1970-90.

Although the definitive cause of infantile hypertrophic pyloric stenosis is unknown, it's probable that several predisposing risk factors would be associated with the condition. We analysed some perinatal factors in relation to the incidence of infantile hypertrophic pyloric stenosis among children observed during the period 1970-90. We examined 61 infants with surgically confirmed hypertrophic pyloric stenosis and, as controls, 61 healty children comparable for age. In every child we studied: sex, birth rank, pregnancy and delivery, birthweight, parental age, type of feeding, familial history of hypertrophic pyloric stenosis and of atopy, seasonal variation in incidence, AB0 and Rh blood phenotypes. In the 61 infants with hypertrophic pyloric stenosis, the incidence of three factors (male sex, primogeniture and feeding with artificial milk) was significantly higher than that in the controls. We conclude that infantile hypertrophic pyloric stenosis probably has a particular genetic basis, but perinatal factors are responsible for the rising of the condition. However the true aetiology remains to be elucidated.