Diarrhea in children: etiology and clinical aspects.

AIM: The aim of this paper was to determine the etiology of diarrhea in children with an age <5 years hospitalised for acute enteritis and to evidence the prevalent clinical aspects in correlation of different etiology agents. METHODS: A total of 402 children with acute diarrhea were examined between February 2003 and December 2006 in the Paediatric Department, Hospital of Sondrio. Fecal samples were collected and was processed by routine microbiological and biochemical tests. For all patients the clinical signs and symptoms at the admission were evidenced. RESULTS: The major part of patients (310/402, 77.1%) resulted infected by rotavirus, while among the remain 82 (22.9%) 40 resulted infected by salmonella species and in 42 any bacterial agent was evidenced by microbiological tests. Clinical signs of mild dehydration were observed in 13 children during the hospital stay (all infected by rotavirus), while any case of metabolic acidosis, hypoglycaemia and hypovolemic shock was documented. Elevated serum levels of uric acid were evidenced in 13/302 (4.3%) of patients with rotavirus infection, while only 1/82 (1.2%) children rotavirus negative presented a minimal increase of serum uric acid level. CONCLUSION: Our retrospective study confirms the major epidemiological and clinical importance of rotavirus, as the principal etiologic agent in hospitalised children affected by acute diarrhea with an age <5 years. Also, we have evidenced a possible correlation between rotavirus infection and hyperuricemia, probably connected with dehydration.

[Ceftriaxone-induced cholelithiasis]. / Colelitiasi da ceftriaxone.

The formation of biliary sludge and cholelithiasis after ceftriaxone administration is not uncommon. Prompt resolution of sludge has been demonstrated with discontinuation of the drug. Despite this, cholecystectomy has been performed in symptomatic patients. Ceftriaxone is popular drug in pediatrics, but the complication is not widely appreciated in the gastroenterology and surgical literature. For this adverse effect and for cost ceftriaxone should be used with more caution. We describe two cases of children with ceftriaxone induced cholelithiasis.

[Facio-auriculo-vertebral syndrome or oculo-auriculo-vertebral dysplasia (Goldenhar): report of 2 clinical cases]. / Sindrome facio-auricolo-vertebrale o displasia oculo-auricolo-vertebrale (Goldenhar): descrizione di due casi clinici.

We describe two cases of oculo-auricolo-vertebral dysplasia (OAV). The OAV spectrum is markedly broad and in some instances could results in diagnostic problems. One of our cases is classic Goldenhar syndrome. The other is a subgroup with microtia and mandibular hypoplasia. In the OAV the possibility of hearing impairment requires early recognition.

[Tuberculous meningitis. A case with severe ocular complications]. / Meningite tubercolare. Un caso con gravi complicanze oculari.

Tuberculosis in the world is the mean cause of death from single infectious agent. It is reported increase not only in underdeveloped countries but in developed too. Tuberculosis meningitis is a very serious form of tuberculosis. Outcome in tuberculosis meningitis is associated with the stage of the disease at presentation. When the child at presentation is extremely ill with coma the completely recovery is seen only in about 20% of cases. In our case patient had severe ocular complications: optochiasmatic tuberculomas. It is difficult recognize the two forms of tuberculomas intra- and perichiasmatic even with RNM. The good response at intrathecal therapy with recovery of the visus proves the perichiamsatic localitation of tuberculomas.

[Partial deletion of the short arm of chromosome 4 (the Wolf-Hirschhorn syndrome) with reference to the neurological and electroencephalographic aspects]. / Delezione parziale del braccio corto del cromosoma 4 (sindrome di Wolf-Hirschhorn) con riferimento ad aspetti neurologici ed elettroencefalografici.

We describe a case of Wolf-Hirschhorn syndrome (partial deletion of the short arm of chromosome 4). The syndrome is characterized by mental and growth retardation and characteristic facial dysmorphism. The fetus was karyotyped for severe intrauterine growth retardation diagnosed on routine ultrasound. High resolution chromosomal analysis of infant and parents showed "de novo" deletion. Very interesting in our case are ictal phenomena and neurological development.

[Dominant polycystic kidney disease in children. Clinical aspects related to age and problems of early diagnosis]. / La malattia policistica renale dominante nel bambino. Gli aspetti clinici peculiari dell'età ed i problemi della diagnosi precoce.

Two cases of Dominant Polycystic Kidney Disease (DPKD) are reported in newborns of two different affected families. One of two infants was prenatally diagnosed by ultrasound, few cases of in utero diagnosis being previously reported. The two infants had different course: one had no symptoms (14 months now), on the contrary the other one had abdominal mass at birth and oliguria in the first 48 hours, then acute pyelonephritis at 15 months. The increasing incidence of DPKD diagnosed in infants and children by US screening in risk subjects is stressed and importance of precocious diagnosis for genetic counselling emphasized.

[Radioimmunologic analysis of calcitonin and parathyroid hormone in the study of calcium homeostasis in the newborn infant during the first days of life]. / Contributo del dosaggio radioimmunologico della calcitonina e del paratormone nello studio dell'omeostasi calcica nel neonato nei primi giorni di vita.

Measurements of serum calcium on the first, third and sixth day of life and serum Parathyroid hormone (PTH) and Calcitonin (CT) by radioimmunoassay on the first and third day of life have been effected on a group of 31 infants born after 29-42 weeks of gestation and weighing at birthday 1300-3510 g. The mean serum iCT levels on the first day of life (996 +/- 95 pg/ml) were significantly higher than on the third day of life (533 +/- 79 pg/ml; p less than 0,001) and both were upper normal range of method (200 pg/ml). Mean serum iCT values were found negatively correlated both with birthweight (p less than 0,025) and with gestational age (on 1st day p less than 0,02; on 3rd day p less than 0,001) in AGA newborns. No correlation was found between iCT values and serum Calcium values. The mean serum iPTH levels on the first and third day of life were in the normal range (on 1st day 416 +/- 61 pg/ml; on 3 rd day 640 +/- 114 pg/ml) and not correlated neither with serum Calcium and serum iCT levels, nor with birthweight and gestational age of the newborns. It is excluded that any transient hypoparathyroidism can cause early neonatal hypocalcemia and it is confirmed the presence of high levels of serum Calcitonin in term and premature infants.