[Maria Sandrucci: up-to-date with science, supporter of equal rights]. / Maria Sandrucci: al passo con i tempi della scienza, testimone delle pari opportunità.

This is the first scientific study on Mary Sandrucci, who has been director of the Pediatric Clinic of the University of Turin from 1965-1966 up to 31 December 1989. Prof. Sandrucci led major studies on congenital heart disease, was the first Italian and among the first in Europe to describe phocomelia cases, to report on valuable studies antibiotics, uric acid, pediatric nephrology, nuclear medicine and genetics. She promoted the development of pediatric specialties, but at the same time promoted the study and practice of paediatrics as a whole. This study describes the past half century of medicine, history of Italian pediatrics and progress of the conquest of rights and equal opportunities for women.

Relationships between IGF-I and weight Z score, BMI, tricipital skin-fold thickness, type of feeding in healthy infants in the first 5 months of life.

AIM: To determine the concentration of insulin-like growth factor-I (IGF-I) in exclusively breast-fed (BF) and formula-fed (FF) infants in the first 5 months of life and to study the relationship between the IGF-I level and Z score for weight, body mass index (BMI) and tricipital skin-fold thickness. METHODS: We performed a cross-sectional study in order to evaluate serum IGF-I in 97 age-matched healthy term infants: 50 FF and 47 BF. RESULTS: FF infants showed higher values of IGF-I (38.9 +/- 12 ng/ml) when compared to BF infants (26.7 +/- 11.6 ng/ml; p < 0.05). A positive correlation was found between IGF-I values and Z score for weight (p < 0.001), BMI (p = 0.014), tricipital skin-fold thickness (p = 0.043) and age (p = 0.02). CONCLUSION: These results show that the IGF-I serum concentration is higher in FF infants. The observed association between IGF-I and Z score for weight, BMI, tricipital skin-fold thickness confirms the effect of different infant feeding on body size.

Infant nutritional recommendations from pediatricians. Epidemiologic survey of feeding recommendations for the first year of life in Piedmont.

AIM: Timing the introduction of solids and milk formulas in infants' diet varies throughout the world. The aim of the present study was to assess the modalities of weaning, suggested by pediatricians in Piedmont, Italy, and to compare them to current scientific guidelines. METHODS: The survey was conducted using data recording forms sent to the pediatricians of our area (both practitioners and hospital physicians) from September 2000 to January 2001. Pediatricians were asked to fill in a questionnaire about the time of solid food introduction in the 1st year of life. The study was supported by 168 pediatricians, of these 105 practitioners, 53 hospital doctors and 9 university physicians. RESULTS: The mean age of weaning was 4.5 months. The 1st beikost was vegetable soup with rice flour, meat and parmesan in 65.4%; in 73.8% it was given with a spoon. In 94.6% no salt was added, in 84.5% no sweetener was added. Homogenized fruit was introduced at a mean age of 4.4 months: apple was the 1st fruit to be introduced (4.5 months), followed by pear (4.8 months) and banana (5.6). Lyophilised meat was introduced at 5 months, homogenized meat was introduced at 6.2 months, and minced meat was introduced at 8.2 months. Vegetables (potatoes, carrots, courgettes) were introduced between 5.2 to 5.4 months of age. Parmesan was introduced at 5.3 months; gluten at 6.2 months. Egg yolk was the 1st to be introduced (mean age = 8.9 months), while albumen was introduced at a mean age of 11.6 months. Fish was given at a mean age of 8.2 months. Cow's milk was introduced at 9 months. CONCLUSION: Paediatricians give indications about the introduction of solid foods according to scientific guidelines, with the exception of cow's milk which is introduced too early.

High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children: predictive value of skin prick test and radioallergosorbent test to egg proteins.

BACKGROUND: Egg skin prick test (SPT) and/or radioallergosorbent test (RAST) positivity has been described in infants and children with a food allergy, or in infants at high risk of atopy who have never eaten eggs. Clinical reactions are also observed when some of these children or infants eat eggs for the first time. OBJECTIVE AND METHOD: A prospective study was made of 107 atopic dermatitis (AD) children (66 boys, 41 girls) aged 1-19 months (median 5 months) who had never ingested egg, to compare the outcome of a first oral egg challenge and the results of albumen and yolk SPTs and RASTs. RESULTS: The egg challenge (conducted at age 12-24 months: mean 16 months, median 15 months) was positive in 72/107 children (67.3%). The reactions were immediate or early (first 6 h) in 56/72 (77.8%). The most severe (all within the first 6 h) were one case of anaphylactic shock (1.4%), three cases of laryngeal oedema (4.1%) and one serious attack of asthma (1.4%). The skin weal diameter at and above which reactions always occurred was 5 mm for both albumen and yolk. They were, however, also observed in the complete absence of a weal. The outcome of the challenge was always positive when the specific IgEs (sIgE) for albumen and yolk were > 99 KU/L and > or = 17.5 KU/L, respectively. Here, too, reactions were noted even when sIgE levels were < 0.35 KU/L. CONCLUSION: AD children who have never eaten eggs may be sensitized and display reactions at the first ingestion. The percentage of reactions in this series was by no means negligible. These findings were observed in children with mild as well as moderate-severe AD when first examined. SPT for albumen and yolk diameter > or = 5 mm, and sIgE for albumen > 99 KU/L and for yolk > or = 17.5 KU/L were 100% specific in predicting the outcome of the challenge. It may thus be concluded that children with AD whose SPT and/or RAST for albumen and/or yolk are equal to or higher than these cut-off values should not be subjected to the oral challenge when consideration is given to the introduction of egg in their diet. Even when these cut-offs are not reached, however, clinical reactions to the challenge cannot be ruled out a priori, and it should be preferably performed in a protected environment, such as a hospital.

Dog bites in children less than fourteen years old in Turin.

BACKGROUND: The purpose of this study was to describe the epidemiology of injuries caused by dog bites treated in the emergency department of OIRM from January 1, 1997 to December 31, 2000. METHODS: Data on dog's attacks were obtained from declaration forms filled in the emergency department. RESULTS: 253 children were observed: 145 boys and 118 girls. The mean age was 6.4 years. The peak incidence was in children aged 3 to 8 years old. Fifty-six children (22.31%) required admission to the hospital. Thirty-five were younger than 5 years. Injuries to the face (29.48%), hands (14.55%), legs (9.33%) were more common. The prognosis was 5 (18.97%), 7 (21.74%) and 10 (16.6%) days. Twenty-five children had prognosis over fifteen days (9.88%). Children aged 5 or younger presented most face and hand lesions while children aged 6 to 14 years had most hand, legs and arms injuries. Tetanus and rabies prophylaxis were administered only in 4 and 2 cases respectively, while immunoglobulin anti tetanus were administered in 5 children. The great number of attacks occurred during the summer months, with a peak in June and July. CONCLUSIONS: More attention should be paid to the prevention of dog bites. Pediatricians should advice parents about the risks of interactions with dogs.

Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches.

In childhood the traditional diagnostic approach to thyroid nodules consists of clinical, laboratory, and imaging evaluations. A safe and accurate procedure is needed to promptly identify patients who require surgery. In regard to the usefulness of fine needle aspiration biopsy, the data in the literature concerning children and adolescents are scanty. The aim of this study was to evaluate and compare the diagnostic accuracies of clinical, laboratory, and imaging data collected retrospectively in a group of pediatric patients with thyroid nodules submitted to fine needle aspiration biopsy. Forty-two patients who underwent surgery for thyroid nodules, recruited in 9 Italian pediatric endocrine units, were retrospectively studied. According to histological diagnosis, they were divided into 2 groups, 22 patients with benign lesions and 20 patients with malignant lesions. From clinical records we obtained data about 1) symptoms of neck compression; 2) cervical adenopathy; 3) thyroid function, calcitonin level, and antithyroid antibody titers; 4) ultrasonography; 5) (99m)Tc scintiscanning; and 6) cytology obtained with fine needle aspiration biopsy. Patients and nodule characteristics were analyzed statistically for associations with the presence of thyroid cancer. Among clinical findings, only adenopathy was significantly higher in the group with cancer (8 of 22 benign lesions vs. 16 of 20 malignant lesions; P = 0.006). Thyroid function and antibody titers were similar in the 2 groups, whereas the serum calcitonin level was elevated only in 1 patient with malignant lesions. Among ultrasonography findings, no significant statistical difference was found between the 2 groups with regard to number, dimensions, growth progression, or hypoechogenic pattern of the nodules. Regarding scintigraphic findings, no significant difference was found between the 2 groups. However, a positive correlation (r = 0.90; P < 0.0001) was found between fine needle aspiration biopsy cytological findings and histological diagnoses. The sensitivity, specificity, and accuracy of fine needle aspiration biopsy were 95%, 86.3%, and 90.4%, respectively. A multiple regression analysis showed that only fine needle aspiration biopsy (beta coefficient = 0.963; P < 0.0001) significantly contributed to detecting malignancy (multiple r = 0.973; P < 0.0001). This study provides strong evidence that fine needle aspiration biopsy is a safe technique even in childhood and adolescence, offering the best sensitivity, specificity, and accuracy in detecting malignancy compared with conventional approaches.

Influence of thyroid in nervous system growth.

Nervous system growth and differentiation are closely correlated with the presence of iodine and thyroid hormones in initial development stages. In the human species, encephalon maturation during the first quarter of pregnancy is affected according to recent studies by the transplacenta passage of maternal thyroid hormones while it depends on initial iodiothyronin secretion by the foetal gland after the 12th week of pregnancy. Thyroid hormone deficiency during nervous system development causes altered noble nervous cells, such as the pyramidal cortical and Purkinje cells, during glial cell proliferation and differentiation alike. Neurons present cell hypoplasia with reduced axon count, dendritic branching, synaptic spikes and interneuron connections. Oligodendrocytes decrease in number and average myelin content consequently drops. Biochemical studies on hypothyroid rats have demonstrated alterations to neuron intraplasmatic microtubule content and organisation, changed mitochondria number and arrangement and anomalies in T3 nuclear and citoplasmatic receptor maturation. Alterations to microtubules are probably responsible for involvement of the axon-dendrite system, and are the consequence of deficient thyroid hormone action on the mitochondria, the mitochondria enzymes and proteins associated with microtubules. Nuclear and citoplasmatic receptors have been identified and gene clonation studies have shown two families of nuclear receptors that include several sub-groups in their turn. A complex scheme of temporal and spatial expression of these receptors exists, so they probably contribute with one complementary function, although their physiological role differs. The action of thyroid hormones occurs by changing cell protein levels because of their regulation at the transcriptional or post-transcriptional level. Genes submitted to thyroid hormone control are either expressed by oligodendrytes, which are myelin protein coders or glial differentiation mediators, or are nervous cell specific, genes coding neurotropins or proteins involved in synaptic excitation. The use of new PMRS and MRI non-invasive techniques has enabled identification of metabolic and biochemical markers for alterations in the encephalon of untreated hypothyroid children. Even an excess of thyroid hormones during early nervous system development can cause permanent effects. Hyperthyroidism in fact initially induces accelerated maturation process including cell migration and differentiation, extension of dendritic processes and synaptogenesis but a later excess of thyroid hormones causes reduction of the total number of dendritic spikes, due to early interruption of neuron proliferation. Experimental studies and clinical research have clarified not only the correlation between nervous system maturation and thyroid function during early development stages and the certain finding from this research is that both excess and deficient thyroid hormones can cause permanent anatomo-functional alterations to the nervous system.

Sentinel lymph node and breast cancer staging: final results of the Turin Multicenter Study.

AIM OF THE STUDY: Validation of the sentinel node (SN) technique in breast cancer by means of lymphoscintigraphy. MATERIALS AND METHODS: From December 1996 to January 1999 102 T1-T2 breast carcinoma cases were recruited in Turin. 99mTc-human serum albumin colloids were injected subdermally the day before surgery (mean activity, 5.2 +/- 2.5 MBq). Scintigraphic imaging was performed after injection. After identification of the SN during surgery by a hand-held gamma probe, the SN was excised and sent for histologic examination. SN histology was compared with that of other axillary nodes. RESULTS: The SN detection rate was 86.3%; among 88 cases with an identified SN, 37 (42%) had axillary metastases; the SN was metastatic in 35 cases (sensitivity, 94.6%); in 51.3% of pN+ cases (19/37) the SN was the only metastatic site. In two of the 53 negative SNs, SN histology did not match with that of the remaining axilla (negative predictive value, 96.2%; staging accuracy, 97.7%). CONCLUSIONS: Our results agree with those reported in the literature; however, except in clinical trials and experienced structures axillary lymph node dissection should not be abandoned when mandatory for prognostic purposes, considering that at present SN biopsy alone is not completely accurate for axillary staging, especially in the absence of an adequate learning period.

Factors at onset predictive of lasting remission in pediatric patients with Graves' disease followed for at least three years.

Seventeen pediatric patients (mean age at diagnosis 10 yr and 9 mo +/- 2 yr and 9 mo) with Graves' disease treated with 0.3-0.7 mg/kg/day methimazole and followed for at least three years, during which drug suspension was attempted on attainment of good clinical and metabolic compensation, were retrospectively studied to look for factors predictive of lasting remission present at onset. Lasting remission was defined as a clinical and laboratory picture of euthyroidism lasting at least one year in the absence of treatment at the end of the follow-up. A distinction was drawn between patients who reached remission after one or two courses (groups 1 and 2) and those who never attained a lasting remission (group 3). TRAb (TBIAb) levels at onset were the only factor significantly correlated with the response to treatment. Age at diagnosis, goiter size and fT3 and fT4 concentrations were not significantly correlated with the clinical picture. The series was too small to allow any assessment of the real importance of these factors, though a generally better response was displayed by children over 11 years old, without appreciable or with very small goiter and moderately increased thyroid hormone levels at onset (fT3 < 25 pg/ml in 10/10 in groups 1 and 2 and 2/7 in group 3 patients; fT4 < 40 pg/ml in 7/10 in groups 1 and 2 and 3/7 in group 3 patients). It was also found that better results were obtained when the initial drug course was protracted for at least two years.

Patients with Hashimoto's disease treated with L-thyroxine and followed for three years.

This study investigated the effectiveness of L-thyroxine management in 32 patients (mean age 11 years and 2 months; M:F = 1:5) with Hashimoto's disease followed annually for 3 years. One (8%) of the 12 patients, euthyroid at the onset, never required treatment; of the four (33%) who began treatment immediately, two were able to stop at the 1st or 2nd follow-up, whereas two had to continue. The other seven (59%) who did not begin treatment immediately had to start at the 1st, 2nd or 3rd follow-up. The findings in this small series suggest that hormone management may prove effective to a certain extent in euthyroid Hashimoto patients, primarily as a means of prevention.

[Pediatrics in Turin at the end of the 19th century]. / La pediatria a Torino alla fine del secolo XIX.

The end of the 19th century represents a period of major innovation in the history of pediatrics. As early as 1888, at the first Congress of Medicine field in Brescia, the need was felt for a pediatric association in Italy; after various attempts, the Italian Association of Pediatrics (SIP) was set up in 1898 during the 3rd Italian Congress of Pediatrics held in Turin. On this occasion it was decided that the association should meet every 2 years in the largest Italian cities and, moreover, the first Status was put to the vote and approved. In this study the authors outline the evolution of pediatric studies in Turin over the years, focusing on the history of all the city's hospitals and the various publications used by doctors during the 19th century. In conclusion, the authors recall that pediatric science became a speciality during the last century, but remained within the framework of general medicine.

[Neonatal hepatic cholestasis with particular regard for the use of radioisotopes in its diagnosis]. / Colestasi epatica del neonato con particolare riguardo all'impiego dei radioisotopi nella sua diagnostica.

The aim of this study was to assess the diagnostic sensitivity and specificity of hepatobiliary scintigraphy using a 99mTc-HIDA compound to differentiate intrahepatic cholestasis from extrahepatic forms during the first months of life. The tracer used was acid N-(2,6)-diethylacetanylido-iminodiacetic (diethyl-HIDA) with almost exclusively biliary excretion and a high concentration of radioactivity in the bile. Each neonate was injected with 0.5 mg/kg i.v. of the compound marked with a dose of 99mTc equivalent to 80-100 microCi/kg. Scintigraphic recordings were carried out every 10' for the first hour and further controls were performed at 2, 3, 4, 8 and 24 hours. Scintiphotos were obtained using a Polaroid scintillation camera, PHO Gamma V. Fifty-four patients were included in the study (34 males and 20 females) aged between 4 days and 3 months old. All patients were clinically suspected of pathologies involving the hepatobiliary tract. All cases were affected by persistent jaundice (total bilirubin between 1.8 and 39.6 mg%) with predominantly direct bilirubin (range 1.5-26.2 mg%), acholic feces and hyperchromic urine. Hepato-biliary scintigraphy revealed an intestinal excretion of tracer in 31 out of the 54 neonates examined, excluding the presence of an extrahepatic obstruction of the biliary tract. On the other hand, only 13 out of 23 cases in which no enteric excretion of the tracer was observed, was the final diagnosis one extrahepatic cholestasis. Scintigraphic tests therefore showed a 100% sensitivity associated with a specificity of only 56.52%. This demonstrates that the finding of tracer in the intestine is pathognomonic of the permeability of extrahepatic biliary ducts and that biliary atresia can be ruled out. On the contrary, the absence of the intestinal excretion of the tracer is nor constantly associated with biliary atresia. This study has confirmed this finding in 10 cases of intrahepatic cholestasis (4 hypoplasias of the intrahepatic biliary tract, 3 thick bile syndromes, 3 cases of hepatitis due to cytomegalovirus). In conclusion, the Authors state that hepato-biliary scintigraphy represents a straightforward and non-invasive diagnostic method which enables the permeability of the biliary tract to be assessed in subjects with jaundice.

[Thyroid hormones and the development of the nervous system]. / Ormoni tiroidei e sviluppo del sistema nervoso centrale.

The growth and differentiation of the central nervous system are closely related to the presence of iodine and thyroid hormones. During the first trimester of human pregnancy the development of the nervous system depends entirely on the availability of iodine; after 12 week of pregnancy it depends on the initial secretion of iodothyronine by the fetal thyroid gland. During the early stages of the development of the nervous system a thyroid hormone deficit may provoke alterations in the maturation of both noble nervous cells (cortical pyramidal cells, Purkinje cells) and glial cells. Hypothyroidism may lead to cellular hypoplasia and reduced dendritic ramification, gemmules and interneuronal connections. Experimental studies in hypothyroid rats have also shown alterations in the content and organization of neuronal intracytoplasmatic microtubules, the biochemical maturation of synaptosomes and the maturation of nuclear and cytoplasmatic T3 receptors. Excess thyroid hormones during the early stages of development may also cause permanent damage to the central nervous system. Hyperthyroidism may initially induce an acceleration of the maturation processes, including the migration and differentiation of cells, the extension of the dendritic processes and synaptogenesis. An excess of thyroid hormones therefore causes neuronal proliferation to end precociously leading to a reduction of the total number of gemmules. Experimental research and clinical studies have partially clarified the correlation between the maturation of the nervous system and thyroid function during the early stages of development; both a deficit and excess of thyroid hormones may lead to permanent anatomo-functional damage to the central nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroid and growth: thyroid hormones and development of the nervous system.

Growth and differentiation of nervous system are closely influenced by the presence of iodine and thyroid hormones during the first stages of development. The deficiency of thyroid hormones causes alterations of the maturation of the upper nervous cells (pyramidal cortical, Purkinje's cells) and of the glial cells with cell hypoplasia and reduction of dendritic branching, of synaptic spines and interneuronal connections. Experimental studies in hypothyroid rats evidenced impairments in the content and organization of intra-cytoplasmic microtubulin, in the biochemical maturation in synaptosomes and in the maturation of the nuclear and cytoplasmic receptors for T3.