[Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician's office]. / Diagnosi e gestione della faringotonsillite acuta nell'ambulatorio del pediatra di famiglia.

Acute pharyngotonsillitis is one of the most frequent causes of visits in the primary care pediatrician'office. Group A b-hemolytic streptococci (GABHS) or Streptococcus pyogenes causes 15-30% of cases of acute pharyngotonsillitis in pediatric age. Children with pharyngotonsillitis due to GABHS commonly present sore throat, fever more than 38 °C, tonsillar exudate, and tender cervical adenopathy, but the severity of illness ranges from mild throat pain to classic exudative tonsillitis with high fever. The McIsaac criteria is a clinical scoring system to predict the likelihood of streptococcal infection among children. This score is based on 5 clinical criteria: age 3-14 years, fever more than 38°C, tonsillar swelling or exudate, tender and enlarged anterior cervical lymph nodes, and absence of cough, but none of these findings is specific for GABHS pharyngotonsillitis. Culture of a throat swab on a blood agar plate (BAP) remains the gold standard for the diagnosis of acute streptococcal pharyngotonsillitis. Because of the major disadvantage of culturing throat swabs on BAP culture is the delay in obtaining the results (at least 1 day), in the past decades rapid antigen detection test (RAD) were introduced for the rapid identification of GABHS directly from throat swabs. Accurate diagnosis and treatment of GABHS pharyngotonsillitis provides positive benefits, including prevention of complications, such as acute rheumatic fever and peritonsillar abscess and reduce the acute morbidity associated with the illness. Conversely, improper diagnosis may result in negative consequences, including unnecessary antibiotic prescriptions that confer increased health care costs and contibute to the development of bacterial resistance.

Shaken baby syndrome: pathogenetic mechanism, clinical features and preventive aspects.

The shaken baby syndrome (SBS) is an extremely serious form of child abuse and a leading cause of death and disability in childhood. The syndrome usually occurs in infants younger than 1 year when a parent or a care-giver tries to stop the baby from crying by vigorous manual shaking. The repetitive oscillations with rotational acceleration of the head can result in injuries of both vascular and neuronal structures. The most frequent injuries associated with SBS include encephalopathy, retinal hemorrhages, and subdural hemorrhage. Fractures of the vertebrae, long bones, and ribs may also be associated with the syndrome. Victims of abuse have various presenting signs and symptoms ranging from irritability, decreased responsiveness and lethargy to convulsions, and death. Diagnosis is often difficult because usually parents or caregivers not tell the truth about what has happened to their child and because usually there is no external evidence of trauma. However, the syndrome might be suspected if the information provided are vague or changing and when the child presents with retinal hemorrhages, subdural hematoma, or fractures that cannot be explained by accidental trauma or other medical conditions. Of infants who are victims of SBS, approximately 15% to 38% die and 30% are at risk of long-term neurologic sequelae, including cognitive and behavioural disturbances, motor and visual deficits, learning deficits and epilepsy. Parents and caregivers must be warned about the dangers of shaking infants.

Postexplant residual cavity hemostasis with a TachoSil patch.

Intracapsular nephrectomy as the standard explant technique for a unfunctional graft is associated with intra- and postoperative complications due mainly to hemorrhage, fluid collections, effusions from damaged tissues and the residual cavity. We have reported herein a positive experience with the use of a collagen medical sponge patch into the surgical site for hemostasis. Use of this device produced a reduction in postoperative bleeding and collections with shortened time of drainage, reduced infection risk, and earlier discharge.

[Sepsis caused by Streptococcus pneumonia in newborn infants. 2 case reports]. / Sepsi da Streptococcus pneumoniae in epoca neonatale. Descrizione di due casi clinici.

Streptococcus pneumoniae is responsible for 2% of all neonatal sepsis. The results of epidemiological studies suggest that newborns acquire infection by the ascending route or during the passage through the birth canal. It has been hypothesized that colonization of the maternal genital tract with S. pneumoniae might be caused by contamination of obstetric instruments with the microorganism or by sexual practices, particularly oro-genital contact. From our NICU's database, two cases of newborn sepsis due to Streptococcus pneumoniae, occurred between 1988 and 1996 have been found; the first case presented a fatal disseminated intravascular coagulation (DIC), the second a severe respiratory failure. Antibiotic treatment of women carrying S. pneumoniae in the genital tract and their infants should be strongly recommended, on the basis of the potentially serious consequences for the infants.

[Perinatal outcomes of newborn infants of mothers over 40 years old. A case-control study]. / Esiti perinatali di neonati da madre ultraquarantenne. Uno studio caso-controllo.

The changing life patterns for women in current society are accompanied by a postponement of pregnancy in advanced reproductive age. The aim of our study was to compare perinatal outcome among 314 newborns from women > or = 40 years old with 6.683 controls from mothers 20-29-year-old who delivered at our Division between 1983 and 1993. For each analyzed variable (birth weight, gestational age, congenital malformations, still-births, neonatal mortality and morbidity) the odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the group of women > or = 40 years old. The incidence of nulliparas in the older age group was 13.5%. The cesarean section rate was higher in the mature mothers than in their younger controls (52.1% vs 34.7%). The more frequent prenatal genetic management in women past the age of 35 years may be the reason for the reduced overall frequency of still-births and malformations in the group > or = 40 years. Preterm delivery was observed more frequently in the older mothers compared with controls (18.5% vs 11.7%). The frequency of LBW and VLBW was higher, but not significant, in the cases than in the controls. Newborns from older mothers had a significant increase of macrosomia (8% vs 4.8%) and a twice increase of mortality (3.2% vs 1.6%) and morbidity (20.4% vs 11.4%). These data suggest to improve the perinatal care of women > or = 40 years old.

Adenocarcinoma of the pancreas in childhood (pancreatoblastoma): report of a case with good response to chemotherapy.

Here we report a case of pancreatoblastoma in a 2-year, 4-month-old girl. The child underwent surgical resection and was managed with chemotherapy (cisplatin plus doxorubicin). The patient is currently disease-free 42 months after being taken off chemotherapy.