["Butter, my love" joy, sorrow and rehabilitation: not simply cholesterol and saturated fatty acids]. / Il burro amore mio gioia, amarezza e riabilitazione: non solo colesterolo e acidi grassi saturi.

The author refers to his "love" for butter and joy to eat and enjoy, during his childhood, bread, butter and jam at a time in which butter was still made with milk from cows that grazed and/or ate the hay. Subsequently the great bitterness occurred, due to the fact that many distinguished researchers have attributed to the the saturated fatty acids (SFA) and cholesterol, abundant in butter, the origin of atherosclerotic cardio vascular diseases (CVD) epidemic exploded in North America from the years 1920-1930. This happened in spite of the fact that various data did not overlap, and also that the most famous of cardiologists, worldwide known at the time, had written and pointed out that, if such a condition were caused by saturated fat animals, a corresponding increase in their consumption in the diet would be recorded, while it had actually dropped 20 percent. The prestige of some, alongside the desire to win their case, associated to the modest epidemiological skills of the time, have led them to fall into the error of "cherry picking", i.e. to choose only those data in support of their theory while ignoring others that contradicted that, for decades, the SFA were banned by encouraging the consumption of margarine and vegetable oils. Only in recent times it has emerged from indisputable surveys, that in the diet, if an excess of SFA is harmful, even an excess of simple carbohydrates or protein or polyunsaturated fatty acids omega-6 are responsible for atherosclerotic CD. The problem is not to eliminate from the SFA diet, as they look toxic while actually in some situations are indispensable, but to reach a correct balance of all the different nutrients in the diet, and not only of the SFA, plus physical activity. Butter, then, also in the light of new and important acquisitions, was rehabilitated. This brings to mind a claim issued by Hippocrates (460-377 BC), the pioneer of Western medicine, about 2400 years ago: "If you were to give each the right amount of nourishment and exercise, we found the road to health".

[The swimmer's otitis. An up to date and prevention options]. / L'otite del nuotatore. Attualità e proposta preventiva.

The swimmer's otitis or acute otitis externa, is a pathology that often occurs in those who practice swimming at a competitive level. The same problem often occurs in the summer with the attendance of swimming pools and bathing areas. A survey made in the United States in 2007 confirms the dynamics of the onset of this pathology, because the contamination of fungi and bacteria in the waters of the swimming pools and the sea cause the inflammation of the epithelium of the auditory canal. To face this issue, in addition to a correct diagnosis, and the necessary and appropriate therapies, it may follow the use of these medicinal preparations. The first one (A) is protective-acting, the second one (B) is characterized as a preventive, hygroscopic, moistening, antiseptic and antimycotic-acting solution. Swimmers who have been using the two (pre-and post) preparations daily for about a year have reported sporadic episodes of otitis. However, there is no doubt that these two compounds deserve a meticulous clinical trial in order to confirm their preventive and therapeutic potentials in external acute otitis.

[Adolescence yesterday and today: care issues]. / L'adolescenza ieri e oggi: aspetti assistenziali.

In ancient Greece, the chronological boundaries of the stages of life hinged upon Solon's theory of human life as divided into ten seven year stages. At the peak of Latin civilization, the chronological limits of the infant, pueritia and adulescentia were respectively 0-8 years, 8-16 years and 16-17 years, when in a ceremony the adolescent (a term derived from adolescente (m) present participle of the Latin verb adolescere = to grow) wearing the "toga of manhood" is declared an adult (teenager adult) and up to 30 years later iuventus. Throughout the following centuries, the chronological boundaries of the various ages came to acquire only a theoretical worth, since the child, once introduced to the world of work, used to suddenly become an adult. Only in the wave of Humanism in the XVI-XVII century, people started to rediscover the Greek 'paideia' (education), the Latin Humanitas' (recognition and respect towards manhood in every man), and, through the Christian 'caritas' (to recognize and to love the son of God in every man) begins a moral vision of childhood, of his weakness and innocence, a reflection of the 'divine purity'. In this evolution, the twentieth century identifies itself with adolescence, so that history moves from an era devoiced of adolescence to an age in which adolescence appears to be the privileged age: the adolescent is the hero of the twentieth century. Several and many important institutions have proceeded to recognize the essential rights of adolescent care in pediatric departments, but many are still admitted to adult wards with suboptimal therapeutic results, particularly for blood-cancer. The pediatrician, both the family one and the one in the hospital, must be the referees for the health of the adolescent, especially in cases of chronic diseases or in those of psychosocial relevance, following her in the path of the disease especially if other specialists are involved with a view to further investigation, and establishing, since early childhood, communication, dialogue and compliance with her and the whole family. One of the greatest philosophers and sophists of Magna Graecia, Gorgia of Lentini, used to state that the word has tremendous power: it can instill the joy, eliminate pain, enhance compassion, put an end to fear: then be medicine for the suffering. The doctor is in fact, in certain situations of life, a drug for his patient. He is the most widely used drug because drugs are not the only thing that matters: the soul of medicine lies in the relationship, in the communication between the healer and the healed.

[Essential fatty acids and lipid mediators. Endocannabinoids]. / Acidi grassi essenziali, mediatori lipidici ed endocannabinoidi.

In 1929 Burr and Burr discovered the essential fatty acids omega-6 and omega-3. Since then, researchers have shown a growing interest in polyunsaturated fatty acids (PUFA) as precursors of "lipid mediator" molecules, often with opposing effects, prostaglandins, prostacyclins, thromboxanes, leukotrienes, lipossines, resolvines, protectines, maresins that regulate immunity, platelet aggregation, inflammation, etc. They showed that the balance between omega-3 and omega-6 acids has a profound influence on all the body's inflammatory responses and a raised level of PUFA omega-3 in tissue correlate with a reduced incidence of degenerative cardiovascular disease, some mental illnesses such as depression, and neuro-degenerative diseases such as Alzheimer's. The CYP-catalyzed epoxidation and hydroxylation of arachidonic acid (AA) were established recently as the so-called third branch of AGE cascade. Cytochrome P450 (CYP) epoxygenases convert AA to four epoxyeicosatrienoic acid (EET) regioisomers, that produce vascular relaxation anti-inflammatory effects on blood vessels and in the kidney, promote angiogenesis, and protect ischemic myocardium and brain. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are accessible to CYP enzymes in the same way as AA. Metabolites derived from EPA include epoxye-icosatetraenoic acids (EETR) and hydroxyeicosapentaenoic acids (19- and 20-HEPE), whereas DHA include epoxydocosapentaenoic acids (EDPs) hydroxydocosahexaenoic acids (21- and 22-HDoHE). For many of the CYP isoforms, the n-3 PUFAs are the preferred substrates and the available data suggest that some of the vasculo- and cardioprotective effects attributed to dietary n-3 PUFAs may be mediated by CYP-dependent metabolites of EPA and DHA. From AA derives also endocannabinoids like anandamide (N-arachidonoylethanolamine) and 2-arachidonoylglycerol, capable of mimicking the pharmacological actions of the active principle of Cannabis sativa preparations such as hashish and marijuana (-)-Delta9-tetrahydrocannabinol. They act as true 'endogenous cannabinoids' by binding and functionally activating one or both cannabinoid receptor present on nervous and peripheral cell membranes. Enzymes that carry out anandamide oxidation are the same fatty acid oxygenases that are known to act on endogenous arachidonic acid namely, the members of the COX, LOX, and P450 families of enzymes. Recent advances in the biochemistry and pharmacology of the endocannabinoid system, also for its central and peripheral roles in regulating food intake, will offer the development of novel therapeutic agents.

Dental enamel, fluorosis and amoxicillin.

INTRODUCTION: Amoxicillin is one of the most used antibiotics among pediatric patients for the treatment of upper respiratory tract infections and specially for acute otitis media (AOM), a common diseases of infants and childhood. It has been speculated that the use of amoxicillin during early childhood could be associated with dental enamel fluorosis, also described in literature with the term Molar Incisor Hypomineralization (MIH), because they are generally situated in one or more 1st permanent molars and less frequently in the incisors. The effect ofAmoxicillin seems to be independent of other risk factors such as fluoride intake, prematurity, hypoxia, hypocalcaemia, exposure to dioxins, chikenpox, otitis media, high fever and could have a significant impact on oral health for the wide use of this drug in that period of life. OBJECTIVE: The aim of this work was to review the current literature about the association between amoxicillin and fluorosis. METHODS AND RESULTS: A literature survey was done by applying the Medline database (Entrez PubMed); the Cochrane Library database of the Cochrane Collaboration (CENTRAL). The databases were searched using the fol-lowing strategy and keywords: amoxicillin* AND (dental fluorosis* OR dental enamel*) and MIH*. After selecting the studies, only three relevant articles published between 1966 and 2011 were included in the review. CONCLUSION: The presence of several methodological issues does not allow to draw any evidence-based conclusions. No evidence of association was detected, therefore, there is a need of further well-designed studies to assess the scientific evidence of the relationship between amoxicillin and fluorosis and to restrict the prescription of this drug for recurrent upper respiratory tract infections especially acute otitis media (AOM) during the first two years of life. When it is possible can be opportune to use an alternative antibiotic treatment.

[The role of eggs in the diet: nutraceutical and epigenetic aspects]. / Il ruolo delle uova nella dieta: aspetti nutraceutici ed epigenetici.

The use of eggs in human diet has been object of many prejudices which are not yet completely disappeared The evolution of knowledge in the field of nutrition has, partially, countered these prejudices by highlighting the biological importance of several compounds present in the eggs. The nutritional and commercial revaluation of the eggs are passed through the enrichment of the lipid fraction in omega3 polyunsaturated fatty acids (PUFA omega3) which, have shown positive effects against cardiovascular diseases and development of the central nervous system and retina. The enrichment of eggs lipid with omega3 fatty acids is carried out by the integration of feeding hens with oils rich in omega3 fatty acids such as plant or marine oils. The results showed that the accumulation of omega3 in the egg yolk lipids is strongly affected by the type of oil used as supplement and by the amounts of oils administrated to the hens.

[Milk and butter. From the Neolithic to the current nutritional aspects]. / Il latte e il burro. Dal Neolitico agli attuali aspetti nutrizionali.

The evolution in the history of nutrition knowledge towards dairy products, is strictly related to the socio-cultural development of humans. In fact, milk and butter have accompanied humans since ancient times, which traces of the consumption of such products are dated back about the earliest times after the last (glaciation) ice age, while the application for extra nutritional uses, such as cosmetics and ceremonial rites, are reported in the writings of the Old Testament. Even in Italy, before the Roman Empire, were known rudimentary techniques of production and storage of dairy products. But only with the advent of the Etruscans, and the Romans later, that the use of milk and dairy products reach a wide diffusion in several applications. Since the advent of Christ until today, milk and its derivatives have maintained a privileged place in the human diet, but it is only with the advent of modern medicine and new findings in lipidic chemistry that emerged multiple biological and nutritional properties, very important for human health. After a short summary of the ancient history of the milk and butter, the role of dairy products in cancer, in hypercholesterolemia, and cardiovascular disease are reported. Moreover, the current opinions on saturated fatty acids, the role of polyunsaturated fatty acids and their lipid mediators obtained by the action of cyclooxygenase, lipoxygenase and the cytochrome P450 enzymes, are treated. Even if sometimes mistreated, the milk, but most of all its high fat content derivatives such as butter, is a rich source of biologically active compounds that foster a controversial action against neolplastic and cardiovascular disease. These compounds, mainly contained in the lipid fraction, for the more obvious relationships that exist between nutrition and health status, have been the subject in the last decades of intense scientific investigation in which there were expressed lights and shadows, but recognizing that not all fats are harmful and further thorough studies are necessary, in particular, on the derived lipid mediators. This will allow a significant progress based on new scientific evidences, further orienting researchers and clinicians on evidence-based nutritional science.

Gastroenteric pathology and probiotics: from myth to scientific evidence. Current aspects.

Starting from Metchnikoff's theory of cell-mediated immunity and work on lactobacillus over 100 years ago, more and more applications for probiotics have been developed. Research into the health properties of probiotics has focused primarily on two areas: the interaction between intestinal microflora and enterocytes and the immune system and the use of probiotic products in the treatment of gastrointestinal diseases in adults and children. This review examines recent studies on the clinical use of monostrain and multistrain probiotic products in gastroenterology. The most widely studied strains are lactobacilli and yeasts, specifically, Lacto-bacillus rhamnosus GG and Saccharomices boulardii; the gastrointestinal disorders most commonly treated with probiotics are inflammatory bowel disease and dysbiosis, both of which clinically manifest as diarrhea.

Stereotactic radiotherapy in oligoprogressive and oligorecurrent urothelial cancer patients: A retrospective experience.

Urothelial cancer is one of the most common malignancies; after relapse or disease progression available therapeutic options are limited. We analyze efficacy and toxicity of local treatment on metastases using stereotactic body radiation therapy (SBRT) in selected patients with oligometastatic disease from urothelial cancer. A significant percentage of treated lesions achieved local control, with a promising overall response rate. OBJECTIVES: to analyze efficacy and toxicity of local treatment on metastases using stereotactic body radiation therapy (SBRT) in selected patients with oligometastatic disease from urothelial cancer. MATERIALS AND METHODS: Data from clinical records of 19 patients treated in our institution since May 2011 to October 2017 with SBRT for oligometastatic/oligoprogressive urothelial carcinoma were retrospectively collected. Clinical outcomes in terms of local control (LC), response rate, symptoms control, progression free and overall survival (PFS and OS), and adverse events were analyzed and reported. RESULTS: Nineteen patients were treated on 25 metastatic lesions; 5 of them received treatment on multiple sites. After an average follow up of 11.5 months, LC was achieved in 17 lesions (68%) and there was no local recurrence in lesions with complete or partial response. OS was 13.8 months. Adverse events were reported only in 3 patients (5 overall events). No late toxicity was reported. CONCLUSIONS: An approach consisting in SBRT for local treatment of oligometastatic or persistent disease can be effective and safe in selected patients. Prospective studies are needed, to find correct selection criteria and optimal dose and fractionation.

[Childhood obesity: recent advances and an experimental contribution]. / Il bambino obeso: attualità e contributo sperimentale.

This work, in addition to the peculiar medical aspects of the children obesity, synthesize the experimental findings about the main plasmatic antioxidants (uric acid, ascorbic acid, retinol, coenzyme Q10, lycopene) and the platelet fatty acids profile in groups of children according to the following BMI criteria: 43 with a BMI ranging between 25 and 29; 43 with a BMI ranging between 21.7 e 22.9 and 20 with a BMI ranging between 18.5 e 20; average age 10.49 +/- 2.66. The antioxidants show a particular behaviour: in fact they decrease according to the BMI recorded within the groups. About this issue the international literature is not consistent. Probably different results can be found in more severe condition of obesity. Another important result is for the platelet fatty acid, independently from the BMI, weight etc. compared to the other subjects. The difference found is for the stearic acid, from 15 to 21 point of percentage, compared to all the other groups investigated. In agreement with the international literature, stearic acid seems to have an important role in the control of the platelet activation. This finding, could offer a better possibility to understand the progression of the atherosclerosis towards the ischemic condition, according to the age. The utilisation of particular mathematic models, the Artificial Neural Network, beyond the normal advanced statistic methods, has open to the understanding of phenomena, otherwise, inexplicable. With the Artificial Neural Network (ANN) it has been possible to classify the children using the ANN map built for the depressive condition (platelet fatty acids markers: palmitic acid, linoleic acid, arachidonic acid) and the ANN map built for the ischemic condition (platelet fatty acids markers: oleic acid, linoleic acid, arachidonic acid). Examining the maps, a certain percentage of children seems to be at high risk for several psychiatric conditions with respect to the major depression, while for the ischemic pathology the children are in the same position of the ischemic subjects. Because we know that the children are not ischemic, probably they have the same biochemical characteristics but are protected by the high level of stearic acid and by the high degree of saturation of the platelets. For this reason, children cannot belong to the map area of the major depression, which, in turn, is characterized by a very high degree of unsaturation of the fatty acids. Further studies are needed to better understand the complex situation of the children from the biochemical and psychiatric point of view.

[Membrane platelet fatty acids: biochemical characterisation of the ischemic cardiovascular disease, characteristics of the paediatric age, through an artificial neural network interpretation]. / Acidi grassi di membrana delle piastrine: tipizzazione biochimica della cardiopatia vascolare ischemica e caratteristiche dell'età pediatrica nell'interpretazione di una Rete Neurale Artificiale.

During the last 30 years, a huge research has been performed about the markers involved in the atherogenetic process and in the fatty acid thrombogenetic effect. More recently many studies have been made on the biochemical aspects of the saturated fatty acids with respect to the cardiovascular risk, in particular, the Stearic Acid (SA). Because of the peculiar characteristic of the platelets in the control of the thrombogenetic risk, we have investigated the platelet fatty acid profile in three groups of subjects: supposed healthy (n = 60), ischemic (n = 50), young children (n = 118). The aim of the study was to understand wich of the fatty acids could be evaluated as markers of the ischemic cardiovascular pathology and to have the possibility to classifie the subjects using the artificial neural network (ANN) system. The results highlight the peculiar position of the Oleic Acid, Linoleic Acid and Arachidonic Acid. According to the ANN results of the ischemic subjects, the young children were in the same position. Because this result is not commonly accepted, as children are healty, we have looked for a reason. There are well strong reasons to believe that all this is due to the stearic acid wich is extremely higher than the stearic acid of all the other subjects investigated. Particularly it has been underlined the possibility to modify the platelet stearic and oleic acid to obtain a better saturation index (Stearic/Oleic ratio). This could bring to a better control of the cardiovascular risk. It is possible, according with the results obtained, to open a new field of research on the lipid metabolism of the young children in relation to the atherogenesis. It is the first time that an observation on the platelet membrane phospholipid stearic acid is made in comparison to other adult subjects and a plausible explanation is given about the protection of the young children against the cardiovascular disease.

Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is characterized by the delivery of high doses of ionizing radiation in few fractions. It is highly effective in achieving local control, and, due to the high biological effective dose administered, it seems to overcome the radioresistance of renal cell carcinoma (RCC). Thus, SBRT could constitute a treatment option for the management of localized RCC in patients who are not surgical candidates. In this paper, we report an overview about data from the current evidence about SBRT in patients affected by localized RCC. MATERIALS AND METHODS: A non-systematic review was performed, including data from both retrospective and prospective studies focusing on the use of SBRT for localized RCC and its biological rationale. Furthermore, ongoing trials on this issue are reported. CONCLUSION: Currently, SBRT might be considered a treatment alternative in inoperable patients affected by primary RCC. Currently, dose-escalation to 48 Gy in 3-4 fractions are effective and well tolerated. Emerging role of immune therapies in RCC patients warrant further studies to explore interactions between SBRT and immune response.

[Childhood feeding, chronic-degenerative disease in adults, and nutrigenomics]. / L'alimentazione del bambino, la patologia cronica-degenerativa dell'adulto e la nutrigenomica.

Significant advances have been made in understanding the relation between dietary factors and disease prevention. However, the identification of those who will or will not benefit from dietary intervention strategies remains a major obstacle. The execution of the Human Genome Project has brought forth a wealth of information about the structure of the genome and the spectacular development of broad genomics technologies have catalyzed a new era in both medicine and nutrition. Each person is genetically unique and phenotypically distinct, and the genetic makeup that individuals inherit from their ancestors is responsible for variation in responses to food. Evidence continues to implicate dietary components and genetic susceptibilities as important determinants of chronic diseases, cancer risk and tumor behavior. Variation in incidence among and within populations with similar dietary patterns suggests that an individual's response may reflect interactions with genetic factors, which may modify gene, protein, and metabolite expression patterns. Nutrigenetics studies the genetic basis of the different individual responses to the same nutritional stimulus and Nutrigenomics is defined as the interaction between nutrition and an individual's genome. With the application of "omic" technologies, proteomic, metabolomic, transcriptomic, will increase our fundamental knowledge of the interaction between life processes and diet. The identification of diet-gene interactions will offers an opportunity to develop dietary interventions that will lead to evidence-based dietary strategies for restoring health and fitness, obviate the effects of genetic factors for preventing diet-related diseases and provide important clues about gene expression and gene modulation by environmental factors.

[Virgin olive oil. From legend to scientific knowledge of the nutraceutical aspects]. / L'olio extra vergine d'oliva. Dalla leggenda al razionale scientifico degli aspetti nutraceutici.

Proper nutrition has been considered the basis of good health since ancient times. Hippocrates (460-377 BC), father of modern medicine in the western world, claimed that "good health implies an awareness of the powers of natural or processed foods", the Salernitan School (eleventh-twelfth centuries) maintained that "the doctor must observe what food consists of, how much, and when it must be eaten", while Leonardo da Vinci (1452-1519) believed that "a man's life depends on what he eats". We know that lipids are important in nutrition and extra-virgin olive oil plays a predominant role in this field, recognised for its high levels of monounsaturated fatty acids. An example of a "nutraceutic" or "functional" food right from infancy, it is one of the best medicaments for delaying aging, and is also a good source of phytochemicals including polyphenolic compounds, squalene, alpha-tocopherol, carotenoid that may contribute to its overall therapeutic characteristics. An integral ingredient of the Mediterranean diet, extra-virgin olive oil has always been considered a middle road between food and medicine and there is growing evidence that its health benefits include reduction of coronary heart disease risk factor, prevention of several types of cancer, and the modification of immune and inflammatory responses. The origins of the olive tree date back to the Eneolithical era, or Copper Age, in the sixth millennium BC. Having first appeared in Italy during the Bronze Age, the fruit and oil of the olive tree were widely used in nutrition, medicine, art, literature, and daily life during the Etruscan and Roman civilisations, and throughout the Middle Ages and Renaissance. Mysteriously entwined with our own history, the olive tree has a human shape, strong, resilient, tenacious, filled with fruit, but also wounded, suffering and moving. Well-grounded reasons exist for considering olive oil the best nutritional gift we can offer ourselves as it preserves good health, improves the quality of our life and also makes it more enjoyable.

[Rhinosinusitis in childhood]. / La rinosinusite in età evolutiva.

Rhinosinusitis is a pathology having a multifactorial genesis, in which predisposing factors can help the transition from simple rhinitis, that is a very frequent disease in pediatric patient, to a more severe acute bacterial infection of nasal and paranasal cavities. Usually rhinosinusitis, at least at the beginning, has viral origin. Symptomatology of rhinosinusitis is aspecific and clinical data are modest. The course can be acute, subacute or chronic and sometimes recourrent. Diagnosis is given by clinical data, and nasal endoscopy with optics fibers, if necessary. Radiological examination, computed axial tomography and nuclear magnetic resonance, are required in complex and recourrent forms. In 70-80% of cases it recuperates spontaneously, without followings, otherwise it needs a support therapy to relieve symptoms, and to prevent complications. This can be made using hypertonic solutions (Iperclean), in order to remove nasal secretion, to decongest mucosa and improve ciliary clearance. Some researcers demonstrated the effectiveness of this approach, also preventig otitis. Nasal decongestants and antinflammatories are useful, too. Antihistaminic, overall those of 2nd generation, like levocetirizina, are used in allergic forms. Antibiotic therapy is required when rhinosinusitis lasts over 15-20 days, to prevent complications and to avoid the illness to become chronic. Endoscopic nasal surgery allows to reopen natural ways of drainage of paranasal cavities, and it is anyway suggested in more complicated cases.

Thymulin deficiency and low 3,5,3'-triiodothyronine syndrome in infants with low birth weight syndromes.

Experimental and clinical evidence indicates that thymic endocrine function is under neuroendocrine control. Recently, a positive correlation was found between plasma thymulin (a major endocrine product of thymus) and serum thyroid hormone concentrations. Low serum thyroid hormone concentrations are frequently found in premature newborn infants. In this study we measured plasma thymulin by bioassay and serum T3 and T4 in a series of healthy fullterm newborns and in premature infants with various disorders. The study subjects were 26 healthy fullterm infants, 23 fullterm small for gestational age infants, 30 preterm appropriate for gestational age (AGA) infants, 22 preterm small for gestational age infants and 30 infants with respiratory distress syndrome, of whom 15 were fullterm and 15 were preterm AGA. Blood samples were obtained 3, 5, 10, 20, and 40 days after delivery. In the healthy fullterm infants plasma thymulin concentrations were low during the first days of life and subsequently increased, reaching normal values for children aged 1-12 months by the 10th day after birth. Persistently low plasma thymulin and serum T3 levels were found in the majority of infants with pathological conditions; the lowest values for both hormones were found in infants with respiratory distress syndrome. A highly significant positive correlation was present in all groups between mean plasma thymulin and serum T3, but not T4. Short term T3 administration in 6 additional preterm AGA infants caused a significant increase in plasma thymulin titers compared to those in 6 untreated infants. We conclude that plasma thymulin is decreased in premature newborns with the low T3 syndrome and that this abnormality may be reversed by administration of T3. These findings indicate that thymic endocrine activity is modulated by thyroid function in early postnatal life.

Varicella in immunocompetent children in the first two years of life: role of treatment with oral acyclovir. Italian Acyclovir-Chickenpox Study Group.

An open multicenter study has been carried out to evaluate efficacy and tolerability of oral acyclovir in the treatment of varicella in immunocompetent patients in the first two years of life. Fifty-three children aged 3-24 months received acyclovir at 80 mg/Kg/day in four divided doses for 4 to 6 days; 24 of them were treated in the first 24 hours following disease onset, while the remaining 29 patients were enrolled within 48 hours. The assessment of evolution of disease signs and symptoms showed a rapid resolution of fever, itching and other constitutional symptoms, with interruption of vesicle formation and acceleration of cutaneous healing processes. No statistically significant differences have been demonstrated as to disease progression between patients treated in the first 24 hours, when compared with subjects receiving acyclovir in the following 24 hours. Acyclovir confirmed its excellent clinical and laboratory safety profile. By acting favorably on both the duration and severity of disease signs and symptoms, acyclovir treatment should be recommended in young children and infants with varicella, since a higher incidence of severe and complicated disease has been observed in these patient groups.

Post-operative monitoring of cortical taurine in patients with subarachnoid hemorrhage: a microdialysis study.

Intracerebral MD enables the retrieval of endogenous substances from the extracellular fluid (ECF) of the brain and has been demonstrated to be a sensitive technique for early detection of subtle vasospasm-induced neurometabolic abnormalities in patients with subarachnoid hemorrhage (SAH). The aim of this study was to monitor cortical extracellular concentrations of energy metabolism markers, such as glucose and lactate, neurotransmitter amino acids, such as glutamate, aspartate, GABA and taurine to identify any neurochemical patterns of cerebral ischemia. A prospective clinical study was conducted on a group of 16 patients with non-severe SAH operated on within 72 hours after initial bleeding. Following aneurysm clipping, an MD catheter was inserted in the cortical region where vasospasm could be expected to develop, and perfused with artificial CSF at 0.3 microl/min flow rate. Dialysate was collected every 6 hours and then analyzed on High Performance Liquid Cromatography (HPLC) for glucose, lactate, pyruvate, glutamate, aspartate, GABA and taurine. Mean ECF taurine concentrations ranged from 1.4 + 0.7 to 12.3 + 7.8 micromol/l in single patients: global mean value was 5.8 + 3.8 micromol/l. In this series, the highest absolute taurine value was 25.7 micromol/l, observed in a patient who developed clinical and radiological signs of cerebral ischemia. Nine patients presented clinical disturbances related to cerebral vasospasm. In this setting, representing a mild-to-moderate hypoxic condition, MD data demonstrated that lactate is the most sensitive marker of cellular energy imbalance. Increased lactate levels positively correlated with glutamate (P<0.0001), aspartate (P<0.0001), GABA (P<0.0001) and taurine (P<0.0001) concentrations. These results suggest that also in humans increased taurine levels reflect a condition of cellular stress. This study confirms that MD is a sensitive technique to reveal subtle metabolic abnormalities possibly resulting in cell damage.

Streptococcal pharyngitis in Italian children: epidemiology and treatment with miocamycin.

A prospective multicentre study of Italian children with acute pharyngotonsillitis was carried out to determine the incidence of beta-haemolytic streptococcal infection and its epidemiological characteristics and to evaluate the effectiveness of a recently marketed macrolide, miocamycin. From February 1988 to March 1989, 865 children (aged 5 months to 14 years) were enrolled in 11 paediatric departments. Of these 31.9% had a positive throat culture for beta-haemolytic streptococci (26.6% group A streptococci, 5.3% group B, C, D or F). In 68.1% of the patients the throat culture did not yield any pathogen and the disease was considered to be probably viral. No epidemiological (age, season of occurrence, sex) or clinical characteristics (fever, pharyngeal hyperaemia, exudate etc.) could differentiate children with streptococcal pharyngotonsillitis from those with a probably viral one. Breese's score correctly identified only 19.1% of the cases with group A streptococcal infection. Miocamycin was given 50 mg/kg/day in 2 divided doses for 10 days in 225 children with streptococcal pharyngitis. The drug exhibited good clinical efficacy (resolution or improvement of acute signs and symptoms) in 96.3% of the children and a microbiological efficacy (eradication of the causative bacteria) in 85.3%.

Epidemiology and treatment of otitis media with effusion in children in the first year of primary school.

In this multicentre study we evaluated the prevalence and risk factors of otitis media with effusion (OME) in Italian school-children and the effectiveness of medical treatment of chronic OME with a new cephalosporin, ceftibuten. During two winter periods, 3413 children, aged 5 to 7 years, were examined for the presence of OME by means of pneumotoscopy and a portable, hand-held tympanometer. The prevalence of asymptomatic OME was 14.2%, with no difference as regards sex, age, month of examination or geographic area. Younger children had significantly more bilateral than unilateral effusion. A recent episode of acute otitis media and previous tonsillectomy or adenoidectomy were associated with an increased risk of OME in multivariate logistic regression models. The presence of OME was unrelated to such factors as birthweight, prematurity, sibling or parental history of allergy, duration of daycare attendance, family history of ear infections. After 12 weeks, 26.6% of children with OME still had middle-ear fluid: 52 were randomized to ceftibuten (9 mg/kg q.d. for 14 days) and 59 to no treatment (nasal saline drops allowed). Children treated with ceftibuten had a significantly better resolution of middle-ear effusion after 4 and 8 weeks. As mass screening programmes for OME in the year of school entry are questioned, a focus only on children with known risk factors seems advisable. Ceftibuten can be useful in reducing the duration of middle-ear effusion.