"All the rest is normal". A pilot study on the communication between physician and patient in prenatal diagnosis.

The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.

[Pre-adolescents and sport: results of a health survey in some secondary schools of Brianza]. / I preadolescenti e lo sport: risultati di un'indagine in alcune scuole medie dell'area brianzola.

This study is aimed at assessing time dedicated to, motivation and involvement in physical activity on behalf of pre-adolescents. 802 students (49.3% boys and 50.7% girls; mean age: 12.6) attending 43 classes of 11 Brianza's post-elementary schools. A questionnaire was prepared and administered to the involved sample. Classes took part in this study through randomized selection and data were analyzed using program Epi Info 6. Most of the respondents (60.1%) stay involved in sport because "it makes me feel good" and 32.4% because sport is "enjoyable and entertaining". Pre-adolescents chose the sport in which they become engaged on the basis of personal inclination (40%), in order to share experiences and their free time with friends (15.4%); 13.7% declare to prefer sport to be practiced in team. (13.7%). The most practiced sport are: football (51.3% boys, 4.5% girls), volley (3.9%-36.4%), dance (0.8%-25.2%) e swimming (9.4%-14%). 80.8% in the sample practice physical activity in settings outside schools and, among these, 51.7% dedicate three or more hours weekly to extra-school activities. There are significant differences (p < 0.05) between males' and females' engagement in physical activity (mean value: 4.1 hours; males: 4.6 h, females: 3.5 h). Among pre-teens, 18% declare to be physically inactive at all; 15.7% do not take part in sport activities because afraid to be bullied or shamed by peers. Research show that males are significantly more involved in physical activity than females.

[Hepato-diaphragmatic interposition of the colon (Chilaiditi syndrome)]. / Interposizione epato-diaframmatica del colon (Sindrome di Chilaiditi).

The authors describe a Chilaiditi's Syndrome which they observed and supervised for two years. They consider its clinical picture, the essential elements for the diagnosis, the evolution and the therapy. In accordance with the pediatric literature the resolution was spontaneous, and this fact confirms the opportuneness of a therapy of wait, also to avoid an unnecessary surgical operation.

[Benign intracranial hypertension caused by sulfenazone]. / Ipertensione endocranica benigna da sulfenazone.

Case report of a iatrogenic benign intracranial hypertension in a 7 months old infant. Unlike in the child and the adult, this syndrome has a peculiar non specific clinical pattern in the infant. Having ruled out other specific acute diseases of the central nervous system, it seems reasonable not to start any treatment since the outcome of this condition is always benign.

[Transient idiopathic hyperphosphatasemia in infancy. Presentation of a case]. / Iperfosfatasemia transitoria idiopatica dell'infanzia. Segnalazione di un caso.

One case of a 13-months-old-female infant with transient idiopathic hyperphosphatasemia is described. This syndrome is characterized by: 1) increased serum alkaline phosphatase activity not associate with an organic disease; 2) normalization of the enzyme activity within 12 weeks. Familial hyperphosphatasemia, a permanens disease, is also excluded because of ALP normal values in both parents. Rickets, hepatic and biliary diseases are excluded by clinical, radiologic and laboratory data.

[Antiphospholipid antibody syndrome as a possible cause of paresis in a child]. / La "sindrome da anticorpi antifosfolipidi" come possible causa di una paresi in un bambino.

The Authors report on the case of a 4-year-old boy, admitted to the pediatric department for left hemiplegia. CT scan of the brain was negative on the day of admission but, on the following day, showed 3 small hypodense focal lesions in the posterior branch of the internal capsule, in the knee of the internal capsule and in the posterior parietal region of the cortex. The acute phase almost completely resolved in 10 days. Twenty days after presentation, cerebral angiography showed a thrombosis of an anterior, right perforating vessel, together with the hypoplasia of the horizontal portion of the cerebral anterior artery. The determination of anti-cardiolipin antibodies, even though performed far from the acute phase of the disease, showed a low IgG positivity. Two months after the onset the neurological symptoms completely resolved. In the presence of hypoplasia, narrowing and other lesions of cerebral vessel, it is possible to hypotesize that the occurrence of thrombotic fenomen, ascribable to anti-phaspholipid antibodies, is responsible for the neurological symptoms. The association of thrombosis and anti-phospholipid antibodies suggest that the assessment of anti-phospholipid antibodies should be routinely performed in the presence of thrombotic phenomena.

[A case of type II achondrogenesis]. / Un caso di acondrogenesi tipo II.

We describe a rare case of type II achondrogenesis (gestational age = thirty-two weeks) dead forty-five minutes after birth. This congenital skeletal dysplasia is classified among the lethal osteochondrodysplasias. Clinical features were enough for diagnosis and autopsy added nothing to our clinical knowledges.

Wild grapevine: silvestris, hybrids or cultivars that escaped from vineyards? Molecular evidence in Sardinia.

Vitis vinifera ssp. silvestris, the spontaneous subspecies of V. vinifera L., is believed to be the ancestor of present grapevine cultivars. In this work, polymorphism at 13 SSR loci was investigated to answer the following key question: are wild plants (i) true silvestris, (ii) hybrids between wild and cultivated plants or (iii) or 'escapes' from vineyards? In particular, the objective of the present study was to identify truly wild individuals and to search for possible hybridization events. The study was performed in Sardinia, the second largest island in the Mediterranean Sea, which is characterized by a large and well-described number of both grape cultivars and wild populations. This region was ideal for the study because of its spatial isolation and, consequently, limited contamination from outside material. The results of this study show that domesticated and wild grapevine germplasms are genetically divergent and thus are real silvestris. Pure lineages (both domesticated and wild) show very high average posterior probabilities of assignment to their own clusters, with a low level of introgression.

[Preadolescents' nutritional habits: a survey in the secondary schools in Brianza]. / Le abitudini alimentari dei preadolescenti: indagine nelle scuole medie della Brianza.

AIM: This study was aimed at assessing eating habits among preadolescents living in Brianza, with a special focus on snacking' and breakfast' habits. METHODS: The research was carried out in 12 post-primary schools in Brianza and included 802 students attending 43 different classes (49.3% males and 50.7% females; mean age:12.6 years). The research tool was an ad hoc questionnaire administered to the preadolescents attending school on the day of the research. Data were analyzed using program Epi Info 6. RESULTS: Many students (78.3%) had breakfast in the morning of the questionnaire's administration. Among those perceiving themselves as overweight, not having breakfast is more common than among others. This information is the opposite of what preadolescents say when inquired about their habit to have ''a good breakfast'': only 36.8% of the responders declare that it happens on a daily basis. As to snacking, 18.7% of the students declare to be used to having multiple snacking during the day; during school recess on the day of the survey, 39.9% of respondents declared that they had eaten various industrial snacks, while 27.4% had cakes or fresh bread, 1.2% both of them and 0.6% fruit. On a daily basis, 59.5% report to eat various and different fruits and 62.9% report the same when inquired about vegetables. CONCLUSION: Considering the importance of a correct nutrition during developmental age and the importance of the phase of adolescence in establishing permanent nutritional habits that will last life-long, it is thus an educational priority to help preadolescents to choose the best foods for their health and well being.

[Treatment of sex identity disorders in children: first results]. / Trattamento dei disturbi dell'identità di genere nell'età evolutiva: primi resultati.

The main character of the disorders of self identification of the sex during the growing ages, is the discrepancy between the sex stated at the birth and the sex self identity of the child. These disorders have in fact a continuity with the transsexualism of the adult. From 1983 15 subjects (11 M, 4 F) aged between 11 and 14 years had been controlled in our Institution for a psychodiagnostic evaluation. All the patients demonstrated psychopathological disorders of different grade: disorders of emotion, familiar or social misfit. The aim of the treatment, when the diagnosis is made early, is to restore both the self role of the sex and the intrinsic sex identity. When the diagnosis is late, the treatment is performed exclusively on the role of the sex. In some cases the treatment is carried out on the parents too. The best results are achieved as early as both the diagnosis and the treatment are made and when the familiar dynamics are mild. However the final results of the treatment can be verified only in the adult, by controlling both the stability of sex identity and the sexual role.

[The early high-dose immunoglobulin treatment of neonatal autoimmune thrombocytopenia]. / Trattamento precoce di trombocitopenia neonatale autoimmune con immunoglobuline ad alto dosaggio.

The paper reports the case of a neonate suffering from autoimmune neonatal thrombocytopenia whose mother had suffered from previous idiopathic thrombocytopenia purpura. Although asymptomatic, the baby received early treatment with high doses of immunoglobulin G (1 g/kg) in a single dose. Treatment was repeated on day 12 using the same method. No other treatment was associated with IgG. The Authors confirm the good level of tolerability and efficacy of IgG in the treatment of autoimmune neonatal thrombocytopenia without complications.

[The persistence after clinical recovery and the suspension of therapy of altered ESR values in a case of meningococcal sepsis and septic shock]. / Persistenza oltre la guarigione clinica e la sospensione della terapia di alterati valori di VES in un caso di sepsi meningoccica e shock settico.

The paper describes a case of meningococcal sepsis and septic shock treated with Ceftriazone, Dexamethosone, plasma and heparin. It was observed that contrary to other hematological parameters, ESR levels remained high for one month after the suspension of antibiotic therapy and complete clinical recovery. The authors relate this alteration of ESR values to the administration of plasma during the acute phase of the disease.

Sibling sex ratio of boys with gender identity disorder.

Sibling sex ratio (the ratio of brothers to sisters) was calculated for 444 boys with gender identity disorder (or with behaviors consistent with this diagnosis). The probands were ascertained from several researchers with expertise with this disorder and from the English language case report literature between 1938 and 1995. Among the probands with at least one sibling (N = 333), the results showed that boys with gender identity disorder had a significant excess of brothers to sisters, 131.1:100, when compared with the expected secondary sex ratio of 106:100. The excess of brothers replicated a previous study by Blanchard, Zucker, Bradley, and Hume (1995), in which the sibling sex ratio was 140.6:100. Further analyses showed that the probands were born later relative to their brothers than they were relative to their sisters. These findings are amenable to several psychosocial and biological explanations, which require further investigation.

Immunization with Haemophilus influenzae type b conjugate vaccine in children given bone marrow transplantation: comparison with healthy age-matched controls.

Forty-seven patients (age range, 7 months-18 years) with malignant (38 cases) and nonmalignant (9 cases) disorders given an allogeneic or an autologous bone marrow transplantation (BMT) were immunized with Haemophilus influenzae type b (Hib) polysaccharide-diphtheria toxoid conjugate vaccine administered in a single dose at different time points after transplantation. Results were compared with those of 13 healthy children matched for age and sex who received the same immunization schedule. Serum and saliva samples for measurement of total IgG subclass and specific antibody levels were obtained from patients and healthy controls before and 3 weeks after vaccination. Twenty-five of the 47 patients (53%) had a specific anti-Hib IgG response, while an effective IgA and IgM response was mounted by 23 (49%) and 11 (23%) children, respectively. In the control group, 13 of 13 subjects mounted a specific IgG antibody production (P < 0.005 in comparison to the patients' response rate), while an IgA and IgM response was demonstrated in 12 (92%; P < 0.01 compared to transplanted patients) and 7 (54%; P < 0.05 in comparison to BMT recipients) children, respectively. Lapse of time from BMT to immunization was the most important factor predicting antibody response, as proved by an effective increase in prevaccination specific IgG levels in the majority of patients vaccinated after 2 years from transplant. Our data demonstrate that BMT recipients have a reduced capacity to mount an antibody response to polysaccharide antigens compared to normal controls, even when a protein-conjugated vaccine is employed. Since time after transplant is the major factor influencing the recovery of immune reactivity to polysaccharide antigens, the ontogeny of the B cell repertoire seems to follow a predetermined sequential program of development.