Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report.

BACKGROUND: Cardiac tuberculosis is rare and usually manifests as tuberculous pericarditis. Involvement of other part of the heart is unusual and descriptions in the pediatric literature are confined to few case reports regarding mainly myocardial tuberculosis. CASE PRESENTATION: We describe a case of pulmonary miliary tuberculosis associated with intracardiac left atrial tuberculoma in an immunocompetent eleven-month-old infant successfully treated with surgery and antituberculous therapy. CONCLUSION: Although unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind.

Chagas disease in Italy: breaking an epidemiological silence.

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.

Forced vital capacity and maximal respiratory pressures in patients with mild and moderate scoliosis.

Lung function and maximal respiratory pressures of 24 adolescent females with mild-to-moderate idiopathic scoliosis (spinal curvature 10-60 degrees) were determined and compared with 38 age- and sex-matched controls. Twelve patients with moderate scoliosis (Cobb angle 35-60 degrees) had significantly reduced mean values for FVC (% predicted) and maximal inspiratory pressure (MIP), as compared to the controls. Twelve patients with mild scoliosis (Cobb angle less than 35 degrees) had normal mean values for FVC and maximal respiratory pressures, but five individual patients had FVC values less than 80% predicted. All but one of the patients with mild scoliosis had normal MIP values. FVC (% predicted) was significantly correlated with the degree of spinal curvature (r = -0.466; P less than 0.05) but was not related to MIP. These results indicate that reduced FVC values do occur in patients with mild-to-moderate idiopathic scoliosis and suggest that these low FVC values can be attributed to the rib cage deformity rather than to an inability to generate adequate inspiratory pressures.

Airway resistance and spirometry in children with perinatally acquired human immunodeficiency virus-type 1 infection.

Airway resistance was measured by the interrupter technique in 54 children [aged 63.8 months (range: 9.1-131.6 months)], with perinatal human immunodeficiency virus-type 1 (HIV-1) infection and in a control group of 315 gender, height, and race-matched healthy children. In addition, 14 HIV-infected children, aged 75-131 months, had spirometry performed. Resistance was significantly higher in infected children than in controls (0.84 +/- 0.3 vs 0.64 +/- 0.08 kPa x l(-1) x s; t = 9.991; P < 0.0001). Resistance decreased with age in controls (r = -0.95; P < 0.001), but not in infected children (r= -0.22; P = 0.105). Resistance did not correlate with mothers' intravenous drug addiction, perinatal data, T-cell subset numbers, treatment, clinical course, or presence of respiratory complications. Resistance was higher (t = 3.103; P < 0.003) in p24 antigen-positive than in negative children. Thirty-nine children underwent a second evaluation 12.3 months (range 11.1-14 months) after the first. Resistance was higher (t = 3.960; P < 0.0001) at the second evaluation compared to the first. Eight of 14 children had abnormal spirometric measurements. We conclude that perinatal HIV-1 infection is associated with increased airway resistance and often abnormal spirometry. The degree of abnormalities in resistance depends on the duration of the infection rather than on HIV-1-related respiratory complications.

[Role of the subfascial endoscopic perforating veins surgery in the treatment of venous ulceration: physiopathology and diagnosis]. / Ruolo della interruzione sottofasciale delle vene perforanti per via endoscopica nella terapia delle ulcere flebostatiche: fisiopatologia e diagnostica.

Chronic venous insufficiency is a recurrent pathology, but affected patients often undergo clinical observation at a most severe and clearly symptomatic stage of the disease. In this late stage, therapy can only relieve symptoms of the disease which often lead to disability. In the clinical course of chronic venous insufficiency, phlebostatic ulceration constitutes a recurrent finding and it is responsible of compromising patients quality of life. The role of perforating veins, made refluxive by various pathogenic noxa, in the genesis of ulcerative lesions has been known since long time. For many years the interest in perforating veins surgery has been limited because of the several negative consequences of the operations. The possibility of modifying the hemodynamics of perforating veins compartment without causing post-operation complications by video-supported surgery, led to the debate on the role of these vessels in the chronic venous insufficiency. The phlebostasis non-invasive diagnosis uses imaging techniques consisting in tests which mostly are cheap, simple and easy to perform, thus representing the best early approach to the patient. It is widely thought that even though complex examinations are available, most precious information can be obtained by only two examinations: color-Doppler ultrasonography and, limitedly, plethysmography. By these diagnostic directions it is possible to better identify the site and the hemodynamic origin of the venous insufficiency.

[Incidence of exercise-induced bronchospasm (E.I.B.) and its correlation with clinical history in children with allergic asthma]. / Incidenza del broncospasmo indotto da esercizio fisico (E.I.B.) e correlazione con la storia clinica in bambini affetti da asma allergico.

In this study, 65 allergic asthmatic children were evaluated for the presence of exercise induced bronchospasm (E.I.B.). Pulmonary function (volume at 1 second of forced expiration--FEV1; maximal mid-expiratory flow--FEF 25-75; peak expiratory flow--PEF) was assessed before and serially for 20' following treadmill exercise. Only 18 children (27.6%) presented a fall in FEV1 > or = 20%. There was a relationship between severity of asthma and incidence of E.I.B., as children with episodic, frequent and chronic asthma presented respectively 13/55 (23.4%), 2/6 (33.3%) and 3/4 (75%) of positive responses. The presence of E.I.B. cannot be predicted by clinical history, as 15/36 (41.7%) of subjects with positive clinical history had E.I.B., against 3/29 (10.3%) of subjects with negative clinical history (p = n.s.). E.I.B. in asthmatic children is less frequent as reported, correlates with severity of asthma and cannot be accurately predicted from the history.

[Incidence of asthma caused by food allergy in childhood]. / Incidenza dell'asma da allergia alimentare in età pediatrica.

Both upper and lower respiratory tracts can be affected by food allergy. In infants these symptoms may be due exclusively to food allergy or may result from the effect of food allergy and another co-factor (gastro-esophageal reflux, immunodeficiency, concomitant allergy to inhalants, etc.). The incidence of food-induced asthma is not well know. In this study, using open and double blind food challenge, we found that the incidence of IgE-mediated, food-induced asthma in children is 5.7%. The most offending foods were milk, eggs, and peanuts. Food allergy respiratory symptoms were almost always associated with other clinical manifestations (cutaneous, gastrointestinal). In fact we have been able to demonstrate only one isolated case of cough due to food allergy. It follows that the recognition of food dependent-IgE-mediated asthma is essentially limited to these cases characterized by food allergy with asthmatic expression.

[Evaluation of the respiratory function in patients with Duchenne's muscular dystrophy]. / Valutazione della funzionalità respiratoria in pazienti affetti da distrofia muscolare di Duchenne.

The purpose of this investigation was to compare the respiratory function of patients with different clinical stages of Duchenne muscular dystrophy (DMD). Twenty-three DMD patients who were followed at Paediatric Department of Florence, were studied. We found a good correlation between the subject's functional capacity and normal predicted values for forced vital capacity (FVC) as well for forced volume at first second (FEV1). Subjects whose FVCs ranging from 10% to 20% were considered mildly involved; subjects with FVCs ranging from 20 to 30% were considered moderately involved, severe involved subjects with FVCs ranging from 30% to 40%. When the FVCs were less than 40% of the predicted values, the subjects were considered to have very severe respiratory impairment. In our study 83% of patients wheelchair bound was characterised by a very severe deterioration of pulmonary function.

[Bronchial response to a provocation test in children allergic to Dermatophagoides pteronyssinus]. / Risposta bronchiale dopo test di provocazione in bambini allergici al dermatophagoides pteronyssinus.

Bronchial provocation tests with allergens are becoming recognized as one of the most important diagnostic parameters for the detection and confirmation of the role of the allergic component directly on the reaction site. Twenty-seven children with positive skin tests and RAST for Dermatophagoides Pteronyssinus were challenged with solutions of the same antigen. Twenty-one (77%) had positive responses expressed by different patterns: Six (28.5%) showed isolated early reaction, seven (33.3%) had biphasic responses. Six (28.5%) showed dual response with prolonged (1-2 hours) late reaction. One child had dual late reaction after 35 hours (ultra-late reaction). Six (28.5%) patients had negative reactions. The results suggest that bronchial provocation tests with antigens performed as outlined in this study can also be applied in the diagnosis of pediatric allergy.

[Subclasses of IgG: biological aspects and functional behavior in response to vaccination]. / Le sottoclassi delle IgG: aspetti biologici e comportamento funzionale in risposta alle vaccinazioni.

The IgG subclasses are known to have different structure and functions. The IgG1 and IgG3 bind to monocyte and neutrophils and activate the complement more easily then IgG2 and IgG4. The levels of IgG subclasses found in newborns are mainly determined by the transplacental passage since the synthesis, in the first time of life, is very low. The levels found in adults are reached only during the adolescence. The immune response to a protein antigen is mainly in the IgG1 subclass, on the contrary the response to polysaccharide antigens is mainly IgG2. For that reason children, who produce very few IgG2 till they are 2 years old, cannot be vaccinated with carbohydrate vaccines unless a protein conjugate vaccine is used. In addition, the route of subministration, the dose of antigen, the age of vaccinated people and genetic factors can modify the subclass pattern obtained in response to vaccinations. For these reasons, probably, the immune response studied after a vaccination or in individuals who recovered from a natural disease is not always the same. Since the role of the different subclasses is not yet completely clarified, the interpretation of the importance of a selective "choice" of a subclass instead of another after vaccination is still difficult.

[Radiologic examination of the paranasal sinuses in asthmatic children]. / L'esame radiologico dei seni paranasali nel bambino asmatico.

We examined the prevalence of abnormalities found by sinus X-Rays in 80 asthmatic children classified into three groups in relation to severity of their symptoms. All the children underwent skin tests and some of them methacholine challenge. 63.7% of asthmatics showed abnormalities in sinus X-Rays. No correlation was found between the severity of asthma, radiographic findings, and atopic status. Bronchial hyperreactivity studied using metacholine challenge according to the method of Chai was the same both in patients with asthma and sinusitis and in those with asthma only. In conclusion, abnormal sinus X-Rays do not seem to be an aggravating factor in asthmatic status.

Inhibition of exercise-induced-asthma (EIA) by nedocromil sodium and sodium cromoglycate in children.

Nedocromil sodium (Ned) 4 mg, sodium cromoglycate (SCG) 10 mg, and placebo were compared for their efficacy in preventing exercise-induced asthma. Nineteen asthmatic children aged six to 15 years performed a treadmill exercise test before and 20' after a single dose of drug in a double-blind trial. Both active drugs performed significantly better than placebo; in fact the exercise challenge resulted in a mean maximum fall in FEV1 of 26.1 +/- 14.9% after placebo, but only of 14.6 +/- 11.5% after SCG (P < 0.05), and 11.0 +/- 12.4% after Ned (p < 0.01). Measurements of PEFR gave similar results, while the effect of treatment on FEF 25-75 was significant for Ned alone (p < 0.05). Direct comparison between Ned and SCG at different time points demonstrated significant differences in FEV1 at 1 min (p < 0.05) with a better overall performance of Ned. In individual patients, complete protection was provided in 9 patients with SCG, in 14 patients with Ned and in 2 with placebo. No side effects were observed. This study suggests that at the dosages used there are only slight differences between SCG and Ned activity in the prevention of exercise-induced asthma.

The preventive effect of nedocromil or furosemide alone or in combination on exercise-induced asthma in children.

BACKGROUND: Recent evidence suggests that inhaled nedocromil and furosemide are effective in preventing asthma by ultrasonically nebulized distilled water, allergen, and exercise. There are, however, no studies that compare the effects of these two drugs. The aim of this study was to investigate the effect of inhaled furosemide (30 mg), nedocromil (4 mg), the combination of these two drugs, and placebo aerosol in preventing exercise-induced asthma. METHODS: Twenty-four children with exercise-induced asthma, aged 6 to 16 years, performed a treadmill test before and 20 minutes after a single dose of drug(s) in a double-blind trial. Lung function measurements were taken before drug administration, before the exercise test (20 minutes after drug administration), and then 2, 4, 6, 8, 10, 15, 20, and 30 minutes after the exercise test. RESULTS: Both active drugs performed significantly better than placebo. In fact, the exercise challenge resulted in a mean maximum fall in forced expiratory volume in 1 second of 28.46% +/- 13.84% after administration of placebo, but of only 15.42% +/- 8.35% after administration of nedocromil (p < 0.001) and of 11.37% +/- 9.14% after administration of furosemide (p < 0.001). When the two drugs were given together, there was a statistically significant additive effect because the mean maximum fall in forced expiratory volume in 1 second was 5.75% +/- 3.57% (nedocromil vs nedocromil + fluorsemide: p < 0.001; furosemide vs nedocromil + furosemide: p < 0.01). CONCLUSION: This study suggests that nedocromil and furosemide provide a comparable effect in preventing exercise-induced asthma in children. The combined administration of the two drugs significantly increases the protective effects, suggesting a potential therapeutic use.

[Importance of a particular formula of soybean milk without S2 globulin, in the treatment of allergy to cow's milk proteins]. / Importanza di una particolare formula di latte di soia priva della globulina S2, nel trattamento dell'allergia alle proteine del latte vaccino (APLV).

Replacing cow's milk with a soybean milk is one of the first measures which are commonly taken with babies suffering from cow's milk protein allergy. Unfortunately soybean can induce sensitization, too, with a variable percentage (ranging from 12 to 80%) according to the different Authors, due to the presence of allergenic proteins, among which the most important one seems to be S2 globulin. An excellent tolerability has been reported in a study carried out with 20 babies suffering from cow's milk protein allergy besides a good palatability of the product with a solution of symptoms in 87.3% of the cases. Only in 16.7% of the treated babies intolerance has been reported and therefore we can conclude that soybean milk has proved to be an excellent substitute of cow's milk in babies suffering from cow's milk protein allergy.

Studies on heterocyclic compounds: spiro [indole-3,2'-thiazolidine] derivatives. II. Antimicrobial activity of halogenated 3'-phenylspiro 3H-indole-3,2'-thiazolidine -2,4 (1H)-diones.

The following polyhalogenated 3'-phenyl 3H-indole-3,2'-thiazolidine -2,4' (1H)-dione of general formula (A) were synthesized and screened for antimicrobial activity. (formula: see text) where: X = H (I, III, V, VII, IX, XI), CH3 (II, IV, VI, VIII, X, XII); Y = H (I, II), 2,4-F2 (III, IV), 2,4-Cl2 (V, VI), 3,4-Cl2 (VII, VIII), 2,6-Cl2 (IX, X), 2,4,6-Cl3 (XI, XII). The general synthetic route involves the preparation of variously substituted isatin-3-imines, which are subjected to cyclocondensation with thioglycolic acid to give compounds I, III, V, VII, IX, XI, or thiolactic acid to give compounds II, IV, VI, VII, X, XII. The prepared compounds were screened against S. aureus, B. cereus, M. paratuberculosis, E. coli, Pr. mirabilis, Ps. aeruginosa, C. albicans, S. cerevisiae, A. niger by a disk-diffusion assay (Kirby-Bauer modified). The results of the antimicrobial screening showed that the polyhalogenated derivatives of type (A) exhibited varying degrees of activity against Gram-positive, Gram-negative bacteria, and fungi. Compound (III) showed a significant activity toward A. niger, moreover compound (IV) was active toward C. albicans. Compound (IX) was very active toward S. typhi and Ps. aeruginosa. Compounds (VII), (IX) and (XII) were very active toward M. paratuberculosis.

Studies on heterocyclic compounds: 1,3-thiazolidin-4-one derivatives. IV. Biological activity of variously substituted 2,3-diaryl-1,3-thiazolidin-4-ones.

The following 2,3-diaryl-1,3-thiazolidin-4-ones of general formula (A) were synthesized and screened for antimicrobial activity. (formula; see text) where: X = H (I, III, V, VII, IX, XI, XIII, XV, XVII, XIX, XXI, XXIII), CH3 (II, IV, VI, VIII, X, XII, XIV, XVI, XVIII, XX, XXII, XXIV); R = H (I, II, V, VI, VII, VIII, XI, XIII), 4-CH3 (XXI, XXII, XXIII, XXIV), 4-Br (III, IV, IX, X), 2-NO2 (XIII, XIV), 3-NO2 (XV, XVI), 4-NO2 (XVII, XVIII), 4-OCH3 (XIX, XX); R' = H (I, II, III, IV, XIII, XIV, XV, XVI, XVII, XVIII, XIX, XX, XXI, XXII), 4-CH3 (XXIII, XXIV), 3-Br (V, VI), 4-Br (VII, VIII, IX, X), 4-J (XI, XII). These compounds were prepared by the general synthetic procedure previously reported for the 1,3-thiazolidin-4-one derivatives already prepared and screened in this SARs program. The synthetic approach involves the cyclocondensation of the appropriate Schiff bases with alpha-mercaptoalkanoic acids. The prepared compounds were screened against S. aureus, S. beta-haemolititicus, B. subtilis, M. paratuberculosis 607, S. typhi, Kl. pneumoniae, E. coli Bb, Ps, aeruginosa, C. albicans, A. niger, S. cerevisiae by a disk-diffusion assay (Kirby-Bauer modified). The results obtained in this investigation showed that the prepared compounds exhibited varying degrees of antimicrobial activity. They were especially inhibitory toward Gram-positive bacteria, and fungi. 4-Nitroderivatives (XVII), (XVIII), and 2-nitroderivatives (XIV) and (XIII) possessed marked antimicrobial activity against S. aureus, S. beta-haemoliticus, and B. subtilis.(ABSTRACT TRUNCATED AT 250 WORDS)

Reference values of interrupter respiratory resistance in healthy preschool white children.

BACKGROUND: Interrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children. METHODS: Rint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze. RESULTS: A total of 284 healthy white children (age range 3.0-6.4 years) were evaluated. Mean inspiratory and expiratory Rint (RintI and RintE) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both RintI and RintE in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with RintI, whereas only height was significantly and independently correlated with RintE. Supporting the cheeks had no significant effect on RintI (n=29, median 0.673 v 0.660 kPa/l.s, p=0.098) or RintE (n=39, median 0.702 v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for RintI (n=50) and 0.242 kPa/l.s for RintE (n=69). Long term repeatability was 0.208 kPa/l.s for RintE (n=26). CONCLUSIONS: We have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.

Studies on heterocyclic compounds: 1,3-thiazolidin-4-one derivatives. III. Biological activity of halogenated 2,3-diaryl-1,3-thiazolidin-4-ones.

In previous communications from these laboratories, thiazolidinone derivatives of general formula (A) were synthesized and screened for antimicrobial activity. (formula; see text) where: X = H, CH3 Ar = phenyl Ar' = fluorinated or chlorinated phenyl The present communication is in part concerned with further extension of these studies to variously halogenated thiazolidinones of general formula (B). (formula; see text) where: X = H, CH3 R = H, 2-F, 3-F, 4-F, 3-Cl, 4-Cl R' = H, 4-F, 4-Cl These compounds were prepared by the general synthetic procedure previously reported for the 1,3-thiazolidin-4-one derivatives already prepared and screened in this SARs program. The general synthetic approach involves the cyclocondensation of the appropriate Schiff bases with alpha-mercaptoalkanoic acids such as thioglycolic and thiolactic acid. The prepared compounds were tested for their possible activity by a disk-diffusion assay (Kirby-Bauer modified). The organisms used were: S. aureus, S. beta-haemoliticus, B. subtilis, M. paratuberculosis 607, S. typhi, Kl. pneumoniae, E. coli Bb, Ps. aeruginosa, C. albicans, A. niger, S. cerevisiae. The results of this antimicrobial screening showed that the prepared compounds exhibited varying degrees of activity against Gram-positive, Gram-negative bacteria, and fungi. The second half of this report deals with the structure-activity relationships in all the compounds prepared and studied in this research program. For comparison of antimicrobial activity, the growth inhibitory activity of all the halogenated thiazolidinones of type (A) and (B), prepared and screened in this SARs study, were tabulated.(ABSTRACT TRUNCATED AT 250 WORDS)