A transition clinic model for inflammatory bowel disease between two tertiary care centers: outcomes and predictive factors.

OBJECTIVE: Few models of transition have been proposed for inflammatory bowel disease (IBD). The aim of the present study is to evaluate the feasibility of a transition model and the predictive factors for success/failure. PATIENTS AND METHODS: Patients with low activity or remission IBD were enrolled. Proposed model: three meetings every four-six weeks: the first one in the pediatric center (Bambino Gesù Children's Hospital); the second one, in the adult center (Foundation Polyclinic University A. Gemelli), with pediatric gastroenterologists; the last one, in the adult center, with adult gastroenterologists only. Questionnaires included anxiety and depression clinical scale, self-efficacy, quality of life, visual-analogic scale (VAS). Transition was considered successful if the three steps were completed. RESULTS: Twenty patients were enrolled (range 18-25 years; M/F: 12/8; Ulcerative Colitis/Crohn's Disease 10/10); eight accepted the transition program, four delayed the process and eight refused. Patients who completed transition generated higher scores on the resilience scale, better scores on well-being perception, and had lower anxiety scores. Patients who failed transition were mostly women. The perceived utility of the transition program was scored 7.3 on a VAS scale. CONCLUSIONS: The proposed transition program seems to be feasible. Psychological scores may help in selecting patients and predicting outcomes.

[Scanning electron microscopy (S.E.M.) aspects of intestinal mucosal surface in childhood coeliac disease]. / Aspetto della mucosa intestinale al microscopio a scansione elettronica (S.E.M.) nella malattia celiaca del bambino.

Intestinal mucosal surface in 5 children suffered with Coeliac Disease was observed at Scanning Electron Microscopy. The comparison between two techniques of dehydration demonstrated that the Alcool-Amile Acetate dehydration reduces the technical errors to the minimum. Therefore, a better visualization allows us to recognize the surface coat, the microvillous and some mucosal functional aspects (scale off), which were previously undistinguished. There are no differences between the mucosal aspects in adult coeliac disease and childhood coelia disease.

[Kaposi's varicelliform eruption. Presentation of 3 cases]. / Eruzione varicelliforme di Kaposi. Presentazione di 3 casi.

Three cases of Kaposi's Varicelliform Eruption are reported. In all cases the herpes virus simplex etiology was demonstrated. Every patients had in the anamnesis clinical signs of atopy. The findings in all patients of depressed cell-mediated immunity confirmed a minimal immunodeficiency as cause of atopy. The course of K.V.E. was normal, but the patients presented constant cherato-conjunctival and palpebral alterations.

[Cushing's ulcer in childhood. Description of a case]. / L'ulcera di Cushing in età pediatrica. Descrizione di un caso.

The authors describe a case of Cushing's duodenal ulcer associated with Encephalitis. Diagnosis was made as the following criteria: neurological manifestations (fever, seizures, coma) and clinical manifestations of ulcer (hematemesis and melena); endoscopic evidence of ulcer and demonstration of increased gastric acid secretion; direct correlation between neurological lesion and duodenal ulcer. The good therapeutic result obtained with Ranitidine was noteworthy. The high dosage (20 mg/kg/die) allowed the control of the bleeding and the ulcer cicatrization.

[Acute ulcer of the stomach caused by the concurrent administration of the antipyretic-intended betamethasone and a non-steroid anti-inflammatory drug]. / Ulcera acuta dello stomaco da somministrazione contemporanea a scopo antipiretico di betametasone e di un farmaco antiinfiammatorio non steroideo (fans).

The authors report a case of acute gastric ulceration in a 4 year-old-child after contemporary administration of Betametason and Dypiron as antipyretic. A pathogenetic interpretation of the rapid formation of gastric ulceration it is briefly noticed. The Authors concluded with some considerations on the side effects of Betametason and Anti inflammatory Non-Steroidal Drugs.

["Qualitative test of fecal fat" and "steatocrit", simple complementary methods for the evaluation of steatorrhea in childhood]. / L'"esame qualitativo dei grassi fecali" e lo "steatocrito", semplici metodi complementari di valutazione della steatorrea nell'infanzia.

The evaluation of fecal fat elimination (steatorrhoea) is of primary importance for diagnosis of gastroenterological disorders. In childhood it is quite difficult to apply the ordinary methods of evaluation, on the other hand it is necessary to make use of them to screen and diagnose maldigestion and/or malabsorption syndromes. In this work "Steatocrit" method by Phuapradit and "Fecal fat qualitative test" (FFQT) on glass, by Jacobson, have been used in a parallel study on stool samples from subjects with suspected gastrointestinal disease. While Steatocrit was determined on 200 samples, FFQT was determined on 1574 samples. Our data show that steatocrit is fully able to detect quantitative steatorrhoea with high significance when compared to controls. Likewise FFQT shows a sensibility of 100% compared to controls and it is able to predict coeliac disease and cystic fibrosis in 85.5% of cases and in 89.9% of cases respectively. We conclude that these two tests are sure and auxiliary each other. They allow, when performed on the same sample, to go toward diagnosis of both malabsorption and maldigestion, furthermore they allow to monitor steatorrhoea under therapy.

[Antigliadin antibodies (AGA) in the various stages of celiac disease in children]. / Gli anticorpi antigliadina (AGA) nelle varie fasi della malattia celiaca del bambino.

Antigliadin antibodies (AGA), both IgA and IgG, were studied in the serum of 84 coeliac children during the various stage (Diagnosis, GFD, Challenge) and in 29 healthy children, with a micro-ELISA technique. The results demonstrated the presence of AGA in the serum of coeliac children and a different behaviour between the two Ig-classes in the various stages of the disease. During acute phase both classes were present at high titre. When gluten was withdrawal from the diet, while the titre of IgA fell rapidly since the first month, the IgG titre decreased slowly and raised the normal limits after six months. If the children didn't observe a corrected GFD, the serum AGA titres remained at high levels. During challenge, while IgG raised since the early days, IgA titres raised later, when the intestinal damage became important. The explanation of this different behaviour could be that AGA-IgA are derived from gut mucosa, on the contrary AGA-IgG are not synthesised in the intestine. We believe that serum AGA seem to be good markers of the immune reaction in the intestine triggered by gluten. Furthermore we conclude that the assay of AGA in the serum of coeliac patients is: 1) high sensible and specific method; 2) the most important screening test for intestinal biopsy; 3) the most important test for diagnosis and follow-up of CD; 4) the test which could substitute 1 or 2 intestinal biopsies of the ESPGAN protocol.

[Effect of the therapy with vitamin K on coagulation factors in celiac disease in children]. / Effetto della terapia con vitamina K sui fattori della coagulazione nella malattia celiaca del bambino.

The Authors carried out a study on 37 untreated coeliac children to investigate the behaviour of K-dependent factors after vitamin K administration. The children were randomized into two groups: 22 children receiving a single dose of 10 mg i.m. of Phytonadione (Konakion, Roche) on the initial day of GFD and 15 children who did not receive vitamin K administration. PT, PTT and clotting activity of Factors II, VII, IX, X were determined before the treatment and/or GFD, and after 24 hours, 7 and 15 days. The results demonstrated that vitamin K administration determined a rapid increase in clotting activity of all K-dependent factors after 24 hours. These values remained normal after 7 and 15 days, except for Factor II, which slightly decreased on the 7th day. On the contrary, the children not treated, had levels similar to those of acute stage. After 7 days these values showed a slight increase and reached normal limits on the 15th day. No significant changes were seen in either PT or PTT in the two groups. They were constantly prolonged, reaching normal limits on the 15th day. These results indicate that the vitamin K deficiency, not only seems constant in children with CD, but also seems responsible for the haemocoagulative deficit of the K-dependent factors. After GFD when intestinal absorption is regained, all parameters returned to normal. The Authors concluded that K-dependent factors can be used as short-term indexes of improved intestinal absorption and that the coeliac children with severely compromised nutritional status can be treated with vitamin K (10 mg bolus).