[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.

Scleral fixation of a posterior chamber intraocular lens in a patient with two dislocated lens implants.

PURPOSE: To report the clinical findings and management of a case of two consecutive intraocular lenses (IOLs) dislocated into the vitreous cavity after complicated cataract surgery. METHODS: Review of clinical findings and treatment. RESULTS: A 69-year-old man sought treatment for posterior chamber IOL dislocation. The patient reported a significant loss of visual acuity in the right eye for 4 months (best-corrected visual acuity (BCVA) 20/200 in the affected eye). In the vitreous cavity two dislocated IOLs were found, complicated by a cystoid macula edema. Surgery was planned and the two IOLs were removed from the vitreous cavity. Aphakia was then corrected by means of a scleral fixated posterior chamber lens. Three months after surgery, BCVA was 20/40. CONCLUSIONS: In the absence of randomized controlled clinical trials evaluating treatment options, preoperative patient work-up should be as accurate as possible in order to reduce the risk of intraoperative and postoperative complications. In this patient, removing the two IOLs and placing a sutured-fixated posterior chamber IOL allowed resolution of the cystoid macular edema.

Bottle-cork injury to the eye: a review of 13 cases.

PURPOSE: To analyze the anatomic and functional consequences of wine-cork injury to the eye in relation to the patient's age and the type of cork and wine. METHODS: We retrospectively studied 13 patients, six women and seven men, presenting to our department with bottle-cork injury to the eye between January 1999 and June 2001. RESULTS: All patients presented with closed-globe injury according to Kuhn et al's classification. All the cases were injured by bottle corks from sparkling wine: white in ten cases and red in three. Mean visual acuity at admission was 20/100 (range, hand motion to 20/20). The most frequent early injury was anterior chamber hyphema (84.6%), followed by corneal injury (62.2%), ocular hypertension (46.1%), lens subluxation (30.8%), traumatic cataract (23.1%), and post-traumatic retinal edema (23.1%). Mean final visual acuity was 20/25; the follow-up ranged from 3 to 29 months, averaging 16.1 months. Late complications were as follows: pupil motility anomalies (38.5%), traumatic cataract (30.8%), iridodialysis (15.4%), traumatic optic neuropathy (7.7%), post-traumatic glaucoma (7.7%), and traumatic maculopathy (15.4%). Surgical treatment was necessary in two cases (15.4%). CONCLUSIONS: Bottle-cork eye injuries account for 10.8% of post-traumatic hospital admissions to our department. Most of them are due to sparkling white wine served at room temperature. There is no correlation between ocular injury and the eye-bottle distance or the type of cork.

Surgically induced astigmatism after manual extracapsular cataract extraction or after phacoemulsification procedure.

Astigmatic changes in three series of cataract surgical procedures were compared. The first two series comprised eyes having a manual extracapsular cataract extraction (ECCE) through a 12.0 mm or 8.0 mm incision and implant of a PMMA posterior chamber lens. The third series comprised eyes having phacoemulsification through a scleral pocket and implant of a PMMA posterior chamber lens. Preoperative keratometry measurements and corneal topography maps were compared with those obtained two days, one week, one, three and six months postoperatively. The keratometry measurements, obtained with computerized videokeratography, revealed: on day 2, 4.89 D (1st series), 3.95 D (2nd series), 2.66 D (3rd series); one week, respectively 4.46 D, 3.51 D and 2.14 D; one month, 0.65 D, 0.53 D and 0.05; three months, 1.44 D, 0.35 D and 0.36 D; six months, 1.36 D, 0.42 D and 0.48 D. The surgically-induced cylinder at three months was four times greater in the manual ECCE 12.0 mm incision series than in the phacoemulsification series. However, by six months all differences were markedly reduced. The results add to the growing evidence that the phacoemulsification procedure produces less astigmatism and more rapid visual rehabilitation than the manual ECCE procedure. Topographic analysis showed much less corneal steepening after phacoemulsification than after manual ECCE. However, all three surgical procedures offered satisfactory clinical results.

[Varicelliform encephalitis: clinical review of a case]. / Encefalite varicellosa: revisione clinica di un caso.

The authors describe on a case of encephalitis varicelliform at levels extremely favorable for the therapy precociously made-up. Therapeutical approach is discussed on the base of literature data.

[Follow-up of children born from gestosis mothers]. / Follow-up di bambini nati da madri gestosiche.

Seventy children, born from mothers affected from EPH gestosis during pregnancy, were examined. They were two-ten years old, forty females and thirty males, nineteen preterms and fifty-one born at term. Their weight, and head circumference were estimated. Thirty-two children were submitted to terman Merril test and further thirty-eight to Picq Vayer test. The findings were evaluated according to term or preterm birth and to importance of mother's gestosis (EPH1, EPH2, EPH3). The auxological outcomes were satisfactory, particularly after the five-six years of age. Two children were heavily retarded. The others had a normal I.Q., but there was evident failure in immediate memory and in vocabulary's subtest. Moreover fifty % of heavier gestosis children revealed a discordant psycomotor behaviour due to specific failures.

[Congenital hydrocephalus: clinico-pathological picture]. / L'idrocefalia congenita: quadri clinico-patologici.

The authors review the main pathologic causes of congenital hydrocephalus from ischemic-vascular injuries, embryofoetal infections and dysraphisms to genetic ones. Abundant illustrations of each condition are furnished and particular attention is paid to each situation, discussing the available pathogenetic mechanisms and hypothesis. Genetic "sine causa" hydrocephalus and X-linked hydrocephalus are mainly stressed, presenting some personal data. The clinic aspects of the varying forms of hydrocephalus are continuously kept in mind and a terminal paragraph details the clinical and neuroradiological means determinant in differential diagnosis versus similar conditions such as hydranencephaly, porencephaly, aracnoid cysts, holoprosencephaly and agenesis of corpus callosum.