[Colonization by group B hemolytic streptococcus in pregnancy. Note of prevention and therapy of the materno-neonatal infection. Casuistics]. / Della colonizzazione da streptococco beta emolitico di gruppo B (SGB) in gravidanza. Note di prevenzione e terapia dell'infezione materno-neonatale. Casistica.

As several international studies show, the knowledge of the wide clinical spectrum of perinatal group B streptococcal infection, particularly of the early and of the late-onset neonatal diseases in GBS carrier mothers, is basically important for medical diagnosis. Risk factors analysis further determines both the diagnosis and the maternal intrapartum chemoprophylaxis. The considerable rate of neonatal disease without risk factors and its possible serious and fatal consequences bring to tendentially non selective prevention approaches that must consider the local background. At Merate Hospital, in a 3 years time, vaginal and rectal specimens for GBS cultures were obtained from 1766 pregnant women either at the 32nd or at the 36th week of gestation and regularly at the labor. 376 women (21.29 percent) resulted GBS carriers; the maternal-fetal contamination rate was 15.42 percent (58/376) i.e. 32.6 per 1000 live births (58/1769). Intrapartum chemoprophylaxis was carried out with i.v. erytromycin, i.v. or i.m. cephalosporins, i.v. ampicillin and per os amoxicillin (which gave the most interesting results). In infants born to mothers who received an antibiotic therapy at labor as compared with those who received no treatment, GBS neonatal colonization was present in 31 of 286 (10.8 percent) versus 27 of 90 (30 percent; P < 0.001); heavy colonization was observed in 10 of 286 (3.4 percent) versus 15 of 90 (16.6 percent; P < 0.001) and early-onset neonatal disease (both symptomatic and asymptomatic) occurred in none of 286 versus 4 of 90 (4.44 percent; P = 0.0031). Perinatal risk factors (no-screened mothers, labor at 36th week of gestation, prolonged membrane rupture) were present only in 1 of 4 GBS infected infants (25 percent). Intrapartum therapy both in carriers and in no-screened women significantly reduced GBS neonatal colonization, particularly the heavy one and, consequently, the early-onset neonatal group B streptococcal disease.

[Celiac disease and the evolution of its diagnosis. Comparison and experience at a hospital pediatric department (1975-1993). (Second part)]. / La malattia celiaca e l'evoluzione nella sua diagnosi. Confronti ed esperienze di un reparto pediatrico ospedaliero (1975-1993). (Seconda parte).

In a period of over 18 years the prominent medical bibliographic marks with regard to definition, diagnosis and examinations of coeliac disease (CD) have been compared and as far as possible reproduced. The results confirm the remarks derivating from wider statistics. From the beginning of 1975 to the first six months of 1993 in Merate Hospital Pediatric Division, 323 patients were submitted to a first jejunal peroral biopsy in 133 cases (41.2%) CD was diagnosed. Since 34 children (25.6%) concluded the ESPGAN diagnostic iter with 3 consecutive biopsies, the reasons why the other patients didn't finish or respect the programs are here examined. Since 1987 a specific anti-gliadin (IgA and IgG) antibodies titrimetry has been available either in the investigation of suspect symptomatology or like control mark during the assessment or after a sure CD diagnosis. Since october 1992 antiendomysium antibodies (EMA or AEA IgA) have been determined only in selected patients. From the examination of 24 subjects now checked with AGA IgA/IgG and EMA and with a first positive biopsy, it is possible to point out that only one jejunal biopsy (or at the most a second one as a control during the gluten challenge) with the guarantee of haematologic patterns doesn't raise doubts about a CD diagnosis. Analogous considerations mainly refer to the atypical CD "late onset" when a constant lack of AGA and EMA during gluten free diet (GFD) or their changes in a non compliance or in gluten challenge, can exclude a following hystological confirmation. By this experience it follows that a specific antigliadin and antiendomysium antibodies investigation is indispensable to the shortening of diagnostic times, to the reduction of an often unwelcome invasive diagnostic method and to the discovery of the "CD iceberg".

[Celiac disease and its diagnostic evolution. Comparisons and experiences in a hospital pediatric department (1975-1992). I]. / La malattia celiaca e l'evoluzione nella sua diagnosi. Confronti ed esperienze di un reparto pediatrico ospedaliero (1975-1992). (Prima parte).

The coeliac disease (CD) or gluten-sensitive enteropathy (GSE) is a permanent intolerance to wheat gliadin and to correlated proteins inducing malabsorption and typical damages of the jejunal mucosa (total or subtotal villous atrophy = SVA) in genetically-predisposed individuals ("DQW2"). A large amount of research has been devoted to CD pathogenesis: the most recent studies, thanks to sophisticated and experimental methods, support the pathogenetic immunological theory and the one of direct cytotoxicity. The correct diagnostic procedure for CD, established in 1970 by the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN), suggested three small bowel mucosal biopsies. In the last years, because of the difficulties of such a practice, the necessity of non-invasive diagnostic approaches has developed; such approaches have been verified in absorption tests (one-hour blood xylose, intestinal permeability methods) and in immunogenetic tests (antibodies antigliadin, anti-reticulin, anti-endomysium, anti 90 KD glycoprotein, anti-human jejunum, HLA I/II antigens). The specific MHC antigens establish CD's incidence in several population and in particular situations, as in first-degree relatives and in diseases associated with CD (dermatitis herpetiformis (DH), insulin dependent diabetes mellitus (IDDM) and other auto-immune syndromes). The specific serum antibodies singly used as first level screening if estimated in combination with absorption tests, reach the highest levels of specificity and sensibility in CD diagnosis. It's anyway fundamental the comparison with at least a typical CD histological feature, caused by a challenge with a sufficient gluten to be carried in dubious cases and in non high auxological risk age (ESPGAN 1989). Adolescence is a period of frequent non compliance with a gluten-free diet and of particular psychological and physical problems: the apparent "gluten insensitivity", typical of teen-agers and adults, recalls the definitions of silent CD and latent CD (iceberg like). In the first case the jejunal mucosa is abnormal and the symptomatology isn't evident. In latent CD, genetically restricted, the mucosa is normal but there are minimal markers of inappropriate immunity to gliadin (at intestinal humoral immunity level) and a possible worsening of histological lesions to the third stage under environmental stimuli. This represents a two-stage model CD. That's why CD is still under-evaluated despite recent statistics reporting an increasing incidence (late and atypical forms). Prevalence rates between 1:300 and 1:4,000 and more are quoted in literature. The necessity of a strict gluten-free diet is confirmed by the evident frequency of lymphoma and by the increased risk of malignancy in untreated CD.(ABSTRACT TRUNCATED AT 400 WORDS)

[A rare congenital malformation: genu recurvatum. Presentation of a case]. / Una rara malformazione congenita: il genu recurvatum. Presentazione di un caso.

The authors report a case of congenital genu recurvatum: a rare malformation characterized for abnormal hyperextension of knee and wide limitation of flexion. Pathogenesis, clinical pictures and therapy are described.

[Sugiura's operation in the treatment of hemorrhaging esophageal varices]. / Trattamento delle varici esofagee sanguinanti con l'operazione di Sugiura.

Rebleeding, the long time high occurrence of encephalopathy and the impairment of hepatic function in the successful cases have led to increasing dissatisfaction in the last years with portasystemic shunt procedures. In the past 12 years we have operated on 14 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization); in two cases the entire procedure was performed through the thoracic approach. We had no mortality. Complications include bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Patient follow-up has been between 16 months and 11 1/2 years with an average of 6 1/2 years. The long term controls have been gratifying in 12 patients with disappearance of the varices and no evidence of rebleeding, esophageal strictures, gastroesophageal reflux, encephalopathy or impairment of the hepatic function; in two other patients the operations was unsuccessful. In our opinion the Sugiura procedure should be the elected operation in the surgical treatment of esophageal varices bleeding in pediatric age, after an attempt with sclerotherapy.

[Primary vesico-uretero-renal reflux. Results of surgical treatment in over 1,100 refluxing ureters]. / Reflusso vescico-uretero-renale primitivo. Risultati del trattamento chirurgico di oltre 1.100 ureteri refluenti.

Primary vesicorenal reflux (P.V.R.R.) is the most important cause in the pathogenesis of chronic pyelonephritis, better known in medical literature as "reflux nephropathy". The Authors stress out the criteria adopted in their Center for surgical treatment of P.V.R.R. and report the results in 1158 refluxing ureters (858 children) operated on. In 5 ureters an ureteronephrectomy and in 1153 remaining ureters and ureteral reimplantation was carried out. About 57% of ureters operated on was affected by severe reflux (IV - V grade). The Authors obtained 98.6% of surgical successes. In 16 ureters operated on, stricture (9 ureters) and reflux (7 ureters) were postoperatively present. The percentage of successes in infants less than 2 years old at operation was 98%.

[Seidlmayer's "cockade" purpura. Report of a case]. / La porpora "a coccarda" di Seidlmayer. Presentazione di un caso.

Among hemorrhagic disorders affecting infants and depending on a vessel increased permeability, Seidlmayer "cockade purpura" is characteristic for its typical cutaneous manifestations. Owing to the rarity of this disease, we report a recently observed case.

[Infantile gluteal granuloma. Case report]. / Granuloma gluteale infantile. Contributo casistico.

A 5 months old infant having "granuloma gluteale infantum" (G.G.I.) is reported. One or more tumorous red-purple nodules on gluteal or on genitocrural area are the usual cutaneus injuries of G.G.I. The histologic aspect resembles pyogenic granulomas. The exact pathogenesis of G.G.I. is still to be defined; nevertheless the use of plastic diaper covers and topical fluorinated steroid preparations seems to have great influence.

[Long-term non-deforming urinary infections in childhood. 2. Proposed treatment and results]. / Le infezioni urinarie di lunga durata non malformativa in età pediatrica. II. Proposte di trattamento e risultati.

In the second part of the Authors work, they report the results obtained in the treatment of 85 female children with recurrent non malformative urinary tract infections. The first group of 15 female children had been treated with phenoxybenzamine and urinary chemyotherapycs with little satisfaction. The other two groups, both of which consisted of 35 children, one group was treated with only chemyotherapycs and the other with chemyotherapycs associated to oxybutynin chloride. The best results were obtained in the last group regarding the improvement of the symptoms and earlier and higher incidence of sterilization of the urine. At the same time in this group the maximum cystometric capacity and vesical compliance were brought back to normal and the detrusorial instability disappeared.

[Polymorphism of the cleidocranial dysplasia syndrome. Presentation of 2 cases]. / Polimorfismo della sindrome cleido-cranica. Presentazione di due casi.

Following a brief description of the clinical and radiological features of cleidocranial dysplasia (see Table), two patients are presented who respectively exemplify the classic and the incomplete form of this syndrome. The morphologic appearance of the bone segments involved may suggest a diagnosis of cleidocranial dysplasia even through occasional radiologic examinations, specially in the pediatric age. The patients suffering from this condition, which in itself is not incapacitating, should be serially observed so that appropriate therapeutic measures can be adopted, mainly in the presence of hip dysplasia or when the thoracic cage or the spine are severely involved.

[N.B.T. - PABA screening test for exocrine pancreatic function in healthy children. Preliminary investigation in 60 normal children]. / N.B.T. - PABA-test: screening diagnostico della funzione pancreatica esocrina. Indagine preliminare su 60 soggetti sani.

The theoretical bases of PABA test as a diagnostic screening test of exocrine pancreatic insufficiency, its mode of execution and the findings obtained in 60 healthy subjects ranging in age from 2 to 14 years are reported. Those conditions related to extra-pancreatic disorders or to other factors that may interfere with the test and reduce its reliability are also discussed.