Recurrent pneumococcal meningitis in a child with transethmoidal encephalocele: a case report and review of literature.

Bacterial meningitis is a life-threatening infection with a low recurrence rate. However, this possibility has always to be considered and avoided. This case report concerns a 5-year-old girl who was admitted in our Emergency Pediatric Unit for symptoms of bacterial meningitis and signs of disseminated intra-vascular coagulopathy. After a successful treatment the girl was discharged in good health. She was admitted to our hospital after one year with the same symptoms of meningitis. Laboratory examinations confirm the admittance suspect. An accurate research allowed to find out immunological deficiencies and showed an occult malformation, transethmoidal encephalocele, responsible for the recurrent meningitis. The present case suggests that the opportunity to perform an accurate cerebral imaging study (with special attention to the ethmoidal region and inner ear) in all cases of meningitis to detect occult anatomical alterations, thus preventing infectious recurrence, should always be taken into account.

[The short-stay observation unit: an experience of the Pediatric Department in Modena]. / Osservazione breve intensiva (OBI) in pediatria: l'esperienza del Policlinico di Modena.

The use of a short-stay observation unit (OBI) in a pediatric department has reduced the number of admissions. Significant cost savings and a better care for children and their families have been also achieved. During the year 2003 in our department 1759 children received OBI. 226 (12.8%) were then admitted. 1553 (87.2%) were discharged after a nine-hour mean stay. Descriptive statistics are used to outline the sample of patients and used treatments.

[Helicobacter pylori. Part II. Epidemiology, diagnosis, and treatment]. / Helicobacter Pylori. IIa Parte: Epidemiologia, diagnosi e terapia.

In recent years, the diagnosis of Helicobacter Pylori (HP)-mediated infection has become increasingly important not only in adults but also in children. Factors such as residence in a country with low social and economic standards and the presence of HP-positive family members underscore the widely-acknowledged fact that the incidence of HP infection tends to increase with age both in children (where the increase is roughly 1% per year) and in adults, where it reaches values of 50% in the industrialized nations and 80% in developing countries. This has led to research aimed at developing more accurate and less invasive diagnostic techniques that can be used in children as well. Also, the development of simple, cost-effective diagnosis is all the more important given the widespread occurrence of HP infection, particularly in the developing countries. The techniques employed range from the classical histological and culture examination, which involves esophagogastroduodenoscopy (a rather invasive technique), to serology and the Urea Breath Test with 13C. Also, the feasibility of tracing HP antigens in the faeces, a non-invasive and simple technique, is under investigation. As for therapy, there is as yet no unanimous agreement about when to start treatment, about which antibiotics (beta-lactams, macrolides and nitro-imidazoles) to use in association, about their effect on the gastric mucosa, nor, indeed, about the treatment routines to be followed in adults and children.

[Helicobacter pylori. I. Morphology, biochemistry, antigenic profile and correlated diseases]. / Helicobacter pylori. I. Parte: Morfologia, biochimica, profilo antigenico e patologie correlate.

Infection by Helicobacter pylori (HP) occurs all over the world and is related to the socio-economic development of the subject's country of residence and age. Various strains of HP can be identified on the basis of the microbiological characteristics of the bacterium and, in particular, or its antigenic profile, while the virulence factors are responsible for the damage that HP can cause. The virulence factors include components (flagellum and adhesin) and substances produced by bacterium (enzymes and cytotoxins), the most important among which are urease and the cytotoxins, CagA and VacA. It is the association of these virulence factors that is responsible for the different pathologies to which HP-positive subjects are prone. The link between HP and gastritis, peptic ulcer and gastric cancers (adenocarcinoma and lymphoma) is now proven. Whether there is a link between HP and RAP in young children is still a matter for debate; some Authors claim that there is, while others refute it.