[Pericarditis caused by Gemella morbillorum. Description of a case]. / Pericardite da gemella morbillorum: descrizione di un caso.

Pericardial diseases, in the pediatric age group are rare, and are usually due to viral infection or collagen diseases. Since the advent of the antibiotic era, bacterial pericardial has rarely been reported, and the bacteria most commonly involved are Staphylococcus aureus, Streptococcus pneumoniae, Haemophylus influenzae and Neisseria meningitidis; other pyogenic agents have rarely been isolated in pericarditis. Gemella morbillorum, also known as Streptococcus morbillorum, is a Gram-positive pyogen, usually a saprophite agent of the human gastrointestinal tract, rarely associated with human infections such as arthritis, endocarditis and meningitidis; to our knowledge, it has never been isolated in pericarditis. We report a case of pyogenic pericarditis in an 11-year-old boy, suffering from substernal chest pain for about one year, in which the clinical symptoms, the presence of acute phase proteins, the large amount of fluid within the pericardial space (echocardiographically estimated to be approximately 18 mm), the lack of improvement in clinical conditions and in laboratory values after therapy (diuretics, broad spectrum antibiotics and steroids) led to the indication for a pericardial drainage with the isolation of Gemella morbillorum. Antimicrobial therapy was then modified according to in vitro susceptibility of the Gemella morbillorum, with a decisive contribution to the recovery of the patient, although long-term steroid therapy (5 months) was necessary because of one recurrence of pericardial effusion. This case report shows how Gemella morbillorum, usually a saprophit microorganism, can become pathogenic and also underlines the importance of a correct etiologic diagnosis of pericarditis resistent to classical antibiotic therapy.

[Correlations between blood pressure values, familial hypertension and anthropometric parameters in a sample of 3-year-old children]. / Correlazione tra valori di pressione arteriosa, familiarità ipertensiva e parametri antropometrici in un campione di bambini di tre anni.

Nowadays evaluation of blood pressure in children is almost routine. In fact hypertension in adults may be preceded by high blood pressure values in childhood. In this study the authors examined systolic blood pressure (SBP) and diastolic blood pressure (DBP), height, weight, ponderosity index and family history of hypertension, in 261 3-year-old children, 139 boys and 122 girls. Average values of SBP were slightly but not significantly higher in males. Coefficients of linear regression and correlation for any pair of the different parameters (SBP-DBP and weight, SBP-DBP and height, SBP-DPB and ponderosity index) were all significantly positive for males, but not for females. The most significant value (r = 0.43) was in the correlation DBP-weight. In studying the family history of hypertension all children were divided into three groups: negative (F.I.-), positive with brothers and/or parents affected (F.I. I+) and positive with other relatives affected (F.I. II+). Average SBP and DPB in the second group were higher than in the third, and much higher than in the first group. These results suggest the importance of prevention in early childhood with alimentary education and serial blood pressure measurements. The individuation of borderline values is also very important.

[Evaluation of renal function in congenital cardiopathies in young children]. / Valutazione della funzionalità renale nelle cardiopatie congenite del piccolo bambino.

The authors evaluated some renal functional parameters of 23 children, the ages ranged 1 to 58 weeks; 8 were affected with cyanotic congenital heart disease and 15 with acyanotic forms. They showed the presence, already in this age, of some affections that are quiet similar to those affecting older children with heart disease. They tried to explain the renal functional deficiency in consideration of the literature data also. The authors formed a functional deficiency greater in the cyanotic forms, proportional to the weight deficiency and the same as that described in dystrophic children. They think that this is due to a first year maturational retardation, because of a low trophism of the body, in particular of the kidney. The authors suggest that these patients have to be fed with appropriate caloric-protein diet.

[Beta-thromboglobulin and platelet regeneration time in children with mitral valve prolapse]. / Beta-tromboglobulina e tempo di rigenerazione piastrinica in soggetti di etè pediatrica portatori di prolasso della valvola mitrale.

We studied 12 children with echocardiographic evidence of mitral valve prolapse (MVP) in order to demonstrate platelet activation or consumption as risk for thromboembolism. Therefore, with a standard radioimmunoassay, we measured the plasma levels of Beta-thromboglobulin (BTG), a platelet-specific protein released during platelet release reaction. Platelet turn-over was evaluated by measuring the Platelet Regeneration Time (PRT) with a non-radioisotopic method. Blood samples for BTG assay were collected at rest and after exercise. BTG plasma levels obtained in children with MVP were significantly higher than in normal subjects (p less than 0.01), both at rest and after exercise. We found no difference in either group between BTG level at rest and after exercise. The TRP was within the normal range in all patients except 2, in whom TRP was slightly shorter. Increased BTG levels and normal TRP suggest that in our patients platelet activation, but not consumption, was increased. In children with MVP, periodic controls of platelet activation may be useful to detect an increased risk of thromboembolism.

Successful triple coronary artery bypass in a child with multiple coronary aneurysms due to Kawasaki's disease.

A 9-year-old girl developed ischemic cardiac symptoms 3 years after she first presented with characteristic manifestations of Kawasaki's disease, namely, high fever, conjunctivitis, lymphadenopathy, macular truncal skin rash, and erythema of both hands followed by desequamation of the skin of the fingertips. This acute illness resolved spontaneously within 2 weeks. Because of progressive and severe anginal symptoms and electrocardiographic signs of myocardial ischemia, she underwent cardiac catheterization and coronary angiography, which demonstrated multiple aneurysms of both right and left coronary artery systems. The two larger aneurysms of the right main and left main coronary arteries were clotted, causing complete occlusion of these vessels. Only collateral branches from the proximal right coronary artery which were supporting the entire coronary circulation, prevented her from having a myocardial infarction. A triple saphenous vein bypass was performed with excellent immediate results. One year later the patient was completely free of symptoms; she was living a normal life and a stress electrocardiogram was entirely normal.

[The single ventricle: plain film and contrastographic radiologic findings (author's transl)]. / Il ventricolo unico: quadro radiografico standard e contrastografico.

The radiologic findings on the plain film are investigated in a series of 9 patients with single ventricle. In 3 of them the cardioangiographic patterns are described. The possible association of malformations is stressed. The value of the cardioangiographic investigations is discussed in planning a possible surgical treatment of the disease.

[Cardiac electrostimulation in childhood (author's transl)]. / La elettrostimolazione in età pediatrica. Su due casi richiedenti impianto di pacemaker.

The AA. relate on two cases of pacemaker implantation in childhood, and they outline the causes that make necessary a cardiac pacemaker in such an age and the troubles can possibly occur.