Safety of electronic molecular resonance adenoidectomy.

Adenoidectomy is one of the most frequent operations in children. In order to reduce hospital stay costs, today, this procedure is performed as day surgery. Even though adenoidectomy is not considered risky, some minor complications may occur, the most important being bleeding (0.5-8% incidence). The surgical technique used can influence considerably postoperative pain and time to recovery. This aspect is essential in the management of day surgery patients, for whom the need of safe and rapid maneuvers associated with early recovery determines the choice of the surgical procedure. Recently, we developed a surgical technique based on the use of an electronic molecular resonance tool associated with bendable suction electrocautery. This study was carried out on 600 patients, divided into two groups, the first undergoing ablation using the molecular resonance tool and the second undergoing curette adenoidectomy. The two groups were homogeneous for age, sex, surgical indications, and grade of adenoid hypertrophy. The following parameters were considered: duration of surgery, importance of intraoperative bleeding, time to cicatrization, incidence of bleeding complications. Duration of surgery and intra- and postoperative bleeding were much lower in the first group than in the group undergoing traditional adenoidectomy. In addition, rhinopharyngeal complete cicatrization, defined as absolute absence of pseudomembrane, was much quicker in the first group, as assessed by postoperative endoscopy. Another major advantage offered by the molecular resonance tool is the accuracy of surgery performed under visual control in a practically bloodless field. To sum up, this method, thanks to its technical features and safety, is particularly indicated in children and in patients with coagulation disorders.

[Nosocomial infection caused by multiresistant Staphylococci in a neonatal and pediatric intensive care unit]. / Infezioni nosocomiali da stafilococchi multiresistenti in Terapia Intensiva neonatale e pediatrica.

We selected a paediatric population with a high risk of nosocomial infection formed by 116 newborns (42.8%) and 155 not newborns (57.2%) admitted into the ICU of the Giannina Gaslini Institute during the period 1-1-1992-30-9-1992; we compared it with a reference paediatric population studied in the same department during the period 1-1-1987-30-6-1988 formed by 310 newborns (44.3%) and 391 not newborns (55.7%). The purpose of this study is to evaluate the possible change in the incidence of colonizations and ICU specific nosocomial infections, the possible increase of nosocomial infections by multiresistant Staphylococci and the appearance of new multiresistant germs. The two populations obviously present similar factors of high risk of nosocomial infection (naso-tracheal intubation, mechanical ventilation, total parenteral nutrition, surgical procedures, thoracic and/or abdominal prothesis, etc.). The obtained data have been examined with the Chi-square method. The incidence of colonizations remained unchanged while we noted a significant increase (10.3% compared to 4.9%-p > 0.0014) of the "ICU" specific nosocomial infections; the increase regarded mainly the neonatal population (18.9% compared to 7%-p > 0.00001). Significant increase of the nosocomial infections by multiresistant Staphylococcus (Staphylococcus haemolyticus) with in vitro and in vivo resistance to teicoplanin. Furthermore, presence in the performed study of multiresistant gram negative germs.

[Results of early external ventricular diversion in posthemorrhagic ventricular dilatation in the newborn]. / Risultati della derivazione ventricolare esterna precoce nella dilatazione ventricolare postemorragica del neonato.

OBJECTIVE AND DESIGN: The authors report the outcome of early treatment with long-term external ventricular drainage (EVD) of progressive post-hemorrhagic ventricular dilatation (PPHVD), following peri-intraventricular hemorrhage (PIVH) in a population of preterm newborns. SETTING: Neonatal Intensive Care Unit (NICU) of a Children's Hospital. PATIENTS: Twenty-one preterms of 29.6 +/- 2.4 weeks of gestational age, weighing at birth 1443 +/- 445 g, mechanically ventilated, submitted to early EVD because of PPHVD following PIVH of III (n 11) e IV (n 10) grade. METHODS: PPHVD was diagnosed on the basis of US and TC findings. An external liquoral drainage suitable, for its technical characteristics, to be maintained for a long period of time and peculiar anesthesiologic, intra and postoperative treatments were utilized. RESULTS: EVD was placed at 21 +/- 5.8 days of life and maintained for 40 +/- 16 days. In all cases reduction of ventricular size was observed. One case (5%) developed liquoral infection and recovered with antibiotic therapy. No obstruction or dislocation of the ventricular catheter occurred. During EVD 3 patients (14%) died because of respiratory complications. After the normalization of cerebrospinal fluid (CSF), a "permeability test" was performed to assess the canalization of the liquoral system. Seven patients (33.5%) underwent ventriculo-peritoneal shunt (VPS) and 11 (52.5%) became shunt-free. CONCLUSIONS: Our results indicate that long-term use of EVD has a low risk of complications, avoids the need for transcutaneous tips and allows monitoring of CSF characteristics. Furthermore EVD protects the brain from liquoral hypertension, while waiting for a possible recurrence of natural CSF circulation, and is associated with a low number of definitive VPS.

An assessment of the efficacy and tolerability of nimesulide vs paracetamol in children after adenotonsillectomy.

The efficacy and tolerability of nimesulide were assessed and compared with those of paracetamol in the treatment of 35 children with pain and inflammation following adenotonsillectomy. The antipyretic and analgesic efficacy of the 2 drugs was similar, although more patients had complete remission of pain after 4 days of treatment with nimesulide. Both drugs were well tolerated, even though occasional elevation of transaminase enzymes and alkaline phosphatase was noted in the nimesulide-treated group. It is postulated that this effect may have been attributable to the volatile anaesthetics used during surgery.

[Teicoplanin therapy in neonatal and pediatric intensive therapy]. / La terapia con teicoplanina in terapia intensiva neonatale e pediatrica.

We administered teicoplanin as specific antibiotic therapy for nosocomial "ICU specific" infections with methicillin-resistant Staphylococcus aureus and epidermidis (MRSA-MRSE). The above mentioned drug has been given to 20 patients (15 newborns and 5 not-newborns) admitted into intensive care unit during the years 1988, 1989, 1990 with MRSA-MRSE localized and/or systemic infection, affected by severe disease (RDS, pulmonary edema, congenital cardiac disease, cystic fibrosis) undergoing invasive procedures which presented high nosocomial infective risk (tracheal intubation, mechanical ventilation, venous and arterial cannulation, total parenteral nutrition, etc.). Complete recovery from systemic or localized infection (sepsis, low respiratory tract infection, high respiratory tract infection) occurred in 19 out of 20 patients, with a rate of success of 95%. Teicoplanin treatment lasted from a minimum of nine days to a maximum of thirty days. The dose was 5-6 mg/kg/die in one administration for the first three days, then 4 mg/kg/die. The tolerability of teicoplanin has proven satisfactory, since we had no major side effects during treatment and follow up.

[Nosocomial infections caused by methicillin-resistant Staphylococcus aureus in a pediatric intensive care unit]. / Infezioni nosocomiali da stafilococco aureo meticillino resistente in un reparto di terapia intensiva pediatrica polivalente.

We performed an epidemiological investigation owing to the appearance between February and March 1988, of subsequent MRSA infections in our ICU; we also started a checking scheme. At the same time we performed a retrospective-perspective study of 701 patients (310 newborns 391 not newborns) admitted into ICU from 1-1-1987 to 30-6-1988. This study allowed us to settle the presence of MRSA in ICU and the manner in which they become infected. From our study the 4.9% of our patients contracted hospital infections and the 34.2% of these were MRSA infections. The 39.7% of our colonized patients were MRSA. It is really significant the frequency of MRSA colonization (p less than 0.0005) among newborn patients compared with other age patients; in the meantime there is not statistical significance in the frequency of MRSA hospital infections among the two groups. The results of our study show that infections were probably transmitted by the hands of the members of staff and that the reservoir of MRSA are tracheostomized hosts or long term ventilated patients.

[Development of auditory evoked potentials of the brainstem in relation to age]. / Evoluzione dei potenziali evocati uditivi del tronco in rapporto all'età.

In order to study the various changes which occur in the waveform, latency and amplitude of the auditory brainstem evoked response (BSER) as a function of age, the authors recorded the BSER from the scalp's surface of 20 newborns and 50 infants, 3 months, 6 months, 1 year and 3 years old as well as from 20 normal adults. The data obtained show that the most reliable waves during the first month of life are waves I, III, V, which is often present even when other vertex-positive peaks are absent. The latencies of the various potential components decreased with maturation. Wave V, evoked by 90 dB sensation level clicks, changed in latency from 7, 12 msec at 1-4 weeks of age to 5,77 msec at 3 years of life. The auditory processes related to peripheral and central transmission were shown to mature at differential rates during the first period of life. By the 6th month, in fact, wave I latency had reached the adult value; in contrast, wave V latency did match that of the adult until approximately 1 year old. One obvious explanation for the age-related latency shift is progressive myelination of the auditory tract in infants, for this is know to occur. The authors conclude that the clinical application of this technique in paediatric patients couldn't provide reliable informations about auditory brain stem activity regardless of evaluation of the relationship between age and characteristics of BSER.

[Advantages of a permanent venous access in children treated for cancer. Preliminary results]. / Vantaggi di un accesso venoso permanente in bambini trattati per malattie oncologiche. Risultati preliminari.

Current therapy for children with cancer includes a variety of invasive procedures many of which require repeated venous access over a considerable period of time. Such procedures are poorly tolerated by children and by their veins. Recently it has become possible to undertake the majority of such procedures by means of permanent indwelling silastic catheters improving the quality of life of the children and their parents and increasing the scope of therapeutic intervention. In the period July '83 - August '84 we have used 46 of these catheters in 45 children with malignant disease, 12 with acute myeloid leukaemia, 12 with neuroblastoma, 7 with B cell leukaemia-lymphoma, 6 with rhabdomyosarcomas, 2 with Ewing's Sarcoma, 2 with Wilms' tumor and 1 case each of Hodgkin's disease, teratocarcinoma, osteosarcoma and juvenile chronic myeloid leukaemia. The children's ages ranged from 2 months to 14 years; 22 were male and 23 female. The catheters were inserted under general anaesthesia (duration 20-40 minutes) usually without difficulty, except for a single patient in whom no suitable vein could be found. No complications connected with the placement of the catheter were observed. Subsequent management of the catheter was initially complicated and time-consuming, but was subsequently simplified so that acceptance by parents, children and nursing staff was eventually excellent. The duration of use of 46 catheters ranges from 7 to 350+ days; 24 catheters are presently in use at 30-350+ days from insertion. Eight children died as a result of disease progression and two of sepsis with the catheter in place.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum kynurenine in rheumatoid arthritis.

The concentration of kynurenine has been measured in the serum of patients with rheumatoid arthritis and in a control group. The mean serum concentration was 2.27 +/- 0.688 mug/ml for patients with rheumatoid arthritis and 2.95 +/- 0.825 mug/ml for the control group.KYNURENINE: creatinine clearance ratios were higher in the rheumatoid arthritis than in the control group. These data suggest that the increased urinary excretion of kynurenine by patients with rheumatoid arthritis is due at least in part to renal factors.