[Sildenafil and nitric oxide inhalation in neonatal pulmonary hypertension. Three case reports]. / Sildenafil ed ossido nitrico inalato nel trattamento dell'ipertensione polmonare neonatale. A proposito di tre casi.

INTRODUCTION: Neonatal persistent pulmonary hypertension (NPPH) is characterised by persistently high pulmonary vascular resistance (PVR). Sildenafil has recently been suggested as an alternative to or an associative therapy with inhaled nitric oxide (iNO) to reduce mortality (10-40%) and morbidity (major neurologic disabilities among surviving newborns remains approximately 15-60%). The objective is to report three cases of NPPH treated with sildenafil in association of iNO. CASE REPORTS: Echocardiography examination of three newborn babies with respiratory distress syndrome and a gestational age between 33 and 39 weeks revealed pulmonary hypertension following early onset sepsis. Synchronized intermittent mandatory ventilation (SIMV) and surfactant therapy had no effect on oxygen saturation (SatO2) and oxygen alveolar-arterial difference (AaDO2). High frequency oscillatory ventilation (HFOV) and iNO therapy proved to be equally ineffective. Oral sildenafil was administered at 2 mg/Kg/6 hs. A gradual but significant improvement in oxygenation was achieved and a reduction in AaDO2 along with oxygenation index (OI) and pulmonary arterial pressure (PAP) was observed in the first 6-10 hrs after administration of sildenafil. The therapy was maintained for 36-48 hrs with total success. CONCLUSIONS: A beneficial pulmonary vasodilator effect was obtained in treating NPPH with sildenafil where conventional methods had failed. Sildenafil used in association with iNO reduces the duration of treatment, the quantity of iNO normally required and the associated toxic effects. A multicentric, randomized trial could be useful in demonstrating the safety, efficacy, doses and forms of administration of sildenafil.

Aging and right-left asymmetry in experimental pain measurement.

Verbal psychophysical measurements were performed on 100 subjects, both male and female, aged from 20 to 82 years, to ascertain whether different responses to pain exist between the right and left sides of the body in relation to aging and to different capacities of the cerebral hemispheres to process emotions. A single-phase step current applied to the forearm provided a standard noxious stimulus. Sensory threshold (S), pain threshold (P), and tolerance threshold (T) were measured. The sample set was divided into 2 comparable groups either older or younger than 60 years of age. A common trend was found in both groups: right-side scores were consistently lower than the homologous left-side scores. This difference was significant for all thresholds in elderly subjects but only for the pain threshold in the younger subject group. Two-way ANOVA test of the two group scores did not reveal differences due to sex, but age was an influencing factor for sensory and pain thresholds, higher scores being found in the older subject group. An interpretation of the results embodies hemispheric capacities to process verbal and emotional stimuli.

[Alport syndrome: 15-year follow-up in 28 cases]. / La sindrome di Alport: follow-up di 15 anni in 28 casi.

Twenty-eight patients aged from 18 mo. to 23 y. (at the onset of the diseases) affected by Alport's syndrome (AS), were studied during last 15 years. The mean time of observation was 10 +/- 0.7 years. Two cases progressed to renal failure at 15 and 21 years respectively, while 26 patients have normal renal function within the 2a decade of life. The diagnosis of hereditary nephritis (AS) was based on the following criteria: Existence of affected kindred. Perceptive deafness. Basal membrane ultrastructural abnormalities. A late exact diagnosis was made in some patients without ascertainable familiarity and without early ultrastructural glomerular study. Perceptive deafness occurred chiefly after 6-8 years of life, increasing the diagnostic difficulties. Isolated hematuria was present in 18 cases (64%) and associated proteinuria (or NS) in 10 (36%). Recurrent otitis media worsened the hearing loss in 5 cases (17.83%). An immuno-allergologic study was carried out because of the great frequency of allergic diseases, respiratory mainly. A significative decrease of plasmatic and secretory IgA was observed in those patients who underwent to recurrent otitis media. The features suggestive of AS in our patients, in addition to the familiarity, were gross haematuria in childhood and diffuse GBM splitting and splintering. Heavy proteinuria and nephrotic syndrome associated to early deafness and to male sex indicate a poor prognosis; but several females also can be affected by serious course of the disease.

[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.

[Vertebrobasilar insufficiency of prenatal origin: a case report]. / Insufficienza vertebro-basilare di origine prenatale. Descrizione di un caso.

The case of a newborn presenting from birth with arthrogryposis multiplex congenita resting mainly on the legs, severe hypotonia, consciousness anomalies, clonic fits, recurrent apnea and bradycardia, absent sucking and swallowing is described. At the age 4 months a further episode of apnea and bradycardia was followed by death. The neuropathologic analysis disclosed a number of bilateral, cystic and symmetric infarcts in the thalamus and hypothalamus, spreading caudally to the tegmentum of the mesencephalon and the pons. Such distribution of lesions does suggest a vascular topography, i.e. in the territories supplied by branches of the vertebro-basilar arteries. There was light clinical and neuropathological evidence of prenatal occurrence of the vascular injuries, possibly at the end of the 7th month by a defective arterial perfusion of the fetus due to protracted menaces of premature birth. We would outline the existence and frequency of the thalamic and dorsal brain stem necrotic involvement by acute anoxia-ischemia occurring in the third trimester of gestation or at birth, and the relative peculiarity of their clinical picture.

[Perforated stress ulcer in a neonate: a case report]. / Ulcera da stress perforata nel neonato: segnalazione di un caso.

The authors describe a case of duodenal perforated ulcer in a 3 day old, 4.080 Kg term female infant who was apparently well. Stress ulceration with duodenal or gastric perforation may be encountered in the first year of life, usually as a complication superimposed upon a serious illness for which the infant is receiving intensive therapy. The mortality of 40% in this patients, implies that effective preventive and therapeutic measures are not yet available and also emphasizes the serious nature of the underlying disorder.

[Evaluation of atopy risk factors during the first year of life. Multicentric study]. / Valutazione dei fattori di rischio di atopia nel 1 degree anno di vita. Ricerca policentrica.

The AA studied 406 newborn babies during the 1st year of life in order to verify the correlation between atopy risk factors and the appearance of early symptoms, particularly gastroenteric (GE). The results obtained did not demonstrate a significant difference concerning the blood cord IgE level and subsequent appearance of food allergy symptoms, whereas positive familiarity showed a better correlation. No significant difference was observed between breast--or formula--fed infants, or between those weaned before or after the 5th month of life. The comparison of dietary regimen adopted during the 1st quarter in the asymptomatic and atopic children respectively, demonstrated that the presence of predisposing factors influences the appearance of GE symptoms much more than the diet in itself. An allergologic study, randomly performed by Prick-test in 156 cases and by RAST in 200 cases, showed a prevalent, positive response with RAST technique in symptomatic children.