The role of gut microbiota in mediating obesity and diabetes mellitus.

OBJECTIVE: This review inspects the relations between the microbiota and the intestinal immune system in the advancement of metabolic illnesses, such as obesity and diabetes mellitus. The role of the microbiota in intestinal immune defense and the control of metabolism are subject to examination. MATERIALS AND METHODS: In type 1 diabetes, the adhesion proteins prompt inside the intestinal epithelium prompt a more significant immune response that may result in the destruction of pancreatic ß cells by CD8+ T-lymphocytes, as well as increased articulation of interleukin-17, which is associated with autoimmunity. Studies suggest that the beginning of metabolic ailments and certain co-morbidities can be viewed in light of the protection between the gut microbiota and the intestinal immune system. The gut microbiota is analyzed as a key regulator of metabolic ailments. Research demonstrates that obese patients with type 2 diabetes have a certain gut microbiota and that the microbiota is translocated from the gut to the tissues in conjunction with the illness, which instigates inflammation. RESULTS: Research in animals and people suggests that a probiotic supplement may regulate the gut microbiota, thereby improving the prognosis for diabetes. CONCLUSIONS: The mechanism underlying this phenomenon relates to a decrease in the inflammatory reaction and oxidative stress, as well as a decrease in leaky gut. Such reactions increase insulin sensitivity and reduce autoimmune responses.

Intrapericardial teratoma in the newborn.

Two cases of intrapericardial teratomas occurring in the newborn are reported. The first was a cystic, well differentiated tumour which was totally excised. The child was alive and well with no evidence of the disease 10 months later. The second was a predominantly solid teratoma which consisted of both mature and immature tissues. It was removed but recurred 2 months later with pleural and pericardial invasion. The patient underwent reoperation but death occurred 9 days after surgical treatment. The recurrence was histologically similar to the primary tumour. The second case is probably the first malignant intrapericardial teratoma described in a neonate. Its morphology and clinical behaviour suggest that, as in ovarian and sacrococcygeal teratomas, the presence of immature neuroepithelium carries a poor prognosis. In such cases radio- or chemotherapy should be performed.

Right pulmonary artery development after modified Blalock-Taussig shunt (MBTS) in infants with pulmonary atresia, VSD and confluent pulmonary arteries.

The ideal palliation for infants with pulmonary atresia, ventricular septal defect and confluent pulmonary arteries should promote normal development of the pulmonary artery branches. In 26 patients who survived a modified Blalock-Taussig shunt (MBTS) in the first year of life, the right pulmonary artery was measured before and after operation by two dimensional (2D) echocardiography. In each patient its size was compared to the normal value for the same body surface area. The patients were divided according to this ratio and according to the real size (mm). Although increased in all cases but two, the size of the right pulmonary artery remained remarkably less than normal in patients with an initially small right pulmonary artery. In view of these results, early palliative enlargement of the right ventricular outflow tract is probably advisable in infants with diminutive pulmonary arteries who do not show adequate pulmonary branch development after MBTS.

Transthoracic echo-Doppler assessment of coronary microvascular function late after Kawasaki disease.

The goal of this study was to demonstrate that Doppler transthoracic echocardiography (TTE) may represent a valuable tool for the noninvasive demonstration of coronary microvascular dysfunction in children with previous Kawasaki disease (KD) by the measurement of coronary flow reserve (CFR) during cold pressor test (CPT). Twenty-five children with previous KD (mean follow-up, 4.6 +/- 2.6 years) were included in the study-16 with no evidence of coronary artery lesions (CALs(-)) by TTE and 9 with coronary aneurysms (CALs(+)). Seventeen age-matched healthy subjects were also recruited. Diastolic peak velocity was measured by pulsed Doppler both at rest (DPV(Rest)) and during CPT (DPV(CPT)) in the anterior descending artery. CFR was calculated as DPV(CPT)/DPV(Rest). KD patients demonstrated significantly higher values of DPV(Rest) (0.21 +/- 0.05 vs 0.13 +/- 0.01 cm/sec, p < 0.0001) and DPV(CPT) (0.33 +/- 0.07 vs 0.27 +/- 0.03 cm/sec, p < 0.005). CFR was reduced in KD compared to control subjects (1.5 +/- 0.4 vs 2.1 +/- 0.2, p < 0.0001). CFR was decreased in a similar manner in both CALs(+) patients (1.4 +/- 0.4, p = 0.002 vs controls) and CALs(-) patients (1.6 +/- 0.4, p < 0.0001 vs controls). Doppler TTE at rest and during CPT may represent a valuable modality for CFR evaluation in children with a history of KD. CFR is significantly reduced in KD patients independently of the presence of CALs.

[Isolated enlargement of the right atrium. Description of a successfully operated case]. / Ingrandimento isolato dell'atrio destro. Descrizione di un caso operato con successo.

We report a case of isolated right atrial enlargement. The patient was an 11 year old boy who had life-threatening supraventricular arrhythmias. Diagnosis was basically performed by Echo-2D Doppler. The surgical treatment performed on cardiopulmonary by-pass, was followed by immediate conversion to sinus rhythm. Histological examination showed chronic inflammatory aspects. Postoperative Echo-2D (2 years later) showed a moderate right atrial enlargement.

[Straddling and overriding atrio-ventricular valves: echocardiographic and angiographic findings]. / Valvole atrio-ventricolari cavalcanti. Rilievi ecoangiocardiografici.

Recent advances in surgical technique for correction of positional abnormalities of atrio-ventricular (A-V) valve require accurate preoperative diagnosis of this malformation which can be distinguished into a complete (overriding + straddling) and a partial form (overriding or straddling). In this study, echocardiography and angiocardiography are shown to be complementary to each other for definition of the anatomic details of this pathology. Six cases of positional abnormalities of the A-V valves are reported. Group I includes three patients with tricuspid valve abnormalities: two are complete forms (overriding + straddling) one of which is associated with DORV and the other is associated with d-TGA. The third patient is a partial form: straddling tricuspid valve with only a large ventricular septal defect involving the inlet septum. Group II includes three patients with mitral valve abnormalities: one complete form and two partial ones (straddling), all associated with DORV. We illustrate the best echocardiographic and angiocardiographic projection for the recognition of A-V valve malposition and demonstrate that both techniques greatly add to the diagnostic accuracy. Echocardiography defines better the abnormal attachments of the leaflet apparatus, whereas angiocardiography identifies better the displacement of the A-V valve annulus.

[The contrast echocardiography for the diagnosis of the venous system anomalies. Echo-angiographic correlations (author's transl)]. / L'ecocontrastografia nelle anomalie delle connessioni veno-atriali sistemiche. Correlazione eco-angiografica.

Contrast echocardiography is described as an important technique for the diagnosis of the anomalies of the venous system. Six patients with intrahepatic interruption of the inferior vena cava (IVC), ten patients with persistent left superior vena cava (PLSVC) connecting to coronary sinus (CS), one patient with PLSVC connecting to left atrium (LA) and ten patients, control group, with normal venous connections were studied by two-dimensional echocardiography; the injections of dextrose were made into the left hand, right hand, leg; the locations of the transducer were: subcostal position, parasternal and suprasternal. All patients underwent cardiac catheterization and cineangiography. When the injection was made into a leg vein, in the patients with infrahepatic interruption of the IVC we observed the contrast medium descending from the superior vena cava into the right atrium (RA). In the cases with PLSVC connecting to CS, contrast medium injected into the left hand, the sequential clouding of CS, RA and right ventricle was seen. The pattern of opacification in the case of PLSVC connecting to LA is discussed. In conclusion, contrast echocardiographic study of the connections of the venous system may be useful in planning the way for cardiac catheterization and also for the diagnosis of some anomalies which might be mistaken even at the time of the hemodynamic study.

[Enlarged coronary sinus. Mono and bidimensional echocardiographic aspects (author's transl)]. / Dilatazione del seno coronarico. Rilievi ecocardiografici mono e bidimensionali.

One case of enlarged coronary sinus with a total anomalous pulmonary venous connection (TAPVC) is described. The echocardiographic findings are compared to those seen in cases with persistence of the left superior vena cava (PLSVC). The diagnosis has been established by single crystal and two-dimensional echocardiography, by cardiac catheterization and angiography and was confirmed at surgery; post-operative echocardiographic control was performed. The differential diagnosis between TAPVC or PLSVC and other anomalies which may simulate a dilated coronary sinus is discussed. The differences between TAPVC and PLSVC by contrast echocardiography are reported.

[Clinical aspects of dilated cardiomyopathy in pediatric age]. / Aspetti clinici della cardiomiopatia dilatativa in età pediatrica.

Natural history and prognostic factors of dilated cardiomyopathy in pediatric age are not well identified so far. The course of the disease, often, presents "odd" characteristics: some of the patients show clinical improvement, someone remains unchanged and some of them have a negative evolution in a very short time. It is necessary to identify the group of patients having a poor outcome in order to define prognostic factors of impending death so that a cardiac transplant could be offered to them as a reasonable therapeutic choice. Twenty-two children, 9 males and 13 females (median age 5 +/- 5 years) with dilated cardiomyopathy were studied. Their natural history was followed for a period of 40 +/- 30 months. Clinical data, laboratory studies (electrocardiogram, Holter monitoring, echocardiogram M-mode, 2-D, Doppler and chest X-ray) were taken into consideration. At the end of follow-up period 7 patients showed improvement in cardiac status (31.8%), 7 remained unchanged (31.8%) and 8 (36%) got worse; 9 died. The survival curve showed a rate of 72% at 12 months and of 59.3% at 60 months. Of 9 died patients, 2 died suddenly and seven for congestive heart failure. Clinical findings and laboratory investigations of 13 survived patients (Group I) and 9 died patients (Group II) were compared to establish the risk factors of poor outcome. The fractional shortening is the only significant factor of poor outcome (p less than 0.025). Other negative factors were identified more in Group II than in Group I.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tetralogy of Fallot. Subcostal approach in bidimensional echocardiography]. / Tetralogia di Fallot. Approccio sottocostale in ecocardiografia bidimensionale.

We have evaluated the diagnostic accuracy of subxyphoid 2-dimensional (2-D) echocardiography in Fallot's tetralogy by employing two planes defined as left anterior oblique (LAO) and right anterior oblique (RAO), similar to the respective angiographic axial projections. Echocardiographic and angiographic findings were compared in 39 patients. The pulmonary branches, the trunk, the infundibulum, the septal defect and the aorta were identified in all cases, the pulmonary valve in 97% and associated defects in 71%. The LAO view was best suited for an overall diagnosis and for the visualization of the left pulmonary branch, of the pulmonary anulus, and of the overriding of the aorta. The RAO proved optimal for the evaluation of the right pulmonary branch, of the infundibulum and of the relationship between ventricular septal defect and adjacent structures. It is concluded that the subxiphoid approach is a valuable technique for the 2-D echocardiographic evaluation of Tetralogy of Fallot.

[Basal left anterior oblique projection in 2-dimensional echocardiography: its usefulness in defects of the atrioventricular septum]. / La sezione obliqua anteriore sinistra basale in ECO 2D: utilità nei difetti del setto A-V.

The defects of the A-V septum have been recently classified into classes with separate orifices and classes with common orifice on the basis of the presence or not of a tissue tongue which joins the two bridging anterior and posterior leaflets as single differential feature. The diagnostic usefulness of the subxiphoid projection by conventionally called left oblique anterior basal has been evaluated. It indicates in a single plan-section the two bridging leaflets together with the connecting tongue. In 18 cases of defect of A-V septum echo-angiographic correlation was made. The 2D-echo diagnosed in 10 cases a defect of A-V septum with common orifice and in 8 cases a defect of A-V septum with separate orifices. On the contrary the angiocardiography pointed out in 9 cases a defect of A-V septum with separate orifices. Ten of the eighteen patients examined underwent an operation, which has always confirmed the echocardiographical diagnosis; even in the unique case of echo-angio disagreement the diagnosis of 2D-echo was confirmed. Therefore we propose the above-mentioned projection in order to obtain a more accurate non invasive definition in the defects of A-V septum.

[Reference values for the echocardiographic calculation of left ventricular mass in normal children between the ages of 0 and 6]. / Valori di riferimento per il calcolo ecocardiografico della massa ventricolare sinistra in bambini normali di età compresa tra 0 e 6 anni.

BACKGROUND: Echocardiographic assessment of left ventricular mass (LVM) and mass/volume ratio (LVM/V) is an accurate method for evaluating left ventricular hypertrophy. However, reference values for LVM and left ventricular volume (V) in children under 6 years of age have not been well established. METHODS: Therefore, we evaluated 106 consecutive children (60 males, 46 females, mean age +/- SD 35 +/- 28 months, range 0-72) free of cardiovascular disease by clinical, electrocardiographic and echocardiographic examination. LVM and V were determined by M-mode echocardiography. RESULTS: The 5th and 95th percentile values of LVM were: 7 and 21 grams for infants aged 0 to 6 months; 13 and 32 grams for 7 to 24 months; 23 and 41 grams for 25 to 36 months; 23 and 59 grams for 37 to 48 months; 30 and 60 grams for 49 and 60 months; 36 and 98 grams for 61 and 72 months. The 5th and 95th percentile values of V were: 4 and 20 ml for infants aged 0 to 6 months; 12 and 36 ml for 7 to 24 months; 16 and 43 ml for 25 to 36 months; 20 to 55 ml for 37 to 48 months; 27 to 64 ml for 49 to 60 months; 39 to 74 ml for 61 to 72 months. The 5th and 95th percentile values of M/V ranged between 1 and 2.3 for infants aged 0 to 6 months, and 0.7-1.2 for those aged 61 to 72 months. LVM, V and LVM/V were significantly (p < 0.0001) related to age, height, weight and body surface area, but were unrelated to gender.

[Balloon occlusion aortography in the angiographic study of pulmonary atresia with interventricular defect]. / L'aortografia con occlusione nello studio angiografico dell'atresia polmonare con difetto interventricolare.

Balloon aortography is a new technique for the angiographic study of pulmonary atresia with ventricular septal defect. A Swan-Ganz angiographic catheter is employed, whose balloon is inflated to stop blood flow in the descending aorta, thus ensuring the opacification of the pulmonary circulation. By this method we have studied 18 patients. Anatomic details of the pulmonary arterial circulation were obtained in all. No complications occurred. Balloon aortography is a simple and safe technique for the routine study of patients with pulmonary atresia and ventricular septal defect, whereas selective injection in collateral arteries or pulmonary veins, which carries more risk and is more complex, should be adopted only in selected cases.

Clinical variability of cardio-facio-cutaneous syndrome: report of two additional cases.

We describe two new cases of cardio-facio-cutaneous (CFC) syndrome, and underline the clinical variability of the CFC phenotype in our two patients presenting with border-line psychomotor development. The first patient showed some additional clinical manifestations, such as cryptorchidism and scoliosis, and the second one had atypical skin lesions.