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Children adopted from abroad by Italian families have increased during the last years. Since 2001 to 2004 they have been more than 10,000, mainly from Eastern Europe, and all indications suggest that they will continue to increase. Most of the internationally adopted children reside in orphanage before adoption where they may experience malnutrition, exposure to infectious diseases, environmental deprivation, neglect. Moreover, their pre-adoptive records are scarcely reliable and their immunization status is not always adequate. The most common long-term problems of internationally adopted children concern developmental and scholastic delay especially if they come from a long and severely deprived institutional setting, precocious puberty and, during adolescence, depressive disorders as well as antisocial behaviours. Inter-country adopted children are at increased risk for health and social problems and have to be recognized as a group of subjects requiring special medical attentions. Specialized centres for internationally adopted children where they could receive medical evaluations upon arrival and a prolonged health follow-up should be set up.

Cisapride is a prokinetic agent thought to be without severe side effects. Recently, rare cisapride-induced cardiotoxic effects (QT interval prolongation, ventricular arrhythmias) have been reported, raising questions about its safety. Some risk factors have been reported: overdosage of cisapride, association with some drugs inhibiting hepatic metabolism via the cytochrome P450 3A4 enzymatic system (such as azole antifungals, macrolide antibiotics, non sedating antihistamines), other pharmacological agents increasing the parasympathetic tone by raising the effect of cisapride (such as ranitidine and cimetidine), electrolyte abnormalities (such as low serum levels of calcium, potassium and magnesium in the blood), liver dysfunctions, congenital long QT syndrome, and infants born before 36 weeks' gestation, for three months after birth. Physicians, prescribing cisapride should pay attention to these risk factors, to avoid the possibility of a rare cardiac adverse effect.

A rare complication of pulmonary tuberculosis of infant is the obstructive emphysema following to the compression by enlarged lymphadenopathy. The authors report a case of obstructive emphysema observed in a 12 month old infant affected by pulmonary tuberculosis, and debate its more important pathogenethic, clinical and differential diagnosis aspects. At last they comment upon favourable clinical course observed as results of an exclusive medical treatment (antitubercular antibiotic therapy shortly combined with moderate corticotherapy) without making use of surgical, but aggressive, treatment.

Pulmonary hemosiderosis is a rare disease of unknown aetiology, whose clinical, pathogenetic and prognostic aspects are still open to discussion. The authors report a case of pulmonary hemosiderosis in a 2 years and 3 months old girl. Peculiar features of this case include antibody deficiency (which may contribute to the pathogenesis of the disease) and severe and protracted melena. Fatal outcome, despite several therapeutic trials, confirms the poor prognosis of pulmonary hemosiderosis.

The infection caused by EBV can be followed by immunological complications. One of these is autoimmune hemolytic anemia that up to today has been observed during infective mononucleosis only a few times. The authors describe a patient with this rare complication of the EBV infection and discuss its main clinical, pathogenetic and laboratory aspects, with particular attention to the presence of hemoglobinuria and to the absence of anti-i-antibodies. The disease's evolution was spontaneously favorable. For this reason and for the possible risks secondary to transfusions and to other therapeutical interventions, the authors believe that in autoimmune hemolytic anemia a vigil wait is more opportune before beginning the therapy.

Anti-endomysium antibodies (AEA) and Antigliadin antibodies (AGA) have been compared in a group of coeliac patients (17 with untreated coeliac disease, 56 after gluten free diet and 14 after gluten challenge), in 69 patients with various intestinal pathological conditions, and in 40 healthy children, in order to appreciate sensitivity and specificity of these tests in diagnosis of coeliac disease. AEA and AGA IgA were detected in 100% and AGA IgG were found in 94.1% of coeliacs with untreated disease; after gluten free diet AGA IgG were found in 27.7% of cases, while AGA IgA and AEA were absent in all coeliacs but one with non correct compliance to diet. After gluten challenge followed by villous atrophy, 78.5% of patients were positive for AGA IgA, 85.71% for AGA IgG and 100% for AEA. Anti-endomysium antibodies were absent both in healthy controls both in control disease patients, while sometimes antigliadin antibodies were present in patients with various intestinal pathology (AGA IgA in 1.44% and AGA IgG in 7.2% of cases). In our experience therefore AEA, because their sensitivity and high specificity, appear to disclose new prospects in diagnosis of coeliac disease.

Kawasaki disease can be characterized by rare complications or by unusual associations. One of these is autoimmune hemolytic anaemia that has been observed seldom up to now. The Authors report a case with this rare association, compare it with cases observed before, and put forth the hypothesis that autoimmune anaemia during Kawasaki disease can be linked to numerous immunological alterations present in mucocutaneous lymph node syndrome. They moreover advise to abstain in these cases from corticosteroid therapy, both to avoid complications, and because, as happened in their patient, this kind of autoimmune hemolytic anaemia can regress spontaneously.

The Authors have performed a study on the dietary habits of 74 celiac children and have analysed retrospectively the type of nursing (breast-feeding or bottle-feeding), the time and the age of gluten introduction. Then they related these data to the age of onset of symptoms. Children breast-fed for 3 months or more showed a marked delay in the onset of the disease and a longer latency time from gluten introduction when compared with bottle-fed children; on the contrary early gluten introduction was not positively correlated to risk of celiac disease. This observations induce to think that breast-feeding may be a protective factor towards coeliac disease, while the precocious gluten introduction is not an important factor of risk correlated to this disease.

IgG are the most common isotype of Ig and include four subclasses which differ from one another in the following ways: their initial amino acid sequence, their physical and chemical properties and the different serum concentrations reached with age. Every subclass has a specific biological function: the response to proteic antigens is prevalently mediated by IgG1 and IgG3, while IgG2 mediates the response to polysaccharide antigens. It is still unclear whether IgG4 are protective or sensitising antibodies; IgG1 and IgG3 also have a major ability to bind to the cells that mediate the immune response, while only IgG4 activate the complement using an alternative route. Although low levels of IgG subclasses may be temporary, deficiencies are often associated with various diseases: 1) recidivating bacterial infections involving the respiratory and digestive tracts, primarily sustained by capsulated or pyogenic microorganisms; 2) IgA deficiency; 3) absence of immune response following vaccination; 4) allergic or autoimmune diseases; 5) diseases of the CNS. IgG subclass deficiencies must therefore be looked for every time these diseases are diagnosed, also because subjects may benefit from gammaglobulin replacement therapy.

The Authors report a case of spondylo-costal dysostosis observed in a child 2 years and 1 month old. They recall its clinical and radiological findings and discuss genetic problems and differential diagnosis of this rare disease.

The dietary habits of 174 infants under 6 months old and suffering from enteritis were analysed revealing a high incidence of feeding errors (almost always feeding with artificial formulas, wrong concentration of milk powder, failure to sterilise the bottle and the water used to dilute the milk, too early administration of undiluted, unboiled bottled cow's milk, too early and incorrect weaning). Such mistakes appeared to be linked to the poor economic and sociocultural conditions of the families concerned. It is claimed that dietary errors conditioned by the poor economic and sociocultural conditions encountered may have favoured the onset of enteritis and that the adequate prophylaxis of acute infantile enteritis will depend on improving people's dietary habits and living conditions.

The case of a patient with tetanic hypocalcemia secondary to celiac disease initially diagnosed as chronic hypoparathyroidism is reported. The rarity and clinical peculiarities of the case are underlined and its pathogenesis discussed with particular reference to the difficulties it presents in terms of differential diagnosis.