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The authors report a case of a child three years old, with severe malnutrition as complication of Ascaris lumbricoides infection. Intestinal nematodes infect many of the world's children and constitute a formidable public health problem. The infected children may suffer nutritional deficits, serious illness and occasionally death. Although infestation is uncommon in our country, it should be considered in children with low social life.

Because of specific laboratory tests are lacking, diagnosis of cow's milk allergy is always made on the basis of improvement after cow's milk protein withdrawal from diet and relapsed after challenge test. However personal and familial anamnesis, supported by few simple laboratory tests (peripheral blood and stool eosinophiles, hemoccult), are important tools for diagnosis. In this work we report the clinical findings of 68 children, suffered from cow's milk allergy, observed in the last 10 years. Children were divided into three groups on the basis of challenge response: Group 1 consisting of children with averse reaction occurred within the first hour after the administration of cow's milk protein (IgE-mediated reaction, 1st class as Gell-Coombs classification); Group 2 consisting of children with averse reaction occurred between 2nd and 12th hour (1st-3rd class as Gell-Coombs classification); Group 3 consisting of children with averse reaction occurred after 24 hours the administration of cow's milk proteins (4th class as Gell-Coombs classification). Auxological parameters show that while weight is widely involved, particularly in children of group 3, height is interested only in children with prolonged diarrhoea. Cow's milk protein withdrawal from diet determine a rapid normalization of weight increment rate, more evident in children over 25th centile. Height rise up normal values slowly without any differences between children below and over 25th centile. At the age of two years 57 children (83%) became tolerant to cow's milk proteins and after 5-year follow-up in 3 children (4.4%) only persisted cow's milk allergy. All these children presented the IgE-mediate clinical form.

In the last years gastroesophageal reflux disease received more attentions, due to an improving in diagnostic techniques. Motility disorders, such as reduced competence of lower esophageal sphincter, motor esophageal disorders, delayed gastric emptying are important factors in the pathogenesis of the disease. Therefore therapy using prokinetic agents has been considered useful. A variety of drugs such as bethanecol, metoclopramide and domperidone have been used. There are conflicting report on the effects of these drugs and it should also be emphasized that they are not devoid of side effects related to dopamine antagonism. Recently cisapride, prokinetic agent which acts through facilitation of acetylcholine release, has been considered effective and well tolerate drug for the treatment of gastroesophageal reflux disease. In this view we investigated the effects of oral administration of cisapride in 12 children (age range 3-40 months), 7 females and 5 males, suffering from gastroesophageal reflux disease diagnosed on the bases of: clinic criteria, barium swallow radiological examination, 24-hour intraesophageal pH monitoring. After diagnosis a treatment with cisapride (1 mg/kg/die) before feedings for 8 weeks was started in all children. At the end of the trial clinical assessment and 24-hour intraesophageal pH test were performed. Clinical assessment was determined through weight, length and a clinical score calculated using the following parameters: regurgitation, vomiting, irritability, nocturnal weeping, meteorism, respiratory complaints. The total score was evaluated at diagnosis and during the follow-up (1st, 2nd, 4th and 8th week).(ABSTRACT TRUNCATED AT 250 WORDS)

23 children, aging from 3 to 13 years, affected by chronic upper airway obstruction, were studied. The clinical suspicion was "obstructive sleep apnea" (O.S.A.). In this study was found a significantly different frequency, in O.S.A. group, if compared with controls, of the following symptoms: nocturnal snoring (100%), mouth breathing when awake (69%), and during sleep (91%), abnormal restless movements (69%), behavioral disturbances (60%). Clinical evaluation revealed: pectus excavatum (82%), enlarged tonsils and adenoids (82%), failure to thrive (39%). Chest index was 0.72 +/- 0.07 significantly higher (p < 0.001) than controls. The authors also carried out in all patients and controls pCO2 venous blood determination during sleep, to screen subjects with high risk of cardiopulmonary dysfunction. Data obtained showed that threshold value of pCO2 was 45.6 mmHg.

Authors report a method on the functional investigation of intestinal epithelium, based upon the dosage of serum carotene levels after administration of carotenoids. This test takes advantage of the modality of beta-carotene absorption that it behaves like a lipid. The "beta-carotene test" has demonstrated, as regards to T.A.R.T., great sensibility and specificity over 90%. It doesn't show value overlapping between normal and coeliac children and also it shows good compliance of children and simplicity in laboratory determination. For all these characteristics the Authors suggest the utilization of "beta-carotene test" as screening tool of malabsorption.

The authors reported a case of a child suffering from Cow's milk protein allergy, in which a soybean milk was administered for one month. The incorrect preparation of the formula determined a megaloblastic anaemia due to folate deficiency. The observation of very high levels of seric aminoacids during the acute phase of the disease was noteworthy. The therapy with folic acid and the introduction of protein hydrolysated formula milk determined a rapid normalization of the haematological picture. During the follow-up the administration of soybean protein caused anaphylaxis showing the contemporary presence of soybean allergy. The challenge test with cow's milk performed afterwards showed the restoration of the tolerance towards cow's milk protein.

Cow's Milk Protein Intolerance (CMPI) is the most common food intolerance in childhood. The I, III and IV type of the immunological mechanisms are involved in the pathogenesis. Nowadays there are no diagnostic tests with good reliability excluding the IgE-mediated clinical pictures. Recently the evaluation of antibodies (IgA and IgG classes) versus milk proteins has been proposed as reliable test. In order to establish the pattern of antibody response against milk proteins we studied 37 children (17 males and 20 females), aged from 3 months to 6 years, divided as follows: 23 with CMPI of which 16 suffering from gastrointestinal complaints (GI) and 7 from cutaneous ones (CT); 5 children with coeliac disease; 9 normal healthy children without any clinical manifestation. All children at the time of the assessment assuming a diet containing cow's milk proteins. IgA, IgG and IgM antibody classes against cow's milk proteins such as alpha-lactoalbumin (alpha LA), beta-lactoglobulin (beta LG), casein (CAS) and pooled proteins (PPL) were measured using an ELISA method. The results obtained in the various groups were as follows: CMPI-GI group: the percentage of positivity for alpha LA-IgA was 43.8% and alpha LA-IgG 68.7%, for beta LG-IgA was 50% and beta LG-IgG 75%, for CAS-IgA was 43.8% and CAS-IgG 68.7%, for PPL-IgA was 37.5% and PPL-IgG 62.5%. CMPI-CT group: the percentage of positivity for alpha LA-IgA was 42.8% and alpha LA-IgG 57.1%, for beta LG-IgA was 71.4% and beta LG-IgG 42.8%, for CAS-IgA and CAS-IgG was 85.7%, for PPL-IgA was 71.4% and PPL-IgG 57.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigliadin antibodies (AGA), both IgA and IgG, were studied in the serum of 84 coeliac children during the various stage (Diagnosis, GFD, Challenge) and in 29 healthy children, with a micro-ELISA technique. The results demonstrated the presence of AGA in the serum of coeliac children and a different behaviour between the two Ig-classes in the various stages of the disease. During acute phase both classes were present at high titre. When gluten was withdrawal from the diet, while the titre of IgA fell rapidly since the first month, the IgG titre decreased slowly and raised the normal limits after six months. If the children didn't observe a corrected GFD, the serum AGA titres remained at high levels. During challenge, while IgG raised since the early days, IgA titres raised later, when the intestinal damage became important. The explanation of this different behaviour could be that AGA-IgA are derived from gut mucosa, on the contrary AGA-IgG are not synthesised in the intestine. We believe that serum AGA seem to be good markers of the immune reaction in the intestine triggered by gluten. Furthermore we conclude that the assay of AGA in the serum of coeliac patients is: 1) high sensible and specific method; 2) the most important screening test for intestinal biopsy; 3) the most important test for diagnosis and follow-up of CD; 4) the test which could substitute 1 or 2 intestinal biopsies of the ESPGAN protocol.

The evaluation of fecal fat elimination (steatorrhoea) is of primary importance for diagnosis of gastroenterological disorders. In childhood it is quite difficult to apply the ordinary methods of evaluation, on the other hand it is necessary to make use of them to screen and diagnose maldigestion and/or malabsorption syndromes. In this work "Steatocrit" method by Phuapradit and "Fecal fat qualitative test" (FFQT) on glass, by Jacobson, have been used in a parallel study on stool samples from subjects with suspected gastrointestinal disease. While Steatocrit was determined on 200 samples, FFQT was determined on 1574 samples. Our data show that steatocrit is fully able to detect quantitative steatorrhoea with high significance when compared to controls. Likewise FFQT shows a sensibility of 100% compared to controls and it is able to predict coeliac disease and cystic fibrosis in 85.5% of cases and in 89.9% of cases respectively. We conclude that these two tests are sure and auxiliary each other. They allow, when performed on the same sample, to go toward diagnosis of both malabsorption and maldigestion, furthermore they allow to monitor steatorrhoea under therapy.