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Aim: The results may be related to the relative delay in diagnosis and thus in treatment. The authors hope that their paper will help make physicians who work in emergency rooms more aware of the increase in stroke in children., Methods and Results: The study a departmental study in the Children's Hospital, carried out at the Giannina Gasslini Children's Hospital of Genoa, Italy. The authors report on 23 children with stroke who were admitted at onset to the pediatric emergency department. The incidence of patients with stroke at the Institute between 2001 and 2005, was 0.8% among neurology patients and 0.02% among all pediatric patients. This incidence would appear to be lower than the rates reported in the literature. This is most likely due to the fact that patients who presented at the Emergency Department at onset of the stroke were not taken in consideration. In the last few years, children with stroke have been treated empirically by anticoagulant or antiplatelet therapy. Patients with sickle cell disease, with venous stroke, or with heart disease are all treated in a rather homogeneous manner., Conclusions: These cases represent the different types of presentation of stroke in children and also clearly display the different therapeutic strategies that have been applied. In fact, the patients were treated on the basis of an individual protocol which was decided case by case but a critical review of these cases establishes a necessary multidisciplinary protocol.

Essential thrombocythemia (ET) is a chronic myeloproliferative disease, rarely observed in pediatric age, characterized by a persistently increased platelet count. Abnormalities of platelet function observed in ET patients may be, at least in part, responsible for the thrombohemorrhagic complications. The authors report about a pediatric patient affected by ET, showing an abnormal platelet response following stimulation by anti-platelet monoclonal antibody. Such finding may be attributable to a structural abnormality of the platelet fibrinogen receptor or to post-receptor alterations.

We examined the auditory function of 29 subjects affected by homozygous beta-thalassemia, managed with an high transfusion scheme and regularly treated with 40-60 mg/kg/day of desferrioxamine. A group of 29 healthy subjects is studied as control. We found conductive hearing defect in 8 thalassemics (6 bilateral) and sensory-neural hearing loss at high frequencies in 4. Thalassemic patients showed more auditory impairment than controls, an higher incidence of tonsillar hypertrophy, adenotonsillitis and submandibular lymph-node enlargement.

The aim of this study is the behavior of Normotest (NT) values in newborns in the first 4 days of life. The study has been carried out between January, 1982, and December, 1984, at the Department of Child Health and Neonatal Medicine - School of Medicine - University of Genoa. The number of infants tested was 1320. 694 were males and 626 females, 529 preterm (G.A. less than 37 weeks) and 791 full term babies. Infants have been tested from one to five times in the first four days of life, with the first evaluation within 12 hours of life. 1215 newborns (92%) presented NT values greater than 20%, 105 babies (8%) had NT below 20% in at least one evaluation, and received Vitamin K1 (0.5 mg/kg i.m.) as prophylaxis, being thereafter excluded from this study. Among the neonate with NT greater than 20%, 426 babies have been considered, who had, at least, three evaluations in the first four days of life. 288 (68%) of the 426 newborns, had not important disease, while 138 (32%) were sick neonates; of these babies 88 (64%) had respiratory distress syndrome and 50 (36%) had an infectious condition. The mean of NT values of the 426 newborns decreased from the first (33.84%) to the 2nd day (32.72%), with a following increment in 3rd (35.29%) and 4th day of life (39.01%). Newborns with gestational age (G.A.) less than 34 weeks showed significantly lower values than newborns with G.A. between 34-37 weeks and those with G.A. greater than 37 weeks. No newborn with NT values greater than 20% either received vitamin K or showed symptoms of haemorrhagic disease in early or later neonatal period.

To investigate the effective usefulness of penicillin prophylaxis in splenectomized patients, we retrospectively focused on a group of sixty-two splenectomized patients affected by thalassemia major. Thirty-six out of 62 has been receiving monthly 1.200.000 Us. of benzathine-penicillin as prophylaxis. The remaining 26 did not receive prophylaxis, but was treated with antibacterial drugs as soon as symptoms of upper respiratory tract infection occurred. During a total period of eleven years of observation we did not observe any pneumococcal sepsis; the incidence of bacterial infections within the two groups is not different. We conclude for the uselessness of penicillin prophylaxis in splenectomized beta-thalassemic patients.

The laboratory tests of 38 patients in pediatric age with Disseminated Intravascular Coagulation (DIC) were retrospectively evaluated. In all patients were performed PT, aPTT, platelets count, FDP dosage and biological assay of Fibrinogen. In most of them the activity of FII, FV, FVII, FX and FVIII was assaied. According to the diagnostic criteria of FSP greater than 8 micrograms/ml, Platelets less than 150 10(9)/1 and Fibrinogen less than 150 ml/dl, in 16 patients the diagnosis of DIC was possible since first examination, while in 9 patients it became possible within 2-4 days; in 13 patients we never could diagnose DIC, although it was reasonably present, since the criteria above mentioned were never simultaneously satisfied. Looking back in our experience, we confirm that the platelets count and the quantitation of plasmatic Fibrin Degradation Products (FDP) are the most useful tests for the diagnosis of full blown DIC, and that the biological assay of plasmatic fibrinogen helps to follow the disorder. A low level of FVIII:C seems to be a forecast of failure. None of the other test performed give any useful information for diagnosis when it is not possible with the above mentioned tests.