Search

Objective: To evaluate the efficacy of the two different drugs (Ketorolac and Fentanyl), used singularly or in association, in the management of postoperative pain in Picu., Study Design: A randomized and prospective study., Methods: 52 children were randomly assigned to receive intravenous Ketorolac and/or Fentanyl, according to four different analgesic treatments: A) Ketorolac 1.2 mg/kg every six hrs; B) Ketorolac 1.2 mg/kg (bolus) + 0.21 mg/ kg/hr; C) Fentanyl 1 gamma/kg/hr; D) Fentanyl 1 gamma/kg/hr + Ketorolac 0.21 mg/kg/hr. Each protocol was given to 13 children. The efficacy of treatments were evaluated by child's behaviour (Affective Facial Scale and CHEOPS score) and hemodynamical parameters (systolic and diastolic blood pressure, breathing rate, heart rate, oxygen saturation and oxygen arterial pressure) and analysed by statistical analysis., Results: The children treated with protocol B (Ketorolac in continuous in infusion) showed better pain relief in respect to those treated with protocol A (Ketorolac in bolus), while the most efficient analgesia was obtained with the association of the two analgesic drugs (protocol D). Two cases of bradycardia, one case of hyperazotemia and one case of transaminase increase were noted., Conclusion: Ketorolac presents a good efficient analgesia, particularly evident when administered in continuous intravenous infusion. However, the association of this NSAID with an opioid drug can be favourably proposed in postoperative pain therapy of moderate to severe grade, since the confirmed analgesic efficacy is not aggravated by important side effects.

Henoch-Schoenlein syndrome (HSS) is one of the most common vasculitis in childhood. It is characterized by non-thrombocytopenic purpura, arthritis, abdominal pain, and sometimes intestinal haemorrhage and renal involvement. It may be complicated by haemorrhages in uncommon sites, such as lungs, testicles, bladder, and central nervous system. Neurological involvement in HSS is often underestimated, usually occurring with headache, irritability, and behavioural alterations, whereas endocranial haemorrhage is quite rare. We report a case of endocranial haemorrhage in a child with HSS.

We report the case of a boy 5 years old we admitted to our PICU with signs of impending hepatic failure (hypertransaminasemia, hyperammonemia, prolonged PT) following mild upper respiratory infection and irrepressible vomiting. We observed no neurological abnormalities excepting slight lethargy; on the contrary, EEG findings showed severe diffuse slowing and high-voltage Delta activity. Our diagnosis of Reye's syndrome was later confirmed by liver biopsy. Clinical and electrophysiological signs recovered after 48-72 hours and no explication was found for this anomalous Reye's syndrome presentation. Further studies are needed for understanding the basis of neurological involvement of stage I Reye's syndrome.

We herein evaluated the analgesic effectiveness of low doses of buprenorphine with or without a primer and the practicality and usefulness of a constant flow disposable infusion set (Infusor Baxter 2 ml/h). Our series consists of 300 patients, seen between January 1992 and December 1993, randomly distributed in three groups of 100 patients each. All patients were informed before operation about the use of pain Visual Analogical Scale (VAS) and how the infusor works. At the end of the operation all patients had an infusor positioned with a 0.01 mg/kg supplied of buprenorphine diluted to 60 ml with Ringer's Lactate solution. In addition to this, group B patients received an i.v. primer of 0.003 mg/kg of buprenorphine diluted to 10 ml with saline solution and group C patients received an i.v. primer of 0.5 mg/kg of ketorolac diluted to 10 ml with saline solution. VAS, systolic arterial pressure, diastolic arterial pressure, heart rate, respiratory rate, request of analgesics and side effects were evaluated at one hour (T0), six hours (T1), 12 hours (T2), 24 hours (T3) and 36 hours (T4) after operation. Group B and C patients showed significant reduction in VAS compared to group A patients at T0 and T1 but the difference disappeared starting from T2. Group B and C patients showed blood pressure, heart rate and respiratory rate values significantly reduced compared to group A patients at T0 and T1. Such values however then stabilized. Side effects encountered were nausea and vomiting in different percentages in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Vigabatrin is an irreversible inhibitor of gamma-aminobutyrate (Gaba) aminotransferase, producing an increase in Gaba concentrations in the brain. It may prove to be an important drug in the treatment of refractory epilepsy, but would be payed attention to behavioural changes noted in association with vigabatrin treatment. Behaviour disturbances, as psychosis, associated to vigabatrin are ben described in adult patients, while are uncommon in childhood. We report a case of acute psychosis occurred in a child in treatment with vigabatrin.

We have studied the T-cell-mediated response to the major allergen of cow's milk, in a group of newborns at risk of developing cow's milk allergy, and in a control group. Before any atopic status has developed, we observe beta-lactoglobulin-specific primary proliferation only in the group at risk for food-related allergies. In this group, the capability to proliferate is not due to placental transmission of 'factors' from allergic mothers. The recognition of the tested beta-lactoglobulin peptides does not show major differences between the responder and nonresponder populations. In the responder population, the response to p145-161 appears linked to a primary response to ovalbumin, another frequent food allergen. On the basis of our findings, we propose a model in which development of allergic diseases is linked to an alteration of T-cell activation through the engagement by the antigen; the HLA phenotype determines the allergen(s) involved, and other genetic or environmental factors dictate the clinical characteristics of the disease.

It has been observed that a hierarchy exists among epitopes such that fewer epitopes are actually involved in the induction of T cell response and tolerance than there are epitopes available in a given antigen. Some epitopes which are "cryptic" for immune activity within the protein, are nevertheless able to elicit a response if administered alone and can also be used to by-pass tolerance. We report that tolerance to a self protein shows the same phenomenon seen for non self proteins. In fact, we elicit a proliferative response toward a predicted minor cryptic epitope, to which animals are clearly not self-tolerant. The minor epitope escapes the induction of tolerance to self proteins more easily than the major epitopes, since we cannot elicit proliferative response to the major epitope. A striking feature of our results however is that lack of self tolerance to the minor epitope appears as not being due to the failure of presentation of this epitope in normal, healthy animals.

The results of previous studies on the proliferative response of resting cord blood mononuclear cells (CBMC) of term neonates to human recombinant interleukin 2 (hrIL-2) are contrasting. Some authors have reported a good and others a poor response. In our study we have obtained a significant reactivity, compared with the response of resting peripheral blood mononuclear cells (PBMC) of adult subjects, of resting CBMC to varying quantities of hrIL-2 in the absence of any known mitogenic or antigenic stimuli. Most responding cells was CD3 positive. Both CD4-positive and CD8-positive cells responded. However, we observed a more marked increase of the percentage of the CD4-positive T cells and a clear reduction of the percentage of the CD21-positive cells (B-lymphocytes) testing CBMC rather than PBMC of the adult subjects. The percentage of the NK cells was reduced in both the categories of subjects. Moreover, we have examined the reactivity to hrIL-2 of CBMC of preterm neonates. The results showed that this response is low. The peculiar level and kinetic of CBMC proliferative response to hrIL-2 are discussed.