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Objective: Previous studies stressed the role of decision-making functioning in predicting antiobsessive treatment outcome with serotonin reuptake inhibitors drugs in patients with obsessive-compulsive disorder. Nevertheless, the use of an augmentation strategy with atypical antipsychotic drugs has proved to be effective in obsessive-compulsive patients nonresponding to serotonin reuptake inhibitors treatment. We investigated whether the performance at the Iowa Gambling Task (IGT), a used neuropsychologic task which assesses decision-making, can be an effective criterion for pharmacologic treatment choice in these patients and whether the use of different treatment strategies, according IGT performance, can increase the rate of antiobsessive outcome., Method: Thirty patients with obsessive-compulsive disorder were treated in a single-blind design with fluvoxamine plus placebo or fluvoxamine plus risperidone according to their IGT performance. Treatment outcome was recorded after 6 and 12 weeks., Results: Patients with good IGT performance showed a good antiobsessive treatment outcome with fluvoxamine only, while only adopting an augmentation strategy with risperidone, the number of responders patients within the subjects with bad IGT performance increased., Conclusions: IGT performance may be considered an effective criterion for pharmacologic treatment choice in obsessive-compulsive patients given that antiobsessive treatment outcome is increased to 85% of responders choosing an appropriate drug strategy according to the IGT performance.

Anorexia nervosa (AN) could be considered a form of obsessive-compulsive disorder in which an impairment of the cognitive domain related to decision-making was found. We explored this function in AN patients, as well as possible differences between restricting type and binge/purge type, with the aim of examining the hypothesis that AN is part of the obsessive-compulsive spectrum. Decision-making was assessed in 59 inpatients with AN and 82 control subjects using the Gambling task, which simulates real-life decision-making by assessing the ability to balance immediate rewards against long-term negative consequences. We confirmed the supposed deficit of decision-making in AN. However, restricting and binge eating/purge subtypes showed different patterns of decision-making impairment. Poor performance on the Gambling task is not a mere consequence of starvation and does not appear to be related to illness severity. The decision-making deficiency that some AN patients show is linked to those individual features that contribute to the phenomenological expression of the disorder.

Stroke in children is a rare condition and has a multifactorial etiology. The association between ischemic stroke in young adults and some minor cardiac abnormalities such as atrial septal aneurysm with or without interatrial shunting has recently been reported: however, the pathogenetic mechanism still remains unclear. Genetic and acquired prothrombotic disorders are also risk factors for cerebral ischemic events in children. We report a case of ischemic stroke in a 10-year-old female child who was heterozygous for the prothrombin G20210A variant and who presented with an atrial septal aneurysm associated with an interatrial shunt. We hypothesize that these risk factors play a synergic role but their relative importance and whether alone they can determine cerebral embolism remain to be determined.

Children with shunted hydrocephalus of differing etiologies were assessed. There was a more selective loss of non-verbal than of verbal intelligence. The verbal and visuo-perceptual abilities were affected by different sets of variables. Variables related to the hydrocephalus had no effects, while associated supratentorial malformations significantly affected non-verbal functions.

We evaluated 38 newborns with acute renal failure (plasma creatinine (Pcr) concentration greater than = 1.5 mg/dl), measured between the 2nd and 5th days. We used renal ultrasound to exclude the possibility of congenital renal anomalies, obstructive pathology or vascular disorders. We calculated the glomerular filtration rate (GFR) using Schwartz' formula and the maximal concentrating capacity using intranasal administration of desamino-cis-1-D-arginine-8-vasopressin (DDAVP test). Two newborns were treated with peritoneal dialysis and died during the first month of life. Thirty-six had a follow-up blood sample drawn: 24 preterm babies between 1 and 12 months, and 12 full-term babies between 1 and 36 months of life. From this sampling 4 babies (11.1%) showed defective maximal concentrating ability. Our data reveal the persistence of altered concentrating ability in newborns affected by renal failure and shows that this problem needs a longitudinal study and further diagnostic investigations.

Necrotizing Enterocolitis (NEC) of the new-born is a serious syndrome characterized by bilious vomiting, gastric retention, abdominal distention and bloody stools. Furthermore, the general condition of the neonate is frequently compromised. The pathogenesis is multi-factorial; however, most authors state that the primary cause of this syndrome is due to ischemia of the intestinal wall. The most serious complication in babies with NEC is perforation of the necrotic bowel, a condition which must always be treated surgically. We present a case of NEC that has a particularly interesting clinical course and, as well, an interesting approach to treatment, which involved the placement of a peritoneal drain. This drain was subsequently utilized for peritoneal lavage once the diagnosis of NEC was confirmed, because we felt that the patient's general condition was so serious that he could not tolerate surgery at this time.

Infants of diabetic mothers have an increased morbidity and mortality in the perinatal period. Nevertheless, there are differences in opinions about the exact incidence of malformations, metabolic disturbances, fetal macrosomia and respiratory distress syndrome. This study was designed to investigate the incidence of embriofetopathy in those of mothers with gestational diabetes. The incidence was highest in the group of mothers on insulin at the time of conception. Major fetal malformations of the cardiovascular and central nervous system were over-represented.

The authors have reviewed their cases of neonatal obstructive malformations of the intestinal tract and analyzed the incidence of association with indirect hyperbilirubinemia. 39 patients in four years are considered. In 23 of them there is a bilirubin level greater than 5 mg/100 ml. A great number of high bilirubin levels (greater than 15 mg/100 ml) is associated with volvulus, malrotations and intestinal atresias. Bilirubin levels between 11 and 15 mg/100 ml are often connected with meconium ileus while ano-rectal atresias have a low bilirubin level (less than 5 mg/100 ml). The reported data allow to conclude that the jaundice is an early, but unfortunately, not specific symptom of congenital intestinal obstruction. The entero-hepatic circulation seems to be an important cause of the neonatal hyperbilirubinemia.

The A.A. reports a case of cystic congenital linphangioma of the face and neck, recently observed on the Neonatal Intensive Care Unit. The therapeutic approach was very difficult and required three times a surgical menagement because of successively relapses. The control and normalization of the compressive and infective complications due to the massa and its removal were hard too. In spite of some aesthetical problems, the results may be considered satisfactory. Our case enphasizes the intrinsec, complex, therapeutical difficulties of the cystic linphangiomas.

Total ketone bodies and 3-hydroxy-3-methylglutaric acid (HMG) were determined in urines of full-term and pre-term newborns from the first day after birth to an age of 17. Significantly higher levels of the two catabolites were observed in the first two weeks of life of the pre-term newborns. A peak of excretion of both ketone bodies and HMG was found between the 7th and the 10th day after birth in both groups of newborns. After the 3rd month there is no significant difference between full-term and pre-term children as far as the excretion of the two analytes is concerned.

During a four-year period, 154 surviving preterm infants of 32 weeks gestation or less were prospectively examined by cerebral ultrasound for periventricular-intraparenchymal cystic lesions (IPCL) subsequent to ischemic and/or haemorrhagic damage. Neurological and developmental outcome was assessed with examinations at 0, 3, 6, 12, 18, 24, 36, 48 months of age corrected for prematurity. Twenty-four (15.5%) patients were found to have IPCL changes at ultrasound. In 8 cases, a porencephalic cyst subsequent to grade IV IVH (Papile's classification) was found; all had cerebral palsy and severe developmental deficit was present in 4. Diffuse bilateral PVL was found in 8 cases: 1 was not evaluable, 7 developed cerebral palsy; the developmental delay was severe in 4, moderate in 2 patients, and only 1 was normal. Four patients had localized bilateral PVL: 3 patients had mild diplegia and 1 was normal; the developmental outcome was normal only in 1 case, 1 had a severe cognitive delay, and 2 were moderate. In the remaining 4 cases, the ultrasound showed a monolateral localized PVL: 1 patient had mild diplegia and moderate cognitive delay, 3 were normal. - This study confirms the important role of the ultrasonographic diagnosis of IPCL in preterm infants to foresee later neurodevelopmental outcome. Extensive parenchymal lesions were strongly associated with major neurodevelopmental handicaps, while localized and small lesions were correlated with more favorable neurological as well as developmental prognosis.

The CT findings in 37 asphyctic newborns are presented, particularly concerning the hypodense lesions. 11 out of 27 term infants and 4 out of 10 preterm neonates had 2 or 3 serial scans, the last when they were 2-5 months old. In most of cases a long run normalization of former periventricular hypodensity has been observed, with normal clinical follow-up, 6 cases (2 preterm and 4 term neonates) had cortical hypodensity too: 2 of these revealed afterwards atrophy and hydrocephalus, 2 ventricular asymmetry and slight cortical spaces enlargement; in 1 case the cortical parietal hypodensity, formerly showed, was confirmed; 1 case finally was normal at three month scan. The relevance of the cortical hypodensity in most serious brain damage is underlined; the hypodensity of the white matter, on the contrary, could mean wether a postasphyctic lighter, reversible brain damage, or the physiologic postnatal condition, such a still unfilled myelinization.

A good correlation between the amniotic fluid surface tension and gestational age was found in 51 amniotic fluid samples from normal pregnancies. The samples were obtained between the 20th and 43rd week of gestation. A good relation also exists between amniotic fluid lecithin concentration and fluid surface tension, and between said surface tension and the foam test carried out according to Clements et al. (4).

Of 20 patients with bronchopulmonary dysplasia (BPD), 17 survived (85%) and were followed prospectively up to one year post-term. Lower respiratory tract infections occurred in 12 patients (70.5%), and in 7 (41%) at least one hospital admission was required. At one year post-term follow-up, 9 patient (52.9%) continued to present respiratory symptoms, and 5 out of 13 (38.4%) radiographic changes. Six cases (35%) presented chronic cor pulmonale. Only 6 children (35%) showed normal growth, while the others showed deficits in one or more growth parameters. Cerebral palsy occurred in 41% of the children; 3 cases of severe tetraparesis and 4 of moderately severe palsy (hemiparesis or diplegia). Developmental quotient (DQ) was less than 70 in 6 cases (35%), from 70-90 in 4 (23.5%), and greater than 90 in 7 (41%). The severe neurodevelopmental outcomes were significantly correlated with the presence of important neonatal cerebral pathology (3-4 degrees IVH or periventricular leukomalacia). Retinopathy due to prematurity was diagnosed in 7 patients (41%), and in 5 it progressed to retrolental fibroplasia. Ten cases (58.8%) showed strabism, of which 8 had previous eye background involvement. Hearing deficit was not detected in any patient. Esthetic and functional sequelae consisted of scalp eschar (3 cases), post-thoracotomy scar (1 case), pleural drainage scars (3 cases), nasal deformity due to prolonged intubation (1 case), laryngeal stenosis (1 case), and post-tracheostomy stenosis (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonography (US) has become an important method for the investigation of neonatal cerebral disorders. Its role in the diagnosis of cerebral malformations has been well illustrated in the recent literature. This report presents 16 children with midline malformations (of 78 neonates and children with cerebral abnormality diagnosed with US) who were also examined with computed tomography (CT). Among the 16 children there were 2 with lipoma of the corpus callosum, 1 neonate with aneurysm of the vein of Galen, 2 with agenesis of the corpus callosum, 1 newborn with a large cyst in the quadrigeminal plate cistern, 3 with a Dandy-Walker malformation, 5 with a posterior fossa cyst, and 2 with a Chiari II malformation. The diagnostic accuracy of ultrasonography in midline malformations and the role of computed tomography for further investigation is emphasized. CT was necessary after US mostly in hyperechogenic lesions such as lipomas and partly thrombosed aneurysms of the vein of Galen, while in the anechogenic cystic lesions US alone was satisfactory.

Mortality and long-term outcome in low birthweight infants (less than or equal to 1500 g) treated in the neonatal intensive care unit of the Department of Pediatrics of the University of Padua in 1975, 1978/79, and 1983 were analysed. Mortality rates fell from 75% in 1975 to 58% in 1978/79 and to 33% in 1983. Incidence of sequelae decreased from 1975 to 1978/79 and did not change between 1978/79 and 1983. No perinatal pathology (RDS, hyperbilirubinemia, endocranial hemorrhage) was statistically related with long-term outcome, but some associations (RDS + endocranial hemorrhage + seizures) appeared more frequently in cases which presented major neurological sequelae.