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The aim of this study is to explore risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies of 205 laboratory-confirmed cases infected with SARS-CoV-2 during the Lombardy outbreak. All patients received the best supportive care and specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation and antiviral drugs, steroids, and interleukin-6 pathway inhibitors. Clinical, laboratory, and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality. Univariate analyses showed prognostic significance for age greater than 70 years, the presence of two or more relevant comorbidities, a P/F ratio less than 200 at presentation, elevated LDH (lactate dehydrogenase) and CRP (C-reactive protein) values, intermediate- or therapeutic-dose anticoagulation, hydroxychloroquine, early antiviral therapy with lopinavir/ritonavir, short courses of steroids, and tocilizumab therapy. Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (-0.37), antiviral lopinavir/ritonavir (-1.22), or steroid (-0.59) therapy. In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia. Results from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia in terms of both clinical risk factors for in-hospital mortality and the effectiveness of the different therapies proposed for the management of COVID19 disease.

Hydatidosis is a parasitic zoonosis caused by Echinococcus granulosus. It is endemic in Argentina and in the province of Buenos Aires, especially to the south of the Rio Salado basin. During 2014 and 2016, the Department of Rural Zoonoses was notified of 479 cases of hydatidosis, with 12.1% confirmed in children under 18 years of age. Fifty-nine percent corresponded to males and the group of 13 to 17 years was the most prevalent one (47%). Sixty-four percent had liver involvement, 22% pulmonary involvement, 5% hepatopulmonary involvement, 5% splenic involvement and 4% cerebral involvement. Thirtythree percent of the cases were asymptomatic. Sixty percent resided in urban areas and of these 20% did not present an epidemiological link. This is a disease of mandatory reporting and there are provincial and national programs that contemplate free actions tending to control it, but despite this, it continues to be a difficult problem to solve., (Sociedad Argentina de Pediatría.)

In biofilms, the bacterial community optimizes the strategies to sense the environment and to communicate from cell to cell. A key player in the development of a bacterial biofilm is the second messenger c-di-GMP, whose intracellular levels are modulated by the opposite activity of diguanylate cyclases and phosphodiesterases. Given the huge impact of bacterial biofilms on human health, understanding the molecular details of c-di-GMP metabolism represents a critical step in the development of novel therapeutic approaches against biofilms. In this study, we present a detailed biochemical characterization of two c-di-GMP phosphodiesterases of the HD-GYP subtype from the human pathogen Pseudomonas aeruginosa, namely PA4781 and PA4108. Upstream of the catalytic HD-GYP domain, PA4781 contains a REC domain typical of two-component systems, while PA4108 contains an uncharacterized domain of unknown function. Our findings shed light on the activity and catalytic mechanism of these phosphodiesterases. We show that both enzymes hydrolyse c-di-GMP in a two-step reaction via the linear intermediate pGpG and that they produce GMP in vitro at a surprisingly low rate. In addition, our data indicate that the non-phosphorylated REC domain of PA4781 prevents accessibility of c-di-GMP to the active site. Both PA4108 and phosphorylated PA4781 are also capable to use pGpG as an alternative substrate and to hydrolyse it into GMP; the affinity of PA4781 for pGpG is one order of magnitude higher than that for c-di-GMP. These results suggest that these enzymes may not work (primarily) as genuine phosphodiesterases. Moreover, the unexpected affinity of PA4781 for pGpG may indicate that pGpG could also act as a signal molecule in its own right, thus further widening the c-di-GMP-related signalling scenario.

Aims: In the opportunistic pathogen Pseudomonas aeruginosa, nitric oxide (NO) triggers the respiration of nitrate (denitrification), thus allowing survival in chronic infection sites as a microaerobic-anaerobic biofilm. The NO-dependent induction of denitrification is mediated by the dissimilative nitrate respiration regulator (DNR), a transcription factor forming a stable complex with heme, which is required to sense the physiological messenger (i.e., NO). The molecular details of NO sensing in DNR and, more in general, in this class of sensors are largely unknown, and a study aimed at integrating microbiology and biochemistry is needed., Results: Here we present a comprehensive study, including in vivo results and spectroscopy, kinetics, and protein engineering, that demonstrates the direct involvement of a histidine residue in heme iron coordination. Moreover, a peculiar phenomenon of ligand switching around heme iron, which hampers the identification of the second heme axial ligand, is also suggested. These results indicate that DNR is characterized by a remarkable flexibility in solution, as observed for other cAMP receptor protein/fumarate and nitrate reductase regulators (CRP-FNR) to which DNR belongs., Innovation: The present work represents one of the few studies focused on the biochemistry of NO sensing by bacterial transcriptional regulators. The data presented demonstrate that structural plasticity of DNR is crucial for the sensing activity and confers to the protein unusual heme binding properties., Conclusions: Protein flexibility and dynamics is a key structural feature essential to explain the evolutionary success and adaptability of CRP-FNR, and may represent a common strategy employed by heme-based redox sensors, which presents features deeply different from those of canonical hemeproteins.

Nitrite, previously considered physiologically irrelevant and a simple end product of endogenous nitric oxide (NO) metabolism, is now envisaged as a reservoir of NO to be activated in response to oxygen (O(2)) depletion. In the first part of this review, we summarize and compare the mechanisms of nitrite-dependent production of NO in selected bacteria and in eukaryotes. Bacterial nitrite reductases, which are copper or heme-containing enzymes, play an important role in the adaptation of pathogens to O(2) limitation and enable microrganisms to survive in the human body. In mammals, reduction of nitrite to NO under hypoxic conditions is carried out in tissues and blood by an array of metalloproteins, including heme-containing proteins and molybdenum enzymes. In humans, tissues play a more important role in nitrite reduction, not only because most tissues produce more NO than blood, but also because deoxyhemoglobin efficiently scavenges NO in blood. In the second part of the review, we outline the significance of nitrite in human health and disease and describe the recent advances and pitfalls of nitrite-based therapy, with special attention to its application in cardiovascular disorders, inflammation, and anti-bacterial defence. It can be concluded that nitrite (as well as nitrate-rich diet for long-term applications) may hold promise as therapeutic agent in vascular dysfunction and ischemic injury, as well as an effective compound able to promote angiogenesis.

Cytochrome cd1 nitrite reductase is a haem-containing enzyme responsible for the reduction of nitrite into NO, a key step in the anaerobic respiratory process of denitrification. The active site of cytochrome cd1 contains the unique d1 haem cofactor, from which NO must be released. In general, reduced haems bind NO tightly relative to oxidized haems. In the present paper, we present experimental evidence that the reduced d1 haem of cytochrome cd1 from Paracoccus pantotrophus releases NO rapidly (k=65-200 s(-1)); this result suggests that NO release is the rate-limiting step of the catalytic cycle (turnover number=72 s(-1)). We also demonstrate, using a complex of the d1 haem and apomyoglobin, that the rapid dissociation of NO is largely controlled by the d1 haem cofactor itself. We present a reaction mechanism proposed to be applicable to all cytochromes cd1 and conclude that the d1 haem has evolved to have low affinity for NO, as compared with other ferrous haems.

In response to environmental conditions, NO (nitric oxide) induces global changes in the cellular metabolism of Pseudomonas aeruginosa, which are strictly related to pathogenesis. In particular, at low oxygen tensions and in the presence of NO the denitrification alternative respiration is activated by a key regulator: DNR (dissimilative nitrate respiration regulator). DNR belongs to the CRP (cAMP receptor protein)-FNR (fumarate and nitrate reductase regulatory protein) superfamily of bacterial transcription factors. These regulators are involved in many different pathways and distinct activation mechanism seems to be operative in several cases. Recent results indicate that DNR is a haem protein capable of discriminating between NO and CO (carbon monoxide). On the basis of the available structural data, a suggested activation mechanism is discussed.

The cd1 NiRs (nitrite reductases) are enzymes catalysing the reduction of nitrite to NO (nitric oxide) in the bacterial energy conversion denitrification process. These enzymes contain two distinct redox centres: one covalently bound c-haem, which is reduced by external electron donors, and another peculiar porphyrin, the d1-haem (3,8-dioxo-17-acrylate-porphyrindione), where nitrite is reduced to NO. In the present paper, we summarize the most recent results on the mechanism of nitrite reduction by the cd1 NiR from Pseudomonas aeruginosa. We discuss the essential catalytic features of this enzyme, with special attention to the allosteric regulation of the enzyme's activity and to the mechanism employed to avoid product inhibition, i.e. trapping of the active-site reduced haem by the product NO. These results shed light on the reactivity of cd1 NiRs and assign a central role to the unique d1-haem, present only in this class of enzymes.

In all, 1,702 unselected pregnant women from the city of La Plata were tested for gestational diabetes mellitus (GDM) and evaluated to determine GDM prevalence and risk factors. In women with GDM, we evaluated compliance with guidelines for GDM management, and perinatal complications attributable to GDM. GDM prevalence was 5.8%, and its risk factors were pre-gestational obesity, previous hyperglycaemia, age > 30 years, previous GDM (and its surrogate markers). In primi-gravida (PG) subjects, GDM was equally prevalent in the presence (4.2%) or absence (4.0%) of risk factors. In multi-gravida (MG) women, although risk factors doubled the prevalence of GDM (8.6%), in the absence of risk factors GDM prevalence was similar to that of PG women (3.9%). Half of all women with GDM received inadequate post-diagnosis obstetric control, and this induced a fourfold increase in infant perinatal complications. In conclusion, all non-hyperglycaemic 24-28-week pregnant women should be tested for GDM, although particular attention must be paid to MG women with risk factors.

The opportunistic pathogen Pseudomonas aeruginosa can grow in low oxygen, because it is capable of anaerobic respiration using nitrate as a terminal electron acceptor (denitrification). An intermediate of the denitrification pathway is nitric oxide, a compound that may become cytotoxic at high concentration. The intracellular levels of nitric oxide are tightly controlled by regulating the expression of the enzymes responsible for its synthesis and degradation (nitrite and nitric oxide reductases). In this article, we present the crystallographic structure of the wild-type dissimilative nitrate respiration regulator (DNR), a master regulator controlling expression of the denitrification machinery and a putative target for new therapeutic strategies. Comparison with other structures among the CRP-FNR class of regulators reveals that DNR has crystallized in a conformation that has never been observed before. In particular, the sensing domain of DNR has undergone a rotation of more than 50 degrees with respect to the other structures. This suggests that DNR may undergo an unexpected and very large conformational rearrangement on activation.

Pseudomonas aeruginosa is a well-known pathogen in chronic respiratory diseases such as cystic fibrosis. Infectivity of P. aeruginosa is related to the ability to grow under oxygen-limited conditions using the anaerobic metabolism of denitrification, in which nitrate is reduced to dinitrogen via nitric oxide (NO). Denitrification is activated by a cascade of redox-sensitive transcription factors, among which is the DNR regulator, sensitive to nitrogen oxides. To gain further insight into the mechanism of NO-sensing by DNR, we have developed an Escherichia coli-based reporter system to investigate different aspects of DNR activity. In E. coli DNR responds to NO, as shown by its ability to transactivate the P. aeruginosa norCB promoter. The direct binding of DNR to the target DNA is required, since mutations in the helix-turn-helix domain of DNR and specific nucleotide substitutions in the consensus sequence of the norCB promoter abolish the transcriptional activity. Using an E. coli strain deficient in haem biosynthesis, we have also confirmed that haem is required in vivo for the NO-dependent DNR activity, in agreement with the property of DNR to bind haem in vitro. Finally, we have shown, we believe for the first time, that DNR is able to discriminate in vivo between different diatomic signal molecules, NO and CO, both ligands of the reduced haem iron in vitro, suggesting that DNR responds specifically to NO.

In eukaryotes, small amounts of nitrite confer cytoprotection against ischemia/reperfusion-related tissue damage in vivo, possibly via reduction to nitric oxide (NO) and inhibition of mitochondrial function. Several hemeproteins are involved in this protective mechanism, starting with deoxyhemoglobin, which is capable of reducing nitrite. In facultative aerobic bacteria, such as Pseudomonas aeruginosa, nitrite is reduced to NO by specialized heme-containing enzymes called cd(1) nitrite reductases. The details of their catalytic mechanism are summarized below, together with a hypothesis on the biological role of the unusual d(1)-heme, which, in the reduced state, shows unique properties (very high affinity for nitrite and exceptionally fast dissociation of NO). Our results support the idea that the nitrite-based reactions of contemporary eukaryotes are a vestige of earlier bacterial biochemical pathways. The evidence that nitrite reductase activities of enzymes with different cellular roles and biochemical features still exist today highlights the importance of nitrite in cellular homeostasis.

The cytochrome cd(1) nitrite reductases are enzymes that catalyse the reduction of nitrite to nitric oxide (NO) in the bacterial energy conversion denitrification process. These enzymes contain two different redox centres: one covalently bound c-haem, which is reduced by external donors, and one peculiar d(1)-haem, where catalysis occurs. In the present paper, we summarize the current understanding of the reaction of nitrite reduction in the light of the most recent results on the enzyme from Pseudomonas aeruginosa and discuss the differences between enzymes from different organisms. We have evidence that release of NO from the ferrous d(1)-haem occurs rapidly enough to be fully compatible with the turnover, in contrast with previous hypotheses, and that the substrate nitrite is able to displace NO from the d(1)-haem iron. These results shed light on the mechanistic details of the activity of cd(1) nitrite reductases and on the biological role of the d(1)-haem, whose presence in this class of enzymes has to date been unexplained.

Cardiac papillary fibroelastoma is a rare benign tumor which involves the heart valves and may cause thromboembolism or mechanical interference with valvular function. The case is presented of an asymptomatic, 22-year-old man in whom a fibroelastoma was localized on the ventricular aspect of the right coronary leaflet of the aortic valve. The tumor was identified during transthoracic echocardiography performed to monitor a mitral valve prolapse that had occurred at the age of 16 years. The patient underwent surgical intervention by means of a minimally invasive thoracotomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Due to the high incidence of embolism, the tumor must be surgically removed immediately a diagnosis is confirmed. A minimal surgical approach appears to be safe and allows good exposure of the lesion.

Aim: The incidence of anastomotic fistula after colorectal surgery did not significantly change in the literature during the last years, despite the advances in the treatment with the use of surgical staplers. Taking into account this and other considerations, the authors present their recent experience in the surgical treatment of colorectal carcinoma, referring in particular to anastomotic fistula, related postoperative mortality and results of consequent reoperations., Methods: From January 1, 2002 to December 31, 2005, 448 patients affected with colorectal cancer were operated on at the Surgical Department of Valduce Hospital in Como, and in 373 cases an anastomosis was performed, subdivided as follows: 144 ileocolic (38.6%), 10 ileorectal (2.7%), 219 colocolic or colorectal (58.7%)., Results: Twenty-five out of 373 anastomotic leaks developed (6.7%). In 9 cases (36%), the fistulas spontaneously closed with conservative treatment, while in 16 (64%) reoperation was necessary. With reference to the anatomical site, the leak occurred in 9 out of 144 patients submitted to right hemicolectomy (6.3%), in 14 out of 219 patients after left hemicolectomy or anterior resection of the rectum (6.4%) and in 2 out of 10 patients (20%) after total colectomy. The following is a detailed report of the therapeutic choices adopted by the authors. Four out of 16 reoperated patients (25%) died postoperatively from infective complications related to the fistula, while the total postoperative mortality was 2.2% (10/448). Therefore, anastomotic dehiscence was responsible for 40% of all postoperative deaths., Conclusions: Among all the different operative choices, the authors give their preference to the direct suture of the fistula and loop ileostomy, which they consider the best available choice. The subsequent operation of ileostomy closure is easier for the surgeon to perform and for the patient to withstand than colostomy closure, particularly after Hartmann's operation.

Starting in January 1995, we performed heart transplantation, randomly using standard and bicaval techniques. In the latter technique, the anatomy of the right atrium is maintained, since the venae cavae are anastomosed. In 38 patients who received heart transplantation with bicaval anastomosis, 339 endomyocardial biopsies (EMB) were performed. EMB was done under echocardiographic control in 309 cases, whereas the remaining 30 were done under fluoroscopy. When EMB was echo-guided there was one major complication, namely right hemothorax in a 29-year-old man, who had had heart transplantation one week before, and this required surgical exploration. Other complications, correlated to venipuncture were: left hemothorax in a 65-year-old woman determined by arterial puncture, treated by means of chest tube drainage; pneumothorax (1 case). Echocardiographic guidance during EMB allows a better choice of biopsy site, reduces the risk of damaging cardiac structures and allows immediate monitoring of heart performance. Moreover the risk of X-ray exposure to both patient and operators is reduced. In any case, because the superior vena cava suture line is not visualized by two-dimensional echocardiography, if the bioptome cannot be introduced easily through superior vena cava, fluoroscopic control should be immediately applied, particularly in the early post-operative period when cicatrization is not complete.

Background: The age of recipient has been thought for several years to be one of the most important predictors of survival after heart transplantation. Therefore patients older than age 50 years were usually excluded from heart transplantation. The marked improvement in survival after clinical introduction of cyclosporine made a critical revision of selection criteria for heart recipients. In this article we retrospectively analyze the outcome of heart transplantation dividing the patients into two groups: Group A < or = 55 years, Group B > 55 years respectively., Methods: We analyzed 437 patients who underwent heart transplantation, immunosuppressive protocol for all the patients was cyclosporine, azathioprine and prednisone. Group A included 284 patients, Group B 153 patients. We studied demographic, clinical and haemodynamic data pre- and post-operatory in both groups., Results: In Group A was more frequent dilated cardiomyopathy (p < 0.01) and the patients arrived at heart transplantation in worse haemodynamic conditions requiring more frequently inotropic infusion and/or mechanical support (intraaortic balloon pump, left ventricular assist device). Post-operatory course was more complicated in Group B patients where ischemic cardiomyopathy was more frequent (p < 0.001); intensive care stay, inotropic drugs infusion, mechanical ventilation and hospital mortality were higher in Group B, although non significantly. The donor age was significantly higher in Group B (p < 0.001), anyway the statistical analysis did not show a correlation between donor age and more complicated post-operative course. Follow-up did not show significative differences in the two groups considering haemodynamic data, metabolic disorders, graft coronary disease, infection and rejection rates. On Group B is significantly higher tumor incidence (p < 0.05) and peripheral vascular complications (p < 0.01). Actuarial survival at 5 and 7 years is respectively in Group A 80.3 and 72.9%, in Group B 75.4 and 71% (p = ns)., Conclusions: Heart transplantation in patients older than 55 years with end-stage heart disease is a valid therapeutic option with excellent long-term survival; pre-operative screening must be particularly accurate and older donors should be considered.

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.

The Authors report a case of multiple benign pulmonary leiomyomatosis, recently observed. They offer a short description of the clinical, anatomo-pathological and therapeutical features of this extremely rare condition.

Since their introduction in clinical practice, antigliadin antibodies (AGA) have simplified the diagnostic iter of coeliac disease. In addition they have allowed us to recognize an even high number of new cases and also to identify new clinical forms. While AGA are widely used in the diagnostic phase, their determination during follow-up of the disease has been always limited. With the present work we observe the behaviour of AGA during the various phases of coeliac disease. The study was carried out on 288 coeliac children divided as follows: 96 at diagnosis, 136 on gluten-free-diet (75 diet adherent and 61 non adherent) and 56 on gluten-challenge. 145 healthy children were also studied as a control group. In all children AGA (IgA and IgG) were determined, with a micro-ELISA method, every two months in the children on gluten-free-diet and monthly in the children on gluten-challenge. Data obtained showed AGA behaviour strictly related to the diet. In fact while children with good compliance to the diet had AGA normalization within the 2nd and 6th month, respectively for IgA and IgG, children with poor adherence to diet had constantly positive AGA. Noteworthy was the AGA behaviour during challenge. Gluten introduction determined a rapid increase of IgA and a slow increase of IgG. Our results confirm the usefulness of AGA determination during the follow-up of coeliac children giving us the possibility to avoid one or more biopsies included in the ESPGAN protocol.

Recent antigliadin antibody (AGA) determination has become an important diagnostic tool in coeliac disease (CD). Although this test has high sensibility for the disease, it is less specific, especially for IgG class, because of its having been found in some acute and chronic common intestinal childhood diseases. We studied the behaviour of AGA, IgA and IgG, in 234 children affected by various gastrointestinal diseases, comparing the results with those obtained in 125 coeliac children and 788 normal children. The intestinal diseases were as follows: irritable bowel syndrome, cow's milk protein intolerance, acute infectious diarrhoea, parasitosis, lactase deficiency, recurrent abdominal pain, cystic fibrosis, chronic constipation, gastroesophageal reflux, intestinal lymphangiectasia, chronic intractable diarrhoea and nodular lymphoid hyperplasia. Our results showed that while AGA-IgA were absent in all children studied, with the exception of 3 cases of acute diarrhoea, a moderate percentage of AGA-IgG was observed in subjects with cow's milk protein intolerance, acute diarrhoea, irritable bowel syndrome, lactase deficiency, chronic intractable diarrhoea and in a low percentage of children with parasitosis, intestinal lymphangiectasia and nodular lymphoid hyperplasia. There was no antibody movement in subjects with cystic fibrosis, gastroesophageal reflux, recurrent abdominal pains and chronic constipation. The different behaviour of the two antibody classes could be explained by the fact that AGA-IgG were detected in diseases where scattered areas of mucosal damage could allow the permeability of the macromolecules inducing passage of gliadin through the mucosal barrier and immune system-induced antibody stimulation.

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.

Results of a multicentric controlled trial on the efficacy of somatostatin in the treatment of severe gastrointestinal bleeding from peptic origin is reported. The trial was carried out on 90 patients presenting with severe bleeding from hemorrhagic gastric disease in 20 cases, from gastric ulcer in 31 and from duodenal ulcer in 39. Diagnosis was ascertained by endoscopy. Fifty-three patients were treated with somatostatin; in 95% of cases the bleeding was controlled in an average time of 7h 37'. Thirty-seven patients were treated with H2 receptors antagonists and the bleeding was controlled in 76.3% of cases in an average time of 21h. Cases treated with somatostatin required a lower amount of blood transfusion (1 Unit/patient, against 2.7 Units). The better efficacy of somatostatin, at least on a temporary basis, in the control of severe upper gastrointestinal bleeding is underlined while keeping in mind that prevention of recurrence is still an open question.

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.

The authors report a case of vascular leiomyosarcoma of the superficial soft tissues, and point out its epidemiologic (rareness of the report), biologic (high degree of malignancy, trend to local relapse and remote conversion into metastases), histopathologic aspects. They consider significant as to prognostic value the appraisal of the "mitotic index" and the opportunity of a radical intervention, followed by radiotherapy. They, moreover, think it useful, in consideration of the frequency of the relapses, to perform a periodic checking of the patient.