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Background : Recent data suggest that the use of extensively hydrolyzed casein formula containing the probiotic L.rhamnosus GG (LGG) (EHCF+LGG) reduces the incidence of other AMs and hastens the development of immune tolerance in children with IgE- mediated cow ' s milk allergy (CMA). To see whether formula choice for CMA treatment could impact the occurrence of other AMs and the time of immune tolerance acquisition. Method : Prospective open non- randomized trial on a cohort of children with a diagnosis of IgE- mediated CMA in the first year of life, already in follow- up. The patients were treated with one of the following formulas: EHCF+LGG, rice hydrolyzed formula (RHF), soy formula (SF), extensively hydrolyzed whey formula (EHWF) or amino- acid based formula (AAF). All subjects were evaluated during a 36 months follow- up. The occurence of AMs (atopic eczema, allergic urticaria, asthma and oculorhinitis) was diagnosed Immune tolerance acquisition was evaluated every 12 month by the result of oral food challenge. Results : A total of 365 subjects completed the study, 73 per group. All children were from families of middle socio- economic status and lived in urban areas. At enrollment, all subjects were in stable clinical conditions without symptoms related to CMA. Demographic and anamnestic features were similar comparing the study cohorts at enrolment. Binomial regression revealed that the estimates of the incidence of the AMs are: EHCF+LGG: 0.22 (Bonferroni corrected 95%CI: 0.09 to 0.34); RHF: 0.52 (Bonferroni corrected 95%CI: 0.37 to 0.67); SF: 0.58 (Bonferroni corrected 95%CI: 0.43 to 0.72); EHWF : 0.51 (Bonferroni corrected 95%CI: 0.36 to 0.66); AAF: 0.77 (Bonferroni corrected 95%CI: 0.64 to 0.89). The incidence of the main outcome in the RHF, SF, EHWF and AAF groups vs the EHCF+LGG group was always higher than the pre- specified absolute difference of 0.25 and significantly higher at the pre- specified alphalevel of 0.0125 ( P - value

To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition.In a 36-month prospective cohort study, the occurrence of other atopic manifestations (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E-mediated children with cow's milk allergy (CMA) treated with extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG (EHCF + LGG), rice hydrolyzed formula, soy formula, extensively hydrolyzed whey formula (EHWF), or amino acid-based formula.In total, 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of atopic manifestations was 0.22 (Bonferroni-corrected 95% CI 0.09-0.34) in the EHCF + LGG cohort; 0.52 (0.37-0.67) in the rice hydrolyzed formula cohort; 0.58 (0.43-0.72) in the soy formula cohort; 0.51 (0.36-0.66) in the EHWF cohort; and 0.77 (0.64-0.89) in the amino acid-based formula cohort. The incidence of atopic manifestations in the rice hydrolyzed formula, soy formula, EHWF, and amino acid-based formula cohorts vs the EHCF + LGG cohort was always greater than the prespecified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46-3.86, P .001) for rice hydrolyzed formula vs EHCF + LGG; 2.62 (1.63-4.22, P .001) for soy formula vs EHCF + LGG; 2.31 (1.42-3.77, P .001) for EHWF vs EHCF + LGG; and 3.50 (2.23-5.49, P .001) for amino acid-based formula vs EHCF + LGG. The 36-month immune tolerance acquisition rate was greater in the EHCF + LGG cohort.The use of EHCF + LGG for CMA treatment is associated with lower incidence of atopic manifestations and greater rate of immune tolerance acquisition.

Highlights • Hypothermic cardiopolmunary bypass is safe for prolonged total vascular exclusion. • Ante situm liver resection is feasible for hepatoblastoma considered unresectable. • Inferior vena cava replacement with aortic graft from cadaveric donor is feasible. • Preoperative and intraoperative assessment are essential to achieve good outcome., Introduction Hepatoblastoma with tumour thrombi extending into inferior-vena-cava and right atrium are often unresectable with an extremely poor prognosis. The surgical approach is technically challenging and might require major liver resection with vascular reconstruction and extracorporeal circulation. However, which is the best surgical technique is yet unclear. Presentation of case A 11-months-old boy was referred for a right hepatic lobe mass(90 × 78 mm) suspicious of hepatoblastoma with tumoral thrombi extending into the inferior-vena-cava and the right atrium, bilateral lung lesions and serum alpha-fetoprotein level of 50.795 IU/mL. After 8 months of chemotherapy (SIOPEL 2004-high-risk-Protocol), the lung lesions were no longer clearly visible and the hepatoblastoma size decreased to 61 × 64 mm. Thus, ante situm liver resection was planned: after hepatic parenchymal transection, hypothermic cardiopulmonary bypass was started and en bloc resection of the extended-right hepatic lobe, the retro/suprahepatic cava and the tumoral trombi was performed with concomitant cold perfusion of the remnant liver. The inferior-vena-cava was replaced with an aortic graft from a blood-group compatible cadaveric donor. The post-operative course was uneventful and after 8 months of follow-up the child has normal liver function and an alpha-fetoprotein level and is free of disease recurrence with patent vascular graft. Conclusions We report for the first time a case of ante situ liver resection and inferior-vena-cava replacement associated with hypothermic cardiopulmonary bypass in a child with hepatoblastoma. Herein, we extensively review the literature for hepatoblastoma with thumoral thrombi and we describe the technical aspects of ante situm approach, which is a realistic option in otherwise unresectable hepatoblastoma.

Intolerance to carbohydrates is relatively common in childhood, but still poorly recognized and managed. Over recent years it has come to the forefront because of progresses in our knowledge on the mechanisms and treatment of these conditions. Children with intolerance to carbohydrates often present with unexplained signs and symptoms. Here, we examine the most up-to-date research on these intolerances, discuss controversies relating to the diagnostic approach, including the role of molecular analysis, and provide new insights into modern management in the pediatric age, including the most recent evidence for correct dietary treatment.