[West syndrome. Clinical, diagnostic and therapeutic aspect]

The authors review the main clinical-electro-encephalographical and therapeutic aspects of the West syndrome (infantile spasms), underlying the problems related to long-term prognosis. The authors describe its clinical variants which, sometimes, can create some difficulties for differential diagnosis. Moreover, the difference between idiopathic and secondary (to pre- and peri-natal) problems syndrome is discussed.

Fetal encephalopathy with cerebral calcifications: a case report

The authors report a case of a newborn with severe encephalopathy and cerebral calcifications. The newborn was admitted to Neonatal Intensive Care Unit in Chieti at 2 days of age suffering from continuous generalized seizures. He was the child of healthy first-degree cousins. Cerebral ultrasonography showed bilateral ventricular dilatation and an intrathlamic hyperechoic image. Computed tomography and magnetic resonance imaging showed ventricular and corpus callosus hypoplasia, pachygyria, widespread delayed myelination areas, and basal nuclei and periventricular calcifications. All serum and urine analyses showed normal results. In particular, all demyelinizing metabolic diseases were excluded. Based upon these findings, we speculate that this infant may be suffering from fetal encephalopathy with cerebral calcifications.

Anti-epileptic therapy and behaviour disturbances in children

In order to evaluate the effects on behaviour of some anti-epileptic drugs, we studied 300 children treated with phenobarbital and other drugs; their age ranged from 3.1 months to 15.9 years. The children were divided into two groups: group A: 197 (116 male and 81 female) children, mean age +/- SD 5.3 +/- 2.8 years, treated with phenobarbital; group B: 103 (66 male and 37 female) children, mean age 6.4 +/- 3.1 years, treated with anti-epileptic drugs other than phenobarbital. In all patients hyperactivity, irritability, disturbances of sleep, and drowsiness were investigated. The parents of patients completed a questionnaire with seven items. In group A, 150 (76.1%) children showed one or more behaviour disturbances, while in Group B a smaller number of patients 32 (31%) had such disorders. There was a significant difference between the two groups (P < 0.0001). The most frequent disorder was hyperactivity. The results of this study suggest that anti-epileptic drugs, in particular phenobarbital, can cause behaviour disturbances.

Coarctation of the aorta, interrupted aortic arch, and hypoplastic left heart syndrome in three generations

Five members in three generations of a family were affected by a congenital heart disease. Four of them had mild or severe coarctation of the aorta (CoA), either isolated or in association with other cardiac defects. Fetal echocardiography allowed prenatal diagnosis in one pregnancy at risk. This family suggests that a rare form of CoA could be the result of an autosomal dominant mutation with high penetrance and variable expressivity rather than polygenic inheritance.

Education, knowledge and metabolic control in children with type 1 diabetes

We studied thirty diabetic patients and we evaluated their knowledge of main topics of diabetes mellitus. The level of the knowledge was evaluated by multiple choice questionnaires. On the basis of score obtained the patients were divided into two groups: Group A, with high knowledge level, Group B, with low knowledge level. All the patients were followed-up for a 12 months period after a careful education. At the end of follow-up, we compared the Group A patients with another group of 14 diabetic children, who have followed an educational programme from the diagnosis of the disease (Group C). We assessed the knowledge score and the principal metabolic parameters in the three groups of patients; during the follow-up, we found a significant increase of these parameters in Group A and B patients, more evident in Group A patients. At the end of follow-up, the Group C patients showed a higher knowledge score and metabolic parameters than the Group A children. This study shows that education of disease is important for the increase of metabolic parameters and its usefulness is higher if is carried out from the onset of the disease.

[Usefulness and limitations of neuroradiologic tests (CT, US, MRI) in periventricular leukomalacia]

Sixteen young patients, with clinical and radiological signs of periventricular leukomalacia (PVL), were investigated with MR imaging. Twelve of them were investigated with US in the perinatal period. The extant 4 patients, older than the others, had a clinical history of PVL. US scans were capable of yielding precise information about the anatomical features of PVL in both the acute and the middle phases. The lesions appeared as hyperechoic areas which subsequently turned to anechoic cavities. MR imaging and CT scans did not present any particular advantage over US scans in the acute phase, but they did detect periventricular damage when the patient was 6-7 months old. MR imaging was superior to CT in detecting the delayed myelination of white matter. Inversion-recovery sequences gave more anatomical details to distinguish normal from abnormal white matter. Spin-echo proton-density images detected periventricular gliosis, which appeared as persistent hyperintense areas. CT might be useful in the acute phase, after US detection of hyperechoic intraparenchymal areas, for it allowed purely ischemic lesions to be distinguished from hemorrhagic ones.

[Periodontal disease and insulin-dependent diabetes. Clinical study]

The Authors present the results of a clinical study concerning 30 IDDM patients and 24 healthy subjects to evaluate periodontal disease. The results show a higher incidence of PI, PD and BTI in diabetic patients.

[Clinical study on the prevalence of dental caries in patients with juvenile diabetes mellitus]

The authors present the results of a epidemiological transversal study concerning 26 type I diabetic patients: as a control have been observed 24 healthy subjects, similar for age and sex to the diabetic patients. The results show a higher incidence of caries in diabetic patients than in the healthy subjects; this is probably due to the high carbohydrates diet of the young patients.

[Congenital hip dislocation. The clinico-echographic correlations]

The authors report their experience with US of the hip in 200 children aged 9 days to 8 months. All the children previously were under-gone physical examination. The sonographic study was carried out with Graf's method. The clinical-sonographic correlation proves the utility of US as a screening method able to show early morphological and functional alterations in the hip. US is thus suggested as a valid alternative to conventional methods to use in those cases where either plastering or surgery is required.

Evaluation of cerebral blood flow in premature newborns by duplex scanning using a high resolution probe

The evaluation of cerebral blood flow in premature newborns offers interesting information about cerebral circulation and, physiological flow variations. Using a high resolution probe as the Access 10 of the ATL ultramark 4 duplex scanner it was possible to define flow in the anterior cerebral artery and in the middle cerebral artery in newborns without significant pathology. This study was performed in premature babies both to evaluate the best technical solution to study these small arteries and to define a standard of flow to be used in future evaluations. By the 10 MHz focus (on the variable focus probe 5-7.5 and 10 MHz) it was observed that a smaller variation of flow determinations is obtained by the 10 MHz focus (both for the middle and anterior cerebral arteries). In conclusion duplex scanning offers probably the best solution to evaluate cerebral blood flow in premature newborns both in qualitative and quantitative way.

The CFC syndrome--report of the first two cases outside the United States

We report on two additional patients with the cardiofaciocutaneous (CFC) syndrome, the first to be reported outside the United States. They have several of the characteristic manifestations of this new multiple congenital anomalies/mental retardation syndrome, namely, mental retardation, growth retardation, relative macrocephaly, unusual face, abnormal hair, skin involvement, heart defect, hernias, and splenomegaly. Similar to all previously reported cases, these also were sporadic and had normal chromosomes.

[Osteoarticular tuberculosis without pulmonary involvement. Description of 2 pediatric cases]

Tuberculosis of bone and joint is becoming uncommon in childhood, overall in absence of clinical and radiologic pulmonary findings. The Authors describe two cases: the first one had typical radiologic picture of the hand localization; the second one had tibial localization. Both the children had none clinical and radiographic findings of pulmonary tuberculosis. Chemiotherapical treatment and bed rest led to complete recovery, without anatomic and functional sequelae.

[Kawasaki's syndrome: description of 4 cases]

In this study we present four cases of Kawasaki syndrome; in two of them were present some particular aspects, besides the characteristic signs of the lymphonodal-mucocutaneous syndrome. One little girl showed, during the acute phase of the disease, paralysis of facial nerve, without other signs of neurological involvement; in the second patient, the outcome of the syndrome was quite atypical, because of an osteoarticular involvement; we also observed the presence of immature white blood cells in the peripheral blood. Three of the four cases were treated with acetyl-salicylic acid for almost one year, two of them were also treated with dypiridamol. A four years follow-up, after the acute phase, demonstrated a complete recovery, a normal clinical status and no damage of the cardiocirculatory system.

[Long-term effects of neonatal medium-degree hyperbilirubinemia on brainstem evoked potentials]

Since neonatal hyperbilirubinemia (greater than 20 mg/100 ml) represents a risk factor for acoustic defects, we examined the effects of moderate hyperbilirubinemia less than 20 mg/100 ml) on the acoustic pathway maturation through the BAEPs technique. Twenty-three children who had suffered from moderate neonatal hyperbilirubinemia (5 FT, 18 PT) were tested at the end of their 1st year. No statistically significant differences were found between their response characteristics and those of a similarly aged control group. We conclude that a low-to-moderate degree of hyperbilirubinemia at birth should not be considered as a potential risk factor affecting the auditory brainstem pathways maturation and functionality.

[Observations on antibiotic sensitivity of "Pseudomonas aeruginosa" strains isolated in pediatric wards (author's transl)]

It has been studied the antibiotic sensitivity of 27 Pseudomonas aeruginosa strains belonging to only two types, isolated hospitalized children and responsible of different clinical pictures. The strains were in vitro resistant to Carbenicillin, Sisomicine, Gentamycine and many other antibiotic tested, partially resistant to Tobramycin and sensitive to Amikacine, Polimixine B and Colistatin.

[Epidemic parotitis in Italy: results of a 1st vaccination trial]

Forty children over 12 months of age were inoculated subcutaneously with live mumps vaccine (Jeryl Lynn strain) and tested before and 6 weeks after vaccination for complement fixing, (CF) and hemadsorption neutralizing (HN) serum antibodies against a wild-mumps virus strain. CF antibody titers were not reliable for assessing both the previous immunity and the vaccine response. Among the 13 HN seronegative subjects the responders to the vaccine were 7, with a seroconversion rate of 53.8% and a geometric mean titer (GMT) of 1:2.6. Twenty (74.1%) of the 27 subjects already seropositive before the vaccination had a booster effect with an increase of the GMT from 1:8.29 to 1:33.89.