[Intracranial hemorrhage in congenital factor II deficiency]

A case of congenital defect of factor II is reported. It concerns a newborn with a not traumatic haematoma due to congenital hypoprothrombinaemia, which is rarely described in scientific literature.

[Intracranial hemorrhage in Schoenlein-Henoch syndrome]

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.

[Clinical-instrumental dissociation in a case of Reye's syndrome]

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.

[Acute psychosis and vigabatrin in childhood]

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.

[The use of spacer devices as an innovative approach in the treatment of asthma]

In recent years the therapy of childhood asthma has progressively improved; in fact we passed from the exclusive use of oral or parenteral therapy to the prevalent use of aerosol-therapy. The aerosol therapeutic use can be carry out by traditional inhalation devices or by spacer devices (or simply spacers). The spacers have a low price and they allow a better effectiveness of the therapy for the good diffusibility of the drugs. Besides the children usually show a good compliance with this method. We studied the different effectiveness of a beta 2-stimulant drug given by traditional aerosol or by spacer devices. Our data seem to encourage the use of spacers in childhood asthma for the real better effectiveness and for the reduced rate and severity of systemic effects of inhaled drugs.

A case of intussusception and lymphoid hyperplasia in a patient with AIDS

Idiopathic intussusception in adults is rare. In tropical climates, enteric infection is causally implicated. Three cases of intussusception in AIDS patients have been reported, two of which were associated with enteric infection. We report the fourth case of ileocolonic intussusception in an AIDS patient in whom lymphoid hyperplasia of the terminal ileum was found but no infection documented. The relationship between lymphoid hyperplasia and intussusception is discussed. The previous cases of AIDS and intussusception are reviewed. Idiopathic intussusception may become more prevalent as the number of AIDS cases increases, and must be considered in the differential diagnosis of abdominal pain in AIDS patients.

A comparison of nimesulide and paracetamol in the treatment of fever due to inflammatory diseases of the upper respiratory tract in children

The efficacy and tolerability of nimesulide were compared with those of paracetamol in a nonblind randomised study that recruited 110 children (64 males, 46 females; aged 3 to 6 years) with inflammation of the upper respiratory tract and fever. Nimesulide suspension (1.5 mg/kg 3 times daily) or paracetamol syrup (10 mg/kg 4 times daily) were administered orally until fever resolved. Body temperature was recorded and local pain and general discomfort assessed. Three patients treated with nimesulide and 6 patients treated with paracetamol withdrew from the study as a result of adverse events, and 1 paracetamol-treated patient discontinued because of a requirement for therapy with steroids. Nimesulide was as effective as paracetamol in reducing fever, local pain, and general discomfort. Nimesulide therefore appears to be at least as effective as paracetamol in terms of antipyretic and anti-inflammatory activity in children with inflammation of the upper respiratory tract and fever.

Multiple promoter elements govern expression of the human ornithine decarboxylase gene in colon carcinoma cells

Overexpression of the ornithine decarboxylase (ODC) gene may be important to the development and maintenance of colonic neoplasms, as well as tumors in general. In this study, we examined the promoter elements governing constitutive expression of the human ODC gene in HCT 116 human colon carcinoma cells and, for comparison, K562 human erythro-leukemia cells. It was determined by functional analysis that the promoter elements responsible reside within the 378 bp immediately upstream from the transcription start site. Within this sequence, there are at least three regions that modulate the efficiency of the ODC promoter cooperatively. Both DNA bandshift and footprint assays demonstrated all three regions to be rich in sites that bind to nuclear proteins isolated from HCT 116 and K562 cells; the protein binding pattern of non-transformed, diploid fibroblasts was found to be much less complex. Several of the protein binding sequences have little or no homology to common regulatory elements. We suggest that the constitutive activity of the ODC gene in HCT 116 colon carcinoma cells, and perhaps transformed cells in general, involves a complex interaction of multiple regulatory sequences and their associated nuclear proteins. Finally, the saturation of the promoter in these transformed cell lines suggests that high levels of protein binding in the ODC promoter may contribute to elevated constitutive expression of this gene.

[Otitis media in childhood: a critical review of the literature]

Infection of the middle ear is one of the most common childhood illnesses accounting for one-third of the pediatrics practice during the first five years of life. Therefore treatment and prevention of the otitis media are of considerable importance. A review of the literature of the otitis media during the pediatric age is reported. In fact in the last years a large amount of knowledge, sometimes referring discordant opinions, has been acquired. The Authors report epidemiology, anatomy, pathology, physiology, microbiology, classification, clinical data diagnosis and therapy of the otitis media. Common conditions of the middle ear (normal, acute otitis media, chronic otitis media, recurrent otitis media) are described. In particular acute otitis media, otitis media with effusion, perforation of the tympanic membrane, fluid level in the middle ear, severe retraction or bulging of the tympanic membrane are pointed out in color-photographs.

[The catarrhal child]

The first seven years of a child's development are often described as the catarrhal stage. This is because of the increased incidence of upper respiratory tract infections. Nasal obstruction in the children is common and symptoms are often distressing. The authors report a rational approach to this problem to produce effective treatment of recurrent nasal obstruction. In particular clinical features, diagnosis, and therapy of recurrent rhinitis, adenoid hypertrophy, and tonsillar obstruction are described. The indications for adenoidectomy, tonsillectomy or adenotonsillectomy has been questioned.

[Computerized prototype of a screening test for the assessment of psychomotor development in childhood]

The aim of Denver's screening test is to study the psychomotor development of normal or supposed normal children aged from 0 to 6 years and to suggest further investigation when an abnormal development is noticed. The test is divided into 4 sections: social behavior, fine motility, language, gross motility. The results are valid only if the test is done in a standardized manner. The aim of this paper is to describe the computerized prototype of the Denver test in use at the Divisional Pediatric Ambulatory of "A. Gemelli" University Policlinic in Rome. This test is used in the context of an automatized ambulatory management system called ARPIA, capable of interacting and guiding "non expert" user. The program performs the following functions: 1) General instructions for the execution and interpretation of the test. The original instructions of the test (1975 version) have been used. 2) Input, modification, exclusion of questions. The archive is organized in the following manner: questions are divided in the above four sections, according to the child, undergoing the test, age limit; the questions regarding information that can be asked directly to the parents or the display of a picture that better explains the test are marked. During the test the questions may be modified using a menu with a certain number of options to facilitate the use of the system. The questions to eliminate from the test may be appropriately marked and removed. The text is not physically deleted from the archive. The inverse operation of inclusion of a formerly removed question may be performed too.(ABSTRACT TRUNCATED AT 250 WORDS)

[Implementation of a computerized pharmacological database for pediatric use]

The authors present a pharmacological database to support teaching and care activity carried out in the Divisional Paediatric Ambulatory of the Catholic University of Rome. This database is included in a integrated system, ARPIA (Ambulatory and Research in Pediatric by Information Assistance), devoted to manage ambulatory paediatric data. ARPIA has been implemented by using a relational DBMS, very cheap and highly diffused on personal computers. The database specifies: active ingredient and code number related to it, clinical uses, doses, contra-indications and precautions, adverse effects, besides the possible wrapping available on the market. All this is showed on a single for that appears on the screen and allows a fast reading of the most important elements characterizing every drug. The search of the included drugs can be made on the basis of three different detailed lists: active ingredient, proprietary preparation and clinical use. It is, besides, possible to have a complete report about the drugs requested by the user. This system allows the user, without modifying the program, to interact with the included data modifying each element of the form. In the system there is also a fast consultation handbook containing for every active ingredient, the complete list of italian proprietary medicines. This system aims to give a better knowledge of the most commonly used drugs, not only limited to the paediatrician but also to the ambulatory health staff; an improvement of the therapy furthering, a more effective use of several pharmacological agents and first of all a training device not only to specialists but also to students.

[Evaluation of the locomotor system during pediatric health examinations and elements of kinesitherapy]

The pediatrician, being a primary health care physician, has the task of bringing the small patient and his parents to the resolution of all those problems which are erroneously referred to a subspecialist. With this in mind, the authors believe that even common orthopedic problems must be evaluated by the pediatrician. He would decide if and when to refer the child to an orthopedic specialist. Certain problems such as congenital hip dysplasia or scoliosis require specific treatment, whereas others (tibial bowing, genu varum-valgum, flatfoot, metatarsus varus) resolve themselves over time. The authors therefore emphasize the role of the pediatrician in preventing any iatrogenic pathology due to inappropriate treatment.

SIR88 – a direct-methods program for the automatic solution of crystal structures

SIR88 is an integrated package of computer programs for the solution of crystal structures. The package is based on the estimation of one- and two-phase structure seminvariants and three- and four-phase structure invariants according to the theory of representations [Giacovazzo (1977). Acta Cryst. A33, 933–944; (1980). Acta Cryst. A36, 362–372]. The program works in all the space groups and in most cases it is able to provide the correct solution without user intervention. Some prior information like the availability of a partial structure or of pseudotranslational symmetry is easily exploited to obtain the structure solution.

[Correlations between blood pressure values, familial hypertension and anthropometric parameters in a sample of 3-year-old children]

Nowadays evaluation of blood pressure in children is almost routine. In fact hypertension in adults may be preceded by high blood pressure values in childhood. In this study the authors examined systolic blood pressure (SBP) and diastolic blood pressure (DBP), height, weight, ponderosity index and family history of hypertension, in 261 3-year-old children, 139 boys and 122 girls. Average values of SBP were slightly but not significantly higher in males. Coefficients of linear regression and correlation for any pair of the different parameters (SBP-DBP and weight, SBP-DBP and height, SBP-DPB and ponderosity index) were all significantly positive for males, but not for females. The most significant value (r = 0.43) was in the correlation DBP-weight. In studying the family history of hypertension all children were divided into three groups: negative (F.I.-), positive with brothers and/or parents affected (F.I. I+) and positive with other relatives affected (F.I. II+). Average SBP and DPB in the second group were higher than in the third, and much higher than in the first group. These results suggest the importance of prevention in early childhood with alimentary education and serial blood pressure measurements. The individuation of borderline values is also very important.

The effect of alkaline earth cations and of ionic strength on the dissociation of earthworm hemoglobin at alkaline pH

1. The effect of alkaline earth cations on the dissociation of the extracellular hemoglobin of Lumbricus terrestris and the effect of ionic strength on the dissociation of the hemoglobins of L. terrestris and Tubifex tubifex at concentrations of ca 2.5 mg/ml, over the pH range 9.0-10.5 was investigated using ultracentrifugation to separate the dissociated from the undissociated molecules. 2. Mg(II), Ca(II) and Sr(II) at concentrations of up to 0.2 M, decreased the dissociation of Lumbricus oxyhemoglobin from 70% at pH 9.0 and 100% at pH 9.5 and higher, to 20-30% at 0.05 M. The three cations were equally effective in decreasing the extent of dissociation of L. terrestris oxyhemoglobin over the pH range 9.0-10.5, with a K1/2 of ca 10 mM. 3. The dissociation of L. terrestris oxyhemoglobin over the pH range 9.0-10.5 was decreased only to 50-60% in the presence of up to 0.5 M NaCl or KCl; there was no further decrease in dissociation at concentrations of the two salts up to 1.5 M. 4. The dissociation of T. tubifex oxyhemoglobin over the pH range 9.0-10.0 was decreased from 100% to ca 40-50% in the presence of 0.5 M NaCl or KCl with little or no change at higher concentrations. At pH 10.5 and 11.0 the decrease in dissociation was more gradual, reaching ca 50% at 1.5 M NaCl.

Allergy indices based on allergen dose-response curve in a randomly selected sample of schoolchildren

Skin-test sensitivity was computed in 61 schoolchildren drawn from a stratified random sample in order to generate two allergy indices based on a quantitative skin-test assay: Individual Allergy Index (IAI) and Population Allergy Index (PAI). The former to quantitate IgE-mediated skin test sensitivity of each subject, the latter to describe the degree of skin reactivity of our sample to a single allergen. Five allergen extracts were tested at 4-fold dilutions. Sensitivity endpoint data were used to generate IAI. Frequency distribution of IAI seemed to be bimodal as asymptomatic subjects gathered at the lower part while symptomatic children showed a peak in the middle. By means of criteria based on the relation between IAI and the prevalence of symptoms we were able to classify atopy in five classes from normal (all asymptomatic subjects) to severe atopy (all symptomatic subjects). Each positive reaction was plotted as a function of the allergen concentration eliciting the weal, and linear regression with confidence limits was calculated for grass and Dermatophagoides pteronyssinus only. PAI was represented by the slope, which depends on the reactivity of the sample, and the intercept, which involves the potency of the allergen as well. Grass and D. pteronyssinus showed the same slope while the intercepts differed. The slope increased if we considered symptomatic subjects only. We propose both these indices for clinical and epidemiological studies.

Effect of two doses of inhaled diltiazem on exercise-induced asthma

Seven asthmatic children with moderately to severely increased bronchial responsiveness to methacholine took part in a double-blind placebo-controlled study to assess the effect of a calcium channel blocker, diltiazem, on exercise-induced asthma (EIA), and its duration. On the control day, bronchial response to exercise was found to be highly reproducible when performed 2 h apart (intraclass correlation coefficient 0.92). Normal saline and diltiazem at concentrations of 1.75 and 3.50 mg/ml (estimated nebulized doses 5 and 10 mg, respectively) were given in random order before exercise on a bicycle ergometer. Exercise challenge was performed 20 min and 2 h after each treatment, and bronchial response was expressed as percent fall in the forced expiratory volume in 1 s. In the overall group, diltiazem did not significantly change resting bronchial tone and produced no significant (p = 0.18) attenuation of EIA. An almost complete protection was detected only in two subjects 20 min after diltiazem 10 mg. This limited effect waned 2 h after the administration.

Comparison of bronchial responses to ultrasonically nebulized distilled water, exercise, and methacholine in asthma

We compared the responses to inhaled methacholine, ultrasonically nebulized distilled water, and exercise in 25 subjects with atopic asthma. The methacholine inhalation test and challenges with distilled water and exercise were performed on three separate days 48 hours apart. Bronchial responsiveness to methacholine and ultrasonically nebulized distilled water was measured as the concentration of methacholine (PC20M) and the volume output of the ultrasonic nebulizer (PO20 UNDW) producing a 20 percent fall in the forced expiratory volume in one second (FEV1). The response to exercise was expressed as the percentage of fall in FEV1 from the value before exercise. Seventeen subjects showed a fall in FEV1 of more than 20 percent after exercise. Eight subjects had a stimulus-response curve to distilled water that was flat up to the maximal volume output from the nebulizer, but only four of them also showed no significant response to exercise. The response to exercise correlated better with PO20 UNDW (r = -0.66; p less than 0.01) than with PC20M (r = -0.19; p greater than 0.5) in those responding to distilled water. In all of the tested subjects, exercise-induced bronchoconstriction correlated with PC20M (r = -0.61; p less than 0.01). The mean PC20M was significantly lower in the subjects with a significant response to distilled water and exercise (p less than 0.001 and p less than 0.0001, respectively). We concluded that ultrasonically nebulized distilled water and exercise provoke significant bronchoconstriction in the subjects with more severe nonspecific bronchial hyperresponsiveness. The correlation found between the two stimuli supports the hypothesis that they act by similar mechanisms.

Protective effect of disodium cromoglycate on allergen-induced bronchoconstriction and increased hyperresponsiveness: a double-blind placebo-controlled study

The protective effect of 40 mg cromolyn on allergen-induced late response and increased hyperresponsiveness were studied in five asthmatic children to whom this drug and saline placebo were administered 20 minutes before allergen inhalation, at random, double-blind. Cromolyn reduced the magnitude of early and late responses and abolished the increase in methacholine responsiveness.

The dissociation of the extracellular hemoglobin of Tubifex tubifex at extremes of pH and its reassociation upon return to neutrality

The dissociation of the extracellular hemoglobin of Tubifex tubifex at alkaline and acid pH, and its reassociation upon return to neutral pH, was investigated using gel filtration, ultracentrifugation, and polyacrylamide gel electrophoresis in sodium dodecyl sulfate (SDS-PAGE). Tubifex hemoglobin dissociated at pH above 8 and below 6; both dissociations appeared to be equilibrium processes. The extent of dissociation increased as the pH moved away from neutrality; although dissociation was virtually complete at pH 11, its extent at acid pH did not exceed 50-60% at pH 4. Ca(II), Mg(II), and Sr(II) cations over the range 1-100 mM decreased the extent of the dissociation only at alkaline pH. The visible absorption spectrum of the oxyhemoglobin remained unaltered in the pH range 4-9. At more extreme pH, it changed with time, altering irreversibly to that of the aquo ferri form. Gel filtration of the hemoglobin at both extremes of pH showed that it dissociated into two heme-containing fragments; one consisting of subunit 1 (Mr approximately 17,000) and the other containing subunits 2, 3, and 4 of the hemoglobin (Mr approximately 60,000). Upon return to neutral pH, the dissociated fragment reassociated to the extent of 50 to 80% to whole hemoglobin molecules. The reassociation decreased with increase in alkaline pH, and with decrease in acid pH to which the hemoglobin had been exposed; it increased in the presence of Ca(II), Sr(II), and Mg(II) only subsequent to dissociation at alkaline pH. The SDS-PAGE patterns, gel-filtration elution volumes, and alpha-helical contents, determined from circular dichroism at 222 nm, of the reassociated whole molecules were identical to those of the native hemoglobin.

The reassociation of Lumbricus terrestris hemoglobin dissociated at alkaline pH

The reassociation of the extracellular hemoglobin of Lumbricus terrestris (Mr approximately 3.9 X 10(6) ) at neutral pH, subsequent to its dissociation at pH above 8.0, was examined using gel filtration, ultracentrifugation, and scanning transmission electron microscopy. Gel filtration on Sephacryl S-200 at pH 6.8 of the hemoglobin exposed to pH above 8 showed the presence of four peaks: Ia, consisting of whole molecules, undissociated and reassociated, and smaller heme-containing fragments Ib (Mr approximately 3.0 X 10(5) ), II (Mr approximately 6.5 X 10(4) ), and III (Mr approximately 1.8 X 10(4) ). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that although the pattern of Ia was identical with that of the native hemoglobin, consisting of six polypeptide chains (I-VI), Ib appeared to have less of chains V and VI; II consisted of polypeptide chains II-VI, and III was identified as chain I. Lumbricus hemoglobin exposed to pH over the range 8.4 to 10.2 was subjected to gel filtration on Sepharose CL-6B and resolved into undissociated and dissociated fractions. The combined dissociated fractions, when brought back to pH 6.8 and subjected to gel filtration on Sepharose CL-6B and Sephacryl S-200, demonstrated that the extent of reassociation into whole molecules (IaR) varied from about 50% at pH 8 to 30% at pH 10.2. IaR possessed a sodium dodecyl sulfate-polyacrylamide gel electrophoresis pattern identical with that of the native hemoglobin. Ia, IaR, and Ib dissociated when exposed to alkaline pH; upon return to neutral pH, both Ia and IaR reassociated partially to whole molecules but Ib did not. These results suggest that reassociation comprises two pathways: one leading to the formation of IaR and a "dead-end" pathway, along which reassociation stops at the level of Ib. Digital image processing of scanning transmission electron micrographs of negatively stained native hemoglobin and IaR showed that the two molecules were very similar.

Interaction of adenosine 5'-triphosphate with metal ions X-ray structure of ternary complexes containing Mg(II), Ca(II), Mn(II), Co(II), ATP and 2,2'-dipyridylamine

The X-ray structures of the isomorphous Mg2+, Ca2+, Mn2+ and Co2+ complexes of ATP have been determined. The metal ions are wrapped in hexa-coordination by the alpha, beta and gamma phosphate groups of two ATP molecules thus blocking the interaction of the metal ions with the adenine base. A second metal ion which is fully hydrated, M(H2O)2+(6), is engaged in a strong hydrogen bond with the gamma phosphate group of ATP and suggests a possible step in facilitating the cleavage between the beta and gamma phosphates in phosphoryl transfer reactions.

8-epiloganic acid and 7-beta-hydroxy-8-epiiridodial glucoside

Two new iridoid glucosides, isolated from Linaria cymbalaria (Scrophulariaceae), are 8-epiloganic acid ( 1) and 7-beta-hydroxy-8-epiiridodial glucoside ( 2). Partial synthesis of 2 from 8-epiloganin ( 3) has been performed.

Analysis and excision of ring-opened phosphoramide mustard-deoxyguanine adducts in DNA

The reaction products formed by reacting deoxyguanosine with phosphoramide mustard at pH 7.4 have been analyzed by high-performance liquid chromatography and Schiff's reaction. The adducts consisted of five fractions of phosphoramide mustard-imidazole ring-opened deoxyguanosine complexes and one fraction of each of intact phosphoramide mustard-deoxyguanosine and phosphoramide mustard-dideoxyguanosine complexes. Thus, contrary to views held previously, the imidazole ring of alkylated guanine can undergo fission at physiological pH. Schiff's reaction suggests that some fractions of phosphoramide mustard-ring-opened deoxyguanosine adducts contain formyl groups, while others do not. When DNA containing phosphoramide mustard-ring-opened guanine adducts was treated with formamidopyrimidine-DNA glycosylase, there was enzymatic removal of formylated ring-opened guanine adducts. The quantification of the full amount of ring-opened guanine released by formamidopyrimidine-DNA glycosylase was precluded by the limitations of our assay system, which requires that any two ring-opened guanines cross-linked by phosphoramide mustard be both excised in order to be detected.