Intervertebral disc calcifications in children

PURPOSE

This study was done to assess the presence of both asymptomatic and symptomatic intervertebral disc calcifications in a large paediatric population.

MATERIALS AND METHODS

We retrospectively reviewed the radiographs taken during the past 26 years in children (age 0-18 years) undergoing imaging of the spine or of other body segments in which the spine was adequately depicted, to determine possible intervertebral disc calcifications. The following clinical evaluation was extrapolated from the patients' charts: presence of spinal symptoms, history of trauma, suspected or clinically evident scoliosis, suspected or clinically evident syndromes, bone dysplasias, and pre- or postoperative chest or abdominal X-rays.

RESULTS

We detected intervertebral disc calcifications in six patients only. Five calcifications were asymptomatic (one newborn baby with Patau syndrome; three patients studied to rule out scoliosis, hypochondroplasia and syndromic traits; one for dyspnoea due to sunflower seeds inhalation). Only one was symptomatic, with acute neck pain. Calcifications varied in number from one in one patient to two to five in the others.

CONCLUSIONS

Apart from the calcification in the patient with cervical pain, all calcifications were asymptomatic and constituted an incidental finding (particularly those detected at the thoracic level in the patient studied for sunflower-seed inhalation). Calcification shapes were either linear or round. Our series confirms that intervertebral disc calcifications are a rare finding in childhood and should not be a source of concern: symptomatic calcifications tend to regress spontaneously within a short time with or without therapy and immobilisation, whereas asymptomatic calcifications may last for years but disappear before the age of 20 years. Only very few cases, such as those of medullary compression or severe dysphagia due to anterior herniation of cervical discs, may require surgical procedures.

Acetic acid treatments to keep postharvest quality of "Regina" and "Taloppo" table grapes

The most important postharvest pathogen for table grape is Botrytis cinerea (gray mold), which cause a rapid deterioration of fruit. An effective control of the disease during storage is difficult and remains an unsolved problem since no pesticide treatments are allowed by European legislation. GRAS compounds, employed with no restriction as preservatives in Europe and North America, are possible candidates to fulfil this gap. The aim of this work is to study the efficacy of Acetic Acid (AAC), used as postharvest treatment to control Botrytis cinerea on "Regina" and "Taloppo" table grapes, by Laboratory and storage tests. The activity of this compound was first assessed with laboratory tests, treating at different concentrations (0, 5, 10, 20, 50, 75 and 100 microl/L) of AAC vapors, for 15 minutes, single berries inoculated with B. cinerea. After treatments fruit was incubated at 20 degrees C for one week. The in vivo experiment took place by using the most promising AAC concentrations (50, 75 and 100 microl/L) followed by eight weeks of storage at 5 degrees C and 95% of relative humidity (RH) and four days at 20 degrees C and 85% RH (simulated shelf-life conditions). At the end of the in vivo experiment decay, weight loss and visual assessment were evaluated. Almost all treatments, after eight weeks of storage, reduced the incidence of gray mould. The best results were achieved by using 50 ppm of AAC, gaining a reduction of decay, compared to untreated "Taloppo" and "Regina" grapes of 61.0% and 41.4%, respectively. Following the simulated shelf-life period differences between treated and untreated (control) became no significant for "Taloppo" grape, while the lowest decay percentage was reached with 50 microl/L of AAC for "Regina" grape (52% of reduction if compared to control). Regarding fruit weight loss all treatments did not affect significantly this parameter that ranged between 8.2% and 11.5% after eight weeks of storage and 13.5% and 18.2% after shelf-life. At the end of storage the highest visual score was attributed to fruit treated with 50 microl/L of AAC evidencing a clear better keeping quality. During this period slight treatment damages were observed on berries following application of AAC at 75 and 100 microl/L. The reported results obtained with these experiments showed that Acetic Acid could be a promising compound to be used as alternative to SO2 in keeping grapes quality and controlling decay during storage.

Cowper's glands and ducts: radiological findings in children

PURPOSE

The aim of this study was to describe the radiological features of simple or dilated (syringocele) Cowper's ducts in a large paediatric population.

MATERIALS AND METHODS

Voiding cystourethrography procedures performed during the past 24 years were evaluated taking into special account urethral morphology. The procedures were performed to study all sorts of possible urinary affections.

RESULTS

A total of 1,676 male children (age: newborn to 18 years) underwent 2,340 voiding cystourethrographies. Opacification of Cowper's ducts was observed in nine children (0.53%) - in six (0.35%) as a thin, radiopaque image running parallel to the inferior edge of the membranous-bulbar urethra and in three (0.18%) as a dilated structure (syringocele); this was a source of significant voiding problems.

CONCLUSIONS

Opacification of Cowper's ducts - even if rare - has to be recognised as a possible anatomical finding during voiding cystourethrography in paediatric patients. An accessory finding devoid of pathological meaning in most cases, it can, however, be a possible cause of voiding disorders in some instances.

Clinical and radiological findings in Kirner’s deformity. A report of nine cases

PURPOSE

The purpose of this study is to report radiological findings and evaluate the frequency with which Kirner's deformity is found in a large paediatric population.

MATERIALS AND METHODS

We reviewed X-ray films of the hands taken over the past 23.5 years in order to assess not only bone age but all sorts of bone abnormalities (trauma, haematological disorders, bone syndromes and dysplasias, dysmorphic features, rheumatic disorders, etc.) to retrospectively evaluate all those presenting Kirner's deformity.

RESULTS

Among the 16,326 patients who underwent X-ray study of the hands, nine (six males and three females, 0.055% of the total) presented the typical radiological features of Kirner's deformity; no patient had a family history of the disorder except for one, in whom the suspicion of familiarity could not be verified radiologically. The diagnosis of Kirner's deformity was straightforward in most cases. In one case, a girl affected by Turner's syndrome, the abnormality was suspected, and its appearance, development and evolution was followed over 10 years.

CONCLUSIONS

Although rare, as also shown by our study, Kirner's deformity must be recognised and properly diagnosed in order to spare the subject unnecessary surgical procedures.

Treatments with gras compounds to keep fig fruit (Ficus carica L.) quality during cold storage

The trade of fresh fig fruit is restricted by its high perishability and numerous attempts have been done to extend the postharvest life. The main difficulties can be found in the fast ripening and the easiness of pathogen spread. Although the ripening can be slowed by low storage temperatures (close to 0 degrees C) the control of pathogens remains still unsolved since no pesticide treatments are allowed. Generally Recognized As Save Compounds (G.R.A.S.) are possible candidates to fulfil this void. Sodium carbonate (SC) solutions (0.5, 1, 2 and 3%) and acetic acid (AAC) vapours (25, 50 and 100 ppm) have been used as postharvest treatments to control Botrytis cinerea on black (Craxiou de Porcu) and white (Rampelina) fig varieties. Fruit was subsequently stored at 2 or 8 degrees C and 90% relative humidity for two weeks. At the end of the experiment decay, weight loss, pH, acidity, total soluble solids and visual assessment were performed. SC treatment at 1% reduced significantly the decay while, lower and higher concentrations did not. Between the two studied varieties the lowest decay percentage (9.8%) was found for the Craxiou de Porcu. Using AAC a good efficacy was achieved only with 100 ppm, this treatment decrease to 2.4% the incidence of decay irrespective to storage temperature. Lower concentrations were lesser effective and the efficacy was strictly dependent on the storage temperature, being higher at 2 degrees C. No treatment damages were observed following SC or AAC applications. Regarding fruit weight loss all treatments did not affect this parameter that was 10.1% and 16.9% at 2 and 8 degrees C, respectively. Chemical analyses performed at the end of the storage period did not evidenced differences among the treatments and slight ones if compared to initial values. Visual score of the fruit at the end of storage evidenced a better keeping quality for Craxiou de Porcu especially when stored at 2 degrees C. Both G.R.A.S. compounds are promising, but in the reported experiments AAC was the most effective.

[Botallo's duct calcification in children: radiologic findings]

INTRODUCTION

Calcification of the ductus and ligamentum Botalli with no cardio-respiratory symptoms is normally a sign of their closure. However, as the calcification can be associated with a patent duct or a ductal aneurysm, its presence must not be misinterpreted. The frequency and the different patterns of this calcification must be known, as well as is diagnostic relevance. It is also important to differentiate it from other types of upper mediastinal calcification.

MATERIAL AND METHODS

Thirty-two cases of ducts Botalli calcification were collected over 16 years, during which time period 38,476 children (24,095 males, 14,381 females) were submitted to chest radiography. Patient populations were divided into the following age-groups: preterms-newborns; 2-3 months; 4-6 months; 7-12 months; 2-3 years; 4-6 years; 7-10 years; 11 years on. We studied the ductus Botalli according to the following parameters; conspicuity, location, size and shape of the calcification; prevalence of the radiographic finding in 1,000 patients by gender and age; persistence of the finding in follow-up examinations.

RESULTS

The calcification was found in left mediastinal site at the posterior aspect of the 4-6th ribs, ranging 1-6 mm in length, and 1-4 mm in width. It had a round, comma-like or elongated shape. In all, 32 cases of ductal calcification (.83/1000) were found: 14 (44%) were in males (age range 7 months-12 years), 18 (56%) in females (age range 11 months-10 years). Age range analysis shows that the calcification is distributed more evenly in the male population with the highest number of calcified ducts (5 = 94/1000) found in the 4-6 year age group and a relative prevalence in the age group 7-12 months (2 cases = 1.05/1000). A marked prevalence is found in females 4-6 years old (11 cases = 3.8/1000). The duct calcification was an occasional finding during chest radiography for other, more severe conditions in 9 of 14 males and in 6 of 18 females.

CONCLUSIONS

No data can be found in the literature on the frequency of ductus Botalli calcification at chest radiography: our results indicate it to be less than 1/1000 (.83/1000). We have found a prevalence of ductus calcification (1.25/1000) in females even though females are less numerous in our population. The ductal calcification is often associated with severe, mostly hematologic, diseases. We believe that the conspicuity of the calcification is due to its density more than to its shape and size. Literature data indicate that ductus calcification may still be visible 6 months to 8 years after its discovery: our results, although on a small series, confirm this observation. The clinical significance of the calcification is still unclear.

Bilateral glenoid hypoplasia

A case of bilateral glenoid hypoplasia in a boy afflicted with posterior fossa medulloblastoma is described. Glenoid hypoplasia is a rarely reported bilateral finding either in subjects complaining of shoulder pain or abduction/adduction movements reduction as well as shoulder recurrent dislocations. In this patient as in most of those reported in the literature the finding was incidental and could have been easily overlooked. It consists of shallow, irregular glenoid fossae which are hypoplastic, whereas the humeral heads are normal in size and shape. At the present time there is no explanation for this anomaly.

Properties of recombinant bacteriophage T4 tail sheath protein and its deletion fragments

A vector for expression of recombinant bacteriophage T4 tail sheath protein (gp18) under control of phage T7 promoter in Escherichia coli cells has been constructed. The entire length recombinant gp18 (659 amino acids) polymerizes in vivo into extended polysheaths. To study gp18 folding mechanisms, six vectors for expression of deletion mutants have been constructed. Three proteins--1N, 2N, and 3N--contain, respectively, 268, 316, and 372 amino acids of the gp18 N-tail region. The other three fragments--1C, 2C, and 3C--contain, respectively, 455, 356, and 288 amino acids of the gp18 C-tail. The fragments 1N, 2N, 1C, 2C, and 3C form insoluble aggregates during expression. However, fragment 3N accumulates in soluble form in the cellular cytoplasm and does not form polymeric structures; this has allowed an effective purification method to be developed for it. The interaction of monoclonal antibodies against recombinant gp18 with protein fragments and with phage sheath before and after contraction has been studied. The fragment 3N seems to be a stable domain of native phage sheath gp18.

Transplantation of cord blood progenitor cells can promote bone resorption in autosomal recessive osteopetrosis

Allogeneic BMT has been reported to be the only curative therapy for children with juvenile autosomal recessive osteopetrosis. We report the case of a 14-month-old child in whom bone resorption was observed after cord blood transplantation (CBT). The patient was given CBT from an unrelated newborn matched for five of six HLA antigens. At the time of transplantation, the child presented with neurological symptoms, with feeding problems and visual impairment. A successful engraftment of donor hematopoiesis was demonstrated and the child experienced grade I acute GVHD. Progressive bone clearing was achieved and a bone marrow trephine demonstrated signs of osteoclast function. Despite full engraftment and bone resorption, neurologic deterioration did not improve. This experience documents that CBT can promote the correction of juvenile osteopetrosis. The shorter time needed both to identify an unrelated donor and to perform the transplant, as well as the lower incidence of GVHD make this procedure more appealing than BMT in children lacking an HLA-compatible relative.

HLA-DM polymorphisms do not associate with multiple sclerosis: an association study with analysis of myelin basic protein T cell specificity

The MHC region on 6p harbors at least one susceptibility gene for multiple sclerosis (MS). Within this region, HLA-DM loci are of interest being involved in class II antigen processing. We investigated the association of HLA-DM polymorphisms with MS. Sixty-three patients with MS and 46 healthy controls from continental Italy were typed for HLA-DM polymorphisms and HLA-DRB1 alleles. Besides, among the donors characterized for the DM polymorphisms, we considered 6 MS patients previously studied for the fine specificity of their MBP-specific T lymphocyte lines (TLL). The frequencies of allelic variants at the DMA and DMB loci were similar between MS patients and controls, even when HLA-DRB1*1501 positive and negative donors were analyzed separately. Patients with predominant responses to different MBP epitopes did not differ for their HLA-DM haplotype while patients with predominant responses to the same MBP epitope could present different HLA-DM haplotypes. HLA-DM polymorphisms do not associate with MS and may not affect specific patterns of T cell responses to MBP.

Down-regulation of cell-surface CD4 co-receptor expression and modulation of experimental allergic encephalomyelitis

Pre-immunization with autoantigens confers resistance in experimental models of autoimmune diseases. Since non-self molecules can also be protective, it is conceivable that part of the effect rests on a non-specific attenuation of the immune response. This study is aimed at identifying mechanisms by which pre-immunization with a moiety suspended in incomplete Freund's adjuvant (IFA) protects from experimental allergic encephalomyelitis (EAE). Lewis rats were immunized with each of either concanavalin A, lipopolysaccharide, bovine serum albumin, 70 or 65 kDa heat shock proteins, or myelin basic protein. All moieties were given in IFA 3 weeks prior to EAE induction. Serial cytofluorimetric monitoring of B cells and of the alpha beta TCR+, CD4+, CD8+, CD45high and CD45low cells was performed. IFN-gamma and IgG1 production was evaluated in parallel. All moieties were able to attenuate or abrogate the clinical signs of EAE. At day 4 and 10 after EAE induction, the surface expression of the CD4 molecule was down-regulated on T lymphocytes. This down-regulation was most evident in animals with the highest degree of clinical protection. By day 21 post-immunization, CD4 expression was restored. The same animals also showed an increase in the B cell percentage and Th2-related IgG1 production while IFN-gamma secretion was reduced. Pre-immunization with diverse antigens suspended in IFA confers resistance to EAE induction. The down-regulation of the CD4 co-receptor accompanied by events suggestive of an immune deviation may be a general mechanism that contributes to the protection.

The immune response to mycobacterial 70-kDa heat shock proteins frequently involves autoreactive T cells and is quantitatively disregulated in multiple sclerosis

Heat shock proteins (HSP) are the most conserved molecules known to date that may also function as immune targets during infection. Hence, theoretically there is a high chance of cross-reactive responses to epitopes shared by host and microbe HSP. If not properly regulated, these responses may contribute to the pathogenesis of autoimmune disease. To determine if immune responses to HSP could contribute to the pathogenesis of multiple sclerosis, we raised T lymphocyte lines specific for the purified protein derivative of Mycobacterium tuberculosis (PPD) from patients with multiple sclerosis, patients with tuberculosis and from healthy individuals. These lines were then screened for their proliferative response to a M. tuberculosis 70-kDa heat shock protein (M.tb.HSP70). The relative frequency of the recognition of highly conserved sequences of M.tb.HSP70 compared to variable ones was also assessed by mapping experiments on those PPD specific T lymphocyte lines which also recognized the mycobacterial 70-kDa heat shock protein. In patients with multiple sclerosis, we observed a significantly higher estimated frequency of PPD-specific T lines responding to M.tb.HSP70 compared to healthy individuals and patients with tuberculosis. Furthermore, mapping experiments using recombinant proteins representing mycobacterial and human HSP70 sequences and a panel of synthetic peptides encompassing the whole sequence of Mycobacterium leprae HSP70, showed that the response to conserved epitopes of HSP70 is a frequent event in each of the three conditions studied, often leading to the cross-recognition of microbial and human sequences. These findings implicate the 70-kDa heat shock proteins as potential autoantigens in multiple sclerosis.

The N-terminal domain of the myelin oligodendrocyte glycoprotein (MOG) induces acute demyelinating experimental autoimmune encephalomyelitis in the Lewis rat

Using a highly purified recombinant protein, mMOG, we demonstrated that autoimmune responses to the N-terminal domain (a.a 1-125) of the myelin oligodendrocyte glycoprotein (MOG) induce an acute demyelinating variant of experimental autoimmune encephalomyelitis (EAE) in the Lewis rat. Immunisation with 100 micrograms of mMOG in adjuvant at the base of the tail induced mild clinical disease in 9 of 11 animals (mean clinical score 1.1). The disease was characterised histopathologically by the presence of inflammation and focal demyelinating lesions in the central nervous system (CNS). Adoptive transfer experiments suggest that this inflammatory demyelinating pathology is mediated by synergy between a weakly encephalitogenic, MOG-specific T cell response and a demyelinating, MOG-specific autoantibody response. Using in vitro selected mMOG-reactive T cell lines, the encephalitogenic T cell response to this domain of MOG was found to recognise two distinct epitopes, MOG1-20 and MOG35-55; whereas ELISA demonstrated that the immunodominant B cell epitope was located within the amino acid sequence MOG1-25. However although active immunisation with synthetic peptides corresponding to the T cell epitopes, MOG1-20 or MOG35-55, induced an inflammatory response in the CNS, this was not associated with demyelination indicating that the demyelinating antibody response recognises other, possibly conformation dependent epitopes. This study unequivocally demonstrates that MOG-specific autoimmune responses are alone sufficient to induce a demyelinating disease of the CNS and supports the proposal that MOG may play an important role in the immunopathogenesis of multiple sclerosis.

Sequence of cDNA coding for a 65 kDa adhesive protein for the specific detection of Trichomonas vaginalis by PCR

A Trichomonas vaginalis cDNA library was constructed and recombinant plaques were screened using rabbit immunoglobulins specific for P65, a protozoan protein involved in pathogenicity that we identified in a previous study. A 1.38 kilobases cDNA fragment coding for the P65 protein was cloned in E. coli and then sequenced. On the basis of of the sequence obtained, six primers were synthesised and used to set up a Polymerase Chain Reaction. The presence of a specific amplicon in all 30 clinical isolates tested shows that P65 is a conserved and stable gene. The reaction is highly sensitive (as few as 5 to 10 parasites can be detected) and specific for Trichomonas vaginalis; the gene coding P65 adhesin can be therefore considered a very good molecular target for polymerase chain reaction-based diagnostic purposes.

[The direct and computed radiographic assessment of vertebral locations in children with acute lymphatic leukemia]

The children affected with acute lymphoblastic leukemia (ALL) often exhibit secondary lesions of the spine. The diagnosis of spinal involvement is currently made by means of conventional radiography in postero-anterior and lateral views. The osteolytic lesions of the vertebral body present with collapse of the vertebral plates in a wide range of severity. Body evaluation is usually made by comparison with the adjacent vertebrae. Since leukemia is a systemic disease, several vertebrae are possibly involved in each case. In the attempt to develop a more sensitive method, which is less dependent on observers' evaluation, a quantitative and comparative analysis of vertebral bodies was performed. The radiographs in lateral view of the dorsal and lumbar spine of 14 children with ALL were analyzed: previous radiological reports suggested the lesion of one or more vertebral bodies. The area of each vertebral body was measured and digitalized by means of a backlighted graphic table and of a software developed to this purpose. The criteria to define the collapse of a vertebral body were the ratio between areas of adjacent vertebral bodies, in conformity to the anatomic and radiographic principle that, in the dorsal and lumbar spine, the body of a normal vertebra is equal to or bigger than that of the upper one. The data obtained by quantitative analysis were compared with conventional radiologic reports. A hundred and fifty-five vertebrae were analyzed by computerized analysis; 17 (10.9%) vertebrae, undetected at conventional analysis, were collapsed. This method allows a more precise diagnosis of collapsed vertebral lesions; its accuracy can be improved with further development of digital technology.

Antley-Bixler syndrome: description of two patients

The Antley-Bixler syndrome comprises malformations of cartilage and bone. The essential signs are a dysmorphic facies with flattening of the central region of the face, humeroradial synostosis with flexed attitude of the upper limbs and swelling of the distal interphalangeal and metacarpophalangeal articulations. Congenital atresia of the nasal choanae, which is often present, makes the prognosis of this syndrome extremely severe. Two patients affected by the syndrome are described. Atresia of the nasal choanae was absent in both. The first patient had genital ambiguity, a condition which has been described in the literature in only two other cases; the second one had all the fundamental characteristics of the syndrome except for humeroradial synostosis, although hypoplasia of the lateral condyle of the humerus and dislocation of the radius are present in association with synostosis between the 2nd metatarsal and the intermediate cuneiform.

Rhabdomyosarcoma with primary osteolytic lesions simulating non-Hodgkin's lymphoma

We report the case of an 8-year-old child presenting with the pathological fracture of two vertebral bodies due to bone lytic lesions. Physical and instrumental examinations did not show any further evidence of disease. However, bone marrow aspirate showed an infiltrate of poorly differentiated cells. When the child was transferred to the Department of Pediatrics, lymphoblastic leukemia was suspected. Although the morphology of the bone marrow biopsy could have suggested a lymphoblastic lymphoma, further immunochemical and immunological studies together with the study of tissue surface antigens resulted in a diagnosis of embryonal rhabdomyosarcoma with an unusual presentation.

[Risk factors and multicentricity of vascular atherosclerotic disease. Our experience]

The objective of this study is the identification of the most important risk factors of atherosclerosis and the determination of its multicentricity, the goal being an efficient primary and secondary prevention of this disease. Over the course of eight years, at the Department of Diagnosis and Surgical Physiopathology of Peripheral Vascular Diseases, 829 subjects with atherosclerosis were examined, of whom 513 males and 316 females between 18 and 85 years old, as well as to 200 healthy control subjects. The risk factors in consideration were: age, sex, hypertension, diabetes, lipoidoproteinosis, smoking, alcohol and coffee intake. From the data obtained it was revealed that smoking represents the most important risk factor for atherosclerosis (65% of the cases, 40% of the controls), followed in decreasing order by hypertension (31% of the cases, 6% of the controls), diabetes (26% of the cases, 2% of the controls), lipoidoproteinosis (15% of the cases, 6% of the controls). Furthermore 21% of the subjects drank coffee and 28% ingested alcoholic beverages, compared with, respectively 19% and 24% of the controls. In 70% of the cases the presence of atherosclerotic lesions were found in more than one vascular region. Atherosclerosis has a multifactorial etiology as there exists a correlation between the predisposition of the patient to acquire the disease and environmental factors. It is difficult to distinguish the determining effects of a single risk factor, because often many risk factors are tightly interrelated in the same individual; a nearly direct relationship clearly exists between the number and entity of the risk factors and the clinical picture of the patient examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phenotypic and functional characterization of cloned T-lymphocytes from cerebrospinal fluid of patients with multiple sclerosis]

T cell clones derived from the cerebrospinal fluid of patients with multiple sclerosis were investigated for their ability to produce IL2, IL4, IFN gamma and TNF alpha. As controls, liver infiltrating T lymphocyte clones from patients with chronic active hepatitis were used. All CSF clones (both CD4+ and CD8+) produced high amounts of IFN gamma and particularly of TNF alpha. TNF was synthesized in a significantly higher amount than control clones. Moreover, they were capable of secreting IL2 but not IL4. From our results we conclude that CSF-CD4+ T clones could constitute a subset with functional properties similar to those of the Th1/inflammatory cells of the mouse. The unusually high amount of TNF produced by CSF derived T cell clones strongly suggests a significant role for this cytokine in MS immunopathogenesis.

Chronic gastric torsion in infancy: a revisited diagnosis

Twenty out of 108 infants with vomiting, who underwent an upper gastrointestinal X-ray study during a period of 2 years, showed a peculiar shape and position of the stomach already described as chronic gastric torsion. We examined clinical, radiologic and laboratory findings of these 20 infants. Our results showed that chronic gastric torsion is frequently associated with gastroesophageal reflux and has a wide spectrum of symptoms, complications and nutritional abnormalities.

Pharmacokinetics of iopamidol 370 in infants and children during ivp

This research was aimed at evaluating the pharmacokinetic parameters of iopamidol 370 (a nonionic water organic iodine compound) during ivp in infants and children. All children examined in the study had symptomatic recurrent urinary tract infections; they were divided into three groups according to age (0-24 months; 25-72 months; 73-120 months). The contrast medium was injected in a dose of 1 ml/kg + 6 ml. Blood and urine samples were taken at regular time intervals over a 24-hour period in children, whereas in infants only blood samples were collected. Pharmacokinetic parameters were estimated using a bicompartmental open model, as follows: t1/2 alpha (h) = 0.33; t1/2 beta (h) = 1.92; Vc (l/kg) = 0.40; V beta (l/kg) = 0.20; Cl (l/kg) = 0.16. These values were not significantly different, as far as our patients were concerned, from those reported in literature for adults.

[Tuberculosis of the breast. Report of a clinical case and review of the literature]

Tuberculosis of the breast is an uncommon disease and the correct diagnosis may be established only by histologic demonstration of granulomatous inflammatory infiltrates with central caseation. In fact, preoperative examination and mammography suggest carcinoma or sometimes bacterial abscess in most instances. Tuberculous mastitis was diagnosed in a 74-year-old woman. The case history and a review of the literature are presented. The Authors emphasize the role of excision of necrotic tissue and drainage, in combination with antimicrobial therapy, in the treatment of this pathology.

[Oto-palato-digital syndrome. Clinico-radiological study]

Oto-palato-digital (OPD) or Tyabi syndrome is a familiar, X-linked bone dysplasia with intermediate expression, in females or autosomal dominant with more severe manifestations in males. In the past both the clinical features (flat face with sunken and broad nasal bridge, antimongoloid slant of palpebral fissures, palatoschysis, conductive deafness, short and broad thumbs and big toes, nail dystrophy) and radiological findings (thick and dense base of the skull, prominence of supraorbital ridges, middle ear bone deformities with dense ossicles, large and broad vertebral bodies, posterior defects of neural arches of the vertebrae, carpal and tarsal bone fusions, short and broad nail phalanges) have been well described and established. The present report describes 7 patients (4 females and 3 males) all belonging to the same family (the first described in this country) and all presenting the clinical and radiological features of OPD syndrome. A cranial and spinal CT was performed on one patient, with peculiar findings.

[Hypertrophic stenosis of the pylorus. Ultrasound and traditional diagnosis. Comparison of methods]

Hypertrophic pyloric stenosis (HPS) is the most frequent cause of abdominal surgery during the first months of life. A new diagnostic approach to this type of pathology is given by ultrasound examination which offers the opportunity to perform a precise study of pyloric muscle thickness, pyloric diameter width and pyloric muscle length. Ultrasound provides a quick diagnostic tool sparing radiation exposure to the patient. X-ray study is only to be reserved to the few cases in which clinical and ultrasound data are doubtful and--in all instances--to rule-out other possible causes of gastric outlet obstruction. We report 20 infants (14 males and 6 females) referred with clinical suspicion of HPS. This diagnosis has been confirmed by ultrasound in 12 cases, suspected in 1 and excluded in 7 cases. Upper gastrointestinal tract series confirmed the presence of HPS in 13 cases; discovered a huge gastroesophageal reflux in one and showed normal findings in 6 cases.

A family with the Saethre-Chotzen syndrome

Acrocephalosyndactyly (ACS) is an inherited syndrome of premature synostosis of the cranial sutures and abnormalities in the distal segments of the limbs. Several forms of ACS have been described. ACS type III (or Saethre-Chotzen syndrome) is characterized by microcephaly, skull asymmetry, mild syndactyly, and facial abnormalities. We describe an Italian family with ACS III in which two sibs are clearly affected; the mother and the maternal grandmother show some features of the syndrome.

[Transient stenosing ureteritis in childhood. A rare complication of rheumatoid purpura]

A case of transient stenosing ureteritis in a boy presenting with the clinical features of Henoch-Schoenlein purpura (diffuse articular swelling, petechiae, abdominal pain) complicated by macroscopic haematuria with blood clots is reported. On urography the right collecting system and the right ureter up to the distal lumbar portion were dilated owing to tight ureteral stenosis at that level. Above the stricture, numerous ring-like functional ureteral wall defects were detectable. On the left a stenosis was evident at the lumbo-sacral level with mild dilatation of the ureter. A small filling defect due to subephitelial haemorrhage was evident in the upper part of this ureter. Three months later, after prednisone therapy, the urography was normal on the right: residual mild stenosis was still evident on the left. Radiological findings in Henoch-Schoenlein purpura and the possible differential diagnosis of this condition are discussed.

Rectal extrusion of the catheter and air ventriculography following bowel perforation in ventriculo-peritoneal shunt

Ventriculo-peritoneal shunt is frequently carried out in infantile hydrocephalus. The peritoneal shunt has a lower morbidity than ventriculo-atrial shunts and severe complications are uncommon. Abdominal complications include intestinal perforation, shunt migration, inguinal hernia, cerebrospinal fluid pseudocysts and hollow viscus perforation. A few cases of catheter extrusion from the rectum, vagina, umbilicus and urethra have been described. We report a new case of intestinal perforation with rectal extrusion of the catheter associated with a ventriculogram.