Unexpected delayed death after manual strangulation: need for careful examination in the emergency room

The aim of this case report was to demonstrate the importance of detailed clinical assessment in victims of attempted manual strangulation, to prevent the occurrence of delayed death due to an airway collapse; and to provide an update on clinical management of these patients. An elderly male patient presented with a sore throat and speech impairment after attempting manual strangulation. Physical examination showed reddish skin of the neck, an extensive haematoma of the hard palate and anterior tongue. Flexible laryngoscopy failed to show any swelling of the hypopharynx or larynx. A few hours after presentation, the patient developed acute dyspnoea and died. Autopsy and post-mortem CT scan showed a haematoma in the thyro-epiglottal space. In conclusion, victims of manual strangulation can survive despite internal neck injury which can lead to delayed fatal airway collapse. This is because often there are few or no signs of assault, therefore medical evaluation should be thorough and timely. Sometimes immediate tracheotomy can be life saving.

Clinical effects of erdosteine in the treatment of acute respiratory tract diseases in children

Erdosteine has positive effects on mucus rheology and transport due to the active metabolite (Metabolite I) which contains a free thiol group. Erdosteine inhibits bacterial adhesiveness and has antioxidant properties. A synergistic effect of erdosteine with various antibiotics has been demonstrated in pharmacological and clinical studies. The present study was multicenter, randomized, double-blind and placebo-controlled. The aims of the study were to compare a combination of erdosteine with amoxicillin against an amoxicillin-placebo combination in pediatric patients with acute lower respiratory tract disease. A total of 158 patients (78 in the erdosteine group and 80 in the placebo group) were treated for 7 +/- 2 days. The efficacy parameters were cough (primary), polypnea, rhonchi, rales and body temperature (all measured at baseline, on Day 3 and at the end of treatment). Safety was assessed by strictly monitoring the occurrence of adverse events and using standard laboratory parameters. The results of the intention-to-treat analysis showed that the severity of cough was decreased by 47% at Day 3 in the erdosteine group with a statistically significant difference compared to placebo, the difference was still significant at the final visit. The decrease in the severity of rales was significantly greater at Day 3 in the erdosteine group than in the placebo group. The incidence of polypnea and rhonchi in the two groups showed similar decreases, an improvement mainly due to the antibiotic. No adverse events occurred and no adverse changes in laboratory parameters were observed. It is concluded that the combination of erdosteine and amoxicillin is a safe medication which is clinically superior to that of the antibiotic combined with placebo, especially in regard to the effects on cough.

Y-chromosome haplotypes in Italy: the GEFI collaborative database

A sample of 1176 males from 10 Italian regions have been typed for DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS392, DYS393, and DYS385. Individual haplotype data are available on line. A low degree of variation is present among regions. Use of this database is specifically recommended for forensic applications in Italy.

Permanent brain damage following acute clonidine poisoning in Munchausen by proxy

A child presented with recurrent episodes of lethargia for which he underwent several hospital admissions and investigations. A further episode culminated in respiratory arrest and hypoxic ischemic encephalopathy with permanent mental regression. Eighteen months later the mother was discovered while providing clonidine pills to the child; the mother appears to feature a Munchausen syndrome by proxy.

[Syncopal pathology in childhood (I)]

Syncope is a common phenomenon, well-known to all pediatricians: it is defined as a sudden transient loss of consciousness associated with inability to maintain postural tone that is incompatible with a seizure disorder, vertigo, dizziness, coma, shock or other states of altered consciousness. The purpose of this study are to analyse the multiple causes of syncope, to determine the characteristics of pediatric patients with syncope, to define the pathophysiologic mechanisms that result in neurally mediated syncope.

[Screening for celiac disease in children attending secondary school around Lucca]

A growing number of clinical and epidemiological data point to the fact that coeliac disease (CD) is a pauci- or asymptomatic occurrence, relatively more frequent than it was supposed in the past, manifested in atypical, silent and latent forms which are often undiagnosed or diagnosed only at a later age. The fact that resolutive treatment is now available means that CD is an ideal field for the application of a screening method. In this context the study by Catassi et al. (1994) is particularly important since it reported a prevalence of 0.38% of CD in healthy children in the Pesaro-Urbino area.

AIM

The aim of this study was to verify the incidence of CD in a nonselected pediatric population in the province of Lucca, using the aforesaid screening method.

METHOD

The eligible population consisted of 1585 students from 5 secondary schools around Lucca, aged between 10 and 15 years old, none of whom were known to be affected by CD. In the first phase of the study anti-gliadin-IgA (AGA-IgA) and IgG antibodies were assayed in capillary blood (collected at school) using Alfa-Gliatest (Eurospital); children with AGA-IgA, AGA-IgG over 7 and 15 U/ml respectively were considered positive. In the second phase children with positive results underwent a further assay of AGA-IgA, AGA-IgG, anti-endomysium antibodies (EMA) and total IgA in venous blood. Lastly, children positive for AGA-IgA and/or EMA, or those positive for AGA-IgG with IgA deficit underwent duodenal jejunal biopsy.

RESULTS

41 children were positive on screening (2.6% of the eligible population, 3.8% of subjects effectively tested). Of these, 39 were assayed for AGA (IgA and IgG), EMA and total IgA in peripheral blood, identifying 4 subjects positive for AGA-IgA and EMA. Of the 4 children selected in this way, only 2 underwent jejunal biopsy and both presented "duodenal mucosa with chronic phlogosis and subtotal villous atrophy". Two cases of CD were formally ascertained with a prevalence of 1 out of 793 (0.13%) of the eligible population and an estimated prevalence of 1 out of 546.5 (0.18%) of the subjects undergoing screening. The cost was approximately Lit. 23,000 per child screened and approximately Lit. 6,100,000 for each coeliac child diagnosed.

COMMENTS AND CONCLUSIONS

The diagnostic iter proved efficacious and enabled 4 "high-risk" children to be selected. If the two subjects who did not undergo biopsy are also formally considered as coeliacs, the prevalence would be 1 out of 396 (0.25%) of the eligible subjects, namely 1 out of 273 (0.37%) of effectively tested subjects. This is a figure which is very similar to that reported by other studies. The 4 children identified here as strongly suspected of CD did not possess any anamnestic and/or objective elements which might have suggested "ex ante" a diagnosis of CD. If confirmed, these data provide concrete evidence of the need to perform mass screenings to identify CD. The economic convenience of this procedure depends on a careful analysis of the costs of the failure to diagnose CD.

[Plasma levels of beta-endorphins and ACTH in labor with continuous peridural analgesia]

In order to investigate whether continuous lumbar epidural analgesia is associated with alterations of plasma levels of beta-endorphins and ACTH, we have studied a group (A) of patients under epidural analgesia and a matched group of control (B) at different stages of labour. Plasma levels of beta-endorphins and ACTH in group A did not significantly change during the labour, while in group B beta-endorphins and ACTH increased in the second stage of labour and decreased thereafter one hour after delivery. The levels of beta-endorphins and ACTH in umbilical cord mix blood were elevated in both groups.

[The surgical remodelling of prominent ears]

It is a common fallacy that the prominent ear correction is easy; on the contrary it is difficult to obtain a perfect result, as indicated by the continuous growth of new methods. For a long time we have used Mustardè's mattress suture technique (Francesconi) but quite often the result was incomplete and not infrequently there was recurrence. In recent years, in order to obtain a more complete and permanent correction, we have added to the mattress sutures the superficial scratching of the anterior aspect of the cartilage as suggested by Stenstrom. A well formed contour of the antihelix and of the crura is so reproduced and maintained by the spontaneous bending tendency of the auricular cartilage following abrasion. The surgeon is dealing with an intact cartilage so that many common inconveniences met with in other techniques are eliminated. No irregularities and no sharp ridges, which may project beneath the skin on the anterior surface, are formed and there is no persistent protrusion on the upper or lower portion of the ear. The technique is equally well suited when insufficient folding of the antihelix or when excessive cupping of the concha are pronounced features.

The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects

BACKGROUND

Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy.

PATIENTS AND METHODS

Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency.

RESULTS

Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7.

CONCLUSIONS

These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.

[Neurocysticercosis: a rare cause of convulsive crises]

The cysticercosis is an infestation caused from the larva of Taenia solium, which is demoniated Cysticercus cellulosae. Infestation by the encysted forms occur within brain, muscle, cutis, eye and more rarely within kidney, liver, thyroid. The cysties cause inflammation, oedema and residual calcification. In the SNC they are responsible for seizures, usually of focal type, hydrocephalus, meningitis, endocranic hypertension, stroke. One case of neurocysticercosis in a 15 years old boy is described: the clinical pictures, the neuroradiologic images and the treatment are discussed.

[Magnesium in the prophylaxis of primary headache and other periodic disorders in children]

Migraine has been recently defined a "central neuronal hyperexcitability state", maybe magnesium-dependent, and magnesium has been occasionally employed in the therapy of adult migraine. The Authors, on the basis of their personal experience (previous electromyographic studies), consider childhood migraine and periodic syndrome as a clinical equivalent of spasmophilia, in which an intracellular deficit of magnesium has been demonstrated, and have employed a magnesium salt in the prophylaxis of childhood migraine and migraine equivalents. 40 children with periodic syndrome (17 M and 23 F, aged 10.4 +/- 2.9 years) have been treated with magnesium pidolate, with doses ranging from 1.5 g/die to 4.5 g/die (corresponding to 122-366 mg Mg++):25 of them presented migraine as the main symptom, 12 recurrent abdominal pain, 3 fever of unknown origin, along with many other periodic symptoms. The first control visits have been done at 1 month, clinical follow-up lasted a mean period of 6.1 months. Therapy was stopped at 1 month visit if ineffective (of some other drug was added); otherwise, magnesium therapy was continued with the same dosage for another month, then gradually reduced. Clinical response was considered good if crises ceased completely or their frequency was reduced to less than 33%; partial if reduced to less than 67% of previous incidence; absent if only slightly or not at all reduced. Clinical response was good in 72.5% of cases at 1 month, in 77.5% later; partial in 12.5% and 10%; absent in 15% and 12.5% respectively. No side effects were observed. The compliance of children and their families was complete.(ABSTRACT TRUNCATED AT 250 WORDS)

[Guidance for the obstetrician encountering a multiple pregnancy]

A retrospective review of multiple birth of higher order delivered at the Obstetric Clinic of University of Rome "La Sapienza" from 1982-1991 was performed. Comparison was made between this group (study group) and other published data. Since 1982 there has been more liberal use of abdominal delivery. Of the 25 multiple pregnancies, 17 were delivered by cesarean section (CS) and 8 by vaginal delivery. The corrected mortality rate in the study group was 19.2% (5/26) for vaginal delivery and 17.5% (10/57) for CS. Indication for CS was: elective (35%), fetal (18%) and maternal (47%). The main neonatal complications resulted from prematurity, and maternal noted complication were post-partum hemorrhage necessitating hysterectomy in one patient. The preferable mode of delivery cannot be stated dogmatically.

[Tests of autonomic nervous system functioning in children: normal values]

The study of cardiovascular autonomic reflexes is the most physiological and reliable test for the assessment of autonomic function: they consist of the analysis of variation of heart rate and arterial pressure provoked by many physiological stimuli. Up to now normal pediatric reference data were not available: we have standardized these tests in 198 normal children (94 M, 104 F), aged 8.3-15.7 years, without any symptom of possible autonomic dysfunction pathology. A complete auxological evaluation has been performed. Autonomic tests were performed by ECG recording and arterial pressure monitoring during normal and deep breathing, Valsalva manoeuvre, lying to standing postural change, isometric muscular contraction (sustained hand-grip and leg rising). Eleven autonomic parameters were obtained. Many statistical correlation between autonomic parameters and auxological features have been explored, without remarkable results. A significative difference emerged only between sexes. Normal reference values has been calculated. Their utility for the study of autonomic dysfunction is discussed.

[Autonomic neural functioning in children with the periodic syndrome]

The pathogenesis of periodic syndrome (recurrent abdominal pain, cyclic vomiting, headache and other equivalents of childhood migraine) is often related in the literature to a "neuro-vegetative dysfunction", by which occasional stimuli (environmental, metabolic, emotional) should find a particular somatic expression. The homeostatic role of the autonomic nervous system could be deficient in these cases, but systematic research has never been done to explore this hypothesis. We have evaluated the autonomic nervous function in 38 children (12 M, 26 F) with periodic syndrome, by cardiovascular autonomic function tests. They consist of ortho- and parasympathetic parameters obtained by ECG registration and pressure monitoring during deep breathing, Valsalva manoeuvre, lying to standing postural change, sustained handgrip. In the absence of adequate pediatric references values, we have previously standardized these tests in a population of 198 healthy children (94 M, 104 F), aged 8.3-15.7 years. Results have been compared with our standard reference values, matching them by t-test for independent data: in both sexes, significant differences have been found out in only one of 11 parameters (p < 0.05) of the autonomic tests performed. Children affected by periodic syndrome reveal a reduced heart rate variation in transition from the early orthosympathetic phase to the late parasympathetic one after lying to standing passage, showing a smaller fluctuation of autonomic feedback systems. The physiological meaning of this result is unclear. However, in children with periodic syndrome no prevalence of ortho- or parasympathetic systems is evident.

[Epidemiologic study of cervico-vaginal pathology in IUD users]

1800 intrauterine contraceptive device users, during a period of more than thirteen years, and 1800 control non-users were examined clinically, cytologically and histopathologically for cervical pathological lesions. There was an increase, but not statistically significant, in the incidence of metaplasia, dyskariosis or mild dysplasia. There was no difference in neoplastic lesions.

[Problems related to resuscitation in studies with contrast media]

This study has the purpose of describing indications and legal implications related to the intravascular use of contrast media (ICM) in order to provide useful guidelines to the intensivist, often involved in the treatment of adverse reactions. The structure of modern contrast media (CM), is a benzenic ring carrying steadily three iodine ions. Adverse reactions due to the use of ICM, are local or systemic ranging from skin rashes or flushes (urticaria et al.), to cardiovascular, respiratory and neurologic symptoms. The prevention of these reactions is mandatory in patients reporting a history of allergy or atopia disease. From a legal point of view, the contraindication to procedures involving i.v. use of CM are not clearly pointed out therefore several concerns have been expressed. The intensivist is not required to physically attend the procedure, in agreement with the circular #64 edited in 1979; on the other hand his prompt intervention should be granted if necessary. Furthermore every therapeutic supply suitable for any resuscitational intervention should be available in the area where the test is performed. In conclusion we would like to stress the financial and ethic implications related to the choice of ICM (ionic versus non-ionic). The use of non-ionic CM offers several advantages: among them the better tolerance for the patient and the lower incidence of adverse reactions. However non-ionic CM have a cost ten-fold higher and both groups of drugs have same incidence of fatal reactions, therefore the use of non-ionic ICM is recommended for high risk patients.

[Clinical evaluation of an immunological test for premature rupture of the fetal membranes (ROM check test)]

Commonly used methods for detecting amniotic fluid in the vagina include research LA cells, ferning, nitrazina paper, ultrasound and dye injection. These methods are difficult to interpret or invasive. We have tested a new method which detects a fetal isoform of fibronectin in vaginal secretion when amniotic fluid is present. Clinical trials demonstrate the sufficient reliability in detecting amniotic fluid in the vagina of women with rupture of amniotic membranes.

[Fever as periodic disorder]

Slight, moderate but also high rises in temperature, excluding other causes of fever, can be considered symptoms of periodic syndrome originating by hypothalamic centers as soon as headache, recurrent abdominal pains, growing pains, dizziness, kinetosis. These rises aren't uncommon, but often aren't considered important and this few statistics are available. The Authors present 16 case reports of fever as periodic symptom and discuss how common factors exist in the mechanism of hyperthermia and other clinical signs of periodic syndrome (ex. migraine) but they are generally modulated differently so that disturbance of temperature regulation predominates in the first case, pain in the second.

[Comparison of periodic syndrome and spasmophilia]

Two casual clinical observations here reported allow the Authors to discuss the possible relationships between periodic syndrome and spasmophilia. Particularly they stress how these common causes of recurrent symptoms (abdominal pain, headache, growing pains, anxiety, irritability) can be the same clinical entity. This suspicion is confirmed by EMG investigation: 25 children with periodic syndrome (8 males, 17 females; 8-13 years) and 10 normal subjects (6-11 years) participate in this study. Post-ischemic EMG shows signs of neuromuscular hyperexcitability as in spasmophilia in 21 children (84%) of the first group and only in 3 of the second group. Such findings should be regarded as the first step towards a better definition of the relationships between periodic syndrome and spasmophilia.

[A diagnostic controversy: the significance of 14-6/sec positive spikes in clinical electroencephalography]

There has been a great dealt of discussion as to the clinical significance of E.E.G. 14-6 per second positive spikes (14-6 PS), a short burst lasting one second or less which occurs during light sleep in monopolar recordings, mainly in the posterior temporal regions and usually involving the parietal and occipital regions as well, for the most part in unsymmetrical fashion. Early interpretations stress the epileptic nature of vegetative attacks in patients with an inter-critical E.E.G. reading characterized by 14-6 P.S. Subsequently, however, this hypothesis has been refuted, mainly because E.E.G. intra-critical recordings have never shown evidence of any sort of paroxysmal activity. At present time expert think that the presence of 14-6 PS may be merely an indication of an electrical alteration associated with disorders in the neurovegetative area. In order to evaluate the possibility of using them as a diagnostic marker of migraine equivalents and periodic syndromes, we reviewed wake and sleep E.E.G. recordings, carried out consecutively and hence not selectively, in 617 children aged 5-16 years. 14-6 PS were present in 109 children (17.6%), 63 of whom showed evident symptoms of periodic syndrome (headache, recurrent abdominal pain, cyclic vomiting, kinetosis, etc.); hence 46 E.E.G. recording were false positive. 510 children were lacking in 14-6 PS, 91 of these presented symptoms of periodic syndromes (false negative). 14-6 PS are hence a marker 40.9% sensitive, 90.1% specific, with a predictable value of 57.7%. The search for 14-6 PS in children with periodic syndrome is not particularly sensitive as a test, but it is fairly specific: it may well constitute an useful element in diagnosis.

[Transient neuromotor anomalies in the follow-up of the newborn infant at risk]

The case history in question refers to 94 high-risk babies, 24 of whom (25%) had neuromotor problems at some time during the first year. Of these, 15 have continued to be supervised up to the present time, i.e. to the age of four. Eight of them have had overall motor treatment and seven have had constant check-ups, advice on posture and active encouragement to move their bodies. All 15 infants developed normal neuromotor behaviour by the age of two (only one was retarded in speech). We therefore feel justified in not encouraging indiscriminate remedial therapy in all cases of abnormal development. It should be used only in those cases in which there are serious, persistent problems in the sphere of feeling and relating.

[The possibility of preventing interactive disorders in the case of prolonged mother-infant separation at birth]

Considerable concern has been expressed that separation of mother and child following birth may interfere with early parent-child relationship and give to problems in the later psychosocial development of the child. In earlier publications we have evaluated the aspects of parents' emotional state and parent-infant interaction in 43 high-risk babies, hospitalized at birth for a period of one-three months. Recurrent interactive patterns and psychosomatic disturbances have been defined in their peculiarities. In this study we expose the results of our experience with 35 infants having the same characteristics as the preceding group, after adopting measures which elicit the parents' participation in looking after the baby in NICU and after studying methodologies of intervention during the follow-up programs which assess the neuropsychological conditions of the infants and their relations with their parents. We have observed a significant reduction of psychosomatic disturbances in the second group (20% vs 64%).

Population genetic studies on Jews. I. The alpha 2HS serum glycoprotein, a polymorphism strongly correlated with latitude

A sample of Jews subdivided according to the birth-place of their parents or grand-parents have been examined for a large number of genetic markers in the course of a long-term project on the genetics of Jews. We report here the findings concerning 794 Jews studied for the AHSG polymorphism. All the subsamples were in Hardy-Weinberg equilibrium. A highly significant difference was found between Sephardic + Near East Jews and Ashkenazi (AHSG*2 frequencies: 0.184 +/- 0.015 and 0.258 +/- 0.016, respectively). For comparative purposes the data available on Caucasoids have been considered. It turned out that they were neatly arranged along a latitude-AHSG gene frequency cline (0.0092 of AHSG*2 gene frequency increase per degree of increase of latitude) in the explored 30 degrees-60 degrees range (r = 0.97; P much less than 0.001). Of the two Jewish frequencies that could be taken into consideration because of their sufficient sizes, that of the Near East + Sephardic Jews was perfectly in line with the above mentioned cline, while that of the Ashkenazi was somewhat displaced in the sense of being more similar than expected to the other, more southern, Jewish group. Since the only AHSG*2 frequency significantly displaced from the regression line is that of the Ashkenazi, whose ancestors lived until centuries ago in more southern areas, this finding is a strong confirmation of the observed cline.

[Serum bile acids in the newborn: our experience]

The study of bile acids in the newborn permits to the AA. to point out that the beginning of the feeding does not influence the "physiologic cholestasis" of the first days of life. Neonatal cholestasis is the expression of the immaturity of bile acids synthesis and hepatic and intestinal carriage, which is not correlated with the maternal conditions. Furthermore, the AA. discuss about the analogy between cholestasis and "physiologic hyperbilirubinemia", from which it differs for the longer time. In fact, the maturation of the enterohepatic circle occurs very slowly under possible dietetic factors influences.

Polymorphism of plasminogen in Tuscany (Italy)

The distribution of PLG phenotypes in the population of Tuscany (Central Italy) has been investigated by means of isoelectric focusing followed by immunofixation of desialyzed sera. In a random sample of 383 unrelated healthy blood donors registered at the Hospital of Pisa, three common phenotypes, PLG A, A-B, and B, and two rare variants were found. The allele frequencies calculated in our study were: PLG*A = 0.6749, PLG*B = 0.3225, and PLG*rare = 0.0026. The theoretical exclusion rate in cases of disputed paternity is 17.42%.

The distribution of some polymorphisms in Italy

A wide data collection on blood group gene frequencies in Italian regions and provinces is presented. This report is the result of a joint collaboration of human geneticists and forensic haematologists started in 1979 and updates a previous work by the same group. The following genetic polymorphisms have been examined: red-cell antigens (ABO, FY, Kell, Kidd, Lewis, Lutheran, MNSs, P, Rhesus), red-cell enzymes (ACP1, ADA, AK1, ESD, GLO1, GPT, PGD, PGM1), plasma proteins (BF, C3, GC, HP, IGK, PI, TF). Data have been classified according to genetic systems, Italian regions and provinces. Gene frequencies were estimated by the maximum likelihood method. The goodness of fit to Hardy-Weinberg proportions has been evaluated by the likelihood ratio statistics. Genetic heterogeneity of provinces and regions is reported.

[Physiopathologic problems of obesity related to anesthesia]

Obesity, its complications and its treatment have a great importance for the anesthesiologist. The pathophysiological consequences of obesity involve great part of the organs so that the perioperative management of these subjects may affect surgical outcome. For this reason care should be taken to the peroperative evaluation of the obese patient regarding his pulmonary, metabolic and cardiac function. The anesthesiologist also needs to be aware of intraoperative problems caused by obesity. Recovery in ICU for a short time could be required for the prevention and treatment of post-operative complications.

[Early mother-infant separation and psychosocial development. II. Longitudinal study on 42 subjects]

It is the purpose of the present investigation to obtain some information as they can be drown from the activity of our follow-up for premature babies and infants at higher risk. The main objectives of the study were: - to evaluate the aspects of parent's emotional status and parent-infant interaction in the first year of life; - to evaluate possible effects of the early separation on later development of the children. We have observed 42 LBW infants (hospitalized at birth for a period of one-three months) and their parents for 7-8 years. Our study has included: interviews with parents, observation of interaction, clinical examinations, designs. Recurrent interactive patterns have been defined in their peculiarities in the first year of life. Patterns of later psychosocial development are also exposed: they are strictly related to the kind of the precocious interaction.

[Early separation of the mother and infant and psychosocial development. I. Theoretical considerations]

Considerable concern has been expressed that separation of mother and child following birth may interfere with early parent - child relationships and give rise to problems in the later psychosocial development of the child. This review highlights recent studies about the delays in maternal attachment to the child, the negative maternal perception of the child compared with the expectation of an "average" baby, the persistent parental anxiety, the effects that early separation can have at least short-term, but also long-term, influences on patterns of parental behavior and on the development of the children.

[Localized scleroderma in childhood]

Scleroderma is a rare disease in children: the clinical presentation in childhood is even more varied than in adult life. It is characterized by 'hard skin' with cutaneous features including hypo- and hyperpigmentation, thickening or thinning and loss of elasticity. It ranges from circumscribed and self-limiting pigmentary disorders to disabling and disfiguring involvement of an extremity and a rapidly fatal outcome. Scleroderma must be differentiated from many scleroderma-like conditions. Therapeutic problems are also discussed.

EsD*5 gene frequency in Tuscany (Italy)

The distribution of the human red cell esterase D (EsD) "extended" polymorphism in a population sample from Tuscany (Italy) was studied using agarose gel isoelectric focusing. The estimated gene frequencies were: EsD*1 0.864, EsD*2 0.115, EsD*5 0.021. The EsD*5 allele frequency is very similar to those reported for other European populations. The "extension" of the EsD polymorphism may prove to be useful in paternity testing.

Distribution of C3 and Bf allotypes in Tuscany (Italy)

The C3 and Bf polymorphisms were studied in 1,000 unrelated Italians. The gene frequencies were calculated and compared with other districts of Italy.

[Thrombophlebitis of the cavernous sinus and inappropriate ADH secretion syndrome]

The septic thrombosis of the cavernous sinus is a rare and serious disease which still occurs occasionally. The physician should be aware of this fact when treating infections of the nasal orbital areas. A case is presented in whom the septic thrombosis of the cavernous sinus is associated with the syndrome of inappropriate secretion of antidiuretic hormone.

Transferrin variants in Tuscany (Italy). Evidence for two "new" Tf alleles

Polyacrylamide gel isoelectric focusing (PAGIF) with carrier ampholytes was used for the determination of Tf phenotypes in a sample of 965 unrelated healthy blood donors from Tuscany (Italy). Thirteen rare variants in a heterozygote state were found (four Tf D, seven Tf B, and two rare Tf C subtypes). Among them two apparently new variants, tentatively called Tf C15 and Tf B4, were identified. The rare Tf B0 mutant was also observed.

[Velo-cardio-facial syndrome (Shprintzen syndrome)]

A patient with the velo-cardio-facial syndrome is described. The most frequent features include cleft palate, cardiac anomalies, typical facies, and learning disabilities. Less frequent findings include microcephaly, mental retardation, small stature, slender hands and digits, minor auricolar anomalies, and inguinal hernia. There were four instances of familial transmission in the 39 patients of the literature.

[Non-immunologic hydrops fetalis. Considerations apropos of a case associated with a chorioangioma of the placenta]

A case of hydrops fetalis in a newborn infant in association with a choroangioma of the placenta in described. It was only with a report in 1943 by Potter that nonimmunologic hydrops fetalis was identified. Until recently immunologic hydrops fetalis secondary to Rh incompatibility has been the most frequent cause for infants with this condition. Presently, because of the decline in the incidence of Rh sensitization, non immunologic hydrops fetalis accounts for a larger number of cases. Numerous etiologies have been reported with the occurrence of non immunologic hydrops fetalis: a review of the literature for those entities found in association with this condition is inclused.