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F Chiarelli

Publications and source records attributed to F Chiarelli.

At least 163 records · Page 9Linked to original sources
PubMed1998

Laser-Doppler-flowmetry in preterm newborns during apneic events.

MATERIALS AND METHODS: We have studied with Laser-Doppler-Flowmetry (LDF) Skin Blood Flow Perfusion (SBFP) during apneic events in 15 preterm newborns (mean GA 32.4 w; mean B.W. 1620). Eighty-four apneic episodes were analyzed and the results were gathered into two groups. Group 1 with SBFP belonging to preterms aged up to 5 days and Group 2 with SBFP records of some older newborns (from 5th to 10th day of life). At first a decrease of LDF was often observed during apneic events. RESULTS: A statistically significant difference between the two groups was noted considering the SBFP percentage reduction, the hematocrit and the time of appearance of the skin blood flow decrease. We also studied the mean of all apneic SBFP reductions in each of those newborns (11/14) who had apneic events in both periods, observing a remarkable increase in mean SBFP reduction when the newborns were older than five days. CONCLUSIONS: These differences can be caused by rheologic factors such as high hematocrit, less pronounced red cell deformability and a sort of cold vasoparalysis more evident in the first days of life. We think laser-Doppler-flowmetry be suggested when the newborn is able to better contrast the negative effects of apnea, for example centralizing the circle in favour of vital organs.

Apnea↗
PubMed1997

Thyroid function in children treated for acute lymphoblastic leukemia.

To determine the late effects of treatment on thyroid function in children who survive acute lymphoblastic leukemia, we assessed plasma levels of thyroid hormones in 24 children (15 girls and 9 boys) who had received combination of chemotherapy along with 18-24 Gy of irradiation to the cranium. The children were aged between 1 and 10.5 years (mean 3.1) at diagnosis and thyroid status was investigated between 1.3 and 13 years (mean 6.8) after completion of therapy. Six children showed a low peak of plasma thyroid stimulating hormone (TSH), after stimulation with thyrotrophin-releasing hormone (TRH). Three children showed a low basal plasma TSH concentration. Serum levels of thyroxine (T4, fT4) and triiodothyronine (T3, fT3) were normal in all patients. The frequency of thyroid hypofunction (low peak response of TSH to TRH) was more common in children receiving 24 compared to 18 Gy cranial irradiation (50% vs 14%; odds ratio = 7) and those who had completed therapy more than 5 years ago (31.3% vs 12.5%, odds ratio 3.18) although no significant association could be found (95% IC: 0.27-65.8 and 0.24-90 respectively). Because of the low mean age at diagnosis of our population no significant association could be found between children younger than 3 years of age at diagnosis and thyroid hypofunction (odds ratio = 0.14; 95% IC: 0.01-1.48). We conclude that treatment for acute lymphoblastic leukemia including cranial irradiation may lead to TRH/TSH dysfunction and therefore long term survivors should be followed for a long period after completion of therapy.

Child↗
PubMed1997

The cardio-facio-cutaneous syndrome: a long-term follow-up of two patients, with special reference to the neurological features.

The cardio-facio-cutaneous (CFC) syndrome is a newly recognized syndrome characterized by congenital heart defects, a particular facial appearance and abnormalities of hair and skin; apart from these, the most evident signs are mental retardation and other neurological abnormalities. Some of the phenotypic manifestations resemble those of Noonan syndrome, but this involves different neurological problems. We report on two children affected by cardio-facio-cutaneous syndrome who have been followed up for at least 6 years. The psychomotor retardation was severe. During the follow-up period we made a careful analysis of the neurological aspects of the course in these two patients and wish to stress that some neurological features are peculiar to this syndrome and can be useful in the diagnosis.

Abnormalities, Multiple↗
PubMed1997

Lipids and lipoproteins in diabetic adolescents and young adults with retinopathy.

PURPOSE: To compare serum concentrations of lipoproteins and apolipoproteins in insulin-dependent diabetic patients with and without retinopathy. METHODS: A cross-sectional study was performed on 42 diabetic adolescents and young adults with different degrees of retinopathy. The mean +/- SD age of the patient was 21.1 years (range 12.8-27.9 years); their mean duration of diabetes was 12.3 years (range 7.1-19.9 years). Their glycosylated haemoglobin (HbA1c) and fructosamine were respectively 10.2% (8.2-15.4%) and 280.8 mumol/l (202.1-458.5 mumol/l). Forty-two diabetics without retinopathy similar to the study population as regards age, sex, duration of disease, HbA1c and microalbuminuria values, and 42 healthy subjects, served as controls. RESULTS: Serum lipid and lipoprotein concentrations were not different from those of healthy controls in patients either with or without retinopathy. The diabetic patients were subdivided in two groups according to the degree of their retinopathy: background and preproliferative/proliferative retinopathy. Patients with preproliferative/proliferative retinopathy were found to have significantly higher lipoprotein (a) values than the other group (background, 73.3 IU/l; preproliferative/proliferative, 205.9 IU/l; p < 0.001). CONCLUSION: The increase in lipoprotein (a) levels might play a role in the development of severe retinopathy.

Adolescent↗
PubMed1997

Changes in serum lipids and lipoproteins in epileptic children treated with anticonvulsants.

OBJECTIVE: To assess the effect of long-term treatment of phenobarbital, carbamazepine and sodium valproate on serum lipids and lipoproteins in epileptic children. METHODOLOGY: One hundred and fourteen (55 male, 59 female) children and adolescents suffering from various types of epilepsy who received different antiepileptic drugs were studied. The patients were subdivided into three groups according to their therapy: (i) carbamazepine (35 patients); (ii) phenobarbital (34 patients); and (iii) sodium valproate (45 patients). One-hundred healthy sex- and age-matched children served as controls. Lipids and lipoprotein profile were evaluated before the beginning of the anticonvulsant therapy and after at least 2.5 years. In the patients receiving phenobarbital, we re-evaluated 12 children (seven male, five female) at the end of therapy. RESULTS: The children receiving phenobarbital showed high levels of serum total cholesterol and low-density lipoprotein (LDL) cholesterol and low levels of triglycerides, while children treated with carbamazepine had high levels of total cholesterol, triglycerides, LDL and high-density lipoprotein (HDL) cholesterol. Children treated with valproate had low triglycerides and LDL cholesterol levels with high levels of HDL cholesterol. The patients treated with phenobarbital showed a normalization of all parameters after the end of therapy. CONCLUSIONS: Anticonvulsant drugs significantly modify serum lipids and lipoproteins in epileptic children. The changes due to phenobarbital seem to be transient.

Adolescent↗
PubMed1997

The importance of microalbuminuria as an indicator of incipient diabetic nephropathy: therapeutic implications.

Nephropathy is the major life-threatening complication of insulin-dependent diabetes mellitus (IDDM). The clinical syndrome is characterized by persistent albuminuria (greater than 300 mg day), a rise in arterial blood pressure, and a relentless decline in glomerular filtration rate leading to end-stage renal failure. The availability of a radioimmunoassay for detecting albumin in low concentrations in urine has allowed the study of urinary albumin excretion rates in diabetics well before clinically persistent proteinuria develops. An albumin excretion rate greater than that in normal subjects and lower than that in macroalbuminuric subjects is called microalbuminuria (range 20-200 microg/min or 30-300 mg/24 h). Although recent studies have challenged the predictive value of microalbuminuria for later development of overt diabetic nephropathy, albumin excretion rate in the microalbuminuric range and its tracking (i.e. annual increase) are still considered reliable markers for prediction of later overt diabetic kidney disease. Overnight urinary collection is preferred for calculation of the rate of albumin excretion, but may be difficult to perform precisely. The albumin:creatinine ratio of the first morning urine sample is a reliable screening method: the microalbuminuric range is considered to be 2.5-25 mg/mmol or 30-300 mg/g (3.5 mg/mol has been proposed as lower limit in females because of their lower creatinine excretion). Irrespective of the procedure used, at least two samples over a 3-6-month period should test positive before microalbuminuria is confirmed and 'persistent microalbuminuria' defined. If the albumin excretion rate is persistently in the microalbuminuric range it is of crucial importance to define strategies and carry out interventions for prevention of decline in kidney function. The goal of achieving the best glycaemic control as early as possible in as many IDDM patients as is safely possible is particularly important in microalbuminuric patients. Although it is unsafe to reduce dietary protein intake drastically, particularly in children and adolescents, moderate decrease of protein intake (i.e. 0.9-1.1/g/kg day) is advisable in diabetic patients from the very beginning of the disease. Timely treatment with an angiotensin-converting enzyme inhibitor, independently of rise in arterial blood pressure, should be considered if improvement of glycaemic control and moderate decrease of dietary protein intake for 6-12 months have failed to reduce the albumin excretion rate. Screening programmes for microalbuminuria and early intervention can substantially modify the natural history of diabetic renal involvement and disease and possibly reduce the incidence of end-stage renal failure.

Albuminuria↗
PubMed1997

Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 levels in children with precocious puberty treated with gonadotropin-releasing hormone analog without or in combination with cyproterone acetate.

In order to assess the behavior of growth hormone, insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in girls with central precocious puberty treated with gonadotropin-releasing hormone (GnRH) analog-therapy, we studied 14 girls with this condition, the patients were subdivided into two groups, according to the therapy followed. Group A (n = 7; age 4.2-7.1 years) received GnRH analog in combination with cyproterone acetate, and Group B (n = 7; age 4.4-6.9 years) received long-acting analog alone. Before treatment, IGF-I levels were significantly increased compared to healthy age-matched children in the two groups (447 +/- 33 micrograms/l for Group A and 435 +/- 38 micrograms/l for Group B vs. control 175 +/- 78 micrograms/l; p < 0.01). Moreover, serum IGFBP-3 levels were significantly higher than the age-related reference range for IGFBP-3 (4478.2 +/- 178 micrograms/l for Group A and 4532.3 +/- 167 micrograms/l for Group B vs. control 2905 +/- 641 micrograms/l; p < 0.01). During the two years of gonadal suppression, Group A patients showed a significant decrease in IGF-I and IGFBP-3 levels, while in Group B there was no significant change in IGF-I; moreover, in Group B, IGFBP-3 levels increased significantly compared to baseline values during the first year of treatment (4532.3 +/- 167 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.05) and decreased significantly at the end of the second year of treatment (3816.1 +/- 189 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.01). Our study shows that the two different treatments of precocious puberty (with and without cyproterone acetate) have different effects on IGF-I and IGFBP-3, and suggests that these growth factors are under different metabolic regulation.

Child↗
PubMed1997

Flicker perimetry in diabetic children without retinopathy.

OBJECTIVE: To determine the flicker fusion frequency in children and adolescents with insulin-dependent diabetes mellitus (IDDM) who did not have fluorescein angiographic signs of retinopathy. DESIGN: Cross-sectional study. SETTING: Antidiabetic Centre, departments of Ophthalmology and Pediatrics, University of Chieti, Chieti, Italy. PATIENTS: Forty-five patients aged 9 to 18 years with IDDM without fluorescein angiographic signs of retinopathy. Forty-five healthy subjects matched for sex and age constituted the control group. The patients were classified into two subgroups according to their metabolic control: good (percentage hemoglobin Alc 9% or less) or poor (percentage hemoglobin Alc greater than 9%). OUTCOME MEASURES: Retinal flicker fusion frequency, evaluated with an automated flicker perimeter in the central 30 degrees of the visual field. RESULTS: The subjects with poor metabolic control had a significantly lower mean flicker fusion frequency than the control subjects (27.43 Hz [standard deviation (SD) 5.16 Hz] vs. 38.72 Hz [SD 4.27 Hz]) and the patients with good metabolic control (33.94 Hz [SD 5.54 Hz]) (p < 0.001). There was a significant relation between flicker fusion frequency and the percentage of hemoglobin Alc (r = -0.533, p < 0.001). CONCLUSIONS: Our results show that children with poorly controlled IDDM without fluorescein angiographic signs of retinopathy have an impairment of retinal flicker sensitivity in the central 30 degrees of the central visual field and that this impairment is related to the degree of metabolic control. Flicker perimetry is a simple, noninvasive tool that may be useful to evaluate the eye function of diabetic children.

Adolescent↗
PubMed1996

Severe hypoglycemia in insulin-dependent diabetic children treated by multiple injection insulin regimen.

The occurrence and risk factors of severe hypoglycemic attacks were analyzed during a 4-year study in a group of children and adolescents who received human insulin and followed a multiple daily injection regimen (three or four injections per day); 29 patients experienced severe hypoglycemia at least once in 4 years. Of these, 13 suffered recurrent episodes: 8 had two episodes, 4 had four episodes, and 1 patient had seven episodes. For comparative purposes, the nonhypoglycemic population (217 diabetic children) was used as a control group. The hypoglycemic children received insulin doses which were significantly higher than for nonhypoglycemic patients (1.05 +/- 0.6 U/kg daily vs 0.87 +/- 0.7; P < 0.05). Moreover, the hypoglycemic group had a significantly higher mean number of previous episodes of severe hypoglycemia than the nonhypoglycemic group (0.98 +/- 1.2 vs 0.26 +/- 0.7; P < 0.001). There was no significant difference in age, sex, duration of disease, and metabolic control between hypoglycemic and nonhypoglycemic children. There was no association between severe hypoglycemia and the presence of retinopathy, persistent microalbuminuria, or autonomic neuropathy. Severe hypoglycemia is a recurrent problem, not related to the quality of metabolic control nor to the presence of long-term microvascular complications, and diabetic children with a personal history of severe hypoglycemia are at risk for future episodes.

Adolescent↗
PubMed1996

Macular recovery time in diabetic children without retinopathy.

The aim of this study was to evaluate whether patients with initial diabetic nephropathy (defined as persistent microalbuminuria) have an impairment of macular recovery time and if this impairment changes in a long-term follow-up. Eighty insulin-dependent diabetic children without fluorescein angiographic signs of retinopathy and 80 controls were included in the study. All patients underwent nyctometry at the beginning of the study; diabetic children repeated the same test after 7 years. Diabetics were divided into two subgroups as regards presence of persistent microalbuminuria (albumin excretion rate > 20 micrograms/min/1.73 m2). At the beginning of the study, diabetics as a whole and normoalbuminuric patients showed similar data to controls, while microalbuminuric ones showed worse data at nyctometry (initial recovery time (IRT): 44.89 +/- 12.50; Summation method (SM): 509.1 +/- 312.0) in comparison with normoalbuminuric (IRT: 38.12 +/- 10.31, P = 0.010; SM 648.6 +/- 272.2, P = 0.036) and control subjects (IRT: 37.77 +/- 11.82, P = 0.004; SM: 661.5 +/- 297.5, P = 0.013). After 7 years, normoalbuminuric subjects showed a slight, but not significant worsening of nyctometry, while in microalbuminuric ones a significant difference between baseline and the end of follow-up was found (IRT: 44.89 +/- 12.50 vs. 52.91 +/- 13.9, P < 0.01; SM: 509.1 +/- 312.0 vs. 374.8 +/- 271.9, P < 0.05). Diabetic patients had a higher rate of abnormal IRT and SM than controls (P = 0.0004 and P = 0.0006, respectively). A higher number of patients in microalbuminuric subgroup than in normoalbuminuric one were found (both at baseline and at the end of follow-up) above the 95th centile of IRT (baseline 3 vs. 15; P = 0.0002; end of follow-up 5 vs. 23; P < 0.0001) and below the 5th centile of SM (baseline 5 vs. 14; P = 0.004; end of follow-up 5 vs. 19; P < 0.0001). Nyctometry was found more altered in microalbuminuric patients than in normoalbuminuric and controls. Unfortunately, there is a large overlap between the two diabetic subgroups and between diabetics and controls; for this reason, this technique is not suited for everyday practice.

Adolescent↗
PubMed1996

Autonomic dysfunction in newly diagnosed insulin-dependent diabetes mellitus children.

In order to evaluate the presence of electrophysiologic signs of autonomic dysfunction (AD) in newly diagnosed diabetic children, cardiovascular reflex tests were performed in 55 (30 female, 25 male) newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients aged 10.3-20.7 years (mean +/- S.D.: 15.2 +/- 5.6). Ten (18.2%) diabetic children had cardiovascular AD, defined as abnormal results in 2 of 5 tests. Autonomic function tests were assessed at entry and after 12, 24, and 36 months of the study. All diabetic children received human insulin and followed an intensive insulin treatment (3 or 4 injections per day), associated with a teaching program of self-management of the disease. In the 3 years of follow-up, all children improved the quality of metabolic control (glycosylated hemoglobin, HbA1c: 10.3 +/- 1.1% versus 7.7 +/- 0.9; P < .01) and manifested no significant difference between baseline and follow-up values of autonomic function tests which remained unchanged in spite of this improvement. Cardiovascular autonomic dysfunction can be present in newly diagnosed IDDM children and it seems to be stable in children who follow an intensive insulin injection therapy.

Adolescent↗
PubMed1996

Immunohistochemical analysis of c-Fos and c-Jun in retinoblastoma.

The c-fos promoter is negatively regulated by the retinoblastoma (Rb)-susceptibility-gene-encoded protein as well as by other genes involved in the control of transcription, cell cycle regulation and neoplastic transformation. We have examined by immunohistochemistry the c-Fos and c-Jun proteins in five cases of retinoblastoma in order to evaluate eventual alterations in their expression in vivo, possibly related to a gene mutation or to loss of Rb negative control.

Animals↗
PubMed1996

Premature thelarche: a long-term follow-up.

The differentiation between premature thelarche and idiopathic central precocious puberty is essential for both long-term prognosis and therapeutic approach but, until now, there have been insufficient data to predict the future of the girls with premature thelarche. We studied 46 girls with premature thelarche longitudinally. The girls were subdivided into two groups according to the time of onset of thelarche: Group A consisted of 26 girls who presented thelarche before the second year of life (mean +/- SD 14.7 +/- 5.2 months) and Group B contained 20 girls who showed breast enlargement after the second year of life (5.7 +/- 3.1 years). The mean basal follicle-stimulating hormone (FSH) level of the patients as a whole was significantly higher than normal values (2.1 +/- 0.05 vs. 0.7 +/- 0.9 mIU/ml, p < 0.01) and the luteinizing hormone (LH) level was not significantly different from that in healthy control subjects (0.8 +/- 0.6 vs. 0.6 +/- 0.7 mIU/ml). After gonadotropin-releasing hormone test the FSH response was significantly higher than normal prepubertal values (12.9 +/- 2.1 vs. 3.9 +/- 2.9 mIU/ml, p < 0.001) whereas the LH response did not differ significantly (1.8 +/- 0.6 vs. 1.7 +/- 0.9 mIU/ml). After a follow-up time ranging from 5.1 to 7.8 years (mean +/- SD 5.9 +/- 1.9) we observed a greater percentage of disappearance in the girls in Group A than in those in Group B. The present data show that the percentage of girls who developed precocious puberty was significantly higher when they presented thelarche after the age of 2 years than before; the age of onset of thelarche can be useful to distinguish patients at risk of progressing towards precocious puberty.

Adolescent↗
PubMed1995

Influence of puberty on lipids and lipoprotein profile in children with type 1 diabetes mellitus.

In order to assess whether or not the lipoprotein profile worsens throughout puberty in children with type 1 diabetes mellitus and if this change is related to dietary compliance, we studied 46 (20 female, 26 male) children. At the beginning of the study, the mean age (+/- SD) was 10.9 +/- 1.1 years; all the children studied had reached a pubertal stage of P1, G1. The mean duration of diabetes (+/- SD) was 4.9 +/- 1.8 years. The diet and the lipoprotein profile of diabetic children were analysed at the beginning of the study and after 6 years. The quality of metabolic control of subjects studied had not changed significantly at the end of the study (haemoglobin HbA1c 7.6% +/- 2.1% vs 7.9% +/- 2.0%; NS). After puberty, the diabetic patients received more energy from carbohydrate and less from lipids. Total serum cholesterol and triglycerides and levels of low-density lipoproteins were significantly higher and of high-density lipoproteins lower in the diabetic patients after puberty than before (4.47 +/- 0.7 mmol/l vs 5.99 +/- 0.6, P < 0.01; 0.90 +/- 0.02 mmol/l vs 1.45 +/- 0.03, P < 0.01; 2.2 +/- 0.3 mmol/l vs 2.8 +/- 0.5, P < 0.01; 1.5 +/- 0.2 vs 1.1 +/- 0.2, P < 0.01, respectively). These results suggest a detrimental effect of puberty on lipoproteins; probably, dietary compliance plays a role in this worsening. Dietary education should be intensified during adolescence in order to present these changes.

Child↗
PubMed1995

Glomerular hyperfiltration increases the risk of developing microalbuminuria in diabetic children.

An elevated glomerular filtration rate (GFR) is frequently detectable in type 1 diabetic children and adolescents and in those without any other evidence of incipient diabetic nephropathy. In 1982 we detected 23 patients with hyperfiltration (GFR > 140 ml/min per 1.73 m2), aged 9-15 years, with diabetes for longer than 4 years; 23 age- and sex-matched patients with diabetes of a similar duration and without hyperfiltration served as controls. Both groups were followed until March 1992, by assessing GFR every 12 months, albumin excretion rate every 6 months, blood pressure and glycated haemoglobin (HbA1) every 3 months. Dietary protein intake was similar in patients with hyperfiltration and in controls. No other drug except insulin was used throughout the study. The insulin regimen was similar in the two groups. There was no significant difference between the two groups regarding albumin excretion, blood pressure and HbA1 at the beginning of the study. Of the 23 patients with hyperfiltration, 7 developed persistent microalbuminuria (defined as an overnight albumin excretion rate > 30 micrograms/min per 1.73 m2 on at least 5 consecutive measurements); 2 of these patients had overt proteinuria. Only 1 of the diabetics with normal GFR developed persistent microalbuminuria. The positive predictive value for microalbuminuria of an initial GFR > 140 ml/min per 1.73 m2 was 63%; the negative predictive value of an initial GFR < 140 ml/min per 1.73 m2 was 94%. The increase of albumin excretion rate into the microalbuminuric range precedes the elevation of both systolic and diastolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Colour vision and persistent microalbuminuria in children with type-1 (insulin-dependent) diabetes mellitus: a longitudinal study.

In an attempt to elucidate colour vision in children with type 1 (insulin-dependent) diabetes mellitus without fluorescein angiographic signs of retinopathy, we studied a group of 50 patients of mean age + or - SD 10.27 + or - 2.89 (range 8.1-13.0 years). Results were compared with a sex-and age-matched control group. The Farnsworth-Munsell 100-hue test showed a significantly higher value in total error score (TES) in diabetics than in controls (64.07 + or - 18.32 and 54.27 + or - 12.87, respectively: P = 0.0004). Diabetic patients were divided in two groups as regards presence of persistent microalbuminuria and followed for 7 years. The HbAlc values of the two groups were: normoalbuminuric 7.10 +/- 2.92%, microalbuminuric 9.79 + or - 1.41 (P = 0.004). Microalbuminuric patients showed a significantly higher TES than normoalbuminuric subjects both at the beginning (94.79 + or - 13.98 vs. 58.10 + or - 11.98) and end of the study (103.07 + or - 14.61 vs. 61.04 + or - 13.36: P < 0.0001), and after follow-up they had a worse TES than at the beginning of the study (P = 0.01); no change in TES was found in normoalbuminuric patients during the study. The results suggest that a deficit in colour vision occurs in diabetic children before the onset of fluorescein angiographic signs of retinopathy. Our follow-up shows that microalbuminuric patients present a significant worsening of colour vision. When a patient shows persistent microalbuminuria, colour vision must be carefully evaluated, also in subjects without fluorescein angiographic signs of retinopathy.

Adolescent↗
PubMed1995

Autonomic neuropathy in diabetic children.

OBJECTIVE: Evaluate the presence of cardiovascular autonomic nerve dysfunction in children and adolescents with insulin-dependent diabetes mellitus. METHODOLOGY: We studied 110 patients (54 male, 56 female) and 100 healthy sex and age-matched children. Autonomic nerve function was assessed by standard cardiovascular reflex tests: (1) Fall in systolic blood pressure in response to standing. (2) Heart rate in response to standing. (3) Beat-to-beat rate variation during deep breathing. (4) Quotient of heart rate during and after Valsalva manoeuvre. (5) Change in blood pressure response to sustained handgrip. The coefficient of variation of heart rate was determined from 150 systoles using a microcomputer-based technique. The lower limits of normal were defined according to statistical analysis taking into account the relationship between heart rate variability and age. RESULTS: Forty-seven of the 110 diabetic children and adolescents studied showed one or more abnormal tests for cardiovascular autonomic dysfunction; many patients had an abnormality in more than one test. Twenty-two patients showed early involvement, 18 patients had definite and 7 severe involvement. No correlation was found between sex, glycaemic control, duration of diabetes or presence of retinopathy and persistent microalbuminuria and the autonomic nerve function. CONCLUSIONS: In the paediatric age group also, autonomic nerve dysfunction can be present in asymptomatic diabetic patients. Heart rate variation during Valsalva manoeuvre and maximum/minimum 30:15 ratio are the most sensitive indices to detect autonomic abnormalities in children.

Adolescent↗