Through a careful examination of the up-to-date literature on the subject, the Authors provide a full account of the present knowledge about the physiopathology of the status asthmaticus; at the same time they draw a practical exhaustive guide to the treatment to be carried out in hospital. The work arises from the considerable increase of mortality rate, due to asthma, recorded in the last few years.

Adolescent↗

PubMedDate not supplied

[The prognostic effect of amplification of the MYCN oncogene in neuroblastoma. The preliminary results of the Italian Cooperative Group for Neuroblastoma (GCINB)].

Of 567 children with neuroblastoma diagnosed between November 1984 and May 1993 in 21 Italian institutions, 235 (41%) have been evaluated for MYCN oncogene amplification. The amplification (3 or more copies of the gene) was found in 39 patients (17%) and was more frequent in patients aged more than one year, abdominal primary site of the tumor, advanced stages, normal urinary excretion of vanillylmandelic acid (VMA), and high level of LDH, NSE and ferritin. The five-year survival of the 235 patients (62%) was significantly better in patients with normal copy number of MYCN (69% versus 29%). By correlating genomic amplification with clinical and biochemical characteristics, MYCN amplification was found associated with a worse prognosis even when patients were subdivided for age (under and above one year), disease extension (localized operable, localized but inoperable, and disseminated) with exception for Stage IV-S, VMA and homovanillic acid excretion, serum levels of NSE and ferritin, but not of LDH. These data confirm the unfavourable prognostic meaning of MYCN amplification, but are unable to define if it represents a new independent variable.

Adolescent↗

PubMedDate not supplied

[Neuroblastoma: update on clinical aspects and therapy].

Despite the remarkable amount of clinical and biologic information that has been cumulated on neuroblastoma, particularly in the last two decades, this embryonal tumor of early childhood remains one of the major challenges of pediatric oncology. It is now clear that the term encompasses at least two entities characterized by different features and outcome. The favorable entity includes patients with localized disease, infants and stage IV-s. The unfavorable entity refers to patients older than one year at diagnosis with disseminated disease. However, in both entities exceptions exploiting a clinical course different from expected do occur. Molecular biology is presently suggesting that specific genomic alterations may predict unfavorable events. Patients evaluation should thus include the study of biologic features since they may provide us with strongly predictive clues. In this article the Authors describe the main clinical features of the neoplasia and focus on some of its more peculiar patterns. They also refer on the criteria that the International Neuroblastoma Staging System (INSS) has recently designed regarding diagnosis, evaluation of disease extent, and response to therapy, in order to improve the cooperations and the understanding among the major Cooperative Groups. Finally, the treatment outlines of the main forms of clinical presentations are described.

Age Factors↗

PubMedDate not supplied

[Minor skull trauma in pediatrics].

Our experience, as well as the latest literature in the field, stresses the importance of the clinical and neurological examinations in cases of minor head injury. This could avoid the performance of unnecessary imaging and EEG studies and the admittance of children who only need pharmacological therapy in order to relieve the neurotoxic effects of trauma at the axonal and cellular levels.

Child, Preschool↗

PubMedDate not supplied

[Effects of PEEP on intrathoracic and extrathoracic blood volumes evaluated with the COLD system in patients with acute respiratory failure. Preliminary study].

AIM OF THE STUDY: To evaluate the effects of positive end expiratory pressure (PEEP) on intrathoracic and extrathoracic blood volumes in patients with acute respiratory failure (ARF). METHODS: In 4 ARF patients, we have measured cardiac output (CI), intrathoracic blood volume (ITBVI), global end-diastolic ventricular volume (GEDVI), pulmonary (PBVI) and total (TBVI) blood volumes, during application of two PEEP levels (0 and 10 cm H2O). These measurements have been performed by PULSION COLD Z-021 system, using the double indicator dilution technique (thermal and dye dilution). RESULTS: PEEP application caused a significant reduction in CI (from 3.8 +/- 0.4 to 2.9 +/- 0.1 1/min/m2) and ITBVI (from 888 +/- 48 to 698 +/- 25 ml/m2). The reduction in intrathoracic blood volume was associated with a significant reduction in GEDVI and PBVI. After PEEP application, there was a significant reduction in TBVI (from 2437 +/- 135 to 1984 +/- 49 ml/m2). CONCLUSIONS: PEEP application decreases cardiac index, mainly through a preload reduction, as evidenced by the reduction in intrathoracic and end-diastolic ventricular blood volumes. The preload effect is due to an increase in intrathoracic pressure with reduction in total circulating blood volume. TBVI reduction is consistent with blood pooling in vascular compartments, e.g., splanchnic compartment, characterized by long vascular time constant.

Acute Disease↗

PubMedDate not supplied

[Sepsis related to a permanent central venous catheter in children with neoplastic disease: practical implications of a continuous surveillance of the etiology].

Indwelling central venous catheter-related bacteremias are an important complication in patients with cancer. In general they are due to Staphylococcus aureus and Candida, while bacteremias caused by Gram-negatives are less common and often related to infusate contaminans. We describe a survey of etiological surveillance of Broviac catheter-related infections at G. Gaslini Children's Hospital of Genoa, Italy. In the period 1989-1992 an increase of Broviac catheter-related bacteremias due to Gram-negatives was demonstrated as compared with previous years (1985-1988). At home parental management was suspected as an important risk factor, since this complication was frequently due to infusate contaminants and no epidemic cluster or positive surveillance culture was observed in the Hospital. Therefore at home management was changed, especially regarding heparin storage. The subsequent, prospective follow-up from July 1993 to December 1995 showed a significant decrease in catheter-related bacteremias due to Gram-negatives (P = 0.003, chi-square test). In conclusion, a strict control on at home catheter management procedures must be maintained in order to reduce the risk of indwelling central venous catheter-related infections in children with cancer.

Bacteremia↗

PubMedDate not supplied

[The Mallory-Weiss syndrome. Review of 85 cases (author's transl)].

Explore the source record for details and available documents.

Humans↗

PubMedDate not supplied

[Bowen type degeneration on a zoniform porokeratosis of Mibelli].

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Aged↗