La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Medullary thyroid cancer (C. M. T.) can be a sporadic form generally in adults or a heredofamilial form where the first symptom appears in pediatric and adolescent age. ⋯ M. T.. The penetrance of this neoplasia in hereditary form is 100%.
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The administration of fentanyl for sedation of ventilated newborns can induce several side-effects such as hypertension, respiratory muscle rigidity and, as shown in this report, decreased gastrointestinal motility. We report a case of paralytic ileus in a ventilated preterm infant who was given fentanyl in the first 24 hours of life. To our knowledge, the association of paralytic ileus with fentanyl has not been reported previously in full-term or preterm infants. This study indicates that early recognition is required to shorten the delay in diagnosis.
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The authors report their surgical experience concerning seriously impaired children due to congenital malformations or other non-congenital anomalies such as burns and traumas. All the patients were operated in one of 13 humanitarian missions undertaken in four developing countries. Throughout the "Third World" the demand for reconstructive surgery is extremely high due to the high birth rate and consequently large number of patients, as well as the shortage of both medical staff and supplies. ⋯ The proportion of emergencies was only 3% as these were normally excluded because of the short duration of the missions. 26 patients had to be reoperated as a result of complications or surgical failure and long-term follow-up provided by either the local staff or as a part of later missions was given in over 70% of the major surgery performed. On the whole, the surgical results were highly satisfactory even if a final evaluation should be made taking the cultural factors and the socio-environmental conditions of each individual country into consideration. Such an evaluation should most importantly be made on the basis of the well-being of the patient, general satisfaction of the families involved and improved quality of life of these children.
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Twenty-eight patients operated with success for isolated coarctation of the aorta (i.e. with normal blood pressure and upper/lower limb gradient < or = 20 mmHg at rest) underwent exercise testing to evaluate blood pressure and upper/lower limb pressure gradient during exercise. At maximum effort: 57% (16/28) of the patients were hypertensive and 43% (12/28) of patients increased upper/lower limb gradient over 35 mmHg. No significant correlation was found between the age at surgery (before or after 3 years of age) and maximal systolic blood pressure on exercise and maximal pressure gradient on exercise. ⋯ Some studies in the literature have shown that many patients with normal blood pressure and no or little residual upper/lower limb pressure gradient at rest, may develop an anomalous blood pressure response e and/or a high upper/lower limb pressure gradient during exercise. We have studied by exercise test a group of patients successfully operated on for isolated coarctation of the aorta to evaluate the behaviour of the systolic blood pressure and the upper/lower limb pressure gradient during exercise. The aim was to recognize the patients who, inspite of very good operative result, remain at cardiovascular risk in the long-term follow-up.
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The febrile child, previously healthy, represents a frequent diagnosis and management problem for pediatricians who work in private offices and those in hospital emergency departments. We are specifically interested in the identification, for the febrile child with septic risk, of severity parameters permitting to assess the likelihood of a serious bacterial infection. ⋯ A significant correlation resulted for levels of temperature over 39 degrees C, toxic-appearing child and very positive C-RP values. We have defined this condition as a "threatening" fever requiring an immediate hospitalization in order to administer appropriate blood tests and cultures, and also, according to our rationale, to start an early antibiotic plus corticosteroid therapy (within 6-12 hours from the disease onset).