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Le problematiche IUGR nei gemelli
No full textIntrauterin Growth Retardation is more common
among twins than singleton. The reduction of intrauterine enviroment and level of transplacental diffusion of
nutrients are main responsible factors. Moreover, anastomosis of vessels between the arterial and venous systems of twins may induce a different irroration and a discordance of growth. Levels of discordane greater than 25% between twin may be associated with a twin¬twin transfusion syndrome, in which the donor is pale and ischemic and the recipient shows hemodynamic troubles within the spectrum of a hyperviscosity syn¬drome. These twins show an additional risk of morta¬lity and morbidity with respect to singleton and con¬cordant twins. The overall number of twins is nowa¬days increased up to 2.5 per thousands livebirths in relation to the diffusion of the pregnancies due to assisted technologies (ART). In faci, both the pharmacological induction of the ovulation and the implantation of in vitro fertilized embryos increase the probability of twinning, dyzygotic as well as monozygotic ones
A case of Kawasaki disease mimicking acute appendicitis
No full textKawasaki disease (KD) is an acute vasculitis of unknown aetiology occurring mostly in infants and young children. KD is characterized by fever (≥5 days), conjunctivitis, rash, cervical lymphadenopathy, lips, oral mucosa, palms and soles erythema, hands and feet oedema [1].
Coronary artery aneurysms develop in 15-25% of untreated children [2] with risk of ischemic heart disease, myocardial infarction, sudden death [3;4]. Treatment with intravenous gamma globulins (IVIG) within the first 10 days reduces the incidence of aneurysms to <5% [4]. The KD diagnosis is clinical, based on the recognition of a characteristic set of signs and symptoms [4]. Children not meeting traditional criteria are considered as “atypical” or “incomplete” KD (10-45%) possessing higher risk of coronary artery aneurysms [4]. Abdominal symptoms, including acute appendicitis and appendicular vasculitis, can occur before the development of classical features [4;5]. A 50% coronary artery aneurysm rate is reported in KD children with a surgical abdomen. It is still unclear if it reflects the delay in diagnosis and treatment or it is a marker of a more severe vasculitis, involving intestinal tract.
Our clinical case is a 3 years-old child with fever (remittent, high-spiking 37.5÷39 °C, 2-3 spikes/day, persisting for two weeks), right lower quadrant abdominal pain, McBurney’s sign, rebound tenderness. Abdominal echography confirmed acute appendicitis with peritonitis diagnosis. Appendicular vasculitis with peritoneal inflammation and serous secretion was postoperative diagnosis. After intervention and cephalosporin injection fever persisted; some days later, he presented conjunctivitis, lips cracking, elevation of the erythrocyte sedimentation rate and C-reactive protein, thrombocytosis (715.000); KD was suspected and echocardiogram revealed two sacciform coronary artery aneurysms in the common trunk proximal part (diameter: 3.1, 2.9 mm). He received IVIG (2 g/kg) and acetylsalicylic acid (100 mg/kg/day in four doses). He failed to defervesce and received a second IVIG dose [4], with a dramatic clinical improvement. Five days later he developed hands oedema and periungueal fingers peeling; he was kept on Aspirin at 5 mg/kg/day. On follow-up echocardiograms demonstrated persistent coronary artery dilatation.
Persistent fever with conjunctivitis and lips cracking is very important marker for KD suspicion. At our patient’s age acute appendicitis is rare; on the contrary medical aetiology of abdominal pain must be excluded. The unusual post-operative course with persistent fever, also after antibiotics administration, is another marker for correct diagnosis.
We suggest to extend differential diagnosis of abdominal pain and fever also to KD and to evaluate by echocardiogram all suspected KD
Ernia diaframmatica congenita: analisi dei fattori prognostici in 27 pazienti (2000-2006).
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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