Buzzi Childrens Hospital

Castelvetro di Modena, Italy

Buzzi Childrens Hospital

Castelvetro di Modena, Italy

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Leo G.,Buzzi Childrens Hospital | Triulzi F.,Buzzi Childrens Hospital Istituti Clinici Of Perfezionamento | Incorvaia C.,Allergy Pulmonary Rehabilitation Unit
Current Allergy and Asthma Reports | Year: 2012

Chronic rhinosinusitis (CRS) is a relatively common disease in children but is often overlooked because at times the clinical symptoms are subtle and nonspecific. This makes imaging very important in the diagnosis. Among the different techniques, plain radiography has limited utility, whereas CT scan and MRI have a major role in evaluating the modifications caused by the disease. In particular, a CT scan provides higher resolution of bone and soft tissue and removes the overlapping structures that are present in conventional radiography. CT is recommended in isolated sphenoid sinusitis, is essential in diagnosing fungal sinusitis, and is the technique of choice when orbital complications are suspected. MRI allows investigation of not only the morphology of structures, but their intrinsic biophysical and biochemical properties, such as water content, cellular density, lipid or blood product deposits, and fibrosis. MRI allows better soft tissue differentiation and high spatial resolution images depicting fine details. When indicated, MRI with contrast gadolinium-based agents may better characterize the local disease extension or its diffusion beyond paranasal and nasal cavities and has excellent contrast resolution. A combination of CT and MRI is useful in cases of diagnostic difficulties, especially when complications are involved. © Springer Science+Business Media, LLC 2012.


Ferrazzi E.,Buzzi Childrens Hospital | Stampalija T.,Buzzi Childrens Hospital | Aupont J.E.,St Damien Children Hospital
Fetal and Maternal Medicine Review | Year: 2013

The evidence from biological, clinical and epidemiological studies support the view of different phenotypes of pre-eclampsia: placental, which usually occurs early in pregnancy and is associated with poor early placentation of different severity with subsequent restriction of fetal growth; and maternogenic, which generally occurs late in pregnancy and it is not related to placental insufficiency and fetal growth restriction. This latter condition is associated with low grade chronic inflammation,raised body mass index and frequently relative insulin insensitivity. Unless these distinctions in the disease are acknowledged, clinicians and scientists will continue to try to treat and investigate two phenotypically quite different conditions as if they are one. Copyright © Cambridge University Press 2013.


Masieri S.,University of Rome La Sapienza | Trabattoni D.,L Sacco Hospital | Incorvaia C.,ICP Hospital | De Luca M.C.,L Sacco Hospital | And 3 more authors.
Current Medical Research and Opinion | Year: 2014

Objective: Adenoids, tubal tonsil, palatine tonsil, and lingual tonsil are immunological organs included in the Waldeyer's ring, the basic function of which is the antibody production to common environmental antigens. Adenoidal hypertrophy (AH) is a major medical issue in children, and adenoidectomy is still the most used treatment worldwide. The response of adenoids to allergens is a good model to evaluate their immunological function. This report assessed the immunological changes in adenoid tissues from children with allergic rhinitis (AR) undergoing sublingual immunotherapy (SLIT). Methods: Adenoid samples from 16 children (seven males, nine females, mean age 7.12 years) with AH and clinical indication to adenoidectomy were collected. Of them, five children were not allergic and 11 had house dust mite and grass pollen-induced AR. Among allergic children, in four AR was treated by antihistamines while in seven AR was treated by high-dose SLIT during 4-6 months. The evaluation addressed the T helper 1 (Th1), Th2, and Th3 cells by performing a PCR array on mRNA extracted from adenoid samples. Results: In non-allergic children, a typical Th1 pattern was found. SLIT induced a strong down-regulation of genes involved in Th2 and Th1 activation and function. In particular, in SLIT-treated allergic children IL-4, CCR2, CCR3, and PTGDR2 (Th2 related genes) and CD28, IL-2, and INHA (Th1 related genes) expression was reduced, compared with children treated with antihistamines. Conclusions: These preliminary findings warrant investigation in trials including larger numbers of patients, but indicate that hypertrophic adenoids of allergic children have the typical response to the specific allergen administered by SLIT. This should suggest that one should reconsider the immunological role of adenoids. © 2014 Informa UK Ltd.


PubMed | St George's, University of London, Bambino Gesu Research Childrens Hospital, Buzzi Childrens Hospital and Fondazione IRCCS Ca Granda
Type: Journal Article | Journal: Journal of pediatric surgery | Year: 2016

The aim of the study was to assess current international practice in the long term follow-up, in managing active problems and transition of care for teenagers born with anorectal malformations (ARM).An original survey was administered to delegates attending two large colorectal surgical meetings in 2015. The 21 questions covered long term follow-up, specific issues for teenagers and transition of care.96/236 delegates completed the survey. Follow-up was routinely suspended before 10 year of age by 33% of respondents. 90% of them did not use a scoring system to assess or risks stratify patients, despite 81% stating that an objective score would be beneficial. 40% of respondents felt that >30% of their teenagers had ongoing active medical or psychosocial issues. 42% thought their patients were not ready to be transitioned. The process of transition should start around 13-16 years according to 54% of respondents. 72% had no protocol for transition and 82% did not hold multidisciplinary meetings with adult practitioners before transition.International consensus on the following aspects of the care in ARM is needed: structured long term follow-up, objective assessment and risk stratification scores, pathways of transition and methods to prepare patients, parents and adult practitioners.


Menni F.,University of Milan | Testa S.,Nephrology Unit | Guez S.,University of Milan | Chiarelli G.,University of Milan | And 2 more authors.
Pediatric Nephrology | Year: 2012

Background Inborn errors of cobalamin (Cbl) absorption and metabolism form a large group of rare diseases that include Cbl-C disorder. Among the renal complications of Cbl-C disorder, atypical hemolytic uremic syndrome (HUS) is the least common and has been described only in a small number of cases. Case-diagnosis/Treatment Four patients were admitted to our clinic after 15-30 days of life with vomiting associated with poor sucking, failure to thrive, lethargy and hypotonia. Examinations showed thrombocytopenia and microangio-pathic hemolytic anemia associated with renal damage. The neonates had high blood homocysteine levels, increased urinary levels of both homocystine and methylmalonic acid, increased propionylcarnitine (C3) levels and an increased C3/ acetylcarnitine ratio. Homozygosity for c.271-272dupA (p.Arg91LysfsX14) of the MMACHC gene was detected in three patients, and heterozygosity for c.271-272dupA and c.666C > A(p.Tyr222X) in one patient, which confirmed the diagnosis of Cbl-C disorder. Treatment with parenteral hydroxycobalamin in combination with folic acid and betaine gradually normalized the metabolic test findings and hematological and renal parameters after about 1 week. Conclusions Atypical HUS in neonates with Cbl-C disorder may be associated with mild to moderate renal involvement also in early-onset disease, and early adequate therapy can reverse renal damage. © 2011 IPNA.


PubMed | University of Padua, University of Milan Bicocca, Neuroradiology Unit, Buzzi Childrens Hospital and Ospedale San Gerardo
Type: | Journal: Neuropediatrics | Year: 2016

Cervical abortive myelocistocele is a very rare congenital malformation. In this case report, we describe the prenatal magnetic resonance imaging (MRI) of such entity in a 20-week gestational age fetus, whose imaging features showed to be different from the only other previous prenatal report. We underscored the value of fetal MR for counseling and prognosis, especially when assessing the integrity of the spinal cord.


Ferrazzi E.,Buzzi Childrens Hospital | Ferrazzi E.,University of Milan | Milani S.,University of Milan | Cirillo F.,Buzzi Childrens Hospital | And 9 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2015

Introduction. The aim of this study was to analyze how the progression of cervical dilatation in active labor can be predicted by digital assessment in low-risk pregnant women, in spontaneous labor at term. Material and methods. This prospective observational study was performed on 328 women with singleton term gestations experiencing midwife-led labor according to local protocols, progressing to full dilatation and spontaneous delivery without any medical intervention. Mixed nonlinear models were adopted to (i) model individual cervical data into centile curves and (ii) calculate the time needed to gain 1 cm in cervical dilatation (TNG1cm) modeled as a function of current dilatation. We correlated the first and the last TNG1cm on parturients with at least four cervical data points. Results. TNG1cm showed large variations, both before and after 6 cm. This variability of natural progression of cervical curves described by the 10th and 90th centiles exceeded the differences observed in published curves from cohorts homogeneous for parity, weight and ethnicity. There was no significant correlation between the first and the last TNG1cm. Neonatal base excess was not significantly different in women with TNG1cm <10th centile and >90th centile. Conclusions. The rate of cervical dilatation, traced by parsimonious nonlinear mixed models, is largely unpredictable in the case of spontaneous naturally progressing labor, even when possible larger individual variability is excluded by prudent clinical rules. Future research in labor and delivery should be focused on the diagnosis of the causes that lie behind apparently erratic cervical changes. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.


PubMed | Buzzi Childrens Hospital and University of Milan
Type: Journal Article | Journal: Acta obstetricia et gynecologica Scandinavica | Year: 2015

The aim of this study was to analyze how the progression of cervical dilatation in active labor can be predicted by digital assessment in low-risk pregnant women, in spontaneous labor at term.This prospective observational study was performed on 328 women with singleton term gestations experiencing midwife-led labor according to local protocols, progressing to full dilatation and spontaneous delivery without any medical intervention. Mixed nonlinear models were adopted to (i) model individual cervical data into centile curves and (ii) calculate the time needed to gain 1 cm in cervical dilatation (TNG1cm ) modeled as a function of current dilatation. We correlated the first and the last TNG1cm on parturients with at least four cervical data points.TNG1cm showed large variations, both before and after 6 cm. This variability of natural progression of cervical curves described by the 10th and 90th centiles exceeded the differences observed in published curves from cohorts homogeneous for parity, weight and ethnicity. There was no significant correlation between the first and the last TNG1cm . Neonatal base excess was not significantly different in women with TNG1cm <10th centile and >90th centile.The rate of cervical dilatation, traced by parsimonious nonlinear mixed models, is largely unpredictable in the case of spontaneous naturally progressing labor, even when possible larger individual variability is excluded by prudent clinical rules. Future research in labor and delivery should be focused on the diagnosis of the causes that lie behind apparently erratic cervical changes.


Leo G.,Buzzi Childrens Hospital | Incorvaia C.,ICP Hospital | Masieri S.,University of Rome La Sapienza | Triulzi F.,Buzzi Childrens Hospital
European Annals of Allergy and Clinical Immunology | Year: 2010

Symptoms of chronic rhinosinusitis (CRS) are nasal blockage, nasal discharge, postnasal drip, facial pain, headache, and reduction or loss of smell, but they are often subtle and make it difficult to obtain a firm diagnosis based only on clinical data, and especially to distinguish CRS from persistent rhinitis. A. diagnosis of certainty of CRS relies upon either direct observation by nasal fibroendoscopy of nasal turbinates, middle meatus, and rhinopharynx, detecting mucopurulent discharge from the middle meatus, and/or oedema or mucosal obstruction, or by imaging of the rhinosinusal cavities. Imaging techniques such as computed tomography (CT) scanning and magnetic resonance (MR) are currently recommended in consensus documents, while plain radiography is considered of poor diagnostic value. However, recent studies indicated that radiography by the Waters projection had a sensitivity of 84.2% and a specificity of 76.6%, which suggests to use it routinely in suspected CRS, limiting the number of more expensive imaging investigations. This seems important in the current economic landscape that requires a cost-effectiveness evaluation in each diagnostic procedure.


Leo G.,Buzzi Childrens Hospital | Triulzi F.,Buzzi Childrens Hospital | Incorvaia C.,Allergy Pulmonary rehabilitation Unit
Pediatric Allergy and Immunology | Year: 2012

Chronic rhinosinusitis (CRS) is a rather common disease in children, but its symptoms are often subtle and non-specific and this may result in overlooking a correct diagnosis. In turn, a missed diagnosis of CRS prevents a correct management to be performed and is associated with uneffective investigations and improper treatments. Actually, when CRS symptoms, which are mainly nasal congestion and obstruction, nasal discharge, facial pain, cough, and halitosis, are correctly assessed, the clinical diagnosis of CRS may be achieved, and confirmation may be obtained by imaging criteria or nasal fibroendoscopy. In imaging, computed tomography (CT) is the first choice technique for the evaluation of CRS and is able to provide an anatomic road map when surgery is required. Magnetic resonance imaging (MRI) of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. Also for middle ear disorders, CT is the first choice because it detects opacification of the middle ear cavity and mastoid cells, presence of fluids or debris, and allows the ossicular chain and the cortical bone of the mastoid to be evaluated. Another important diagnostic issue is the need to look for disorders that are frequently associated with CRS, such as obstructive sleep apnea syndrome (OSAS), that has some recognized risk factors in adenotonsillar hypertrophy, craniofacial anomalies, obesity, and neuromuscular disorders. Other associated disorders requiring investigation are recurrent or persistent otitis media and difficult asthma. © 2012 John Wiley & Sons A/S.

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