A Rare Case of Esophageal Dysphagia in Children: Aberrant Right Subclavian Artery

Dysphagia is an impairment of swallowing that may involve any structures from the mouth to the stomach. Esophageal dysphagia presents with the sensation of food sticking, pain with swallowing, substernal pressure, or chronic heartburn. There are many causes of esophageal dysphagia, such as motility disorders and mechanical and inflammatory diseases. Infrequently dysphagia arises from extrinsic compression of the esophagus from any vascular anomaly of the aortic arch. The most common embryologic abnormality of the aortic arch is aberrant right subclavian artery, clinically known as arteria lusoria. This abnormality is usually silent. Here, we report a case of six-year-old child presenting to us with a history of progressive dysphagia without respiratory symptoms. A barium esophagogram showed an increase of the physiological esophageal narrowing at the level of aortic arch, while at esophagogastroduodenoscopy there was an extrinsic pulsatile compression of the posterior portion of the esophagus suggesting an extrinsic compression by an aberrant vessel. Angio-CT (computed tomography) scan confirmed the presence of an aberrant right subclavian artery

Kawasaki facile e difficile: Dieci messaggi attraverso i casi degli specializzandi italiani

La malattia di Kawasaki (MK) \ue8 una vasculite sistemica che di norma colpisce bambini di 2-5 anni: la diagnosi ed il trattamento sono in genere facili, come descritto nel primo caso. Tuttavia, nonostante un'ageguata terapia, il 10-15% dei pazienti sviluppa aneurismi dell'arteria coronarica. I pazienti ad alto rischio sono quelli sotto l'anno di et\ue0 o con forme incomplete o atipiche. Per questo motivo la tempestivit\ue0 della diagnosi risulta fondamentale per iniziare una terapia adeguata. Questo articolo descrive alcuni casi di forme atipiche di MK: un ascesso retrofaringeo, un ittero colestatico febbrile e una sindrome da attivazione macrofagica. Tuttavia, l'articolo riporta alcuni casi severi di MK come uno shock emodinamico, il caso di un paziente che ha ricevuto una terapia anti-TNF a causa dell'inefficacia della terapia standard ed infine il caso di un adulto che ha subito un intervento di bypass aorto-coronarico dovuto alle conseguenze di un aneurisma gigante sviluppato all'et\ue0 di 2 anni dopo la MK. Alla fine dell'articolo, i messaggi trasmessi dai casi descritti sono riassunti in 10 punti

A prospective study on BK viral load: prediction of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.

Prospective study on the predictive value of BK viral load on blood on the occurrence of H

Time of Onset and Risk Factors of Renal Involvement in Children with Henoch-Schönlein Purpura: Retrospective Study

Background: Henoch-Schönlein purpura (HSP) is a common systemic vasculitis in children, involving the skin, musculoskeletal system, gastrointestinal tract and kidneys. Some studies in children have shown possible risk factors linked with the development and severity of HSP Nephritis (HSPN). The aim of this study was to research predicting factors for the development of HSPN. Methods: We retrospectively evaluated 132 pediatric patients with HSP, according to EULAR/PRINTO/PRESS criteria. All patients were screened for HSPN by urinalysis. Finally, we compared demographic, clinical and laboratory data in HSP patients with and without nephritis. Results: The median age at HSP diagnosis [6.2 (2.6–17.5) vs. 5.5 (0.8–15.4) years, p = 0.03] and the incidence of abdominal pain (48 vs. 27%, p = 0.01) were significantly higher in HSPN patients. No differences were evidenced regarding gender, allergic diseases, skin recurrences, gastrointestinal involvement, musculoskeletal involvement, scrotal involvement, and laboratory data (white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, erythrocyte sedimentation rate, and blood concentration of IgA). Conclusions: The age at diagnosis and abdominal pain were independent risk factors for renal involvement in HSP patients. However, due to the retrospective nature of this study, further long-term and prospective studies will be necessary