A persistent fever associated with elevated inflammatory indices and ultrasound lesions of liver and spleen

The case of a 13 years old girl presenting hyperpirexya and admitted to hospital is described. Laboratory tests showed a neutrophilic leucocytosis with considerable elevation of inflammatory indices. The ultrasound of the abdomen showed irregularities in the hepatic and spleen structure due to multiple lesions with well defined and regular margins. Laboratory exams excluded infectious. The persistence of fever induced to practice MRI, and the anamnestic data of the girl’s life spent often in the countryside at her grandparents’ house led to repeat laboratory exams for infectious diseases that led to the diagnosis of a rare disease. A disease that is normally easily diagnosed and does not present all the complications presented in the case described

Bronchiolitis: Compliance with guidelines

Background - Bronchiolitis is the most common infection of the lower respiratory tract during the first year of life. The American Academy of Pediatrics (AAP) guidelines and the Italian Society of Paediatrics (SIP) Consensus underline that the diagnosis of bronchiolitis is based on the clinical history and the objective examination and that the key points of the treatment are mainly to guarantee a proper nutrition/hydration and to administer oxygen where necessar y. Objectives - To assess the compliance with international and national guidelines in hospital settings before and after sharing and discussing a care protocol Materials and Methods - Two groups consisting of 27 patients each affected by bronchiolitis were studied. The children of the first were hospitalised in 2014-2015 and were managed without complying with the unit protocol and those of the second group were hospitalised in 2015-2016, after the protocol sharing. Treatment modalities and the incidence of complication were compared. Results - Following the sharing of the clinical protocol a trend towards the decrease in the use of the antibiotic therapy and steroids was observed. A larger use of nebuliser therapy with hypertonic solution was observed with respect to the sole physiological solution or the steroidal one. The duration of hospitalisation was similar in the two considered periods. No major complications were observed in both the above two periods. Conclusions - The present study, though it considers a low number of samples, shows that the sharing of an internal protocol for the management of paediatric patients can allow resources to be optimised as well as ineffective and potentially dangerous treatments to be avoided

Road accident-related injuries can produce different types of consequences: Description of a rare case

We describe the case of an infant who, following a car accident, suffered a fractured tibia on which subsequently developed an osteomyelitis clinical management of the child has included, in addition to a prolonged antibiotic therapy, a careful evaluation by MRI and a very careful follow-up

An almost accidentally diagnosis

The case of a 13 year old girl with elevated and persistent fever is described. During hospitalization infectious mononucleosis is diagnosed. For the progressive enlargement of the spleen the patient undergoes an ultrasound examination of the abdomen which showed a mass of pancreatic origin. Further investigations confirm the presence of a rare pancreatic tumor that primarily affects adolescent females and young women in the second decade of life

Refractory primary sclerosing cholangitis becoming responsive after sulphasalazine treatment of an underlying silent colitis

Primary sclerosing cholangitis is often unresponsive to treatment. It is still controversial whether the treatment of associated gastrointestinal conditions improves the course of liver disease. We report a case of refractory primary sclerosing cholangitis benefiting from sulphasalazine treatment, prescribed for a poorly symptomatic associated microscopic colitis. The usefulness of investigating the possible presence of a silent associated intestinal disease and the use of sulphasalazine in combination with ursodeoxycholic acid as a more effective treatment for normalizing serum hepatobiliary enzymes, are pointed out

An odd septic arthritis of the hip

The paper reports the case of a 3-year-old girl presenting with septic arthritis of left hip with poor clinical response to treatments. The child had been treated for at least 3 weeks by hip joint drainage and antibiotic therapy based on synovial fluid culture (positive for coagulase negative Staphylococcus). Seven days after discharge she was admitted to our paediatric division for relapse of hip pain. Biochemical investigation showed increase in inflammatory parameters and mild anemia. Roentgenogram of the hips and femora revealed a markedly altered left proximal femoral region with disruption of subcortical bone. Hip ultrasonography was compatible with diagnosis of septic arthritis of the hip. After few days of antibiotic treatment she revealed worsening of hip pain, right knee pain, and abdominal pain, poorly responsive to analgesic treatment. Eventually, abdominal US scan showed a mass in adrenal right region compatible with malignancy. It was diagnosed as neuroblastoma stage 4, n-myc unamplified. Copyright © 2001 - 2013 Medico e Bambino

Nutrition and Liver Disease

Malnutrition in people with liver disease is a challenging issue due to its multifactorial nature, which includes hypermetabolism, increased energy needs, malabsorption, and anorexia. Despite advances in both assessment and management, correct nutritional support is still an often-unanswered need in the care of these patients to avoid poor outcomes. One of the central issues remains how to improve muscolar mass of sarcopenic chronically malnourished individuals with end stage liver diseases and cirrhosis, as only a correct nutritional assessment and subsequent nutritional handling may enhance quality of life and disease outcome. Nutritional management is mandatory in certain inherited metabolic/genetic defects: in these patients specific dietary restrictions/supplementations represent a challenge to guarantee optimal growth and liver health. A nutraceutical approach dealing with hepatoprotective effects of specific nutrients, has been proposed for several chronic liver disease, mainly in obesity related liver disease and alcoholic liver disease. Finally, other challenges are represented by tailored nutritional intervention in improving gut–liver axis dysfunction also in parenteral nutrition/intestinal failure associated liver disease, inflammatory bowel disease, and celiac disease. The purpose of this Special Issue, “Nutrition and Liver Disease”, is to provide novel information and perspectives in the field of nutrition in liver disease and its management