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De Nigris A, Arenella M, Di Nardo G, Marco GMD, Mormile A, Lauretta D, De Simone C, Pepe A, Cosimi R, Vastarella R, Giannattasio A, Salomone G, Perrotta S, Cioffi S, Marzuillo P, Tipo V, Martemucci L. The diagnostic and therapeutic challenge of atrial flutter in children: a case report. Ital J Pediatr 2023; 49:137. [PMID: 37814308 PMCID: PMC10563290 DOI: 10.1186/s13052-023-01542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes. CASE PRESENTATION A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history. CONCLUSIONS The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children.
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Affiliation(s)
- Angelica De Nigris
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, Naples, 80138, Italy.
| | - Mattia Arenella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, Naples, 80138, Italy
| | - Giangiacomo Di Nardo
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Giovanni Maria Di Marco
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Annunziata Mormile
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Daria Lauretta
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Caterina De Simone
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, 80126, Italy
| | - Angela Pepe
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi, 84081, Italy
| | - Rosaria Cosimi
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Rossella Vastarella
- Division of Cardiology, Department of Pediatrics, Santobono-Pausilipon Children Medical Hospital, Naples, 80129, Italy
| | - Antonietta Giannattasio
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children's Hospital, Naples, 80129, Italy
| | - Giovanni Salomone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, Baronissi, 84081, Italy
| | - Silverio Perrotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, Naples, 80138, Italy
| | - Speranza Cioffi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, Naples, 80138, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, Naples, 80138, Italy
| | - Vincenzo Tipo
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children's Hospital, Naples, 80129, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Bucci C, Caruso F, Quitadamo P, Tipo V, Martemucci L, Marmo R. COVID-19 lockdown led to fewer ingestion cases but a higher percentage of more serious cases needed hospitalisation. Acta Paediatr 2021; 110:1293-1294. [PMID: 33404132 DOI: 10.1111/apa.15748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Cristina Bucci
- Pediatric Gastroenterology Santobono‐Pausilipon Hospital Naples Italy
| | - Flora Caruso
- Pediatric Gastroenterology Santobono‐Pausilipon Hospital Naples Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology Santobono‐Pausilipon Hospital Naples Italy
| | - Vincenzo Tipo
- Emergency Department Santobono‐Pausilipon Hospital Naples Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Santobono‐Pausilipon Hospital Naples Italy
| | - Riccardo Marmo
- Gastroenterology and endsocpy Unit, L. Curto Hospital ASL Salerno Italy
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Naddei R, Bruno V, Martemucci L, Pecoraro C, Di Nardo G. Shiga Toxin Producing Escherichia coli-Hemolytic Uremic Syndrome Mimicking Acute Severe Ulcerative Colitis in a Child With Bloody Diarrhea. Inflamm Bowel Dis 2019; 25:e92-e93. [PMID: 30934058 DOI: 10.1093/ibd/izz058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Roberta Naddei
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Naples, Italy
| | - Valentina Bruno
- Pediatric Nephrology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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Mauro A, Mauro S, Rega R, Martemucci L, Sottile R. Successful treatment of hemorrhagic bullous Henoch-Schonlein purpura with intravenous immunoglobulins. Pediatr Dermatol 2019; 36:e34-e36. [PMID: 30561101 DOI: 10.1111/pde.13715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. There is no consensus about the management for isolated cutaneous manifestations in HSP. We describe a case of HSP presenting with severe skin lesions that did not respond to standard therapy with corticosteroids. The 11-year-old child was treated with intravenous immunoglobulins, which induced rapid and persistent resolution of symptomatology.
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Affiliation(s)
- Angela Mauro
- Department of Paediatrics, Santa Maria della Pietà Hospital, Nola-Naples, Italy
| | - Salvatore Mauro
- Department of Paediatrics, Santa Maria della Pietà Hospital, Nola-Naples, Italy
| | - Roberto Rega
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Luigi Martemucci
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rita Sottile
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Di Nardo G, Calabrese C, Conti Nibali R, De Matteis A, Casciani E, Martemucci L, Pagliaro G, Pagano N. Enteroscopy in children. United European Gastroenterol J 2018; 6:961-969. [PMID: 30228882 PMCID: PMC6137589 DOI: 10.1177/2050640618789853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Device-assisted enteroscopy is a new endoscopic technique for the evaluation of small bowel in adults and children. Data in pediatric population are limited. This review aims to identify diagnostic and therapeutic benefits of enteroscopy in children. METHODS We have analysed paediatric literature on device-assisted enteroscopy focusing on indications, technical aspects and complications, with attention given to adult publications that may be applicable to the paediatric population. RESULTS Obscure gastrointestinal bleeding, Crohn's disease and small bowel polyps are the main indications of enteroscopy in children. Device-assisted enteroscopy has high diagnostic yield for the main paediatric indications, but MR-enterography and capsule endoscopy should be used beforehand in diagnostic work-up to better identify candidates for enteroscopy and to improve its diagnostic and therapeutic yield. Major complications are rare and mostly related to therapeutic procedures. CONCLUSION Despite limited data in the paediatric population, device-assisted enteroscopy represents a useful and safe endoscopic technique in children. Its use, combined with MR-enterography and capsule endoscopy, allows identification and treatment of many of the small bowel paediatric diseases with a low risk of complications.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
- International Hospital Salvator Mundi – UPMC, Rome, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Arianna De Matteis
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Emanuele Casciani
- International Hospital Salvator Mundi – UPMC, Rome, Italy
- Department of Emergency Radiology, Sapienza University of Rome, Rome, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Giuseppe Pagliaro
- Pediatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nico Pagano
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
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Di Nardo G, Cremon C, Frediani S, Lucarelli S, Villa MP, Stanghellini V, La Torre G, Martemucci L, Barbara G. Allergic Proctocolitis Is a Risk Factor for Functional Gastrointestinal Disorders in Children. J Pediatr 2018; 195:128-133.e1. [PMID: 29352590 DOI: 10.1016/j.jpeds.2017.10.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/23/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test the hypothesis that allergic proctocolitis, a cause of self-limiting rectal bleeding in infants, can predispose to the development of functional gastrointestinal disorders (FGIDs) later in childhood. STUDY DESIGN We studied a cohort of 80 consecutive patients diagnosed with allergic proctocolitis. Their sibling or matched children presenting to the same hospital for minor trauma served as controls. Parents of the patients with allergic proctocolitis and controls participated in a telephone interview every 12 months until the child was at least 4 years old. At that time, they were asked to complete the parental Questionnaire on Pediatric Gastrointestinal Symptoms, Rome III version. RESULTS Sixteen of the 160 subjects (10.0%) included in the study met the Rome III criteria for FGIDs. Among the 80 patients with allergic proctocolitis, 12 (15.0%) reported FGIDs, compared with 4 of 80 (5.0%) controls (P = .035). After adjustment for age and sex, the OR for FGIDs in allergic proctocolitis group was 4.39 (95% CI, 1.03-18.68). FGIDs were significantly associated with iron deficiency anemia, duration of hematochezia, and younger age at presentation. In a multivariate analysis, only the duration of hematochezia was significantly associated with the development of FGIDs (OR, 3.14; 95% CI,1.72-5.74). CONCLUSIONS We have identified allergic proctocolitis as a new risk factor for the development of FGIDs in children. Our data suggest that not only infection, but also a transient early-life allergic inflammatory trigger may induce persistent digestive symptoms, supporting the existence of "postinflammatory" FGIDs.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Simone Frediani
- Pediatric Gastroenterology Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Sandra Lucarelli
- Pediatric Gastroenterology Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Maria Pia Villa
- Pediatric Unit, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Sofia VM, Da Sacco L, Surace C, Tomaiuolo AC, Genovese S, Grotta S, Gnazzo M, Ciocca L, Petrocchi S, Alghisi F, Montemitro E, Martemucci L, Elce A, Lucidi V, Castaldo G, Angioni A. Extensive molecular analysis suggested the strong genetic heterogeneity of idiopathic chronic pancreatitis. Mol Med 2016; 22:300-309. [PMID: 27264265 DOI: 10.2119/molmed.2016.00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Rationale: Genetic features of Chronic Pancreatitis (CP) have been extensively investigated mainly testing genes associated to the trypsinogen activation pathway. However, different molecular pathways involving other genes may be implicated in CP pathogenesis. Objectives: 80 patients with Idiopathic CP were investigated using Next Generation Sequencing approach with a panel of 70 genes related to six different pancreatic pathways: premature activation of trypsinogen; modifier genes of Cystic Fibrosis phenotype; pancreatic secretion and ion homeostasis; Calcium signalling and zymogen granules exocytosis; autophagy; autoimmune pancreatitis related genes. Results: We detected mutations in 34 out of 70 genes examined; 64/80 patients (80.0%) were positive for mutations in one or more genes, 16/80 patients (20.0%) had no mutations. Mutations in CFTR were detected in 32/80 patients (40.0%) and 22 of them exhibited at least one mutation in genes of other pancreatic pathways. Of the remaining 48 patients, 13/80 (16.3%) had mutations in genes involved in premature activation of trypsinogen and 19/80 (23.8%) had mutations only in genes of the other pathways: 38/64 patients positive for mutations showed variants in two or more genes (59.3%). Conclusions: Our data, although to be extended with functional analysis of novel mutations, suggest a high rate of genetic heterogeneity in chronic pancreatitis and that trans-heterozygosity may predispose to the idiopathic CP phenotype.
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Affiliation(s)
| | - Letizia Da Sacco
- Multifactorial Diseases and Complex Phenotypes Research Area, "Bambino Gesù" Children's Hospital, IRCCS
| | - Cecilia Surace
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Silvia Genovese
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Simona Grotta
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS; Present address: S. Pietro Fatebenefratelli Hospital, UOSD Medical Genetics
| | - Maria Gnazzo
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Laura Ciocca
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | - Stefano Petrocchi
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Enza Montemitro
- Cystic Fibrosis Unit, "Bambino Gesù" Children's Hospital, IRCCS
| | | | - Ausilia Elce
- Ceinge-Biotecnologie avanzate, Naples, Università Telematica Pegaso, Naples, Italy
| | | | - Giuseppe Castaldo
- Ceinge-Biotecnologie avanzate, Naples, Dipartimento di Medicina Molecolare and Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Adriano Angioni
- Laboratory of Medical Genetics, "Bambino Gesù" Children's Hospital, IRCCS, Viale di San Paolo 15, 00146 Rome, Italy, 0668592536
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