Papers by Franco Zacchello
The Journal of Pediatrics, 2003
Ten children (4.6%) among a cohort of 219 with Kawasaki disease (KD) had their onset with severe ... more Ten children (4.6%) among a cohort of 219 with Kawasaki disease (KD) had their onset with severe abdominal complaints. Incomplete KD presentation at the time of acute abdomen was present in nine of 10 patients. Acute abdominal pain and distension, vomiting, hepatomegaly, and jaundice were the most common symptoms at onset. Hematemesis was present in one; toxic shock syndrome requiring care in the intensive care unit occurred in four. Five patients had laparotomy, three had percutaneous transhepatic biliary drainage, and one had a gastrointestinal endoscopy. Postoperative diagnosis was gallbladder hydrops with cholestasis in five, paralytic ileus in three, appendicular vasculitis in one, and hemorrhagic duodenitis in one. All patients completely recovered, but 50% developed coronary aneurysms despite early intravenous gammaglobulin treatment. Acute surgical abdomen can be the presenting manifestation of KD. In older children with fever, rash, and acute abdominal pain or hematemesis, KD should be considered in the differential diagnosis.
Rheumatology, 2004
Objective. Pharmacokinetic studies have shown that the biological effect of triamcinolone acetoni... more Objective. Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide (TA) is equivalent to that of triamcinolone hexacetonide (TH), if used at double the dosage. In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints, in children with juvenile idiopathic arthritis (JIA). Method. Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study. The symmetry was assessed by both clinical examination and synovial fluid analysis. The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA. The identity of injected compound was blinded to the patient and to the physician. Results. Thirty-seven patients, 30 female, seven male, with JIA, entered the study. A total of 86 joints were injected. Twentyone (53.8%) of the joints injected with TA relapsed first compared with only six (15.4%) of the joints injected with TH. In three (7.7%) relapse occurred simultaneously. Nine (23%) were still in remission after 24-month follow-up. The percentage of joints with lasting remission was higher with TH than with TA (80 vs 47.5% after 12 months and 63.6 vs 32.4% after 24 months, respectively; log rank test P ¼ 0.003). Conclusion. Even when TA is given at higher doses, TH is more effective and should be considered the drug of choice for intraarticular treatment of JIA.
Rheumatology, 2003
Objective. To compare the efficacy and safety of intra-articular triamcinolone hexacetonide (TH) ... more Objective. To compare the efficacy and safety of intra-articular triamcinolone hexacetonide (TH) and triamcinolone acetonide (TA) in children with oligoarticular juvenile idiopathic arthritis (JIA). Methods. One hundred and thirty joints of 85 patients undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. The efficacy of both treatments was evaluated prospectively in a blinded fashion. A good response was defined as a decrease in the articular score of !60% from baseline. Clinical, laboratory and immunological variables were noted in order to examine possible factors, other than treatment, predictive of the result. Results. Seventy injections were performed using TH and 60 with TA. The two groups were comparable for clinical, immunological and laboratory characteristics. The rate of response was significantly higher with TH than with TA: 81.4% vs 53.3% (P ¼ 0.001) at 6 months, 67.1 vs 43.3% (P ¼ 0.006) at 12 months, and 60 vs 33.3% (P ¼ 0.002) at 24 months. Conclusion. At comparable doses TH appeared to be much more effective than TA for intra-articular use, in both short-and long-term follow-up. This result was not affected by disease duration or degree of local and systemic inflammation.
Pediatric Research, 2005
Background : Increased activity of chitotriosidase, a human enzyme with chitinolytic properties, ... more Background : Increased activity of chitotriosidase, a human enzyme with chitinolytic properties, has been observed to increase in neonates with fungal and microbial infections. IL-10 is an antiflammatory cytokine associated with Th-2 response and thus alternative activation of macrophages which are believed to produce chitotriosidase. Aim : To investigate chitotriosidase activity in relation to IL-10 levels in neonates with fungal and microbial infections. Neonates-Methods : A total of 20 neonates, 6 with fungal (1 Aspergullus niger, 5 Candida albicans) and 14 with microbial infections, were studied. In all, chitotriosidase activity (fluorometric method) in urine samples and IL-10 plasma levels (Elisa Diaclone kit) were measured on diagnosis and in 16/20 neonates in serial samples. Results : A positive statistically significant correlation was observed between chitotriosidase activity in urine and IL-10 plasma levels (chitotriosidase activity: 0-10060, mean: 594.86 nmoles/mg creatinine/hr, nϭ42, IL-10 : 0.8-263.6 mean : 58.8 pg/ml, nϭ44; Pearson qϭ0.411, pϭ0.008). In fungal, but not in microbial infections, the highest IL-10 levels were observed in neonates that died. Conclusions : Our results, in agreement with previous studies, support the proposal that chitotriosidase is produced by alternatively activated macrophages. Increased IL-10 levels may be an indicator of adverse outcome in fungal infections.
Pediatric Research, 2005
Background : Increased activity of chitotriosidase, a human enzyme with chitinolytic properties, ... more Background : Increased activity of chitotriosidase, a human enzyme with chitinolytic properties, has been observed to increase in neonates with fungal and microbial infections. IL-10 is an antiflammatory cytokine associated with Th-2 response and thus alternative activation of macrophages which are believed to produce chitotriosidase. Aim : To investigate chitotriosidase activity in relation to IL-10 levels in neonates with fungal and microbial infections. Neonates-Methods : A total of 20 neonates, 6 with fungal (1 Aspergullus niger, 5 Candida albicans) and 14 with microbial infections, were studied. In all, chitotriosidase activity (fluorometric method) in urine samples and IL-10 plasma levels (Elisa Diaclone kit) were measured on diagnosis and in 16/20 neonates in serial samples. Results : A positive statistically significant correlation was observed between chitotriosidase activity in urine and IL-10 plasma levels (chitotriosidase activity: 0-10060, mean: 594.86 nmoles/mg creatinine/hr, nϭ42, IL-10 : 0.8-263.6 mean : 58.8 pg/ml, nϭ44; Pearson qϭ0.411, pϭ0.008). In fungal, but not in microbial infections, the highest IL-10 levels were observed in neonates that died. Conclusions : Our results, in agreement with previous studies, support the proposal that chitotriosidase is produced by alternatively activated macrophages. Increased IL-10 levels may be an indicator of adverse outcome in fungal infections.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1998
Aim-To evaluate the eVects of low dose fentanyl infusion analgesia on behavioural and neuroendocr... more Aim-To evaluate the eVects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in premature infants ventilated for hyaline membrane disease. Methods-Twenty seven ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of 1.1 (0.08 SE) µg/kg/h for 75 (5) hours, and 28 untreated infants were considered a control group. A behavioural sedation score was used to assess the infants' behaviour. Urinary metanephrine and the normetanephrine:creatinine molar ratio were determined at 0, 24, 48 and 72 hours. Outcome data and ventilatory indexes were recorded for each infant. Results-The fentanyl group showed significantly lower behavioural stress scores and O 2 desaturations than controls and lower urinary concentrations of metanephrine and normetanephrine at 24, 48, 72 hours. The two groups showed no significant diVerence in ventilatory variables or short term outcome. Conclusions-A short course of low dose fentanyl infusion reduces behavioural sedation scores, O 2 desaturations and neuroendocrine stress response in preterm ventilated infants.
European Journal of Pain, 1998
The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mi... more The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mixture of local anaesthetics) in controlling pain due to arteriovenous fistula cannulation in teenagers undergoing chronic haemodialysis. The study was conducted in two phases, one prospective, the other a blind randomized trial, at the Paediatric Haemodialysis service of the Paediatrics Department of Padua University, Italy. It involved six teenagers, aged 12-18 years. Pain was measured using the visual analogue scale, indirect evaluation by nurses and a four-category verbal rating scale. Results showed that: (1) the visual analogue scale calls for an adequate training period; and (2) the EMLA cream might be effective in controlling cannulation-related pain but emotional factors, such as uncontrolled fear and stress, can interfere with the global efficacy of the analgesic approach. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
American Journal of Respiratory and Critical Care Medicine, 2001
Journal of Medical Genetics, Nov 1, 1999
Mutations in the gap junction protein connexin 26 (Cx26) gene (GJB2) seem to account for many cas... more Mutations in the gap junction protein connexin 26 (Cx26) gene (GJB2) seem to account for many cases of congenital sensorineural hearing impairment, the reported prevalence being 34-50% in autosomal recessive cases and 10-37% in sporadic cases. The hearing impairment in these patients has been described as severe or profound. We have studied 53 unrelated subjects with congenital nonsyndromic sensorineural hearing impairment in order to evaluate the prevalence and type of Cx26 mutations and establish better genotype-phenotype correlation. Mutations in the Cx26 gene were found in 53% of the subjects tested, 35.3% of the autosomal recessive and 60% of the sporadic cases in our series. Three new mutations were identified. The hearing deficit varied from mild to profound even in 35delG homozygotes within the same family. No evidence of progression of the impairment was found. Alterations of the Cx26 gene account for a large proportion of cases of congenital non-syndromic sensorineural deafness, so it seems appropriate to extend the molecular analysis even to subjects with mild or moderate prelingual hearing impairment of unknown cause.
Archives of Disease in Childhood-fetal and Neonatal Edition, 2000
Background-Methylxanthines are often administered to preterm infants for the treatment of apnoea.... more Background-Methylxanthines are often administered to preterm infants for the treatment of apnoea. Aims-To study the eVects of theophylline on energy metabolism, physical activity, and lung mechanics in preterm infants. Methods-Indirect calorimetry was performed for six hours before and after administration of a bolus of theophylline (5 mg/kg) in 18 preterm infants while physical activity was recorded with a video camera. Lung mechanics measurements were performed at baseline and 12 and 24 hours after theophylline treatment. Results-Theophylline increased mean (SEM) energy expenditure by 15 (5) kJ/kg/ day and augmented carbohydrate utilisation from 6.8 to 8.0 g/kg/day, but fat oxidation was unchanged. After theophylline treatment, preterm infants had faster respiration, lower transcutaneous CO 2 , and improved static respiratory compliance without increased physical activity. Conclusions-A bolus of 5 mg/kg theophylline increased energy expenditure independently of physical activity, increased carbohydrate utilisation, and improved respiratory compliance. The increased energy expenditure could be detrimental to the growth of the preterm infant.
Pediatric Anesthesia, 2008
Background: There is limited evidence on the analgesic efficacy of opioids during percutaneous i... more Background: There is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants.Aim: To assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants.Methods: Fifty-four neonates [mean gestational age (±sd) 28 ± 2 weeks; birth weight 1126 ± 337 g] were randomly assigned to remifentanil infusion at 0.03 mcg·kg−1·min−1 (R) or placebo (C) in addition to 0.3 ml of 12% sucrose per os and non-nutritive sucking.Results: Validated pain scales [Neonatal Infants Pain Scale (NIPS) and Premature Infants Pain Profile (PIPP)] administered at the baseline T0, skin preparation T1, needle insertion T2, and recovery T3, revealed differences in mean NIPS scores (C 5.3 ± 1.3 vs R 4.2 ± 1.4 at T1 and C 5.0 ± 1.3 vs R 3.4 ± 1.3 at T2) and PIPP scores (C 9.3 ± 1.6 vs R 7.1 ± 1.5 at T1 and C 8.6 ± 1.7 vs R 6.1 ± 1.4 at T2); P < 0.05. Cardiovascular and respiratory response,...
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1998
Aim-To evaluate the eVects of low dose fentanyl infusion analgesia on behavioural and neuroendocr... more Aim-To evaluate the eVects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in premature infants ventilated for hyaline membrane disease. Methods-Twenty seven ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of 1.1 (0.08 SE) µg/kg/h for 75 (5) hours, and 28 untreated infants were considered a control group. A behavioural sedation score was used to assess the infants' behaviour. Urinary metanephrine and the normetanephrine:creatinine molar ratio were determined at 0, 24, 48 and 72 hours. Outcome data and ventilatory indexes were recorded for each infant. Results-The fentanyl group showed significantly lower behavioural stress scores and O 2 desaturations than controls and lower urinary concentrations of metanephrine and normetanephrine at 24, 48, 72 hours. The two groups showed no significant diVerence in ventilatory variables or short term outcome. Conclusions-A short course of low dose fentanyl infusion reduces behavioural sedation scores, O 2 desaturations and neuroendocrine stress response in preterm ventilated infants.
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Papers by Franco Zacchello