[Celiac disease and the evolution of its diagnosis. Comparison and experience at a hospital pediatric department (1975-1993). (Second part)].

In a period of over 18 years the prominent medical bibliographic marks with regard to definition, diagnosis and examinations of coeliac disease (CD) have been compared and as far as possible reproduced. The results confirm the remarks derivating from wider statistics. From the beginning of 1975 to the first six months of 1993 in Merate Hospital Pediatric Division, 323 patients were submitted to a first jejunal peroral biopsy in 133 cases (41.

[Celiac disease and its diagnostic evolution. Comparisons and experiences in a hospital pediatric department (1975-1992). I].

The coeliac disease (CD) or gluten-sensitive enteropathy (GSE) is a permanent intolerance to wheat gliadin and to correlated proteins inducing malabsorption and typical damages of the jejunal mucosa (total or subtotal villous atrophy = SVA) in genetically-predisposed individuals ("DQW2"). A large amount of research has been devoted to CD pathogenesis: the most recent studies, thanks to sophisticated and experimental methods, support the pathogenetic immunological theory and the one of direct cytotoxicity. The correct diagnostic procedure for CD, established in 1970 by the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN), suggested three small bowel mucosal biopsies.

[A rare congenital malformation: genu recurvatum. Presentation of a case].

The authors report a case of congenital genu recurvatum: a rare malformation characterized for abnormal hyperextension of knee and wide limitation of flexion. Pathogenesis, clinical pictures and therapy are described.

[Indications and results of surgical treatment in gastroesophageal reflux and hiatal hernia].

It is well known that closure of the cardia is incomplete in about 25-30% of all infants; the GER is a direct consequence. Roughly two-thirds of these infants do not show symptoms and only one-third become symptomatic. The symptoms are mild in about 75% of the symptomatic children; no treatment or medical treatment by pediatrician is required.

[Long=term evaluation of renal damage in primary vesico-renal reflux after corrective surgery].

Traditionally 3 mechanisms are responsible for the development of renal damage when primary vesico-renal reflux is present: reflux is a manifestation of abnormal embryological development of the ureteral bud, with subsequent dysplasia; sterile reflux damages the kidney, perhaps trough a mechanical or/and an immunological mechanism; renal damage occurs as a result of the reflux of infected urine into susceptible renal papilla (intrarenal reflux). Whatever the mechanism, it is apparent that reflux and renal damage are intimately related. It does appear that for the most part damage is done at an early age.