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Appendicitis in children less than five years old:A challenge for the general practitioner

World Journal of Clinical Pediatrics 2015年第2期4卷 19-24页

作者： Pierluigi Marzuillo claudio germani Baruch S Krauss Egidio Barbi Department of Women and Children and General and Specialized Surgery Seconda Università degli Studi di Napoli Institute for Maternal and Child Health IRCCS Burlo Garofolo Boston Childrens Hospital

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical *** is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness(61% of the patients) followed by guarding(55%), diffuse tenderness(39%), rebound(32%), and mass(6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.

关键词： Appendicitis Children Early diagnosis Newborn Appendicitis complications

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Acute lobar nephritis in children: Not so easy to recognize and manage

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World Journal of Clinical Pediatrics 2016年第1期5卷 136-142页

作者： Cristina Bibalo Andrea Apicella Veronica Guastalla Pierluigi Marzuillo Floriana Zennaro Carmela Tringali Andrea Taddio claudio germani Egidio Barbi Depart-ment of Pediatrics University of Trieste Department of Womenand Children and General and Specialized Surgery Seconda Università degli Studi di Napoli Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" Pediatric Ward Ospedale di San Daniele San Daniele del Friuli

Acute lobar nephritis(ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.

关键词： Acute lobar nephritis Children Computed tomography Magnetic resonance imagine Upper urinary tract infection

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