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Neurofibromatosis type 1 (NF1) is a progressive, multisystem disorder affecting about 1:3000 individuals. About one third of patients show serious complications and about one half are mildly affected. Since the original National Institutes of Health Consensus Conference in 1987, that established the clinical criteria for the diagnosis of NF1, there has been significant progress toward a more complete understanding of the molecular bases for NF1, and our knowledge of the natural history and management of the NF1 has significantly improved. Despite these advances, the diagnosis of NF1 is still based largely on clinical criteria and no individual prognostic evaluation or definitive medical therapy are available. The recommendations for the care of NF1 patients and their families are constantly changing: according to the new guidelines, the mainstay of management is anticipatory guidance and surveillance for treatable complications; surveillance usually includes annual follow-up visits, unless symptoms call for more frequent visits or more accurate diagnostic evaluation.

The increasing immigration from developing countries has determined new health problems. Italian Pediatricians must become acquainted with these health concerns such as the excessive use of public pediatric structures, especially hospitals, specific diseases unusual among Italian children (malaria, tuberculosis, tropical parassitosis, sickle cell anemia, rickets and others), control of previous immunizations and repetition when one is not sure of their efficacy. Moreover, immigrated children seem to be more susceptible to common pediatric diseases (mostly infections) than Italian children. Finally, children adopted from developing countries deserve special attention because they arrive from a very poor social context with frequent history of important infectious diseases, congenital diseases, malnutrition and abuse. Central precocious puberty is a frequent evolution in some of the adopted girls.

One of the most frequent and important complications of IDDM is hypertension. It begins usually in adulthood and is rare in children. In order to study the behaviour and control of BP in IDDM children and adolescents we analyzed the BP levels of 106 patients (48 males, 58 females; age 1.5-16 yrs) in relation to sex, age, duration of the disease, and different parameters of metabolic control; moreover we studied the modifications of BP levels with years (tracking). BP levels, registered every 3-6 mos, were compared to the standard levels for age of the local population (2000 students between 7 and 16 yrs of age) and expressed as standard deviation scores (SDS) of the means. For each subject a line describing the change of the SDS over time was calculated by the method of least squares: the slope of this line is called trend and represents the tendency of the BP to increase or maintain stable or decrease with time, i.e to develop or not hypertension. All patients, except one 16 y. old girl, had normal BP and no microalbuminuria, but 10 of them presented with mean levels in the upper quartile and a constantly upward BP trend. Two of these patients showed after a 2 year follow-up stable hypertension and microalbuminuria. Moreover, an analytical and statistical study pointed out that BP levels of IDDM children seem to be influenced in addition to age, sex, height, weight, ponderal excess, as the general population, by the duration of the disease the insulin dose and some metabolic parameters (HbA1, HbA1c, glycemia, creatininemia).(ABSTRACT TRUNCATED AT 250 WORDS)