Marina Vakaki

The efficacy and safety of gonadotropin-releasing hormone analog treatment in childhood and adolescence: a single center, long-term follow-up study.

OBJECTIVE The objective of the study was to evaluate the long-term effect of GnRH analog (GnRHa) treatment on final height (FH), body mass index (BMI), body composition, bone mineral density (BMD), and ovarian function. SUBJECTS/METHODS Ninety-two females, evaluated in adulthood, were categorized as follows: group A, 47 girls with idiopathic central precocious puberty (33 GnRHa treated and 14 nontreated); group B, 24 girls with isolated GH deficiency (15 GnRHa and GH treated and nine GH treated); group C, 21 girls with idiopathic short stature (seven GnRHa and GH treated, seven GnRHa treated, and seven nontreated). RESULTS FH, BMD, and percent fat mass of GnRHa-treated patients in all three groups were comparable with those of the respective nontreated subjects. BMI values of GnRHa-treated and nontreated subjects in groups A and C were comparable, whereas in group B, a higher BMI was found in subjects treated only with GH. Nontreated patients with ICPP had greater maximal ovarian volumes, higher LH and LH to FSH ratio, and more severe hirsutism than GnRHa-treated ones. Menstrual cycle characteristics were not different between treated and nontreated subjects. The prevalence of polycystic ovary syndrome in treated and untreated girls with ICPP was comparable, whereas in the entire cohort, it was 11.1% in GnRHa treated and 32.1% in the untreated (P = 0.02). CONCLUSIONS Girls treated in childhood with GnRHa have normal BMI, BMD, body composition, and ovarian function in early adulthood. FH is not increased in girls with ICPP in whom GnRHa was initiated at about 8 yr. There is no evidence that GnRHa treatment predisposes to polycystic ovary syndrome or menstrual irregularities.

Aberrant thymus in infants : sonographic evaluation

Abstract We report five children with aberrant thymus, four of whom presented with an upper suprasternal mass and one with a lateral neck mass. Awareness of this entity, together with knowledge of its variable presentation, is essential for unnecessary surgery to be avoided. US should be the initial diagnostic approach and occasionally leads to the correct diagnosis.

Sonographic features of intestinal and biliary ascariasis in childhood: case report and review of the literature.

Abstract Despite the fact that Ascaris lumbricoides is one of the commonest intestinal infections in developing countries, there are very few reports in the literature about the sonographic findings of intestinal and biliary ascariasis in childhood. The clinical manifestations, diagnostic procedures and imaging appearance of intestinal and biliary ascariasis in two patients are discussed with a brief review of the literature.

Appendiceal and appendiceal-ileocolic intussusception: sonographic and radiographic evaluation

Abstract The sonographic appearances of two children with appendiceal intussusception and two others with appendiceal-intestinal intussusception are described. All the cases were documented by barium enema and surgically confirmed.

New sonographic appearance of hepatic mesenchymal hamartoma in childhood

We present clinical, radiographic, and sonographic findings in 3 children with hepatic mesenchymal hamartoma, a rare benign tumor of childhood. The presence of round hyperechoic parietal nodules within the cystic spaces of the hamartomas is a new sonographic finding.

Lung Ultrasound as First-Line Examination for the Diagnosis of Community-Acquired Pneumonia in Children.

Objectives The diagnosis of pediatric community-acquired pneumonia (CAP) is based on clinical criteria. Even though chest x-ray (CXR) is only recommended in severe cases, it is often requested from physicians in mild cases, thus increasing radiation exposure. Lung ultrasound (LUS) is not included in the diagnostic workup. The objective of this study was to evaluate the diagnostic performance of LUS against CXR. Methods Children who presented to the emergency department with clinical signs suggesting CAP and had already been evaluated with a CXR were included in the study. Availability of a pediatric sonographer expert in LUS was also considered a criterion for participation. Chest x-ray and LUS were considered positive for CAP in cases of alveolar or interstitial pattern of disease. The diagnostic criterion standard was the ex post diagnosis of pneumonia, made by an independent senior expert pediatrician, after evaluation of the complete medical chart. Results Sixty-nine children were enrolled in the study, with 66 of 69 positive for CAP. Receiver operating characteristic curve analysis results for CXR were 95.5% sensitivity and 100% specificity, whereas for LUS, sensitivity was reported 92.42% and specificity 100%. Comparison of the 2 receiver operating characteristic curves revealed no difference in the diagnostic value of the 2 methods for the diagnosis of pneumonia (P = 0.658). However, LUS classified more cases as alveolar disease compared with CXR. Conclusions Lung ultrasound plays a significant role in the detection of CAP, not inferior to CXR. The aim of this study was to encourage the use of ultrasound as a first-line examination for CAP in children.

Treatment with Thyroxine Reduces Thyroid Volume in Euthyroid Children and Adolescents with Chronic Autoimmune Thyroiditis

Background/Aims: Treatment with thyroxine in children with chronic autoimmune thyroiditis (AT) is controversial. The aim of this study is to investigate, by using thyroid ultrasonography, whether thyroxine influences thyroid volume in non-goitrous euthyroid children with AT. Methods: We studied 50 euthyroid non-goitrous children and adolescents with AT for 2 years by thyroid function tests and ultrasonography; 25 were randomized to receive thyroxine and 25 did not receive treatment. Median (IQR) age was 12.1 (11.1–13.2) years. Results: At baseline there was no difference in thyroid volume SDS between the two groups (treatment group 1.1 (0.7–1.5) and controls 0.9 (0.4–1.4), respectively). After 2 years the treatment group had lower thyroid volume SDS compared to the controls (0.6 (0.3–1.0) vs. 2.0 (1.1–2.3), p = 0.001). One child of the treatment group and 12 of the control group developed goiter. Two control children developed subclinical hypothyroidism. Within the treatment group, thyroid volume SDS was lower after 2 years of treatment (p = 0.002). Within the control group, thyroid volume SDS and TSH levels increased after 2 years of follow-up (p = 0.016, 1.9 (1.5–2.8) vs. 3.2 (2.4–4.4) mIU/ml, p = 0.006, respectively). Conclusions: Treatment with thyroxine reduces thyroid volume in non-goitrous euthyroid children with AT and may prevent goiter development.

Evolution of sonographic appearance of the thyroid gland in children with Hashimoto's thyroiditis.

BACKGROUND Although thyroid ultrasound is a valuable tool for the diagnosis and follow-up of patients with Hashimotos thyroiditis (HT), classical sonographic findings are not always present. AIM To calculate the time needed for children with HT and normal ultrasound at diagnosis to develop characteristic sonographic findings. PATIENTS AND METHODS 105 children (23 male and 82 female) with HT (mean age 9.4 +/- 2.9 years) were studied. Physical examination and measurements of TSH and fT4 levels were performed at diagnosis, at 3-month intervals for the first year, and twice yearly thereafter. Thyroid ultrasound was performed at diagnosis and twice yearly thereafter. The median follow-up duration was 18 months (range: 6-61 months). RESULTS The time needed for 30%, 50%, and 70% of children to demonstrate an abnormal thyroid sonographic pattern was 4, 7, and 14 months, respectively. Important factors accelerating sonographic changes were goiter (p = 0.023), hypothyroidism (p = 0.0255), and seropositivity for both thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) autoantibodies (p = 0.0005). CONCLUSION Sonographic findings of HT are present in 37% of children at diagnosis. Fifty percent of children with normal initial thyroid US will develop changes within 7 months; however, characteristic findings may not develop for over 4 years.

Scrotal hematocele as an unusual presentation of blunt abdominal trauma in three male infants.

Three infants presented with bluish discoloration and swelling of the scrotum with no history of scrotal trauma. Sonography revealed unilateral hematoceles in 2 cases and bilateral hematoceles in the third. All 3 infants had intact testes. The communicating hematoceles were the result of hemoperitoneum due to splanchnic hematoma.

Perforation of multiple gastric duplication cysts: diagnosis by sonography.

Abstract. A case of perforation of multiple gastric duplication cysts is presented. The rarity of this case is based on its multiplicity, its small size, its perforation into peritoneal cavity, as well as on the detection of tiny foci of ectopic pancreatic tissue at the site of perforation. The sonographic appearance and the clinical manifestations are discussed.