A Case of Cystic Dysplasia of the Rete Testis in a 17-Months-Old Boy

Cystic dysplasia of the testis (CDT) is a benign, congenital malformation of the testis and a rare cause of painless scrotal swelling in children, mimicking testicular cancer. It is commonly unilateral, often associated with ipsilateral wolffian duct and ureteral abnormalities. Cystic dysplasia of the rete testis (CDT) represents a diagnostic challenge made easier if age, precise localisation, typical ultrasonographic features, the presence or absence of associated genitourinary malformations, as well as tumor markers are considered. The definite treatment of such a benign lesion is testis-sparing surgery, however in most cases watch and wait strategy can be recommended. We present a case of cystic dysplasia of the testis in a 17-month-old boy with right multicystic dysplastic kidney, epididymal cyst, history of vesicoureteral reflux (VUR), as well as of solitary umbilical artery. We performed epididymidal cyst enucleation and right testicular biopsy

Osteoprotegerin, Soluble Receptor Activator of Nuclear Factor- κ

Aims. To evaluate carotid intima-media thickness (cIMT) and biomarkers of the osteoprotegerin/receptor activator of nuclear factor-κB ligand (OPG/RANKL) system in type 1 diabetes (T1DM) children and adolescents and controls. Subjects and Methods. Fifty six T1DM patients (mean ± SD age: 12.0 ± 2.7 years, diabetes duration: 5.42 ± 2.87 years and HbA1c: 8.0 ± 1.5%) and 28 healthy matched controls, were studied with anthropometric and laboratory measurements, including serum OPG, soluble RANKL (sRANKL) and cIMT. Results. Anthropometric, laboratory, and cIMT measurements were similar between T1DM youngsters and controls. However patients with longer diabetes duration (>/7.0 years) had indicatively higher cIMT (cIMT = 0.49 vs 0.44 mm, P 0.072) and triglyceride levels than the rest of the patients (93.7 vs 64.6 mg/dl, P 0.025). Both in the total study population (β 0.418, P 0.027) and among T1DM patients separately (β 0.604, P 0.013), BMI was the only factor associated with cIMT. BMI was further associated with OPG in both groups (β −0.335, P 0.003 and β −0.356, P 0.008 respectively), while sRANKL levels were not associated with any factor. Conclusions. BMI was the strongest independent predictor of cIMT among the whole population, and especially in diabetics, suggesting a possible synergistic effect of diabetes and adiposity on atherosclerotic burden. BMI was overall strongly associated with circulating OPG, but the causes of this association remain unclear

The color and pulsed Doppler study of the terminal veins and its contribution to the prognosis and follow-up of the neonatal intraventricular hemorrhage of the brain

PURPOSE: a) To evaluate the sonographic appearance and velocities of the terminal veins (TV) in premature neonates without/ with subependymal (GMH) or intraventricular hemorrhage (IVH), and b) to investigate for an early sonographic finding, with the contribution of the color and pulsed Doppler technique, which could be helpful in the prognosis of IVH, with great clinical significance. MATERIAL AND METHODS: We studied two groups of prematures (24-36 gestational weeks), in a Neonatal Intensive Care Unit: The I group (60 prematures without GMH/IVH), and II group (40 neonates with GMH/IVH). All neonates were examined with gray-scale brain sonography, as well as color and pulsed Doppler sonography of their TVs with estimation of their Tmax and Tmean velocities. In group I, the brain sonographic examination was performed in the first week of life. In group II, the first sonogram was performed between day 1 and 3 of life, and was repeated every 3 days for the 10 days after the initial. 2-4 sonographic weekly re-examinations followed depending on size and evolution of the hemorrhage. No flow in the TV was attributed to its thrombosis. RESULTS: In group I, the 117 out of 120 TVs were visualized with the color Doppler technique. Their flow pattern was continuous, monophasic. Tmax and Tmean velocities increased in a linear correlation with the gestational weeks. Tmax velocities ranged from 2.04 cm/sec (24 gestational weeks) to 4.63 cm/sec (36 gestational weeks), and Tmean velocities from 1.16 to 2.81 cm/sec, respectively. In group ΙΙ, 14 GMH, 33 IVH GrIΙ, 17 IVH GrIΙΙ and 4 PHI were demonstrated. In the case of one large GMH, in two IVH GrIΙ, and one IVH GrIΙΙ no flow was identified in the ipsilateral TV. All these cases were followed by ipsilateral PHI appearance. In the initial brain sonogram of 3 newborns, 4 PHI were revealed and no flow in the ipsilateral TV was detected. In all the remaining neonates, flow was identified in the normal positioned or displaced TV. CONCLUSION: The TVs are sonographically illustrated in 97.5% of normal prematures. Their flow pattern is monophasic continuous, and their velocities lower than term neonates. In normal prematures only the gestational weeks correlate statistically significantly to Tmax/Tmean (both right and left) velocities. They increase in a linear correlation to gestational weeks. They aren’t considerably associated neither to the type nor the size of a GMH/IVH. In premature neonates with GMH/IVH, the demonstration of the ipsilateral TV with color Doppler, even if it is displaced, represents a good prognostic sign for the evolution of the hemorrhage. In contrary, no flow in the TV seems to be a bad prognostic sign preceding the PHI appearance.ΣΚΟΠΟΣ: α) Η καταγραφή της υπερηχογραφικής απεικόνισης και των ταχυτήτων των τελικών φλεβών (ΤΦ) σε πρόωρα νεογνά χωρίς και με υποεπενδυματική ή ενδοκοιλιακή αιμορραγία, και β) η αναζήτηση και πιθανή καθιέρωση ενός πρώιμου υπερηχογραφικού ευρήματος, με τη βοήθεια του έγχρωμου και παλμικού Doppler, το οποίο θα μπορούσε να αποβεί χρήσιμο στον καθορισμό της πρόγνωσης της ενδοκοιλιακής αιμορραγίας, με μεγάλη κλινική σημασία. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ: Η μελέτη περιελάμβανε δυο ομάδες προώρων νεογνών (24-36 εβδομάδων κύησης), νοσηλευομένων σε Μονάδα Εντατικής Νοσηλείας Προώρων Νεογνών: την ομάδα Ι (60 πρόωρα χωρίς υποεπενδυματική/ενδοκοιλιακή αιμορραγία), και την ΙΙ (40 πρόωρα με αιμορραγία, ετερόπλευρη/αμφοτερόπλευρη). Όλα τα νεογνά μελετήθηκαν με gray-scale υπερηχογράφημα εγκεφάλου. Επιπλέον ελέγχθηκαν οι ΤΦ με έγχρωμο και παλμικό Doppler και υπολογίστηκαν οι Tmax και Tmean ταχύτητές τους. Στην ομάδα Ι ο υπερηχογραφικός έλεγχος έγινε την πρώτη εβδομάδα ζωής. Στη ομάδα ΙΙ, το αρχικό υπερηχογράφημα έγινε στη διάρκεια των 3 πρώτων ημερών ζωής. Επαναλαμβανόταν ανά 3ήμερο επί 10 ημέρες. Ακολούθησαν 2-4 υπερηχογραφικοί επανέλεγχοι ανά εβδομάδα (αναλόγως της έκτασης και εξέλιξης της αιμορραγίας). Η μη απεικόνιση ροής εντός της ΤΦ θεωρήθηκε συμβατή με θρόμβωσή της. ΑΠΟΤΕΛΕΣΜΑΤΑ: Από τα 60 νεογνά της ομάδας Ι (120 ΤΦ), το έγχρωμο Doppler ανέδειξε τις 117 ΤΦ με μονοφασική, συνεχή κυματομορφή. Οι Tmax, και Tmean ταχύτητες ροής αυξάνονταν γραμμικά με τις εβδομάδες κύησης. Η Tmax κυμαινόταν από 2,04 cm/sec (24 εβδομάδες) έως 4,63 cm/sec (36 εβδομάδες κύησης) και η Tmean από 1,16 έως 2,81 cm/sec, αντίστοιχα. Στην ομάδα ΙΙ διαπιστώθηκαν 14 IVH GrI, 33 IVH GrIΙ, 17 IVH GrIΙΙ και 4 παρεγχυματικά αιμορραγικά έμφρακτα (ΠΕ). Σε μια περίπτωση μεγάλης υποεπενδυματικής αιμορραγίας, σε δυο IVH GrIΙ, και μια IVH GrIΙΙ δεν απεικονίστηκε ροή στη σύστοιχη ΤΦ. Όλες οι περιπτώσεις αυτές εξελίχθηκαν σε ΠΕ. Σε 3 νεογνά απεικονίστηκαν 4 ΠΕ ήδη από το πρώτο υπερηχογράφημα εγκεφάλου. Σε καμία από αυτές τις περιπτώσεις δεν απεικονίστηκε ροή στη σύστοιχη ΤΦ. Σε όλα τα υπόλοιπα νεογνά, το έγχρωμο Doppler ανέδειξε ροή στη σύστοιχη ΤΦ, με/χωρίς παρεκτόπιση αυτής. ΣΥΜΠΕΡΑΣΜΑΤΑ: Στα φυσιολογικά πρόωρα νεογνά οι ΤΦ απεικονίζονται υπερηχογραφικά στο 97,5% των περιπτώσεων με κυματομορφή μονοφασική, συνεχή, και ταχύτητες μικρότερες των τελειόμηνων. Στα φυσιολογικά νεογνά, μόνο οι εβδομάδες κύησης σχετίζονται στατιστικά σημαντικά με την Tmax/Tmean, τόσο της αριστερής όσο και της δεξιάς ΤΦ. Οι ταχύτητες ροής αυξάνονται με γραμμική συσχέτιση με τις εβδομάδες κύησης. Επί αιμορραγίας, οι ταχύτητες αυτές δεν επηρεάζονται στατιστικά σημαντικά από το βαθμό και την έκτασή της. Σε πρόωρα νεογνά με υποεπενδυματική ή ενδοκοιλιακή αιμορραγία, η απεικόνιση της σύστοιχης ΤΦ, ακόμη και εάν αυτή είναι παρεκτοπισμένη, αποτελεί καλό προγνωστικό σημείο για την εξέλιξη της αιμορραγίας. Αντιθέτως, η μη απεικόνισή της αποτελεί κακό προγνωστικό σημείο που προηγείται της εμφάνισης ΠΕ

Solitary round pulmonary lesions in the pediatric population: a pictorial review

The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings

Juvenile Granulosa Cell Tumor of the Testis: A Preoperative Approach of the Diagnosis with Ultrasound

Granulosa cell tumor of the testis is a rare intermediate stromal cell tumor that can be distinguished in adult and juvenile type. The juvenile type is commonly presented in infants less than a year old-most often during the first 6 months of life and can be associated with ambiguous genitalia and chromosomal anomalies. We report two cases of juvenile granulosa cell tumor (JGCT) of the testis diagnosed in the neonatal period and review the typical sonographic findings of this entity

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. (J Clin Endocrinol Metab 95: 109-117, 2010