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  • 1
    ISSN: 1432-1076
    Keywords: Isolated premature thelarche ; Central precocious puberty ; Pelvic ultrasonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 55 girls with isolated premature thelarche between the ages of 0.3 and 7.3 years (group A), 20 children with central precocious puberty between 2.1 and 7.7 years of age and 101 age-matched controls. The children with precocious puberty were divided according to distribution of pubic hair into group B (Tanner stages PH1, B2–3;n=11), representing an early stage of the disorder, and group C (stages PH2–3, B3–4;n=9), representing an advanced stage. Uterine and ovarian volumes were measured sonographically, peak serum levels of luteinizing hormone and folliclestimulating hormone were determined after intravenous administration of luteinizing hormone-releasing hormone. The mean uterine and ovarian volumes were significantly greater in children with precocious puberty than in controls (group B: uterine volume: 3.8±2.0 ml vs 0.9±0.3 ml for controls,P〈0.001; ovarian volume: 2.2±1.3 ml vs 0.6±0.2 ml for controls,P〈0.01; group C: uterine volume: 8.0±4.4 ml vs 1.0±0.3 ml for controls,P〈0.01; ovarian volume: 2.6±1.3 ml vs 0.4±0.1 ml,P〈0.01). No significant differences were found between children with premature thelarche and the control group. As a diagnostic method for the early detection of central precocious puberty, ultrasound measurement of uterine volume had a sensitivity and specificity of 100% (cut-off value, 1.8 ml), while ultrasound determination of ovarian volume had a sensitivity of 82% and a specificity of 95% (cut-off value, 1.2 ml). In contrast, as a diagnostic criterion the ratio of levels of luteinizing hormone to follicle-stimulating hormone as determined following stimulation with luteinizing hormone releasing hormone had a sensitivity of 33% and a specificity of 100% (cut-off value, 1.0). Conclusion: ultrasonographic measurement of uterine and ovarian volume offers a reliable means of distinguishing between isolated premature thelarche and early stages of central precocious puberty.
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  • 2
    ISSN: 1432-1076
    Keywords: Key words Isolated premature thelarche ; Central precocious puberty ; Pelvic ultrasonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 55 girls with isolated premature thelarche between the ages of 0.3 and 7.4 years (group A), 20 children with central precocious puberty between 2.1 and 7.7 years of age and 101 age-matched controls. The children with precocious puberty were divided according to distribution of pubic hair into group B (Tanner stages PH1, B2–3; n = 11), representing an early stage of the disorder, and group C (stages PH2–3, B3–4; n = 9), representing an advanced stage. Uterine and ovarian volumes were measured sonographically, peak serum levels of luteinizing hormone and follicle-stimulating hormone were determined after intravenous administration of luteinizing hormone-releasing hormone. The mean uterine and ovarian volumes were significantly greater in children with precocious puberty than in controls (group B: uterine volume: 3.8 ± 2.0 ml vs 0.9 ± 0.3 ml for controls, P 〈 0.001; ovarian volume: 2.2 ± 1.3 ml vs 0.6 ± 0.2 ml for controls, P 〈 0.01; group C: uterine volume: 8.0 ± 4.4 ml vs 1.0 ± 0.3 ml for controls, P 〈 0.01; ovarian volume; 2.6 ± 1.3 ml vs 0.4 ± 0.1 ml, P 〈 0.01). No significant differences were found between children with premature thelarche and the control group. As a diagnostic method for the early detection of central precocious puberty, ultrasound measurement of uterine volume had a sensitivity and specificity of 100% (cut-off value, 1.8 ml), while ultrasound determination of ovarian volume had a sensitivity of 82% and a specificity of 95% (cut-off value, 1.2 ml). In contrast, as a diagnostic criterion the ratio of levels of luteinizing hormone to follicle-stimulating hormone as determined following stimulation with luteinizing hormone releasing hormone had a sensitivity of 33% and a specificity of 100% (cut-off value, 1.0). Conclusion: ultrasonographic measurement of uterine and ovarian volume offers a reliable means of distinguishing between isolated premature thelarche and early stages of central precocious puberty.
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  • 3
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Choledocholithiasis ; Common channel ; Rezidivierende Oberbauchschmerzen ; ERCP ; Key words Choledocholithiasis ; Common channel ; Abdominal pain ; ERCP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A 14 year old macedonic girl was admitted with recurrent colicky abdominal pain that had lasted for several weeks. Laboratory check, plain abdominal film and abdominal sonography did not show abnormalitities immediately. Increasing enzyme parameters though indicated cholestasis. Endoscopic retrograde choledocho-pancreaticography (ERCP) was performed after abdominal sonography showed a dilatation of the choledochus. It revealed a common-channel situation (ductus choledochus and pancreaticus) and choledocholithiasis. Papillotomy and stone-extraction could not remove abdominal pain. Laparatomy and choledocho-jejunostomy could finally remove the symptoms. Discussion: ERCP should be considered in patients with colicky abdominal pain and cholestasis, when abdominal sonographic situation is unclear.
    Notes: Zusammenfassung Eine 14jährige mazedonische Patientin wurde nach 2wöchigem auswärtigem Klinikaufenthalt mit seit Wochen rezidivierenden krampfartigen Oberbauchschmerzen übernommen. Labor, Röntgen und Sonographie zeigten bis dato keine pathologischen Befunde. Nach Anstieg der Cholestaseparameter zeigte sich dann doch der sonographische Befund eine Gallengangerweiterung, und es erfolgte eine endoskopisch-retrograde Choledochopankreatikographie (ERCP). Es fanden sich ein gemeinsamer Gallen- und Pankreasgang (common-channel) sowie Gallengangsteine. Endoskopische Papillotomie und Steinentfernung erbrachten keine Besserung. Erst eine Laparatomie mit Durchführung einer Choledochojejunostomie konnte die Beschwerden beseitigen. Diskussion: Bei Oberbauchkoliken, Cholestase und unklaren sonographischen Befunden ist an die Durchführung einer ERCP zur Diagnosesicherung eines gemeinsamen Gallen- und Pankreasgangs (common-channel) zu denken.
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  • 4
    ISSN: 1432-0584
    Keywords: Key words Hepatic veno-occlusive disease ; VOD ; Treatment ; Pediatric ; Duplex ultrasound ; Prostaglandin E1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Limited data exist on therapeutic options for established hepatic veno-occlusive disease (VOD) in pediatric patients after stem cell transplantation (SCT). In this report, we present data on the successful treatment of VOD in three children following allogeneic SCT and report the duplex ultrasound criteria for the confirmation of the diagnosis and for the evaluation of the treatment progress. All patients were 〈2 years at the time of transplantation and had received preparative regimens containing busulfan and cyclophosphamide. There were no known pretransplant risk factors for VOD. Allogeneic stem cell transplantation was performed from a sibling donor for CMML and from unrelated donors for Wiskott-Aldrich syndrome and familial hemophagocytic lymphohistiocytosis (FHL). The onset of first clinical symptoms of VOD (as defined by the Seattle and Baltimore criteria) was relatively late in all three patients (days +19, + 20, and +25, respectively). Time from onset of first symptoms until confirmation of diagnosis by serial duplex ultrasound examination was 4–11 days. Duplex ultrasound criteria are as follows: complete change of direction of blood flow in the portal vein, decrease of flow in the hepatic veins, and development of collateral circulation. Treatment was initiated upon confirmation of VOD by continuous infusion of prostaglandin E1 (initial dose 0.075 μg/kg/h) in addition to low-dose heparin (100 units/kg/d). Treatment was continued at the maximum tolerated dose of 0.3–0.5 μg/kg/h of PGE1. After 9, 14, and 25 days of treatment respectively, normal portal vein flow was restored and treatment could be discontinued. All three patients are alive and well without apparent sequelae.
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  • 5
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 1-year-old child with an aneurysmal bone cyst in the scapula is presented. The sonographic examination showed a cystic formation with intraosseal fluid levels that shifted after repositioning of the child. Similar findings have been reported on CT scans and it is suggested that shifting fluid levels are an indicative feature of aneurysmal bone cyst.
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  • 6
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sonographic measurement of uterine and ovarian volume was performed in 178 healthy girls ranging in age from newborn to 14 years. High values were measured during the neonatal age and puberty, in contrast to those in subjects between 1 month and 7 years of age. We conclude that age and pubertal stage are important parameters in correctly interpreting the size of the uterus and ovaries in childhood.
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