Biomedical subjects
Publications and source records attributed to I Varsano.
A 2 1/2-year-old boy was examined because of swelling of the penis of six weeks' duration. Several strands of hair wrapped around the penis and buried under the epithelium were found to cause a constriction. The penile tourniquet syndrome should be suspected whenever the penis is swollen, especially in children, even if a foreign body is not visible.
Nonpyogenic discitis (NPD) is diagnosed on radiograms by the demonstration of the narrow disc-space with involvement of the adjacent vertebral bodies, and with radioisotope--by showing the increased uptake at the same level. Four phases are recognised in the development of the imaging changes. The isotope scan is important, especially in the latent phase of the disease when the radiograms are still negative. Radiologists are urged to consider the possibility of NPD in any child with vague abdominal, leg or back complaints whose origin cannot be ascertained. The experience of imaging diagnosis in five children is described and the differential diagnosis is discussed.
A 7-year-old boy with Prader-Labhart-Willi syndrome who had precocious adrenarche was found to have primary gonadal failure, as evidenced by appropriate laboratory investigations: elevated basal levels of plasma FSH and LH with exaggerated responses to LH-RH stimulation and unresponsiveness of plasma testosterone to repeated hCG stimulations. The elevated values of plasma DHEA which were found indicate an early activation of the adrenal gland. This patient demonstrates the variability of pubertal development in the Prader-Labhart-Willi syndrome, with the unusual association of primary gonadal failure and precocious adrenarche.
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An eleven-year-old boy was diagnosed to have Addison's disease with an ACTH level of over 4500 pg/ml after a short episode of fever and dehydration. From the age of 6 years his skin and buccal mucosa had been hyperpigmented but there were no other subjective complaints. The clinical examination also revealed signs of advanced puberty for his age (3rd--4th stage according to Tanner's criteria), with advanced bone age (13 years). The elevated levels of plasma testosterone and gonadotropins and their response to LH-RH stimulation were appropriate for his clinical stage of puberty and supported the diagnosis of true precocious puberty. It is proposed that the concomitant appearance of Addison's disease and precocious puberty is due to a "drift" phenomenon of LH-RH and/or gonadotropins following the prolonged elevation of ACTH secretion.
A 3-month-old male infant with type I Klein-Waardenburg syndrome with an imperforated anus and a perineal fistula is reported. The possible association of this gastrointestinal malformation with the KW syndrome is discussed.
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A 2 1/2-year-old girl developed arthritis in a metatarsophalangeal joint concomitantly with varicella. As she recovered within 2 days without antimicrobial treatment, it was considered that the arthritis was directly due to the viral infection. The importance of differentiating viral arthritis from septic arthritis, a well-known complication of varicella, is stressed.
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The paradoxical movement of the mediastinum, in relation to the respiratory cycle, is a valuable fluoroscopie sign in the evaluation of partial obstruction of air-flow through the trachea or larynx. Its recognition in the presence of the normal chest radiograms together with the clinical history of aspiration, is of importance in the diagnosis of a foreign body located above the tracheal bifurcation. The pathophysiology and the radiographic manifestations of this phenomenon are described. Various etiologies are discussed in which this sign is also seen. The experience with 18 pediatric patients is presented and 3 cases are outlined in details.
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Repeated hypoglycaemic attacks, associated with transient hepatomegaly, in a 12-year-old insulin-dependent diabetic girl continued despite reduction in dose and, later, complete discontinuance of insulin. The attacks ceased while she was in hospital, necessitating reinstitution of insulin. The hepatomegaly resolved when surreptitious additional insulin injections were discovered and stopped. Hepatomegaly in diabetics should arouse suspicion of overdosage with insulin.
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