The development of spinal cord injuries without radiologic abnormality in chlidren / 国际儿科学杂志

Spinal cord injuries without radiologic abnormality (SCIWORA) refers to the violence caused by spinal cord injury and radiological examination such as X-ray or CT no visible spine fracture and dislocation,abnormal findings,19％ to 34％ of children traumatic spinal cord disease.After SCIWORA occurs,there was no fever or low heat,and the progress period was short,and the disease of the spinal cord was more than normal,and the disease was less subjective.It should be identified with acute myelitis and other diseases.To improve pediatrician's understanding of SCIWORA,this review summarizes the etiology,clinical characteristics and imaging manifestations of SCIWORA in children in recent 10 years.

Endogenous Cushing's Syndrome in a Patient with Systemic Lupus Erythematosus

Systemic lupus erythematosus is an autoimmune disease for which glucocorticoids are the mainstay of treatment. Cushing's syndrome is caused by glucocorticoid excess, which can be either exogenous or endogenous. Although iatrogenic Cushing's syndrome is the most common form, especially in patients undergoing glucocorticoid treatment, endogenous glucocorticoid excess should be considered because it has a different treatment strategy. We describe a 51-year old woman with a longstanding history of SLE. She was treated with steroid and cytoxan pulse therapy and plasmapheresis. Her lupus activity had been stable for 7 years with low-dose glucocorticoid treatment. She showed excessive weight gain, easy bruising, moon facies, truncal obesity, acne, and menstrual disorder. Given her history of long-term steroid therapy, iatrogenic Cushing's syndrome was considered the most likely diagnosis; however, worsening features of Cushing's syndrome with a minimal dose of glucocorticoid led us to diagnose endogenous Cushing's syndrome due to a left adrenal adenoma. The patient underwent laparoscopic left adrenalectomy. Her SLE was controlled with transient low-dose glucocorticoid treatment, and her lupus activity remained stable without glucocorticoid treatment. This is the first reported case of concomitant endogenous Cushing's syndrome in a patient with preexisting SLE in Korea. This case shows the importance of differential diagnosis including exogenous Cushing's syndrome and endogenous Cushing's syndrome in autoimmune disease patients with glucocorticoid therapy.

Orbital Myositis with Rapid Successful Treatment with Corticosteroids.

A 41-year-old Japanese female was admitted to our hospital with a history of right abducens nerve palsy, right gaze diplopia, right eye pain and double vision. Thyroid function, thyroid autoantibody levels, and tests for other pathologies were normal. Orbital contrast-enhanced short-TI Inversion Recovery-magnetic resonance imaging before treatment showed contrast-enhanced, severe lateral rectus and rectus superior muscle swelling in the right eye. We therefore diagnosed this patient as orbital myositis. Intravenous glucocorticoid pulse therapy with methylprednisolone (mPSL) was initiated. After prescribing a daily dose of 1,000 mg of mPSL three times a week, all symptoms, including physical abnormalities, disappeared. The patient was discharged on day 14 after hospitalization and was prescribed oral PSL (30 mg/day). This report indicates that early and initial adequate treatment with a high dose of mPSL is very effective for orbital myositis treatment. However, the possibility of recurrences must be always considered at subsequent follow-up.

Tratamento com hrGH da baixa estatura induzida pelo uso crônico de glicocorticóide em crianças: [revisão] / hrGH treatment of glucocorticoid-induced short stature in children: [review]

O uso crônico de glicocorticóides no tratamento de doenças sistêmicas causa diminuição da velocidade de crescimento (VC), podendo acarretar perda estatural final. As interações entre o eixo adrenal e o eixo GH-sistema IGF têm sido descritas, podendo ocorrer em nível hipotalâmico-hipofisário e na regulação do sistema IGF, inclusive modulando o sinal do IGF-1R. Pode-se dizer que o quadro clínico deve ser considerado como estado de deficiência de Igf-1, absoluta e/ou funcional. As intervenções que possibilitam a normalização funcional do eixo GH-IGF poderiam reduzir a perda estatural destas crianças. Os estudos realizados em pacientes com artrite reumatóide juvenil em tratamento com corticóides mostraram aceleração da VC e diminuição da perda protéica com o uso de GH recombinante humano (hrGH). A aceleração da VC foi também descrita em pacientes sob corticoterapia crônica por causa da doença intestinal inflamatória ou do transplante renal após o uso de hrGH. A dose de hrGH guarda correlação positiva com a aceleração da VC e os resultados reforçam que esta deficiência funcional do eixo GH-IGF pode ser revertida com a administração de hrGH. O efeito do hrGH é restrito ao período de tratamento e depende do esquema de reposição do hrGH, do estado nutricional e das condições da doença de base.

The treatment of systemic diseases with glucocorticoids is often associated with decreased height velocity (HV), and can result in shorter final height. Interactions between adrenal and GH-IGF axis have been described and can occur at hypothalamic-pituitary level or at the regulation of IGF system, including the IGF1R signaling. The clinical state of these patients may be considered as an absolute and/or functional IGF-1 deficiency. Interventions aiming to restore the normal function of GH-IGF axis might reduce the glucocorticoids-induced growth suppression in these children. It has been shown that recombinant human GH (hrGH) induces an increase in HV and a decrease in protein loss in patients with juvenile idiopathic arthritis treated with glucocorticoids. Significant increment in HV was also described after hrGH treatment in children under glucocorticoid therapy due to inflammatory bowel disease or renal transplantation. There is a positive correlation between HV and the dose of hrGH. The results support that the IGF-1 deficiency in these children may be counteract by hrGH therapy. The effect of hrGH is observed only during the treatment period and depends on the replacement strategy, nutritional status and disease control.

The clinical study of the effect of steroid pulse therapy on Graves' ophthalmopathy / 中国实用内科杂志

7 and the course of GO