Rectum sizes: Assessment by ultrasonography in children with functional constipation.

AIM: This study aimed to compare the transverse diameter and thickness of the anterior wall of the rectum in children with normal bowel movement and children with functional constipation in different age groups. Another objective was to find correlations of rectum sizes with faecal incontinence and constipation duration. METHODS: In the study, we included children with normal bowel movement and functional constipation diagnosed based on the Rome III and Rome IV criteria. We collected clinical data from the parents. We measured the rectum transverse diameter and the thickness of the anterior wall by abdominal ultrasound. RESULTS: The study included 65 children, 31 with normal bowel movement and 34 with functional constipation. The rectum transverse diameter and the thickness of the anterior wall had statistically significant higher values in patients with constipation (P < 0.05). There was a moderate and significant correlation between the duration of the disease (mean ± standard deviation = 31.7 ± 33.1 months) and rectum transverse diameter (r = 0.54; P = 0.0009). The rectum transverse diameter correlated moderately with the presence of faecal incontinence (r = 0.62; P = 0.003), but the thickness of the anterior wall did not correlate with this symptom (r = 0.02; P = 0.39). CONCLUSIONS: We found statistically significant differences between the transverse rectal diameter and thickness of the rectum anterior wall, measured by abdominal ultrasound, in children with functional constipation compared with normal defaecation patterns. Faecal incontinence and long-term constipation were correlated with the increased rectum diameter.

Changes in the parameters of the rectoanal inhibitory reflex in children with functional constipation and large rectum.

BACKGROUND: Abdominal ultrasound and anorectal manometry are part of the investigations used to assess children with functional constipation. This study aimed at assessing the changes in the characteristics of the rectoanal inhibitory reflex (RAIR) in children with functional constipation and correlating them with the dimensions of the rectum, measured by abdominal ultrasound. A secondary objective was to compare the rectum size in children with and without constipation. METHOD: We retrospectively reviewed the clinical data and investigations results of 51 children (mean age±standard deviation (SD) = 5.8±3.5 years) with functional constipation who came to our clinic between January 2013 and February 2020. The assessment of these patients included both the assessment of the transverse diameter of the rectal ampulla by abdominal ultrasound and anorectal manometry. The studied parameters of RAIR were: the minimal volume of air necessary to induce RAIR, in all the patients with functional constipation, and in 20 of them, relaxation time, latency and relaxation percentage. A control group was formed of 27 children (mean age±SD = 5.1±4 years) without digestive diseases and with normal intestinal transit, who were assessed by abdominal ultrasound. RESULTS: The mean value ±SD of the volume of air necessary to induce RAIR was 21.9±12.1 cm3 air. There was no correlation between the rectum transverse diameter and the minimal air volume that triggered RAIR (r=-0.01, p=0.94). The mean value ±SD of the transverse diameter of the rectum in patients with functional constipation was 39±14 mm, and in children without constipation 26±6 mm (p<0.05). The mean duration of the symptoms in children with functional constipation was 2.8 years. CONCLUSIONS: There were no correlations between the volume of air that induced the RAIR and the transverse diameter of the rectum in children with functional constipation. The transverse diameter of the rectum was increased in children with long-term functional constipation.

Ultrasonographic findings in hyperimmunoglobulin D syndrome: a case report.

Hyperimmunoglobulin D syndrome due to mevalonate kinase deficiency is a rare autoinflammatory disease with digestive tract involvement. We report an 11-year female child who has presented since the age of 1 year, bouts of fever, rash, joint swelling, pulmonary consolidation, lymph node involvement and hepatosplenomegaly. Hyperimmunglobulin D and increased urinary mevalonic acid were detected. The ultrasonographic features of hepatosplenomegaly ranged from increment in size to pseudotumoral involvement, with hypoechogenic masses without apparent wall. Abdominal CT during a disease flare showed hypodense, hypoenhancing nodular lesions, suggesting metastases. Nevertheless, a thorough search for malignancy was negative and the masses disappeared after the flare. Mevalonate kinase deficiency may add to the causes of hepatosplenic and pulmonary inflammatory pseudotumors.

Overweight and Underweight Prevalence Trends in Children from Romania - Pooled Analysis of Cross-Sectional Studies between 2006 and 2015.

AIM: High-quality national representative data on obesity in Romanian children are needed to shape public health policies. To provide a unified data landscape on national prevalence, trends and other factors associated with underweight, overweight, and obesity in Romanian children aged 6-19 years, across the last decade (2006-2015). METHODS: Using a common protocol, we selected published and unpublished studies that measured Romanian children in schools between 2006 and 2015. Children's BMI was classified using the current WHO, IOTF, and CDC references. RESULTS: 25,060 children from 8 Romanian counties were included in the analysis. The prevalence of underweight children was 5%/4.5%/8.5% (WHO/IOTF/CDC), while the prevalence of overweight (including obese) children was 28.3%/23%/23.2% (WHO/IOTF/CDC). The prevalence of overweight children did not change significantly over the last decade (chi-square test p = 0.6). Male gender (odds ratio (OR) 1.37; 95% CI 1.29-1.45, compared to female); prepubertal age (OR = 3.86; 95% CI 3.41-4.36,compared to postpubertal age), and urban environment (OR 1.12; 95% CI 1.01-1.26, compared to rural environment) had higher risk for overweight. CONCLUSION: While the prevalence of underweight children was low, almost one in four children in Romania was overweight or obese (according to WHO criteria) between 2006 and 2015. This prevalence remained relatively stable over the last decade. Male gender, prepubertal age, and urban environment, were the most relevant risk factors associated with overweight status in Romanian children.

Diagnostic use of magnetic resonance imaging (MRI) of a cervical epidural abscess and spondylodiscitis in an infant - case report.

Epidural abscess in infancy is very rare and has non-specific features, requiring very careful attention and early diagnosis. We present a case of a 3-month-old girl in which the diagnosis of spontaneous cervical epidural abscess developed after an initial episode of acute enterocolitis and was subsequently identified at a later visit to the emergency department for right-upper extremity hypotonia. Endoscopy revealed slightly domed retro pharynx and magnetic resonance imaging (MRI) scan showed cervical spondylodiscitis at the level of intervertebral disc C5-C6 with right-sided epidural abscess that compressed the spinal cord and right C6 nerve root, without extension into superior mediastinum. The systemic antibiotic treatment with meropenem and clindamycin solved the symptoms but the spondylodiscitis complicated with vertebral body fusion which can be symptomatic or not in the future and needs follow-up. Cervical spontaneous spondylodiscitis with abscess is very rare, especially in this age group. This case emphasizes the importance of investigating an upper extremity motor deficiency in infancy and diagnosing any potential spondylodiscitis complication.

Large spectrum of complete urinary collecting system duplication exemplified by cases. Pictorial essay.

Urinary collecting system duplication is a congenital anomaly and can associate various types of urinary tract pathologies. Authors will illustrate by cases some of associated anomalies such as ureterocele, extravesical ectopic ureter, vesicoureteral reflux or reflux nephropathy; one case presented an association between posterior urethral valve and bilateral collecting system duplication.

The role of exhaled nitric oxide assessment in children with bronchial asthma.

BACKGROUND: Exhaled nitric oxide (eNO) assessment in children with bronchial asthma (BA) is an easy and non-invasive test that provides informations on the presence of bronchial inflammation. METHODS: The study included 110 children aged between 5-18 years with a diagnosis of BA. The patients were assessed clinically (objective examination, questionnaire regarding the disease control) and by medical tests (exhaled breath analysis for nitric oxide, induced sputum, spirometry). RESULTS: Of the 33 patients with non-atopic BA, 9 (27.27%) presented normal eNO values, and 24 (72.72%) had higher than normal levels. There were 26 patients with controlled BA, 59 with partially controlled BA and 25 with uncontrolled BA, the levels of eNO demonstrating the existence of the statistically significant differences between the mean values of the variables obtained in the studied groups (p=0.003). Increased individual values were more frequently noted in patients with an exacerbation of asthma in the last month (70% vs 56.6%), but the differences were not statistically significant. Of the 77 patients with atopic BA, 35 (45.45%) had normal eNO, while 42 (54.54%) had increased values. The normal values of the eNO were most frequently noted in patients undergoing treatment with inhaled glucocorticoids (IGC). Patients with low percent of eosinophils in sputum had increased eNO values (p=0.03). CONCLUSIONS: The investigation of the airways by measuring the eNO levels is a useful method of assessing bronchial inflammation in children with bronchial asthma, in order to establish the disease responsiveness and therapy.

[Influence of cheeks support on the results of respiratory resistance measured by the interrupter technique in children]. / Influenta sustinerii obrajilor asupra rezultatelor rezistentei respiratorii determinata prin tehnica intreruperii fluxului.

INTRODUCTION: Interrupter technique (TIF) determines the respiratory resistance (Rocc) and can be used successfully in children, even at low ages as it requires only minimal cooperation. Efforts to standardize this technique are focused on limiting the contribution of upper airway resistance during the measurement. OBJECTIVE: Assessing the influence of cheeks support during the examination on the results of Rocc determined by TIF, both when used as basal examination or for measurement of bronchodilator response. MATERIAL AND METHODS: Sixty-one children diagnosed with asthma were included. Rocc was determined in all patients with both cheeks supported, and without support. Forty-three children subsequently performed spirometry in order to assess the correlation between spirometry and Rocc in the two situations described. To assess bronchodilator response two groups of children were studied, one with the basal and postsalbutamol measurements made with the cheeks supported and the other group with the same tests made without support. RESULTS: Rocc mean values were higher when the cheeks are supported during the examination, the difference being statistically significant. Regarding the correlation with spirometry, there is a good correlation between FEV1, PEF, MEF50 and Rocc in both cases (P < 0.001). deltaFEV1 correlated better with deltaRocc when cheeks were supported. CONCLUSIONS: Rocc measurements using interrupter technique with the cheeks supported registered higher values than those obtained in the absence of cheek support. Assessment of bronchodilator response using the interrupter technique is more accurate when performed with the cheeks supported.

Ultrasonography contribution in detection of reno-urinary anomalies: a cohort study.

AIMS: The current study aims to assess the role of ultrasound (US) parameters in explaining the variance of hydronephrosis grades in reno-urinary anomalies, as well as their performance in quantifying the incidence of patients with uropathies. METHODS: In this study 196 patients were prospectively included. All of them had renal/urinary tract anomalies and were recruited from 5992 US examined hospitalized patients. Fifty patients were referred also to renal 99mTc- DMSA or 99mTc-DTPA scintigraphy. The diagnostic performance of renal ultrasound and scintigrafy parameters was assessed. RESULTS: Pelvis antero-posterior diameter (APD) values were strongly correlated with other investigated parameters. They correlated with measurements of US parenchyma values (r=0.59, p=0.001), pelvis area (r=0.76, p=0.001) and with scintigraphy long axis measurements (r=0.89, p=0.001). In multiple regression analysis, the pelvis APD is the only independent predictor of high grades hydronephrosis (p=0.001) and explained 62.4% of the variance of hydronephrosis grades. The cut-off values for detection of significant hydronephrosis (grades 3,4) was 11 mm or more, and for detection of severe, in need of surgery, hydronephrosis was 19 mm or more. CONCLUSIONS: The diagnostic performance of ultrasound was good, similar to those previously published by other authors. US detected pelvis APD is the main predictor for high grades hydronephrosis but other parameters also influence the uropathy grades.

The interrupter technique: feasibility in children in acute asthma.

BACKGROUND: Asthma exacerbation's severity is difficult to evaluate, as it is mainly assessed by clinical parameters. Evaluation of lung function during the acute asthma might provide an objective assessment on the severity of respiratory function impairment. OBJECTIVE: To determine feasibility of interrupter technique in evaluating respiratory resistance (Rocc) on children with acute asthmaMethods: The study included 30 children aged 3 to 14 years, diagnosed with asthma, during an exacerbation; severity of acute asthma has been assessed according to the GINA classification 2007, evaluating individual parameters like intercostals retractions, wheezing, air entry intensity, as well as their association in a clinical score. For every patient spirometry, peakflowmetry and the interrupter technique was applied for assessing respiratory function. The feasibility rate for each method was calculated and compared with the clinical parameters. RESULTS: Out of the 30 children examined, the feasibility rate during the attack was 90% for the interrupter technique, 47% for peakflowmetry and only 27% for spirometry. Fifty-three percent of the exacerbations were classified as mild, 30% of moderate intensity and the remaining 37% being classified as severe exacerbations. The baseline Rocc has been correlated with clinical parameters and the clinical severity score. Best correlations were recorded between baseline Rocc and respiratory rate (r=0.73, p<0.0001), Rocc and heart rate (r=0.5, p=0.0076) and Rocc and the clinical score (r= 0.78, p<0.0001). CONCLUSION: The study shows good feasibility of interrupter technique during asthma exacerbations, as well as strong correlation with clinical parameters assessing severity.

[Relationship between asthma and obesity in school age students]. / Relatia dintre astm si obezitate la copiii de vârsta scolara.

BACKGROUND: Obesity and asthma are both public health problems with an increasing prevalence all over the world. The association between asthma and obesity was studied and proved in some papers, although the pathogenic pathway between them is not exactly known. The aim of this study was to examine the relationship between obesity and asthma by measuring the prevalence of obesity in asthmatic children compared with a control population. METHODS: Two groups of children aged between 7 and 18 years were studied: one group of asthmatic children and a control group, with the same age and sex with the first group. The differences between the two groups regarding the BMI were calculated, obesity being defined as a body mass index greater than the 95th percentile. RESULTS: A number of 200 children with asthma and 200 children in the control group were studied. The mean age was 10.49 years. 61.5% of children were boys. No significant difference was observed in the two groups regarding the percentage of overweight and obese children, except in the group of 7-10 years, where there is a greater percentage of children with overweight in the asthmatic group (23.3% vs 1% in the control group, p = 0.045). CONCLUSION: Obesity does not constitute, therefore, a risk factor for asthma and does not contribute to the severity of the disease.