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.

Clinical, imaging and cystometric findings of voiding dysfunction in children.

UNLABELLED: The AIM of the study was to validate some of the imaging criteria for voiding dysfunction in children. MATERIAL AND METHODS: The study included a number of 55 children with voiding dysfunction symptoms. They were investigated clinically as well as through imaging techniques: renourinary ultrasound, voiding cystourethrography and cystometry. RESULTS: The most common symptoms were urgency (87.3%), increased frequency (81.8%), and daytime urinary incontinence (76.3%). Ultrasound scans detected a reduced bladder capacity in 65.5% patients. The voiding cystourethrography detected bladder trabeculations (58.2%) and spinning top urethra (63.6%). Cystometric recordings indicated overactive bladder in 70.9% patients. Reduced bladder capacity detected by ultrasound associated with trabeculated bladder and spinning top urethra detected by voiding cystourethrography in a patient with specific symptoms may suggest an overactive bladder. In CONCLUSION, voiding dysfunction in child can be diagnosed by minimal or non-invasive methods.

Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire).

BACKGROUND: The prevalence of asthma and allergy has increased during recent decades. OBJECTIVE: We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years. MATERIAL AND METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area. RESULTS: The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064). CONCLUSIONS: The prevalence of asthma and allergy increased significantly during the past 6 years.

[The effects on growth velocity of inhaled corticosteroids therapy in children with asthma]. / Efectele glucocorticosteroizilor inhalatori administrati de durata asupra velocitatii cresterii la copiii cu astm bronsic persistent.

INTRODUCTION: Studies have demonstrated growth suppressive effects in case of use of inhaled corticosteroids therapy. OBJECTIVE: To assess growth velocity during 12 months of inhaled corticosteroids therapy in children with persistent asthma. METHODS: Measurements of height were performed in the study group including 109 children with mild and moderately severe, persistent asthma, after 12 month with low or medium doses of either beclomethasone dipropionate or fluticasone propionate. The results were compared with a control group including 71 children with asthma treated with montelukast or cromones. RESULTS: There were statistically significant differences between study group and controls concerning the growth velocity after 3 months of inhaled glucocorticoid therapy (GSI). CONCLUSIONS: The velocity of growth was decreased in the study group compared to controls after 3 months of treatment, but the differences become unsignificant after 12 months of therapy.

[Increase of the prevalence of bronchial asthma and related symptoms in students in Cluj-Napoca. Epidemiologic study with a five-years interval]. / Cresterea prevalentei astmului bronsic si simptomelor asociate la scolarul mare în Cluj-napoca. Studiu epidemiologic la 5 ani interval.

BACKGROUND: The prevalence of asthma is increasing in developed countries during the past decade. In Romania there are few studies on asthma epidemiology and no data on the trend of the prevalence. AIMS: The authors investigate the prevalence of asthma and associated symptoms in children and evaluate the trend of prevalence 5 years apart. METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children (ISAAC). The questionnaire was applied during 1995 in 2,866 children aged 13-14 years from a Romanian city, and during 2001 in 1,657 children from the same area. RESULTS: The prevalence of previous diagnosed asthma increased significant, from 3.3% in 1995 to 5.5% in 2001 (p = 0.0005). A higher percentage of pupils presented probable asthma (4.3% in 1995 and 13.6% in 2001; p < 0. 00001). Similar results were obtained regarding symptoms related to asthma like wheezing, cough during exercise and night cough. Previous diagnosed asthma was more frequent in boys, but probable asthma and symptoms related to asthma were more prevalent in girls both in 1995 and in 2001. The prevalence of asthma is similar with that reported in other central and eastern European countries that used the same core questionnaire provided by ISAAC. CONCLUSION: The prevalence of asthma and associated symptoms increased significantly during the past 5 years.

[The effects of long-term inhaled glucocorticoids on children's bones]. / Efectele glucocorticoizilor administrati de durata, pe cale inhalatorie, la copil, asupra osului.

The authors study, by calcanean ultrasonographic method, the effects of inhaled steroids, administered for long term, on the bone status, in children with persistent asthma. The study group consisted in 33 children with persistent asthma, treated for 12 months with low or moderate doses of either beclomethasone dipropionate or fluticasone propionate. In all of them there were measured the main ultrasonographic parameters, before and after treatment. The results were compared with those recorded in a control group. The control group consisted in 16 children with asthma that did not receive long term inhaled steroids. In the study group the were no statistically significant differences between ultrasonographic parameters measured before and after steroids inhaled treatment. There were no statistically significant differences between ultrasonographic parameters measured after steroid treatment in the study group and the same parameters recorded in the control group. The results of our study reveal that long term inhaled steroids therapy do not influence the bone density at the calcanean level.

[Effectiveness of antireflux therapy in asthmatic children with gastroesophageal reflux disease]. / Eficienta terapiei antireflux la copiii astmatici cu boala de reflux gastroesofagian.

There is an increased interest within literature regarding the relationship between gastro-esophageal reflux disease and asthma. The study was performed to assess the efficiency of antireflux therapy in asthmatic children. In a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years) the pulmonary function tests were made by means of spirometry in those patients in which reflux disease was diagnosed by means of 24h esophageal pH-monitoring and upper digestive endoscopy. All these patients were reevaluated by means of spirometry 3 months after the antireflux therapy with ranitidine and cisapride added to antiasthmatic therapy. Three months later the results showed a significant decrease in frequency of asthma exacerbations from 3.18 +/- 4.86 to 0.45 +/- 0.80 (p = 0.016). There is also a significant increase of FEV1 (p = 0.04) and of FEV1/FVC (p = 0.018) in asthmatic patients with reflux disease and a positive symptomatic index, and of FEV1/FVC (p = 0.002) in all asthmatic children with abnormal gastro-esophageal reflux respectively. In conclusion, by adding antireflux therapy in asthmatic children there is a significant improvement in clinical and some of functional parameters.

[Gastroesophageal reflux in asthmatic children: prevalence and pathogenic role]. / Refluxul gastro-esofagian patologic la copii cu astm bronsic: prevalenta si rol patogenetic.

The relationship of gastroesophageal reflux disease and asthma is controversial. This study was performed to assess the prevalence of pathologic gastroesophageal reflux and its effect on pulmonary function tests in asthmatic children. The following study protocol was performed in a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years): diagnosis of pathologic gastroesophageal reflux by means of 24h esophageal pH-monitoring; diagnosis of reflux esophagitis by means of upper digestive endoscopy and pulmonary function tests by means of spirometry. The results show a high prevalence (87%) of pathologic gastroesophageal reflux in asthmatic children. Additionally, there is an inverse correlation (r = -0.67) between the severity of pathologic gastroesophageal reflux and FEV1/FVC. In conclusion, there is a high prevalence of pathologic gastro-esophageal reflux in asthmatic children, contributing to asthma severity.

[The effectiveness of montelukast in recurrent post-bronchiolitis wheezing]. / Eficienta Montelukastului în wheezingul recurent post bronsiolitic.

Some studies showed increased levels of leukotrienes in the nasopharyngeal secretions in children with wheezing secondary to viral infections, leading to therapeutical attempts with leukotriene receptor inhibitors in infants and small children with recurrent wheezing. This is a double blind randomized study for evaluating the efficacy of montelukast in infants and small children. In the study group (20 children) treated with montelukast, 5 mg/day for 3 months, the frequency of bronchial obstruction episodes in the 6 months following the start of therapy was significantly lower (p = 0.001) than the 6 months before treatment (1.25 +/- 1.41 versus 3.79 +/- 2.41). In the control group (18 children) treated with placebo, the frequency of the bronchial obstruction episodes decreased (from 3.04 +/- 1 to 2.41 +/- 1.5) in the two analyzed periods, but the differences were not statistically significant (p = 0.067). The differences between the two groups are present also after excluding the children with atopy. The results suggest the beneficial role of leukotriene receptor antagonists in improving the symptoms of patients with recurrent post-bronchiolitis wheezing.