Familial X-Linked Acrogigantism: Postnatal Outcomes and Tumor Pathology in a Prenatally Diagnosed Infant and His Mother.

Context: X-linked acrogigantism (X-LAG), a condition of infant-onset acrogigantism marked by elevated GH, IGF-1, and prolactin (PRL), is extremely rare. Thirty-three cases, including three kindreds, have been reported. These patients have pituitary adenomas that are thought to be mixed lactotrophs and somatotrophs.

Interpretation of androgen and anti-Mullerian hormone profiles in a Hispanic cohort of 5- to 8-year-old girls with premature adrenarche.

Purpose: Premature adrenarche (PA) often leads to polycystic ovary syndrome (PCOS). Higher anti-mullerian hormone (AMH) levels are reported in PCOS. We studied the androgen profile and AMH profiles in Hispanic girls with PA (aged 5-8 years) and age and body mass index (BMI) matched controls.

Spiral Fracture in Young Infant Causing a Diagnostic Dilemma: Nutritional Rickets versus Child Abuse.

Fractures are uncommon in young, nonambulatory infants. The differential diagnosis includes nonaccidental injury (NAI) and metabolic bone disease, including rickets. While rickets typically present after six months of age, multiple cases have been reported in younger infants.

Salivary Testosterone during the Minipuberty of Infancy .

Background: The hypothalamic-pituitary-gonadal axis is transiently activated during the postnatal months in boys, a phenomenon termed "minipuberty" of infancy, when serum testosterone (T) increases to pubertal levels. Despite high circulating T there are no signs of virilization. We hypothesize that free T as measured in saliva is low, which would explain the absence of virilization.

Childhood acromegaly due to X-linked acrogigantism: long term follow-up.

Purpose: Acromegaly in infancy is extremely rare. We describe a 32 year old woman who presented at 6 months of age with isolated macrocephaly, followed by accelerated linear growth. At 21 months of age, her head circumference was 55 cm (+5.

20 MHz forward-imaging single-element beam steering with an internal rotating variable-angle reflecting surface: Wire phantom and ex vivo pilot study.

Feasibility is demonstrated for a forward-imaging beam steering system involving a single-element 20MHz angled-face acoustic transducer combined with an internal rotating variable-angle reflecting surface (VARS). Rotation of the VARS structure, for a fixed position of the transducer, generates a 2-D angular sector scan. If these VARS revolutions were to be accompanied by successive rotations of the single-element transducer, 3-D imaging would be achieved.

Devolution's policy impact on non-emergency medical transportation in State Children's Health Insurance Programs.

Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care.

Age of onset of polycystic ovarian syndrome in girls may be earlier than previously thought.

Objectives: To study the age at diagnosis of polycystic ovarian syndrome (PCOS) in a pediatric population. To compare risk factors involved in causing PCOS in preadolescent and adolescent girls. To review the current literature on the reported age of PCOS in girls.

Proof of concept: In vitro measurement of correlation between radiodensity and ultrasound echo response of ovine vertebral bodies.

An acoustic guidance method for pedicle screw placement during spine fixation surgery was recently investigated, with a view toward preventing complications such as injury to the spinal cord, thecal sac, and spinal nerve roots due to screw misplacement. The method relies upon the change in the ultrasound amplitude reflected at different sites-from the outer posterior cortex, through the pedicle, and towards the distal ventral cortex. The amplitude change was empirically observed through in vitro measurement of ultrasound amplitude at the different sites by inserting a 2.

Outcomes of children and adolescents with well-differentiated thyroid carcinoma and pulmonary metastases following ¹³¹I treatment: a systematic review.

Background: The optimal dose and efficacy of ¹³¹I treatment of children and adolescents with well-differentiated thyroid carcinoma (WDTC) and pulmonary metastases are not well established. A therapeutic challenge is to achieve the maximum benefit of ¹³¹I to decrease disease-related morbidity and obtain disease-free survival while avoiding the potential complications of ¹³¹I therapy.

Summary: We systematically reviewed the published literature on children and adolescents with WDTC and pulmonary metastases treated with ¹³¹I to examine outcomes after ¹³¹I administration and the risks and benefits of therapy.

Thyrotropin-secreting pituitary adenoma in an adolescent boy: challenges in management.

Thyrotropinomas tend to be aggressive, invasive tumors that are difficult to resect because of their marked fibrosis and their proximity to vital structures such as the optic chiasm. The latter characteristic also limits the use of radiation therapy. In the few cases reported of children younger than 18 years whose thyrotropinomas were treated surgically, the results were disappointing.

A-Mode ultrasound guidance for pedicle screw advancement in ovine vertebral bodies.

Background Context: In pedicle screw fixation surgery, rigid instruments are inserted into a vertebral body. When the instruments are misdirected within the pedicle or advanced too far beyond it, perforations of the inner or outer cortex can cause damage to the spinal nerve roots and spinal cord. These complications can occur despite the use of imaging modalities, such as radiographs, fluoroscopy, and computerized axial tomography (CAT) scans.

Endometrial thickness, uterine, and ovarian ultrasonographic features in adolescents with polycystic ovarian syndrome.

Objective: Our aim was to evaluate uterine and ovarian ultrasonographic features including endometrial thickness (ET) in adolescent females with PCOS, which is limited in this population.

Methods: We performed a retrospective chart review of young females (n=51) ranging in age from 10 to 18 years with the diagnosis of PCOS. Clinical, biochemical and pelvic sonography data were reviewed.

The prevalence of abnormal liver enzymes and metabolic syndrome in obese adolescent females with polycystic ovary syndrome.

Objectives: We sought to determine the prevalence of abnormal liver enzymes suggestive of nonalcoholic steatohepatitis and metabolic syndrome in obese adolescent females with polycystic ovary syndrome.

Design: A retrospective chart review.

Participants: Patients included 39 obese (body mass index Z score >/= 2) adolescent females with a diagnosis of polycystic ovary syndrome.

Evaluation of adolescents for polycystic ovary syndrome in an urban population.

Objective: To assess the quality of diagnostic work-up received by patients with "possible" polycystic ovary syndrome (PCOS).

Design: A retrospective chart review.

Setting: A hospital based Pediatric Clinic in New York City.

The relationship between leptin and norepinephrine levels during OGTT in normotensive and hypertensive obese adolescents.

Background/aims: Studies in adult population have suggested that leptin might play a role in inducing obesity related hypertension mediated by the sympathetic nervous system. This association has not been established for adolescents. Our study is designed to explore the relationship between leptin and norepinephrine levels in pediatric patients and to identify any contributors to hypertension for this population.

Antenatal treatment of fetal goiter: a therapeutic challenge.

Objective: Pre-natal ultrasonography presents an opportunity for in-utero therapy of a fetal goiter. Because of the morbidity associated with a large goiter and the risks of repeated intra-amniotic injections, controversy arose about the precise indications of this mode of treatment. We describe our observations in treating a 22-week-old fetus with a large goiter because of dyshormogenesis, monitored with serial 3D high frequency, high resolution ultrasonography and amniotic hormonal measurements.

Images of spinal nerves and adjacent structures with optical coherence tomography: preliminary animal studies.

Unlabelled: Multiple complications have been reported with spinal intervertebral transforaminal injection procedures, despite the use of fluoroscopic needle-positioning measures. We explored an imaging technology (optical coherence tomography, or OCT) for its possible use in spine interventional procedures as a means of providing needle tip vision at the neuroforamen. Optical coherence tomography is the B-mode optical analog of ultrasound.

Pediatric airway and esophageal profiles with acoustic reflectometry.

Acoustic reflectometry is a technique by which the dimensions of a cavity can be estimated in the form of an area-distance profile. We conducted a pilot study to obtain the acoustic reflectometry (AR) images associated with breathing tube (endotracheal tube, ETT) placement (inner diameter 4.5-6 mm) and positioning in 21 (n = 21) children, aged 2-12 yr.

Frontal slab composite magnetic resonance neurography of the brachial plexus: implications for infraclavicular block approaches.

Background: Magnetic resonance neurography (MRN) is an imaging method by which nerves can be selectively highlighted. Using commercial software, the authors explored a variety of approaches to develop a three-dimensional volume-rendered MRN image of the entire brachial plexus and used it to evaluate the accuracy of infraclavicular block approaches.

Methods: With institutional review board approval, MRN of the brachial plexus was performed in 10 volunteer subjects.

Acoustic reflectometry esophageal profiles minimally affected by massive gas ventilation.

Acoustic reflectometry can be used to distinguish between breathing tube placement in an esophagus vs the trachea via characteristic area-distance profiles for both cavities. In the cardiopulmonary resuscitation setting, capnography may be useless because the patient has little or no pulmonary circulation. With the breathing tube in the esophagus, can massive ventilation with a manual resuscitation bag, as might occur in the cardiopulmonary resuscitation setting, markedly alter the form of the obtained esophageal reflectometry profile? Nine hounds were induced, endotracheally intubated, mechanically ventilated, and anesthetized.

Hemorrhagic pituitary apoplexy in an 18 year-old male presenting as non-ketotic hyperglycemic coma (NKHC).

Pituitary apoplexy is an acute clinical event usually caused by hemorrhage or infarction in a pituitary adenoma. We report the unusual case of hemorrhagic pituitary apoplexy in an 18 year-old male with previously undiagnosed type 2 diabetes mellitus who presented with unexplained hyperglycemia (glucose 49.2 mmol/l [887 mg/dl]) and obtundation and in whom an initial diagnosis of non-ketotic hyperglycemic coma (NKHC) was made.

Hormonal effects in infants conceived by assisted reproductive technology.

Objective: The purpose of this report is to describe 7 infants conceived by assisted reproductive technology (ART) who presented with breast development and/or pubic hair. The clinical presentation in these infants raises awareness that an altered intrauterine hormonal milieu may impact the fetal and infant stages of children conceived by ART.

Methods: Between May 2001 and April 2004, 7 children between the ages of 5 and 21 months conceived by ART were referred by their pediatricians to the Division of Pediatric Endocrinology at the New York University School of Medicine for evaluation of possible precocious puberty.