Could Lower Bone Turnover be a Cause of Chest Pain During Childhood?

Chest pain, a frequent complaint during childhood, rarely originates from a cardiac pathology. Although it usually is idiopathic, it also could be associated with psychogenic, musculoskeletal, respiratory, and digestive disorders. This study aimed to investigate a possible relation between bone mineral density and chest pain in children. Bone mineral density and bone metabolism parameters were measured for 50 children with chest pain, and the findings were compared with those for 40 age- and sex-matched healthy children. Most of the cases (64%) were in the idiopathic group, and musculoskeletal chest pain was the second most frequent complaint (12%). Although bone mineral densities and osteocalcin levels did not differ significantly between the whole chest pain group and the control group, both were found to be lower in the musculoskeletal chest pain group than in other groups and the control group (p < 0.05). Musculoskeletal chest pain may be related to reduced bone mineral metabolism, and monitoring of risk factors is of particular importance.     

Comparison of Vascular Complications Between Conventional Treatment and Bone Marrow Transplantation for Children with ß-Thalassemia Disease

Patients with ß-thalassemia may be predisposed to premature atherosclerosis due to vascular dysfunction. This is observed in adults. Whether atherosclerosis changes in ß-thalassemia disease (BTD) occur early in childhood is not clear. To prevent cardiovascular complications, this needs evaluation. Moreover, it remains uncertain whether curative treatment with bone marrow transplantation (BMT) would improve this vascular alteration. For this study, 37 ß-thalassemia children age 10.1 ± 2.7 years were classified into group 1 (25 children with BTD treated conventionally) and group 2 (12 children with BTD who underwent BMT). A control group of 29 age-matched healthy children were studied simultaneously. The carotid stiffness index and intima–media thickness (IMT) were measured. Group1 had a greater arterial stiffness index than the control subjects (4.57 ± 1.78 vs. 2.87 ± 1.07; p < 0.001). The carotid IMT was significantly greater in both BTD groups than in the control group (group 1: 0.45 ± 0.03 vs. 0.34 ± 0.04 mm; p < 0.001; group 2: 0.43 ± 0.03 vs. 0.34 ± 0.04 mm; p < 0.001). Carotid IMT and arterial stiffness are increased in conventionally treated children with ß-thalassemia, suggesting an early atherosclerotic change in these children, whereas children with BTD who underwent BMT had an increased carotid IMT but normal arterial stiffness.     

Bone Metastases in Medulloblastoma –Single Institution Experience

Background: Medulloblastoma has one of the highest rates of metastasis outside the central nervous system (CNS). Bone metastases are the most common lesions, although lymph node and visceral spread have also been reported. Objective: To present patients with bone metastasis in medulloblastoma and discuss their radiologic appearances and treatment approach. Patients and methods: From 1993 to 2008, 82 patients diagnosed with medulloblastoma were treated at the Institute for Oncology and Radiology of Serbia. Three (3.6%) developed extraneural metastasis (ENM). In primary treatment, patients were treated with surgery, craniospinal radiotherapy with local boost to tumor bed, and adjuvant chemotherapy [lomustine (CCNU) and vincristine]. Of the three patients with ENM, all developed bone metastases at the time of relapse. Relapse occurred within 17 to 42 months of initial diagnosis. Patients received secondary chemotherapy and palliative radiotherapy to the affected bone in two cases. Results: Among these three patients, case 1 had initially a solitary lytic lesion. Case 2 had diffuse blastic lesions and also bone marrow involvement. Case 3 had multiple mixed lytic-sclerotic lesions but later developed lymph node metastasis and metastases to both breasts, as well. All patients were without concurrent CNS involvement at the time of ENM. Unfortunately, after initial partial response, the three patients died at 24, 13, and 18 months after detection of metastases, respectively. Conclusion: With prolonged survival times in children with medulloblastoma, more emphasis should be placed on the possibility of systemic involvement. A greater understanding of the pathogenesis of the systemic metastases may be valuable in designing future, more aggressive multimodal therapy.     

Bone measurements of infants in the first 3 months of life by quantitative ultrasound: the influence of gestational age, season, and postnatal age

Background: There are a few quantitative ultrasound (QUS) studies of bone status for Chinese children. Objective: To evaluate the clinical application and to investigate the bone status of neonates and young infants with QUS. Materials and methods: An ultrasound bone sonometer was used to measure the bone speed of sound (SOS) of the tibia in 542 neonates within 3 months of birth. Results: At birth, no significant difference of SOS was found between boys and girls, but there was a significant difference of SOS between premature infants and full-term infants. The SOS in neonates born during spring and summer was significantly lower than those born during autumn and winter. There were significant correlations between SOS and gestational age, and between bone SOS and birth weight in appropriate for gestational age (AGA) infants. Multiple regression analysis found that gestational age and infant birth season were two important factors influencing SOS. During the first 3 months, there was no significant difference in SOS between sexes. The SOS of infants showed an inverse correlation with postnatal age, and the decrease of bone SOS with age in premature infants was more marked than in full-term infants. Conclusions: QUS is suitable for evaluating bone status in infants with high precision. The study offers some basic data for neonates and young infants.     

Bone marrow transplantation for hematological disorders—Shiraz experience

Objective : In the past 8 years, 120 cases of hematological disorders were transplanted from the HLA identical donors.Method: Using chemotherapy based conditioning regimen with cyclophosphamide 200 mg/kg and busulfan 15–16 mg/kg, 80 cases of β-thalassemia major and 35 cases of leukemia and five patients with aplastic anemia had received bone marrow transplantation.Result : The five-year-survival in thalassemic group was 72%, for leukemic group (acute and chronic) was 58%, and also for aplastic anemia 65%. Transplantation related mortality was the cause of death in 29 cases. The two major causes of death were acute graft versus host disease and poor medical condition of patients before marrow transplantation.Conclusion : At the present time, allogenic marrow transplantation is curative mode of treatment for many hematological diseases.     

Bone health in children with long–term idiopathic subclinical hypothyroidism

Background

Previous Italian paediatric blood pressure (BP) tables overestimated the prevalence of hypertension in adolescents of specific geographic areas, such as Sardinia, an island in the Mediterranean Sea. This is probably due to a not very homogeneous distribution of the subjects studied, most from Middle and Northern Italy, and the long period from the survey.

Methods

BPs were repeatedly measured over a period of 3 years in 839 children (52.6% males. Age range: from 11 to 14 years during this period), using a standard mercury sphygmomanometer. For each gender, the specific percentile curves of systolic and diastolic BP were constructed.

Results (corrected by the 50^th percentile of height)

Males (11-14 years)

mean systolic BP (50^th centile): from 111 to 115 mmHg. Hypertensive systolic BP (> 95^th percentile): from 127 to 135 mmHg. Mean diastolic BP (50^th centile): from 65 to 69 mmHg. Hypertensive diastolic BP (> 95^th percentile): from 78 to 82 mmHg.

Females(11-14 years)

mean systolic BP (50^th centile): from 110 to 112 mmHg. Hypertensive systolic BP (> 95^th percentile): from 127 to 130 mmHg. Mean diastolic BP (50^th centile): from 65 to 67. Hypertensive diastolic BP (> 95^th percentile): from 78 to 80 mmHg.

Conclusions

Sardinian BP tables emphasizes the need to integrate the previous standards with more up-to-date and representative reports on Italian children, as periodically performed in the USA, in order to increase the number of subjects to be checked, and to obtain a national coverage better and more completely representative of every geographic area of our country.     

Doppler Flow Parameters of Left Ventricular Filling in Infants: How Long Does It Take for the Maturation of the Diastolic Function in a Normal Left Ventricle to Occur?

Objective To study the impact of the maturational process of diastolic left ventricular function on trans-mitral Doppler flow parameters.Methods and Participants In a survey we examined pulsed-wave Doppler signals and diastolic time intervals from 238 healthy neonates and infants. Using multiple linear regression analysis, we evaluated the impact of physiological determinants on parameter expression.Results Early-filling and atrial-filling peak velocities, early-filling acceleration and deceleration rates, and the atrial-filling time velocity integral reached a climax within 2 months after birth, while early-filling time velocity integral followed increasing throughout the study period. The isovolumic relaxation time was found to be significantly longer for neonates than for infants older than 2 months. The observed parameter movements could be attributed to changes of stroke volume and mitral valve area for early filling-time velocity integral (R² = 0.93), and of heart rate, stroke volume, and mitral valve area for early filling peak velocity (R² = 0.84), and atrial-filling time velocity integral (R² = 0.65). Isovolumic relaxation time and atrial-filling peak velocity became heart rate dependent not before 3 months after birth.Conclusions The observed parameter changes are powerful indicators for the maturational process in diastolic function. This process is mainly completed by 3 months of age.     

Bone age estimation and prediction of final height in patients with β-thalassaemia major: a comparison between the two most common methods

Background Thalassaemic patients are in need of frequent assessment of bone age because of growth failure and pubertal disorders. Objective To compare the “rapid” Greulich and Pyle (G&P) method with the third edition of the Tanner and Whitehouse (TW3) method for determining skeletal maturity and predicting final height in thalassaemic patients. Materials and methods A total of 191 radiographs from 58 patients (28 male, 30 female) were retrospectively evaluated by two investigators, one for each method. In 47 radiographs from 15 patients having attained their adult height, predicted final height was calculated according to each method. Results The mean bone ages determined by both the G&P and TW3 methods were lower than mean chronological age, although the differences were not statistically significant (10.04  ±  3.69 years and 9.98 ± 3.39 years vs. 10.78 ± 3.96 years, respectively). Both methods had a tendency to over-estimate final height. Overall, the TW3 method seemed to be more accurate than the G&P method (mean absolute error 3.21 ± 2.51 years vs. 3.99 ± 2.99 years, respectively, P=0.048). Conclusions The same method should be used when serial assessments are performed, as both methods provide similarly reliable, although not equivalent, results. The TW3 height prediction method seemed to be more accurate in patients with β-thalassaemia major than the G&P method, albeit with a large confidence interval.     

Does Gluten-Free Diet Protect Children with Celiac Disease from Low Bone Density?

Objective: We aimed to assess the effect and duration of gluten-free diet on bone health in children with celiac disease in our study. Methods: Sixty three patients with celiac disease (CD) formed the study group. They were divided into two subgroups according to their dietary compliance. Bone mineral density (BMD) values of the patients at two and five years of gluten-free diet (GFD) were determined. Findings : The relationship between BMD and compliance to GFD was found to be statistically significant (P<0.01). BMD z-scores were increased (0.12±0.15 and 0.10±0.14 units respectively) (P<0.01). The patients in group 1 and 2 had mean -1.18±0.83 and -2.06±0.73 z-scores in the first DXA. In the second DXA, these values were -1.10±0.73 and-1.94±0.93 respectively. Conclusion: Dietary compliance is important for bone health, and the time needed to normalize the BMD is not known. Patients with positive anti-endomysium antibody (EMA), poor dietary history and history of bone pain should be evaluated with DXA during follow-up.Key Words: Celiac, Gluten Free Diet, Low Bone Density, Bone Mineral Density     

Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil

BACKGROUND: To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD. METHODS: Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained. RESULTS: The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm2 v 1.060 +/- 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal. CONCLUSIONS: The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.     

Bone marrow transplantation for sickle cell disease: where do we go from here?

Bone marrow transplantation has curative potential for patients who have sickle cell disease. However, concerns about short-term and long-term toxicity, lack of suitable stem cell donors, and limited access to this treatment currently make it an infrequently utilized treatment for sickle cell disease. The current results of bone marrow transplantation for sickle cell disease and barriers to wider application are reviewed. Strategies that might lead to broader availability and reduced toxicity of bone marrow transplantation are discussed.     

Clinical Parameters in the First 5 Minutes after Birth Have a Predictive Value for Survival of Extremely Preterm Infants

Extreme preterm infants (<28 weeks’’ gestation) often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room. To date, optimal inspired fraction of oxygen (FiO2) still represents a conundrum in newborn care oscillating between higher (>60%) and lower (<30%) initial FiO2. Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial ox...     

Bone age in the 21st century: is Greulich and Pyle’s atlas accurate for Israeli children?

Background  

The applicability today of Greulich and Pyle's Radiographic Atlas of Skeletal Development of the Hand and Wrist (G&P) is uncertain.     

Exercise Capacity Assessment by the Modified Shuttle Walk Test and its Correlation with Biochemical Parameters in Obese Children and Adolescents

Objectives

To evaluate exercise capacity of obese children and adolescents compared with normal-weight individuals and to investigate possible correlations with blood biochemical parameters.

Methods

In this study, children and adolescents between 6 and 18 y were included and divided into control (eutrophic) and obese groups according to body mass index (BMI). Data were collected regarding demographic, anthropometric, waist circumference and exercise capacity through the Modified Shuttle Walk Test (MSWT). In the obese group, biochemical parameters in the blood (total cholesterol, HDL, LDL, triglycerides and glucose) were evaluated, and a physical activity questionnaire was applied.

Results

Seventy seven participants were included; 27 in the control group and 50 obese. There was no significant difference between the two groups regarding sample characteristics, except for body weight, BMI and waist circumference. Most obese children presented results of biochemical tests within the desirable limit, though none were considered active. There was a significant exercise capacity reduction (p?<?0.001) in the obese group compared to control subjects. Positive correlations were identified for the MSWT with age and height, and a negative correlation with BMI. However, there were no correlations with the biochemical parameters analyzed.

Conclusions

Obese children and adolescents have reduced exercise capacity when compared to normal individuals. The MSWT performance seems to have a negative association with BMI, but is not correlated with blood biochemical parameters.