The radiographic features of meningiomas in childhood and adolescence

Meningiomas, although rare in the first two decades of life, must be considered in the differential diagnosis of intracranial neoplasms in this age group. Their radiographic appearance in children is sufficiently characteristic to suggest the diagnosis. Although their appearance differs little from that of adult meningiomas, childhood meningiomas are characterized by an increased frequency of calcification and higher incidence of location in the posterior fossa and within the ventricles.     

��ע��ͯ��������״�л�ϰ�����ԹDz����Ŵ��ԹDz�

??Childhood and adolescence are key periods for bone development and mineralization. Bone diseases in childhood and adolescence can result in skeleton deformities, decreased adult height and changed peak bone mass. It would be very important to early diagnose and treat bone diseases in childhood and adolescence. According to the clinical manifestation, laboratory examinations and X-ray, bone diseases can be classified as metabolic bone disorders of calcium and phosphate, and genetic bone diseases. The pathogenesis, clinical manifestations, biochemical and radiological features of bone disease in childhood and adolescence were summarized. Progress in radiological examinations and treatment of these diseases were reviewed.     

Osteochondroma of the sacrum with a correlative radiographic and histological evaluation

Primary benign sacral tumors are rare representing only 1-4% of solitary exostoses and constituting 4% of all solitary spinal tumor. The tumor usually comes to attention in childhood or adolescence. The treatment of symptomatic lesions is resection. We present here a case of a sacral osteochondroma with characteristic histological and radiological features in an adolescent presenting with radicular pain.     

Massive congenital intracranial immature teratoma of the lateral ventricle with retro-orbital extension: a case report and review of the literature

Germ cell tumors comprise 0.4-3.1% of all intracranial tumors, and teratoma constitutes 9-30% of them. Congenital intracranial tumors are very rare and only account for 0.5-1.5% of all childhood brain tumors. The most common type of these tumors present at birth is teratomas, which represent 0.5% of all intracranial tumors. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. In this study, we report a neonatal intracranial immature teratoma at the lateral ventricle because of its rare location. A 5-day-old female neonate presented with a history of irritability and left eye protrusion since birth. A head computed tomographic (CT) scan and magnetic resonance imaging (MRI) disclosed a large tumor filling the left lateral ventricle and extending into the ipsilateral retro-orbital space. With left frontotemporoparietal craniotomy, a large grayish-white lobulated vascular mass was encountered, and total removal of tumor was performed. Histological examination revealed the diagnosis of immature teratoma. The prognosis of congenital intracranial immature teratoma is usually poor because the lesions are extensive when they are identified. Prenatal ultrasonography is necessary for the prenatal diagnosis. Fetal MRI should be made for the evaluation of intracranial tumor. If the tumor is detected before the 24th week of gestation, termination of the pregnancy should be considered.     

VIP secreting tumours in infancy

Vasoactive intestinal polypeptide (VIP) secreting neural crest tumours are an uncommon but important treatable cause of intractable childhood diarrhoea. The radiological appearances of two cases are presented with a review of radiological findings in childhood VIP secreting neural crest tumours. Twenty eight cases of childhood VIP secreting neural crest tumours were reviewed. Nineteen (68%) were ganglioneuroblastomas and nine (32%) were ganglioneuromas. The majority of tumours (66%) were in a paravertebral location in the abdomen indicating that a search for such a tumour should be initiated at this site. Eighteen of the twenty eight cases reviewed discussed relevant radiological investigtions. Calcification was detected in 50% of abdominalradiographs. Gut dilatation was often a prominet feature. A mass was detected in 5 of 5 cases where ultrasound findings were reported, and seven of seven cases with CT findings reported. Prior to the availability of CT and ultrasound the most useful investigation was IVU which demonstrated evidence of a mass in 5 of 9 cases. The presence of paravertebral calcification and gut dilatation on the plain radiograph of a child with intractable diarrhoea suggests the presence of a VIP secreting neural crest tumour. If an abdomil tumour is not found in the appropriate clinical setting and VIP levels are elevated, a widespread search of the paravertebral region is indicated.     

Early anxious/withdrawn behaviours predict later internalising disorders

BACKGROUND: The aim of the study was to examine the association between anxious/withdrawn behaviours at age 8 and the development of internalising disorders in adolescence and young adulthood (ages 16-21). METHODS: Data were gathered over the course of a 21-year longitudinal study of a birth cohort of over 1,000 New-Zealand-born young people. Over the course of the study, data were gathered on: (a) anxious/withdrawn behaviour at age 8; (b) anxiety disorders and major depression at ages 16-18 and 18-21; (c) a range of potential confounding factors, including measures of adversity and family factors during childhood. RESULTS: Increasing anxious/withdrawn behaviour at age 8 was associated with increasing risks of social phobia; specific phobia; panic/agoraphobia; and major depression during adolescence and young adulthood. These associations persisted after adjustment for a series of confounding social, childhood, and family factors. CONCLUSIONS: Anxious/withdrawn behaviour in childhood is associated with elevated rates of anxiety disorders and major depression during adolescence and young adulthood. These data are consistent with, and extend, previous clinical and epidemiologic findings, by showing consistent linkages between childhood anxious/withdrawn behaviours at age 8 and increased risk for anxiety disorders and depression at ages 16-18 and 18-21 among young persons in the community. These results may point to the need to provide support and possibly intervention to children showing early anxious or withdrawn behaviours.     

Type 1-primary cutaneous meningioma of the scalp.

Type 1-primary cutaneous meningioma is a rare and often clinically unsuspected lesion of the scalp, forehead or paravertebral region which occurs at birth or during childhood. The pathogenesis of these lesions still remains uncertain. Several authors have emphasized that type 1-cutaneous meningiomas are not real tumors but sequestrated meningoceles or heterotopic meningeal nodules of the skin. Nevertheless, the search for an intracranial or intravertebral connection should be carried out. We describe the clinical and pathological features of a congenital type 1-meningioma of the vertex. No cranial defect or intracranial tumor was found. However, the cutaneous lesion was directly linked to a large cranial vein. The purpose of this study was to illustrate this rare lesion and to indicate the possible surgical risks and the pathological characteristics.     

Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

BACKGROUND: The present study was aimed to define the gender ratio, familial occurrence, age of onset, precipitating factors, clinical types, nail and joint involvement of psoriasis in childhood and adolescence in Turkey. METHODS: A total of 61 children with psoriasis under 18 years old were evaluated retrospectively, for age, gender, age of disease onset, family history, concomitant disease, the clinical type of psoriasis, clinical localization, nail and joint involvement and treatment modalities. RESULTS: Of the patients, 23 (37.70%) were boys and 38 (62.30%) were girls. Mean age was 9.28 +/- 4.02 years in girls and 11.18 +/- 3.85 years in boys (9.96 +/- 4.03 years in all children). Mean age at the onset of the disease was 6.81 +/- 4.11 years in girls and 7.03 +/- 4.28 years in boys (6.89 +/- 4.14 years in all patients). In 14 (23%) cases, a positive family history was detected. The most frequent probable triggering factors were upper respiratory tract infections (14.8%) and positive throat culture for A group ss-hemolytic streptococcus (21.3%). Frequency of emotional stress and psychiatric morbidity were 54% and 9.8%, respectively. The most frequent localizations at onset were trunk (44.3%), extremities (54.0%), and scalp (36.0%). Three children (4.9%) had a history of dissemination from psoriatic diaper rash. In total, 51 (83.6%) patients presented with psoriasis vulgaris, eight (13.1%) with generalized pustular psoriasis, and the remaining two (3.3%) with erythrodermic psoriasis. CONCLUSION: The incidence of psoriasis among dermatological patients in childhood and adolescence was 3.8%. The disease tends to appear earlier in girls than boys. The authors suggested that stress and upper respiratory infections are the most important triggering factors in childhood and adolescence psoriasis.     

Descriptive epidemiology of pediatric intracranial neoplasms in egypt

Objective: The characteristics of 451 Egyptian children (aged 0-14 years) with primary intracranial neoplasms were investigated for demographic, clinical, topographical and pathological features using the most recent 2007 Classification of Central Nervous System Tumors. Patients and Methods: This was a retrospective study performed in the Departments of Pediatric Neurosurgery of the Cairo University Hospitals from 2005 to 2008. Results: There was a slight male predominance (51.4%) observed in our study, and the most affected age group was 5-9 years old (43.2%). Most of the tumors were confined to a single compartment (infratentorial in 49.7%, supratentorial in 46.6%), while 3.8% of the tumors involved multiple compartments. The most common intracranial tumors were astrocytomas (35%), medulloblastomas (18.8%), craniopharyngiomas (11.3%) and ependymomas (10%). Pilocytic astrocytomas constituted 55% of all astrocytomas and 19.3% of all brain tumors, only slightly ahead of medulloblastomas. Less common types were primitive neuroectodermal tumors (2.7%), followed by meningiomas, germ cell tumors and choroid plexus tumors (2.4% each). According to the International Classification of Diseases for Oncology Coding (ICD-O-4), benign, borderline and malignant tumors constituted 7.54, 36.14 and 56.32%, respectively. Conclusion: The characteristics of pediatric intracranial tumors in Egypt are generally similar to those reported in the literature, with only minor differences.     

Cystic meningiomas in children: A diagnostic challenge

Two cases of cystic meningioma in children are presented. The MR imaging features of each case presented difficulties in differential diagnosis because of the cystic nature of the neoplasms and their location. Cystic areas in meningiomas are encountered more frequently in children than in adults. Meningioma must be included in the differential diagnosis of cystic intracranial tumors in children.     

LATE PRESENTATION OF STRICTURE OF THE AQUEDUCT OF SYLVIUS

8 children with insidious onset of manifestations of stricture of the Aqueduct of Sylvius in later childhood are reported. These children present with raised intracranial pressure, without lateralising signs, thus mimicking tumours, and the radiological features are those of raised intracranial pressure. Stricture of the Aqueduct is one of the commoner causes of this “midline syndrome”, and compared with the other causes, its treatment is simple and the prognosis good.     

Association of television viewing during childhood with poor educational achievement

BACKGROUND: Excessive television viewing in childhood has been associated with adverse effects on health and behavior. A common concern is that watching too much television may also have a negative impact on education. However, no long-term studies have measured childhood viewing and educational achievement. OBJECTIVE: To explore these associations in a birth cohort followed up to adulthood. DESIGN: Prospective birth cohort study. SETTING: Dunedin, New Zealand. PARTICIPANTS: Approximately 1000 unselected individuals born between April 1, 1972, and March 31, 1973. Ninety-six percent of the living cohort participated at 26 years of age. MAIN OUTCOME MEASURES: Educational achievement by 26 years of age. RESULTS: The mean time spent watching television during childhood and adolescence was significantly associated with leaving school without qualifications and negatively associated with attaining a university degree. Risk ratios for each hour of television viewing per weeknight, adjusted for IQ and sex, were 1.43 (95% confidence interval [CI], 1.24-1.65) and 0.75 (95% CI, 0.67-0.85), respectively (both, P<.001). The findings were similar in men and women and persisted after further adjustment for socioeconomic status and early childhood behavioral problems. Television viewing during childhood (ages 5-11 years) and adolescence (ages 13 and 15 years) had adverse associations with later educational achievement. However, adolescent viewing was a stronger predictor of leaving school without qualifications, whereas childhood viewing was a stronger predictor of nonattainment of a university degree. CONCLUSIONS: Television viewing in childhood and adolescence is associated with poor educational achievement by 26 years of age. Excessive television viewing in childhood may have long-lasting adverse consequences for educational achievement and subsequent socioeconomic status and well-being.     

Understanding desisting and persisting forms of delinquency: the unique contributions of disruptive behavior disorders and interpersonal callousness

Background: While associations between conduct disorder (CD), oppositional defiant disorder (ODD), attention deficit hyperactivity disorder (ADHD), and interpersonal callousness (IC) symptoms and delinquency onset are well established, less is known about whether these characteristics differentiate desisting and persisting delinquency. The current study examined whether childhood and adolescent CD, ODD, ADHD, and IC symptoms uniquely distinguished boys who exhibited persisting versus desisting delinquency from adolescence into adulthood. Methods: Participants were 503 boys (57% African American) repeatedly assessed from ages 7 to 25. Associations between childhood and adolescent CD, ODD, ADHD, and IC symptoms and desisting and persisting delinquency were examined independently and after controlling for their co‐occurrence and multiple covariates. Results: Conduct disorder and IC symptoms in childhood and adolescence were higher among boys whose delinquency persisted into adulthood relative to those boys whose delinquency desisted across time. After controlling for the overlap between symptoms of ADHD, ODD, CD and IC, only adolescent CD and IC symptoms emerged as unique predictors of the differentiation between persisters and desisters. Moreover, adolescent CD and IC symptoms continued to contribute unique variance even after childhood levels of these characteristics were accounted for. Conclusions: Boys with elevated levels of CD and IC symptoms in childhood and adolescence are at risk for exhibiting a pattern of delinquency that persists from adolescence into adulthood. Intervention efforts designed to prevent chronic delinquency should target youth with co‐occurring CD and IC symptoms in childhood and adolescence.     

Urinary tract diseases in adolescence: A radiological and clinical view

A total of 2,003 adolescent in-patients aged 14–19 years were studied. Of these 801 (40 per cent) were found to have urinary tract disease. In 224 patients (28 per cent) a previously undetected urinary tract anomaly was diagnosed: this number including 59 per cent of girls and 41 per cent of boys. This is the first analysis showing such a high frequency of urinary tract anomalies in clinical and radiological investigations during the period of adolescence. Of particular importance are minor anomalies, in so far as these are responsible for disorders to the flow of urine. It is thought that urinary tract anomalies manifest themselves in adolescence because of increased stress and a different pattern of life, as compared with that in the preceding era of childhood. The present paper shows the cardinal importance of radiological examination and of the radiologist's role in evaluating the dynamics of the process and the prognosis of the disease and, in helping to assess the future potential for physical stress in either work or sport.     

Lumbar disc herniation in adolescence

Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13-17 years) who were surgically treated for lumbar disc herniation in our clinic between 1998 and 2003 were retrospectively reviewed. The mean follow-up time for these cases was 60 months. The collected histories revealed that 14 (82%) of the 17 cases involved trauma or intense sports activity. Low back pain was the most common complaint (15 cases, 88%). None of the 17 patients had major symptoms during follow-up, and most were engaged in intense sports or heavy work-related activities during this period. The main features of lumbar disc herniation in adolescents are different from those seen in adults. Careful assessment is vital to avoid misdiagnosis and prevent undesirable results from inappropriate surgery. When surgery is indicated and patients are carefully selected, the results of lumbar discectomy in adolescence can be satisfactory.     

Comparison of longstanding pediatric-onset and adult-onset Crohn's disease

INTRODUCTION: Limited information is available on the characteristics of longstanding Crohn's disease with onset in childhood or adolescence. MATERIALS AND METHODS: In this retrospective study, 224 patients with pediatric-onset Crohn's disease were compared to a group of patients with disease diagnosed as adults. RESULTS: More than 50% of the patients in the pediatric-onset group were followed for more than a decade, with a mean follow-up of 12.2 years. There were 96 male (42.9%) and 128 female (57.1%) patients. Most had disease diagnosed in adolescence. The female predominance, similar to adult-onset disease, was noted only among patients with disease diagnosed in adolescence (13-19 years), not in childhood. Disease most often involved both ileum and colon (128 of 224; 57.1%). Isolated ileal or colonic disease was less common. Upper gastrointestinal tract disease was present in 42 of 224 (18.8%) patients. The incidence of strictures (28.6%) and penetrating complications (46.4%) was similar to that of adults followed for the same period of time. CONCLUSION: In pediatric-onset Crohn's disease, female-predominance emerges during adolescence. Pediatric-onset disease is more extensive than adult-onset disease. When followed for an extended period of time, it has high rates of disease complexity, with strictures and penetrating complications similar to adult-onset disease.     

Peritoneal hemorrhage due to a ruptured ovarian cyst in ITP

Immune thrombocytopenic purpura in children rarely causes severe bleeding. The incidence of intracranial hemorrhage is approximately 0.2% to 1.0%, and severe bleeding (defined as persistent epistaxis, melena, menorrhagia, gastrointestinal bleeding, etc, requiring hospitalization or transfusion) occurs in only 5% of patients. Epstein-Barr virus (EBV) associated idiopathic thrombocytopenic purpura (ITP) tends to behave similarly to non-EBV - associated ITP with no increase in hemorrhagic complications and only a small increase in time to remission. Immune thrombocytopenic purpura diagnosed in adolescence is more likely to be chronic then in childhood ITP, but has a higher rate of spontaneous resolution than in adults. However, females in this age group are in their early childbearing years and present a unique set of possible hemorrhagic complications not seen in younger patients. We present the case of an 18-year-old female with EBV-associated ITP, who developed a severe intra-abdominal bleed secondary to a hemorrhagic ovarian cyst.     

Cigarette consumption during childhood and persistence of smoking through adolescence

BACKGROUND: The childhood cause of adolescent smoking requires prospective study. OBJECTIVES: To compare prospective with retrospective estimates of childhood smoking and to test cigarette consumption and susceptibility to smoking during childhood as predictors of smoking behavior at late adolescence. DESIGN: Eight-year prospective study. SETTING: From February through April of 1994, 1995, and 1996, surveys were completed in elementary schools in central North Carolina; from February through May 2002, telephone interviews were completed wherever participants resided. PARTICIPANTS: Of 868 age-eligible children, 737 (84.9%) provided survey data between the ages of 8 and 10 years; of these subjects, 594 (80.6%) were interviewed at the age of 17 years. MAIN OUTCOME MEASURES: Current, established, and daily smoking. RESULTS: Current smoking was reported by 23.0% of those having never puffed on a cigarette (abstinent) in childhood vs 42.7% (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.58-3.82), 50.0% (OR, 3.36; 95% CI, 1.41-8.01), 58.3% (OR, 4.41; 95% CI, 1.46-14.18), and 56.5% (OR, 4.37; 95% CI, 1.86-10.29) of those who smoked 1 or fewer, 2 to 4, 5 to 20, and more than 20 cigarettes, respectively, during childhood. Established smoking was reported by 15.0% of those abstinent in childhood vs 21.3% (OR, 1.52; 95% CI, 0.89-2.58), 40.6% (OR, 3.93; 95% CI, 1.61-9.59), 50.0% (OR, 4.96; 95% CI, 1.77-16.18), and 47.8% (OR, 5.21; 95% CI, 2.20-12.32) of those who smoked 1 or fewer, 2 to 4, 5 to 20, and more than 20 cigarettes, respectively, during childhood. Daily smoking was reported by 10.1% of those abstinent in childhood vs 11.2% (OR, 1.10; 95% CI, 0.56-2.18), 28.1% (OR, 3.45; 95% CI, 1.24-9.03), 33.3% (OR, 4.47; 95% CI, 1.29-15.84), and 39.1% (OR, 5.75; 95% CI, 2.35-14.08) of those who smoked 1 or fewer, 2 to 4, 5 to 20, and more than 20 cigarettes, respectively, during childhood. Among abstinent children, high vs low susceptibility to smoking predicted greater likelihood of current (37.5% vs 16.7%; OR, 2.98; 95% CI, 1.55-5.74), established (32.1% vs 9.3%; OR, 4.81; 95% CI, 2.29-10.07), and daily (21.4% vs 7.0%; OR, 4.02; 95% CI, 1.71-9.44) smoking at follow-up. CONCLUSION: Relatively small increases in the number of cigarettes consumed during childhood are associated with significantly higher odds of current, established, and daily smoking in adolescence.     

质子治疗儿童常见颅内肿瘤疗效和安全性的系统评价和Meta分析

目的：评价质子治疗儿童常见颅内肿瘤的疗效和安全性。方法：检索Web of Science、Embase、Cochrane Library、PubMed和中国生物医学文献数据库,检索截止时间为2016年9月,纳入质子治疗儿童常见颅内肿瘤的临床研究。对纳入的文献进行质量评价,采用MetaAnalyst及STATA12.0进行合并分析,对无法合并的结局指标采用描述性分析。结果11篇研究进入系统评价,9篇为病例系列报告, 2篇为非随机对照试验,共纳入接受质子治疗的颅内肿瘤患儿531例,颅咽管瘤2篇（45例）,星形细胞瘤2篇（59例）,髓母细胞瘤4篇（228例）,室管膜瘤2篇（120例）,未分病理类型报道1篇（79例）。①总生存率(OS)：分别有5、10和6篇文献报道了2、3和5年OS。2篇非随机对照试验中,3年OS质子治疗组分别为94.1%和94.0%,光子治疗组分别为96.8%和92.5%;1篇报道了5年OS,质子治疗组和光子治疗组分别为82.0%和87.6%。病例系列报告的文献间存在异质性（I2＞50%,P＜0.1）,亚组采取随机效应模型合并,2、3和5年的OS分别为94%(95%CI：0.90~0.97)、90%(95%CI：0.86~0.93)和87%(95%CI：0.82~0.93)。②局部控制率（LC）：分别有3、4和2篇文献报道了2、3和5年LC,文献间有异质性（I2＞50%,P＜0.1）,亚组采取随机效应模型合并,2、3和5年的LC分别为 93%(95%CI：0.88~0.98)、86% (95%CI：0.81~0.92)和77% (95%CI：0.70~0.85)。③第二原发性恶性肿瘤（SMN）：4篇文献报道了1例髓母细胞瘤治疗后并发急性髓细胞性白血病。④不良反应： 9篇文献报道了不良反应,1篇未进行分级报道,8篇文献（465例）报道了3级以上听力损伤16例,3级以上视力损伤6例,需要激素替代治疗的内分泌功能障碍16例。结论：质子治疗儿童颅内肿瘤患者前,尚需高质量、大样本的临床验证。     

GROWTH STATUS IN CHILDREN AND ADOLESCENTS WITH SICKLE CELL DISEASE

Objectives: To assess the BMI status of children and adolescents with sickle cell disease (SCD) and determine if zBMI status during adolescence is predicted by gender, childhood zBMI status, disease genotype, and healthcare utilization (emergency department visits or hospitalizations). Study Design: Medical chart reviews were conducted on 133 patients followed through a regional Comprehensive Sickle Cell Center to obtain anthropometric measures and healthcare utilization data. Gender-specific BMI z-scores were calculated based on Centers for Disease Control (CDC) norms using Epi Info NutStat Software and SPSS generated syntax. Data were summarized categorically across two time periods for each participant: childhood (age 6–12 years) and adolescence (age 13–18 years). Results: Males were three times more likely to be underweight in adolescence compared to CDC norms, whereas females were three times more likely to be obese in adolescence. In addition, regression analyses indicated that BMI in adolescence was predicted by gender, average weight in childhood, and the average number of emergency department visits. Conclusions: Children with SCD generally exhibit normal growth during childhood and adolescence, although 5–10% are at risk for poor growth or obesity. Prevention and intervention efforts should consider gender, average weight in childhood, and healthcare utilization factors.