Beneficial role of intravenous calcitriol on bone mineral density in children with severe secondary hyperparathyroidism

OBJECTIVES: In this prospective study, the effect of calcitriol therapy on bone mineral density and osteopenia in patients with severe secondary hyperparathyroidism has been investigated. MATERIALS AND METHODS: The study was carried out on 24 chronic dialysis patients consisting of 13 boys and 11 girls, aged between 8-18 years. Patients were divided into 3 groups according to the severity of hyperparathyroidism and therapy regimens. Group I consisted of 5 patients with normal parathormon levels who did not receive calcitriol therapy. In group II and III, there were patients with secondary hyperparathyroidism. Group II consisted of 10 patients receiving oral calcitriol therapy. Group III consisted of 9 patients receiving intravenous (i.v.) calcitriol. Bone mineral density was measured by dual energy x-ray absorptiometry. Osteopenia was defined as a Z-score worse than -2. Bone mineral density was assessed as baseline and at the end of one year. RESULTS: A significant improvement was observed in Z-score in the group III whereas the mean value of Z-score tended to be worse in group I and it was not significantly different in group II from the initial values. The better Z-score in group III was associated with more effective stabilization of alkaline phosphatase level and bone specific alkaline phosphatases (BAP) concentrations. CONCLUSION: Significant improvement of Z-score in group III suggested the beneficial role in i.v. administration of calcitriol in chronic dialysis patients.     

CT presentation of Wegener's granulomatosis in a child: rapidly progressive changes of pulmonary nodules to cavities

We present a child with Wegener's granulomatosis who showed lung lesions progressing from nodules to cavities within a 1-month period on CT.     

Duplicated right coronary artery: multidetector CT angiographic findings

Multidetector CT is becoming an alternative method for the diagnosis of coronary artery anomalies. We present the multidetector coronary CT angiography findings from a patient with right coronary artery duplication. Two separate right coronary arteries originating from the right aortic sinus were observed. Their anatomical course was well depicted, and atherosclerosis was excluded based on the CT angiography findings.     

Diaphragmatic mesothelial cyst in a child with Fanconi aplastic anemia

Fanconi aplastic anemia (FAA), an inherited form of bone marrow failure syndrome, is characterized by progressive bone marrow failure and high risk of developing a malignancy. One or more congenital malformations may be detected in at least 90% of the affected individuals. Despite many forms of congenital malformations in FAA, there are no reports of coexisting FAA and diaphragmatic mesothelial cyst. Here, we report a 7-year-old female patient with FAA is associated with diaphragmatic mesothelial cyst.     

MRCP diagnosis of Mirizzi syndrome in a paediatric patient: importance of T1-weighted gradient echo images for diagnosis

We report a 15-year-old boy with Mirizzi syndrome diagnosed by MR cholangiopancreatography (MRCP). Respiratory-triggered 3D MRCP was performed during free breathing. An impacted gallstone was noted in the infundibulum; this was not visible on T2-weighted images, but was hyperintense on T1-weighted gradient-echo images. This case illustrates the utility of 3D MRCP with parallel imaging in paediatric patients and the importance of T1-weighted gradient-echo images for the diagnosis of impacted gallstones.