Pelvic ultrasound findings in different forms of sexual precocity

Recently produced reference curves for various ultrasound dimensions were used to retrospectively assess 67 pelvic ultrasound scans carried out at the initial presentation in girls with sexual precocity. At presentation the group with precocious puberty had significantly increased uterine lengths and ovarian volumes compared with the normal population, and a significantly increased fundal–cervical ratio. Ovarian volume was also significantly increased in thelarche and thelarche variant. The fundal–cervical ratio was significantly increased in thelarche variant. There was considerable overlap between individuals with sexual precocity and normal subjects. The ultrasound findings that best discriminated early or precocious puberty from other forms of sexual precocity were the presence of a midline endometrial echo, and a uterine length above the 97th centile for age. An entirely normal pelvic ultrasound at presentation did not rule out the possibility of precocious puberty.     

Camurati-Engelmann disease with recurrent bone marrow hypoplasia

A one year old girl with Camurati-Engelmann disease suffered from recurrent episodes of anemia and mucocutaneous bleeding, following upper respiratory or diarrheal infections. On two of such occasions, the bone marrow trephine biopsy showed hypoplastic marrow. Each time she showed complete hematological recovery, after corticosteroid therapy.     

Intracranial tuberculoma. Evaluation and treatment

We used computerized tomography (CT) to screen 83 patients with partial seizures who had 1) increased intracranial pressure; 2) evidence of systemic tuberculosis; or 3) focal neurological deficit. We found intracranial tuberculoma in 20 (24%). In addition, of 55 patients with tuberculous meningitis, 12 had associated tuberculoma. The image morphology on CT scans showed ring lesions (14), discs (10), and irregular coalescing masses (8). Perilesional edema frequently was present. After appropriate antitubercular therapy, clinical outcome for seizures, neurological deficit, and increased intracranial pressure was satisfactory. CT lesions regressed within 12 weeks of inauguration of medical therapy in most patients. Medical management of tuberculoma is advocated, with surgery limited to those in whom such treatment is ineffective.     

Progressive dystonia with marked diurnal variation

A8 year old girl with progressive dystonia with marked diurnal variation who showed marked response to L-DOPA therapy, is being discussed to highlight the need for prompt recognition of this treatable disease.     

Clinical variables associated with glaucomatous injury in eyes with large optic disc cupping.

BACKGROUND AND OBJECTIVE: To characterize the range of retinal nerve fiber layer (RNFL) and standard automated perimetry damage in eyes with large vertical cup-disc ratio (VCDR). PATIENTS AND METHODS: Complete examination, standard automated perimetry, scanning laser polarimetry with variable corneal compensation, and optical coherence tomography (OCT) of the RNFL and optic nerve head were performed. Large VCDR was defined as > or = 0.80 using stereoscopic disc examination and OCT optic nerve head analysis. Structural and functional characteristics were assessed separately in eyes with a disc area of less than 2 mm2, 2 to 2.5 mm2 and greater than 2.5 mm2. RESULTS: Fifty-seven eyes of 57 subjects were enrolled. A broad range in mean deviation (2.0 to -32.8 dB) and mean RNFL thickness with OCT (24.3-100.4 microm) and scanning laser polarimetry with variable corneal compensation (24.0-61.7 microm) was identified. Predictors of standard automated perimetry severity using multiple linear regression were mean RNFL thickness using OCT (P = .001) and scanning laser polarimetry (P = .001), OCT-vertical cup diameter (P = .003), temporal, superior, nasal, inferior, temporal standard deviation (P = .03), and OCT-disc area (P = .04). Eyes with an OCT-disc area of less than 2 mm2 demonstrated significantly greater standard automated perimetry damage, RNFL loss using OCT and scanning laser polarimetry, and OCT-rim area (P = .002, .0007, .03, and < .0001, respectively) compared with eyes with a disc area of greater than 2.5 mm2. CONCLUSIONS: Eyes with large VCDR have a wide range of RNFL atrophy and standard automated perimetry damage. Small optic discs are associated with more advanced glaucomatous injury.     

Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter

The use of central venous catheters as access for hemodialysis has become common in children with end-stage renal disease. Phrenic nerve palsy is an unusual complication of this procedure. We report a case of delayed right diaphragmatic palsy due to phrenic nerve damage resulting from an indwelling right subclavian catheter in a 3-year-old child. Received: 29 March 1999 / Revised: 16 July 1999 / Accepted: 17 July 1999     

Mechanism of participation of medial preotic area in the hippocampal inhibition of ovulation

Bilateral hippocampal (HPC) stimulation with anodal direct current on the afternoon of proestrus blocked sponstaneous ovulation in 87.5% of the Wistar rats subjected to the experiments. The incidence of the ovulation block by this procedure was reduced to 16.7% on bilateral injection of 0.25 μg picrotoxin into the medial preoptic area (mPOA) preceding as well as following the stimulation. Ovulation was also blocked in 53.8% of the animals by bilateral injection of 50.0 μg GABA into mPOA, while only 20.0% animals showed a blockade of ovulation of HPC stimulation can be simulated mPOA. These observations indicate that blockade of ovulation by saline injection into by local injection of GABA into mPOA while the effect of stimulation can be blocked by local injection of picrotoxin. Thus, indicating the possibility of GABA being neurotransmitter involved at the level of mPOA for mediating the inhibitory hippocampal influence on ovulation.