Twenty-four hour Holter ECG is a noninvasive and very sensitive method for discovering heart rhythm disturbances in children after the repair of tetralogy of Fallot, especially in asymptomatic patients. The patients after the repair of this congenital heart disease needed a long-term follow-up for early recognition of serious heart rhythm disturbances and their treatment.
Micromastia or breast hypoplasia is described as underdevelopment of a woman’s mammary tissue. We present the case of a 15-year-old girl with unilateral micromastia, with familial predisposition. Ultrasound, hormonal, dysmorphic, cardiologic, genetic examinations and testing were performed. No mutation in the whole- exome sequencing was found, nor novel mutation. Some of these cases have been reported to be related to breаst cancer so further follow-up is mandatory. Therapy consists of surgical reconstruction of the affected breast. This is a rare condition and it requires a multidisciplinary approach.
Brugada syndrome is a type of arrhythmia disorder, which is characterised by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. The most frequent sign is a persistent ST elevation in the electrocardiographic leads V 1 -V 3 with a right bundle branch block (RBBB).We present a case of 12 years old healthy child, without any complains until then. He had 2 episodes of collapse/syncope, which lasted long and spontaneously disappeared. The collapses were provoked by physical activity. On ECG we found sinus rhythm 62 bpm, RBBB (right bundle brunch block) and Brugada signs in V 2 and V 3 channel-ST elevation ³ 2 mm. The child was sent in electrophysiological centre abroad where the electrophysiological study was performed. They did not found any accessory pathway. The atrioventricular (AV) conduction was normal. Long lasting polymorphic ventricular tachycardia/fibrillation was induced with programed stimulation with 3 extrastimuli in right ventricular outflow tract. Performing one defibrillation the rhythm turned in sinus way. Then they performed ECG with translocation of electrodes V 1-3 in 2 nd intercostal space and the Brugada I type findings was discovered. After confirming of presence of Brugada type -1 syndrome the implantable cardioverter-defibrillator (ICD) was applied on child heart.
Cor triatriatum sinister е ретка срцева мана кај која левата преткомора е поделена на два дела со фибромускулна мембрана. Проксималната преткомора ги прима пулмоналните вени заедно со крвта која тие ја носат, а дисталната или (вистинска) преткомора е вообичаено празна и таа е поделена од комората со митралната валвула. Има постојана комуникација помеѓу двата дела на поделената преткомора преку која крвта се пренасочува кон левата комора. Маната е многу ретка, најчесто е изолирана, но може да оди во комбинација со други срцеви мани. Презентираме случаи на две деца на возраст од 8 и 3 години во времето кога е поставена дијагнозата. Кај обете причина за дијагнозата бил замор и чуен срцев шум. За поставување на дијагнозата беа користени анамнезата, клиничките знаци и симптоми, ЕКГ, рендген на срце и бели дробови и златниот стандард - ехокардиографијата. Дефинитивно излекување беше направено со изведување на кардиохируршка ресекција на фибромускулната мембрана со користење на екстракорпорална циркулација. Потребно е регуларно периодично следење на децата со цел откривање на доцни компликации од типот на нарушувања на срцевиот ритам.
There is a small number of studies that have reported abnormalities in endocrine function after a long-term gonadotropin-releasing hormone agonist (GnRHa) treatment in girls. This treatment is considered as safe and effective by most authors. We report our second case of unusual outcome of long-term GnRHa therapy in a girl with central precocious puberty (CPP) of idiopathic or familial etiology. She has received monthly depot of injections of triptorelin for a time period of 4 years. We have examined thyroid function by measuring serum levels of thyrotropin (TSH), thyroxine (T4), thyroid antibodies and ultrasound of thyroid gland. At the age of 11 years she developed a mild goiter and presented with autoimmune thyroiditis, having elevated thyroid antibodies and ultrasound of thyroid gland typical for Hashimoto thyroiditis. Having in mind these two cases, we suggest a closer monitoring of thyroid function in girls with CPP, before and during therapy with GnRH agonist.
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