BackgroundThe present study investigated the relationship between detection of organic pathologies with magnetic resonance imaging of the pituitary gland, clinical and laboratory findings, and treatment response.Material/MethodsThe study included a total of 183 patients who had isolated growth hormone deficiency, received at least 1 year of treatment, returned regularly for follow-ups, and whose pituitary magnetic resonance images were available. The patients were divided into 2 groups: those with and without pathological evidence with magnetic resonance imaging. Clinical and laboratory features and treatment responses were compared between patients with and without pathological evidence with magnetic resonance imaging.ResultsOf the 183 patients, 105 were females and 78 were males, and 114 patients (62.2%) were prepubertal and 69 patients (37.8%) were pubertal. Their mean age was 10.01±3.25 years (1–17.6 years). Pituitary images of 153 (83.6%) patients were normal. Of the patients with detected pathologies (16.4%), 19 (10,4%) had pituitary hypoplasia, 5 (2.7%) had partial empty sella, 3 (1.7%) had ectopic neurohypophysis and 3 (1.7%) had empty sella, pineal, and arachnoid cyst. A statistically significant increase was observed in the height increase rate after treatment compared to before treatment in both groups (p<0.001). However, the group with pathology had a statistically significant (p=0. 007) post-treatment increase height rate. Although in the group with pathology there was a lower L-DOPA and clonidine peak GH response, there was not any statistically significant difference between the 2 groups (p=0.051, p=0.113). Pituitary gland length was also shorter in the group with pathology compared to the group without pathology (P<0.001).ConclusionsMagnetic resonance imaging is a useful tool in assessing GH deficiency pathogenesis and in predicting treatment response.

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Background Chronic non‐bacterial osteomyelitis is a chronic sterile inflammatory bone condition. We aimed to describe patients' clinical and radiographic findings and to evaluate their response to therapy and their quality of life. Methods This cross‐sectional study included 18 patients from a single center in Turkey whose clinical, radiological features, and outcomes were reviewed retrospectively. The quality of the patients' lives after treatment was compared with healthy controls using the Pediatric Quality of Life Inventory 4.0. Results The median age of disease onset was 12 years (IQR 10–14 years) and 11 (61.1%) patients were male. The median follow‐up duration was 15 months (IQR 12–22 months). The persistent form of chronic non‐bacterial osteomyelitis was the most common pattern in 15 (83.3%) patients and a recurrent pattern was defined in three (16.7%) patients. The lesions were multifocal in all patients and 15 (83.3%) patients had symmetric distribution in whole‐body magnetic resonance imaging. The most common sites of arthritis were the knee and sacroiliac joints. Methotrexate was used in 16 (88.9%) patients as first‐line therapy. However, some patients were unresponsive to the first‐line therapy and needed tumor necrosis factor‐α inhibitors (55.6%) and bisphosphonates (16.7%). We observed remission in only four (22.2%) patients, and three (16.7%) patients were unresponsive. The patients had a significantly poorer quality of life than controls (P = 0.005). Conclusions Chronic non‐bacterial osteomyelitis is an insidious disease that requires detailed analysis for diagnosis and whole‐body magnetic resonance imaging is an effective tool for its diagnosis. Despite the advanced treatment, patients with chronic non‐bacterial osteomyelitis have a poor quality of life.

Objective Portable X-rays remain one of the most frequently used diagnostic procedures in neonatal intensive care units (NICU). Premature infants are more sensitive to radiation-induced harmful effects. Dangers from diagnostic radiation can occur with stochastic effects. We aimed to determine the radiation exposure in premature infants and staff and determine the scattering during X-ray examinations in the NICU. Study Design In this prospective study, dosimeters were placed on premature infants who were ≤1,250 g at birth and ≤30 weeks of gestational age who stayed in the NICU for at least 4 weeks. The doses were measured at each X-ray examination during their stay. The measurements of the nurses and the doctors in the NICU were also performed with dosimeters over the 1-month period. Other dosimeters were placed in certain areas outside the incubator and the results were obtained after 1 month. Results The mean radiation exposure of the 10 premature infants, monitored with dosimeters, was 3.65 ± 2.44 mGy. The mean skin dose of the six staff was 0.087 ± 0.0998 mSV. The mean scattered dose was 67.9 ± 26.5 µGy. Conclusion Relatively high exposures were observed in 90% of the patients and two staff. The radiation exposure levels of premature infants and staff may need to be monitored continuously. Key Points

Background: Vesicoureteral reflux is the most common urinary congenital anomaly in children. Given the risk associated with radiation exposure there has been an increasing need for radiation-free method in the diagnosis and follow-up of the vesicoureteral reflux. The aim of our study is to compare conventional urosonography without contrast enhancement and x-ray voiding cystourethrography.Patients and Methods: Children with recurrent urinary tract infection with suspected vesicoureteral reflux were included to the study. Vesicoureteral reflux is demonstrated and graded by x-ray voiding cystourethrography. DMSA is used for the evaluation of renal scar. Conventional sonographic procedure was performed in all patients. Ureterovesical junction insertion angle was evaluated. The diameter and length of the ureterovesical junction were also measured.Results: 268 children enrolled to the study. Vesicoureteral reflux was demonstrated in 62 children by x-ray voiding cystourethrography. Ureterovesical junction insertion angle measurement had a statistically significant relation for right and left vesicoureteral reflux presence (right: r: .646, p: .01 and left: r: .446, p: .01). Diagnosis sensitivity of vesicoureteral reflux with conventional ultrasonography is 95.10% and specificity is 81% (Youden’s index 76.1%) for the cutoff value of the ureterovesical junction insertion angle is 28.6 degrees. Positive predictive value is 87.2%, negative predictive value is 94.73% and diagnostic accuracy is 86.29% with conventional ultrasonography.Conclusions: Measurement of ureterovesical junction insertion angle, length and diameter by conventional urosonography is an easy accessible and cheap technique with high sensitivity and specificity for the diagnosis and followup of the vesicoureteral reflux without exposure to ionizing radiation.