To report on the particular imaging features and high success rate of cold mode radio-frequency thermal ablation (RFTA) as the treatment of choice for intramedullary osteoid osteoma.

Background/Purposes: Delayed gastric emptying (DGE) is a cofactor in the etiopathogenesis of gastroesophageal reflux disease (GERD). Scintigraphy is the criterion standard to evaluate gastric emptying (GE). This study aims to define typical scintigraphic activity-time curves (ATCs) related to DGE and esophageal atresia (EA) and to demonstrate the effectiveness of pyloromyotomy (P) in improving GE.Methods: Since 2002, 83 children underwent Nissen fundoplication. Patients were divided into 2 groups: group I, GORD-only patients; group II, patients with GORD owing to OA. Depending on preoperative scintigraphy, each group was subdivided into 2 subgroups. Before surgery and 1 year after, endoscopy and scintigraphy were performed. In the presence of DGE, P was associated with Nissen fundoplication. Gastric emptying differences at baseline and at follow-up were estimated by the Student t test. Pre- and post-ATCs were evaluated by the chi(2) test.Results: During follow-up, GE completely normalized in subgroups with DGE. Scintigraphic ATC analysis documented an association between DGE and a typical rectilinear fitting, with a higher rate in OA patients. After P, the scintigraphic pattern changed in an exponential manner related to a faster GE.Conclusions: Delayed gastric emptying is frequent in OA, and the scintigraphic ATCs are typical. Pyloromyotomy is a safe and effective technique to fully normalize GE. (C) 2011 Elsevier Inc. All rights reserved.

Gastroesophageal reflux represents a physiological phenomenon in the first year of life. The reflux associated with clinical complications is defined as "gastroesophageal reflux disease" (GERD), that may be esophageal or extra-esophageal, as is for respiratory problems. Nuclear medicine investigations have given an important contribution to the diagnostic assessment and therapeutical management of GERD in children, by means of the following procedures: scintigraphy of the gastroduodenal transit and reflux detection, scintigraphic quantification of gastric emptying, scintigraphy of the esophageal transit, radioisotopic salivagram, scintigraphy of lung perfusion, ventilation and of mucociliary clearance. All of these investigations are among the less irradiating nuclear medicine procedures, therefore particularly adapted to paediatrics. The main clinical advantages of this body of information include: improvements in the management of many asthmatic children, surgical anti-reflux intervention success-rate increase, prompt regional lung alterations detection for preventing stable tissue damage, and many others.

Hypertrophic osteoarthropathy (HOA) is characterized by digital clubbing, long bone periosteal reaction, and polyarthralgias. Primary familial HOA is very rare and is not associated with underlying disorders and has a good prognosis. Secondary pediatric nonneoplastic HOA is associated with cystic fibrosis, congenital heart disease, biliary atresia, and inflammatory bowel disease. Secondary neoplastic HOA may be associated with intra or extrathoracic tumors.A 5-year-old girl was admitted to our hospital for an abdominal mass, digital clubbing, and diffuse articular pain. The bone scan revealed symmetrical tracer uptake in the long bones. Upper and lower extremity x-rays were diagnostic for HOA. Paraneoplastic HOA in childhood accounts for not more than 12% of HOA paitents. HOA has been reported in 2 other cases of rhabdomyosarcoma.

To determine photopeak efficiency for 99mTc of the NaI(Tl) detector used for liquid waste monitoring at the Nuclear Medicine Unit of IRCCS Paediatric Hospital Bambino Gesù in Rome, a specific experimental procedure, with traceability to primary standards, was developed. Working with the Italian National Institute for Occupational Prevention and Safety, two different calibration source geometries were employed and the detector response dependence on geometry was investigated. The large percentage difference (almost 40%) between the two efficiency values obtained showed that geometrical effects cannot be neglected.

Background A new Tc-99m national standard has been developed at the Italian National Metrology Institute for Ionizing Radiation quantities of ENEA (ENEA-INMRI).Methods The stock radioactive solution was prepared at the Ospedale Pediatrico Bambino Gesu (OPBG) and standardized at the ENEA-INMRI by using the 4 pi gamma absolute measurement method. The new standard was used to calibrate the dose calibrator of the OPBG Nuclear Medicine Unit (NMU) and the ENEA-INMRI portable ionization chamber which was employed as the secondary standard measurement system to calibrate the dose calibrator of another Italian nuclear medicine unit.Results and conclusion Remarkable improvement of measurement accuracy was achieved. The importance of traceable calibrations is underlined. Specific comments are made about quality control performance and measurement accuracy for the instrumentation used in nuclear medicine units of paediatric hospitals.

Sensory motor cortex, frontal lobe, and, more recently, temporal lobe hypoperfusion were described in attention deficiency hyperactivity disorder (ADHD) in adults and children. We report a 12-year-old boy with worsening ADHD. Emotional and behavioral state evaluation met the criteria for ADHD combined with a generalized anxiety disorder. Diagnostic multi-imaging included CT and 2 SPECT studies. Right sphenoidal bone fibrous dysplasia was diagnosed by CT. Tc-99m ECD and Tc-99m MDP-SPECT slices registration and fusion revealed right temporal lobe hypoperfusion, bordering on the metabolically active sphenoid lesion.

The purpose of this set of guidelines is to help the nuclear medicine practitioner perform a good quality lung isotope scan. The indications for the test are summarised. The different radiopharmaceuticals used for the ventilation and the perfusion studies, the technique for their administration, the dosimetry, the acquisition of the images, the processing and the display of the images are discussed in detail. The issue of whether a perfusion-only lung scan is sufficient or whether a full ventilation–perfusion study is necessary is also addressed. The document contains a comprehensive list of references and some web site addresses which may be of further assistance.

Background: Delayed gastric emptying (DGE) is a motility disorder that contributes to the pathogenesis of gastro-esophageal reflux (GER) with a chronic gastric distension. GER is associated with DGE in approximately 40% of children. Gastric scintigraphy is a quantitative, non invasive and reproducible technique; it must be considered as the gold standard for the study of gastric emptying (GE). Nissen fundoplication (NF) is the most commonly used operation for the treatment of gastroesophageal reflux disease (GERD) but the role of gastric emptying procedure (GEP) is debated. However, a large series of international studies underlined the relationship between untreated DGE and GERD recurrence. Aim: We report our scintigraphic, endoscopic and surgical data before and after NF in children with GERD and DGE to determine the efficacy of pyloromyotomy (P) in GE normalisation. Methods: From January 2002, 38 children (20 male; 7 esophageal atresia (A/E) and 2 congenital diaphragmatic hernia), mean age 14 years (range 4 months-23 years), with GERD refractory or dependent on medical therapy, without neurologic disorders, were enrolled. In all cases, endoscopy and scintigraphy were performed before and one year after NF. Fifteen patients (pts) with atypical symptoms were evaluated with 24h-pH-monitoring. GE scintigraphy used a 99 mTc-DTPA labelled liquid and solid meal. Gastric activity/time (A/T) curves are obtained and analysed by rectilinear or exponential fitting; GE% in 60' was measured. GE differences at baseline and at follow up were estimated by the student's t test. In all cases, NF was performed; in presence of DGE, P was associated. Clinical symptoms, esophagitis and weight-gain were assessed. Results: No intra/postoperative complications occurred. The baseline scintigraphy identified two groups of pts: I)19pts with normal GE (mean GE% = 60), underwent to NF alone; II) 19pts with DGE (mean GE% = 16.8), considered for NF+P. GE% difference was striking (t = 11.226; P < 0.000). At follow up, GE% was increased in both groups. In the 1st group mean postoperative GE% was 66% but its variation is not statistically significant (t = 1.164; p = 0.259). In the NF+P group, mean GE% increased to 56% (t = 9.532; p = 0.000) with normalisation of the preoperative data. GERD disappeared in 36 pts. Two patients with E/A, operated on N+P at 4 months of life for ALTE, had recurrent GERD. Weight was satisfactory in 36 pts; two children presented transitory dysphagia. Conclusions: Our study shows a permanently normalisation of GE after P in patients with DGE. P is, in our experience, a safe and efficacious GE procedure. Before surgery, all patients with GERD should be evaluated by scintigraphy.

Heterotopic gastric mucosa (HGM), which results from embryonic tissue displacement, can be found throughout the length of the gastrointestinal tract. Heterotopic gastric mucosa in the rectum is uncommon, and few cases have been described in children [1] [2] [3].

OBJECTIVETo detect the different extent of renal parenchymal involvement in primary vesico-ureteric reflux (VUR), and to evaluate the relationship between VUR grade, patient age and different patterns of parenchymal damage.PATIENTS AND METHODSThis blinded retrospective study included 197 consecutive children (mean age 4.26 years, range 1 month to 13 years) with primary VUR detected by voiding cysto-urethrography (VCUG), Tc-99m-dimercaptosuccinic acid (DMSA; 120 MBq/1.73 m(2)) renal scintigraphy, with scanning for 3 h after intravenous injection. An abnormal DMSA scan was classified into three subtypes: cortical defects as a single scar (SS), multiple cortical scarring (MS) and diffuse reduced uptake with small renal size. Renal absolute uptake (AU), and split-kidney relative uptake were evaluated in refluxing and nonrefluxing renal units, and correlated with parenchymal damage and patient age. Student's t-test and the chi-square test were used for the statistical analysis.RESULTSIn all, 282 refluxing and 112 nonrefluxing units were assessed. Renal damage was detected in 188 of 282 units with VUR (67%) and in 18 of 112 (16%) contralateral nonrefluxing kidneys. The mean AU was 18.7% in kidneys with VUR and 29% in nonrefluxing units (P < 0.001). The mean (SD) AU decreased from lower to higher grades of VUR, i.e. grade 0 VUR (group A), 28.97 (9.71); grade 1-3 (group B), 21.28 (8.33); grade 4-5 (group C), 14.78 (8.02). The differences were statistically significant (A vs B, B vs C, both P < 0.001). Renal damage was differently distributed in the three groups: 69 of 109 kidneys (63%) in group C (MS prevalent), 39 of 173 (22.5%) in group B (SS prevalent) and 17 of 112 (15.2%) in group A. There was no significant difference in the distribution of renal damage subtypes in patients aged < or > 2 years (SS 19.6% vs 17.9%, MS 29.6% vs 30.1%, small size 48.2% vs 46.3%). The VUR was severe (group C) in 65% of patients aged < 2 years and in 46% aged > 2 years (chi-square, P= 0.016).CONCLUSIONSVUR is commonly associated with renal damage. Age (< or > 2 years) did not significantly influence the kidney lesion subtype. Reduced parenchymal function (AU) progressively decreased with the severity of VUR. Focal MS, reduced size and relative uptake were significantly more common in severe VUR, leading to multifocal lesions and hypo-dysplasia. Renal scarring was present in up to 15% of contralateral nonrefluxing kidneys. Severe VUR behaved differently from lesser VUR in the renal scan parenchymal uptake.

Epidemiological information on symptoms affecting extra-respiratory organs and apparatuses in asthmatic children is scarce. The aim of this study therefore was to evaluate, at a population level, if and what extra-respiratory symptoms are associated with asthma. Two questionnaire-based, cross-sectional surveys were carried out on 1,262 students (651 males; mean age 9.57 years, age-range 6-14 years) in 1992 and on 1,210 students (639 males; mean age 9.02 years, age-range 6-14 years) in 1998, from two elementary and two junior high schools in Rome, Italy. Questionnaires included queries about asthma and its risk factors and extra-respiratory symptoms (headache, restlessness, sleep disturbances, urticaria, itching, and abdominal pain). Of responders, 11.9% (279/2,342) had a history of asthma. After adjustment for gender, family history of atopic disease, low birth weight, early respiratory problems, and damp house, asthma was significantly associated with recurrent abdominal pain (odds ratio [OR] 1.90; 95% confidence interval [CI]: 1.04, 3.16), itching (OR 3.15; 95% CI: 1.75, 5.68), and urticaria (OR 2.52; 95% CI: 1.02, 6.20). Asthma was reported by 10.2% (201/1,962) of children unaffected by this triad, by 20.1% (56/279; OR 2.20) with one of the symptoms, and by 31.6% (12/38; OR 4.04) with two or more symptoms. An emerging characteristic of pediatric asthma in our setting appears to be its association with certain extra-respiratory symptoms (abdominal Pain, itching, and urticaria). A global, internistic approach to asthmatic children is increasingly required both in the clinical setting and in future epidemiological studies.

BACKGROUND:Several studies report substantial differences in the prevalence of skin test reactivity to allergens in children from adjacent geographic areas; others report an increased prevalence over time. To find out whether these differences depend on variations in skin reactivity to histamine, we determined the time trend of histamine wheal sizes in successive cohorts of unselected children living in the same area (Viterbo, Italy).METHODS:We conducted three epidemiologic surveys, each including children aged 9 and 13 years. The 1983-7 study investigated 170 children (150 were tested twice); the 1992 study, 158 children; and the 1996 study, 208 children.RESULTS:In both age groups, the mean diameter of the wheal induced by histamine skin prick tests (10 mg/ml) increased significantly over time (9-year-olds: 3.25 mm in 1983, 4.68 in 1992, and 5.89 in 1996; 13-year-olds: 3.89 mm in 1987, 5.18 in 1992, and 6.50 in 1996) (P < 0.001 between subsequent studies). The distribution of the wheal diameters for both ages showed a trend to a right shift in the three successive studies (P < 0.001). The dose-response curves for three histamine concentrations (0.2, 1, and 10 mg/ml) had significantly steeper slopes in 1996 than in 1983-7 (P < 0.001).CONCLUSION:The marked time-related increase in the size of the histamine wheals could help to explain the trend toward an increased prevalence of positive allergen skin test reactions reported during the past years. The causes of increased skin reactivity to histamine remain conjectural.

Time trends in the prevalence of asthma, family history of asthma and atopy in Roman schoolchildren were assessed. The study population consisted of all children (aged 6-14 yrs) attending two primary schools in Rome, situated in urban areas that differed markedly in socioeconomic conditions and environmental pollution. Three questionnaire-based surveys were conducted in 1974, 1992 and 1998 in 2,259, 1,229 and 1,139 children. The prevalence of asthma in males and females increased significantly during 1974-1992 and remained stable from 1992-1998. In age groups born in the subsequent 4-yr periods it increased almost linearly, for children born from 1962-1965 to 1982-1985 (4.4%-12.5%), and remained remarkably stable in children born after 1985. Because the prevalence of asthma had a steeper trend in males than in females (approximately 0.55% x yr(-1) versus 0.25% x yr(-1)), the male:female asthma ratio increased (1:38 in 1974; 1:84 in 1992 and 1:62 in 1998). No single environmental factor, including area of residence, seemed to influence the prevalence of asthma. Family history of asthma and atopy also increased steadily (0.72% x yr(-1) and 0.30% x yr(-1) respectively) more than doubling during the 24-yr study period. The strong relationship between asthma and a family history of atopy not only persisted but also strengthened over time (23.3% of asthmatic children belonged to families with atopic illnesses in 1974 but 44.2% in 1998). The environmental factors that might explain the almost three-fold rise in childhood asthma between 1974 and 1992 remain unknown but the genetic background of the disease has presumably remained unchanged since the early 1970s. The fact that the prevalence of asthma increased no further during the past 6 yrs suggests that the progressive induction of asthma symptoms in genetically predisposed subjects is a self-limiting process that has probably come to an end in the authors' study area.