Mastering hysteresis in magnetocaloric materials

Hysteresis is more than just an interesting oddity that occurs in materials with a first-order transition. It is a real obstacle on the path from existing laboratory-scale prototypes of magnetic refrigerators towards commercialization of this potentially disruptive cooling technology. Indeed, the reversibility of the magnetocaloric effect, being essential for magnetic heat pumps, strongly depends on the width of the thermal hysteresis and, therefore, it is necessary to understand the mechanisms causing hysteresis and to find solutions to minimize losses associated with thermal hysteresis in order to maximize the efficiency of magnetic cooling devices. In this work, we discuss the fundamental aspects that can contribute to thermal hysteresis and the strategies that we are developing to at least partially overcome the hysteresis problem in some selected classes of magnetocaloric materials with large application potential. In doing so, we refer to the most relevant classes of magnetic refrigerants La-Fe-Si-, Heusler- and Fe2P-type compounds.This article is part of the themed issue 'Taking the temperature of phase transitions in cool materials'.

Side-effects of topical androgenic and anabolic substances and steroids. A short review

There is an increasing interest, including androgenic and anabolic substances (AAS). The uncritical use may be associated with severe adverse effects. We observed five patients with different patterns of adverse reaction to AAS: two females and three males, they were identified when seeking medical help and advice. The following adverse effects from of AAS have been observed: deepening of the voice due to topical use of AAS in an anti-cellulite cream; circumscribed hypertrichosis and late onset acneiform eruptions due to testosterone replacement therapy after ovariectomy; homolateral gynecomastia and infertility, acne and striae distensae in males using injectable AAS.

CONCLUSIONS

ASS can trigger significant adverse effects. An interdisciplinary approach may be necessary for evaluation. The dermatologists should be familiar with the adverse effects.

Topical PDGF-BB results in limited healing in a patient with Werner's syndrome and chronic leg ulcers

Impaired wound healing is a feature of Werner's syndrome. Treatment of one such patient with painful chronic leg ulcers included topical application of PDGF-BB. Granulation increased slightly, enabling full-thickness skin grafting to take place.

Liquid chromatographic method for detection and quantitation of STI-571 and its main metabolite N-desmethyl-STI in plasma, urine, cerebrospinal fluid, culture medium and cell preparations

An isocratic online-enrichment HPLC-assay was developed allowing for the simple and fast separation and quantitation of STI-571 and its main metabolite N-desmethyl-STI (N-DesM-STI) in plasma, urine, cerebrospinal fluid (CSF), culture media and cell preparations in various concentrations using UV-detection at 260 nm. The analytical procedure consists of an online concentration of STI-571 and N-DesM-STI in the HPLC system followed by the elution on a ZirChrom-PBD analytical column. Time of analysis is 40 min including the enrichment time of 5 min. The detection limit is 10 ng/ml in plasma, CSF, culture medium (RPMI) and 25 ng/ml in urine for both STI-571 and N-DesM-STI. The intra-day precision, as expressed by the coefficient of variation (CV), in plasma samples ranges between 1.74 and 8.60% for STI-571 and 1.45 and 8.87% for N-DesM-STI. The corresponding values for urine measurements are 2.17-7.54% (STI-571) and 1.31-9.51% (N-DesM-STI). The inter-day precision analyzed over a 7-month time period was 8.31% (STI-571) or 6.88% (N-DesM-STI) and 16.45% (STI-571) or 14.83% (N-DesM-STI) for a concentration of 1000 ng/ml in plasma and 750 ng/ml in urine, respectively. Moreover, we demonstrate that with an alternative, but more time and labor consuming sample preparation and the implementation of electrochemical detection, a detection limit < 10 ng/ml can be achieved. The method described was used to perform pharmacokinetic measurements of STI-571 and N-desmethyl-STI in patient samples and for kinetic measurements of intracellular STI-571 and N-DesM-STI following in vitro incubation.

The First Example of a σ2λ2-Dioxaphosphenium Cation, Stabilized by an Intramolecular Dative P+ ← S Bond

[structure in text] The first example of a sigma(2)lambda(2)-dioxaphosphenium cation 5 bearing dioxathiophosphocin ring systems stabilized by an intramolecular dative P(+) <-- S bond and its reactivity with pyridine and cycloaddition reaction with 2,3-dimethylbutadiene are reported.

Synthesis and isolation of homeomorphous isomers of P-containing cryptands

The novel isomeric phosphite cryptands 2, 3, and 4 could be synthesized by a simple one-pot tripod capping method starting from bisphenol 1 and PCl3. The assembling of five components led to the formation of a macrobicyclic structure, which probably requires an appropriate preorganization of the reactants. In contrast to the NMR spectra of 2, 3, and 4 in solution, the X-ray structures of 2 and 3 reveal that these molecules have no C3 symmetry in the solid state. In the 31P NMR spectra, both in- and out-P atoms have remarkably different chemical shifts due to a distorted geometry around the in-phosphorus. Phosphorus atoms in the inposition have a decreased reactivity. They are, therefore, more slowly oxidized by cumene hydroperoxide than out-P atoms. A stepwise synthesis was developed for phosphite/phosphatecryptands (5, 7, 9, and 15) via the monoprotected bisphenol 11 and the phosphate 14. In addition, the cylindrical macrotricycle 16 was isolated as a mixture of diastereomers from the crude product of this reaction.

Linoleic acid cytotoxicity to bovine lens epithelial cells: influence of albumin on linoleic acid uptake and cytotoxicity

The high cytotoxicity of linoleic acid (LA) to cultured bovine lens epithelial cells is correlated with high uptake rates for the fatty acid (FA). Both, LA uptake and LA cytotoxicity strongly increase with the increasing LA-to-albumin molar ratio in the culture medium. Cellular uptake and cytotoxicity of LA can be competitively inhibited with the noncytotoxic palmitic acid. The findings may be of interest in view of the low albumin concentration in aqueous humor, resulting in extremely low buffering capacities for free FAs including LA, oleic acid and other cytotoxic cis-unsaturated free FAs, which are strongly raised in pathological situations like diabetes mellitus.

Pleuroperitoneal shunt in the management of chylothorax caused by thoracic lymphatic dysplasia

Three cases of intractable chylothorax secondary to thoracic lymphatic dysplasia were treated by pleuroperitoneal shunt insertion. These cases included one with Gorham's syndrome, and one case with a bilateral chylothorax and chylous ascites. Pleuroperitoneal shunts allowed an adequate internal drainage in all cases, alleviating protein and lymphocyte losses caused by recurrent pleural taps. In the third case with chylous ascites, valved shunts were used to avoid reflux between the peritoneal cavity and the pleural space. Such palliative therapy did not change the bad prognosis of these patients with lymphatic disorders but improved the children's quality of life.

Laparoscopic diagnosis of contralateral patent processus vaginalis in children under 1 year of age with unilateral inguinal hernia: comparison with herniography

PURPOSE

The effectiveness of laparoscopic diagnosis of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia was evaluated.

METHODS

Ninety-three consecutive children under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral CPPV was diagnosed by laparoscopy via the inguinal hernia sac before ligation. The laparoscopy results of this technique were correlated with those of herniography or inguinal exploration.

RESULTS

Laparoscopy was performed on 88 patients; sensitivity was 71% and specificity 89%. The only complication arising from the procedure was wound infection in two patients.

CONCLUSION

This method is a simple, safe, and accurate procedure for selecting children for contralateral surgical exploration.

Acute scrotal pain in children: results of 543 surgical explorations

A total of 543 boys suffering from acute scrotal pain underwent emergency surgery between 1986 and 1996. Of these, 91 had a testicular torsion (TT) (16.8%) and 250 had an appendage torsion (AT) (46%). The cause varied with patient age, with most TTs in newborns and boys of 15 years and most ATs in 10-11-year-olds; 21.5% were operated upon within 6 h of the onset of pain and 69.2% within 24 h. Most stayed in hospital for less than 24 h. Pre-surgical examination identified no criterion for excluding TT. We therefore believe that all children complaining of acute scrotal pain should undergo surgery. As release of an inflamed AT reduces pain, three-fourths of the children benefited directly from surgery.

Ischemic necrosis of bile ducts complicating Schönlein-Henoch purpura

Gastrointestinal complications of Schönlein-Henoch purpura are frequent and sometimes severe. However, there seem to be no reports of liver involvement. A child is described in whom Schönlein-Henoch purpura was complicated by bile duct lesions, resulting in biliary cirrhosis and requiring liver transplantation. At surgical removal, the liver had lesions of bile ducts and of adjacent small blood vessels in the hilum, very similar to those complicating hepatic artery thrombosis after liver transplantation. These findings suggest that Schönlein-Henoch purpura can be complicated by vasculitis of the peribiliary vessels resulting in ischemic necrosis of the bile ducts. Schönlein-Henoch purpura can be added to the list of causes of ischemic cholangiopathies.

[Treatment of appendiceal peritonitis in children by video laparoscopic conversion: conversion is not a one-way procedure]

PATIENTS AND METHODS

This method was used in 14 children, seven boys and seven girls, aged from 2.7 to 14 years, with acute appendicitis and peritonitis.

RESULTS

Conversion to median laparotomy was necessary in order to perform adhesiolysis in two cases in which small bowel was observed. Postoperative complications occurred in four patients involving three wound infections and one mechanical intestinal obstruction. There was no intra-abdominal abscess.

CONCLUSION

This procedure allows appendectomy by an open classical approach to be performed, and subsequently allows the treatment of the generalized peritonitis by video laparoscopy, usually without median laparotomy.

Lipoma of the preputium clitoridis in neonate: an exceptional abnormality different from ambiguous genitalia

A lipoma of the preputium clitoridis was found in a newborn girl. Ambiguous genitalia was first suspected. Surgery was successfully performed at 5 months.

[A survey of the contralateral inguinal hernial sac in infants less than 1 year of age using laparoscopy with anatomic verification using peritoneal radiography or surgery]

STUDY AIM

The aim of this prospective study was to evaluate the laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia.

PATIENTS AND METHOD

Between November 1995 and February 1998, 91 consecutive children (78 boys, 13 girls) under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral hernia was diagnosed by a laparoscopy through the inguinal hernia sac before ligation. Results of this technique were correlated with those of herniography (79 cases) or with inguinal exploration (12 emergency).

RESULTS

Laparoscopy was performed in 88 patients. Laparoscopy was impossible in three cases: one inguinal sac too thin, two cases of ectopic testis in the inguinal canal. Sensitivity was 73% and specificity 92%. The only complication arising from the procedure was wound infection in two patients.

CONCLUSION

This method is a simple, safe and accurate procedure in order to select children for contralateral surgical exploration.

[Spermatic cord torsion in children]

OBJECTIVES

Definition of prognostic factors for torsion of the testis in children.

MATERIAL AND METHODS

From January 1986 to December 1996, 91 children were operated for torsion of the testis. Torsions were observed at all ages of childhood, but with two frequency peaks: during the neonatal period and in adolescence. Typical clinical features were observed in only three-quarters of cases.

RESULTS

Thirty-nine testes were considered to be necrotic versus 52 with a chance of recovery. Factors of poor prognosis were: neonatal forms, delayed management or tight torsion with several turns. 28 of the necrotic testes were conserved: two were complicated by purulent necrosis, but 14% retained normal trophicity on long-term examination.

CONCLUSION

The possibility of torsion at all ages of childhood and the frequently incomplete clinical features means that emergency surgical exploration must always be performed in the case of testicular pain. A conservative attitude is motivated by the possibility of recovery of testes considered to be necrotic at operation.

[Treatment of ruptures of the posterior urethra in children? The value of the symphyseal approach]

Eight cases of rupture of the posterior urethra were observed in children and treated via a trans-symphyseal approach. Repair was easy in the cases seen rapidly (2 to 10 days), urethral suture was effective and the result was excellent. On the other hand, in cases seen later (6 cases), between 6 months and 5 years, marked fibrous callus had to be resected. Urethral repair was not always possible (only one failure out of 6 late cases). This approach preserves genital functions.

Intraoperative localization of neuroblastoma in children with 123I- or 125I-radiolabeled metaiodobenzylguanidine

BACKGROUND

This study describes a novel method of intraoperative localization of neuroblastoma with a gamma-detecting probe, to detect in situ tumor binding of radiolabeled 123I- or 125I-metaiodobenzylguanidine (MIBG) and improve the quality of tumor resection.

METHODS

Fifty-eight children underwent 66 surgical procedures with intraoperative detection of radiolabeled MIBG. All patients with positive MIBG scintiscans at diagnosis were included in the study. A tumor/background ratio exceeding 2:1 at the time of operation was considered positive, indicating a significant uptake of MIBG, compatible with the presence of malignant cells. The surgeons were requested to evaluate the contribution of the method to the surgical procedure. Sensitivity and specificity of the method with either 123I-labeled MIBG or 125I-labeled MIBG, on the basis of correlations between probe findings and pathologic analysis of 288 resected specimens, were determined.

RESULTS

Intraoperative detection was helpful in 65% of surgical procedures, allowing a better definition of tumor limits and extension to locoregional nodes or detection of small and nonpalpable tumors in sites with difficult surgical access, especially during operation for relapse. The detection was not contributory in 35% of the procedures (well-localized tumors, thoracic neuroblastoma for technical reasons, highly differentiated tumors as ganglioneuroma, and tumors with mainly necrosis or fibrosis). The sensitivity of 123I and 125I was the same (91% and 92%), but the specificity of 125I (85%) was significantly higher than that of 123I (55%) (p < 0.005).

CONCLUSIONS

First, this study demonstrates the feasibility of intraoperative detection, with radiolabeled MIBG, of neuroblastoma in children. We advocate the use of 125I rather than 123I. Second, the method is useful to improve the quality of macroscopic resection in widespread neuroblastoma with nodal involvement, in sites with difficult access, and in operations for relapse.

[The role of surgery in tuberculosis in children]

Despite increasingly rigorous preventive measures which have limited the number of cases in France, the number of children undergoing surgery for tuberculosis has remained unchanged. Over the last ten years we operated on 40 children in our pediatric unit. In 10 cases, surgery was indicated for diagnosis, in 19 cases surgery was required in an emergency situation during treatment and in 11 the operation was performed at the stage of sequellae. The type of surgery depended on the clinical situation. Thoracoscopy was used for surgical diagnosis and to empty caseous nodes in the lateral tracheal chain but was generally impossible at the sequellae stage.

[Value of percutaneous nephrostomy in the management of posterior urethral valves in newborn infants]

OBJECTIVES

This study evaluates the place of percutaneous nephrostomy (PCN) in neonates with posterior urethral valves (PUV).

MATERIAL AND METHODS

11 neonates with PUV, 10 of which were diagnosed antenatally, were treated. PCN drainage was performed in 9 cases, prior to endoscopic resection. Six PCN were bilateral and 3 were unilateral, for the following indications: renal failure in 5 cases, severe infection in 2 cases, evaluation of a dilated kidney in 2 cases.

RESULTS

These PCN were left in place for an average of 18 days. Two cases of asymptomatic postoperative bacteriuria were observed. One nephrectomy and one cutaneous ureterostomy followed by reimplantation for megaureter were performed on the diverted kidneys.

CONCLUSION

PCN has become the method of upper tract diversion in most cases of neonatal PUV. In addition to the classical indications (severe urinary tract infection, renal failure), it allows perfectly safe resection of valves in the case of upper tract dilatation and assessment of the kidneys.

[A case of pulmonary mesenchymal hamartoma in a 9-year-old child]

This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.

Umbilical incision for pyloromyotomy

The umbilical incision is a new approach for the curative procedure of hypertrophic pyloric stenosis in order to avoid the cosmetic impairment from the right upper quadrant incision. Our purpose was to evaluate the morbidity of the two approaches. One hundred and eighteen children operated on through an umbilical incision (UMB) from 1992 to 1994 were retrospectively compared with 121 children who underwent standard incision, in the right upper quadrant (RUQ), from 1989 to 1991. The two groups were homogeneous with regard to age, sex ratio, weight, and prematurity rate. Mean operating times were longer in the UMB group (52 [ +/- 14] minutes versus 38 [+/- 14] minutes, p < 0.001, t test). Morbidity was not significantly different with regard to mucosal perforations, vomiting during the first 24 postoperative hours, wound infections, stenosis relapses, and wound dehiscences. Postoperative hospital stays tend to be shorter in the UMB group as compared to the RUQ group. Thus, despite slightly increased mean operating times, the umbilical incision did not modify the morbidity of pyloromyotomy and left an almost undetectable scar.

[Post-traumatic hematoma of the duodenum. A case in a young child]

We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT, and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum.

Low concentrations of cis-linoleic acid induce cell damage in epithelial cells from bovine lenses

As low as 5 micromol/l of cis-linoleic acid proves to be cytotoxic for bovine lens epithelial cells in culture. Albumin eliminates the linoleic acid cytotoxicity completely, presumably by binding the fatty acid. However, the damaging effect appears again when the molar ratio of linoleic acid to albumin exceeds 1:1. The assumption that the linoleic acid-caused cell damage would be mediated by peroxidation products could not be confirmed. The results obtained rather favor the idea that linoleic acid molecules themselves injure lens epithelial cells. Obviously, cell damage even occurs in the presence of albumin if one molecule of albumin binds more than one molecule of linoleic acid. Micromolar concentrations of linoleic acid produce reversible bleb formation as well as cell retraction within 30 min. In primary culture 10 micromol/l linoleic acid damage lens epithelial cells irreversibly within some hours. Trans-linoleic acid, linolenic acid and oleic acid are also harmful to lens cells but to a lesser degree, while saturated fatty acids are without any effect. Bleb formation as a leading early sign hints at the plasma membrane as the primary target for linoleic acid induced cytotoxicity.

The value of split renal function in severe neonatal and infant pelviureteric obstruction managed by percutaneous nephrostomy

A percutaneous nephrostomy (PCN) was inserted as part of the management in 17 newborns and infants with severe pelviureteric junction obstruction between 1981 and 1993. Nephrectomy was performed in eight cases and pyeloplasty in nine cases, successfully in six cases (mean follow-up: 7.7 years). PCN was useful for predicting that no non-functioning kidney on intravenous pyelography (IVP) in this series should have been preserved. Among the kidneys with a high excretion delay on IVP, PCN showed that only those that had a split creatinine clearance of more than 1 ml/min/1.73 m2, or theoretical clearance for age and weight of over 6%, should be preserved.

[A case of intrapancreatic duodenal duplication communicating with the biliopancreatic channel]

Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.

Collagen-coated Vicryl mesh: a new bioprosthesis in pediatric surgical practice

Collagen-coated Vicryl mesh (C.C.V.M.) was used in 28 children who needed repair of thoracic and abdominal wall defects. Herein the authors report the clinical experience, surgical technique, and outcome in these cases.

Growth regulation by cell shape alteration and organization of the cytoskeleton

The correlation between cellular growth and microfilament-dependent morphology was investigated. It was found that the proliferative growth of various nontransformed cell lines does not only depend on cell adhesion to a suitable substratum and cell flattening but also on intact microfilaments. Disintegration of microfilaments by cytochalasin D (CD) as well as lactrunculin (LAT)-A and LAT-B is correlated with a strong decline of the number of DNA-synthesizing cells during a period of 8 to 12 h after application of the drug. RNA and protein synthesis are reduced already after a preincubation time of 2 h. Although microinjected rhodamine-phalloin is colocalized with microfilaments there is no stabilizing effect against CD even at high phaloidin concentrations. Microinjection of DNAse I results in a strong alteration of the microfilament system. The disorganization of microfilaments was correlated with a moderate decrease of protein synthesis 2 h after microinjection, whereas RNA synthesis remained unchanged, if RNase-free DNase I was used. The number of DNA-synthesizing cells was somewhat diminished 24 h after microinjection. Furthermore, the microfilament system is disorganized by microinjection of gelsolin and gelsolin segment 1 + 2, respectively. The severing the microfilaments by gelsolin is correlated with a significant restriction of RNA and protein synthesis during a period of 2 to 4 h after injection, but the labeling index remaining unchanged. Therefore, we assume that inhibition of the G0-G1-S transition is only caused by a disintegration of microfilaments lasting longer than 4 h. The significance of microfilament organization for growth regulation is discussed.

[Unilateral inguinal hernia in infants: costs, risks and benefits of herniography? Results]

AIM

To assess the advantages of systématic herniography in cases of unilateral inguinal hernia in infants.

METHOD

Decision analysis presented in the first part of this article was used. A preliminary retrospective study of 348 cases as well as a literature review were utilized to determine the probabilities required in order to create and run the decision aid algorithm. Gonadic benefit was used as the health indicator.

RESULTS

For males, gonadic benefit procured by the herniography depends on the risk of strangulation in cases of groin hernia and on the frequency of testicular atrophy after inguinal hernioplasty. The evaluation of these two elements largely determines the choice of medical and surgical practices. For a 0.44% risk of post-operative testicular atrophy and a risk of strangulated hernia estimated at 20%, the cost-effectiveness ratio is FF, 199681 to save a testicle. One testicle is saved every 455 herniographies, with 24 possible post-examination complications. For female, herniography provides no gonadic benefit.

DISCUSSION

Decision analysis permits the quantification of results, leading to improved clinical judgement and facilitating the evaluation of medical practice.

[Multilocular cyst of the kidney in a child. Value of MRI?]

We report one case of multilocular cyst of the kidney in one year and three months female infant who underwent echography, computed tomography and MRI before surgery. MR image accurately reflect the morphology of the tumor: the capsule is hypointense on T1-weighted images, the septa show moderate enhancement with intravenous contrast. Varied intensities from fluid in the visualised locules presumably represent different concentration of proteins. MR imaging features are highly suggestive but non pathognomonic of the disease. Positive diagnosis always require histology.

[Laparoscopic radical nephrectomy and ureterectomy in a child. A case report]

The authors report a case of laparoscopic nephroureterectomy in a four year old girl with a small kidney destroyed by vesicoureteric reflux.

Histiocytosis X revealed by complex anal fistula

A very unusual clinical case of histiocytosis X in a young girl with no unusual medical history, is presented. The patient presented with chronic suppuration of the groin and complex anal fistulae and multiple recurrent abscesses, despite surgical treatment (abscess drainage, terminal colostomy). Intestinal and immunologic evaluation were normal. Only histology made the diagnosis. Chemotherapy (vinblastine) resulted in healing and the colostomy was closed.

The risk of wound infection after inguinal incision in pediatric outpatient surgery

To study the risk of wound infection in pediatric outpatients, two series of children operated on with an inguinal incision during a 5.2 year period in the same department, either in day-surgery or in standard hospitalization, are compared. It appears that the frequency of inguinal wound infection is lower for outpatients (1%; 18/1816) than for inpatients (4%; 17/427). This difference is due, on the one hand, to the way day-surgery hospitalization functions and, on the other hand, to the difference of population produced by the criteria for selection for admission in the Day-Surgery Unit.

Amputation of penis after circumcision--penoplasty using expandable prosthesis

A two-year-old boy was referred for correction of an amputation of penis following ritual circumcision. The reconstruction involved mobilization of the profound part of corpora cavernosa and coverage by a vascularised flap taken from the hypogastric area through the use of a sub-cutaneous expandable prosthesis. After two years, appearance of the neo-penis is satisfactory considering the initial lesions.

[A rare cause of bone pain in children: primary hyperparathyroidism caused by adenoma]

BACKGROUND

Primary hyperparathyroidism is rare in children and adolescents. Bone changes may produce pain in the back or extremities, but this is rarely the first symptom of the disease.

CASE REPORT

A 13 year-old girl suffered from pain in the back and lower extremities. Progressive bilateral genu valgum appeared. One year later, she became lame because of the deformity. ECG showed cardiac arrhythmia with atrial extra systoles. The serum calcium concentrations were 3.36 and 3.8 mmol/l, phosphate 0.76 mmol/l and alkaline phosphatases 6,612 U/I (N: 90-300). Urinary excretion of calcium was 17 and 26 mg/kg/day and the renal tubular reabsorption of phosphate was 77%. Radiological studies revealed resorption of subperiosteal bone, best seen along the margins of the phalanges, demineralization of the skull vault, bilateral coxa vara and zones of calcification on knee metaphyses. The serum concentration of parathyroid hormone (PTH) was 1,066 pg/ml (N: 10-55) and that of 1-25(OH)2D3 was 125 ng/ml (N: 20-80). Ultrasonography showed a heterogeneous mass, 23 x 15 mm, suggesting a parathyroid adenoma. This adenoma was independent of the left inferior parathyroid. It was removed and the biochemical findings gradually returned to normal. Bone demineralization also disappeared and the knee deformities were surgically corrected 9 months later.

CONCLUSIONS

Bone changes may occasionally cause severe pain, indicating demineralization and hypercalcemia: hyperparathyroidism is one cause of such changes.