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Lala R. A Critical Understanding of Inclusion in Oral Microbiome Research through the Lens of Racial Capitalism. Community Dent Health 2024; 41:70-74. [PMID: 38533922 DOI: 10.1922/cdh_iadr24lala06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
There are important calls for greater inclusion of Indigenous and racialised communities in oral microbiome research. This paper uses the concept of racial capitalism (the extractive continuity of colonialism) to critically examine this inclusion agenda. Racial capitalism explicitly links capitalist exploitations with wider social oppressions e.g., racisms, sexism, ableism. It is not confined to the commercial sector but pervades white institutions, including universities. By using the lens of racial capitalism, we find inclusion agendas allow white institutions to extract social and economic value from relations of race. Racially inclusive research is perceived as a social good, therefore, it attracts funding. Knowledge and treatments developed from research create immense value for universities and pharmaceutical companies with limited benefits for the communities themselves. Moreover, microbiome research tends to drift from conceptualisations that recognise it as something that is shaped by the social, including racisms, to one that is determined genetically and biologically. This location of problems within racialised bodies reinforces racial oppressions and allows companies to further profit from raciality. Inclusion in oral microbiome research must consider ways to mitigate racial capitalism. Researchers can be less extractive by using an anti-racism praxis framework. This includes working with communities to co-design studies, create safer spaces, giving marginalised communities the power to set and frame agendas, sharing research knowledges and treatments through accessible knowledge distributions, open publications, and open health technologies. Most importantly, inclusion agendas must not displace ambitions of the deeper anti-oppression social reforms needed to tackle health inequalities and create meaningful inclusion.
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Affiliation(s)
- R Lala
- Population Health, School of Medicine and Population Health, University of Sheffield, UK
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Lala R. The Case for Decolonising the Dental Curricula in the UK. Community Dent Health 2022; 39:143-148. [PMID: 35543461 DOI: 10.1922/cdh_iadr22lala06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Students across disciplines in UK universities are demanding decolonisation of their education. These demands aim to resist the white European colonial endeavour that create racist inequalities. To address racial inequalities, the dental discipline has predominantly focused on diversity rather than decolonisation. By using two inter-related referents of decolonisation to dental caries and cosmetic dentistry, this article demonstrates the epistemic violence exerted through the objective hierarchised knowledge practices in dentistry. First, by starting from the position of racisms, empire and slavery, the enduring colonial patterns of power and hierarchies come into view. We see how knowledge production in dentistry has neglected the interconnected histories of colonialism, racial capitalism and patriarchy that continue to shape oral health inequalities and work towards promoting white supremacist beauty ideals. Moreover, the interconnected character of inequalities - race, class and gender - begin to emerge. Second, by proceeding from the place of colonialism, the limits of dental knowledge and the violence embedded in knowledge practices emerge. This highlights the need for new ways of knowing. To decolonise is to confront and weaken the dental discipline's entanglement with the enduring colonial patterns of power and hierarchies that are complicit in maintaining inequalities. Diversity without decolonisation will simply subsume marginalised voices into the existing hierarchised knowledge paradigm and continue to reproduce a hierarchised, unequal world. I argue that if dental schools want to address racial and intersectional inequalities, they need new transformative ways of learning and knowing to equip students to work towards social justice in the outside world.
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Affiliation(s)
- R Lala
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
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Lala R, Baker SR, Muirhead VE. A Critical Analysis of Underrepresentation of Racialised Minorities in the UK Dental Workforce. Community Dent Health 2021; 38:142-149. [PMID: 33769723 DOI: 10.1922/cdh_iadrlala08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article analyses the underrepresentation of racialised minorities across the three stages of the dental workforce pipeline through the critical lens of power. The reformist view of power was used, which focuses on concealment caused by systemic biases. We observed adequate representation of racialised minorities in the first two stages of the pipeline; entry to dental schools and completion of dental education. However, the categorisation of diverse groups into a single 'BAME' category conceals the underrepresentation of Black people and those who experience intersectional forms of discrimination rooted in race, gender and class. We observed all racialised minorities to be underrepresented in the third stage of the pipeline; career development and progression. The data suggest that institutional processes are more likely to recruit and promote White1 people, and racialised minorities are more likely to be exposed to bullying and inequitable disciplinary processes. Consistently across dental institutions, as the level of seniority increases, the representation of racialised minorities decreases. Thus, senior decision-making and agenda-setting spaces in UK dentistry are overwhelmingly White. Multiple actions are suggested; including collation of comprehensive, inclusive data, widening participation and representation initiatives to help re-distribute the power dynamics towards racialised minorities and ensure equality of representation across the dental pipeline, including in senior spaces. We hope this will work towards putting some of the systemic problems that we see in dentistry; such as differential staff and student experiences, inequitable recruitment, promotions and disciplinary proceedings, and colonial dental curricula and research on the institutional agenda.
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Affiliation(s)
- R Lala
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - V E Muirhead
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Affiliation(s)
- R Lala
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - B J Gibson
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, SA, Australia
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Lala R, Jones K. The use of the NICE ten step model to conduct an oral health needs assessment in South Yorkshire and Bassetlaw. Community Dent Health 2019; 36:5-8. [PMID: 30211484 DOI: 10.1922/cdh_4384jones04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Health and Social Care Act 2012 created a new commissioning framework for the provision of health, social care and public health in England (UK Government, 2012). NHS England became the sole commissioner for all NHS dental services, including primary, secondary and unscheduled dental care. Local authorities became responsible for public health, epidemiological surveys, improving the oral health of their communities and for commissioning oral health improvement services including water fluoridation (NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations (SI 2012/3094)). At the time this needs assessment was conducted, NHS South Yorkshire and Bassetlaw Area Team commissioned all the NHS dental services in the local authority areas of Barnsley, Doncaster, Rotherham, Sheffield and Bassetlaw. The dental Local Professional Network provided clinical and public health input to the commissioning process through its annual work plan. However, there was no up to date information on local oral health needs and how these needs were being met by NHS dental services, hence it was difficult to determine what were the local commissioning priorities.
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Affiliation(s)
- R Lala
- School of Clinical Dentistry, University of Sheffield S10 2TA
| | - K Jones
- Dental Public Health, Public Health England, London
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Doughty J, Lala R, Marshman Z. The dental public health implications of cosmetic dentistry: a scoping review of the literature. Community Dent Health 2017; 33:218-224. [PMID: 28509518 DOI: 10.1922/cdh_3881doughty07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/11/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The popularity of cosmetic surgery has seen a rapid increase recently, with the trend mirrored in dentistry. The Department of Health expressed concerns about the potential for biological and psychosocial harm of these cosmetic procedures. Furthermore, the dental public health implications (DPH) of the growing uptake of cosmetic dental procedures have not been explored. OBJECTIVES Conduct a scoping review to explore the DPH implications of cosmetic dentistry and identify gaps for future research. METHODS A fivestage scoping review was conducted of studies identified using the search terms cosmetic AND dentistry. Data from the studies meeting the inclusion criteria were extracted, collated and summarised into themes. RESULTS Fifty-seven papers met the inclusion criteria (11 cross-sectional studies, 10 literature reviews and 36 opinion pieces). The DPH implications were summarised into five emergent themes: dento-legal and ethical, marketing, psychosocial, biological and workforce. These themes revealed patients' increased expectations, expanding commercialisation of the profession, psychological risks to vulnerable patients, the iatrogenic consequences of invasive cosmetic dental procedures and workforce implications of the current trends. CONCLUSIONS The scoping review found that existing literature on cosmetic dentistry is predominately anecdotal - professional opinions and discussions. Despite this, our findings demonstrated workforce training and governance implications due to increased demand for cosmetic dentistry. Further empirical research is needed to understand the DPH implications of the increasing demand and uptake of cosmetic dental procedures to guide evidence-based policy to safeguard patients and improve the quality of dental services.
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Affiliation(s)
- J Doughty
- Barts Health Community Dental Service, London. UK
| | - R Lala
- Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Z Marshman
- Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Tessaris D, Corrias A, Matarazzo P, De Sanctis L, Wasniewska M, Messina MF, Vigone MC, Lala R. Thyroid abnormalities in children and adolescents with McCune-Albright syndrome. Horm Res Paediatr 2013; 78:151-7. [PMID: 23006743 DOI: 10.1159/000342641] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, there is no agreement about the frequency or the features of thyroid abnormalities in McCune-Albright syndrome (MAS). The aim of our study was to detect thyroid abnormalities in a cohort of MAS children and adolescents and to give indications for their treatment and follow-up. METHODS In 36 patients, 22 females and 14 males, thyroid function and sonographic features of thyroid were evaluated every 6-12 months. RESULTS Three males and 1 female had hyperthyroidism: 2 with nodular, 2 with diffuse goiters. They were treated with methimazole (0.2-0.5 mg/kg/day) with good clinical and biochemical responses. The remaining 32 patients were euthyroid, even if 7 displayed sonographic alterations, of whom 5 had nodular goiter with nodules >1 cm, and 2 micronodular goiter. Fine-needle aspiration biopsy was performed in 2 patients with nodules >1 cm, 1 showing hemorrhagic nodule and 1 colloid cystic nodule. CONCLUSIONS Prevalence of thyroid alterations in the studied MAS series was 31%. 64% of 11 patients with thyroid alterations had nodular goiters, with nodules >1 cm. As the onset of thyroid disease ranged from 1 to 20 years, a strict monitoring of thyroid function is recommended every 6 months. Satisfactory treatment can be obtained and maintained with antithyroid drugs.
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Affiliation(s)
- D Tessaris
- Departments of Pediatric Endocrinology and Diabetology, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
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Mussa A, Porta F, Baldassarre G, Tuli G, de Terlizzi F, Matarazzo P, Einaudi S, Lala R, Corrias A. Phalangeal quantitative ultrasound in 1,719 children and adolescents with bone disorders. Osteoporos Int 2012; 23:1987-98. [PMID: 21947033 DOI: 10.1007/s00198-011-1794-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
SUMMARY We measured bone properties by phalangeal quantitative ultrasound in 1,719 pediatric patients with bone disorders, classifying them according to fracture status. Quantitative ultrasound discriminated fractured and nonfractured pediatric patients and enabled us to stratify fractured patients into classes according to the severity of the causative trauma (spontaneous, minimal trauma, appropriate trauma fractures). INTRODUCTION The correlation between quantitative bone measurements and fractures is poorly established in pediatric patients with bone disorders. We correlated phalangeal quantitative ultrasound (QUS) and fracture history in children and adolescents with bone disorders and evaluated the ability of QUS to recognize fractured patients. METHODS Amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were measured in 1,719 pediatric patients with bone disorders and related to fracture history. The patients were classified as (1) spontaneously (77), (2) minimal trauma (101), or (3) appropriate trauma fractured (206), and (4) nonfractured (1,335). The likelihood of fracture according to QUS was calculated as odds ratio per SD decrease (OR/SD), and the effectiveness in discriminating fractured patients was evaluated by receiver operating characteristic (ROC) analysis. The influence of age, sex, puberty, height, and BMI was explored by respective adjustments and multiple logistic regression. RESULTS Fractured patients showed significantly reduced AD-SoS and BTT standard deviation score (-0.32 ± 1.54 and -0.78 ± 1.49) compared to nonfractured subjects (0.43 ± 1.63 and -0.11 ± 1.34). QUS measurements paralleled the causative trauma severity, ranging from the lowest values in spontaneously fractured patients to normal values in appropriate trauma fractured subjects. The OR/SD were increasingly higher in appropriate trauma fractured, minimal trauma fractured, and spontaneously fractured patients. At ROC analysis, both parameters proved to have significant discrimination power in recognizing spontaneously and minimal trauma-fractured patients. CONCLUSIONS QUS identifies fractured pediatric patients with bone disorders, reflecting the severity of the causative trauma with a high discrimination power for fragility fractures.
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Affiliation(s)
- A Mussa
- Division Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy.
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Guanà R, Gesmundo R, Morino M, Matarazzo P, Pucci A, Pasini B, Lala R, Fiore L, Repici M, Canavese F. Laparoscopic unilateral adrenalectomy in children for isolated primary pigmented nodular adrenocortical disease (PPNAD): case report and literature review. Eur J Pediatr Surg 2010; 20:273-5. [PMID: 20099223 DOI: 10.1055/s-0029-1243203] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- R Guanà
- Regina Margherita Children's Hospital, Division of Pediatric Surgery, Turin, Italy.
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Canavese F, Lala R, Valfrè L, Vinardi S, Bianco E, Cortese MG. Effectiveness of primary inguinal orchiopexy as treatment of non-palpable testes in the first two years of age. Minerva Pediatr 2010; 62:245-248. [PMID: 20467375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM The best treatment of non-palpable testes is currently argument of debate. The aim of present study was to describe authors' experience in surgical treatment with inguinal standard orchidopexy of non-palpable testes. METHODS In the last 17 years we have treated 2002 cryptorchid testes, among these 327 (16.33%) were non palpable. Age and distribution of cryptorchid testes was: 0-1 y (165 NPT), 1-2 y (84 NPT), 2-5 y (43 NPT), 5-10 y (16 NPT) and >10 y (19 NPT). RESULTS Non-palpable testes were diagnosed and treated earlier (76.14% in the first two years). At surgical examination 204 (62.38%) were intrabdominal, 80 (24.46%) were atrophic and 43 (13.14%) vanishing. Among atrophic testes 54 (67.5%) were intracanicular, 21 (26.5%) were at the external inguinal ring, 4 (5%) were intrabdominal and 1 (1.25%) ectopic; among vanishing testes 22 (51.16%) were intrabdominal, 14 (32.55%) intracanicular and 7 (16.27%) at the external ring of inguinal canal. CONCLUSION Atrophic and vanishing testes were in intrabdominal location in 26 cases: only in these cases (7.95% of all non palpable testes) laparoscopy should have avoided inguinal surgery. Inguinal standard orchiopexy performed as day-surgery with general anaesthesia associated to caudal analgesia should be considered effective and less invasive than laparoscopic approach.
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Affiliation(s)
- F Canavese
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy.
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Lala R, Matarazzo P. SHOX mutation as a rare disease: molecular diagnosis and growth hormone treatment supported by the Italian public health system. J Endocrinol Invest 2010; 33:39-43. [PMID: 21057185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Short stature homeobox-containing (SHOX) gene deficiency is acknowledged under the term "dyschondrosteosis", which is included in the family of congenital osteodystrophies. Under current regulations, the cost of the genetic testing and treatment with GH in children with short stature, and SHOX gene deficiency may be reimbursed. Prescription of costs exemption is subject to the identification of the regional centers qualified to diagnose congenital osteodystrophies (RNG060). The centers qualified to diagnose and treat "dyschondrosteosis" have been identified in only a few regions, whereas in other regions centers for the diagnosis and treatment of congenital osteodystrophies have been identified, and in still others, no specific centers have been identified yet. Treatment with GH as indicated by European Medicines Agency (EMEA) for people with short stature and evidence of SHOX gene deficiency is governed by Agenzia Italiana del Farmaco (AIFA) note number 39. The latest version does not provide for the medication to be directly reimbursed by the National Health Service, although it may be prescribed for patients with well-defined auxological characteristics, subject to the prior authorization of the regional commission qualified to monitor the use of the GH. Therefore, a diagnostic/ therapeutic course for patients with short stature with SHOX gene mutation has been proposed. The healthcare course relating to such patients has not been thoroughly defined in terms of implementation and is affected by regional organizational approaches. Implementing specific healthcare courses for such patients may provide a model for treating other patients with short stature and rare diseases with GH.
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Affiliation(s)
- R Lala
- Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
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Canavese F, Mussa A, Manenti M, Cortese MG, Ferrero L, Tuli G, Macchieraldo R, Lala R. Sperm count of young men surgically treated for cryptorchidism in the first and second year of life: fertility is better in children treated at a younger age. Eur J Pediatr Surg 2009; 19:388-91. [PMID: 19826983 DOI: 10.1055/s-0029-1241171] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Recent data has indicated the usefulness of performing orchiopexy in the first years of life. In this study, we evaluated testicular function in young men operated on for cryptorchidism in the first year of life. To our knowledge, this is the first report on the effects of such an early treatment. MATERIALS AND METHODS Testicular function was assessed in a group of young men operated for cryptorchidism during the first year of life (Group A, n=13) and during the second year of life (Group B, n=16). RESULTS Total sperm counts were clearly higher in Group A (52.3+/-14.3 million/ml vs. 30.4+/-23.5 million/ml, p=0.005) as was sperm motility (36.2+/-8.7 vs. 23.1+/-15.7%, p=0.009). A clear inverse relationship was found between age at orchiopexy and total sperm count (r=-0.394, p=0.034) and sperm motility (r=-0.382, p=0.041). The relationship between volume of testes, position at surgery, uni/bilaterality of cryptorchidism, evidence of Ad spermatogonia at biopsy performed during surgery and treatment with LHRH and hCG performed before surgery and fertility was not significant. The latter findings may be partially explained by the low number of patients participating in the study and need further investigation. CONCLUSIONS We obtained, for the first time, results showing the benefit of treating cryptorchidism during the first year of life rather than in the second year or even later.
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Affiliation(s)
- F Canavese
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, Italy.
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Savino F, Castagno E, Lala R, Monti GE. Reply. Ann Nutr Metab 2008. [DOI: 10.1159/000114840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Campagnoli MF, Pucci A, Garelli E, Carando A, Defilippi C, Lala R, Ingrosso G, Dianzani I, Forni M, Ramenghi U. Familial tumoral calcinosis and testicular microlithiasis associated with a new mutation of GALNT3 in a white family. J Clin Pathol 2006; 59:440-2. [PMID: 16567474 PMCID: PMC1860360 DOI: 10.1136/jcp.2005.026369] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2005] [Indexed: 11/04/2022]
Abstract
BACKGROUND Familial tumoral calcinosis (FTC) is a rare autosomal recessive disease characterised by the development of multiple calcified masses in periarticular soft tissues; GALNT3 gene mutations have recently been described in an African American and in a Druse Arab family with FTC. OBJECTIVE To report the clinical and histological features caused by a new GALNT3 mutation in a white family. RESULTS Homozygosity for the nonsense mutation Lys463X was found in both affected siblings, who displayed a classic phenotype, the male also having testicular microlithiasis. He is the first subject described with testicular microlithiasis in FTC. CONCLUSIONS The high testicular expression of GALNT3 suggests that the gene alteration could act locally by causing deposition of calcium, and the testis may be an underestimated site of calcification in FTC. Autoimmune diseases are present in several members of the family. Although immune disorders have been described in FTC, autoimmunity does not segregate with the GALNT3 mutation in this family.
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Affiliation(s)
- M F Campagnoli
- Paediatric Department, University of Turin, Turin, Italy
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Matarazzo P, Genitori L, Lala R, Andreo M, Grossetti R, de Sanctis C. Endocrine function and water metabolism in children and adolescents with surgically treated intra/parasellar tumors. J Pediatr Endocrinol Metab 2004; 17:1487-95. [PMID: 15570985 DOI: 10.1515/jpem.2004.17.11.1487] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hydroelectrolytic disorders often complicate surgery of intra/parasellar tumors in children and adolescents. Eighteen patients undergoing microneurosurgical procedures for intra-supra-sellar craniopharyngioma (10 patients), hypothalamic germinomas (3 patients), hypothalamic-chiasmatic astrocytomas (3 patients), pituitary adenomas (2 patients) were studied. The hydroelectrolytic balance was assessed from 8 hours before surgery to 1 week after with a specific protocol in which water metabolism alterations were treated with standard procedure. Diabetes insipidus (DI) was observed in 10/18 patients before surgery and in 15/18 patients after surgery; during surgery it was effectively treated with synthetic desmopressin (DDAVP) and hydroelectrolytic solutions. Hyponatremia, isolated or associated (with diuresis contraction or polyuria), seen during surgery and in the following 24 hours, was treated with variation of the infusion rate. We show that close monitoring and treatment of hydroelectrolytic disorders in patients submitted to neurosurgery for intra/ parasellar tumors may significantly reduce their morbidity and mortality rate.
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Affiliation(s)
- P Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children 's Hospital, Turin, Italy.
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de Sanctis C, Lala R, Matarazzo P, Andreo M, de Sanctis L. Pubertal development in patients with McCune-Albright syndrome or pseudohypoparathyroidism. J Pediatr Endocrinol Metab 2003; 16 Suppl 2:293-6. [PMID: 12729407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Gain or loss of function mutations of the GNAS1 gene lead to McCune-Albright syndrome (MAS) or pseudohypoparathyroidism Ia (PHP-Ia), respectively. Patients with MAS, caused by a post-zygotic missense mutation leading to constitutive activation of Gs alpha, suffer from gonadotropin-independent precocious puberty, and delayed or incomplete sexual development and reproductive dysfunction is found in women with PHP-Ia, an inherited disorder caused by deficient expression or function of the Gs alpha protein. In females with MAS, 50% developed precocious puberty by the age of 4 years, the remaining between 4 and 8 years. Peripheral precocious puberty is often atypical and characterized by alternate periods of rapid progression and regression of pubertal development; menstrual bleeding may occur before breast development. Ovarian cyst growth and regression is often described as a sign of ovarian follicle hyperactivation. Notwithstanding this clinical heterogeneity, a subset of patients with MAS develop relentlessly progressive precocious puberty ultimately resulting in premature epiphyseal fusion and reduced adult stature. Long-term information on reproductive function has been obtained in females: some patients had regular menses without ovarian cysts on pelvic US scan, whereas others were oligomenorrheic and showed recurrent ovarian cysts. In males with MAS, precocious puberty occurred in three patients between 4 and 9 years of age. In one patient, long-term follow-up demonstrated normal plasma testosterone and gonadotropin values at the age of 17 years. On testicular sonography, multiple hyperechogeneic spots were found in both testicles (snow-storm appearance). Female patients with PHP-Ia were oligomenorrheic or amenorrheic; more than half had delayed or incomplete sexual development, They were mildly hypoestrogenic with normal to slightly elevated serum gonadotropin levels. These clinical and biochemical findings indicate partial resistance of the theca and granulosa cells of the ovary to gonadotropins due to deficient Gs alpha activity. Responsiveness might be sufficient to promote some degree of follicular development and steroid secretion, but insufficient to induce ovulation
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Affiliation(s)
- C de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children 's Hospital, Turin, Italy.
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Isaia GC, Lala R, Defilippi C, Matarazzo P, Andreo M, Roggia C, Priolo G, de Sanctis C. Bone turnover in children and adolescents with McCune-Albright syndrome treated with pamidronate for bone fibrous dysplasia. Calcif Tissue Int 2002; 71:121-8. [PMID: 12200645 DOI: 10.1007/s00223-001-1098-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2001] [Accepted: 02/28/2002] [Indexed: 11/30/2022]
Abstract
Bone fibrous dysplasia is one of the main features of McCune-Albright syndrome, a rare genetic condition caused by constitutive activating mutations of Gs-protein and defined by skin dysplasia, bone fibrous dysplasia, and autonomous multiple endocrinopathies. Raised serum alkaline phosphatase (ALP) and urinary hydroxyproline levels indicating bone metabolic hyperactivity have been reported in these patients. Encouraging therapeutic results have been achieved, mainly in adults, with pamidronate, an aminobisphosphonate. In this study we investigate newer bone metabolic indices in a cohort of 11 children and adolescents treated with pamidronate. Tenfold increases of bone ALP and urinary pyridinoline cross-links were found and osteocalcin levels were twofold higher compared with reference values. After treatment, significant decreases in bone ALP and cross-links (Wilcoxon test P < 0.06) were found. Bone mineral density (BMD) significantly increased during treatment. There were signs of radiological healing as thickening of the cortical bone was found in some cases.
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Affiliation(s)
- G C Isaia
- Department of Internal Medicine, University of Turin, Italy.
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18
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Riminucci M, Collins MT, Lala R, Corsi A, Matarazzo P, Gehron Robey P, Bianco P. An R201H activating mutation of the GNAS1 (Gsalpha) gene in a corticotroph pituitary adenoma. Mol Pathol 2002; 55:58-60. [PMID: 11836449 PMCID: PMC1187148 DOI: 10.1136/mp.55.1.58] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In the pituitary gland, activating mutations of the GNAS1 (Gsalpha) gene at Gln227 have been identified in adrenocorticotrophin secreting, growth hormone secreting, and prolactin secreting adenomas. To date, mutations at the codon encoding R201, typically underlying the McCune-Albright syndrome and isolated fibrous dysplasia of bone, have been demonstrated only in growth hormone secreting pituitary adenomas. In this study, a polymerase chain reaction amplified target sequence in exon 8 of the GNAS1 gene was sequenced, identifying the first R201 mutation seen in an isolated basophilic adenoma which generated Cushing's disease in a child. This case adds Cushing's disease to the range of human diseases caused by R201 mutations of the GNAS1 gene.
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Affiliation(s)
- M Riminucci
- Dipartimento di Medicina Sperimentale, Università dell'Aquila, Via Vetoio, Coppito II, 67100 L'Aquila, Roma, Italy
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Matarazzo P, Lala R, Masi G, Andreo M, Altare F, de Sanctis C. Pamidronate treatment in bone fibrous dysplasia in children and adolescents with McCune-Albright syndrome. J Pediatr Endocrinol Metab 2002; 15 Suppl 3:929-37. [PMID: 12199352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Thirteen patients with McCune-Albright syndrome (MAS) and bone fibrous dysplasia (BFD) have been treated for 2-6 years with pamidronate, an aminobisphosphonate which inhibits osteoclastic function. MAS is a rare genetic condition caused by constitutive activating mutations of the Gs protein and manifests with skin dysplasia, bone fibrous dysplasia, and multiple endocrinopathies. Raised serum alkaline phosphatase and urinary hydroxyproline have been reported in these patients, indicating bone metabolic hyperactivity. Encouraging therapeutic results have been achieved with pamidronate, mainly in adults. In our study, treatment reduced bone pain, fracture rate and metabolic indices of bone turnover, in particular significantly decreased bone alkaline phosphatase and cross-links (Wilcoxon test; p <0.06), and increased bone mineral density (DEXA). Signs of healing, such as thickening of the cortical bone, were found in some patients. Three patterns of MRI were found: homogeneous hypointense fibrous tissue, 'dotted' hypointense fibrous tissue, and hyperintense cystic images. Pamidronate treatment can be considered a favorable therapeutic option for patients with MAS.
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Affiliation(s)
- P Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
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20
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Lala R, Matarazzo P, Andreo M, Defilippi C, de Sanctis C. Impact of endocrine hyperfunction and phosphate wasting on bone in McCune-Albright syndrome. J Pediatr Endocrinol Metab 2002; 15 Suppl 3:913-20. [PMID: 12199350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Skin dysplasia, as café-au-lait spots, bone fibrous dysplasia and peripheral endocrinopathies are the main clinical features of McCune-Albright syndrome (MAS). This illness is due to activating mutations of the Gsalpha protein and is spread with a mosaic pattern in affected tissues that consist of intermixed areas of normal and mutated cells. Peripheral endocrine secretion, free of hypothalamic pituitary control, is the hallmark of the endocrine syndromes: precocious puberty, Cushing's syndrome, hyperthyroidism and gigantism/acromegaly. In addition, phosphate wasting as hyperphosphaturia is often present. The impact of hormonal hypersecretion and phosphate loss on the bones of patients with MAS is poorly understood both in normal and fibrous bone tissue. As hypercortisolism and hyperthyroidism increase bone resorption, hyperestrogenism and growth hormone hypersecretion stimulate bone growth and mineralization, and phosphate wasting reduces bone mineral content. All these actions can be exerted at varying times and degrees in a single patient on lesional and non-lesional bones. Sonographic evidence of multiple diffused hyperechogenic spots in the testes of patients with MAS do not seem to be related to alterations in calcium-phosphate metabolism but rather to zonal dysplasia/hyperplasia of testicular tissue.
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Affiliation(s)
- R Lala
- Department of Pediatric Endocrinology, Regina Margherita Children 's Hospital, Turin, Italy.
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21
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Bagna R, Tonetto P, Spola R, Martano C, Ferrero L, Becchino L, Nicocia M, Ciaccia R, Giuliano V, Lala R, Fabris C. [Neonatal pseudohypoaldosteronism: when a denied truth can delay a diagnosis]. Acta Biomed Ateneo Parmense 2001; 71 Suppl 1:769-71. [PMID: 11424844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A child with neonatal pseudohypoaldosteronism is referred. The diagnosis was delayed and complicated as her parents didn't tell us that her sister had been affected by the same illness. The child was born after premature rupture of membranes at 34 weeks. At birth, her conditions were satisfactory. The general conditions of the child gradually worsened and, though she regularly ate human pastorized bank milk, she didn't gain any weight. After 13 days she appeared dehydrated with marbled dry skin and haloed eyes, hypotonic and hyporeflexic. Her suction became more and more weaker, with frequent regurgitations and vomiting. Laboratory tests pointed out hyponatremia (110 mEq/l) and hyperkalemia (6.8 mEq/l). We were able to establish diagnosis of primary pseudohypoaldosteronism measuring plasma concentrations of aldosterone (> 5000 pg/ml), 17 hydroxyprogesterone (normal) and corticosteroids (normal). The child was then supplemented with sodium chlorure. A gradual improvement of general conditions took place. We assumed that both childrens and mother were affected by a milder form of primary pseudohypoaldosteronism, characterized by an autosomal dominant way of transmission. We found high levels of aldosterone with normal levels of blood salts also in the sister and mother patient's. After the neonatal period, pseudohypoaldosteronism can be only suspected in case of positive family history.
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Affiliation(s)
- R Bagna
- Cattedra di Neonatologia, Università di Torino.
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Das BB, Richardson C, Lala R, Sahoo S. Primary immature mediastinal teratoma in a newborn. Indian Pediatr 2001; 38:1181-4. [PMID: 11677311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- B B Das
- Department of Pediatrics, Lincoln Medical Center, 234 East 149th Street, Bronx, NY 10451, USA
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Lala R, Canavese F, Andreo R, Vinardi S, Gesmundo R, Manenti M, de Sanctis C. Testicular function of young men treated in childhood for cryptorchidism. Horm Res 2001; 55:53. [PMID: 11423746 DOI: 10.1159/000049967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R Lala
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
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24
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Silengo M, Del Monaco A, Linari A, Lala R. Low birth-weight, microcephalic malformation syndrome in a 46,XX girl and her 46,XY sister with agonadism: third report of the Kennerknecht syndrome or autosomal recessive Seckel-like syndrome with previously undescribed genital anomalies. Am J Med Genet 2001; 101:275-8. [PMID: 11424145 DOI: 10.1002/ajmg.1384] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on two sisters, one 46,XX with normal female phenotype, the other 46,XY with ambiguous external genitalia and agonadism. Both have a low birth weight and microcephalic malformation syndrome leading to early death. The 46,XX patient also had a diaphragmatic defect. The XY sister, in addition to absence of gonads and Mùllerian and Wolffian derivatives, had severe hypoplasia of the pulmonary artery and its branches, multicystic kidneys, and pachygyria. This combination of malformations, in part, fits in the autosomal recessive condition described by Kennerknecht et al. [1993] in a 46,XX and 46,XY pair of sibs with agonadism. The craniofacial appearance of our patients is similar to that observed in the 46,XY sister with agonadism reported by Kennerknecht et al. [1995]. On the other hand, intrauterine growth retardation, microcephaly, and pachygyria are not part of the phenotype of the Kennerknecht "syndrome" and agonadism was not present in our 46,XX patient. We suggest two hypotheses to explain the abnormal phenotype in our cases. The first is that they might represent the third sibship affected by the Kennerknecht syndrome with additional anomalies. Alternatively, our two sibs might have a Seckel or a Seckel-like syndrome. The 46,XY patient would then be the first case of Seckel syndrome with sex reversal and agonadism.
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Affiliation(s)
- M Silengo
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Universita' di Torino, Torino, Italy.
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25
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Rajegowda BK, Das BB, Lala R, Rao S, Mc Neeley DF. Expedited human immunodeficiency virus testing of mothers and newborns with unknown HIV status at time of labor and delivery. J Perinat Med 2001; 28:458-63. [PMID: 11155432 DOI: 10.1515/jpm.2000.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New York State introduced the first statewide program in the U.S. of expedited HIV testing (48-hour turn-around results) of mothers with unknown HIV status at the time of labor or delivery and their newborns on August 1, 1999. We evaluated the results of this program during its first 5 months at Lincoln Medical and Mental Health Center (Lincoln Hospital) in the Bronx, New York. There were 1,274 total live birth deliveries between August 1 and December 31, 1999. The HIV infection status of 539 mothers (42.3%) was unknown to medical providers in the labor-delivery suite, either due to lack of testing during the current pregnancy or unavailability of HIV documentation at the time of delivery. During labor and delivery, a total of 462 (85.7%) mothers with unknown HIV status consented to expedited HIV testing (Single Use Diagnostic System for HIV-1 antibody or SUDS). The newborns of 77 mothers (14.3%) who did not consent were tested immediately after birth. Seventeen tested positive for HIV-1 antibody by the SUDS test. The results of 10 of these infants (58.8%) were subsequently confirmed positive for HIV-1 antibody by Western Blot analysis. This new rapid HIV testing program facilitated early diagnosis of these previously unknown HIV-exposed infants, although the low positive predictive value of the test in our community calls for careful communication of these results pending confirmation.
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Affiliation(s)
- B K Rajegowda
- Department of Pediatrics, Lincoln Medical and Mental Health Center, Bronx, New York, USA
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26
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Abstract
PURPOSE The aim of the study was to evaluate testicular hormones and sperm counts of young men treated in childhood for cryptorchidism METHODS Testicular volume, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone as well as semen specimens were evaluated in 57 men (mean age, 19 years; range, 18 to 27 years) treated in childhood for unilateral (n = 47) and bilateral (n = 10) cryptorchidism. In 3 unilateral cases monorchidism was found. Thirty-seven patients underwent orchiopexy after hormonal treatment (luteinizing hormone releasing factor, 1.2 mg/d for 28 days followed by human chorionic gonadotropin, 500 IU intramuscularly 3 times a week for 3 weeks). The remainder underwent surgery. Mean age at surgical treatment was 5.4 years (range, 2 to 12 years). These patients were examinated again after a mean period of 13.3 years (range, 10 to 19 years). RESULTS Reduced testicular volume (<12 mL) was found in 6 of 64 testes (9.3%). LH, FSH, and testosterone levels were found within the normal range in all patients. With linear regression, inverse relations were found between FSH and, respectively, testicular volume (P =.002), sperm concentration (P =.013), sperm motility (P =.023), and normally shaped sperms (P =.019). There were direct relations between testicular volume and sperm concentration (P =.02), sperm motility (P =.000), and normally shaped sperms (P =.001). We did not find any statistical correlation between age at surgery and semen quality. Significantly better results in terms of sperm counts were found in patients directly operated on in comparison to those treated with hormones before orchiopexy. CONCLUSIONS Presented data indicate tubular impairment in young men operated on in childhood for cryptorchidism; FSH values increase and testicular volume decrease are related to sperm deterioration. Studies on children treated in the first 2 years of life are required to clarify the usefulness of early treatment of cryptorchidism.
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Affiliation(s)
- S Vinardi
- Departments of Pediatric Surgery, Andrology, and Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Bertelloni S, Baroncelli GI, Federico G, Cappa M, Lala R, Saggese G. Altered bone mineral density in patients with complete androgen insensitivity syndrome. Horm Res 2000; 50:309-14. [PMID: 9973670 DOI: 10.1159/000023296] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Androgens have major influences on the regulation of bone mineralization. Because of their unique peripheral metabolism androgens may act on bone via activation of the androgen and/or estrogen receptor. Patients with complete androgen insensitivity syndrome (cAIS) are natural models to assess androgen actions on bone. We studied bone mineral density (BMD) in 10 patients with cAIS (mean age 13.70, range 4.7-19.8 years); 3 patients were studied before gonadectomy; the others were castrated and 6 were on hormonal replacement therapy. The BMD area (aBMD) was measured by dual energy X-ray; lumbar 'apparent' volumetric density (vBMD) was calculated using the formula vBMD = aBMD x [4/(pi x width)]. In the patients, aBMD (0.72 +/- 0.16 g/cm2) and vBMD (0.23 +/- 0.04 g/cm3) were significantly (p < 0.001) reduced in comparison with those of a control group (n = 15, age 5.0-20.5 years: aBMD 1.028 +/- 0.20 g/cm2; vBMD 0.35 +/- 0.04 g/cm3). Both aBMD and vBMD were also reduced in comparison with normal values for males (aBMD -2.66 +/- 0. 99 SDS, p < 0.001; vBMD -3.08 +/- 1.53 SDS, p < 0.0005) and females (aBMD -2.88 +/- 1.05 SDS, p < 0.001; vBMD -2.84 +/- 1.18 SDS, p < 0. 0007). Real lumbar bone density, assessed by computed tomography in 1 patient, was also reduced (-6.2 SDS and -3.5 SDS for male and female normal values, respectively). Biochemical markers of bone metabolism were normal and not significantly different in patients and controls. Girls with cAIS did not have more fractures than controls. In conclusion, both aBMD and vBMD are reduced in cAIS patients, while bone turnover and the fracture risk seem not to be increased. Our data indicate that both androgens and estrogens may be required for acquisition of bone density during childhood.
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Affiliation(s)
- S Bertelloni
- Pediatric Endocrine Unit, Department of Reproductive Medicine and Pediatrics, University of Pisa, 'Santa Chiara' Hospital, Pisa, Italy
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de Sanctis C, Lala R. Diagnosis and medical-surgical treatment of cryptorchidism. J Endocrinol Invest 2000; 23:341-4. [PMID: 10882155 DOI: 10.1007/bf03343734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Lala R, Matarazzo P, Bertelloni S, Buzi F, Rigon F, de Sanctis C. Pamidronate treatment of bone fibrous dysplasia in nine children with McCune-Albright syndrome. Acta Paediatr 2000; 89:188-93. [PMID: 10709889 DOI: 10.1080/080352500750028816] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
McCune-Albright syndrome is a rare genetic disorder consisting of skin and bone dysplasia and peripheral endocrinopathies. Little data have been collected regarding bisphosphonate treatment of bone fibrous dysplasia in paediatric patients with this syndrome. The aim of our study was to investigate the therapeutic efficacy of pamidronate in these patients. Nine patients with moderate to severe forms of bone fibrous dysplasia were treated with pamidronate intravenously (0.5-1 mg/kg/daily for 2-3 d) at 0.5-1-y intervals. Patients were treated over a time period of 0.5-3.5 y. During treatment no spontaneous fracture occurred. Bone pain and gait abnormality due to pain disappeared after 2-3 therapeutic cycles. Cranial asymmetry and limb length discrepancy remained unchanged. Elevated serum alkaline phosphatase and urine hydroxyproline values were reduced by the treatment, demonstrating drug activity at the lesional level. The effectiveness of pamidronate was also seen at the non-lesional level through an increase in bone density. Radiographic and scintigraphic evidence of lesion healing was not attained. Pamidronate treatment can ameliorate the course of bone fibrous dysplasia in children and adolescents with McCune-Albright syndrome.
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Affiliation(s)
- R Lala
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital of Turin, Italy.
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30
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de Sanctis C, Lala R, Matarazzo P, Balsamo A, Bergamaschi R, Cappa M, Cisternino M, de Sanctis V, Lucci M, Franzese A, Ghizzoni L, Pasquino AM, Segni M, Rigon F, Saggese G, Bertelloni S, Buzi F. McCune-Albright syndrome: a longitudinal clinical study of 32 patients. J Pediatr Endocrinol Metab 1999; 12:817-26. [PMID: 10614538 DOI: 10.1515/jpem.1999.12.6.817] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report the diagnostic clinical features and their long term evolution in 32 patients with McCune-Albright syndrome. Patient data are made up of two periods: the first, classified as personal history, is from birth until the time when the diagnosis of McCune-Albright syndrome was made; the second, classified as clinical observation, is from the first observation until the end of follow up. The total duration of these two periods was 9.6+/-2.9 yr; mean age at first observation was 5.7 yr (range 0.7-11 yr). The probability of manifesting main clinical signs according to age was calculated: almost all had skin dysplasia at birth, 50% probability of peripheral precocious puberty in females at 4 years and 50% of bone dysplasia at 8 years of age were found. Other clinical signs had diagnostic relevance when preceding the main signs leading to diagnosis of McCune-Albright syndrome even without specific genetic investigation. The most important clinical manifestations have different evolutions: skin lesions increase in dimensions according to body growth; precocious puberty in females evolves rapidly but periods of regression can be seen in some patients; bone dysplasia in most patients evolves with an increase both in the number of affected bones and in the severity of lesions.
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Affiliation(s)
- C de Sanctis
- Divisione di Endocrinologia Pediatrica, Ospedale Regina Margherita, Torino, Italy
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31
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Affiliation(s)
- M Riminucci
- Dipartimento di Medicina Sperimentale, Universitá dell'Aquila, L'Aquila, Italy
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v Agoston D, Santha E, Shieh G, Lala R, Dobi A. Isolation and structural and genetic analysis of the mouse enkephalin gene and its d(AC/TG)n repeats. DNA Seq 1999; 9:217-26. [PMID: 10520752 DOI: 10.3109/10425179809105208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Enkephalins, the endogenous opioids, mediate a wide variety of intercellular communications through ontogeny and their involvement has been suggested in drug addiction and alcohol abuse as well as in various neuropsychiatric disorders. In order to generate a genetic model, we have isolated the mouse enkephalin (mENK) gene, analyzed its regulatory region and compared its structure to the well characterized rat ENK (rENK) gene. We analyzed 2600 bp and found 3 highly homologous regions: The highest level (98%) of positional and sequence homology between mice and rats was in the TATA/proximal regulatory region. This region contains all the inducible regulatory elements (enkCRE1, NF1, AP-2, NFkappaB, etc.) and also an octamer-like element at -543 bp. This high homology is interrupted in both mice and rats by the typically polymorphic d(AC/TG)n and d(TC/GA)n dinucleotide repeats positioned between nucleotides -670 and -950. The position and orientation of these repetitive elements differ substantially in the two species. Genomic PCR analysis of the d(AC/TG)n repeat in various mouse strains, including aberrant behavioral or neurological phenotypes, showed lack of polymorphism at this repeat. The positional and sequence homologies between the rat and the mouse ENK genes decrease in more upstream regions due to the presence of nonhomologues repetititve DNA sequences.
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Affiliation(s)
- D v Agoston
- Molecular Control of Neurodifferentiation, NICHD, NIH, Bethesda, MD 20892, USA.
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Tenywa MM, Isabirye MI, Lala R, Lifafa A, Achan P. Cultural practices and production constraints in smallholder banana-based cropping systems of Uganda's Lake Victoria Basin. ACTA ACUST UNITED AC 1999. [DOI: 10.4314/acsj.v7i4.27756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The progressive course of a congenital bronchogenic cyst in a very low birth weight infant with respiratory distress is presented. A bronchogenic cyst, while uncommon, should be in the differential diagnosis of pneumomediastinum or medial pneumothorax even in premature infants who are on ventilators.
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Affiliation(s)
- D S Shah
- Department of Pediatrics, Medical College of Georgia, Augusta, USA
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35
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Abstract
Since cryptorchidism can cause infertility and early orchiopexy can improve fertility, we tried to determine whether medical and surgical treatment in the 1st year of life can improve testicular fertility. We concluded that this is the best time to treat cryptorchid tests.
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Affiliation(s)
- F Canavese
- Department of Paediatric Surgery, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Torino, Italy
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36
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Affiliation(s)
- F Garofalo
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Universita di Torino, Italy
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37
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Lala R, Chiabotto P, Di Stefano M, Isaia GC, Garofalo F, Piga A. Bone density and metabolism in thalassaemia. J Pediatr Endocrinol Metab 1998; 11 Suppl 3:785-90. [PMID: 10091147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Twenty-seven thalassaemic patients (13 F, 14 M, aged 8.1-14.9 yr), regularly transfused and chelated with desferrioxamine (30-40 mg/kg/day) were studied. Every patient was submitted to auxological evaluations, dual X-ray absorptiometry to measure bone mineral density (BMD), and to the determination of bone metabolic markers of osteoclastic activity (total urinary hydroxylysylpyridinoline crosslinks, carboxyterminal pyridinoline crosslinked telopeptide of type I collagen [ICTP]) and of osteoblastic activity (bone Gla protein [BGP] and carboxyterminal propeptide of type I procollagen [PIPC]). The evaluations were repeated after 1 year, during which 13 patients continued desferrioxamine chelation while 14 underwent deferiprone chelation (75 mg/kg/day in 3 doses). The data demonstrate widespread bone alterations consisting of osteoporosis, growth failure and bone age delay. Lumber spine (L2-L4) BMD areal values (Z score) inversely correlated with age, as did height SDS of both male and female patients, indicating osteoporosis progressing with age in parallel with growth insufficiency. No clear-cut alterations in bone mineral metabolism were found in basal state and after 1 year. Extensive MR imaging studies are needed to define the contribution of residual bone marrow hyperplasia to thalassaemic osteopathy suggested by subtle radiological signs as enlargement of bone marrow cavities with thinning of the cortical bone and abnormalities of the trabecules of spongy bone.
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Affiliation(s)
- R Lala
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Bertelloni S, Baroncelli GI, Lala R, Cappa M, Matarazzo P, De Sanctis C, Saggese G. Long-term outcome of male-limited gonadotropin-independent precocious puberty. Horm Res 1997; 48:235-9. [PMID: 9362394 DOI: 10.1159/000185521] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Long-term outcome of five new cases of male-limited precocious puberty (MPP) is reported. Three patients had positive family history. One patient was untreated; 2 boys received cyproterone acetate (2.0-3.6 mg/kg/daily) without clinical effects. Two patients were treated with ketoconazole (600 mg/daily); in 1, GnRH analogue therapy (Buserelin, 1,600 microg/day) was added after 6 months of effective ketoconazole treatment for development of central precocious puberty. The other patient did not develop central puberty under ketoconazole treatment and improved his predicted adult height from 172.4 to 181.1 cm. Four patients reached final height [B.A. (therapy cyproterone acetate): age 22.0 years, -2.0 SDS; B.G. (untreated): age 15.5 years, -1.7 SDS; M.M. (therapy cyproterone acetate): age 19.5 years, -1.6 SDS; M.F. (therapy ketoconazole plus GnRH analogue): age 21.3 years, -2.2 SDS]; three had reduced testicular volume (B.A.: -1.6/-1.6 SDS; B.G.: -2.1/-2.1 SDS; M.F.: -2.4/-1.9 SDS); one (M.F.) showed oligospermia. We concluded that in MPP cyproterone acetate treatment did not improve final height; ketoconazole was effective in reducing testosterone secretion, but its real effect on final height cannot be determined; the timing of central puberty may be precocious, suggesting that an adjunctive GnRH analogue treatment may be needed. In some patients, testicular impairment may be present in young adulthood.
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Affiliation(s)
- S Bertelloni
- Endocrine Unit, II Paediatric Clinic, University of Pisa, Italy
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Bamshad M, Lin RC, Law DJ, Watkins WC, Krakowiak PA, Moore ME, Franceschini P, Lala R, Holmes LB, Gebuhr TC, Bruneau BG, Schinzel A, Seidman JG, Seidman CE, Jorde LB. Mutations in human TBX3 alter limb, apocrine and genital development in ulnar-mammary syndrome. Nat Genet 1997; 16:311-5. [PMID: 9207801 DOI: 10.1038/ng0797-311] [Citation(s) in RCA: 395] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ulnar-mammary syndrome is a rare pleiotropic disorder affecting limb, apocrine gland, tooth and genital development. We demonstrate that mutations in human TBX3, a member of the T-box gene family, cause ulnar-mammary syndrome in two families. Each mutation (a single nucleotide deletion and a splice-site mutation) is predicted to cause haploinsufficiency of TBX3, implying that critical levels of this transcription factor are required for morphogenesis of several organs. Limb abnormalities of ulnar-mammary syndrome involve posterior elements. Mutations in TBX5, a related and linked gene, cause anterior limb abnormalities in Holt-Oram syndrome. We suggest that during the evolution of TBX3 and TBX5 from a common ancestral gene, each has acquired specific yet complementary roles in patterning the mammalian upper limb.
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Affiliation(s)
- M Bamshad
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City 84112, USA
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Lala R, Matarazzo P, Chiabotto P, Gennari F, Cortese MG, Canavese F, de Sanctis C. Early hormonal and surgical treatment of cryptorchidism. J Urol 1997; 157:1898-901. [PMID: 9112559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We investigated the efficacy of early gonadotropin treatment of cryptorchidism for promoting testicular descent and ameliorating testicular histology. MATERIALS AND METHODS We treated 319 cryptorchid testes in 281 boys 4 months to 3 years old with luteinizing hormone-releasing hormone and human chorionic gonadotropin sequential therapy. Surgery was done on the 207 testes that did not respond to medical treatment. Microscopic biopsies were performed in 134 of these 207 testes. Histological findings were compared to those of 30 cryptorchid testes in boys younger than 1 year who underwent surgery without previous hormonal treatment. RESULTS Combined luteinizing hormone-releasing hormone and human chorionic gonadotropin treatment induced scrotal descent of a percentage of cryptorchid testes depending on clinical position. Therapeutic success was greater when testes were in a lower position and results were not age dependent. Hormonal treatment of cryptorchidism during the first year of life stimulated spermatogonia maturation. CONCLUSIONS When administered at the end of age 6 months, hormonal treatment can be considered an effective and timely substitution for gonadotropin and testosterone insufficiency in cryptorchid infants. Therefore, we recommend this therapeutic procedure combined with surgery in the first year of life.
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Affiliation(s)
- R Lala
- Division of Pediatric Endocrinology (Unit of Pediatric Andrology), Regina Margherita Children's Hospital of Turin, Italy
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Lala R, Palomba E, Matarazzo P, Altare F, Tovo PA. ACTH and cortisol secretions in children with perinatal HIV-1 infection. Pediatr AIDS HIV Infect 1996; 7:243-5. [PMID: 11361716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Serum cortisol and adrenocorticotropic hormone (ACTH) values and CD4 cell count were evaluated in 25 perinatally HIV-1-infected children. The children were divided into three groups: group 1 included eight asymptomatic or paucisymptomatic children, group 2 nine moderately symptomatic children, and group 3 eight children with severe clinical manifestations. Group 1 children were without antiretroviral therapy; the remaining children received zidovudine (AZT) treatment. Only one group 3 patient had primary adrenal insufficiency. No significant differences in cortisol and ACTH secretion were found either between all HIV-1-infected and 126 age- and sex-matched normal children or among the three groups of patients. Mean CD4 cell count of each group declined in parallel to disease progression. No correlations were found between cortisol or ACTH values and CD4 cell count. Adrenal failure may be a late complication of HIV-1 infection and should be searched for in severely ill patients. Our data argue against the hypothesis of a cortisol-induced shift from T-helper-1 (Th1) to Th2 cytokine production profile as the pathogenetic mechanism of progression to AIDS.
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Affiliation(s)
- R Lala
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Matarazzo P, Lala R, Artesani L, Franceshini PG, De Sanctis C. Sonographic appearance of ovaries and gonadotropin secretions as prognostic tools of spontaneous puberty in girls with Turner's syndrome. J Pediatr Endocrinol Metab 1995; 8:267-74. [PMID: 8821904 DOI: 10.1515/jpem.1995.8.4.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We evaluated the possibility of anticipating spontaneous puberty in peripubertal Turner girls, in order to plan substitutive estrogen treatment. In the 24 patients studied, spontaneous puberty was seen in 4/11 girls with 45 XO karyotype, 5/5 with mosaicisms, 1 out of 2 with structural aberrations of the X chromosome and 0 out of 6 with Xq isochromosomes. When considering sonographic findings, the 6 girls with normal ovaries and 4/9 of those with intermediate ovarian appearance showed spontaneous puberty; the remaining 5 with intermediate ovaries and 9 with streak gonads did not undergo spontaneous puberty. Gonadotropin secretion was normal in girls with normal ovaries, moderately elevated in patients with intermediate ovarian appearance, and very high in those with streak gonads. The prognostic value of sonography and gonadotropins is particularly important in girls with intermediate ovaries. Therefore these evaluations should be performed at peripubertal age in patients with Turner's syndrome to elucidate the degree of ovarian insufficiency.
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Affiliation(s)
- P Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Abstract
From 1986 to 1990, 53 non-palpable testes were treated in the department of Pediatric Surgery and Endocrinology at the Regina Margherita Hospital, Turin, Italy. The reported patients were 45, 8 of them were bilateral with both testes non-palpable, 13 of the remaining patients were right cryptorchid and 24 were left. All patients received medical treatment, by LH-RH nasal spray and HCG, before surgery. None of the non-palpable testes descended by hormone therapy only, so that surgical exploration was always required. In the 53 reported cases, 10 gonads were not found, 13 were atrophic and 30 were abdominal. All abdominal gonads were positioned into the scrotum by orchiopexy in a single stage. Half of the patients underwent operation before the age of 2. Therefore, it is to be pointed out that the younger a patient the shorter his inguinal canal, this facilitates orchiopexy for high, undescended testes. In 10 patients a testicular biopsy was made during surgical procedure. Normal morphology and normal spermatogonia content were observed in the abdominal testes of the patients who had reached the age of 1 year. During the follow-up of the reported patients no upward displacement was observed. Eleven patients underwent postoperative testicular ultrasonography which showed that parenchymal structure of the operated testis was normal and the volume of the testis was slightly smaller than normal. Based on their experience, the authors suggest to correct cryptorchidism before the age of one year, surgical procedure follows immediately after ineffective hormone therapy.
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Affiliation(s)
- F Canavese
- Department of Pediatric Surgery, Regina Margherita Hospital, Turin, Italy
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de Sanctis C, Lala R, Canavese F. [Cryptorchidism]. Pediatr Med Chir 1995; 17:23-8. [PMID: 7739922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cryptorchidism is the most frequent anomaly of an endocrine gland; it entails risks of infertility and testicular cancer. Its pathogenesis is thought to be multifactorial including anatomical and mechanical together with endocrine causes. In the last decades most Authors favoured the hypothesis that some degree of androgen insufficiency during fetal life may play a role in determining testicular maldescent. Morphological alterations have been demonstrated in cryptorchidism testes since birth; both tubular and interstitial damage already can be found in the first months of life. A critical phase in germinal development occurs during the third month when gonadotropin and testosterone postnatal surge induces the first maturational step in germ cells development. In cryptorchid infants, gonadotropin insufficiency at this time reduces germ cells differentiation, leading to progressive germinal decline, which becomes manifest after 12 months of life. In the opinion of some Authors, germinal alteration can be partially reversed by early scrotal reposition of the cryptorchid testes. Hormonal therapy with human chorionic gonadotropin (HCG) and luteinizing hormone releasing hormone (LHRH) has been used in the past decades with variable results. A combination of the two hormones has had a greater effect in inducing testicular descent compared to single hormone treatment. Although some surgeons already treat cryptorchid patients during childhood, an increasing number of pediatric surgeons believe that early treatment, performed during infancy is preferable, when considering the early and progressive histological damage seen in cryptorchid gonads. In our opinion, also hormonal treatment performed during the first year of life seems preferable since it can at the same time induce scrotal descent of cryptorchid testes and substitute postnatal gonadotropin insufficiency.
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Affiliation(s)
- C de Sanctis
- Divisione di Endocrinologia Pediatrica, Ospedale Infantile Regina Margherita Istituti Universitari di Pediatria di Torino, Italia
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Matarazzo P, Palomba E, Lala R, Ciuti E, Altare F, de Sanctis L, Tovo PA. Growth impairment, IGF I hyposecretion and thyroid dysfunction in children with perinatal HIV-1 infection. Acta Paediatr 1994; 83:1029-34. [PMID: 7841697 DOI: 10.1111/j.1651-2227.1994.tb12977.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We evaluated the growth pattern, bone age, insulin-like growth factor I (IGF I) secretion and thyroid function in 24 perinatally infected children: 9 asymptomatic or paucisymptomatic (group 1) and 15 with a more advanced disease state and treated with zidovudine (group 2). Statural and ponderal growth were compared with those of 37 at-risk children who seroreverted. During the two-year follow-up, 22% of children in group 1 had impaired growth, 33% bone age delay, 45% reduced IGF I levels but none had thyroid dysfunction. In group 2, 53% had growth failure, 53% bone age delay, 86% reduced IGF I levels and 40% thyroid dysfunction. Among seroreverters, none showed growth impairment; statistically significant differences were found for height, weight and height velocity between perinatally infected children and seroreverters. Since auxological and hormonal evaluations run parallel to the clinical course of infection, these indices may be useful in monitoring disease progression.
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Affiliation(s)
- P Matarazzo
- Department of Paediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Einaudi S, Borelli I, Lala R, Praticŏ L, Curtoni ES, De Sanctis C. HLA haplotypes and hormonal studies in 25 Italian families of patients with classical and non-classical 21-OH deficiency. J Pediatr Endocrinol Metab 1994; 7:349-55. [PMID: 7735374 DOI: 10.1515/jpem.1994.7.4.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To investigate the genetic polymorphisms of the HLA region and the molecular defect of the P450c21B gene in congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, we studied 89 individuals from 25 families of CAH patients (14 classical forms, 11 non-classical forms). The following immunogenetic and hormonal investigations were performed: HLA-A and B typing, restriction fragment length polymorphism (RFLP) analysis of 21-hydroxylase A and B genes, and serum 17-OH-progesterone values determined basally and 60 min after ACTH stimulation. In the patients affected by the classical form, RFLP analysis revealed 5 deletions and 1 gene conversion in 6 haplotypes and no molecular defect in the others, who probably carry point mutations. In the patients with non-classical form we found P450c21A duplication in 11/18 haplotypes; 9 of the 11 patients shared the HLA-B14 allele. Utilizing both hormonal and genetic data we identified two cryptic forms; hormonal data alone failed to differentiate heterozygous from normal individuals.
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Affiliation(s)
- S Einaudi
- Division of Pediatric Endocrinology, Hospital Regina Margherita, Torino, Italy
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Einaudi S, Lala R, Corrias A, Matarazzo P, Pagliardini S, de Sanctis C. Auxological and biochemical parameters in assessing treatment of infants and toddlers with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Pediatr Endocrinol 1993; 6:173-8. [PMID: 8348221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We studied height velocity (HV), bone age progression (delta BA/delta CA), urinary pregnanetriol (PT) and plasma 17-hydroxyprogesterone (17-OH-P) during the first years of life in 12 patients with 21-hydroxylase deficiency, treated by cortisone acetate. In the well-controlled phases normal growth rate (SDS between -1 and +1), satisfactory bone age progression (delta BA/delta CA < or = 1) and no clinical sign of poor treatment were found; in the undertreatment phases enhanced growth rate, rapid bone age progression and, in some instances, signs of virilization were found; in the overtreatment phases, reduced growth rate was the only sign of poor treatment. Hormonal values were only weakly correlated to therapeutic control. Therefore, growth rate evaluation can represent the best method of monitoring treatment in very young patients with 21-hydroxylase deficiency.
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Affiliation(s)
- S Einaudi
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
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Abstract
In 238 boys with cryptorchidism, between the ages of 4 and 48 months, luteinizing hormone releasing hormone (LHRH) was administered as nasal spray 1.2 mg/day for 4 weeks. The nonresponders received human chorionic gonadotropin (HCG) 500 I.U. i.m. three times a week for 3 weeks. With the combined treatment 37.8% of testes descended into the scrotum. Testicular descent occurred more often in patients whose testes were located in a lower position. Histological findings indicated a reduction in the number and maturation of germ cells. A clear improvement of germ cells trophism was observed in boys hormonally treated and operated on before the 12th month of life. Early administered combined treatment with LHRH and HCG can be considered as a substitution of the gonadotropins insufficiency manifested by most cryptorchid infants in the first months of life.
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Affiliation(s)
- R Lala
- Division of Pediatric Endocrinology, Regina Margherita Children's Hospital, Torino, Italy
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Franceschini P, Vardeu MP, Dalforno L, Signorile F, Franceschini D, Lala R, Matarazzo P. Possible relationship between ulnar-mammary syndrome and split hand with aplasia of the ulna syndrome. Am J Med Genet 1992; 44:807-12. [PMID: 1481852 DOI: 10.1002/ajmg.1320440618] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a 3-generation family in which mother, maternal grandfather, and 2 (male and female) children have variably manifestations of the ulnar-mammary syndrome, including ulnar ray defects, obesity, hypogenitalism, delayed puberty, hypoplasia of nipples and apocrine glands, and a previously undescribed ectopia of upper canines. The index patient also had split-hand appearance on the right due to complete absence of the 4th ray. To our knowledge this is the first documented example of split hand in the ulnar-mammary syndrome. The hand anomaly raises the question of a possible causal relationship between ulnar-mammary syndrome and the split hand with aplasia of the ulna syndrome, as already hypothesized by Lenz [1980].
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Affiliation(s)
- P Franceschini
- Istituto di Discipline Pediatriche, Università di Torino, Italy
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Abstract
We report a new case of Rubinstein-Taybi syndrome with a hypoplastic right kidney, persistent pulmonary hypertension, and mitral valve regurgitation. Other pertinent features included broad thumbs, broad big toes, syndactyly of the third and fourth fingers bilaterally, beaked nose, broad columella of the nose, patent ductus arteriosus, and motor and mental retardation. The testes were descended. The 3 month old patient had delayed motor and mental development corresponding to a 1 month old infant.
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Affiliation(s)
- D Kanjilal
- Department of Pediatrics, Lincoln Medical and Mental Health Center-New York Medical College, Bronx 11206
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