Meyer Dysplasia in the Differential Diagnosis of Hip Disease in Young Children

Total Page:16

File Type:pdf, Size:1020Kb

Meyer Dysplasia in the Differential Diagnosis of Hip Disease in Young Children ARTICLE Meyer Dysplasia in the Differential Diagnosis of Hip Disease in Young Children Liora Harel, MD; Liora Kornreich, MD; Shai Ashkenazi, MD, MSc; Avinoam Rachmel, MD; Boaz Karmazyn, MD; Jacob Amir, MD Objectives: To describe a rare developmental disorder Results: Two of the 5 patients were initially diagnosed of the femoral capital epiphysis in infants and children as having osteomyelitis and 3 as having Perthes disease. that is often misdiagnosed and to suggest an evaluation The diagnosis of Meyer dysplasia was confirmed by plain protocol to differentiate it from other hip problems. film of the pelvis, a negative bone scan, or normal bone marrow findings on magnetic resonance imaging. The Design: Case series. limping resolved without treatment in all patients within 1 to 3 weeks. Setting: Tertiary care center. Conclusions: Meyer dysplasia is a benign condition that Subjects: Five consecutive patients referred for evalu- should be included in the differential diagnosis of hip dis- ation of acute onset of limping between January 1990 and ease in infants and children. Awareness of this condi- December 1997. tion may prevent unnecessary hospitalization and treat- ment. Intervention: All clinical and imaging data were col- lected. Arch Pediatr Adolesc Med. 1999;153:942-945 5 patients. The 5 children included 4 males Editor’s Note: Keep this in mind next time you see a limping and 1 female aged 9 to 48 months. All pre- toddler or preschooler. sented with acute onset of limping of 2 to Catherine D. DeAngelis, MD 30 days’ duration. Patient 3 was being ob- served by a pediatric endocrinologist for short stature, and patient 4 had a family EYER dysplasia is a history of congenital dislocation of the hip symptomless develop- and Perthes disease. Otherwise, the his- mental disorder of the tories were unremarkable. hip manifested by de- Physical examination revealed a de- layed, irregular ossifi- creased range of motion of the hip joint Mcation of the femoral epiphysial nucleus.1 in 3 of the 5 patients; in 1 (patient 2), it The dysplasia is noted during the second was accompanied by fever. Acute-phase re- year of life and usually disappears by the actants (high erythrocyte sedimentation end of the sixth year without treatment.2 rate, high white blood cell count) were This rare condition may easily be mis- found in 2 patients (patients 1 and 2). Hip taken for other hip problems, leading to radiographs revealed various epiphysial unnecessary diagnostic procedures and changes compatible with Meyer dyspla- treatments. sia in all patients, 3 of whom had bilat- We describe 5 children who were ul- eral involvement (Figure 1). From the Department of timately diagnosed as having Meyer dys- The initial diagnosis in patients 1 and Pediatrics (Drs Harel, plasia and suggest guidelines for the evalu- 2 was acute osteomyelitis, based on the Ashkenazi, Rachmel, and Amir) ation of this condition based on our clinical presentation and the presence of and Imaging Department findings and a review of the literature. an elevated sedimentation rate with leu- (Drs Kornreich and Karmazyn), Schneider kocytosis and radiolucent lesions of the Children’s Medical Center of RESULTS femoral head. However, the normal find- Israel, Petah Tiqva, and Sackler ings on bone scan ruled out this possibil- Faculty of Medicine, Tel Aviv Table 1 presents clinical findings and ity and supported the diagnosis of Meyer University, Tel Aviv, Israel. Table 2 presents imaging findings in the dysplasia. ARCH PEDIATR ADOLESC MED/ VOL 153, SEP 1999 942 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 COMMENT PATIENTS AND METHODS Pedersen3 and Meyer2 were the first to describe a sub- group of patients with Perthes disease who showed a Five consecutive patients referred to our tertiary care distinct radiological and clinical picture found rarely center between January 1990 and December 1997 for among the clinical conditions affecting the hip joint in acute onset of limping were evaluated clinically and childhood. Meyer estimated that this subgroup by imaging studies. accounted for 10% of all patients with Perthes disease and was characterized by a male predominance and young age (,5 years). He reported that this dysplasia is noted during the second year of life and usually disap- pears by the end of the sixth year. It is more often bilat- The 3 other patients (patients 3, 4, and 5) were first eral than typical Perthes disease (42% vs 7%) and has a suspected to have Perthes disease, based on the clinical higher familial frequency of other hip diseases such as presentation, lack of signs of infection, and the pres- congenital dislocation and Perthes disease.2 Meyer ence of epiphysial changes on the hip radiographs. Again, traced the pathogenesis to circulatory disturbances that normal bone scan findings excluded this diagnosis. Be- caused delayed, irregular ossification. Other authors cause of a family history of Perthes disease in patient 4, have attributed the dysplasia to congenital focal hypo- magnetic resonance imaging was performed, revealing plasia of the femoral epiphysis.4 multiple centers of ossification of the femoral heads. The The possibility that we are dealing with a physi- normal bone marrow intensity in all sequences ruled out ologic variant of ossification of the femoral head cannot edema and ischemia and confirmed the diagnosis of Meyer be ruled out in those who completely recover with nor- dysplasia (Figure 2). mal epiphysial shape and size. In all patients, the limping resolved without treat- Radiologically, affected patients show a marked de- ment within 1 to 3 weeks. Bone survey did not dis- lay in the development of the femoral epiphysial nucleus close epiphysial dysplasias in other bones in any of the and its pathological appearance at a later date. Matura- children. Results of thyroid function tests were nor- tion is retarded in other parts of the skeleton as well.1 In mal. Bone age (by Greulich Pyle) was retarded in all Meyer dysplasia, ossification of the femoral head does not patients. usually set in until 2 years of age. The ossification cen- Table 1. Clinical Findings in Meyer Dysplasia Laboratory Findings* Patient No./ Clinical Maximal Physical Initial Initial Sex/Age, mo Presentation Temperature Findings ESR, mm/h WBC, 3109/L Diagnosis Treatment 1/F/9 Guarding of left leg Normal Limited internal rotation 60 15 Osteomyelitis Cefuroxime of left hip joint 2/M/24 Limping in left leg 39.5° C Tonsillitis, limited internal 62 26 Osteomyelitis, Cefuroxime rotation of left hip joint tonsillitis 3/M/48 Limping, waddling gait Normal Normal 25 8.8 Perthes disease None 4/M/30 Limping in left leg Normal Limited internal rotation 25 10 Perthes disease None of left hip joint 5/M/36 Limping Normal Normal 11 Not done Perthes disease None *ESR indicates erythrocyte sedimentation rate; WBC, white blood cell count. Cefuroxime was given as cefuroxime sodium. Table 2. Imaging Findings of the Hip Joints in Meyer Dysplasia Patient Affected Magnetic Resonance No. Side x-Ray Film Bone Scan Ultrasound Imaging 1 Left Small, irregular epiphysis Normal Not done Not done with radiolucent lesion 2 Left Flattening, irregularity, Normal Fluid within Not done sclerosis, and joint radiolucent foci of femoral head 3 Bilateral Bilateral dysplastic changes Normal Not done Not done of femoral heads 4 Bilateral Bilateral small and irregular Normal Normal Multiple centers of ossification femoral heads of femoral heads (with normal bone marrow intensity) 5 Bilateral Bilateral fragmentation of Normal Not done Not done femoral heads ARCH PEDIATR ADOLESC MED/ VOL 153, SEP 1999 943 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 A B C Figure 1. Anteroposterior view of hip joint, demonstrating the various appearances of Meyer dysplasia. A, Patient 1, demonstrating radiolucent defect in the femoral head. B, Patient 2, showing flattening, sclerosis, and a radiolucent focus in the femoral head. C, Patient 4, demonstrating fragmentation of the femoral head. lateral involvement may have a mild inconsistent wad- dling gait. Pain, limping, or limitation of movement are rarely observed and are usually transient.4 As healing is complete, Meyer dysplasia needs no treatment. Patients show continuous improvement with steady unification and growth of the epiphysis,1 usually over a 3-year period.2 The final outcome is a normal hemi- spherical shape and size of the femoral head,5 although some have reported diminished height.1,4 Function is prob- ably normal. Nevertheless, biomechanically induced de- generative joint changes may be anticipated in adult- hood in those with smaller femoral heads. In Perthes disease, by contrast, the natural course is associated with increased fragmentation that may result in permanent de- Figure 2. Patient 4. Magnetic resonance imaging scan, T2-weighted coronal 1 cut of the hip joints, demonstrating multiple centers of ossification of the formity of the femoral head if left untreated. However, femoral heads. The bone marrow shows normal signal intensity. in children younger than 5 years, the disease is quite be- nign and usually requires no intervention. ter, instead of the normal single unit, appears as a small The results of a recent prospective, clinical, and ra- epiphysial nucleus composed of multiple independent diological study of 18 children with Meyer dysplasia4 have bony foci. These foci gradually grow, coalesce, and fi- confirmed most of Meyer’s observations. Half the cases nally fuse into a single center.1 A small, single ossifica- were bilateral and boys were affected 5 times more often tion center with a cortical defect on the articular surface than girls. The imaging studies showed a delayed ap- has also been described.4 pearance of the ossification centers, with complete heal- Magnetic resonance imaging shows multiple cen- ing by an average age of 51⁄2 years, except for a slight loss ters of ossification of the femoral head, with a normal sig- in epiphysial height.
Recommended publications
  • Association Between Dietary Habits and Parental Health with Obesity Among Children with Precocious Puberty
    children Article Association between Dietary Habits and Parental Health with Obesity among Children with Precocious Puberty 1, 1, 2 1 3, Yong Hee Hong y , Yeon Ju Woo y, Jong Hyun Lee , Young-Lim Shin and Hee-Sook Lim * 1 Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Korea; [email protected] (Y.H.H.); [email protected] (Y.J.W.); [email protected] (Y.-L.S.) 2 Department of Pediatrics, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi 39371, Korea; [email protected] 3 Department of Food Sciences and Nutrition, Yeonsung University, Anyang 14011, Korea * Correspondence: [email protected] These authors contributed equally to this work as first author. y Received: 25 September 2020; Accepted: 5 November 2020; Published: 8 November 2020 Abstract: Precocious puberty, resulting in various physical, mental, and social changes, may have negative consequences for children and their families. In this study, we investigated whether there were differences between parental obesity, children’s and parent’s awareness of body shape, and dietary habits according to obesity levels in children with precocious puberty. A total of 193 children (93.3% girls) diagnosed with precocious puberty were classified into three groups according to their obesity levels. Negative body shape awareness and dissatisfaction were significantly higher in the obese group than in the normal-weight group, and parents were more likely to perceive their children as fat than the children themselves. In addition, the obesity rate of parents in the obese group was higher, and the body mass indexes of children and parents were significantly correlated.
    [Show full text]
  • Identification of Teeth, Wrist and Femur Bone Features for Age and Gender Identifiction
    Vidyashree H S et al. / International Journal of Computer Science Engineering (IJCSE) IDENTIFICATION OF TEETH, WRIST AND FEMUR BONE FEATURES FOR AGE AND GENDER IDENTIFICTION Vidyashree H S Department of Computer Science and Engineering, Bapuji Institute of Engineering and Technology, Davanagere, India. Email: [email protected] Pradeep N Department of Computer Science and Engineering, Bapuji Institute of Engineering and Technology, Davanagere, India. Email: [email protected] Abstract: Personal identification is defined as establishing the identity of an individual. The need for personal identification arises in natural mass disasters like earth quakes, tsunamis, landslides, floods etc., and in man-made disasters such as terrorist attacks, bomb blasts, mass murders, and in cases when the body is highly decomposed or dismembered to deliberately conceal the identity of the individual. Computers have been widely used in the field of medical research over the past few decades. Machine Learning and Biomedical Image Processing Techniques have enormously contributed in the field of Medical Image Analysis, classification and recognition. But fewer contributions have been made in the area of forensics by researchers. There is a scope for researches, where they can make their contributions especially in medical image analysis where they can estimate age and identify gender using digital X-ray images. In this paper, we are identifying features of Femur, Teeth and Wrist features that are helpful for age and gender identification. Keywords- Forensic Science, Femur Bone Age, Gender Estimation, teeth, wrist bone age and gender comparison. I.INTRODUCTION The age of an individual is often a fundamental piece of data in connection with forensic identification of unidentified bodies.
    [Show full text]
  • Original Article Clinical Characteristics and Mutation Analysis of Two Chinese Children with 17A-Hydroxylase/17,20-Lyase Deficiency
    Int J Clin Exp Med 2015;8(10):19132-19137 www.ijcem.com /ISSN:1940-5901/IJCEM0013391 Original Article Clinical characteristics and mutation analysis of two Chinese children with 17a-hydroxylase/17,20-lyase deficiency Ziyang Zhu, Shining Ni, Wei Gu Department of Endocrinology, Nanjing Children’s Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China Received July 25, 2015; Accepted September 10, 2015; Epub October 15, 2015; Published October 30, 2015 Abstract: Combined with the literature, recognize the clinical features and molecular genetic mechanism of the disease. 17a-hydroxylase/17,20-lyase deficiency, a rare form of congenital adrenal hyperplasia, is caused by muta- tions in the cytochrome P450c17 gene (CYP17A1), and characterized by hypertension, hypokalemia, female sexual infantilism or male pseudohermaphroditism. We presented the clinical and biochemical characterization in two patients (a 13 year-old girl (46, XX) with hypokalemia and lack of pubertal development, a 11 year-old girl (46, XY) with female external genitalia and severe hypertension). CYP17A1 mutations were detected by PCR and direct DNA sequencing in patients and their parents. A homozygous mutation c.985_987delTACinsAA (p.Y329KfsX418) in Exon 6 was found in patient 1, and a homozygous deletion mutation c.1459_1467delGACTCTTTC (p.Asp487_Phe489del) in exon 8 in patient 2. The patients manifested with hypertension, hypokalemia, sexual infantilism should be sus- pected of having 17a-hydroxylase/17,20-lyase deficiency. Definite diagnosis is depended on mutation analysis. Hydrocortisone treatment in time is crucial to prevent severe hypertension and hypokalemia. Keywords: 17a-hydroxylase/17,20-lyase deficiency Introduction patients with 17a-hydroxylase/17,20-lyase defi- ciency, and made a confirmative diagnosis by Deficiency in cytochrome p450c17 (MIM mutation analysis of CYP17A1.
    [Show full text]
  • Alan E. Oestreich Growth of the Pediatric Skeleton a Primer for Radiologists Alan E
    Alan E. Oestreich Growth of the Pediatric Skeleton A Primer for Radiologists Alan E. Oestreich Growth of the Pediatric Skeleton A Primer for Radiologists With illustrations by Tamar Kahane Oestreich 123 Alan E. Oestreich, MD, FACR Radiology 5031 Cincinnati Children’s Hospital Medical Center 3333 Burnett Ave. Cincinnati OH 45229-3039 USA Library of Congress Control Number: 2007933312 ISBN 978-3-540-37688-0 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is con- cerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publica- tion or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is part of Springer Science+Business Media http//www.springer.com Springer-Verlag Berlin Heidelberg 2008 Printed in Germany The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regula- tions and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature. Medical Editor: Dr.
    [Show full text]
  • REVIEW ARTICLE Interactions Between GH, IGF-I, Glucocorticoids
    0031-3998/02/5202-0137 PEDIATRIC RESEARCH Vol. 52, No. 2, 2002 Copyright © 2002 International Pediatric Research Foundation, Inc. Printed in U.S.A. REVIEW ARTICLE Interactions between GH, IGF-I, Glucocorticoids, and Thyroid Hormones during Skeletal Growth HELEN ROBSON, THOMAS SIEBLER, STEPHEN M. SHALET, AND GRAHAM R. WILLIAMS Department of Clinical Research [H.R.], Department of Endocrinology [S.M.S.], Christie Hospital National Health Service Trust, Manchester, U.K.; University Children’s Hospital, University of Leipzig, Leipzig, Germany [T.S.]; IC Molecular Endocrinology Group, Division of Medicine and MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College School of Science Technology and Medicine, Hammersmith Hospital, London, U.K. [G.R.W.] ABSTRACT Linear growth occurs during development and the childhood Abbreviations years until epiphyseal fusion occurs. This process results from 5'-DI, 5'-iodothyronine deiodinase endochondral ossification in the growth plates of long bones and FGF, fibroblast growth factor is regulated by systemic hormones and paracrine or autocrine FGFR, fibroblast growth factor receptor factors. The major regulators of developmental and childhood GC, glucocorticoid growth are GH, IGF-I, glucocorticoids, and thyroid hormone. GHR, GH receptor Sex steroids are responsible for the pubertal growth spurt and GR, glucocorticoid receptor epiphyseal fusion. This review will consider interactions between HSPG, heparan sulfate proteoglycan GH, IGF-I, glucocorticoids, and thyroid hormone during linear 11␤HSD, 11␤-hydroxysteroid dehydrogenase growth. It is well known from physiologic and clinical studies IGF-IR, IGF-I receptor that these hormones interact at the level of the hypothalamus and IGFBP, IGF binding protein pituitary. Interacting effects on peripheral tissues such as liver are Ihh, Indian hedgehog also well understood, but we concentrate here on the epiphyseal JAK-2, Janus-activated kinase-2 growth plate as an important and newly appreciated target organ PTHrP, PTH-related peptide for convergent hormone action.
    [Show full text]
  • Guidelines for Best Practice Imaging for Age Estimation in the Living
    Journal of Forensic Radiology and Imaging 16 (2019) 38–49 Contents lists available at ScienceDirect Journal of Forensic Radiology and Imaging journal homepage: www.elsevier.com/locate/jofri Guidelines for best practice: Imaging for age estimation in the living T ⁎ Edel Doylea, , Nicholas Márquez-Grantb, Lisa Fieldc, Trish Holmesa, Owen J Arthursd,e,f, Rick R. van Rijng,h, Lucina Hackmani, Kathleen Kasperj, Jim Lewisk,l, Peter Loomism, Denise Elliotta, Jeroen Krolla,n, Mark Vinera,b,o, Soren Blaup, Alison Broughq,r, Stella Martín de las Herass, Pedro Manuel Garamendit,u,v a International Association of Forensic Radiographers, UK b Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom,UK c International Society of Radiographers & Radiologic Technologists, UK d Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK e UCL Great Ormond Street Institute of Child Health, London, UK f ISFRI Paediatric Working Group, Switzerland g Department of Radiology, Emma Children's Hospital – Academic Medical Center Amsterdam, the Netherlands h Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands i Leverhulme Centre for Forensic Science, Ewing Building, University of Dundee, Dundee, UK j Tarrant County Medical Examiner's District, Ft. Worth, Texas; Forensic Odontologist, Collin County Medical Examiner, McKinney, TX, USA k The University of Tennessee, Graduate School of Medicine, Department of General Dentistry, Division of Forensic Odontology,
    [Show full text]
  • Hand-Wrist Bone Age in Children Treated for Acute Lymphoblastic Leukemia Mary Elizabeth Martin University of Tennessee Health Science Center
    University of Tennessee Health Science Center UTHSC Digital Commons Theses and Dissertations (ETD) College of Graduate Health Sciences 5-2006 Hand-Wrist Bone Age in Children Treated for Acute Lymphoblastic Leukemia Mary Elizabeth Martin University of Tennessee Health Science Center Follow this and additional works at: https://dc.uthsc.edu/dissertations Part of the Neoplasms Commons Recommended Citation Martin, Mary Elizabeth , "Hand-Wrist Bone Age in Children Treated for Acute Lymphoblastic Leukemia" (2006). Theses and Dissertations (ETD). Paper 161. http://dx.doi.org/10.21007/etd.cghs.2006.0203. This Thesis is brought to you for free and open access by the College of Graduate Health Sciences at UTHSC Digital Commons. It has been accepted for inclusion in Theses and Dissertations (ETD) by an authorized administrator of UTHSC Digital Commons. For more information, please contact [email protected]. Hand-Wrist Bone Age in Children Treated for Acute Lymphoblastic Leukemia Document Type Thesis Degree Name Master of Dental Science (MDS) Program Orthodontics Research Advisor Edward Harris, Ph.D. Committee William Parris, D.D.S., M.S. Quinton C Robinson, D.D.S., M.S. DOI 10.21007/etd.cghs.2006.0203 This thesis is available at UTHSC Digital Commons: https://dc.uthsc.edu/dissertations/161 HAND-WRIST BONE AGE IN CHILDREN TREATED FOR ACUTE LYMPHOBLASTIC LEUKEMIA A Thesis Presented for The Graduate Studies Council The University of Tennessee Health Science Center In Partial Fulfillment Of the Requirements for the Degree Master of Dental Science From The University of Tennessee By Mary Elizabeth Martin, D.D.S. May 2006 Copyright © Mary Elizabeth Martin, 2006 All rights reserved ACKNOWLEDGEMENTS I would first like to thank Dr.
    [Show full text]
  • Hand Bone Age: a Digital Atlas of Skeletal Maturity
    V. Gilsanz/O. Ratib · Hand Bone Age Vicente Gilsanz · Osman Ratib Hand Bone Age A Digital Atlas of Skeletal Maturity With 88 Figures Vicente Gilsanz, M.D., Ph.D. Department of Radiology Childrens Hospital Los Angeles 4650 Sunset Blvd., MS#81 Los Angeles, CA 90027 Osman Ratib, M.D., Ph.D. Department of Radiology David Geffen School of Medicine at UCLA 100 Medical Plaza Los Angeles, CA 90095 This eBook does not include ancillary media that was packaged with the printed version of the book. ISBN 3-540-20951-4 Springer-Verlag Berlin Heidelberg New York Library of Congress Control Number: 2004114078 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable to prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg New York Springer is a part of Springer Science+Business Media http://www.springeronline.com A Springer-Verlag Berlin Heidelberg 2005 Printed in Germany The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book.
    [Show full text]
  • Hand Bone Age: a Digital Atlas of Skeletal Maturity, Second Edition
    Hand Bone Age Vicente Gilsanz • Osman Ratib Hand Bone Age A Digital Atlas of Skeletal Maturity Second Edition Prof. Vicente Gilsanz Prof. Osman Ratib Department of Radiology University Hospital of Geneva Childrens Hospital Los Angeles Nuclear Medicine Division 4650 Sunset Blvd., MS#81 24, Rue Micheli-du-Crest Los Angeles, CA 90027 1205 Geneva USA Switzerland ISBN 978-3-642-23761-4 e-ISBN 978-3-642-23762-1 DOI 10.1007/978-3-642-23762-1 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2011940860 © Springer-Verlag Berlin Heidelberg 2012 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protec- tive laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.
    [Show full text]
  • Growth Plate Modulation Through Nutrition Supports Catch-Up Growth
    H ILD OO H D Growth Plate Modulation C ROSS PETERSON, PHD Through Nutrition Supports Regulatory Science & Innovation GROWTH & Abbott Nutrition NUTRITION E Catch-up growth X S P E RT SCIENTIFIC OVERVIEW The height a child achieves in adulthood is the result of dynamic processes that THE GROWTH PLATE OF A LONG BONE IS WHERE Figure 1 CHONDROGENESIS OCCURS occur at the growth plate of long bones.1 Each long bone has at least two growth plates that determine the future length and shape of the mature bone through a process called chondrogenesis (Figure 1).2 Genetic factors like parental height are an important determinant of a child’s height, but environmental factors such as nutrition during childhood also affect bone growth. Nutrition provides the required “building blocks” for optimal growth, including energy, proteins and micronutrients.1 Without adequate nutrition, children will be at high risk of Growth Linear becoming underweight and not achieving their growth potential.3 In times of nutrient deficiencies, the growth plates of long bones conserve growth capacity by delaying senescence. When nutrition improves, growth factors reactivate the growth plates, and growth takes place at a faster-than-usual rate: Figure 2 INTERVENE EARLY TO MAXIMIZE HEIGHT POTENTIAL this type of growth is known as catch-up growth (Figure 2).4 Ultimately, a child’s bone growth velocity decreases to zero (i.e., growth stops) after growth plate senescence in late puberty. SIZE Nutritional Intervention Point About 60% of adult height is achieved within the first 5 years of life, and growth Normal growth Impaired growth continues until late puberty.5 For a child to reach his or her full-growth potential, it Type A catch-up growth is crucial to identify those who fall behind during the active growth interval.
    [Show full text]
  • Factors Associated with Advanced Bone Age in Overweight and Obese Children
    Pediatr Gastroenterol Hepatol Nutr. 2020 Jan;23(1):89-97 https://doi.org/10.5223/pghn.2020.23.1.89 pISSN 2234-8646·eISSN 2234-8840 Original Article Factors associated with Advanced Bone Age in Overweight and Obese Children Min-Su Oh ,1 Sorina Kim ,1 Juyeon Lee ,1 Mu Sook Lee ,2 Yoon-Joo Kim ,1 and Ki-Soo Kang 1 1Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea 2Division of Diagnostic and Interventional Radiology, Keimyung University Dongsan Medical Center, Daegu, Korea Received: Jul 7, 2019 ABSTRACT Accepted: Oct 2, 2019 Correspondence to Purpose: Obese children may often present with advanced bone age. We aimed to evaluate Ki-Soo Kang the correlation between factors associated with childhood obesity and advanced bone age. Division of Gastroenterology, Hepatology Methods: We enrolled 232 overweight or obese children. Anthropometric and laboratory and Nutrition, Department of Pediatrics, Jeju National University School of Medicine, 102 data, and the degree of nonalcoholic fatty liver disease (NAFLD) were measured. We analyzed Jejudaehak-ro, Jeju 63243, Korea. factors associated with advanced bone age by measuring the differences between bone and E-mail: [email protected] chronological ages. Results: The normal and advanced bone age groups were comprised of 183 (78.9%) and 49 Copyright © 2020 by The Korean Society of (21.1%) children, respectively. The prevalence of advanced bone age significantly increased as Pediatric Gastroenterology, Hepatology and Nutrition the percentiles of height, weight, waist circumference, and body mass index (BMI) increased. This is an open-access article distributed BMI z-score was higher in the advanced bone age group than in the normal bone age group under the terms of the Creative Commons (2.43±0.52 vs.
    [Show full text]
  • The Problem of Aging Human Remains and Living Individuals: a Review
    Forensic Science International 193 (2009) 1–13 Contents lists available at ScienceDirect Forensic Science International journal homepage: www.elsevier.com/locate/forsciint Review The problem of aging human remains and living individuals: A review E. Cunha a, E. Baccino b, L. Martrille b, F. Ramsthaler c, J. Prieto d, Y. Schuliar e, N. Lynnerup f, C. Cattaneo g,* a Department of Anthropology, Instituto Nacional de Medicina Legal, University of Coimbra, Largo da Se`-Nova, 3000 Coimbra, Portugal b Service de Me´decine Le´gale, Centre Hospitalier Universitaire, Hopital Lapeyronie, Avenue du Doyen Gaston Giraud, 34295 Montpellier, Cedex 5, France c Department of Legal Medicine, University of Frankfurt/Main, Kennedyallee 104, 60596 Frankfurt/Main, Germany d Laboratory of Forensic Anthropology and Odontology, Instituto Anato`mico Forense de Madrid, Ciudad Universitaria, Avenida Complutense, 28040 Madrid, Spain e Service de sante´ des arme´es, Institut de Recherche Criminelle de la Gendarmerie Nationale, 1, Bd The´ophile Sueur, 93111 Rosny-sous-bois, France f Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik d. 5’s Vej 11, DK-2100 Ø Copenhagen, Denmark g LABANOF, Laboratorio di Antropologia ed Odontologia Forense, Dipartimento di Morfologia Umana e Scienze Biomediche, Sezione di Medicina Legale, Universita` degli Studi di Milano, Via Mangiagalli 37, 20133 Milan, Italy ARTICLE INFO ABSTRACT Article history: Forensic anthropology is affected by the unavoidable limits concerning difficulties in standardization
    [Show full text]