An autochthonous case of cystic echinococcosis in Finland, 2015.

We report a case of pulmonary cystic echinococcosis in a child from eastern Finland with no history of travelling abroad. The cyst was surgically removed and the organism molecularly identified as Echinococcus canadensis genotype G10. This parasite is maintained in eastern Finland in a sylvatic life cycle involving wolves and moose; in the present case, the infection was presumably transmitted by hunting dogs.

Postnatal ovarian activation has effects in estrogen target tissues in infant girls.

CONTEXT: Shortly after birth, pituitary gonadotropin secretion transiently activates in both sexes, and this surge is more robust in preterm (PT) than in full-term (FT) infants. In boys, the gonadotropin surge is associated with testicular activity and is considered an important part of normal reproductive development. In contrast, gonadal activation and its consequences in infant girls are poorly understood. OBJECTIVE: Our objective was to evaluate the association of postnatal ovarian activity with simultaneous changes in estrogen target tissues in FT and PT girls. PATIENTS AND METHODS: We measured urinary estradiol (E2) levels in 29 FT and 34 PT girls using a mass spectrometric method from 1 week (D7) to 6 months of age (M1-M6). To assess the contribution of ovarian E2 on urinary E2 levels, the levels in girls were compared with the levels of boys of similar cohorts (29 FT and 33 PT boys). E2 levels were compared with simultaneous changes in estrogenic target tissues including mammary glands in both sexes and uterus and vulvar epithelium in girls. RESULTS: Median urinary E2 levels increased after D7 in girls, but not in boys. Mammary gland diameter was larger in girls than in boys from M4 in FT (P < .001) and M2 in PT infants (P < .0001). In PT girls, E2 levels increased at term and were then higher than those in FT girls (P < .0001). Urinary E2 levels in PT girls were positively associated with mammary gland and uterine growth. CONCLUSIONS: These findings indicate that gonadal steroidogenesis activates during the postnatal gonadotropin surge in girls. In addition, the resulting elevated E2 levels affect target tissues, suggesting that postnatal pituitary-ovarian activation plays a role in normal female reproductive development.

Osteochondral lesions in children with juvenile idiopathic arthritis.

BACKGROUND: Joint pain and swelling are typical symptoms in children with juvenile idiopathic arthritis (JIA) and these are often related to inflammation of the joint. Juvenile osteochondritis dissecans (JOCD), that is separation of a bone-cartilage segment from the articular surface, can manifest with similar symptoms. FINDINGS: We studied thirteen cases of osteochondritis dissecans lesions (OCD) in children with JIA. There were nine girls and four boys with a mean age of 6.5 (2-12) years at the time of diagnosis of JIA. Mean time between diagnosis of JIA and manifestation of OCD was 5.5 (1-11) years. Indications for MRI were the presence of pain or discomfort in the joint, despite otherwise effective treatment, with no evidence from ultrasound examination of any obvious signs of active inflammation. The most common location of osteochondral lesion was the knee, although the ankle joint was affected in one case. Five patients had lesions in both knees. Operative treatment was needed in eight cases (joints). CONCLUSIONS: Pain, and minor dysfunction of the joint are common complaints of children suffering from JIA. Earlier research has discounted the possibility of children who were not athletes presenting with this condition. However, this study demonstrates that these lesions also seem to be relatively common in patients with JIA. When there is no sign of inflammation, the possibility of OCD must therefore be considered in these children.

Postnatal developmental changes in the pituitary-ovarian axis in preterm and term infant girls.

CONTEXT: Postnatal pituitary-testicular activation in infant boys is well characterized. However, the ovarian response to pituitary activation in infancy is less well understood. OBJECTIVE: The aim of the study was to compare postnatal developmental changes in the pituitary-ovarian axis in preterm and term infant girls. PARTICIPANTS AND DESIGN: Sixty-three infant girls, divided into three groups according to gestational age (GA) [i.e. full term (FT; n = 29; GA, 37-42 wk), near term (NT; n = 17; GA, 34-37 wk), and preterm (PT; n = 17; GA, 24-34 wk)] were examined monthly from 1 wk (D7) to 6 months (M1-M6) of age and reexamined at the corrected age of 14 months (cM14). MAIN OUTCOME MEASURES: We performed a longitudinal follow-up of urinary FSH and serum anti-Müllerian hormone (AMH) levels and the number of follicles in transabdominal ovarian ultrasonography. RESULTS: The postnatal FSH surge was stronger and more prolonged in NT and PT girls than in FT girls (P ≤ 0.001). Increased folliculogenesis and a rise in AMH levels were observed in all three groups after the FSH surge. In NT and PT girls, follicular development was delayed in comparison with FT girls, and a decrease in high FSH levels around the 40th postmenstrual week was temporally associated with the appearance of antral follicles in ultrasonography and an increase in AMH levels. CONCLUSIONS: The postnatal FSH surge results in transient ovarian stimulation in term and preterm girls. A delay in ovarian folliculogenesis shown in ovarian ultrasonography and by low serum AMH levels may provide an explanation for the exaggerated FSH surge in NT and PT girls.

Increased activity of the hypothalamic-pituitary-testicular axis in infancy results in increased androgen action in premature boys.

CONTEXT: Transient activation of the hypothalamic-pituitary-gonadal (HPG) axis is observed in boys during the first months of life. Previous research suggests increased HPG axis activation in premature infants, but the physiological significance of this has not been studied. OBJECTIVE: The objective of this study was to evaluate the differences in reproductive hormone levels and their biological effects between full-term (FT) and preterm (PT) infant boys. STUDY DESIGN AND PARTICIPANTS: Twenty-five FT and 25 PT (gestational age 24.7-36.6 wk) boys were recruited at birth and followed up monthly from 1 wk to 6 months of age (d 7, months 1-6). Nineteen FT and 20 PT boys were reexamined at 14 months of age. MAIN OUTCOME MEASURES: Urinary gonadotropins and testosterone were measured in serial urine samples and compared with testicular and penile growth. Urinary prostate-specific antigen was measured as an androgen biomarker. RESULTS: LH and testosterone levels were higher in PT boys (P < 0.001 for both) than FT boys. Compared with FT boys, FSH levels were lower at d 7 (P = 0.002) but higher from month 1 to month 3 (P = 0.002-0.030) in PT boys. This was associated with significantly faster testicular and penile growth in PT boys compared with FT boys. Transient increase in the prostate-specific antigen levels in both groups indicated androgen action in the prostate. CONCLUSIONS: Postnatal HPG axis activation in infancy is increased in PT boys and associated with faster testicular and penile growth compared with FT boys. Possible long-term consequences of hyperandrogenism in PT infant boys warrant further research.

[Loss of mobility in a child with Down syndrome]. / Lastenreuma vei Down-lapsen liikuntakyvyn.

Down syndrome is associated with the risk of various structural abnormalities or functional disturbances of organ systems, and with several abnormalities of the immune system. Screening and monitoring of congenital heart defects or orthopedic problems are managed and the increased risk to develop leukemia, diabetes of hypothyroidism is well known. The 3 to 6-fold incidence of juvenile idiopathic arthritis in Down syndrome compared with the general juvenile population is, however, less known. We describe a patient, for whom the diagnostic delay of juvenile idiopathic arthritis was eight years.

Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.

OBJECTIVES: To examine the objective physical function of the lower extremities, to measure the properties of quadriceps femoris muscle (QFM), and to assess subjective disabilities in men with knee osteoarthritis (OA) and to compare the results with those obtained from age- and sex-matched control subjects. DESIGN: Cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Male volunteers (n=54) (age range, 50-69y) with knee OA and randomly selected healthy, age- and sex-matched control subjects (n=53). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical function evaluated with a test battery including the QFM composition measurement, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the RAND 36-Item Short-Form Health Survey, version 1.0. RESULTS: Knee OA patients had 13% to 26% poorer (P range, .050-.001) physical function and muscle strength compared with the controls. There were also significant differences in QFM composition. WOMAC (P range, .050-.001) and muscle strength (P<.001) associated with physical function tests, but subjective pain correlated with neither physical function nor muscle strength in knee OA patients. The radiographic knee OA grade did not have any significant effect on physical function, but passive knee motion, knee extension strength, and WOMAC were related to the severity of the disease (P<.05). CONCLUSIONS: The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls. The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease. The results highlight the effect of QFM strength on physical function as well as the importance of patient's subjective and objective physical function when deciding on knee OA treatment policy.