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BackgroundMethotrexate (MTX) is the first-choice disease-modifying drug in juvenile idiopathic arthritis (JIA) treatment. Methotrexate is metabolized in the liver and can cause liver toxicity and fibrosis with long-term use. Ultrasound shear wave elastography (SWE) is a non-invasive method and can detect liver fibrosis by evaluating the liver elasticity. The aim of this study was to assess liver stiffness and detect if there is an increase in liver stiffness or fibrosis findings with the non-invasive SWE method in JIA patients under MTX treatment.MethodThe study included 49 JIA patients under MTX treatment and 48 healthy controls, matched for age and sex with a body mass index below the 95th percentile. The demographic data and clinical characteristics of patients were obtained from medical records. Liver function tests were evaluated, and liver tissue stiffness measurements were performed with SWE.ResultsOf the 49 patients, 67.35% were girls and the mean age was 10.69 (±4.33) years. The duration of MTX treatment was 23.00 (1–80) months, and the cumulative dose of MTX was 1,280.867 mg (±934.2) in the patient group. There was no statistically significant difference in liver stiffness between patients receiving MTX and healthy controls (P = 0.313). There was no relationship between MTX duration, cumulative dose, route of administration, and liver stiffness. Only gamma glutamyl transferase values were weakly correlated with liver stiffness (P = 0.029).ConclusionsWe did not detect an increase in liver tissue stiffness in JIA patients using methotrexate in comparison with controls.

Tuberculosis (TB) is still a global health concern. Although thoracic TB is the most common manifestation, TB can also affect extrathoracic sites, including the central nervous system, musculoskeletal system, and abdomen. The incidence of extrathoracic TB in children is higher compared to adults. This study aimed to examine the radiological findings of pediatric extrathoracic TB involvement in the central nervous system, musculoskeletal system, and abdomen. The radiological features of 19 patients diagnosed with extrathoracic TB in childhood at Erciyes University Medical School between 2011 and 2024 were examined retrospectively. Patient gender, age, medical history, and laboratory data were reviewed from the hospital archiving systems. Nineteen patients diagnosed with extrathoracic TB were evaluated. Ten patients (52.9%) were female, and nine (47.1%) were male. The mean age was 97.5±20.8 months (ranging from 2 to 300 months). Three patients (15.8%) were immunocompromised, and nine patients (47.1%) had coexisting pulmonary TB. Central nervous system involvement was observed in six patients (31.6%), musculoskeletal system involvement in ten patients (52.6%), and abdominal involvement in three patients (15.8%). Recognizing the classic radiological findings of pediatric extrathoracic pulmonary TB is crucial for prompt diagnosis, initiation of appropriate treatment, and prevention of long-term morbidity.

Background. Metabolic syndrome (MetS) and insulin resistance (IR) are known predictors of nonalcoholic fatty liver disease (NAFLD) which is one of the significant comorbidities of obesity. Obese children with MetS and IR are reported to be more likely to have advanced liver fibrosis compared to those without MetS or IR. The aim of this study is to determine the effects of excess weight, MetS and IR on liver fibrosis assessing liver stiffness in children using ultrasound elastography and compare gray scale ultrasonographic findings of hepatic steatosis (HS) with liver fibrosis. Methods. The study group involved 131 overweight/obese children. The control group involved 50 healthy lean children. Groups were adjusted according to body mass index (BMI) and BMI-standard deviation scores (SDS). Liver stiffness measurements which are expressed by shear wave velocity (SWV) were performed for each individual. The study group was further subgrouped as children with MetS and without MetS, with IR and without IR. Results. The mean SWV of liver was 1,07 ± 0,12 m/s in the control group and 1,15 ± 0,51 m/s in the study group. The difference was significant (p=0,047). SWV of liver was weakly correlated with age, BMI, BMI-SDS, Homeostatic Model Assessment-Insulin Resistance and high-density lipoprotein cholesterol. The mean SWV of the liver in the study group for children without MetS was 1,1 ± 0,44 m/s, with MetS was 1,23 ± 0,70 m/s. The difference was not significant (p=0,719). The mean SWV of the liver in the study group for children without IR was 1,02 ± 0,29 m/s, with IR was 1,24 ± 0,61 m/s. The difference was not significant (p=0,101). In multivariate regression analysis, the only independent factor affecting liver stiffness was BMI-SDS (OR:2,584, 95% CI: 1,255- 5,318, p=0,010). Conclusions. Obesity itself, regardless of MetS or IR seems to be the major problem affecting liver stiffness in this study. However, large scale longitudinal studies might clarify this issue.

Lipofibromatous hamartoma is a rare, slow-growing, benign, fibrofatty tumor-like condition. The upper extremity nerves are commonly involved. It is characterized by thickened axonal bundles with epineural and perineural fibrosis and fatty infiltration around the axonal bundles. Macrodactyly is a characteristic symptom in one-third of cases. Treatment options are differentiated according to the symptomatology. The diagnosis can be made by ultrasonographic and magnetic resonance imaging findings for those obviating diagnostic biopsy.

Background: Gastric adenocarcinoma is an extremely rare tumor with a poor prognosis in childhood. Patients are usually diagnosed late, as they present with non–specific symptoms and therefore, patients have low survival rates after diagnosis. Case Report: Here, we present two cases of gastric adenocarcinoma, one with dysphagia and weight loss, and the other with abdominal pain, leg pain, and weight loss as the presenting complaints with literature review. Conclusion: Gastric adenocarcinoma patients can be presented with non–specific symptoms such as dysphagia, weight loss, and leg pain.

Background: Pancreatic pseudoaneurysm (PSA) is a rare, potentially fatal complication of pancreatitis that is commonly associated with a pseudocyst. There is no clear information on the incidence of PSA in children. Surgery and endovascular techniques are the primary treatment options for PSA. Case Report: We describe the case of a 16-year-old girl with a pancreatic pesudoaneurysm in association with chronic pancreatitis. The diagnosis was made using ultrasonography and magnetic resonance imaging findings. The pseudoaneurysm was successfully treated by endovascular transcatheter embolization without intra- or post-procedural complications. Conclusion: Early diagnosis and appropriate management are essential to prevent fatal outcomes because the timing of rupture is unpredictable. Endovascular transcatheter embolization of PSA is an invasive, safe, and effective procedure and should be the first choice in the management of PSA.

Encephalocraniocutaneous lipomatosis (ECCL) is an extremely uncommon, neurocutaneous disease, with a classical triad of ocular, skin lesions and central nervous system anomalies. We here report a case of ECCL in a newborn baby, characterized with naevus psiloliparus, choristoma, lipodermoids, cervical subcutaneous soft tissue mass, lowset ear, porencephalic cyst, polymicrogyria, arachnoid cyst, leptomeningeal angiomatosis and spinal lipomas. We here stress on the importance of early diagnosis to prevent misdiagnosis and employ a multidisciplinary approach in the management of these patients.

Purpose Spina bifida is a major disorder that occurs when the membranes of the spinal cord and medulla fail to close during the embryonic period and affects the individual for the rest of life. Some physical, mental, and social difficulties can be observed in the lives of children with spina bifida after surgery. The aim of this study is to determine what kind of volumetric changes occur in the brain when spina bifida occurs in different regions of the cord. Methods The volume of intracranial structures of 14 children aged 1 to 9 years (7 cervical, 7 lumbosacral) with different levels of spina bifida compared with vol2Brain. Results Spina bifida occurring in the cervical region was found to cause a greater volumetric reduction in subcortical structures, cortex and gyrus than spina bifida occurring in the lumbosacral region. Conclusion We believe that our study will help clinicians involved in the management of this disorder.

Dyslexia is a specific learning disability that is neurobiological in origin and is characterized by reading and/or spelling problems affecting the development of language-related skills. The aim of this study is to reveal functional markers based on dyslexia by examining the functions of brain regions in resting state and reading tasks and to analyze the effects of special education given during the treatment process of dyslexia. A total of 43 children, aged between 7 and 12, whose native language was Turkish, participated in the study in three groups including those diagnosed with dyslexia for the first time, those receiving special education for dyslexia, and healthy children. Independent component analysis method was employed to analyze functional connectivity variations among three groups both at rest and during the continuous reading task. A whole-brain scanning during task fulfillment and resting states revealed that there were significant differences in the regions including lateral visual, default mode, left frontoparietal, ventral attention, orbitofrontal and lateral motor network. Our results revealed the necessity of adding motor coordination exercises to the training of dyslexic participants and showed that training led to functional connectivity in some brain regions similar to the healthy group. Additionally, our findings confirmed that impulsivity is associated with motor coordination and visuality, and that the dyslexic group has weaknesses in brain connectivity related to these conditions. According to our preliminary results, the differences obtained between children with dyslexia, group of dyslexia with special education and healthy children has revealed the effect of education on brain functions as well as enabling a comprehensive examination of dyslexia.

Purpose Chiari malformation type 1 (CM-1) is a posterior fossa anomaly characterized by herniation of the cerebellar tonsils from the foramen magnum (FM). This study compares FM, medulla spinalis (MS), and herniated cerebellar tonsils ratios by making area measurements from axial plane MRI in CM-1 patients and the control group. Methods Our study evaluated 30 pediatric patients with CM-1 and 30 people in the control group. The lengths of the McRae line, twining line, and clivus line were measured on the posterior cranial fossa evaluation. The areas of FM (A FM ), MS (A MS ), and herniated cerebellar tonsils (A TONSILS ) were measured by axial images. Results As a result of area measurements obtained from axial cross-sectional MRI, a statistically significant difference was found between CM-1 patients and the control group. According to the results of the ROC analysis, if an individual’s A MS /A FM value is above 17.9% or the A TONSILS /A FM value is above 18.4%, it can be interpreted as a CM-1 patient. Conclusion It will be easier to diagnose the patient with the new approach we obtained from axial MR images in addition to sagittal MR images. This method can be a guide in some cases when the surgeons are undecided.