The authors review the technique of ultrasound-guided hydrostatic reduction of childhood intussusception and illustrate, in real-time fashion, the treatment of three cases with this technique. Two cases of successful reduction of ileocolic intussusception are demonstrated. The third case is an example of the complex fronded appearance of ileo-ileocolic intussusception and failed reduction. This technique is recommended as an alternative method for the treatment of childhood intussusception, as it does not involve ionizing radiation and is a simple and safe procedure.

Enema↗

PubMedDate not supplied

The therapeutic use of growth-hormone-releasing hormone.

As a significant number of children with growth hormone deficiency have been shown to be able to respond to GHRH with a rise in serum growth hormone (GH) levels, GHRH has been used to treat such children with varying success. GHRH has been given subcutaneously (SC) in GH deficient children to improve growth in dose frequencies of daily, twice daily, three-hourly overnight or three-hourly throughout the day. The dosages of GHRH used have been wide ranging, varying from 4 micrograms/kg/day to 50 micrograms/kg/day. Continuous infusion of GHRH has been shown to augment GH secretion in normal adults and GH deficient children without evidence of desensitization of the somatotrophs. Continuous SC infusion of GHRH has been shown to promote growth in short slowly growing children. Poor growth response to GHRH has been reported by some authors using daily SC injection while others reported significant growth acceleration in 42-87% of GH deficient children treated using different GHRH regimens. Although GH treatment in GH-deficient children results in more consistent growth acceleration, comparable growth response can be seen in some children treated with GHRH. The optimal mode of GHRH therapy remains to be determined, but it would appear that the growth response is dependent on the dose used and possibly on the frequency of administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMedDate not supplied

A partial transient effect of short-term growth hormone (GH) treatment in short non-GH deficient prepubertal children.

This study reports the growth of 11 short non-GH deficient children before, during short-term GH therapy for 1 year and for 2 years after the cessation of treatment. The mean growth velocity increased significantly (p < 0.0001) from the pretreatment mean of 4.6 (SD = 0.95) cm/year to 8.4 (SD = 1.1) cm/year after 1 year of GH treatment without accelerated advancement of skeletal maturation. The serum IGF-1 levels also increased significantly with treatment. In nine children who remained prepubertal followed for one year after GH treatment, the mean growth velocity increased from 4.5 (SD = 0.69) cm/year before treatment to 8.7 (SD = 1.28) cm/year after 1 year of GH treatment (p < 0.0001). After stopping GH treatment, the growth velocity decreased significantly (p < 0.001) to 2.4 (SD = 0.68) cm/year during the first year of follow-up. In the six prepubertal children followed up for 2 years after treatment, the mean growth velocity was 4.1 (SD = 1.04) cm/year which was not significantly different from the pretreatment growth velocity. The significant decrease in growth velocity during the first post-treatment year could not be explained by the usual fall of growth velocity with increasing age in prepubertal children. Our results indicate that the effect of one year of GH treatment on height gain is partly transient and cast doubt on the efficacy of short-term GH therapy in short non-GH deficient patients.

Age Determination by Skeleton↗

PubMedDate not supplied

Growth, puberty and endocrine function in beta-thalassaemia major.

Although delay in onset of puberty is a common cause of growth failure in adolescent thalassaemic patients, growth retardation could also be due to iron overload, the toxic effects of desferrioxamine, or the development of other endocrinopathies such as GH insufficiency or primary hypothyroidism. Abnormal body proportions with truncal shortening are commonly seen and could be due to the disease itself, iron toxicity, delay in puberty or the toxic effects of desferrioxamine. The absence of a pubertal growth spurt during spontaneous or induced puberty is detrimental to the achievement of a normal final adult height. Low serum IGF-I and normal GH reserve in short thalassaemic children imply that a state of relative GH resistance exists. The rise in IGF-I and improvement in growth with GH therapy suggest that this GH resistance is only partial. Although the results of short-term GH therapy are encouraging, the impact of treatment on final height of non-GH deficient short thalassaemic children remains uncertain. Multiple endocrinopathies, including hypogonadism, hypothyroidism and diabetes mellitus, occur mainly in older patients who tend to have high serum ferritin levels. Prognosis for survival is greatly improved if the serum ferritin is kept below 2000 micrograms/l by regular chelation. Chelation therapy initiated early before the accumulation of a significant iron burden or dosages of desferrioxamine in excess of 50 mg/kg/day should be avoided. Serum ferritin should be checked regularly and the "toxicity index" should be used to monitor chelation therapy. In cases of delayed puberty, sexual development should be induced at an appropriate age.

Adolescent↗

PubMedDate not supplied

Gonadotropin independent precocious puberty.

Clinicians should now be fully aware of this intriguing condition of GIPP. The condition is characterized by pubertal sex steroid concentrations and gametogenesis in the presence of prepubertal or suppressed gonadotrophins. In patients with MPP especially without a family history, one should exclude the possibility of pseudoprecocious puberty due to premature production of sex steroids without pituitary gonadotrophins resulting from a primary disorder of the gonad or adrenal gland or to autonomous secretion of gonadotrophin by a tumor. Similarly in patients with recurrent ovarian cyst formation, persistence of the cysts especially with a significant solid component beyond three months should alert a clinician to the possibility of juvenile granulosa cell tumor of the ovary /75/. After confirmation of the diagnosis appropriate treatment should be instituted.

Amino Acid Substitution↗

PubMedDate not supplied

Body mass index is different in normal Chinese and Caucasian infants.

Body mass index (BMI) is one of the anthropometric measurements for assessing nutritional status, body composition and adiposity in children. Racial differences in BMI between black and white children and adolescents have been shown in several studies. The aim of this study was to determine whether an ethnic difference in BMI exists between Chinese and Caucasian children in the first two years of life. The BMI of Chinese and Caucasian infants was compared so as to assess the usefulness of the National Center for Health Statistics (NCHS) growth reference data in the assessment of nutritional status of Chinese children. Mean weight, length and BMI were compared between six cohorts of Chinese children and five cohorts of Caucasian children together with the NCHS growth reference data. The changes in the mean BMI curves during the first two years of life in the two ethnic groups were entirely different but the different cohorts in the same ethnic groups displayed a similar pattern of change with age. The difference in change in BMI in the Chinese cohorts was related to the difference in change in their mean weight as compared to the NCHS weight-for-age reference data. In contrast, the change in mean length of the well-nourished Hong Kong Chinese children in the present study followed the mean NCHS height-for-age values. The results of this study suggest that linear growth would be better for the assessment of health and nutrition in infancy and early childhood. If BMI and weight-for-height standards were to be used then an ethnic group-specific and population based reference data set should be used.

Aging↗