Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age

PURPOSE

The purpose of this study is to report our experience of fractures in children riding Hoverboards.

METHODS

We undertook a prospective review of all children attending our hospital who sustained fractures whilst riding a Hoverboard. Data such as patient demographics, type of fracture sustained, treatment received, complications and outcome were collected.

RESULTS

Twelve children, 5 males and 7 females with ages ranging from 5.5 to 15.3 years were included in this study. All patients sustained upper limb fractures and the distal radius was the commonest fracture site (30%). Surgery was required in 6 (50%) out of the 12 patients because the respective fractures were displaced. No patient had any ongoing complaints or disability at the last clinic review.   Conclusion : Children riding Hoverboards are predisposed to upper limb fractures and parents who purchase Hoverboards should be warned about this.

Displaced distal end radius fractures in children treated with Kirschner wires - A systematic review

The indications for Kirschner wiring, the technique of wiring, type of cast immobilization, period of immobilization and complications of K wires are unclear. We conducted a systematic review of the literature on Kirschner wiring of distal radius fractures in children. A total of 4263 articles were identified. The full text of the remaining 78 articles was reviewed. 64 articles were finally excluded because of incomplete data leaving 14 for analysis. Complete fracture displacement and translation more than 50% are the commonest indications for Kirschner wiring of these fractures with 2 retrograde wires in non-Kapandji fashion being the commonest technique. Long arm casts are the favored modality of immobilization with superficial infection being the commonest complication. Re-displacement rates are low after Kirschner wiring. Most studies were retrospective and there is the need for a multicenter randomized controlled trial to define protocols for management of displaced distal radius fractures in children.

Locked rigid antegrade intramedullary nailing of adolescent femoral fractures using a lateral trochanteric entry point

The purpose of this study is to present our experience of treating adolescent femoral fractures using a locked intramedullary nail with a lateral trochanteric entry point. We retrospectively reviewed 15 femoral fractures in 13 adolescents who were treated in our unit between 2011 and 2014. Data collected included patient demographics, mechanism of injury, type of fracture, associated injuries, time to union and complications. A radiographic review was also undertaken. The mean time to radiological union in 14 out of the 15 fractures was 13 weeks (range, 10-20 weeks). One patient had a delayed union that required bone grafting and united finally at 30 weeks post injury. The mean difference in the neck shaft angle between the operated and non-operated side was 1.5 degrees (range : -10 to 10 degrees). No patients had infection or avascular necrosis. Five nails were removed after the fractures had healed without complications. Locked rigid intramedullary nailing of adolescent femoral fractures is a safe and effective treatment option when the lateral aspect of the greater trochanter is used as an entry point.

Displaced distal end radius fractures in children treated with Kirschner wires - A systematic review

The purpose was to analyse two reported risk factors on the outcome of Birmingham hip resurfacing (BHR). We reviewed consecutive BHR arthroplasties and found 1,476 cases eligible for analysis. The mean follow-up was 7.3 years. Patients were classified into groups according to their head size and body mass index (BMI). Statistical analysis examined the follow-up Oxford Hip Scores (OHS) and revision rates between groups. In the large head group (50mm and above) the OHS was 0.5 points higher (p=0.003) than the small head group. In the non-obese group (BMI <30) it was 0.3 points higher (p=0.007). No significant difference in the survival of the implants by either head size or by BMI was detected. BHR is a suitable option offering good survival and higher functional outcomes in non-obese patients (BMI<30) with larger femoral head diameters (50 and above). Although results are statistically significant such a small difference in OHS will rarely show significant clinical difference. Therefore, despite.

Identification and Host Relations of Turnip ringspot virus, A Novel Comovirus from Ohio

Viruslike chlorotic ring spot symptoms and line patterns of unknown origin were observed on a greenhouse-grown turnip plant. The suspected virus was mechanically transmissible to plants in the Brassicaceae. Electron microscopic analysis revealed icosahedral particles approximately 28 nm in diameter. Reverse transcriptase-polymerase chain reaction (RT-PCR) analyses suggested that the pathogen is a comovirus, an observation that was confirmed by analysis of portions of the genomic sequence. This virus was provisionally named Turnip ringspot virus (TuRSV). Based on the RNA 1 sequence, TuRSV is most similar to Radish mosaic virus, another pathogen that infects members of the Brassicaceae. Arabidopsis thaliana is susceptible to TuRSV, and 12 out of the 23 ecotypes studied showed symptoms when inoculated with the virus. TuRSV induced a variety of responses on ecotypes from death to no infection. Some ecotypes showed one or two rounds of symptom display followed by recovery when inoculated with TuRSV. About half of the ecotypes (11/23) analyzed showed no symptoms when inoculated with TuRSV. Col-0 plants showed no symptoms, and infectious virus was not recovered from systemic leaves, although it could be detected by RT-PCR. Col-0 plants harboring mutations impairing the ethylene, jasmonic acid, or salicylic acid signaling pathways did not show symptoms when inoculated with TuRSV.

Endoscopic therapy for stenosis of the biliary and pancreatic duct orifices

BACKGROUND

Manipulation of the duodenal papilla may lead to symptomatic stenosis of the orifices of bile duct, main pancreatic duct or accessory pancreatic duct.

METHODS

Seventeen patients with stenosis of the orifice (bile duct 7, bile duct/main pancreatic duct 7, accessory pancreatic duct 3) underwent sphincterotomy and/or dilation and stent placement for a median of 140 days (range 30 to 1080 days). Patients were interviewed at a median of 720 days (range 120 to 990 days) after removal of the final stent.

RESULTS

Median age was 50 years (range 17 to 68 years); 78% were women. The etiology of stenosis of the orifice was sphincterotomy in 8, sphincteroplasty in 7 and papillectomy in 2 patients. Indications for treatment were abdominal pain (100%), dilated bile duct and/or main pancreatic duct (14 patients) and pancreas divisum (3 patients). Sixty procedures (median 4 per patient) were performed with mild morbidity (hospital stay less than 3 days) in 17% of procedures and 35% of patients. Symptoms improved in 100%, 57% and 33% of patients with bile duct, bile duct/main pancreatic duct and accessory pancreatic duct, respectively. Surgery was ultimately needed in 3 (43%) patients with bile duct/main pancreatic duct and 2 (67%) with accessory pancreatic duct stenosis.

CONCLUSIONS

Endoscopic therapy successfully relieves pain due to biliary stenosis of the orifice but less frequently relieves pain due to pancreatic stenosis of the orifice.

Temperature-sensitive differential affinity of TRAIL for its receptors. DR5 is the highest affinity receptor

TRAIL is a member of the tumor necrosis factor (TNF) family of cytokines which induces apoptotic cell death in a variety of tumor cell lines. It mediates its apoptotic effects through one of two receptors, DR4 and DR5, which are members of of the TNF receptor family, and whose cytoplasmic regions contain death domains. In addition, TRAIL also binds to 3 "decoy" receptors, DcR2, a receptor with a truncated death domain, DcR1, a glycosylphosphatidylinositol-anchored receptor, and OPG a secreted protein which is also known to bind to another member of the TNF family, RANKL. However, although apoptosis depends on the expression of one or both of the death domain containing receptors DR4 and/or DR5, resistance to TRAIL-induced apoptosis does not correlate with the expression of the "decoy" receptors. Previously, TRAIL has been described to bind to all its receptors with equivalent high affinities. In the present work, we show, by isothermal titration calorimetry and competitive enzyme-linked immunosorbent assay, that the rank order of affinities of TRAIL for the recombinant soluble forms of its receptors is strongly temperature dependent. Although DR4, DR5, DcR1, and OPG show similar affinities for TRAIL at 4 degrees C, their rank-ordered affinities are substantially different at 37 degrees C, with DR5 having the highest affinity (K(D) </= 2 nm) and OPG having the weakest (K(D) = 400 nm). Preferentially enhanced binding of TRAIL to DR5 was also observed at the cell surface. These results reveal that the rank ordering of affinities for protein-protein interactions in general can be a strong function of temperature, and indicate that sizeable, but hitherto unobserved, TRAIL affinity differences exist at physiological temperature, and should be taken into account in order to understand the complex physiological and/or pathological roles of TRAIL.

Inhibition of CD23 processing correlates with inhibition of IL-4-stimulated IgE production in human PBL and hu-PBL-reconstituted SCID mice

BACKGROUND

CD23, the low affinity serum immunoglobulin E (IgE) receptor, is upregulated on B cells following interleukin (IL)-4 stimulation and is concomitantly cleaved to generate soluble CD23 (sCD23) fragments with cytokine-like activity.

OBJECTIVE

Compounds that selectively inhibit the proteolytic release of CD23 to generate sCD23 were assessed for their ability to inhibit IgE production in order to evaluate the contribution of sCD23 in the production of human IgE as well as the ability of such compounds to block IgE production.

METHODS

IgE production was measured in IL-4-stimulated human peripheral blood lymphocytes (PBL) and PBL-reconstituted SCID mice in the presence of a broad-spectrum matrix metalloprotease (MMP) inhibitor, a compound selective for inhibition of CD23 processing over MMPs and an anti-CD23 mAb, MHM6.

RESULTS

The two compounds were equipotent in inhibiting IgE production without inhibition of IgG production by IL-4/anti-CD40-stimulated PBL. Soluble CD23 release was also shown to precede IgE accumulation in the cell-free medium. Addition of compound at later times other than day 0 in the 14 day assay resulted in progressively less inhibition of both IgE and sCD23, and exactly paralleled the effect of an anti-CD23 mAb, MHM6 on IgE levels. Both compounds also inhibited the release of CD23 from human RPMI 8866 cells adoptively transferred i. p. to mice. Doses required for inhibition of CD23 correlated well with the doses required for inhibition of IgE production in IL-4-challenged hu-PBL-SCID mice. IgE was selectively inhibited over total IgG in the SCID mice as well.

CONCLUSIONS

Inhibition of CD23 processing alone is sufficient to inhibit IL-4-stimulated IgE production both in vitro and in vivo.

Crystal structure of beta-ketoacyl-acyl carrier protein synthase III. A key condensing enzyme in bacterial fatty acid biosynthesis

Beta-ketoacyl-acyl carrier protein synthase III (FabH), the most divergent member of the family of condensing enzymes, is a key catalyst in bacterial fatty acid biosynthesis and a promising target for novel antibiotics. We report here the crystal structures of FabH determined in the presence and absence of acetyl-CoA. These structures display a fold that is common for condensing enzymes. The observed acetylation of Cys(112) proves its catalytic role and clearly defines the primer binding pocket. Modeling based on a bound CoA molecule suggests catalytic roles for His(244) and Asn(274). The structures provide the molecular basis for FabH substrate specificity and reaction mechanism and are important for structure-based design of novel antibiotics.

Scintigraphic detection of post-pneumonectomy bronchopleural fistulae

A total of 20 ventilation studies [16 with xenon-133 and four with technetium-99m diethylenetriamine pentaacetic acid (DTPA)] were performed in 11 patients with suspected post-pneumonectomy bronchopleural fistulae. The findings on the ventilation scan were correlated with bronchoscopy, taken as the gold standard for purposes of comparison. The sensitivity and specificity for 133Xe scans were 83% and 100% respectively, while the sensitivity for 99mTc-DTPA aerosol studies was poor at 0%. Special techniques for optimal visualization of the fistulae are enumerated.

Successful medical treatment of peptic pyloric stenosis: Dr Sippy revisited

BACKGROUND

Surgery and balloon dilatation are perceived by many as the principal treatments for peptic pyloric stenosis. We questioned whether, with the availability of modern acid suppressant treatment, this was still appropriate or whether patients could be managed with medical treatment alone.

METHODS

Seventeen consecutive patients with peptic pyloric stenosis were treated with endoscopic gastric drainage, followed by oral omeprazole in 15 or cimetidine in two. Gastric emptying half times for solids and liquids were assessed in 11 of the 17 patients when they had become asymptomatic.

RESULTS

Endoscopic drainage and medical treatment successfully relieved symptoms in all 17 patients, although the gastric emptying studies in 11 patients still showed prolongation in eight. Symptoms resolved completely after a mean of 28 days. Five patients relapsed when changed from omeprazole to cimetidine treatment, but all responded to re-starting omeprazole. Four patients remain well on cimetidine alone.

CONCLUSIONS

Medical treatment preceded by endoscopic gastric drainage was effective in all patients in this series and may be the preferred choice of treatment in patients with pyloric stenosis.

The immune response to soluble D10 TCR: analysis of antibody and T cell responses

In order to evaluate the potential of TCR as vaccines for immunomodulation, the immunogenicity of soluble versions of D10 TCR has been investigated in mice. Soluble D10 TCR containing the extracellular domains were produced either as dual chain (dc) TCR lacking transmembrane and cytoplasmic regions or as a TCR-IgG1 chimeric protein. Soluble single chain (sc) D10 TCR contained only the Valpha and Vbeta segments joined by a peptide linker. Syngeneic D10 dcTCR or D10 TCR-IgG1 immunizations of AKR mice induced antibody responses to D10 clonotypic epitopes and to constant region epitopes that are not exposed on D10 cells. Only clonotypic antibodies were produced after D10 scTCR immunizations. Immunization of AKR mice with D10 dcTCR and D10 TCR-IgG1 primed I-Ak- and I-Ek-restricted CD4+ T cells recognizing constant region epitopes, but there was no detectable response to the variable region. Comparison of the in vitro proliferative responses of CD4+ T cells from D10 scTCR-primed H-2 congenic mice revealed that H-2u was a responder haplotype for the variable region. How the immunogenicity of particular regions of the TCR appears to be shaped by tolerance induction in vivo and the implications for immunotherapy with soluble TCR vaccinations are discussed.

Maternal immunization with a soluble TCR-Ig chimeric protein: long term, V beta-8 family-specific suppression of T cells by maternally transferred antibodies

Maternal transfer of TCR clonotypic Ab protected young NOD mice against the adoptive transfer of diabetes by the BDC 2.5 T cell clone. The effect of maternal anti-TCR Vbeta-8 Ab on T cell development and function has now been investigated. SJL/J mice, which lack TCR Vbeta-8, were immunized with soluble, chimeric D10 TCR-IgG1 containing Vbeta-8.2. The (SJL/J x AKR/J) F1 offspring of immunized female SJL/J mice were severely depleted of peripheral T cells bearing Vbeta-8 until 11 to 17 wk of age. The loss of Vbeta-8 expression did not appear to be due to modulation of cell surface TCR. Since the Vbeta-8+ T cell population was unperturbed in the (AKR/J x SJL/J) F1 offspring of D10 TCR-IgG1-immunized AKR/J mothers making D10 clonotypic Ab, the effect was immunologically specific. The deletion of Vbeta-8+ T cells had functional consequences. In the in vitro response to the superantigen, staphylococcal enterotoxin B, the usually observed participation of Vbeta-8.2+ T cells was largely suppressed, whereas the recruitment of Vbeta-3+ T cells remained unaltered. In control mice, T cell responses to the 134- to 146-residue peptide of conalbumin (pCA(134-146)) were biased toward use of Valpha-2/Vbeta-8.2 TCR. In D10 TCR-IgG1 maternally immunized (SJL x AKR/J) F1 mice, the T cell responses to pCA(134-146) were suppressed, and T cell lines derived from these in vitro were devoid of Vbeta-8.2 expression. With an increased understanding of TCR V gene usage in autoimmune diseases, similar strategies for the depletion of autoreactive T cells may become feasible in humans.

Maternal immunization with a soluble TCR-Ig chimeric protein: long term, V beta-8 family-specific suppression of T cells by maternally transferred antibodies

Maternal transfer of TCR clonotypic Ab protected young NOD mice against the adoptive transfer of diabetes by the BDC 2.5 T cell clone. The effect of maternal anti-TCR Vbeta-8 Ab on T cell development and function has now been investigated. SJL/J mice, which lack TCR Vbeta-8, were immunized with soluble, chimeric D10 TCR-IgG1 containing Vbeta-8.2. The (SJL/J x AKR/J) F1 offspring of immunized female SJL/J mice were severely depleted of peripheral T cells bearing Vbeta-8 until 11 to 17 wk of age. The loss of Vbeta-8 expression did not appear to be due to modulation of cell surface TCR. Since the Vbeta-8+ T cell population was unperturbed in the (AKR/J x SJL/J) F1 offspring of D10 TCR-IgG1-immunized AKR/J mothers making D10 clonotypic Ab, the effect was immunologically specific. The deletion of Vbeta-8+ T cells had functional consequences. In the in vitro response to the superantigen, staphylococcal enterotoxin B, the usually observed participation of Vbeta-8.2+ T cells was largely suppressed, whereas the recruitment of Vbeta-3+ T cells remained unaltered. In control mice, T cell responses to the 134- to 146-residue peptide of conalbumin (pCA(134-146)) were biased toward use of Valpha-2/Vbeta-8.2 TCR. In D10 TCR-IgG1 maternally immunized (SJL x AKR/J) F1 mice, the T cell responses to pCA(134-146) were suppressed, and T cell lines derived from these in vitro were devoid of Vbeta-8.2 expression. With an increased understanding of TCR V gene usage in autoimmune diseases, similar strategies for the depletion of autoreactive T cells may become feasible in humans.

Thyroid function in haemodialysed patients of Gassim, Saudi Arabia: TRH stimulation

To study the hypophysical-pituitary-thyroid axis in Saudi patients on (RDT), 200 units of TRH were given intravenously predialysis to each of 21 such subjects. As expected (TSH) rose promptly within 30 minutes followed by a gentle decline at 60 minutes. A more gentle rise was also noted in T3 which continued for the 60 minutes of observation. Rather unexpectedly, T4 level was noted to show a reciprocal decline. To our knowledge, this pattern has not been defined in literature. In 12 patients (GH) was noted to rise promptly within 30 minutes followed by a gentle decline at 60 minutes. (LH) and (FSH) did not follow any definite pattern as observed for T3 and T4. Since the oral preparation of TRH is now available, can (TRH) be effectively used to treat renal dwarfism?

Immunization with soluble BDC 2.5 T cell receptor-immunoglobulin chimeric protein:antibody specificity and protection of nonobese diabetic mice against adoptive transfer of diabetes by maternal immunization

The BDC 2.5 T cell clone is specific for pancreatic beta-cell antigen presented by I-Ag7, and greatly accelerates diabetes when injected into 10-21-d-old nonobese diabetic (NOD) mice. The BDC 2.5 T cell receptor (TCR) has been solubilized as a TCR-IgG1 chimeric protein. All NOD mice immunized against BDC 2.5 TCR-IgG1 produced antibodies recognizing TCR C alpha/C beta epitopes that were inaccessible on the T cell surface. 56% of the mice produced antibodies against the BDC 2.5 clonotype that specifically blocked antigen activation of BDC 2.5 cells. We have used the adoptive transfer model of diabetes to demonstrate that maternal immunization with soluble TCR protects young mice from diabetes induced by the BDC 2.5 T cell clone.

The incidence of scintigraphically viable and nonviable tissue by rubidium-82 and fluorine-18-fluorodeoxyglucose positron emission tomographic imaging in patients with prior infarction and left ventricular dysfunction

BACKGROUND

Although reversible perfusion defects, perfusion-metabolism mismatch and match patterns are important for differentiating viable from nonviable myocardium, the frequency of these scintigraphic patterns has not been reported. The study objective was to establish the incidence of these scintigraphic patterns to estimate the clinical need for metabolic positron emission tomography for evaluating tissue viability in patients with prior myocardial infarction (MI).

METHODS AND RESULTS

82Rb perfusion images were interpreted to identify reversible or irreversible defects, followed by determination of their 18F-fluorodeoxyglucose (18F-FDG) uptake pattern. In 155 patients with prior MI, analysis of 613 abnormal segments showed reversible perfusion defects in 13%. The 87% irreversible defects, 18% showed perfusion-metabolism mismatch, whereas 69% showed the match pattern. Reversible perfusion defects and perfusion-metabolism mismatches were noted in 20% (31/155) and 29% (45/155) of patients, respectively, whereas the match pattern was noted in 51% (79/155) of patients.

CONCLUSION

Irreversible perfusion defects were common in our patients with prior MI, and distinction between viable and nonviable tissue was not possible by perfusion imaging alone. The identification of hibernating myocardium was possible only with the additional 18F-FDG imaging in about one third of patients. This indicates a significant clinical demand for 18F-FDG imaging that identifies patients who will benefit from revascularization.

Central adiposity and atherogenic lipids in Saudi diabetics

A high caloric intake from fat sources and prevailing obesity in the Saudi population prompted this study. Waist to hip circumference ratio (WHR), fasting cholesterol, triglycerides and insulin were measured in 76 non-insulin dependent adult Saudi diabetics. Serum LDL, HDL and VLDL were measured in 45 of these diabetics. WHR of Saudi diabetics was higher (0.98 in males, 0.91 in females) than reported for diabetics from the West. Serum cholesterol levels (5.52 mmol/L in males, 5.98 mmol/l in females) were higher than reported in the past for normal Saudi subjects. Lipid profile was strikingly different in the two sexes. Male diabetics (n=28) had significantly higher WHR associated with elevated triglycerides and VLDL but a lower HDL/cholesterol ratio. Female diabetics (n=48) were obese and had healthier HDL levels. Interestingly, LDL cholesterol changed reciprocally with WHR in female diabetics. This preliminary study reveals the presence of significant central adiposity and an atherogenic lipid profile in Saudi diabetics. The sex differences in lipids indicates the need for studies involving lipoprotein metabolism in Saudis. Further, an increase in atherosclerosis-related disorders should be expected in Saudi diabetics.

Human Hsp60: bacterial expression, purification, development of monoclonal antibodies and a sandwich ELISA for quantitation

Bacterial hsp60 proteins are major targets of immune responses during infection, and the highly conserved nature of bacterial and mammalian hsp60 has led to speculation that immune reactivity to these stress proteins may be a component of certain autoimmune diseases. We have developed recombinant proteins and monoclonal antibodies to facilitate further study of human hsp60 and its association with disease. The human hsp60 gene was expressed in Escherichia coli and a method for purification of the recombinant protein essentially devoid of E. coli GroEL was developed. Using the purified protein we have generated a number of monoclonal antibodies which are specific for human hsp60 and do not cross-react with its counterparts from E. coli and mycobacteria. A highly sensitive sandwich ELISA was developed to quantitate hsp60 levels and was used to study hsp60 accumulation in cells due to vaccinia virus infection and heat shock. This ELISA will be useful for monitoring hsp60 levels in body fluids or tissues during autoimmune reactions and/or inflammatory responses.

46 XX male with dysgenetic testes

A 46 XX male with dysgenetic gonad is described. The patient was brought up as a girl and reported with primary amenorrhoea and hirsutism. The pathogenesis and management strategy of this condition are briefly discussed.

Effect of sulphonylurea therapy on insulin sensitivity in non insulin dependent diabetics

Insulin tolerance test was done to assess the insulin sensitivity in a group of untreated non insulin dependent diabetic subjects before and after sulfonylurea (tolbutamide, glibenclamide, glipizide) therapy. The parameters studied were KITT, slope of the blood glucose fall, summation values, and area under the curve of glucose response. All the three commonly used sulphonylurea drugs improved insulin sensitivity after 4 weeks of therapy.

Ketoconazole in the treatment of Cushing's disease

Six patients with Cushing's disease received ketoconazole for 7-10 weeks following ketoconazole challenge test. Clinical and hormonal alterations in circulating cortisol, 17 OH progesterone, androstenedione and testosterone were assessed during the therapy. There was significant clinical improvement which corresponded to a fall in cortisol, androstenedione and testosterone. The rise in 17 OH progesterone and the fall in cortisol suggest a blockade at 17,20 desmolase and 11 B-hydroxylase in the cortisol bio-synthetic pathway.

Persistent Cushing's disease in a patient with invasive pituitary adenoma

A patient with invasive basophilic pituitary adenoma is described, in whom the hypercortisolaemia and clinical features persisted despite two attempts to reduce the tumour mass by transfrontal pituitary surgery and external beam radiotherapy. The patient responded to oral ketoconazole with clinical and biochemical improvement.

Circulating cortisol & related steroids following ketoconazole challenge in Cushing's disease

Circulating levels of cortisol, 17 alpha hydroxy progesterone and delta 4 androstenedione were analysed by specific radioimmunoassays in 11 patients with Cushing's disease before and at 2, 4, 6, 12 and 24# h following an oral dose of 400 mg ketoconazole. A significant fall in cortisol (26 - 79.6%, 59.8 +/- 18.7 SEM), delta 4 androstenedione (21.5 - 63.3%, 47.8 +/- 4.87) with a concomitant rise in 17 alpha hydroxy progesterone (113 - 218%, 116 +/- 11.43) were noted, suggesting inhibition of 17, 20 desmolase and 11 beta-hydroxylase enzymes in cortisol biosynthetic pathway.

Clinical and hormonal studies in precocious puberty

Data from 31 children, 23 females (74.2%) and eight males (25.8%) with precocious puberty were analysed. They included 19 cases with central precocious puberty, 5 with premature thelarche, 5 with premature adrenarche and 1 each with adrenal adenoma and virilizing hepatoblastoma. Their clinical and hormonal profile and the treatment outcome are briefly discussed.

Screening for late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Basal and post-ACTH levels of 17 alpha hydroxy-progesterone (17 OHP) were determined in 53 subjects with hirsutism. Late onset congenital adrenal hyperplasia (LOCAH) was detected in five (10.6%) on the basis of elevated basal and/or ACTH stimulated levels of 17 OHP. Of the five patients, two were considered to have a heterogygous state on account of a small rise in stimulated 17 alpha OHP. Screening tests for LOCAH are essential as the clinical diagnosis is not otherwise possible for this treatable and often familial disorder.

Circulating androgens in hirsutism

The androgen status in fifty consecutive women with hirsutism in the reproductive age group referred to the endocrine clinic was studied. Mean BMI was 24.3 +/- 5.6 kg/M2, 42% had menstrual disturbances and 30%, had severe hirsutism. The hirsute patients had significantly higher estimates of testosterone (48%), dihydrotestosterone (38%) and androstenedione (86%). Based on clinical and hormonal data, polycystic ovarian disease was diagnosed in 20 patients, nonclassical 21 hydroxylase deficiency in one and idiopathic hirsutism in 29.