SUMMARY Nine girls presenting under the age of 7 years with unsustained sexual precocity are described. Large ovarian cysts were detected by ultrasound in three and laparotomy in one. In two girls the symptoms resolved after surgical removal of the cyst; the other seven had spontaneous remission of symptoms, but in two of these transient breast development and bleeding recurred: further ovarian cyst formation was found in one of these patients. Endocrine studies performed before resolution of the cysts showed raised plasma oestradiol concentrations (64 to 440 pmol/1) in three girls and no appreciable rise in plasma luteinising hormone after gonadotrophin releasing hormone stimulation in two.We conclude that ovarian cyst formation with spontaneous resolution may cause transient sexual precocity in girls, and that ultrasound examination is an effective means of diagnosing and following these patients.Transient breast enlargement and menstrual bleeding-sometimes recurring at irregular intervals -without progression into puberty has been described in prepubertal girls.' Apart from cases due to ingestion of oestrogen, the aetiology of this condition is uncertain, although there is evidence from patients undergoing laparotomy that formation of large follicular cysts of the ovary may underlie the disorder.2 3We review the clinical, endocrine, and ultrasound findings in nine girls who were seen because of transient breast development occurring before the age of 7 years.
This paper reviews the clinical findings, pituitary gonadotrophin reserve and plasma oestradiol, neurological findings and pelvic ultrasound appearance in 47 girls with precocious puberty starting before the age of 7 years. Of the 39 girls who had air encephalograms or cranial CT scans, 19 showed intracranial abnormalities (hamartomas 11; hydrocephalus 5; optic glioma 2; arachnoid cyst 1). There was no significant difference in the peak serum luteinizing hormone and follicle-stimulating hormone responses to intravenous gonadotrophin stimulating hormone in girls with and without intracranial lesions. Pelvic ultrasound examination showed development of the ovaries, uterus, and vagina similar to that seen in normal puberty. Treatment with cyproterone acetate (50-100 mg/day) in 26 girls resulted in arrest of breast development and suppression of menstruation, but a definite effect on growth was not documented.
A case of congenital cytomegalovirus infection acquired by intra-uterine blood transfusion and complicated by the nephrotic syndrome is described. Experience with the use of the antiviral agent ganciclovir is reported.
Birth size in Indian ethnic sub-groups born in Britain. Arch Dis Child 1985;60:868-70. 2 Woods DL, Malan AF, Heese H de V. Patterns of retarded fetal growth. Early Hum Dev 1979;3:257-62. SIR,-The ratio of mid-arm circumference to occipitofrontal circumference in the newborn baby appears from the paper by Dr Nigel Meadows and his colleagues to be a useful marker of intrauterine growth retardation, especially in areas -where a large multiethnic population causes significant variations in birth weight.Their findings of a similar ratio in Asian (presumably referring to parents from countries of the Indian subcontinent) as in black and white babies is important. In Britain Asian babies are on average of lower mean birth weight, but it iswrong to assume, as is often implied, that intrauterine growth retardation necessarily plays a major part. These Asian families are heterogeneous in their geographical origins, culture, diet, social predicaments, etc. The extent to which prenatal undernutrition can be held accountable for the shape of the fetal growth curve during the latter part of the third trimester (on which birth weight distribution depends) will depend on interactions between these influences. For example, in Leicester in the early 1980s it could not be shown that the lower mean birth weight in Asian babies than in those of European origin (2998 and 3320 g respectively: p
On-site vaccination during working hours was by far the most effective method of vaccinating this population; community clinics were not cost-effective, nor were general practices apparently accessed. The number of workers recorded in the contact list of registered poultry premises provided by DEFRA/DH has been shown to be unreliable; this has implications for the future implementation and evaluation of this programme. Immigrant workers within the poultry worker population make communication about the benefits of vaccination and access to primary care an issue, both factors which impact on uptake. Strategies for engaging smaller farms, immigrant and non-registered workers need to be developed.
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