Eleven teenage boys with bilateral anorchia and 12 with gonadotrophin deficiency were treated by injections of testosterone ester (enanthate) at an initial dose of 100 mg every six to eight weeks, rising to 250 mg every four weeks after three to four years. In the anorchic boys average adult height was 177-1 cm, compared with a mean mid-parental height of 174-4 cm, and mean predicted adult heights of 177-0 cm (Tanner-Whitehouse method) and 178-0 cm (Bayley-Pinneau method). In the patients with gonadotrophin deficiency, mean adult height was 176-9 cm, compared with a mean mid-parental height of 176*1 cm, and mean predicted adults heights of 174-0 cm (Tanner-Whitehouse method) and 177-3 cm (Bayley-Pinneau method). We conclude that this testosterone regimen allows achievement of full growth potential in such patients.During the last 20 years treatment with depot testosterone by intramuscular injection has become well established in the management of boys with different disorders of puberty. Initially introduced for the management of anorchia,' 2 testosterone has been widely used in the management of constitutional delay of puberty,25 and gonadotrophin deficiency either as an isolated defect or as part of a wider range of anterior pituitary failure.2 5 6 Though early reports suggested that testosterone treatment might be associated with some reduction in adult height because of rapid advancement in bone age,7 it is now believed that treatment with low doses of testosterone has no ill effect on ultimate height. Most of the studies supporting this view, however, have been in patients receiving relatively short term courses of testosterone.The present retrospective study on the effects of testosterone on boys with anorchia or gonadotrophin deficiency was carried out to confirm that the testosterone regimen that had been used had no significant ill effects on adult height. The study also provided an opportunity to compare two different methods of assessing bone age and predicting adult height.
Empyema of gallbladder in an infant Although acute cholecystitis has been described in the past in published reports as a complication of scarlet fever and typhoid (Swing and Bullowa, 1938; Reid and Montgomery, 1920), and perforation of the gallbladder has been noted in infants (Prevot and Babut, 1971), empyema of the gallbladder remains rare. Case report A female, birthweight 3 35 kg after a normal pregnancy, was bottle fed and was well until the 10th day of life when she developed a paronychia of the left thumb and an infected spot on her back for which no treatment was given. At age one month the baby was admitted to hospital with a 3-day history of fever up to 39°C and feeding poorly. On examination the liver was palpable 1 cm below the costal margin. The white cell count was 17 000/mm3, of which 46% were neutrophils. Blood and CSF cultures were sterile. Treatment with ampicillin and flucloxacillin was given by injection. Her temperature settled and feeding improved. On the third day after admission a tender hard mass was noted apparently arising from the medial third of the liver. Further investigations showed that Hb had dropped from 10 3 g/dl to 7-6 g. Plasma bilirubin was 0 3 mg/100 ml; plasma glutamic oxaloacetic transaminase 14 IU/l; plasma glutamic pyruvic transaminase 10 IU/l; alkaline phosphatase 15 KA units/ 100 ml. The control film (Fig. 1) of the otherwise normal intravenous pyelogram revealed a mass continuous with FIG. 1.-Plain film of upper abdomen with mass and liver edge marked and liver scan superimposed.
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