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Final height, body proportions, pubertal growth and body mass index were studied retrospectively in 142 survivors of acute lymphoblastic leukaemia (ALL). Treatment consisted of combination chemotherapy and cranial irradiation (18 or 24 Gy). Significant standing height loss and disproportion, with a relatively short back, was seen in both radiation dose groups. Girls were more severely affected than boys. Pubertal growth was adversely affected, with a reduction in peak height velocity in both sexes. Puberty occurred early in girls but at the normal time in boys. Nearly half the group were obese at final height, with no significant difference in incidence between the sexes. The relative roles of cranial irradiation and chemotherapy in the disturbance of growth, puberty and body composition observed in survivors of childhood ALL remain unclear. The aetiology is almost certainly multifactorial, with radiation‐induced growth hormone insufficiency, early puberty, steroids and chemotherapy all having a role.

Salt taste detection thresholds have been measured by a forced-choice, up-down sip method in 146 healthy subjects aged 10-95 years, and in 43 ill elderly patients. Thresholds are shown to increase log linearly with age after the age of 20 years. Thresholds are higher in smokers than non-smokers and the lower thresholds of women are accounted for by their lower prevalence of smoking. Ill patients have higher thresholds than healthy subjects of the same age and this is not specifically associated with any diagnosis. The methodology of taste threshold measurement and earlier studies of taste thresholds are reviewed.

Purpose:To determine the effect of cranial irradiation (18 Gy and 24 Gy) on pubertal growth in young adult survivors of childhood acute lymphoblastic leukemia (ALL).Patients and Methods: Final height (FH) and pubertal growth were retrospectively examined in 142 young adult survivors of childhood ALL. All were in first remission and had received either 18 or 24 Gy of cranial irradiation. Eighty-four children (48 girls) were treated with 24 Gy and 58 (35 girls) with 18 Gy. None had received either testicular or spinal irradiation. Timing and duration of puberty were studied in 110 patients.Results: Significant reduction in height standard deviation score (SDS) from diagnosis to FH was seen in both sexes and in both dose groups. In girls, in both dose groups, mean age at peak height velocity (PHV) and A CUTE LYMPHOBLASTIC leukemia (ALL) is the most common childhood malignancy, with an incidence of 3.5 per 100,000. Survival rates for children with ALL have improved enormously over the last 20 years, such that 70% of children can now expect to be longterm survivors with current therapy.', 2 Since 1970, this has in part been achieved by the introduction of treatment directed at the CNS, with a combination of cranial irradiation and intrathecal methotrexate. 3 Until 1980, the dose of cranial irradiation given was 24 Gy (usually administered in 15 fractions over 3 weeks). This was reduced to 18 Gy (administered in 10 fractions over 2 weeks) in 1981 in an attempt to reduce the morbidity seen with the higher dose. It is well recognized that higher doses of cranial irradiation (21 to 24 Gy) can cause significant loss in standing height.4 -6 At lower doses, the effects on growth and, more importantly, on final height have been less clear. 68 Early and precocious puberty in girls have also been reported after both doses of cranial irradiation.Disproportion at final height after treatment for ALL in childhood was recently reported by our group. This suggests that at least in some children, much if not all of the height loss is due to a reduction in sitting height."' In this study, we examined the effect of both 18 Gy and 24 Gy of cranial irradiation on growth and the timing and duration of puberty. PATIENTS AND METHODSYoung adult survivors of childhood ALL were identified from three regional pediatric oncology/hematology centers. All had received combination chemotherapy and cranial irradiation as CNS prophylaxis. All were in first remission, and none had received either mean age at menarche occurred significantly earlier than in the normal population. In boys, there was a normal timing of PHV. The amplitude of PHV was significantly reduced in both sexes and in both dose groups. Parameters of pubertal duration (PHV to menarche, PHV to FH, and menarche to FH) were not significantly different from normal population values.Conclusion: In conclusion, puberty occurred early in girls, but not in boys. Amplitude of PHV was reduced in both sexes, with no reduction in the duration of puberty. It is likely that disturbances of both ti...