mean (range) follow-up of 44.3 (15-115) months. RESULTSThe MCDK was removed in 17 children; the follow-up of 75 children (five lost to followup) showed total involution of the MCDK in 25%, shrinkage in 60% and a stable size in 15%. None had any sign of malignancy . The contralateral kidney showed anomalies in 19 of 97 children (20%); 12 had a dilated renal pelvis (two with megaureter), six had a high echogenicity of the contralateral kidney (one had reflux, and two also pelvic dilatation). In only four of the 89 children was reflux found by VCUG; 16 of the 19 anomalies were detected by US. Five children needed surgery on the contralateral urinary tract (three a pyeloplasty, and one each a pyeloplasty plus ureteroneocystostomy, and an antireflux procedure). Of the contralateral kidneys 43% showed compensatory hypertrophy. There was mild renal insufficiency in three children; renal function seemed to be slightly impaired in many. Five infants had hypertension (four with spontaneous resolution) caused by renal scarring after pyelonephritis or inborn dysplasia of the contralateral kidney. There were symptomatic urinary tract infections in seven children. CONCLUSIONUS can be used safely to diagnose unilateral MCDKs and malformations of the contralateral urinary tract and kidney. In cases where US of the dysplastic kidney remains uncertain renal scintigraphy is necessary to detect the lack of renal function. The low rate of reflux makes routine VCUG unnecessary if the contralateral upper urinary tract and kidney appear to be normal on US. Nephrectomy of the dysplastic kidney in typical cases is also unnecessary. A long-term nephro-urological follow-up of children with MCDK is recommended.

No abstract

Forty-nine pubertal tall boys with a mean height prediction of 203.59 cm according to the Bayley-Pinneau (BP) method were treated prospectively with 500 mg testosterone-oenanthate every 2 weeks for a period of 6 months. Before therapy chronological age (CA) was 14.14 years and bone age (BA) 13.88 years using the Greulich-Pyle (GP) method. During therapy BA advanced by 1.37 years. It continued to accelerate during the 6 months following therapy with a mean delta BA/delta CA being 3.01 at 3 months and 2.24 at 6 months after therapy. The 6 months value was only slightly less than the delta BA/delta CA of 2.47 obtained during therapy. The reduction in adult height was 7.26 cm or 50.8% of the predicted further growth in 12 boys with a long-term follow up of 2.5 years. This is similar to the 51.6% or 9.63 cm observed in 50 boys with a long-term follow up after 14.25 month treatment until a BA of 17 years or more. It is concluded that in the majority of cases high-dose testosterone therapy in boys of tall stature can be limited to a 6-month treatment period. Reassessment of the height prediction after a 6-month interval without therapy should define those patients who have to resume treatment because of their remaining excessive growth potential.

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The incidence of aseptic osteonecroses in the therapy of acute leukaemias in children has been studied. Out of 551 children treated at the Children's Hospital in Münster from 1971 to 1985, 6 developed osteonecrosis, an incidence of 1.09%. Of these children, 5 showed unilateral or bilateral necrosis of the femoral head. The osteonecroses occurred 8-109 months after initiation of the primary therapy or of the relapse treatment. The corticoid doses did not differ from those administered to other leukaemia patients without necrosis. Only 1 patient had received prednisone continuously for 1 year, at a total dose of 20.5 g/m2 of body surface area. Of these 6 children, 4 had been immobilized for several weeks before or during therapy. Two children had presented with pain-related relieving posture of the joints in which subsequently the osteonecrosis developed. Inactivity associated with the cortisone therapy seems to be an important factor in the development of aseptic osteonecroses.