A retrospective analysis of 98 patients, less than 15 years of age, treated for caustic ingestion during 1976–1990 was performed to evaluate the modern consequences of caustic ingestion in children and to set indications for esophagoscopies and radiographic and laboratory examinations. Dishwasher detergents were ingested by 56 children. There were no lye ingestions, since lye has not been freely available in Finland since 1969. Household acetic acid (vinegar) was the most commonly (12/23) ingested acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal burns were found in 20 patients. Acids caused burns more often than alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6–43.3%) and acid burns more often developed into scars (7.4% versus 4%; p = 0.029; 95% CI for the difference 1.4–25.4%). The only esophageal stricture developed after ingestion of a Clinitest tablet. The mean time for hospitalization as a result of acid ingestion was significantly longer than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5 (1.6) days, n = 15; p < 0.05; 95% CI for the difference 0.7–2.8 days). Prolonged drooling and dysphagia (12–24h) predicted esophageal scar formation with 100% sensitivity and 90.1% specificity, but signs and symptoms did not predict esophageal burns after primary esophagoscopy. Radiographic examinations and leukocyte counts were of no value in predicting esophageal burns and scars. The panorama of caustic ingestion appears to have changed, probably due in part to the law banning sale of lye products since 1969. This type of law should be encouraged elsewhere. Acids cause even more caustic burns than alkalies. Vinegar should be regarded as a potent caustic substance and distributed in baby‐safe bottles with appropriate information on its caustic nature. As severe esophageal lesions after accidental ingestion of caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of drooling and dysphagia during follow‐up.
The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.
Ring chromosome 15 syndrome is a rare condition in which severe growth retardation is a major finding. We report a 4 year old boy with the karyotype 46,XY, r(15)(pll.2q26.2) whom we have treated with recombinant human growth hormone (GH) for two years. During the first year oftreatment, the insulin-like growth factor I increased from subnormal 4-2 nmol/I to normal 13 8 nmol/l and the insulin-like growth factor binding protein 3 levels increased from 2*6 to 3 8 mg/l, whereas high binding protein 1 concentrations normalised from 52 0 to 16-7 ttgIl. During the two years of treatment his relative height improved from -6*2 SD to -4.4 SD and the predicted adult height from 159-6cm to 163-5 cm. Owing to the good growth response, we have decided to continue GH treatment. (J Med Genet 1995;32:486-487)
We have determined the concentrations of pregnenolone, progesterone, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, testosterone, 5a-dihydrotestosterone, and androsterone in serum collected from 34 boys and 11 girls between 5-40 weeks of age, and we have compared these data with the concentrations of FSH, LH, and PRL in the same samples.Clear sex differences in the serum concentrations of testosterone and 5a-dihydrotestosterone were found to exist between 5-25 weeks of age, and during this period the serum concentrations of these steroids in the male infant population are similar to those in the lower normal adult male range. This sex difference is indicative of a high level of testicular steroidogenesis, which was also supported by the higher serum concentrations of 17-hydroxyprogesterone in boys compared to girls, between 10-25 weeks of age, and the good correlation between serum concentrations of 17-hydroxyprogesterone and testosterone in these boys. High serum concentrations of 5a-dihydrotestosterone in boys between 5-25 weeks of age also suggest a high level of 5a-reductase activity at this age.There were no sex differences in serum concentrations of the other steroids measured, but it was observed that concentrations of steroids of direct or indirect adrenal origin, i.e. pregnenolone, dehydroepiandrosterone, androstenedione, and androsterone, were generally highest in the youngest subjects and correlated well with each other. Unlike 5a-dihydrotestosterone, serum androsterone concentrations did not correlate with those of testosterone in boys, indicating that its origin is more closely linked to adrenal androgen production.High concentrations of serum FSH were found in girls compared to boys, while the corresponding concentrations of LH were higher in boys below 20 weeks of age compared to girls of a similar age. There was no sex difference in the serum concentrations of PRL and, although the concentrations of PRL were generally highest in infants below 10 weeks of age, no significant correlations were found to exist between serum PRL and steroids of adrenal origin. However, good correlations were found to exist among testosterone, 5a-dihydrotestosterone, and the gonadotropins in the male infant population, which supports the hypothesis that testosterone and/or 5a-dihydrotestosterone may play a role in the development of a very sensitive negative feedback control of pituitary gonadotropin secretion during infancy in boys. (J Clin Endocrinol Metab 49: 40, 1979) T HE CONCENTRATIONS of gonadotropins and steroids of gonadal origin display particular sex differences in the peripheral circulation during the first year of infant life (1-6). In boys, rapid increases in serum concentrations of FSH and LH occur during the second week of life, but these decline to the prepubertal range by 4 months of age. Increases in serum concentrations of FSH and LH also occur in girls but are quantitatively quite different; the relative concentrations of LH are lower than in boys, while those of FSH are higher ...
A method of graded sieving for counting of glomeruli in removed kidneys is described. The number of nephrons (glomeruli) in six normal kidneys deriving from autopsies of three children 22–73 months of age was 1.82 ± 0.35 × 106. The results give a little higher number than most previous studies with which they are compared. In the kidneys of two 10- and 15-month-old patients with the congenital nephrotic syndrome of the Finnish type the mean number of nephrons was 3.17 ± 0.52 × 106 which is on the average 73 % higher than in the normal kidneys studied. The number of nephrons in kidneys of five other patients showed an average of at least 3.42 ± 0.30 × 106 the counting method being a little different. The unusually high number of nephrons in CNF kidneys seems to be fully evident.
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