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Background: To evaluate the rate of nocturnal enuresis (NE), body weight and obstructive sleep apnea in children 5 to 10 years of age in South Italy and the possible association among these disorders., Methods: We have administered 1100 validated questionnaires, in Italian language, to parents and we have analyzed data with a logistic regression., Results: Forty-two percent of children had a BMI≥85th (group 1) vs 58.0% normal weight children at the same age (group 2). There is a higher number of overweight males compared to females without statistically differences. In group 1 there was a higher number of children with NE and obstructive sleep disorders and some children present with the association among these three disorders., Conclusions: There are no statistically differences between two study groups for the association body weight-NE, body weight-NE-obstructive sleep disorders.

Puberty is regulated by the endocrine system. Disruption of that system by exposure to environmental hormone-mimicking substances (i.e. endocrine disruptors) may, therefore, affect this development profoundly. There has been a great secular trend in the earlier timing of puberty such as both puberty onset and menarche age. This is apparently caused by environmental factors such as improved socioeconomic status, better healthcare and improved nutrition. However, part of the phenomenon could be associated with exposure to endocrine disruptors that have intrinsic estrogen activity or increase endogenous sex hormone levels. These estrogen pollutants tend to degrade slowly in the environment, to bioaccumulate in the food chain and to have long half-lives in humans. Because most of environmental chemicals, called estrogen disruptors or xenoestrogens, are toxic and estrogen/antiandrogen active, they can disregulate hypothalamic-pituitary-gonadal axis potentially inducing reproductive disorders. There are several case reports of accidental exposure to estrogenic compounds in cosmetic products, food and pharmaceuticals. The outbreak of epidemics of premature thelarche in some geographical areas has also been suggested to be linked to exposure to estrogen disrupters such as dioxins, furans and organohalogens. We review data on adverse health and reproductive outcomes have been attributed to estrogen disruptors in laboratory animals and in wildlife as well as in humans, specially focusing on the puberty timing.

Laboratory experiments and animal evidences support the fact that thyroid function can be altered by a large number of chemicals routinely found in the environment and in samples of human and wildlife tissues. Although humans are commonly exposed to low pollutant doses, disrupting effects on endocrine function (e.g. thyroid) from such chemical exposures represent major health concerns. Thyroid is essential for mammalian brain development both before and after birth, and recent clinical evidences strongly suggest that brain development is much more sensitive to thyroid hormone excess or deficit than previously believed. Thyroid hormone deficit or excess during development can have permanent, pervasive and profound effects on the neurological function of the child. In addiction, maternal thyroid hormones play a role in fetal brain development before the onset of fetal thyroid function, and thyroid hormone deficit in pregnant women can produce irreversible neurological effects in their offspring. Considering that thyroid hormones are important in fetal brain development and child neurological outcome, environmental factors affecting maternal/fetal/infant thyroid function, or thyroid hormone action directly, may affect fetal brain development and child neurological outcome. The aim of this paper is to discuss how environmental chemicals can interfere with the normal production, metabolism, and excretion of thyroid hormones, and their known impact on the thyroid system during child development.

Short stature in adolescence may cause some medical, psychological and social concerns, in addition to specific diagnostic and therapeutical problems. Among the various causes of short stature, the present review will examine in detail some forms such as constitutional delay of growth and puberty, growth hormone deficiency and Turner's syndrome, since these forms will benefit from an appropriate medical approach in adolescence. The diagnostic and therapeutical problems these forms may present in adolescence are also discussed.

The major health problems in adolescents are represented by some conditions, known as "new morbidity", affecting about 20-25 % of young people. Pediatricians should be able to address the adolescents health needs by the development of specific health programs. In organizing such programs, the pediatricians should be able to co-ordinate the activities of other care-givers, such as neurologists, psychiatrist, gynecologists, dermatologists and other people working with young people as well (teachers, social assistants, etcetera). If the health programs will be developed, they could reduce the incidence of the new morbidity in the adolescents, improving their health status and those of adults as well.

Background: Admission to Pediatric Departments for 0/18- year-old patients is an important issue for the best organization of pediatric hospital assistance. Aim of the study. To locate adolescent health care and identify the percentage of adolescent admissions to Pediatric Departments in an Italian region (Tuscany)., Methods: Adolescent health care in pediatric departments and pediatric admissions (0-18 years old) in 1999 into the reference hospital of Pisa and into 5 other regional hospitals in Tuscany are reported. The percentages of patients, subdivided by age, hospitalyzed in Pediatric Departments have been determined., Results: In 1999 the admissions for subjects aged 0 to 18 years were 12573 of which 4966 adolescents (39.6 %). The percentage of adolescent admissions is not smaller than children's admissions (aged 0 to 1 year: 16.2%; aged 2 to 5 years: 26.2%; aged 6 to 9 years: 17.8%; aged 10 to 14 years: 20.4%; aged 15 to 18 years: 19.2%). Analysis by age demonstrated a continuous decrease of patient percentages admitted to Pediatric Departments with the increased age. A minority of 15/18- year-old subjects has been admitted to Pediatric Departments., Conclusions: The percentage of adolescent admissions is similar to there of children. Most adolescents are admitted to structures unsuitable for assistance to subjects aged 0 to 18 years. These data underline the necessity for a strong recovery of adolescent admissions to pediatric structures also equipping suitable nursing rooms.

Two cases of intervertebral disk infection in 2 3-year-old boys are presented. The study reported on the anamnesis, clinical, laboratory and instrumental findings as well as therapy in both cases. Diagnosis was suspected on the basis of pain, refusal to assume any position that flexes the spine and irritability. Low-grade fever, the moderate increment of inflammatory indexes and the characteristic changes seen in 1 case on Magnetic Resonance Imaging (MRI) only and in the other one on both Technetium 99m polyphosphate bone-scanning and MRI verified the clinical diagnosis. Furthermore the authors briefs discuss the differential diagnosis of disc-space inflammation and several acute and subacute diseases of infancy and childhood some of them not localized in the spine (myopathy, appendicitis, peritonitis, urinary infections) for which discitis may be often mistaken.

In this study the authors examined 14 subjects with "classic" growth hormone (GH) deficiency and 40 with "non classic" GH deficiency treated with GH for a period of 6-36 months. Height velocity (HV) and plasma Somatomedin C (SmC) levels have been evaluated every 6 months during GH therapy. Both HV and SmC significantly increased (p < 0.001) during GH therapy in comparison to pretreatment values, but without any difference between the two groups; furthermore no significant difference was present among each six-monthly value of SmC. During GH treatment the following correlations resulted between SmC and HV: at time 0, r = 0.494 (p = 0.0004); after 6 months, r = 0.779 (p < 0.0001); after 12 months, r = 0.660 (p = 0.0001); after 18 months, r = 0.657 (p = 0.0001); after 24 months, r = 0.593 (p = 0.0038); after 30 months, r = 0.550 (p = ns); after 36 months, r = 0.465 (p = ns). Furthermore, mean value of SmC (y) correlated with mean value of HV (x) during GH treatment: r = 0.697, p < 0.0001; regression equation: y = 242x + 576. Finally no correlation was present among six-monthly SmC values, including those pre-treatment, and HV values in each of following periods. In conclusion, during GH treatment in subjects with GH deficiency plasma SmC levels correlate with HV, but have not a predictive value of the growth response to GH treatment itself.

The past 10 years have seen a return of rickets. Clinical and/or biochemical signs of vitamin D deficiency are still found in some children and adolescents, mainly during the winter. Sunlight exposure is able to prevent vitamin D deficiency and rickets but the dramatic influence of changes in solar ultraviolet-B radiation on cutaneous vitamin D3 synthesis, related to latitude and season effects, suggest that a vitamin D supplementation may be advisable. Moreover, human milk and common foods contain low quantities of vitamin D. So, we recommend routinely 400 IU of supplementary vitamin D per day in all infants. The vitamin D requirements in low-birth-weight infants are higher than at term infants; it is recommended the use of 1000-1600 IU per day in the first months of life. Intermittent high-dose of vitamin D and vitamin D metabolites are not advisable for prophylaxis of rickets.

In this study the Authors examined the response in growth hormone (GH) to thyrotrophin releasing hormone (TRH) administration in a group composed of 29 children (17 males, 12 females) suffering from insulin-dependent diabetes mellitus (IDDM) (group 1). All subjects were prepubertal, had a chronological age of 8.82 +/- 1.76 years (m +/- SD), a bone age of 8.60 +/- 1.65 years; the time elapsed since the diagnosis was 2.45 +/- 1.51 years, glycosylated hemoglobin (HbA1c) was 7.33 +/- 1.80%. Some of the same subjects (all those with a response in GH to TRH higher than 4 ng/ml; no. 11; group 2) were examined again 12-18 months later; as controls, 13 short children were also examined (group 3). All the subjects of the three groups showed a TSH peak ranging from 10-25 microU/ml, whereas GH peak resulted higher than 4 ng/ml ("paradoxical" response) in 6 subject of the group 1 and in an only subjects of the group 2. All the responders of the 3 groups showed a value in HbA1c higher than 8%. A significant difference was not present between males and females in GH and TSH values. Cortisol levels and glycaemia remained almost constant during the performance of the tests. By considering all the groups, TSH and GH values during TRH-test were not correlated with glycaemia, chronological age, bone age, the time elapsed since the diagnosis, height, height velocity, HbA1c values. In conclusion, our data demonstrated that "paradoxical" response in GH to TRH administration was present only in some subjects and particularly in those with a poor metabolic control of the disease.

In this study, on the basis of the inhibiting action of l-dopa administration on prolactin (PRL) secretion, we evaluated in a number of short children the levels of PRL during the provocative stimuli test with l-dopa in order to identify an index able to give reliability to the test and to investigate whether some differences may exist among the subjects showing a different response in growth hormone (GH) secretion to l-dopa. We examined 76 subjects (44 boys and 32 girls) with chronological age from 4.5-15.17 years. The subjects, on the basis of the GH peaks during two provocative stimuli tests [l-dopa and insulin-induced hypoglycemia (IIH)], were subdivided into 3 groups: group 1 (n = 24) with both deficient responses (peak less than 10 ng/ml); group 2 (n = 28) with discordant responses and further subdivided into group 2a (n = 14) with normal responses to IIH and 2b (n = 14) with a normal response to l-dopa; group 3 (n = 24) with both normal responses. PRL levels peaked between times -20' (58 cases) and +20' (2 cases) whereas nadir occurred between +80' (4 cases) and +120 (48 cases) without any significant difference (p = ns) among the groups. PRL levels significantly decreased in all groups, also in those with a deficient response to l-dopa (1 and 2a); furthermore no significant correlation between PRL and GH levels was demonstrated. In conclusion, this study showed the importance of PRL evaluation during l-dopa test in order to give reliability to the test and did not demonstrate any difference in PRL levels among the examined groups of short children.

In this study the authors evaluated the correlation between plasma somatomedin C (SmC) levels and auxological features in 129 short children, who have been subdivided into four groups: classical growth hormone (GH) deficiency (14 prepubertal subjects), normal responses to provocative stimuli tests, but diminished spontaneous GH secretion (40 prepubertal subjects), normal responses to provocative stimuli tests and normal spontaneous GH secretion (45 prepubertal subjects and 30 subjects at stage G2/B2-Ph2 of puberty). The following correlations with SmC are resulted, when all the subjects were considered: chronological age (r = 0.415, p = 0.0002), bone age (r = 0.557, p less than 0.0001), bone age/chronological age ratio (r = 0.493, p less than 0.0001), height SDs (r = 0.574, p less than 0.0001), height velocity SDs (r = 0.599, p less than 0.0001), but not weight variation % (r = -0.020, p: ns). In conclusion, the results of the study demonstrate a high correlation between SmC levels and auxological features, with the exception of weight.

Five children (3 boys and 2 girls) ranging in age form 5-12 years and suffering from Prader-Willi syndrome have been evaluated. In each subject the Authors have examined auxological parameters and the following hormonal values: GH after two pharmacological stimuli tests, gonadotropins after LHRH, TSH and prolactin after TRH, cortisol rhythm, testosterone after hCG in males, thyroid hormones and steroids. The results have shown a height less than 3 degrees centile only in a subjects and ranging from 10 degrees-50 degrees in the others, a weight greater than 97 degrees centile for the height age in all, a low response in GH to both stimuli in two subjects, an increased response to LHRH in FSH in two subjects. All other endocrine evaluations were in the normal range with the exception of insulin that resulted augmented in spite of normal glycaemic values. In conclusion, our data would suggest the existence of an eventual alteration of the hypothalamus-pituitary structures.

The authors report the experience of a pediatric clinic on hydrocarbon poisoning. Among the reported cases was that of a girl showing a serious pneumonitis.

GHRH test was performed in 11 girls suffering from Turner's syndrome ranging in age from 5.6-13.5 years. GH peak resulted lower than 10 ng/ml in three subjects, who had also shown reduced GH values after two conventional pharmacological stimuli (L-dopa- and insulin-induced hypoglycemia) and a value of mean GH concentration over 24 hours lower than 3 ng/ml. Both GH peak and area under the curve were not correlated with height, height velocity, bone age/chronological age ratio, GH peak after conventional pharmacological stimuli and mean GH value of spontaneous secretion. The comparison with the results of GHRH test in other kinds of short stature evidenced in girls with Turner's syndrome the presence of GH values (peak and area under the curve) higher than those in subjects with "classical" GH deficiency, lower than those in "short normal stature" and similar to those in subjects with "non classical" GH deficiency. In conclusion, our data suggest, even if within a certain variability of the responses, a possible involvement of GH deficiency to the pathogenesis of short stature in Turner's syndrome, suggesting the existence of a prevalent hypothalamic nature of GH deficiency.

We have examined a group composed of 60 short prepubertal children (height less than 3 degrees centile; 31 M, 29 F, age from 4.17-10.5 years) with a decreased height velocity (less than 10 degrees centile) and in which endocrine, systemic or specific causes of short stature have been ruled out by the performance of several instrumental or laboratory analyses. Auxological features of a 12-month period (from time -12 to time 0) without any treatment ("off" period) have been compared with an immediately following 12-month period (from time 0 to time +12), during which hydrochloride arginine was administered ("on" period); 2 phials per day in subjects older than 6 years and 1 phial per day in those less old than 6 years. In the absence of the pubertal development, height changed from -1.95 +/- 0.29 (m +/- 1 SD) standard deviation scores (SDS) at time -12 to -2.17 +/- 0.28 SDS at time 0 and -2.24 +/- 0.29 SDS at time +12 with a variation of -0.22 +/- 0.09 SDS in "off" period and of -0.07 +/- 0.14 SDS in "on" period (p less than 0.001) and therefore a difference between the two periods of 0.16 +/- 0.13 SDS. Height age (HA)/chronological age (CA) ratio was 0.74 +/- 0.05, 0.73 +/- 0.04 e 0.73 +/- 0.04, at time -12, 0 and +12, respectively. Height velocity changed from 4.18 +/- 0.47 cm/yr, -1.84 +/- 0.45 SDS for CA and -2.07 +/- 0.41 SDS for bone age (BA) during "off" period to 4.72 +/- 0.74 cm/yr, -1.05 +/- 0.83 SDS for CA and -1.31 +/- 0.77 SDS for BA during "on" period (p less than 0.001) with a variation of 0.53 +/- 0.56 cm/yr, 0.78 +/- 0.65 SDS for CA and 0.77 +/- 0.69 SDS for BA. BA resulted 6.57 +/- 1.55 years at time 0 and 7.34 +/- 1.54 years at time +12; HA/BA ratio changed from 0.86 +/- 0.07 at time 0 to 0.88 +/- 0.07 at time +12 (p less than 0.01) with a ratio between the two values of 1.01 +/- 0.02. Height and height velocity did not result statistically different between males and females or between subjects with delayed BA and those with non-delayed BA, while HA/BA ratio resulted significantly higher in the subjects with non-delayed BA than in those with delayed BA.(ABSTRACT TRUNCATED AT 400 WORDS)

Chronic granulomatous disease (CGD) is a genetic syndrome, mostly inherited as an X-linked recessive trait, characterized by severe and recurrent infections due to defective neutrophil leukocytes and monocytes respiratory burst and microbicidal activity. Consequently, the affected patients are prone to infections by catalase-positive bacteria and fungi. The Authors describe a case of X-linked CGD with red cells of the rare McLeod phenotype. These red cells show acanthocytosis and are not reacting with anti-Kx antibody. Moreover, the Authors discussed the diagnosis and chemotherapy of CGD in addition to biochemical and clinical characterization of McLeod phenotype.

The calcitonin (CT) gene encodes at least 3 peptides: CT, the 21-aminoacid carboxyl-terminal flanking peptide (katalcin or PDN-21) and CT-gene related peptide. Normal thyroid C-cells as well as malignant ones co-secrete CT and PDN-21 in response to hypercalcemia, so assay of PDN-21 may be an usefull method to assess C-cells secretion. Because of our knowledge no data are available on PDN-21 values in children, we measured this peptide in healthy children and in spasmophilia (Sp), a disease that has been related to CT deficiency. We studied 16 healthy children (9 males, 7 females; aging from 3.0 to 11.6 years) and in 21 patients with diagnosed Sp (8 males, 13 females, aging from 4.6 to 13.0 years). PDN-21 were assayed in whole serum by RIA using synthetic human PDN-21 for standards, 125I-PDN-21 for tracer and specific antiserum. CT was measured the serum of the same subjects by RIA using an ultrasensitive methods. In healthy children PDN-21 serum values were 12.3 +/- 2.0 pg/ml and no significant differences were found between males and females. Children with Sp showed slow higher PDN-21 concentrations (14.0 +/- 1.4 pg/ml) than normals, but the difference was not statistically significant. Also CT values were not significantly different between normal children (21.4 +/- 3.7 pg/ml) and patients with spasmophilia (22.5 +/- 1.8 pg/ml). A high significant positive relation was found between katalcacin and CT levels in normals as well as in spasmophilics. The physiological effects of PDN-21 are actually unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

Three children with selective deficiency of serum IgA associated with oligoarticular juvenile rheumatoid arthritis (JRA) are presented. Before the appearance of JRA, all 3 children had shown frequently some respiratory infections. Indeed IgA deficiency may be asymptomatic or may cause a higher frequency of respiratory, gastrointestinal, allergic or autoimmune diseases, among which, JRA is one of the most important conditions.

The authors evaluated bone mineralization by single photon absorptiometry and mineral homeostasis in 7 patients with anorexia nervosa. The patients with anorexia nervosa showed a reduction of bone mineralization in respect to age-sex matched normal values. Serum levels of calcium, ionized calcium, phosphate, magnesium, alkaline phosphatase, calcitonin and 25-hydroxyvitamin D were normal as well as phosphate and hydroxyproline urinary excretion. Osteocalcin levels were significantly low as compared to normal values (5.0 +/- 3.0 ng/ml vs 14.3 +/- 5.2 ng/ml, p less than 0.01) as well as urinary calcium excretion (0.02 +/- 1.01 vs 0.08 +/- 0.06, p less than 0.05); 1,25-dihydroxyvitamin D values were low only in 4 patients. Parathyroid hormone means levels were increased in respect to normal values (74.1 +/- 12.7 pg/ml vs 38.0 +/- 12.0, p less than 0.02). We confirm that adolescents with anorexia nervosa showed a reduced bone mineral content and alterations of mineral homeostasis that may contribute to the development of bone mineral loss.

Some tests to study the dynamic secretion of calcium-regulating hormones in childhood are presented. A low-calcium diet (less than or equal to 2 mg/kg/daily) for 1,25-dihydroxyvitamin D [1.25-(OH)-2D], ASU-eel-CT i.m. injection (80 U MRC/1.73 mq) for parathyroid hormone (PTH), and calcium infusion (2 mg/kg in 5') for calcitonin (CT) are employed. A significant increase in 1,25-(OH)-2D level (1 degree day: 47.0 +/- 6.7 pg/ml; 3 degree day: 73.2 +/- 6.9 pg/ml; p less than 0.001; n = 19), intact PTH values (basal: 29.7 +/- 7.5 pg/ml; +120': 68.2 +/- 7.8 pg/ml; p less than 0.001; n = 10) and monomeric CT concentrations (basal: 5.2 +/- 2.3 pg/ml; +10': 26.2 +/- 4.4 pg/ml; p less than 0.001; n = 18) have been observed. The employed tests are able to show a significant increase in calcium-regulating hormones in healthy children. These tests are a simple and reliable method without side-effects that may provide further information on the pathogenesis of some pediatric diseases with altered mineral homeostasis.