Search

Objective: To study the changes in body composition during a weight reduction program in obese children and adolescents., Design: A short-term longitudinal study., Subjects: Forty-one obese children and adolescents (19 M, 22F, age 8.5-14.8 [median 11.8] years., Measurements: Lean body mass (LBM) was estimated from Resistance Index (RI) obtained by Bioelectrical Impedance Analysis (BIA) before and after the 3 week program., Results: Mean percentage weight for height at baseline was 151 (s.d. 20)% and significantly decreased at the end of the three weeks (139 (s.d. 18)%, P = 0.005). The mean percentage body fat also decreased (from 46.0 s.d. 5.8% to 41.5 s.d. 6.5%, P = 0.0015). All individuals lost body fat during the three weeks, whereas the change in LBM was heterogeneous. The individual change in body fat was inversely correlated with the change in LBM (r = -0.64, P = 0.0001). After 4 months, 18 out of the 41 children could be reevaluated for height and weight. The regain in body weight during these 4 months was inversely correlated with the change in LBM during the weight reduction program (r = -0.55, P = 0.018)., Conclusions: Changes in LBM during a weight reduction program can predict the short term result those children who manage to increase LBM having the greatest reduction in body fat. Changes in LBM during weight reduction seem also to predict the longterm outcome, a reduction in LBM being associated with greater regain of weight. Weight reduction programs for obese children should focus not only on weight loss but also on maintenance or increase of lean body mass to improve longterm results.

A new Method for HbA1c measurements (Abbott vision) was evaluated. 107 patients (45 F, 62 M) of a paediatric diabetes clinic participated. The mean age was 14.9 (5.8-26.3) years, the mean duration of diabetes was 7.6 (0.1-21.1) years. Measurements were performed immediately after capillary blood sampling, the result was available within 15 min. The automated HPLC-system Diamat was used as a reference method, blood samples were stored at 4 degrees C and analysed within 24 h after blood sampling. There was a close correlation between both methods (r = 0.96, P < 0.0001). In the lower range the results measured by Abbott Vision were slightly lower, whereas in the higher range the results were slightly higher (HbA1c (Abbott) = 1.53 + HbA1c (Diamat).0.84). The accuracy seems to be satisfactory for estimating metabolic control. The HbA1c-result is available within 15 min which means a major advantage for the management of children and adolescents with type I diabetes.

We describe a further case of SHORT syndrome. This girl shows nearly all the typical manifestations reported in patients with SHORT syndrome. However, at 14 years she presented with non-ketotic hyperglycemia. At 16 1/2 years, the diagnosis of diabetes mellitus secondary to severe insulin resistance was made by intravenous insulin challenge. Insulin resistant diabetes mellitus seems to be a new finding in SHORT syndrome, not previously described in this condition.

Unlabelled: Children with type I diabetes often believe that they are able do gauge their blood glucose value without measurement. This study investigated how accurate these estimates are and which of the patient characteristics might affect accuracy. Nineteen children with type I diabetes (age 7.3-17.3 years, duration of diabetes 0.1-12.0 years) estimated their blood glucose immediately before a blood glucose measurement by reflectance meter. Ten to 54 estimations and measurements were done by each individual during a summer camp. According to the method of Cox et al. accuracy of estimates was evaluated by error grid analysis. Five zones were defined: accurate estimates (zone A); clinically benign errors (zone B); clinically dangerous errors (zone C, D, E). An overall accuracy index was calculated by subtracting the summed percentage of estimates in zones C, D, E from the percentage in zone A. The mean percentage of estimates in zone A was 41.5 (10.0-75.0)%, the mean overall accuracy index was 9.8 (-47.4-62.5)%. Except for mean blood glucose which was inversely correlated with accuracy index (r = -0.53, P = 0.02) none of the other patient characteristics showed an effect on accuracy index., Conclusions: Accuracy of blood glucose estimates is lower in children with type I diabetes than in adults and varies substantially between individuals. High mean blood glucose values are associated with a lower accuracy of estimates.

The venous cord blood levels of free thyroxine (fT4), free triiodothyronine (fT3), reverse triiodothyronine (rT3), thyrotropin (TSH), thyroglobulin (TG) and thyroxine binding globulin (TBG) were studied in 56 mature and healthy newborns. Newborns with a gestational age less than 37 or more than 42 weeks, a delivery by forceps or cesarian section, a birth-weight less than 2500 g, a pH-value of the cord-artery blood less than 7.15, an Apgar-value after 1 minute less than 7 were excluded from the study. All mothers were non-smokers. The values of fT4 were 18.66 +/- 4.18 pmol/L, of fT3 were 1.59 +/- 0.75 pmol/L, of fT3 were 2152 +/- 666 pg/ml, of TSH were 7.83 +/- 4.49 mU/ml, of TG were 44.61 +/- 23.84 ng/ml, and of TBG were 25.61 +/- 5.42 micrograms/ml. A weak negative correlation was found between the TG-value and the pH-value of the cord-artery blood (r = -0.27, y = 191.55 - 22.82.x, p less than 0.05), and between the fT4 values and the gestational age (r = -0.34, y = 67.53-1.22.x, p = 0.01). The rT3-values were positively correlated to the gestational age (r = 0.29, y = -4571 + 167.x, p less than 0.03).

Intrauterine supraventricular tachycardia with consequent congestive heart failure is a high-risk fetal complication. It is one of the causes of non-immunological hydrops fetalis and may lead to premature delivery or even fetal loss. We report the successful intrauterine treatment of a case of hydrops fetalis due to supraventricular tachycardia by administration of digoxin and verapamil to the mother. Echocardiography is diagnostic and mandatory for follow up.

Endocrinological function was evaluated in 31 children after successful treatment of acute lymphoblastic leukaemia. All patients had received combination chemotherapy and 12-24Gy of cranial irradiation according to the German therapy protocols BFM-81, BFM-83 and BFM-86. Height, weight, bone age and pubertal development, as well as hypothalamic-pituitary function were measured. Long-term linear growth was unaffected in all patients. However, 9 patients showed subnormal serum growth hormone levels in response to pharmacological stimulation of the pituitary. All patients had normal levels of T3 and T4, but one patient showed an increased response of thyrotropin to thyrotropin releasing hormone. All prepubertal and postpubertal children demonstrated appropriate secretion of follicle-stimulation hormone (FSH) and luteinizing hormone (LH) after stimulation with LH-releasing hormone (LH-RH). 3 pubertal girls showed adequate oestradiol levels, but abnormally high levels of gonadotropins in response to LH-RH. Sexual development was normal in two of them, but the third had a late menarche and irregular menses. The significance of these findings is discussed in the context of recommendations possibly to further reduce or completely delete prophylactic cranial irradiation.

The precision and accuracy of reacted reagent strips (Haemoglucotest 20-800 R, Reflocheck) stored in an envelope and analysed 24 and 48 hours later, by means of glucose reflectance meters (Reflolux II, Reflocheck) was studied. A good correlation of the values estimated after 24 and 48 hours to the value analysed immediately after sampling was found for both systems (Reflolux II 24 hours later, r = 0.9713, y = 24.16 + 0.7369. x, and 48 hours later, r = 0.9388, y = 44.21 + 0.5234. x; Reflocheck 24 hours later, r = 0.977, y = 9.72 + 0.9525. x, and 48 hours later, r = 0.9433, y = 45.97 + 0.4802. x). Our data show, that the initial value can be calculated using the 24 and 48 hour values by means of linear regression. Therefore the analysis of reacted reagent strips for blood glucose determination is beneficial in the management of Typ-I-Diabetics.

Sexual behavior has changed during the last decades. Teenage fertility rate, and the number of gonococcal infections are both extremely high; the incidence of HIV-infections is increasing. Preventive measures include sex education. Sex education may help the adolescents to identify their own goals for sexual behavior, to avoid unintended and unwanted pregnancy, and to avoid sexually transmitted diseases.

A now 10 month old female infant suffered from persistent non ketotic neonatal hypoglycemia despite continuous intravenous application of glucose (greater than 10 mg/kg/min). There was only a transient response of blood glucose after intravenous administration of glucagon and prednisolon. Biochemical findings indicated hyperinsulinismus (insulin level of 26 mE/ml during hypoglycemia). Oral diazoxid treatment in high doses (22 mg/kg) stopped hypoglycemia episodes for several days but the newborn remained glucose infusion depended. Finally the treatment had to be interrupted because of vomiting. At the age of 4 1/2 weeks a subtotal pancreatectomy was performed. The histological examination of the pancreas confirmed the clinically suspected diagnosis of nesidioblastosis. After pancreatectomy the infant required insulin therapy. Since six months the girl is without insulin in a good condition. Despite periods of arrested head growth before pancreatectomy the psychomotoric development is normal.

We report on 143 newborns of mothers with insulin dependent diabetes during pregnancy. The mean birth weight was 3.091 (+/- 619) g at a mean gestational age of 38.4 (+/- 2) weeks. Neonatal morbidity was associated with the disease class, insulin levels in the amniotic fluid, urine and cord blood; and especially persistent fetal hyperinsulinism as indicated by repeatedly high amniotic fluid insulin levels during pregnancy. One infant died (neonatal mortality 0.69%) of a severe cardiac malformation combined with a caudal regression syndrome. This was the only major malformation in the group.

Aseptic bone necrosis is a well known complication after corticosteroid treatment in adults and several hundred cases have been reported. Alterations in fat metabolism with vascular occlusion due to fat embolization, as well as microtraumata and osteoporosis are discussed as etiologic factors. In contrast, aseptic bone necrosis in relation to corticosteroid treatment is rare in children and adolescents. We therefore report 3 patients, aged from 10 to 18 years, suffering from severe aplastic anemia, meningeal relapse after acute lymphocytic leukemia and acute myelocytic leukemia respectively, who developed aseptic bone necrosis 6, 11, and 20 months following the onset of corticoid therapy. The patients survive from 28+ to 50+ months after diagnosis of their initial hematologic disease, as it can be expected today for increasing numbers of patients. We therefore believe, that aseptic bone necrosis may represent a serious therapy related complication and suggest that, diagnostic examination in patients with suspicious complaints of the hip, shoulder or knee should also exclude the possibility of a bone necrosis after leucemic relapse has been ruled out. Since radiological changes only develop several weeks to months after the onset of the clinical symptoms and because of the disabling consequences for patients, misdiagnosed at the beginning, a 99 technetium bone scan should be done as early as possible. Corticosteroids, despite their serious side effects are still being considered as a important part of hematologic therapy and are not being omitted in the near future, so that the earliest possible diagnosis of bone necrosis will remain of great importance.(ABSTRACT TRUNCATED AT 250 WORDS)

Ten children who underwent allogeneic (n = 5) or autologous (n = 5) bone marrow transplantation (BMT) for chronic myelogenous leukaemia (n = 2), acute lymphoblastic leukaemia (n = 1), acute myelogenous leukaemia (n = 2), severe aplastic anaemia (n = 2), malignant histiocytosis (n = 1), neuroblastoma (n = 1) and teratoma (n = 1) were assessed for endocrinological function. Transplant preparative regimens consisted of high-dose cyclophosphamide, high-dose cyclophosphamide in combination with high-dose busulphan, high-dose melphalan as well as BACT (BCNU, cytarabine, cyclophosphamide and 6-thioguanine) chemotherapy. None of the patients received total body irradiation (TBI). Median survival following BMT was 37 months (range 7-115). Growth hormone deficiency was present in only one patient; none of the patients had abnormal thyroid or adrenocortical function. This is in contrast to previous reports in which growth hormone deficiency and abnormal thyroid and adrenocortical function occurred in a much higher percentage of patients after BMT conditioned with TBI.