Variation of bone age progression in healthy children.

Bone age assessments were related to auxological variables in 407 Italian boys, between 7 and 12 years of age, in order to elucidate the factors that affect the rate of skeletal maturation and to examine the possibility of using measures of skeletal maturation of evaluate individual patients. Using the radius-ulna-short bones (RUS) method of assessment, bone age velocity was greater in the Italian boys than for the UK reference standards, although there was considerable interindividual dispersion around the mean. Bone age velocity and height velocity were poorly correlated, and there was little correlation between skeletal and pubertal maturation. There was a slight positive correlation between bone age velocity and height SDS and between bone age velocity and body mass index. Bone age estimations using RUS were greater than those obtained using the carpus. In conclusion, the marked interindividual deviation in measured bone ages makes it difficult to relate data on an individual basis to other measures of growth and maturation

Body proportionality of the small-for-date fetus: is it related to aetiological factors?

The classification of small-for-gestational-age (SGA) fetuses into symmetrical and asymmetrical has been widely used since the introduction of ultrasound into obstetric diagnosis. The purpose of this study was to assess the possibility of relating body proportionality of the SGA fetuses to aetiological factors. Ultrasound measurements of the head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained in 348 SGA fetuses subdivided into aetiological groups (structural and/or chromosomal anomalies, twins, abnormal placental vascularization, maternal malnutrition, infectious diseases, drug addiction, unknown). The difference in Z-score between each couple of parameters (HC-AC, HC-FL, FL-AC) was used to assess the presence of asymmetry and its degree. The distribution of the Z-score differences was Gaussian; +1 S.D. and +2 S.D. were chosen as cut-off values of the Z-score for the definition of asymmetry. No significant differences in the frequency of HC-AC asymmetry could be detected among aetiological groups. SGA fetuses with abnormal placental vascularization and those with congenital malformations were more frequently asymmetric for the difference HC-FL and less frequently asymmetric for the difference FL-AC compared to the ones of unknown cause. It is concluded that body proportionality among SGA fetuses is a continuum, and that information about it derived from ultrasound measurements is of limited use in clinical practice.

Main problems associated with bone age and maturity evaluation.

In scientific papers, skeletal maturation-expressed as bone maturity scores or bone age-is often used as a quantifiable variable similar to height or weight. This paper discusses whether this approach is appropriate. The questions addressed are whether skeletal maturation can be measured on a quantitative scale, whether its use is appropriate in computing, and what the 'numbers' used represent. Reference will be made mainly to the Tanner-Whitehouse method, which, in the opinion of the authors, has been the most reliable method of assessment to date. Many of the remarks made in this paper may be extended to other methods of assessment, and have been stressed by Tanner himself. The authors are aware that, in the future, some of the remarks could be made redundant by the development of more detailed definitions of bone maturation. This is becoming feasible with the advent of expert systems for the automatic recognition of different stages of bone maturation.

Growth velocity monitoring of the efficacy of different therapeutic protocols in a group of thalassaemic children.

Since intensive chelating therapy for thalassaemic children was introduced, growth rates appear to have diminished. To investigate what factors were responsible we compared velocities of growth in length over a period of 1 year between groups distinguished by different strategies of treatment. Forty-two thalassaemic patients, 30 males aged 4-12 years, and 12 females, 4-10 years old, were assigned from their current treatment into subgroups based upon blood ferritin levels, daily dose of desferrioxamine and urinary zinc levels. CONCLUSION The results confirm that a reduction in desferrioxamine results in greater growth. If blood ferritin is low, the change effect may be greater. Secondly, any zinc deficiency should be treated. The changes in treatment convert a growth velocity of -2 to -3 SDS to a velocity of about -1 SDS.

The distribution of age at menarche in a random series of Turin girls followed longitudinally.

A longitudinal study on 508 girls chosen at random from the elementary schools of Turin showed that age at menarche had a Gaussian distribution. The mean age was 12.58 +/- 0.05 years. Peaks of incidence of menarche were observed in January and July-September. The correlation coefficient of mothers' (recollected) age at menarche with daughters' was 0.32.

Distinctive skeletal dysplasia in Cockayne syndrome.

Cockayne syndrome is a well-known autosomal recessive form of dwarfism with senile-like appearance. Skeletal changes such as flattening of vertebral bodies, ivory epiphyses and thickening of cranial vault, have been observed in some patients with this condition. We describe here a 5.5-year-old girl with the typical clinical signs of Cockayne syndrome and a distinctive form of bone dysplasia with major involvement of the spine.

[The age of menarche]. / L'epoca del menarca.

PIP: A review of the literature concerning age at menarche is presented, and the various methods for measuring age at menarche are described. Factors considered include genetic and ethnic factors, family characteristics, physique, geographic factors, morbidity, and socioeconomic factors. The results of a wide range of studies from historical times to the present are summarized. The geographic focus is worldwide. (summary in ENG)^ieng