Growth charts, growth velocity and bone development in childhood obesity.

OBJECTIVE: To compare the growth charts of obese subjects (4-18 years) with the Tanner's growth curves and to analyze the growth velocities and bone age of obese children in prepuberty and adolescence. Moreover to compare the relationship between the serum insulinemic and glycemic levels and height standard deviation score (HSDS). DESIGN: Growth charts: this study included 1250 obese subjects (669 males, 581 females) observed between 1981 and 1993 and divided into seven age categories (4-6, 7-8, 9-10, 11-12, 13-14, 15-16, 17-18 years). Growth velocities: yearly growth velocities of 579 obese subjects (325 males, 254 females) were compared to growth velocities of 473 controlled children of the same sex, chronological age and pubertal stage. Bone age (BA) of 846 obese subjects (470 males, 376 females) was estimated. Blood analysis: insulin secretion of 70 obese children was considered and compared to 70 lean controls of equal chronological age and sex. MEASUREMENTS: Growth rate, standardized height and other physical characteristics of the children were measured by trained examiners. All subjects were evaluated singularly for at least 4 years with a follow-up every 6 months. BA was estimated by radiograph of the left hand and wrist using the Tanner-Whitehouse II system by a single observer. For the insulin secretion study and glycemic levels oral glucose tolerance test (OGTT) was performed using a glucose load of 1.75 g/kg per body weight. Plasma insulin was assessed by a double antibody radioimmunoassay. RESULTS: In adipose children the growth charts, referred to 97th centile, 50th centile and 3rd centile, were superior to those of the normal population up to the age of 13 and 12.5 years for male and for female respectively; growth decreases at the above age in both sexes. The obese subjects were equal in height to the non obese subjects as they reached their 18th birthday. The growth velocity (cm/yr) of the obese child, in the age range considered here, does not show differences when compared with the lean child in the prepubertal status (P not significant) but decreases during Tanner's stage II, III IV in boys and girls (P < 0.0001). BA is more advanced over chronological age (delta BA-CA) in both sexes. The increase of BA over CA does not show a remarkable difference during pubertal maturation in boys (P not significant); whereas in girls the delta BA-CA decreases with advancing sexual maturation (P < 0.0001). Our obese subjects have significantly higher plasma insulinemic levels compared with the lean controls (P < 0.0001). Moreover there is a positive correlation between plasma insulinemic levels and HSDS (r = 0.881, P < 0.0001). We did not observe a correlation between serum glycemic levels and HSDS. CONCLUSION: Our data demonstrate that the growth increase in an obese child starts in the first years of life. The statural advantage acquired in the first years of life would be exploited and maintained up to the beginning of puberty and with a growth velocity equal to that of the lean subject. Skeletal maturation is strongly increased in both sexes. Bone age remained advanced during the entire period of pubertal development. During puberty obese subjects demonstrate a less notable growth spurt when compared with lean subjects. The growth advantage gradually decreases and final adult height of obese and normal subjects is equal.

Transvenous sclerotherapy of the gonadal veins for treatment of varicocele: long-term results.

Percutaneous occlusion of the spermatic vein has been performed on 136 consecutive patients with varicocele scroti during the last six years. The authors report their long-term results on the first 119 cases to have a follow-up of at least six months. Occlusion of the insufficient gonadal vein is induced by the selective transcatheter injection of sclerosing agent with local anesthesia. Their patients are always evaluated before and after the procedure by Doppler examination. A spermiogram is done before the procedure and after six months. In this series they registered only 4 recurrences with no major complications.

[Embolization of the splenic artery in cirrhotic patients with portal hypertension. Ultrasound results and follow-up]. / L'embolizzazione dell'arteria splenica nei pazienti cirrotici con ipertensione portale. Risultati e controlli ecografici.

Over the last four years the authors performed transcatheter embolization of the splenic artery by Gianturco coils in 32 consecutive cirrhotic patients with portal hypertension, splenomegaly, cytopenia and gastro-esophageal varices endoscopically proved. This procedure was especially useful for treatment of splenomegaly and cytopenia because a constant reduction of spleen dimensions and increase in platelet count were registered. The effectiveness of transcatheter embolization and follow-up are based on clinic, hematologic and sonographic findings. We believe sonographic monitoring to be very useful both to evaluate splenomegaly and signs of portal hypertension and to reveal splenic complications (abscesses). We never registered severe complications.

Therapeutic embolization of renal artery to control severe hypertension due to renal trauma.

In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.

Effects of age, education and sex on two tests of immediate memory: a study of normal subjects from 20 to 99 years of age.

Spatial span (Corsi's block-tapping test) and verbal span (Wechsler Digits Forward) were measured in 1354 normal subjects, aged from 20 to 99 yr., who were subdivided into seven age groups, into three groups according to education, and according to sex. Analysis of variance showed that the three main factors were significant for the spatial span test. The two spans examined held well up to the 60s, and only after this age did significant differences appear in the other age groups. On both tests there were significant differences between the groups divided according to education.

[Percutaneous treatment of varicocele]. / Trattamento percutaneo del varicocele.

Percutaneous occlusion of the spermatic vein has been performed in 104 patients with varicocele in the last five years. We report our long-term results on the first 87 cases with a follow-up of at least six months. The occlusion of the gonadal vein is generally induced by selective transcatheter injection of sclerosing agent. Our patients are always evaluated before and after sclerotherapy by telethermography and/or doppler examination. Furthermore spermiogram is obtained before and six months after therapy. We registered only four recurrences with no major complications.

[Pharmacological test with cerulein during manometric cholangiography via external biliary drainage]. / La prova farmacologica con ceruleina durante colangiografia manometrica attraverso drenaggio biliare esterno.

The manometric post-operative cholangiography through external drainage is now a method of everyday use. However in some cases the substenotic appearance of the terminal bile tract and of the Oddi's sphincter gives rise to doubts as to the real cause of this alteration. Caerulein solves the functional hypertone. It also starts a good peristalsis of the terminal bile tract, reducing the intrabiliary pressure and causing an evident transpapillary passage. Thus, the use of this substance allows a differential diagnosis between organic or functional stenosis.