Foetal alcohol syndrome: a dental and skeletal age analysis of patients and controls.
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Foetal alcohol syndrome (FAS) consists of multisystem abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human foetus has now been established beyond reasonable doubt and FAS is one of the most important human teratogenic conditions known today. The purpose of this study was to assess the dental age (DA) and skeletal age (SA) of children with FAS and compare them with matched controls. The samples of 90 children diagnosed with FAS and 90 controls were matched for age, gender, and social class. The mean chronological age (CA) of the FAS subjects was 8.95 years, with the controls slightly older at 9.04 years. This difference was not significant. Dental maturity was determined by assessing the stage of tooth formation and SA assessment was made from hand-wrist radiographs for the patients and controls by assigning a SA and comparing it with standard plates. The means and standard deviations of CA and DA for the stages of calcification were calculated and the Pearson ranked order correlation coefficient was applied to measure the associations between skeletal maturity indicators and DA. t-tests were used to test for group differences between independent groups, and paired t-tests to determine paired group differences. This study provided evidence of a positive association between DA and SA in both the FAS children and the controls. The data suggest that both DA and SA may be a reflection of general somatic growth. It must be acknowledged that growth of individuals is often irregular, when any norms of development based on central tendencies and variabilities of healthy children are applied. Some aspects of growth and development for healthy children may show a variable pattern of growth. Therefore, correlation of these aspects of growth and development will often not show the degree of correlation that theoretically exists between different areas of growth and development. A more complete appraisal of the entire skeleton and an evaluation of the entire dentition, rather than just the mandibular teeth, might improve the correlation between the variables. (+info)
Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche.
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OBJECTIVE: To determine if uterine and ovarian measurements can significantly distinguish between precocious puberty (PP) and premature thelarche (PT) and whether ultrasound has any advantage over the gonadotropin-releasing hormone (GnRH) stimulation test. DESIGN: Prospective. METHODS: One hundred and three girls referred consecutively for evaluation of breast budding before age 8 years underwent physical examination, GnRH stimulation test, bone age assessment, and transabdominal pelvic ultrasound. The diagnosis of PP or PT was based on clinical judgment. The clinical, laboratory, and ultrasound data of the PP and PT groups were compared. RESULTS: Eighty-one girls were diagnosed with PP and 22 with PT. Significant differences in most of the uterine and ovarian measurements were found between the groups. On logistic regression analysis, bone age standard deviation score, uterine transverse diameter, and uterine volume were the most significant variables predicting PP. Comparison of 30 girls with PP and 21 with PT in whom peak luteinizing hormone was <5 mIU/ml on the GnRH stimulation test, using analysis of variance, yielded significant differences in uterine width (P<0.001), fundus diameter (P <0.04), uterine volume (P= 0.006), and ovarian circumference (P <0.02). CONCLUSIONS: Increased uterine and ovarian measurements may be an early and sensitive sign of PP. Pelvic ultrasound, a noninvasive, inexpensive, and reliable tool, may give the clinician a complementary indication to the GnRH test in distinguishing isolated PT from early-stage PP in girls with early breast budding. (+info)
Bone age and onset of puberty in normal boys.
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Many conditions that delay skeletal maturation also delay the onset of puberty, whereas conditions that accelerate skeletal maturation often hasten the onset puberty, raising the possibility that skeletal maturation influences pubertal onset. To determine whether this concordance is also present in normal children, we analyzed data from 30 normal boys participating in a longitudinal study. Height, weight, and serum testosterone concentrations were assessed every 6 months and bone age (Fels method) every year. Pubertal onset was defined by serum testosterone > or =30 ng/dL. The variability in bone age at onset of puberty was not less than the variability in chronological age. In addition, there was no significant correlation between skeletal advancement and pubertal advancement (r=0.01, P=0.9). Similarly, there was not a significant correlation between pubertal advancement and height age advancement, weight age advancement, or BMI age advancement. Our findings do not support the hypothesis that skeletal maturation directly influences the age of pubertal onset in normal boys. (+info)
Evidence for involvement of the vitamin D receptor gene in idiopathic short stature via a genome-wide linkage study and subsequent association studies.
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Stature is a highly heritable trait under both polygenic and major gene control. We aimed to identify genetic regions linked to idiopathic short stature (ISS) in childhood, through a whole genome scan in 92 families each with two affected children with ISS, including constitutional delay of growth and puberty and familial short stature. Linkage analysis was performed for ISS, height and bone age retardation. Chromosome 12q11 showed significant evidence of linkage to ISS and height (maximum non-parametric multipoint LOD scores 3.18 and 2.31 at 55-58 cM, between D12S1301 and D12S1048), especially in sister-sister pairs (LOD score of 1.9 for ISS in 22 pairs). These traits were also linked to chromosomes 1q12 and 2q36. The region on chromosome 12q11 had previously shown significant linkage to adult stature in several genome scans and harbors the vitamin D receptor gene, which has been associated with variation in height. A single nucleotide polymorphism (SNP) (rs10735810, FokI), which leads to a functionally relevant alteration at the protein level, showed preferential transmission of the transcriptionally more active G-allele to affected children (P=0.04) and seems to be responsible for the observed linkage (P=0.05, GIST test). Bone age retardation showed moderate linkage to chromosomes 19p11-q11 and 7p14 (LOD scores 1.69 at 57 cM and 1.42 at 50 cM), but there was no clear overlap with linkage regions for stature. In conclusion, we identified significant linkage, which might be due to a functional SNP in the vitamin D receptor (VDR) gene and could be responsible for up to 34% of ISS cases in the population. (+info)
Age determination by magnetic resonance imaging of the wrist in adolescent male football players.
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BACKGROUND: In football there are established age-related tournaments for males and females to guarantee equal chances within the game for all the different age groups. To prevent participation in the incorrect age group, and owing to the fact that in some Asian and African countries registration at birth is not compulsory, other methods of age determination need to be available. Standard radiographs of the left wrist have been used for assessment of skeletal age for many years. This is, however, not ethical in the sporting environment. AIM: To study the possible use of magnetic resonance imaging (MRI), which has no radiation risk, in estimating the age of healthy adolescent football players. METHODS: The examination protocol was applied in four countries using, their respective MRI equipment using a 1-T or 1.5-T magnet and a wrist coil. 496 healthy male adolescent football players between the ages of 14 and 19 years from Switzerland, Malaysia, Algeria and Argentina were selected for the study. The degree of fusion of the left distal radial physis was determined by three independent raters by a newly developed grading system which can be used in future MRI epiphysial fusion grading studies. RESULTS: The inter-rater reliability for grading was high (r = 0.91 and 0.92); all correlations were highly significant (p<0.001). The average age increased with a higher grading of fusion, and the correlation between age and grade of fusion was highly significant (r = 0.69, p<0.001). Only one player (0.8%) in the 16-year-old age group was graded as completely fused. CONCLUSION: MRI of the wrist offers an alternative as a non-invasive method of age determination in 14-19-year-old male adolescents. The grading system presented here clearly identifies the skeletal maturity by complete fusion in all MRI slices, which eliminates any risk associated with standard radiographic rating as determined by the International Atomic Energy Agency. (+info)
Comparative evaluation of hand wrist radiographs with cervical vertebrae for skeletal maturation in 10-12 years old children.
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A comparative evaluation of hand wrist and cervical vertebrae was done to know the validity of cervical vertebrae as maturity indicators. A sample of 50 subjects (25 females and 25 males) in the age group of 10-12 years were selected on criteria of normal occlusion and the result showed that cervical vertebrae can be used with the same confidence as hand wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph. (+info)
Failure of laboratory and radiological studies to predict jejunal mucosal atrophy.
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Of 58 children with suspected malabsorption, 27 were shown to have subtotal or partial atrophy, and 31 had normal mucosal histology. Oral glucose tolerance tests, faecal fat excretion, D-xylose excretion tests, Prosparol absorption studies, haematological investigations, and radiological examination of the small bowel failed to distinguish these two groups and frequently gave misleading results. It is concluded that in suspected coeliac disease small intestinal biopsy should be performed as a primary investigation. (+info)
Discordant twins with the smaller baby appropriate for gestational age--unusual manifestation of superfoetation: a case report.
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BACKGROUND: Documentation of superfoetation is extremely rare in humans., The younger foetus has invariably been small for gestational age (estimated from the date of the last menstrual bleed) in all the cases reported in the literature. We report a case where the younger twin was of appropriate size for gestation. CASE PRESENTATION: The first of twins was of 32 weeks gestation and the baby was of appropriate size and development for the gestational age. The second twin was of 36 weeks gestation. Gestational age was estimated with the New Ballard score, x-ray of the lower limbs, dental age on x-ray, and ophthalmic examination. CONCLUSION: Bleeding on implantation of the first foetus probably helped demarcate the two pregnancies. Dental age and the New Ballard score can be used to diagnose superfoetation in discordant twins, when detailed first trimester ultra-sound data is not available. (+info)