Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle

During childhood the lung not only grows in size but alveoli and arteries multiply and the pattern of muscularity of the arteries changes. A quantitative study is here reported on 4 cases of scoliosis. The limitation and distortion of space available affect lung growth. In scoliosis, alveoli are too few in number, often emphysematous, and may even atrophy, the changes being irregularly distributed throughout a lobe or lung. Generally, the size of the large pulmonary arteries is appropriate to the lobar volume and hence small for the age of the child: arterial muscle hypertrophy and abnormal extension to the periphery were seen only in 2 of the 4 cases in which there was right ventricular hypertrophy. In these, hypoxaemia had been present for some time before death and this, not hypoplasia, seemed responsible for the muscle hypertrophy. In 2 cases where scoliosis was associated with a mesodermal dysplasia, there was an excessive number of intra-acinar arteries.     

Prenatal progesterone I. Its effect on development and on intellectual and academic achievement

The development of two groups of children whose mothers had been given progesterone supplements during pregnancy to relieve symptoms of toxaemia was assessed, one group at 2 yr of age and the other at 16 yr of age. There was no evidence that progesterone supplements accelerated development in the 2-yr-old age group or enhanced intellectual and academic attainment in the 16-yr-old age group. In addition, the evidence regarding the reported beneficial effects on intellectual attainment of in utero exposure to excess sex steroids is discussed.     

Effects on Control and Growth

ABSTRACT. Jansen, M., Wit, J. M. and Van den Brande, J. L. (Departments of Paediatrics, Universities of Rotterdam and Utrecht, the Netherlands). Reinstitution of mineralo-corticoid therapy in congenital adrenal hyperplasia. Effects on control and growth. Acta Paediatr Scand, 70:229, 1981. –The results of reintroduction of mineralocorticoid substitution therapy (9-α-fluorohydrocortisone) in five children with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency are described. All children had shown a salt-losing syndrome in infancy, but were off mineralocorticoids during several years; at the start of this study they all had elevated plasma renin activity (PRA). Four of them had increased and fluctuating pregnanetriol excretion during the year preceding reintroduction of mineralocorticoids, indicating poor control despite substantial substitution with hydrocortisone: 26±1.9 mg/m²/day (mean±S.E.M.). Reintroduction of mineralocorticoid therapy at ages 5.0–9.4 years resulted in a marked improvement of control, significant reduction in hydrocortisone requirements (to 17.6±1.4 mg/m²/day) and improvement in linear growth. The data suggest that, in all children with CAH and elevated PRA, continuation throughout childhood of mineralocorticoid therapy in addition to glucocorticoid therapy is necessary for optimal control and linear growth.     

Smoking during pregnancy--effects on the fetus and on thiocyanate levels in mother and baby.

Twenty-eight mothers smoking 10--20 cigarettes daily during pregnancy had significantly higher serum thiocyanate concentrations at delivery compared in 25 non-smoking controls. The thiocyanate levels were positively correlated to cigarette consumption and inversely correlated to the birth weights of the infants. A highly significant correlation existed between serum thiocyanate levels of the mother and umbilical cord serum thiocyanate levels, reflecting a nearly complete equilibration. The thiocyanate concentrations in human milk on the 4th day after delivery were considerably lower than the serum concentrations, and no correlation existed between serum and milk concentrations. The infants of smoking mothers had significantly decreased weight and length at birth compared in infants of non-smokers. Birth weights were 3 344 +/- 434 g and 3 620 +/- 504 g respectively (p less than 0.05), and lengths 49.8 +/- 1.7 cm and 51 +/- 1.6 cm respectively (p less than 0.05). No differences were found between smokers and non-smokers in placental and umbilical cord histology, and umbilical cord artery medial area. It is concluded that serum thiocyanate concentration in smokers may be used as an objective measure for smoke exposure, and that maternal cigarette smoking acts as an exogenous factor which interferes with intrauterine development of the fetus in a dose related way.     

重度尿道下裂分期手术与一期手术的疗效比较

目的 通过分析分期手术与一期手术的临床特点和疗效差异,总结重度尿道下裂的治疗经验.方法 回顾性分析2005年9月-2011年7月重度尿道下裂92例,年龄8个月～23岁,中位年龄4.8岁.全组均为首次手术病例,其中分期手术32例,一期手术60例.比较2组阴茎阴囊转位情况、阴茎伸直前后尿道外口位置、尿道缺损长度、并发症、手术成功率.结果 2组阴茎阴囊转位的差异无统计学意义(P =0.303 9).2组手术成功率的差异无统计学意义(P =0.796 1).分期手术组阴茎伸直后尿道外口位于阴囊的比率高于一期手术组(P=0.022 8),分期手术组尿道缺损平均长度大于一期手术组(P=0.0001),一期手术组尿道狭窄发生率高于分期手术组(P=0.0441).结论 重度尿道下裂手术方式的选择必须在阴茎伸直以后才能决定.如果尿道缺损长度超过Duckett皮管和Duplay皮管总长度,应该选择分期手术.尽管分期手术与一期手术成功率没有明显差异,但是手术方式选择的失误将导致尿瘘或者尿道狭窄的高发生率.