Single-incision pediatric endosurgery-assisted ileocecectomy for resection of a NEC stricture

A single-incision pediatric endosurgery (SIPES) has not been typically used for operations in premature infants yet. We report a case of a 3-month-old 25-week premature infant who underwent SIPES-assisted ileocecal resection for a stricture after medically treated necrotizing enterocolitis. The patient recovered uneventfully, and was discharged on full feeds 15 postoperatively with virtually no appreciable scar. SIPES is a reasonable alternative for NEC stricture resection in premature infants. Prematurity should not be considered a contraindication to single-incision endosurgery.     

Laparoscopy in uterovaginal anomalies

Providing its excellent visualization, access to pelvic structures, and less postoperative adhesion, laparoscopy has been an important tool for the treatment of uterovaginal anomalies. We have used it to define the anomaly, monitor endometriosis or a hysteroscopic procedure, replace an absent vagina, and resect abnormal Müllerian structures. This article details the technique and reports the results of the use of operative laparoscopy for the treatment of uterovaginal anomalies in children and adolescents. The author's experience demonstrates some"nonclassical" applications of endosurgery in the management of these anomalies in the pediatric age.     

The rabbit model serves as a valuable operative experience and helps to establish new techniques for abdominal and thoracic endosurgery

Minimally invasive surgery in infants requires great experience and highly specialised skills. However, in most paediatric surgical departments, the number of patients requiring such surgery is usually small and the personal experience of the surgeon limited. An experimental setting with small animals could improve these training conditions if it adequately simulates the underlying situation and conveys beneficial surgical experiences. The authors implemented an endosurgical training model with New Zealand white rabbits. The mean body weight was 3.3 (range 2.9–3.5) kg. The abdominal cavity had a volume of about 580 ml and the thoracic cavity a volume of about 250 ml, comparable with those of a newborn baby. Several relevant techniques were established (gastrostomy, colostomy, gut biopsies, lung biopsies, and anastomosis of the oesophagus). Overall, the rabbit model served to refine technical skills and operative experience. In paediatric surgical departments with a specific focus on endosurgery in the abdominal and thoracic cavities, this training model could help to introduce new techniques and add valuable educational strategies.     

Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchidism: preliminary report

During the laparoscopic approach of undescended testis, an associated inguinal hernia is a frequent finding that must be treated at the same time. The objective of this presentation is to show the incidence and management of the inguinal hernia that were found during laparoscopic orchidopexy, reporting how the scar tissue will join the edges of the canal and the parietal peritoneum will grow above. Between January 1999 and December 2002, 31 patients with 33 palpable and nonpalpable undescended testes were treated by laparoscopic orchidopexy. Patients were between 6 months and 9 years. We used four ports, and 2 mm instrument. When an associated inguinal hernia were found we only removed the membranes of the processus vaginalis and did not close the defect. All cases were treated by the same surgeon. The average surgical time was 50 min that included the orchiopexy and the treatment of the associated inguinal hernia. We found inguinal hernia in 23 cases (69.9%). We did not find any inguinal hernia in the opposite side of the undescended testis. In two patients with bilateral undescended testis that were approached in two stages 3 months later we confirmed the closure of the hernia defect. These 23 patients have 21.5 months average follow up and confirm no recurrence. With an average follow up of 21.5 months, we found no inguinal hernia in any of the patients. A larger volume study with longer follow up is needed to confirm that there is no need for closure of the internal inguinal ring during laparoscopic orchidopexy. Presented at the IPEGs 12th annual congress for endosurgery in children, in Los Angeles, CA, USA, March 2003.     

Incidence and Familial Occurrence of the Congenital Anomalies of the Face, Hand and Foot

We made an epidemiological study of congenital anomalies of the face, hand and foot in newborns from 1973 to 1992 in Miyagi Prefecture which has a population of about two million. In these twenty years 579,766 babies were born in Miyagi Prefecture. Out of these newborns 3,416 babies with 3,759 congenital anomalies of the face, hand and foot were registered. Of all registered congenital anomalies, face anomalies were most commonly encountered, followed by hand and foot anomalies. Among face anomalies, in order of frequency, accessory ear was the most common, next cleft lip with or without cleft palate, cleft palate alone, cryptotia and microtia. The occurrence ratio per 10,000 live births was 9.6 in accessory ear, 6.7 in cleft lip, 6.1 in cleft lip with cleft palate, 4.2 in cleft palate alone, 2.9 in cryptotia, and 1.8 in microtia. In hand and foot anomalies, polydactyly was the most common and syndactyly the next. Incidence ratio of polydactyly was 5.8 in the hand and 6.4 in the foot. Polydactyly was the most frequent in the preaxial ray in the hand and in the postaxial ray in the foot. About half of cases of postaxial polydactyly the foot was associated with syndactyly between the fourth and fifth toe. In addition, we reported on variation of the incidence ratio and familial occurrence of congenital anomalies of the face, hand and foot.     

Hydrocephalus manifestation in the genetic polydactyly/ arhinencephaly mouse (Pdn/Pdn)

ABSTRACT  The genetic polydactyly/ariiinencephaly mouse, Pdn/Pdn , exhibits severe polydactyly both in the fore-and hindlimbs, hydrocephalus, and agenesis of the olfactory bulbs, corpus callosum, and anterior commissure. The mechanism of hydrocephalus manifestation in Pdn/Pdn was investigated in the present study. Ink was injected into the left lateral ventricle in the Pdn/Pdn and +/+ newborn mice. After incubation at 32°C for different time intervals, the heads were fixed in Bouin's solution and were subsequently decalcified in 0.5 mol/L of EDTA solution, paraffin sectioned, and stained with hematoxylin and eosin.
Ink spread into the 3rd and right lateral ventricles and flowed to the 4th ventricle and Magendie's foramen rapidly in Pdn/Pdn mice. This rapid spread was due to the dilatation of the interventricular foramen and that the lateral ventricle was directly connected with enlarged 3rd ventricle in Pdn/Pdn. In spite of the rapid spread of ink in the cerebrospinal fluid pathway, ink was not observed in the subarachnoid space around the superior sagittal sinus at 3.5 or 10 hours in Pdn/Pdn mice.
The superior sagittal sinus was narrower in Pdn/Pdn than in +/+, and the arachnoid villi were not observed in Pdn/Pdn. From these observations, we suggested that absorption of cerebrospinal fluid from the arachnoid villi in the superior sagittal sinus stagnated and that stagnation of the fluid in the ventricles was the cause of hydrocephalus in Pdn/Pdn mice.     

发热、头痛、皮肤紫癜2例

该研究2例学龄期患儿于春季急性起病,表现为发热、头痛、呕吐、意识障碍,以及皮肤紫癜、脑膜刺激征阳性。外周血白细胞及中性粒细胞均增高、血红蛋白及血小板不同程度降低;CRP明显增高;脑脊液白细胞数增高达数百或上千、且以中性粒细胞为主,脑脊液蛋白增高,糖、氯化物正常。其中1例头颅CT示右侧小脑、双侧大脑多发血肿。骨髓细胞学提示感染性骨髓象,血培养、骨髓培养均提示金黄色葡萄球菌(MRSA)。患儿抗感染治疗过程中出现心脏杂音,并且血红蛋白及血小板进行性下降,心脏彩超发现主动脉瓣赘生物形成,确诊为感染性心内膜炎(IE)。根据药敏试验改为万古霉素抗感染治疗,1例6周后痊愈,1例放弃治疗死亡。儿童IE起病隐匿,临床表现多样,建议对于不明原因发热患儿要注意动态观察心脏杂音,及时行心脏彩超排除IE;以化脑为表现的患儿伴有难以用血小板减少解释的皮肤、黏膜出血时,也应警惕IE。     

The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children

Objective: To evaluate the value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children.
Design: A retrospective analysis of clinical signs and symptoms, supplemented with chest radiograph and serum procalcitonin data, in 101 children with community-acquired pneumonia. Viral and bacterial aetiology was studied prospectively by antibody assays, and pneumococcal infection was found in 18, atypical bacterial infection in 28 and viral infection alone in 22 cases.
Methods: Chest radiographs and serum procalcitonin were studied in all cases. Data on clinical signs and symptoms were retrospectively collected from the medical cards of the patients.
Results: Among symptoms, cough was present in 89% and fever (>37.5°C) in 88% of the cases. Among physical signs, crackles were present in 49% and decreased breath sounds in 58%. No significant associations were found between any of the clinical signs or symptoms and the aetiology of pneumonia. In multivariate analyses, age over 5 years and serum procalcitonin over 1.0 ng/mL were the only independent predictors of bacterial aetiology, but no finding was able to screen between pneumococcal and atypical bacterial aetiology of infection.
Conclusion: No clinical or radiological characteristic was helpful in the separation between viral, pneumococcal and atypical bacterial aetiology of community-acquired pneumonia (CAP) in children.     

The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period

BACKGROUND: Cytokines play an important role during labor and full- or preterm delivery. They influence physical immunity of the fetus-neonate and express a leading role in the perinatal period, being present in maternal and fetal tissues. AIM: To investigate whether cytokine concentrations in the mother, fetus and neonate depend on the labor and the mode of the delivery. STUDY DESIGN: Prospective study. SUBJECTS: Seventy-eight healthy, non-smoking parturients (mean age 28+/-4, range 21-39 years, delivering vaginally: n=52 or by elective cesarean section: n=26) and their single, healthy, appropriate for gestational age, full-term neonates. OUTCOME MEASURES: We correlated determined circulating levels of IL-2, sIL-2R, IL-4, sIL-4R, IL-6, sIL-6R, IL-1beta, IL-8, IFN-gamma, TNF-alpha, sTNF RI, sTNF RII and RANTES in the mothers before delivery (MS), the fetuses (UC) and the neonates in days 1 (N1) and 4 (N4) of life, with the mode of delivery. RESULTS: sIL-2R in N1 and N4, sIL-4R in MS, IL-6 in MS and UC, IL-1beta in MS, UC and N1, IFN-gamma in MS and UC, TNF-alpha in UC, N1 and N4, sTNF RI in UC were significantly higher in cases of vaginal delivery than in cases of elective cesarean section (p ranging from 0.0005 to 0.05). CONCLUSIONS: Vaginal delivery promotes the production of various cytokines and their receptors, which are implicated in neonatal immunity.     

关注儿童肺血管疾病的研究

由于循环系统在个体生存和生长发育中的重要地位,以及肺脏是人体惟一具备体循环和肺循环两套系统的器官,肺血管疾病一直以来都是血管疾病研究的热点领域之一。随着儿科各亚专业临床技术的发展,儿童肺血管疾病获得了越来越多的关注。该文从儿童与成人肺血管疾病谱的差异、儿童肺高压的研究方向、儿童肺栓塞的疾病规律和早产后慢性肺疾病中的血管异常这四个方面对儿童肺血管疾病目前的研究进展和关注焦点进行综述,以期能够展示儿童肺血管疾病研究的重要性,在未来能够聚合多学科和多专业的交叉融合,以开展更为系统的研究。     

小儿颅脑外伤后继发癫癎18例

目的　分析和评价颅脑外伤后继发癫 (PTE)患儿的临床、CT、MRI特征及其危险因素。方法　通过随访和EEG、CT及MRI等辅助检查 ,对患儿的年龄、临床发作史、意识、神经体征、头颅骨折、脑损伤程度及颅内并发症等方面进行分析和评价。结果　 1 8例中 ,男 1 2例、女 6例 ;首发年龄 :2个月～ 1 2岁 ,平均 3岁 8个月。其中小于 5岁的婴幼儿多于伤后 6～ 1 2个月发病。 1 8例中呈部分及继发全身大发作共 1 3例 ,局灶神经征及偏瘫 1 2例 ;脑外伤后昏迷大于 1 2h 1 1例 ,凹陷性及粉碎性骨折 1 0例 ;CT示颅内血肿及皮层下混合损伤各 1 2例 ;5例做MRI检查 ,其中 4例有局限性长T2 高信号 ;EEG示外伤后 6～ 1 2周局限性慢波异常或性放电明显增多 ,局灶或多灶性棘 (尖 )波或棘 (尖 )慢复合波 1 3例 ,单一节律放电 2例。结论　PTE可发生于各年龄期 ,婴幼儿发病较早 ,年长儿较晚 ;PTE发生的主要危险因素包括 :昏迷 >1 2h的严重脑外伤、早期惊厥反复发作、局灶性神经征、凹陷性颅骨骨折、皮层及皮层下同时损伤、硬膜下及脑内出血等。PTE发作主要表现为部分或继发全身大发作 ;EEG具有早期诊断及预后判断价值     

Azithromycin is the answer in paediatric respiratory medicine,but what was the question?

The first clinical indication of non-antibiotic benefits of macrolides was in the Far East, in adults with diffuse panbronchiolitis. This condition is characterised by chronic airway infection, often with Pseudomonas aeruginosa, airway inflammation, bronchiectasis and a high mortality. Low dose erythromycin, and subsequently other macrolides, led in many cases to complete remission of the condition, and abrogated the neutrophilic airway inflammation characteristic of the disease. This dramatic finding sparked a flurry of interest in the many hundreds of macrolides in nature, especially their anti-inflammatory and immunomodulatory effects. The biggest subsequent trials of azithromycin were in cystic fibrosis, which has obvious similarities to diffuse panbronchiolitis. There were unquestionable improvements in lung function and pulmonary exacerbations, but compared to diffuse panbronchiolitis, the results were disappointing. Case reports, case series and some randomised controlled trials followed in other conditions. Three trials of azithromycin in preschool wheeze gave contradictory results; a trial in pauci-inflammatory adult asthma, and a trial in non-cystic fibrosis bronchiectasis both showed a significant reduction in exacerbations, but none matched the dramatic results in diffuse panbronchiolitis. There is clearly a huge risk of antibacterial resistance if macrolides are used widely and uncritically in the community. In summary, Azithromycin is not the answer to anything in paediatric respiratory medicine; the paediatric respiratory community needs to refocus on the dramatic benefits of macrolides in diffuse panbronchiolitis, use modern – omics technologies to determine the endotypes of inflammatory diseases and discover in nature or synthesise designer macrolides to replicate the diffuse panbronchiolitis results. We must now find out how to do better!     

Cellular Peripheral Neural Tumors (Neurofibromas) in Children and Adolescents: A Clinicopathological and Immunohistochemical Study

Nine examples of a cellular peripheral neural tumor (CPNT) were identified in a review of 139 peripheral nerve sheath neoplasms in children, which included 60 neurofibromas and 16 malignant peripheral nerve sheath tumors. The mean age at diagnosis of these nine patients was 7 years, with six presenting in the first decade of life and four were noted at birth. The male:female ratio was 0.5. Topographically, the tumors were located in the extremities, 4; head and neck, 3; and trunk, 2. One or another stigmata of von Recklinghausen's neurofibromatosis (VRN) was present in four patients. After initial resection, seven children remained well, but two developed a recurrence; the histology was identical to the original tumor in one case but overt malignant transformation had occurred in the second. This case was the only tumor-related death in this series. The CPN as a circumscribed but nonencapsulated mass measuring 1.8-7.5 cm in greatest dimension in the subcutaneous and deep soft tissues and had a compact spindle cell pattern, occasional mitoses, and minor foci of typical neurofibroma. Immunohistochemical staining revealed vimentin expression in all seven cases, Leu-7 in six, myelin basic protein and S-100 protein in five, desmin in one, and actin in none. In contrast to neurofibroma and malignant peripheral nerve sheath tumors, CPNT tended to occur earlier, either congenitally or in the first decade, and slightly more commonly in females. The anatomical distribution and pattern of immunoreactivity were similar to neurofibroma. However, the cellularity and mitotic activity of these neoplasms were sufficiently disquieting as to raise concerns about the prognosis, and in one case, the tumor behaved in an unequivocally malignant fashion. When a peripheral neural tumor with the pathologic features described in this study is encountered, wide excision and careful clinical follow-up are recommended.     

Trends in neonatology and pediatrics publications over the past 12 years

OBJECTIVE: To test the hypothesis that the number of publications in Neonatology and Pediatrics increases over time, and to verify whether the categories of publications all follow the same pattern over time. DESIGN AND SETTING: We evaluated all Medline articles during 1994-2005. Search was limited to humans, English and to 'newborn' or 'all-child'. We used regression analysis to determine the effect of year-of-publication upon the number-of-publications of each type. RESULTS: Medline reported 36,141 publications in Neonatology and 169,823 in Pediatrics during the evaluation period. There was a significant linear increase in the number of publications in Neonatology and Pediatrics. There was a steady increase over time in Neonatology and in Pediatrics in meta-analyses, reviews and editorials. There was a steady decrease over time in letters in Neonatology, but no significant change in letters in Pediatrics. While there was no significant change in clinical trials (CTs), randomized control trials (RCTs) in Neonatology, there was a significant increase in CTs and RCTs in Pediatrics. CONCLUSIONS: The field of neonatology has not had a significant yearly increase of original studies, but has seen an increase of reviews, meta-analyses and editorials. This contrasts with Pediatrics, which shows a similar increase in reviews, meta-analyses and editorials, but also an increase in the number of CTs and RCTs and guidelines.     

Lymphoid–Epithelial Secretory Immune System in Human Fetuses in the Second Trimester of Gestation

The development of the secretory immune system (SIS) in the respiratory, digestive, and urogenital tracts and other organs of fetuses in the second trimester of gestation is described. Tissues of all internal organs of human fetuses (n = 36) that had died between 13 and 25 weeks of gestation were studied immunohistochemically for the presence of secretory component (SC), J chain, IgA, IgM, IgG, macrophages, and different subsets of lymphocytes. We found protein elements of the SIS in fetuses during the entire second trimester in the epithelium of the digestive, respiratory, and urinary tracts; in hepatocytes; in the epithelium of the bile duct, renal tubules, and all the urinary tract; in the salivary glands, pancreas, and thyroid; in the epithelium of the Fallopian tubes and uterus; in the epididymis and the rete testes; in the skin; and in other organs. Immunocompetent cells, including IgA- and IgM-secreting cells, were located in these organs under the epithelium and sometimes between epithelial cells. In fetuses with acute infection, the number of immunocompetent cells was higher, reflecting a whole–immune system reaction, including the SIS. We conclude that the fetal SIS is a ramified, defensive immune system that is distributed throughout most organs of epithelial origin in second-trimester fetuses, and that it reacts against intrafetal infiltration by foreign antigens. Received December 6, 2000; accepted May 19, 2001.     

Nucleotide and polyamine levels in colostrum and mature milk in relation to maternal atopy and atopic development in the children

The prophylactic benefit of breastfeeding against atopic disease is still controversial. It seems to be limited to infants with genetic propensities to allergy in combination with late solid food introduction. Lower levels of n-3 polyunsaturated fatty acids in human milk have been related to atopy in children, stressing a non-specific role of nutritional components in the development of atopy. Nucleotides and polyamines have been related to intestinal integrity and immune function in infancy. The main sources of these nutrients are human milk nucleotides and polyamines early in life. Our aim was to study the composition of nucleotides and polyamines in colostrum and mature milk from atopic and non-atopic mothers and the relationship to sensitization against egg, milk or cat in their children during the first year of life. The nucleotide/nucleoside and polyamine levels were measured by HPLC in colostrum and in milk at 3 mo of lactation from mothers of 21 atopic and 14 non-atopic children. Among the mothers, 10 were atopic and 25 non-atopic. The nucleotides cytidine monophosphate (CMP), uridine monophosphate (UMP), adenosine monophosphate (AMP) and guanosine monophosphate (GMP) and the nucleosides cytidine and uridine were detected in human milk. In colostrum, CMP dominated, and the levels increased in mature milk, while the levels of the other compounds remained constant. The nucleotide/nucleoside composition was similar in colostrum from all mothers independent of the development of sensitization in their babies, except for the higher cytidine levels in mature milk from atopic mothers of atopic babies, as compared to healthy mothers of atopic babies. The polyamine levels were similar in colostrum from atopic and non-atopic mothers. However, putrescine and spermine levels were lower in mature milk from atopic mothers than non-atopic mothers. No relationship was found between milk putrescine and spermine levels and development of atopy in the children. In conclusion, low levels of human milk putrescine and spermine seem to be related to maternal atopy.     

温州地区儿童血清特异性过敏原检测的临床意义

目的了解温州地区不同年龄组儿童哮喘及过敏性疾病的过敏原状况,以指导临床防治。方法采用体外过敏原检测系统(法玛西亚CAP系统)对我院呼吸科门诊及住院患儿468例进行过敏原特异性IgE(sIgE)抗体检测,将所有受检儿童分为婴幼儿、学龄前、学龄期3组,对过敏原状况进行分析比较。结果哮喘发病主要集中于学龄前和婴幼儿期,过敏性鼻炎主要发生于学龄儿童;各种过敏性疾病中过敏性鼻炎sIgE阳性检出率最高,其次是哮喘和过敏性咳嗽;婴幼儿以食物过敏为主,较大年龄儿童以吸入性过敏为主,学龄前儿童两者均可发生;温州地区吸入性过敏原以尘螨为主,食入性以虾为主;在螨sIgE阳性者中哮喘比率最高,其次是过敏性鼻炎和过敏性咳嗽。结论螨及虾是温州地区儿童最常见过敏原。哮喘应在婴幼儿及学龄前期及早进行针对性防治,体外血清过敏原特异性抗体检测CAP系统是婴幼儿及学龄前儿童过敏原检测的方法之一。     

脑干功能障碍与婴儿突然死亡综合征

目的　 探讨婴儿突然死亡综合征 (SIDS)的病理机制。 方法 　SIDS和对照组各 16例脑标本 ,通过常规神经病理检查、胶原纤维酸性蛋白 ( glialfibrillaryacidicprotein ,GFAP)、酪氨酸羟化酶 (tyrosinehydorxylase ,TH)免疫组织化学染色 ,观察脑组织病理变化、胶质细胞增生和脑干TH活性的改变。 结果 　 16例SIDS中 7例可见白质软化坏死 ,白质区GFAP阳性胶质细胞增生明显 ,与对照组比较差别显著。在SIDS组 ,桥脑滑车神经核、延髓迷走神经核和腹外侧网状结构GFAP阳性胶质细胞明显增加 ,与对照组比较差别显著 ;中脑黑质GFAP阳性胶质细胞虽然也增加 ,但与对照组比较 ,差别不显著。迷走神经核和腹外侧网状结构中或强阳性TH免疫反应在SIDS组明显低于对照组 ,但在中脑黑质和滑车神经核 ,两组间差别不显著。 结论 　慢性缺氧或缺血可能引起脑干儿茶酚胺神经元的改变 ,从而导致睡眠时呼吸或循环中枢调节功能障碍 ,成为SIDS的一个重要促发因素。     

Bacterial translocation, intestinal morphology, and enzyme activities after ileal ischemia in newborn piglets

Intestinal ischemia was created after a limited laparotomy by ligation of the terminal mesenteric vessels in the last 10 cm of distal ileum in 2-day-old piglets. Five groups (each n = 15) were studied: 1 (unoperated control group, killed on day 4), 2 (sham control with laparotomy, killed on day 4), 3 (ischemia, killed on day 4), 4 (ischemia, killed on day 9), and 5 (unoperated control on day 9, not killed). All animals in groups 1, 2 and 5 survived. Two animals in group 3 and 1 in group 4 died (peritonitis and distal ileal perforation). In animals killed on day 9, less weight gain was observed in group 4 compared to the unoperated controls. Macroscopically, no alteration was found at laparotomy in the animals in group 1, whereas in group 2, 1 animal showed beginning peritonitis and another some degree of peritoneal adhesions in group 3, 1 piglet had an intestinal perforation and 4 had intestinal distention above the ischemic loop. In group 4, 7 animals had dilatation of the upper loops, 4 a complete stricture, and 3 peritonitis with complete necrosis of the distal ileum. Microscopic examination revealed severe lesions of the ischemic area in groups 3 and 4 and mild lesions of the upper loop. The kidney was contaminated by translocation of gram-positive cocci in 36% of cases in group 2. Germ carriage for staphylococci was estimated at 80% in the terminal ileum of animals in group 3 versus 8.3% in group 2. In groups 3 and 4, the translocation rate was 30% in the kidney and 40% in the liver. Low disaccharidase activities were found in ischemic areas in groups 3 and 4, with no difference in activity in the upper loops.     

PREVALENCE AND TEN-YEAR (1970-1979) INCIDENCE OF INSULIN-DEPENDENT DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS IN FINLAND

ABSTRACT. The prevalence and incidence of insulin-dependent diabetes mellitus in Finnish children and adolescents were studied by means of a national register of drug-treated diabetics and hospital records. At the end of 1979 the prevalence of diabetes in children aged 0-14 was 191/100000, and in those aged 0-19, 262/100000 respectively. During the 10-year period from 1970 to 1979, 3916 new diabetics aged 0-19 years were registered. The annual incidence of diabetes was 27.3/100000 in the age group 0-19 years and 28.6/100000 in those 0-14 years. The peak incidence of diabetes in girls occurred at 12 years of age and in boys at 14 years. There was a seasonal variation in the symptom debut, with peaks in April and in September and low rates in the summer. A regional variation in the prevalence and incidence rates was evident the rates being highest in eastern and lowest in northern Finland. The prevalence of diabetes mellitus increased clearly during the observation period, and the incidence tended to increase especially during the last years. Both prevalence and incidence rates of diabetes mellitus in Finnish children are high by international standards, possibly the highest in the world.