Premature sexual development in children following the use of estrogen- or placenta-containing hair products.

Four African-American girls aged 14 months to 93 months developed breast or pubic hair 2 to 24 months after starting the use of estrogen or placenta-containing hair products. Discontinuing the use of the hair products resulted in regression of the breast or pubic hair. Serum gonadotropins and estradiol levels were variable. No other cause for early sexual development was noted in these girls.

Effect of pectin on satiety in healthy US Army adults.

OBJECTIVE: We tested the hypothesis that pectin, a source of dietary fiber that delays gastric emptying, increases satiety. METHODS: Male (n = 49) and female (n = 25) US Army employees within normal weight limits were fasted overnight then fed 448 mL of orange juice on 2 separate days followed 4 hours later by 0.473 L of ice cream. On 1 of the 2 days, 5, 10, 15 or 20 g of pectin was mixed with the orange juice. Satiety was measured on a visual analog scale before and at 0, 1, 2, 3 and 4 hours after orange juice and at 0, 30 and 60 minutes after ice cream. Multivariate ANOVA was used to examine satiety as a function of beverage (orange juice vs. orange juice plus pectin), time and pectin dose. RESULTS: There were significant differences in satiety as a function of beverage (p < 0.001) and time (p < 0.001) but not pectin dose (p = 0.121). The effect lasted up to 4 hours after ingesting pectin and orange juice and for 60 minutes after a second meal consisting of ice cream. CONCLUSIONS: Pectin in doses as small as 5 g mixed with orange juice increases satiety and can aid in a program to reduce weight by limiting food intake.

A survey of use of hormone/placenta-containing hair preparations by parents and/or children attending pediatric clinics.

OBJECTIVE: To survey the frequency of use of certain hair-treatment products containing hormones or placenta among different racial groups attending the pediatric clinics of military medical treatment facilities. METHODS: Parents/caretakers attending pediatric clinics at four U.S. Army hospital clinics were requested to complete a questionnaire listing hormone/placenta-containing hair products. RESULTS: Of the 521 respondents, 64% of African-Americans and 6.9% of whites used products containing hormone/placenta (p < 0.0001). Of those parents who used such products, 55.5% used them on their children. An additional 5.5% of children (from a restricted sample) went to a barber and might have been exposed to hormone/placenta-containing products. Analysis of four products showed the presence of estriol and/or estradiol. CONCLUSIONS: A majority of African-Americans but very few whites use hair products containing hormone/placenta, and more than half of those who use such hair products also used them on their children. We speculate that the use of these hair products on children may effect their sexual maturation.

Incidence of diabetes among dependents of the U.S. military forces admitted to U.S. Army treatment facilities, 1971-1991.

OBJECTIVE: To determine the national incidence of diabetes in children by studying a group representing all parts of the country: the dependent children of U.S. military personnel. RESEARCH DESIGN AND METHODS: Dates of admission, diagnosis of diabetes, age, and gender were collected for all 522,326 children, age 21 or younger, of active duty military personnel admitted to U.S. Army treatment facilities during fiscal years 1971-1991. Incidence rates were expressed as cases per 100,000 person-years. RESULTS: A total of 2,308 cases of diabetes were diagnosed in 14.3 million person-years of follow-up over the 21 years. The overall incidence rate of diabetes in this population is 16.2 (95% confidence interval 15.5-16.9). For 1987-1991, the age-specific rates were 8.1 (0-4 years), 15.9 (5-9 years), 25.6 (10-14 years), 23.9 (15-19 years), and 23.4 (20-21 years). CONCLUSIONS: The rates may be biased because of exclusion of people with diabetes from entering military service, and are limited by lack of age adjustment. The racial admixture of our study population does not match the U.S. population as a whole.

Prevalence of obesity among children of military dependents at two major medical centers.

BACKGROUND: Prevalence of childhood obesity is unknown among military dependents. We ascertained the prevalence among all children aged 1 year or older attending the pediatric and adolescent clinics at the Walter Reed Army Medical Center (WRAMC) during 1978 and the Brooke Army Medical Center (BAMC) during 1986 and 1990. METHODS: Obesity was defined according to the child's relative weight computed from growth charts of the National Center for Health Statistics. RESULTS: The study sample included 1715 children (1078 at BAMC, 637 at WRAMC). Among them, 14.8% were overweight, 10.8% were obese, and 7.7% (3.0% males, 4.7% females) were grossly obese. The prevalence of grossly obese children was 5.5% at WRAMC and 9.0% at BAMC; 11.5% among children of retirees and 7.3% among children of active duty personnel (P less than .008); 5.5% among children of officers and 12.2% among children of sergeants (P less than .0005). The prevalence of very obese children was 10.1% for those older than 12 years of age and 3.3% for those aged 6 years or younger (P less than .0001). CONCLUSIONS: Retiree status of the sponsor was more important than sponsor's rank or child's age in determining the prevalence of childhood obesity. Prevalence of obesity approximately doubled over the 8 to 12 years of the study.

Testicular injury in breech delivery: possible implications.

In a prospective study of 166 male breech babies, 13 babies delivered by cesarean section did not show damage to the genital area. Of the 134 delivered vaginally, 19 showed injury to buttocks, scrotum, or testis. Ten babies (6.5%) showed damage to testis. On follow-up of three months to four years, the testis became normal to palpation in only 3 babies. In 1 baby, the testis became impalpable, leaving an empty scrotum. The testicular injury is more likely to occur in babies with a birth weight of greater than or equal to 2,500 g and born to primipara. The breech babies delivered vaginally should be examined and followed up for possible damage to testis. To avoid costly investigation and risky exploration, a history of breech delivery should be obtained in all cases presenting as anorchia, undescended testis, delayed sexual maturation, or male infertility.

Neonatal screening for metabolic and endocrine diseases.

The screening of neonates for metabolic diseases is important in order to identify a population with or at risk for metabolic diseases. Early diagnosis can then be made, treatment instituted and physical and/or mental handicaps due to the disease can be prevented. The World Health Organization's screening criteria are helpful in selecting those diseases appropriate for screening. Usually a state-designated central laboratory performs the screening tests. All states screen for phenylketonuria (PKU) and hypothyroidism; in addition, 26 states screen for galactosemia, 20 for maple syrup urine disease and 19 for homocystinuria. The cost-benefit ratio for screening programs is excellent, varying from 1:13 to 1:20. The necessary follow-up of patients for diagnosis and treatment can be enhanced by maintaining a close liaison with the laboratory and providing adequate information to parents. As a result of instituting a screening program, the incidence of mental retardation due to PKU has been practically eliminated and new insights about metabolic diseases have been obtained. The rapid progress in technology may soon result in better and cheaper tests capable of identifying more diseases amenable to treatment.

Proposed guidelines for screening of metabolic and endocrine diseases of dependent neonates of the U.S. Armed Forces. Derived from a survey of state guidelines for neonatal screening of metabolic diseases.

State regulations for neonatal screening for metabolic diseases do not optimally serve the needs of the dependents of the U.S. Armed Forces. Guidelines are therefore proposed for the neonatal screening for metabolic disease based both on responses received across the United States and on the unique needs of the U.S. Armed Forces. The guidelines agree with the policies outlined by various national medical and scientific organizations. It is suggested that neonates be screened for phenylketonuria (PKU), hypothyroidism, galactosemia, and maple syrup urine disease (MSUD). The screening program is cost-effective and feasible. Prior to implementing the program throughout the U.S. military, a pilot program based at the Armed Forces Institute of Pathology should be started.

An inexpensive method for assessing pituitary response to luteinizing hormone releasing hormones: analysis of serum gonadotropins in pooled samples.

Sixty-two children, aged 2-18 years, suspected of an endocrine disorder were given one of several IM injections of the LHRH and the blood was drawn prior to and at 30, 60, 90, 120, 240 minutes after the injection. An aliquot of .2 ml of serum was taken from each post-LHRH specimen and pooled. The gonadotropins were measured in all the individual and pooled samples. A high correlation (r = .974, LH; r = .981, FSH) between the peak and the pooled sample suggests that the analysis of gonadotropins in a pooled sample gives information comparable to that obtained by the gonadotropin analysis in multiple serum samples. A formula to calculate the peak LH and FSH from the pooled specimen taken from only four post-LHRH injections is: peak LH = 3.015 + 1.049 times the pooled LH; peak FSH = 3.153 + 1.072 times the pooled FSH value. The correlation coefficient between the observed and the calculated LH was .98; the same for the FSH was .987. I suggest that the pooled sample, due to it's integrated response, is a better reflection of the pituitary response to the LHRH.

Assessment of fetal pulmonic maturity by measurement of the surface tension of amniotic fluid lipid extract.

Fetal pulmonic maturity is currently predicted by the lecithin/sphingomyelin (L/S) ratio which utilizes the changes with increased gestation in the lecithin component of amniotic fluid surfactant. The surface tension lowering property of lipids extracted from the amniotic fluid of 45 patients was measured directly. The surface tension (gamma) of various aliquots of the amniotic fluid lipid extract was measured by a modification of the Wilhelmy plate method. At 80 gamma of the extract, a gamma of 67 dynes/cm or less indicated pulmonic maturity, while a gamma of greater than 67 dynes/cm suggested immaturity, provided that the gamma at 200 gamma was greater than 56 dynes/cm. The fluid was termed transitional if the gamma was greater than 67 dynes/cm at 80 gama, but less than 56 dynes/cm at 200 gamma. A comparison was made with the L/S ratio; there were no false positive values and only 13.6% false negative surface tension values. Addition of blood to amniotic fluid, mature and immature, yielded the same results as with the L/S ratio. Two infants with respiratory distress syndrome had both immature L/S ratios and surface tension results. Results indicate that the surface tension of the amniotic fluid lipid extracts is a reliable and rapid means of antenatally predicting fetal pulmonic maturity.

Age-adjusted analysis of insulin responses during normal and abnormal glucose tolerance tests in children and adolescents.

This report analyzes age-specific glucose (PG) and immunoassayable insulin (IRI) responses during oral glucose tolerance testing (OGTT) and examines test results in children and adolescents with OGTT abnormality using the age-appropriate control data. Controls' (n = 93) and patients' (n = 63) results were compared on the basis of statural age (SA) at the time of testing. Control tests (n = 101) showed significant positive correlation of fasting and four-hour postingestion PG with SA (p less than 0.001), but mean area under the PG curves did not vary between the SA groups (I--18.69 months, II--70-131 months, III--132+ months). The absence of differences of other sampling times permits uniform diagnostic criteria for this age group. IRI was positively correlated with SA at all testing times, and mean levels differed significantly between each SA group at every sampling time; the mean areas under the IRI curve also differed significantly between SA groups as did the mean ratios of IRI area to PG area (group I--0.2639 +/- 0.0175 S.E.M., group II--0.3864 +/- 0.0235, group III--0.6262 +/-0.0491). Patient tests (n = 110) were separated into normal (N), borderline (B), and chemical-diabetic (C) for each SA group. IRI means were above control data for each test type in each SA group at all sampling times; one fourth of these differences were significant. IRI responses also increased within each SA group from N to B to C tests. Mean IRI areas and IRI area to PG are mean ratios were higher than in controls, and this difference was greatest with the most abnormal (C) test type in each SA group. A subgroup of three patients who had low IRI responses from the outset and developed overt diabetes in one to three years was excluded from the analysis. In contrast to apparent relative insulin inefficiency with normal maturation and with chemical diabetes, they had exceptional responsiveness to their low IRI levels. Variable involvement of alpha as well as beta cells in the pathophysiology of diabetes is suggested as one explanation for these paradoxic observations. Changing receptor affinity might also be implicated.