Reuben D. Rohn

Magnesium, zinc and copper in plasma and blood cellular components in children with IDDM

The levels of magnesium (Mg), zinc (Zn) and copper (Cu) in the plasma, erythrocytes (RBC) and polymorphonuclear (PMN) and lymphocyte (L), leukocytes (WBC) of 45 diabetic children were compared to those of 12 normal children and were related to the diabetic control via HbA1 and fasting blood sugar (FBS) assessments. Mineral levels were determined via Zeeman-effect atomic absorption spectrophotometry following separation of plasma, RBC, and WBC fractions (PMN vs. M). ANOVA (four-way, blood components, by two-way, diabetic vs. normal children) was significant for Mg only (F = 4.60, P < 0.004). Plasma Mg and M-WBC Mg were significantly lower in children with diabetes (780 +/- 16 vs. 860 +/- 29 mumol/l and 519 +/- 33 vs. 866 +/- 86 micrograms/10(10) cells, respectively). RBC Zn was significantly lower in diabetic youngsters by t-test (0.48 +/- 0.012 vs. 0.57 +/- 0.046 per mumol/g Hgb, t = 2.79, P < 0.004), but the ANOVA for Zn was not significant. Cu level differences were not significant. HbA1 was predicted only by PMN-WBC Mg (F = 8.78, P < 0.04) and FBS by none. In conclusion, the mineral status of these diabetic children was altered in regard to Mg, but was mainly independent of diabetic control.

Benign galactorrhea/breast discharge in adolescent males probably due to breat self-manipulation

Three adolescent males presented with nipple discharge. In two boys, the expressed secretion was clinically consistent with galactorrhea. Galactorrhea/breast discharge is a rare complaint in males of any age. Although galactorrhea is commonly associated with a neuroendocrine disorder or drug ingestion, the work-up in each, including basal prolactin level, was normal. Reluctantly, each by admitted to breast self-manipulation to reduce gynecomastia. When the behavior was discontinued, the galactorrhea/breast secretion ceased. Clinicians should be aware of this heretofore undescribed and apparently benign phenomenon. If basal hyperprolactinemia is absent in a male with a breast discharge and a history of breast manipulation, then an extensive work-up is not usually indicated.

Neck pain due to acute suppurative thyroiditis and thyroglossal duct abscess

One case of acute suppurative thyroiditis and one case of thyroglossal duct abscess are presented and discussed. Although they may often present similar symptoms and signs, they need to be differentiated from each other and from other causes of painful thyroid-related neck masses to ensure appropriate therapeutic intervention. Techniques and new developments helpful in differential evaluation, including thyroid radioscintigraphy and ultrasonography, are discussed.

Papilla (nipple) development during female puberty

The purpose of this study was do compare breast papilla (nipple) development to the established criteria of secondary sexual maturation. One hundred and sixty-eight girls (100 black and 68 white) ranging in age from 2-21 years had their papilla diameter measured and their Tanner stage assessed. Minimal nipple development occurred from stages PH1-PH3 (2.91-4.08 mm) and B1-B3 (2.75-3.96 mm) or premenstrually (3.61 mm). Significant growth occurred beyond stages PH3, B3 (PH4-7.22 mm, Ph5-9.36 mm, B4-7.74 mm, B5-9.47 mm) and near or after menarche (7.82 mm for girls 0-2 years post-menarche, 9.23 mm for girls 2-4 years post-menarche and 9.65 mm for girls more than four years after menarche). A more objective definition for breast stages B4 and B5, based on nipple diameter, may now be feasible, thus enhancing the precision with which physiologic events occurring toward the close of puberty can be studied.

Osteoporosis as the presenting sign of leukemic relapse in an adolescent: Case report and literature review

Osteoporosis in adolescence is rare and usually secondary to an underlying disease process whose diagnosis may be difficult to detect. Osteoporotic vertebral collapse is an uncommon presenting sign of acute lymphoblastic leukemia (ALL). We describe a 13-year-old boy with osteoporotic vertebral collapse secondary to relapse of ALL whose blood count and blood morphology were normal but whose 1,25 = (OH2) = vitamin D level was deficient. A combination of chemotherapy, calcitriol and calcitonin therapy was successful in reversing the process. His case is presented to describe the diagnostic and therapeutic issues involved.

Child abuse in an infant presenting as unexplained acute systemic hypertension

Abstract Hypertension in the infant is uncommon and is usually associated with renal vascular or parenchymal disease, coarctation or thrombosis of the aorta, or chronic lung disease. A 3-month-old infant who presented with unexplained acute systemic hypertension was subsequently discovered to have an undiagnosed femoral fracture secondary to child abuse. Undiagnosed fractures, which are often associated with child abuse, should be considered in the differential diagnosis of an infant presenting with unexplained systemic hypertension.

Nipple (papilla) development in girls: III: The effects of pregnancy

Previous cross-sectional and longitudinal studies of girls have documented that they have a significant growth in nipple size during Tanner stages pubic hair (PH)4 and PH5 or breast (B)4 and B5. This study assesses whether there is any effect of pregnancy on nipple development in adolescent girls. Thirty-three pregnant girls were compared to a previously reported group of 390 girls who were not pregnant. Of the 33 girls, ten were followed longitudinally for a period of nine to 79 months, during which time they became pregnant. In each girl, nipple diameter was measured and the Tanner stage assessed. A markedly significant increment in nipple size was noted in the girls who were pregnant (pregnancy nipple size 12.6 mm vs. PH5 9.7 mm and B5 9.9 mm). Comparison of ten girls prior to and during pregnancy revealed a significant increment as well (10.2 mm vs. 12.8 mm, respectively). Pregnancy provides a further stimulus for nipple development in girls beyond that which occurs during normal puberty.

Papilla (nipple) development in puberty: The adolescent male

Papilla (nipple) development was studied in 230 males (119 black, 111 white) aged 3-29 years to compare this development to the established criteria for sexual maturation. Comparison was also made with a previous study of female nipple development to determine whether or when any differences between male and female nipple development occurred. Our male subjects were further assessed to determine if nipple size differed in the presence or absence of gynecomastia. Significant nipple development occurred between pubic hair stages PH1 (diameter 2.8 mm), PH4 (4.4 mm), and PH5 (5.4 mm). Similarly, there was significant incremental growth between genital stages G1 (3.0 mm), G3 (4.6 mm), and G5 (5.5 mm). Nipple development was similar in both sexes through stage PH3, but significantly diverged at stage PH4 (p less than 0.000001) because of a marked increase in female nipple diameter. Boys with gynecomastia had a significantly larger nipple size than boys who had none (p less than 0.001). Differences in nipple diameter between the sexes and between boys with and without gynecomastia probably result from differences in estrogen levels. Perhaps in the future, it will be possible on the basis of nipple diameter to predict which adolescent boys will have persistent gynecomastia.

Short Stature and Dysmorphism in the Child and Adolescent Female: Diagnostic Dilemmas

The clinician often encounters girls with varying combinations of short stature and subtle dysmorphic features that are compatible with either Turner or Noonan syndrome. A classic case of either syndrome with extensive unmistakable traits is the exception rather than the rule. Six cases are presented to help describe some of the difficulties in differential diagnosis and provide strategies to avert them.

Dyspnea as the Presenting Symptom of Thyroid Disease Two Unusual Cases

* Department of Pediatrics, University of Kentucky Medical Center, Lexington, Kentucky. t Department of Pediatrics, Eastern Virginia Medical School, Children’s Hospital of the King’s Daughters, Norfolk, Virginia. Correspondence to: Reuben Rohn, M.D., Children’s Hospital of the King’s Daughters, 800 West Olney Road, Norfolk, VA 23507. Received for publication January 1, 1980; revised February, 1980 and accepted April 1, 1980. DISEASE of the thyroid gland in children ~~E~SIr rarely causes symptoms of respiratory difficulty. The following two case reports represent un-