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A childhood splenic torsion presenting as an acute abdominal mass is reported.

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The World Health Organization (WHO) is the agency of the United Nations with primary responsibility for international health matters and public health. Through the exchange of the knowledge and experience of health professionals from 165 nations WHO promotes comprehensive health services worldwide. As a part of this effort WHO has in recent years been concerned with improving the availability and utilization of diagnostic imaging, especially as it relates to health services in developing countries. Having devised and specified suitable basic radiographic equipment (the WHO BRS) a WHO Scientific Group was convened in 1982 to study the utilization of radiographic procedures and to to recommend their more efficacious and rational use. Then in 1984, recognizing the implications of newer imaging technology on world health, a second WHO Scientific Group considered the design, impact and future use of ultrasonography and computed tomography in developing countries. The findings of these scientific groups were published as part of the WHO Technical Report Series which makes available the recommendations of such international groups of experts. Although some of the needs of children were considered in these previous Technical Reports, WHO felt that the size and socioeconomic importance of the paediatric population worldwide warranted a further study and report to address the particular technical and clinical problems of diagnostic imaging in the paediatric age group. Thus a third WHO Scientific Group met in Geneva from 18 to 24 November 1985 to review established practices and experience in paediatric imaging throughout the world; and to recommend rational guidelines for diagnostic imaging for children to age 14 years.(ABSTRACT TRUNCATED AT 250 WORDS)

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Fifteen children with cholelithiasis who were treated at the Royal Hospital for Sick Children, Glasgow between 1973 and 1985 are reviewed. Ten patients had idiopathic gallstones and five had gallstones in association with hereditary spherocytosis. All patients have been followed up for between 4 months and 12 years (mean 4.1 years): ultrasonography has been carried out on 13. Fourteen patients underwent surgery of whom only seven had symptoms from their gallstones. Nine patients had cholecystostomy and removal of gallstones, four patients had cholecystectomy (one had negative exploration of the common bile duct in addition) and one patient with choledocholithiasis underwent choledochotomy with transduodenal sphincterotomy. One patient did not have surgery; she has remained asymptomatic and ultrasound examination confirms that she still has a solitary gallstone in her gallbladder. Clinical review with ultrasonography shows that cholecystostomy with removal of gallstones appears to be an acceptable alternative to cholecystectomy.

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Complete ascertainment of lethal neonatal short-limb chondrodysplasias was attempted in the West of Scotland for the period 1970-1983. Forty-three cases were identified, representing a minimum incidence of 1 in 8,900. The differential diagnosis included 11 well-delineated skeletal dysplasias, one case of warfarin embryopathy, and one apparently new condition with presumed autosomal recessive inheritance that has radiographic similarities to those of thanatophoric dysplasia (TD). In this series TD had an incidence of 1 in 42,221, which is consistent with new dominant mutation at a rate of 11.8 +/- 4.1 X 10(-6) mutations per gene per generation. Ultrasonic measurement of fetal long bone length was performed in eight subsequent pregnancies at risk. Five unaffected fetuses were predicted correctly and three affected fetuses were detected during the second trimester (one with rhizomelic chondrodysplasia punctata-second trimester prenatal diagnosis not previously reported; one with achondrogenesis type II; and one with the new lethal condition).

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31P- and 1H-NMR spectroscopy were used to demonstrate that the primary metabolites of the anticancer drug cyclophosphamide (4-hydroxycyclophosphamide and its acyclic tautomer, aldophosphamide) are quantitatively converted by O-methylhydroxylamine, at pH 7.4 and 37 degrees, into the E and Z isomers of aldophosphamide O-methyl oxime. These trapping products are readily extracted from aqueous media with either chloroform or ethyl acetate, are stable at pH 6-8 toward oxime hydrolysis and elimination of phosphoramide mustard (a secondary metabolite of cyclophosphamide), and showed no evidence for transoximination with either ketone or aldehyde acceptors. All of these features support the use of aldophosphamide O-methyl oxime in quantitative studies related to cyclophosphamide metabolism.

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One hundred and ninety six Asian, 89 African, 96 Chinese and 98 Scottish children from 173 families were studied to assess growth in relation to country of birth, time of parental residence in Scotland, child order in family, social class, living conditions and dietary factors. The growth measurements (standardised height, weight and bone age) differed between ethnic groups. The Africans were the tallest and Scottish the shortest. In all immigrant groups, children born in Scotland were on average, taller and more advanced in bone age than those born in their country of origin. In this study, there was no demonstrable effect on growth of social class or of living conditions. Dietary variable showed a lack of coherent effects on growth.

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As judged by admissions to a children's hospital, the prevalence of Asian rickets in Glasgow increased from 1960 to 1973 and then decreased gradually. 400 children born of Indian or Pakistani parents (200 in 1974 and 200 in 1979), from two schools, were examined for clinical, biochemical, and radiological evidence of vitamin-D deficiency. In 1974 there were 10 children with florid rickets and 15 with subclinical rickets, whereas in 1979 no child had florid rickets and only 9 had subclinical rickets. Most Asian children now receive vitamin-D supplements. In the short term, general practitioners, physicians, and obstetricians in the United Kingdom must try to ensure vitamin D supplementation not only by children but also by young adults (aged 13-18 years) of Asian origin. A particular target should be pregnant Asian women, to prevent osteomalacia, fetal hypovitaminosis, and congenital rickets. The long-term answer to Asian probably lies in health education and a change towards the Western diet and life-style.

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Radiological estimates of gestational age in late pregnancy were compared with the gestational ages based on first trimester ultrasound crown-rump length measurements in a series of 125 patients. It was found that the 95 per cent confidence limits of a radiological estimate were +/- 3 1/2 weeks, that both distal femoral and upper tibial epiphyses were frequently present much earlier than 36 and 38 weeks respectively, and that in almost half of the growth-retarded babies in the series there was a bone-age discrepancy of three or more weeks. It is recommended that more liberal use is made of early ultrasound measurements for the assessment of gestational age.

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200 Asian 300 African, Chinese, or Scottish children were examined for clinical, biochemical, and radiological evidence of vitamin-D deficiency. Among the Asians there were 10 with florid rickets and 15 with subclinical rickets. Among the African, Chinese, and Scottish children there were no cases of florid rickets and only 7 cases of subclinical rickets (3 African, 3 Chinese, and 1 Scottish). Loss of metaphyseal definition is considered to be the radiological pattern of minimal active rickets and metaphyseal bands to represent the healing stage. Serum 25-hydroxycholecalciferol concentrations were low in clinical and subclinical minimal active rickets although there was some overlap with the wide range found in the "normal" group. Elevated serum-alkaline-phosphatase levels alone should not be regarded as indicating vitamin-D deficiency. The continuing prevalence of rickets in Asian children and in particular among schoolchildren warrants immediate action, which is long overdue.

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This article is meant to serve as a simple introduction to diagnostic ultrasound, explaining the nature of sonar and the basic equipment for its production and use. A scans, B scans, time-position scans, and Doppler-shift techniques are described, with some examples of the clinical applications of each. Some recent innovations such as scan conversion to improve gray scaling and electrocardiographically triggered cardiac sector scans are mentioned. The limitations of the technique are indicated, with measures that can be adopted to reduce them. The safety of the procedure is emphasized, with its freedom from the known biological effects of ionizing radiation.

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