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6. Heterosexual Precocity in the Male 7. Heterosexual Precocity in The

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6. Heterosexual Precocity in the Male 7. Heterosexual Precocity in The References 295 Adrenal tumours (p. 195) very seldom produce simple iso-sexual precocity, and those which have caused a premature onset of menstruation have usually caused also virilism or signs of Cushing's syndrome. In all adrenal cases the 17 -keto­ steroid, as well as the oestrogen output, is raised. Sexual precocity may result from the use of synthetic oestrogens: this has been seen during the course of treatment of various conditions (JOLLY) but also when the child has had access to stilboestrol tablets prescribed for elderly relatives. The approach to the problem of precocity in the female may be summarized as follows: apart from the routine clinical assessment, a bimanual pelvic examination under anaesthetic and a careful neurological investigation including if necessary air studies are important. The urinary output of 17 -ketosteroids and of oestrogens should be estimated. If all these investigations are negative a constitutional precocity should be diagnosed and no medical or surgical treatment given. 6. Heterosexual precocity in the male A stimulation of growth processes accompanied by gynaecomastia, and due to adrenal cortical tumour has been reported by WILKINS. Gynaecomastia may also result from interstitial cell tumour and gonadal stromal cell tumour (androblastoma) of the testicle. It is seen at puberty in Klinefelter's syndrome and in true hermaphroditism. 7. Heterosexual precocity in the female Adrenal cortical tumours are the usual cause of a post-natal onset of virilism in a girl: hyperplasia is very seldom responsible at this stage. The diagnosis of the tumours has already been discussed. Arrhenoblastoma is exceptionally rare in children, but has been recorded by FLANNERY in a 13 year old girl. References A. Introduction III. Investigation BROCKHAUS, J.: Subkutane Pyelographie bei jungen Kindern mit Hilfe der Hyaluronidase und mit Anwendung des Tomographen. Fortschr. Rontgenstr. 77, 602 (1952). - BRODNY, M. L., and S. A. ROBINS: Urethrocystography in the male child. J. Amer. med. Ass. 137, 1511 (1948). - CAMMENOS, A.: L'urographie intramusculaire chez Ie nourisson et enfant (hyaluronidase et diodone). J. Urol. med. chir. 59, 505 (1953). - CAMPBELL, M. F.: Miniature sound. J. Urol. (Baltimore) 60, 653 (1948). - Radiologic diagnosis of urinary tract tumours in infants and children. Radiology 54, 646 (1950). - CHRISTIANSEN, H.: Some practical hints in the performance of urography in infants. Acta radiol. (Stockh.) 26, 46 (1945). - COHEN, R., and M. L. BLATT: Urine collector for female infants. Amer. J. Dis. Child. 60, 897 (1940). - EpSTEIN, B. S.: Subcutaneous urography in infants. J. Amer. med. Ass. 164, 39 (1957). - FAINSINGER, M. H.: Excretory urography in the young subject. Hyaluronidase and tomography as aids. S. Afr. med. J. 1950, 418.-FRIESE-CHRISTIANSEN, A.: Urography on children after administration of the contrast substance by mouth. Acta radiol. (Stockh.) 27, 197 (1947). - GLADNIKOFF, H., U. E. JACOBSSON: Hyaluronidase in the urographic examination of children. Acta paediat. (Uppsala) 42, 393 (1953). - HACKWORTH, L. E.: Urethrography in infants and children. J. Urol. (Baltimore) 60, 947 (1948). - HARDER, E.: Micturition cysto-urethrogram in children. Radiography 21, 255 (1955). - HELMHOLZ, H. F.: Simple procedure for catheterizing girls. Amer. J. Dis. Child. 82,426 (1951). -LANDELIUS, E.: Death following renal arteriography in a child. Acta chir. scand. 109,469 (1955). - MCCREA, 296 References L. E.: New infant cystoscope. J. Urol. (Baltimore) 58,217 (1947). - Infant curved urethral sounds. J. Urol. (Baltimore) 59,330 (1948). - PONCHER, H. G., and J. C. RICEWASSER: Quantitative collection of urine from infants and young children. J. Pediat. 20, 759 (1942).­ SILVERMAN, F. N.: Urologic problems in pediatric X-ray diagnosis. Radiology 58, 325 (1952). - SINGLETON, E. B., and G. H. HARRISON: Excretory pyelography in infants: technique for intravenous injection. Amer. J. Roentgenol. 75, 896 (1956). - ST. MARTIN, E. C., J. H. CAMPBELL and C. M. PESQUIER: Cystography in children. J. Urol. (Baltimore) 75, 151 (1956). - STEPHENS, F. D.: Urethral obstruction in childhood. The use of urethro­ graphy in diagnosis. Aust. N.Z. J. Surg. 25, 89 (1955). - WYATT, G. M.: Excretory uro­ graphy for children. Indications and methods. Radiology 36, 664 (1941). IV. Management of surgical cases ANDERSON, S. M.: Controlled hypotension with arfonad in paediatric surgery. Brit. med. J. 195511, 103.-CAMPBELL, M.F.: Caudal anaesthesia in children. J. Urol. (Baltimore) 30, 245 (1933). - GROSS, R. E.: Surgery of childhood. Philadelphia: W. B. Saunders Com­ pany 1953. - MARTIN, S. J., and T. M. FELNEY: Anaesthesia in pediatric urology. J. Amer. med. Ass. 148, 180 (1952). - ORSTEN, P., u. A. MATTSSON: Hospitalisation symptoms in children. Acta paediat. (Uppsala) 44, 79 (1955). - RICKHAM, P. P.: The surgery of pre­ mature infants. Arch. Dis. Child. (awaiting publication). - VAUGHAN, G. F.: Children in Hospital. Lancet 19571, 1117. V. Fluid balance BARNETT, H. L.: Kidney function in young infants. Pediatrics 5,171 (1950). - BARNETT, H. L., and F. SERENI: Kidney function tests in infants and children. Pediat. Clin. N. Amer. 2,191 (1955). - BLAND, J. H.: The clinical use of fluid and electrolyte. Philadelphia: W. B. Saunders Company 1952. - CAMERON, G., and R. CHAMBERS: Direct evidence of function in kidney of an early human foetus. Amer. J. Physiol. 123,482 (1938). - DALY, H., L. J. WELLS and G. EVANS: Experimental evidence of secretion of urine by the foetal kidney. Proc. Soc. expo BioI. (N.Y.) 64,78 (1947). - GROSS, R. E.: Surgery of Childhood. Philadelphia: W. B. Saunders Company 1953. - GRUENWALD, P., and H. POPPER: Physiology of the renal glomerulus in early postnatal life. J. Urol. (Baltimore) 43,452 (1940). - MCCANCE, R. A., N. J. NAYLOR and E.M. WIDDOWSON: The response of infants to a large dose of water. Arch. Dis. Childh. 29, 104 (1954). - MCCANCE, R. A., and E. M. WIDDOWSON: Renal function before birth. Proc. roy. Soc. B 141, 488 (1954). - New thoughts on renal function in the early days of life. Brit. med. Bull. 13, 3 (1957). - McNAIR SCOTT, T., and W. W. PAYNE: In: Diseases of Children, editor A. MONCRIEFF and P. R. EVANS, 5. edit. London: Arnold & Co. 1953. - POTTER, E. L., and T. THIERSTEIN: Glomerular development in the kidney as an index of foetal maturity. J. Pediat. 22, 695 (1943). - RICKHAM, P. P.: The metabolic response to neonatal surgery. Cambridge, Massachusetts: Harvard University Press 1957. - TAUSCH, M.: Der Fetalharn. Arch. Gynak. 162, 217 (1936). - VESTERDAL, J.: Renal ex­ cretion of water and osmotically active substances in young infants. Helv. paediat. Acta 10, 167 (1955). - WELLS, L. J., and E. T. BELL: Functioning of the foetal kidney as reflected by stillborn infants with hydroureter and hydronephrosis. Arch. Path. (Chicago) 42, 274 (1946). B. Congenital abnormalities of the upper urinary tract I. Renal agenesis BOUND, J. P.: Two cases of congenital absence of the kidney in the same family. Brit. med. J. 1943, ii, 747. - BRAUM, 0., u. H. GROSS: Zur Kenntnis der eigenartigen mit Nierenfehl­ bildungen kombinierten Gesichtsveranderungen (Dysplasia renofacialis). Virchows Arch. path. Anat. 329, 433 (1956). - CAMPBELL, M. F.: Clinical paediatric urology. Philadelphia and London: W. B. Saunders Company 1951. - GUNTER, J. U., and F. S. OSER: Ante-mortem diagnosis of bilateral renal agenesis. N. C. med. J. 9, 307 (1948). - GUTIERREZ, R.: Surgical aspects of renal agenesis. Arch. Surg. (Chicago) 27, 686 (1933). - NATION, E. F.: Renal agenesis; a study of 30 cases. Surg. Gynec. Obstet. 79, 175 (1944). - POTTER, E. L.: Bilateral renal agenesis. J. Pediat. 29,68 (1946). - Facial characteristics of infants with bilateral renal agenesis. Amer. J. Obstet. Gynec. 51, 885 (1946). - SELBY, G. W., and A. H. PARME­ LEE: Bilateral renal agenesis and oligohydramnios. J. Pediat. 48,70 (1956). II. Renal hypoplasia BAGENSTOSS, A. H.: Congenital anomalies of the kidney. Med. Clin. N. Amer. 35, 987 (1951). - BELL, E. T.: Renal diseases. London: Kimpton & Co. 1950. - BLACKLOCK, J.W. S.: Renal aplasia in an infant. J. Path. Bact. 37,502 (1933). - COLLINS, D. C.: Congenital References 297 renal aplasia. Ann. Surg. 96, 715 (1932). - EINECKE, F.: Zur Pathogenese der Schrumpf­ niere im Kindesalter. Mschr. Kinderheilk. 42, 130 (1929). - EKSTROM, T.: Renal hypoplasia. Acta chir. scand. Suppl. 203 (1955). - HUTCHISON, R., and A. A. MONCRIEFF: Primary Hypertension in a Child. Brit. J. Child. Dis. 27,201 (1930). - LIGHTWOOD, R.: Specimens and clinical history of a case of renal aplasia with adrenal cortical hyperplasia. Proc. roy. Soc. Med. 27, 400 (1934). - MACKENZIE, D. W., and A. B. HAWTHORNE: Unilateral renal aplasia. Surg. Gynec. Obstet. 46, 42 (1928). - MARSHALL, A. G.: Persistence of foetal structures in pyelonephritic kidneys. Brit. J. Surg. 41, 38 (1953). - MULLER, H. P.: Ober doppelseitige Aplasie der Nieren beim Neugeborenen. Zbl. Gynak. 67, 1055 (1933). III. Cystic disease BANSILLON et GUICHARD: Reins polykystiques bilateraux chez un nouveau-ne. (Etude anatomo-clinique.) Bull. Soc. Obstet. Gynec. Paris 22, 415 (1933). - BELL, E. T.: Cystic disease of the kidneys. Amer. J. Path. 11,373 (1935). - BEESON, H. G.: Polycystic disease in a premature infant. J. Urol. (Baltimore) 30,285 (1933). - BIALESTOCK, D.: Morphogenesis of renal cysts in the stillborn. J. Path. Bact. 7,51 (1956). - BOCIAN, J. J., and M. LIANG: Rare case of polycystic disease of the kidneys. Amer. J. Dis. Child. 89, 615-617 (1955). - BOURLAND, J. W.: Polycystic disease of the kidneys causing dystocia. Urol. cutan. Rev. 60, 669 (1946). - BURRELL, N. L.: Multilocular cyst of the kidney. J. Urol. (Baltimore) 43, 656 (1940). - CADERAS, J., et J. M. BERT: Hematome perirenal spontane bilateral avec maladie polykystique des reins chez un nouveau-ne mort en hyperthermie au cinquieme jour. Arch. Soc. Sci. med. Montpellier 20,34 (1939). - CAMPBELL, M.: Clinical pediatric urology. London and Philadelphia: W. B. Saunders Company 1951. - CHALKLEY, T. S., and L. E. SUTTON: Infected solitary cyst of kidney in a child. J. Urol. (Baltimore) 60, 414 (1943). - CHAUVIN, M. E.: Un cas de rein polykystique partiel. J.
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