Japanese children appear to grow and mature faster than Caucasian children. To investigate such ethnic differences, we studied 2 cohorts of children in the Tokyo metropolitan area. Skeletal maturation (Greulich-Pyle method) and secondary sex characteristics (Tanner's criteria) were assessed in 731 boys and 573 girls aged 1-19 years who attended for minor illnesses between 1985 and 1991. The menarchial age (“status quo”method) was assessed in 2234 girls aged 9-18 years who were enrolled in a private school in 1989.
The mean bone age exceeded chrononological age by at least 1 year in pubertal children of both sexes. The first sign of puberty was testicular growth (≥ 3ml) in boys, being attained at a mean age of 10.8 years, and breast development (Tanner stage 2) in girls, at a mean age of 10.0 years. The mean age for Tanner stage 4 pubic hair development was 14.9 years for boys and 13.9 years for girls, respectively. The mean menarchial age was 12.25 years with a standard deviation of 1.25 years.
The results indicate that skeletal and sexual maturation is approximately 1 year earlier in Japanese compared to Caucasians, though pubic hair development is significantly slower in Japanese. The difference in the overall pattern of skeletal and sexual maturation between Japanese and Caucasians calls for specific Japanese standards for bone age and sexual maturation stages.

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The problem of skeletal maturity assessment is to measure, stage by stage, the metamorphosis of the cartilaginous and membranous skeleton of the foetus into the fully ossified bones of the adult. Whilst skeletal maturation is a continuous process its assessment requires the identification of discrete indicators of development that are sequential, invariate between individuals, universal, and that cover the full range of development from birth to full maturity. The Tanner-Whitehouse II method is a bone-specific scoring technique in which a numerical score is assigned to selected hand-wrist bones depending on the appearance of certain well defined maturity indicators. The advantage of this technique over previous Atlas methods is that the maturational differences between bones is statistically minimised thus reducing disagreement between bones. The resulting bone maturity score is indicative of a specific maturational level in the sample to which the bone maturity scores are compared. Whilst the TW II technique has been applied to a variety of samples from many countries it is accepted that population and geographic differences exist in rate of maturation and that, therefore, there is a need to develop population specific “standards”. Such national standards would allow the sensitive diagnosis and treatment of children with growth disorders.

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Variation in the rate at which children mature is familiar to all clinicians dealing with growth. Choronological age gives little indication of physiological development and the TW II method of assessing skeletal maturity was developed as a means of obtaining information about the biological age of children and maturational changes. In practice the method requires sequen tial assessment of twenty bones of a carefully positioned radiograph of the left hand and wrist.
Each bone is rated independently and scores assigned depending on written criteria. Some difficulties arise when interpreting the criteria of the system. The definition of terms such as capping and fusion, will be discussed, as will problems encountered from poor positioning of the radiograph. The aim is to give practical advice in the use of the system, and to look at some of the problems.

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A short term multicenter study on evaluation of the usefulness, acceptability and tolerability of Genotropin KabiQuick (GKQ) was carried out in 36 patients with classical growth hormone (GH) deficiency. Of 36 patients or their parents, 32 (88.9%) evaluated GKQ as superior in preparative procedure to the conventional injection syringe system. Thirty (83.3%) including all of the 6 self-injection patients evaluated that dosing with GKQ was easier. Thirty-two (88.9%) said that GKQ could be handled in a more sanitary condition. Twenty-six (72.2%) felt that the handling of GKQ was easier. The average time needed for each injection with GKQ was 4.0±3.2 min. which was significantly shorter than that with the conventional system (7.8±6.2 min). Ten, twelve and thirteen patients complained that GKQ gave more, equal and less pain respectively. Nineteen (52.8%) commented that the plunger of GKQ was hard to push. Twenty-two (61.1%) preferred GKQ and 5 (13.9%) reverted to the conventional system for future treatment. Doctors concerned with this study assessed that GKQ was useful in 27 patients (75%), but not useful in 2 patients (5.6%). It is concluded that GKQ is an easy handling device which provides quick, safe and sterile daily injections for patients or parents, but an easily movable plunger, a smaller size device and a lower dose-system GKQ are requested for further improvement.

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The effect of one year of human growth hormone (hGH) treatment on height velocity, height SDS, height velocity SDS and bone age was studied in 71 children with non-endocrine short stature. At the start of hGH treatment, mean chronological age (CA) was 8.75 yr, mean bone age (BA) 6.63, mean height SDS -3.09SD, mean height velocity 4.4 cm/yr, mean height velocity SDS for CA -1.66SD and mean height velocity SDS for BA was -2.19SD. Subjects were divided into four groups: 22 cases with familial short stature (M 14, F 8). 16 cases with SFD short stature (M 11, F 5), 5 cases with both familial and SFD short stature (M 5), and 28 cases with idiopathic short stature (M 20, F 8). There was no significant difference in height SDS, height velocity, mean peak GH and mean sleep GH before treatment among these four groups. The children received rhGH at a dose of 0.5U/kg/week 6-7 times a week subcutaneously.
During hGH treatment, 8 cases developed pubertal sign. Since there was no significant difference in the effect hGH treatment between prepubertal group and pubertal group, both group were analyzed together. After one-year hGH treatment, mean height SDS increased significantly to -2.63SD (+0.44SD), mean height velocity to 7M5 cm/yr (+2.63cm/yr), height velocity SDS for CA to+ L62 SD (+3.84SD) and height velocity SDS for BA to +1.63SD (+ 3.845D). There was no significant difference in these values among four groups. During hGH treatment, plasma IGF- I levels increased significantly, but serum osteocalcin levels remained at the same level. Bone age advanced 1.57 years and height age advanced 1.20 years during one-year hGH treatment. The mean ratio of δ bone age/δ height age was 1.34. The effectiveness judged by δheight velocity ≥2cm was 67.6% and that was 62.0% judged by Aheight velocity SDS≥2.5SD. There was no significant difference in these effectiveness among four groups.
Short-term hGH treatment was useful in children with non-endocrine short stature. However, long-term effects remained to be clarified.

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