Bilateral VII weakness. General. Definition: 2nd facial nerve paresis occuring within 30 days of 1st. Frequency: 0.3% to 2% of patients with facial paralysis. VII nerve lesions. Hereditary. Amyloidosis: Gelsolin. Melkersson syndrome. Möbius syndrome & Congenital facial paresis Children with Facial Asymmetry All people have asymmetric faces. When one looks closely, these differences become more apparent. However, there are conditions in children in which the normal minor differences are much more significant Cheah A, Billings S, Goldblum J, Hornick J, Uddin N, Rubin B. Spindle cell/pleomorphic lipomas of the face: an under-recognized diagnosis. Histopathology . 2015;66(3):430-437. doi: 10.1111/his.12548 PubMed Google Scholar Crossre ©sylvainchamberland.com Differential Diagnosis •Facial asymmetry caused by a functional shift KaHa080205KaVe080801 75. ©sylvainchamberland.com Class II subdivision right •Slight asymmetry to the right •Right posterior Xbite •Lower midline deviated to the right CrBo050901; 13a 76 The differential diagnosis between asymmetry of the glenoid fossa and hemimandibular elongation is established, which requires a careful correlation of clinical findings and imaging tests, since both have similar clinical characteristics, but differ in their therapeutic approach
portant to exclude the diagnoses of polycythemia vera, photosensitive eruption, lupus erythematosus, mixed connective tissue disease, carcinoid syn-drome, systemic mastocytosis, or side effects from long-term facial application of topical steroids. Since rosacea is typically limited to the face, extrafacial erythema is generally an exclusionary. A 30-year-old woman presented for orthodontic treatment, with a chief symptom of a 'shifting bite' and concurrent facial asymmetry with aesthetic concerns. The patient had previously received treatment from several general dentists and several specialists, without accurate diagnosis. Radiological in The diagnostic evaluation and treatment of a neonate with an asymmetrical face depends on the cause of the asymmetry. Neonatal facial asymmetry worse when crying is due to: (1) central lesions, (2) nuclear or intrapontine fiber lesions, (3) peripheral nerve lesions, (4) branch lesion, or (5) agenesis of the depressor angularis oris facial asymmetry. 2a: Panoramic radiographic view of the lesion. A Large Mass in the Maxilla: Clinical Features and Differential Diagnosis Cagri Delilbasi, DDS, PhD; Metin Sencimen, DDS, PhD; Kemal Murat Okcu, DDS, PhD What is your provisional diagnosis? Answer on p. 272 A 21-year-old man was referred to our clini
Facial asymmetry and differential diagnosis of the nature of superior oblique palsy It has been well-documented that patients with superior oblique palsy tilt their head to prevent diplopia. 7, 23 Therefore, there is a chance of developing facial asymmetry in a long term torticollis while no facial asymmetry is detected in acquired torticollis Extraoral examination showed facial asymmetry resulting from a widening of the left mandibular angle (Fig. 1). Axial computed tomography (CT) scans revealed a radiolucent lesion causing cortical expansion on the left side of the mandible (Fig. 2a), and 3-dimensional CT scans showed severe facial asymmetry caused by the expansile lesion (Fig. 2b) . Asymmetry of glenoid fossa as differential diagnosis for hemimandibular elongation www.medigraphic.org.mx skeletal imbalances may be masked through dental compensation, soft tissue compensation or a change head posture.1 Severt and Profﬁ t6 found in a group of patients with facial asymmetry that only 5% of these involved th The differential diagnosis of more amorphous odontomas includes focal cemento-osseous dysplasia, ameloblastic fibro-odontoma, and adenomatoid odontogenic tumor. ossifying fibromas of the craniofacial skeleton grow slowly and symmetrically and can result in bone expansion with facial asymmetry. In the craniofacial region, there are two. Silent sinus syndrome. The silent sinus syndrome represents maxillary sinus atelectasis that results in painless enophthalmos, hypoglobus and facial asymmetry 1-3. Some authors restrict the term to patients with no history of sinusitis, trauma or surgery 2. Some authors suggest that is part of the spectrum of chronic maxillary atelectasis 6
A facial asymmetry in a newborn is, on a regular basis, determined upon birth and requires an incisive physical examination. An ACF diagnosis is made on the basis of the clinical symptoms listed in Table 1 after having eliminated central facial nerve palsy. Neuroimaging is essential to this end While asymmetry of motor symptoms is a diagnostic feature of PD, it is not common to have such striking facial asymmetry so as to mimic facial weakness. Other differential diagnoses to consider in patients with facial asymmetry and their typical semiologies include seventh cranial nerve pathologies (upper and lower facial paralysis), upper. The silent sinus syndrome is a rare entity that is well-known to the ophthalmologist and ENT surgeons. This condition is characterized by painless enophthalmos and facial asymmetry caused by chronic maxillary sinus atelectasis. The diagnosis is usually made clinically, however, imaging of the sinuses can help in the diagnosis Section VIII Differential Diagnosis of the Adult Skin, Face, and Neck, Including the Thyroid and Parathyroid Chapter 52: Rash or Itching Chapter 53: Ulceration Chapter 54: Lesion (Nonpigmented or Pigmented) Chapter 55: Vascular Lesion/Birthmark Chapter 56: Facial Asymmetry (Including Paralysis) Chapter 57: Swelling/Edema (Periorbital, Nose. Focal neurologic deficits. A focal neurologic deficit is a problem with nerve, spinal cord, or brain function. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits
Facial diplegia is an extremely rare  condition which occurs with various systemic illnesses such as sarcoidosis, Lyme disease and Guillain-Barre Syndrome (GBS), to name a few.It often occurs as a simultaneous onset, which means the involvement of the opposite side occurs about 30 days of the onset of the first side Once complete clinical examination has been made the clinician should be able to quantify and delineate the site, extent and balance between hard and soft tissues that contributes to the facial asymmetry. This will allow for the formulation of a differential diagnosis and guide in obtaining the most appropriate investigations . When patients complain of facial asymmetry, the underlying cause should be investigated. The etiology includes congenital disorders, acquired diseases, and traumat-ic and developmental deformities. The causes of many cases of developmental facial asymmetry are indistinct. Bell's palsy causes a temporary weakness or paralysis of the facial muscles. Learn about its symptoms, diagnosis, and treatment. READ MORE. This feature is for informational purposes only and.
We developed and tested machine learning and parametric approaches to automated syndrome diagnosis using 3D facial images. 28 Though facial asymmetry is a syndrome differential diagnoses,. Facial paralysis is usually related to the 7th cranial nerve. Rabbits suffering from this problem present an asymmetric face, when looked from the front. Depending on the extent of the damage, it can cause the dropping of the ear, eyelid, appearance of the third eyelid, and dropping of the lip A term female newborn with antenatal concern for right-sided multicystic dysplastic kidney (Fig 1) is noted to have facial asymmetry and left microtia (Figs 2 and 3). Figure 1. Ultrasound scan at 22 weeks' gestation showing right-sided multicystic dysplastic kidney. Figure 2. Left facial asymmetry. Figure 3. Deformed left ear with micrognathia
. Speech is fluid. By forming a differential diagnosis and having good communication with hospital staff, EMS providers can have great impact on the outcome of. Differential diagnosis includes localized scleroderma, Rasmussen syndrome, hemifacial microsomia, Goldenhar syndrome, idiopathic facial palsy, Berardinelli-Seip congenital lipodystrophy and partial acquired lipodystrophy. Patients with face injuries (e.g. burns), fat necrosis and congenital deformities (e.g. wry neck) should also be considered
Tremor, an involuntary, rhythmic, oscillatory movement of a body part, is the most common movement disorder encountered in clinical practice. Rest tremors occur in a body part that is relaxed and. . Keywords: Dentofacial Asymmetry, Functional Appliances, Growth Modification, Orthognathic Surgery Perfect facial symmetry is extremely rare. I Differential diagnosis. Finally, cranial neuropathies or asymmetry of cranial nerve function should raise suspicion for a lesion involving the foramina through which the cranial nerves exit the skull. Differential diagnosis of facial pain and guidelines for management Cardiofacial, Moebius, Poland's and Goldenhar's syndromes encompass CFP as part of their symptoms.2 An important differential diagnosis is congenital 'facial asymmetry during cry' due to a congenital absence or weakness of depressor anguli oris muscle (cardiofacial syndrome), so when the child is crying the corner of the mouth does not.
Diagnosing HEENT Disorders : primary and differential diagnoses. Further examination reveals the following. Face: Faint asymmetry with left periauricular area slightly edematous. Eyes: sclera clear, conj wnl • L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible • R ear: no tenderness, R. The differential diagnosis is broad and is summarized separately. (See Lymphangitis, section on 'Nodular lymphangitis' .) Botryomycosis - Botryomycosis is a chronic, suppurative infection characterized by a granulomatous inflammatory response to S. aureus and other bacteria; it occurs most commonly in immunocompromised patients
Facial pain must develop simultaneously with the onset or acute exacerbation of rhinosinusitis. Facial pain must resolve within seven days of remission or successful treatment of acute or acute-on-chronic rhinosinusitis. Sinonasal pain is usually deep, aching and non-pulsatile. Non-sinogenic facial pain 10.1055/b-0034-92453 Differential Diagnosis of Acute Facial ParalysisMaurizio Barbara Facial paralysis (FP) consists of weakness of the face musculature. The timing of this weakness usually is immediate, taking place within a few hours ( Table 7.1 ), although some etiologies of facial weakness cause paralysis over weeks to months. The most common type of FP occur Simultaneous, bilateral facial palsy is much rarer than uni-lateral palsy, with an incidence of 0.3-2 per cent.8 When a peripheral facial palsy recurs or affects both sides of the face, an idiopathic cause is less likely. We present two cases of recurrent and (at times) bilateral facial palsy, and we summarise the differential diagnose
Facial asymmetry, OS proptosis, and exotropia, as well as several subcutaneous lesions on the forehead and face, in a 20-year-old man with neurofibromatosis type 2. Posterior cervical scar from cord lesion resection, thoracic scoliosis, and subcutaneous masses in a young adult with neurofibromatosis type 2 Hemihyperplasia, also known as hemihypertrophy, is asymmetry in size between the right and left of the body, more than can be attributed to normal variation. On this page: Article: Terminology. Epidemiology Breast asymmetry is very common and affects more than half of all women. There are a number of reasons why a woman's breasts can change in size or volume, including trauma, puberty, and hormonal. Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry.
Figure 1: The differential diagnosis included; trauma to the orbito-zygomatic complex, malignancy in the maxillary sinus, an undiagnosed congenital facial asymmetry, or silent sinus syndrome. D e n tis r y ISSN: 2161-1122 Dentistr Clinical features were evaluated, and area density of papular lesions was quantitatively measured with CAIA. Based on these variables, we developed a predictive model for differential diagnosis using classification and regression tree analysis. Results: The EPF group showed lesion asymmetry and annular clusters of papules in all cases Bell's palsy is among the most common causes of unilateral facial paresis (weakness) or paralysis, second only to stroke. 2 Often considered a diagnosis of exclusion, Bell's palsy is the most common diagnosis among patients who experience unilateral facial nerve paresis or paralysis of unknown origin. 3 There are approximately 40,000 new. Facial nerve palsy: etiology and approach to diagnosis and treatment. Pediatr Emerg Care. 2010 Oct;26(10):763-9; quiz 770-3. Facial nerve palsy has a broad differential diagnosis and possible psychological and anatomical consequences. A thorough investigation must be performed to determine the cause of the palsy and to direct treatment Diagnosis in Endodontics 1. DIAGNOSIS IN ENDODONTICS Fatima A. A. 2. Diagnosis The science of recognizing disease by means of signs, symptoms and tests. Effective treatments depends on an accurate diagnosis Two broad diagnostic scenarios: Emergency As part of a comprehensive treatment 3
Major characteristics of skeletal Class III with facial asymmetry have been described in previous studies and include dental midline deviation, canted occlusal plane upward to the side of the mandibular shift, different buccal inclination of the right and left posterior teeth (both in the maxillary and mandibular dentition), a large curve of. Torticollis is not simply a diagnosis, but a sign of an underlying disorder. Torticollis means twisted neck and describes an abnormal neck posture with persistent rotation of the head to one side and lateral flexion to the opposite side. There are over 80 differential diagnoses which may cause a torticollis posture
Cerebral hemiatrophy or Dyke-Davidoff-Masson syndrome is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis, and mental retardation. In the differential diagnosis are other conditions that are associated with cerebral hemiatrophy such as Sturge-Weber syndrome,. AOT also deserves inclusion in the differential diagnosis because of its characteristic presentation in the anterior maxilla. AOT is the most common benign odontogenic tumour of anterior maxilla presenting in the second decade of life. 2,4,5 AOT frequently shows calcifications which further favours this diagnosis
Facial asymmetry was mainly located on, but not limited to, the lower two-thirds of the face in skeletal Class III patients. The lower cheek and nose asymmetry were detected to have more extensive and of a greater magnitude of asymmetry than other facial anatomical regions but with various individual variations Cases of facial asymmetry may be managed by orthodontic or surgical means depending upon the degree of severity and the patient's expectations regarding their treatment. A detailed clinical examination and formulation of the correct diagnosis would help the clinicians to achieve the desired treatment goals Differential Diagnosis of Developing Asymmetry Malignancies presenting as developing asymmetry may be of either ductal or lobular origin. Invasive ductal carcinoma is the most likely histologic finding ( Figs 2 , 4 )
PART II CLINICAL DIAGNOSIS SECTION 1 Introduction to Section 1 65 Diagnosis 65 Terms of direction, position and movement 65 Chapter 5 Facial Symmetry and Asymmetry 165 Introduction 165 Relationship between symmetry and proportion 165 Balance and harmony: a note on terminology 16 dictive model for differential diagnosis using classification and regression tree analysis. Results: The EPF group showed lesion asymmetry and annular clusters of papules in all cases. The GPD-LMDF complex group had significantly higher per-iocular density. The GR-PPR complex group showed a high Differential diagnosis for facial weakness. Common and important causes of facial weakness for doctors and medical students This page is currently being written and will be available soon. To be updated when it is complete please like us on Facebook, follow us on Twitter or subscribe on YouTube using the 'follow us' buttons
asymmetry is normal and acceptable in the average face. It may be caused by a range of factors that affect the underlying skeletal structure or soft tissue drape. However, the importance of early diagnosis and the detection of progressive causative conditions is essential for the management of facial asymmetry. This article wil Asymmetry Distal ≥ Proximal Hereditary Face & Periocular With EOM Weakness No EOM Weakness Limb-Girdle Syndromes: Focal Congenital Cranial Bulbar Go to Differential Diagnosis of Neuropathies Return to Neuromuscular Home Page or newly revised Other revision in the differential diagnosis of tumours involving the parotid gland. The extent of surgery should be determined at the time of operation with dual goals of complete mass resection, including normal tissue and facial nerve preservation. Also, intramuscuclar liopma of SCM is rare and should not be overlooked in the differential diagnosis Rash on face / Red Facial Rash, Differential diagnosis. Perioral dermatitis (the skin immediately adjacent to the vermillion border of the lip is classically spared). -This table is helpful in distinguishing between common causes of red facial rash. Facial redness (erythema) is caused by cutaneous blood vessel dilation and increased blood flow.
DIFFERENTIAL DIAGNOSIS 65 Dermatophyte infection versus psoriasis 214, 215 Tinea capitis. Alopecia and minor scaling are clues to diagnosis 216, 217 Scalp psoriasis. 218 Tinea corporis. Note the active, scaly border. 219 Flexural psoriasis; minimal scale noted in this form Differential diagnosis. The differential diagnosis for brow ptosis includes dermatochalasis, upper eyelid ptosis, facial nerve palsy or mechanical ptosis secondary to mass. Management General treatment. The treatment of brow ptosis is surgical. Surgery. Several approaches have been utilized in the treatment of brow ptosis Clinical geneticists use these face shape differences as important clues in the early stages of diagnosis prior to detailed clinical examination and genetic testing Nonsyndromic Facial Asymmetry with Unilateral Condylar Aplasia. Ranganadh Nallamothu,1 Rama Mohan Kodali,1 N. Koteswara Rao,1 Leela krishna Guttikonda,1 and U. Vijayalakshmi1. 1Department of Oral and Maxillofacial Surgery, Drs. Sudha & Nageswara Rao Siddhartha Institute of Dental Sciences, Chinoutpalli, Gannavaram, Krishna District, Andhra.
Facial Aesthetics: Concepts and Clinical Diagnosis is a unique new illustrated resource for facial aesthetic surgery and dentistry, providing the comprehensive clinical textbook on the art and science of facial aesthetics for clinicians involved in the management of facial deformities, including orthodontists, oral and maxillofacial surgeons, plastic and reconstructive surgeons and aesthetic. The following differential diagnosis case studies will explore possible causes of facial rashes, with the aim of making it easier to understand the presentations and complexity. Case 1. Samantha is 45 years old and works in a media job, which involves entertaining guests and public speaking
•Ramsay-Hunt syndrome: disease of geniculate ganglion of facial nerve (CN-VII) → ipsilateral facial nerve paralysis, dry mouth/eyes, anterior 2/3 tongue taste loss, and auditory (e.g., deafness and tinnitus) and equilibrium issues (vestibulocochlear nerve Facial pain from various sources-diagnoses and differential diagnoses. The most common reason a patient seeks dental care is the sensation of pain in the teeth, jaw or face. While the assumption is that this pain is dental in origin, on occasion the pain may have a medical origin, either due to a medical disease, or a medical or neurological. Facial dysmorphism and asymmetry are considered typical features of the syndrome, although the range of phenotypic variance is unknown. Fifty seven subjects varying in age from 0.84 to 35.01 years, in whom the diagnosis of SRS had been considered definite or likely, were re-evaluated in a combined clinical and molecular study by a single. Purpose: To create a practical desk reference for clinicians focused on the differential diagnosis of individuals presenting with features that suggest an inherited disorder of connective tissue
Facial paralysis. Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one or both sides of the face. The facial nerve (cranial nerve 7) that controls your facial muscles passes through a narrow corridor of bone on its way to your face The differential diagnosis of the breathless patient Introduction Breathlessness is the subjective sensation of difficulty in breathing, which may be laboured or uncomfortable.1 In health it is not always un-pleasant and not associated with anxiety or fear. It results from multiple interactions of signals an The differential diagnosis of heavily pigmented melanocytic neoplasms includes melanoma (especially animal type), melanosis of partially or completely regressed melanoma, blue naevus (BN), pigmented Spitzoid lesions, recurrent naevus, combined naevus, pigmented spindle cell naevus, epithelioid blue naevus of the Carney complex/pigmented epithelioid melanocytoma, deep penetrating naevus. When located on the face, flat SKs may require a careful differential diagnosis from lentigo maligna (LM). RCM is particularly useful, with the face region representing one of its best indications. A regular epidermal pattern, the absence of perifollicular infiltration of pagetoid melanocytes, the absence of DEJ nesting together with features.
Discussion General consideration of lipoma. Lipomas are the most common benign neoplasms of mesenchymal origin and may arise in any location where fat is normally present. 1 Lipomas are composed of mature fatty cells and occur predominantly on the upper back, shoulder and abdomen. 2,3 In the head and neck region, where only 13% of lipomas are seen, 4 the posterior neck space is the most common. Key Difference - Bell's Palsy vs Facial Palsy Structural or functional damage to the facial nerve can give rise to a weakness of the facial muscles known as facial nerve palsy. Infection of the facial nerve within the bony facial canal of the petrous bone causes the facial nerve to swell, giving rise to a set of clinical manifestations that are identified as the Bell's palsy To our knowledge this is the first described Brissaud-Sicard syndrome caused by a large diffuse brainstem glioma. The unilateral sustained tonic contractions of the facial muscles that were seen in our patient may present a challenging differential diagnosis of hemifacial spasm due to some similarities such as mild facial weakness or Babiñski's-2 sign Blepharoptosis, or ptosis, refers to the drooping or downward displacement of the upper eyelid. The levator muscle, its aponeurosis, and the superior tarsal muscle are responsible for upper eyelid resting position and elevation. When these structures are compromised, the resultant depressed eyeli..
Blepharospasm is abnormal contraction of the eyelid muscles. It often refers to benign essential blepharospasm (BEB) which is a bilateral condition and a form of focal dystonia leading to episodic closure of the eyelids. The exact cause of BEB is unknown and, by definition, it is not associated with another disease entity or syndrome. Symptoms usually begin as mild and infrequent spasms that. Bell's Palsy is essentially a diagnosis of exclusion, so once other causes of facial palsy have been eliminated, we call an isolated facial palsy Bell's Palsy, or Idiopathic Facial Palsy. MRI scanning can be used to exclude other causes of facial nerve dysfunction  , such as Facial Schwannoma or Acoustic Neuroma ICD-10-CM Diagnosis Code Q83.8 [convert to ICD-9-CM] Other congenital malformations of breast. Asymmetry of breasts, congenital; Congenital absence of breast; Congenital asymmetry of breasts; Tubular anomaly of breast; Tubular breast. ICD-10-CM Diagnosis Code Q83.8 Cavernous sinus syndrome can be caused by various disease entities. Understanding the characteristic clinical features and their implications as well as the characteristic imaging findings will assist in the differential diagnosis focused on this small but complex structure, the cavernous sinus
Diagnosis . Very often, a physician can diagnose Bell's palsy just by hearing your story and doing a thorough physical exam. The doctor may examine your hearing as well as your sense of taste to see if those parts of the facial nerve have been affected. If they have, the problem is more likely Bell's palsy than stroke. The most important thing is to see if the upper and lower parts of the. 1 Diagnosis and Differential Diagnosis of Parkinson s Disease Paul Lingor 1, Jan Liman 1, Kai Kallenberg 2, Carsten-Oliver Sahlmann 3 and Mathias Bähr 1 1University Medicine Göttingen, Departments of Neurology, 2Neuroradiology, 3Nuclear Medicine, Germany 1. Introduction Parkinsonian syndromes are a heterogeneous en tity of movement disorders, which can b The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)1 is used by health professionals to help diagnose tic disorders Sparsecurlyhair, ptosis, left facial asymmetry, and delayed hypocalcified carious dentition were also noted'3 (fig 2). Subsequent development has been slow withdaytimecontinenceat 5 years,nighttime continence at 8 years, and walking indepen-dently at 7 years. Sheattends a special school. Theleft foot developed a severe valgus defor. CHARGE syndrome is a congenital condition (present from birth) that affects many areas of the body. CHARGE stands for c oloboma, h eart defect, a tresia c hoanae (also known as choanal atresia), r estricted growth and development, g enital abnormality, and e ar abnormality. Signs and symptoms vary among people with this condition; however, infants often have multiple life-threatening medical.
Clinical diagnosis. Scrapings of vesicles and surrounding skin may yield multinucleated giant cells, known as Tzanck cells. Skin rash (erythema migrans or other), frontal headache, fever, malaise, fatigue, myalgia, arthralgia, known tick exposure, or recent travel to Lyme disease-endemic region Start studying Advanced Health Assessment and Differential Diagnosis Module 3. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Note the patients posture, eye contact, and facial expression unusual facial movements, and asymmetry of expressio Etiology of Class III malocclusion can be genetic or environmental. Proclination of mandibular incisors and retroclination of maxillary incisors can cause posturing of the mandible in an anterior position due to incisal interference, a condition called pseudo Class III malocclusion that can be misleading in evaluating a patient with skeletal Class III malocclusion Keratoconus is a non-inflammatory, bilateral (but usually asymmetrical) disease of the cornea which results in progressive corneal steepening. It is characterised by para-central corneal thinning and ectasia so that the cornea takes the shape of a cone. Visual loss occurs primarily from myopia and irregular astigmatism and secondarily from corneal scarring. Duddell in 1729, described a patient
Guidelines for the diagnosis and assessment of eczema — codes and conceptsopen. This document incorporates and summarises guidelines recently published by the American Academy of Dermatology  and the British Association of Dermatologists . It is relevant to the treatment of eczema in New Zealand Based on a thorough literature search, the causes and consequences of small birth size for gestational age are described, as are the results of GH treatment