The key to improving the care of people with advanced cancer is understanding their experiences of care. Communication between the patient, family, and health-care team ensures assumptions that misinterpret attributes of positivity are not made.

More than half of the deaths occurring under the age of 12 years take place during the first week of life, and the term 'biochemical death' is sometimes used where an adequate pathological explanation cannot be found at necropsy. Following the pioneer work of Selye (1936), which drew attention to the prominent role of the adrenal cortex in the endocrine response to stress, it became established that an increased secretion of corticosteroids occurred in adults under conditions of stress, and that, in some unknown manner, such hormonal activity was essential to the well-being and even to the survival of the subjects in such circumstances.In paediatric circles, however, it was thought that the adrenocortical response to stress might be relatively deficient in newborn infants, and Bongiovanni (1951) al., 1959;Colle et al., 1960) found that the urinary excretion of Porter-Silber chromogens by infants undergoing surgery during the first 4 days of life showed no significant increase over the excretion of these compounds in normal controls, though there was a marked increase in the excretion of 17-hydroxycorticosteroids measured in this way when infants were subjected to surgery during the second week of life. Studies of plasma corticosteroids measured as Porter-Silber chromogens by Klein, Fortunato, and Papadatos (1954) showed that the normal newborn infant from the second to the fifth

946. Excretion of individual adrenocortical steroids in obese children. The excretion of 13 individual adrenocortical metabolites in the urine of 21 obese children aged 7 months to 16 years is reported. Fractionation of the steroids was carried out on 24-hour samples of urine by paper chromatography using Bush systems and incorporating a radioactive steroid recovery technique. The excretion of the 17-hydroxycorticosteroids and of the oc-ketolic metabolites of cortisol and corticosterone exceeded that of normal children studied in the same manner. These differences persisted when the results were corrected for surface area but were eliminated by correction for body weight. The raised corticosteroid excretion in obese children is therefore related to the increased weight. In addition the excessive calorie intake enhances the hepatic metabolism of cortisol leading to an increased corticosteroid excretion.The excretion of the 17-oxosteroids and 11-deoxygenated-17-oxosteroids exceeded that of normal children. Before puberty these steroids represent the adrenal androgens, and the raised excretion in the obese children was associated with an advanced bone age. The early onset of puberty in obesity may be related to the increased body weight, but it is suggested that the increased adrenal androgen secretion may stimulate early maturation of the hypothalamic centre controlling the onset of puberty.

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