Normal male articular cartilage (34 specimens, age range 1--30 years) has been examined in vitro for response to somatomedin (SM) activity. Basal 3H-thymidine and 35S-sulfate incorporation both decreased with increasing age of the cartilage donor. However, enhancement of isotope incorporation which was attained on addition of 10% normal plasma (containing IU SM/ml) was greatest in cartilage from adolescents in the age range 12--17 years. The mean enhancement of 3H-thymidine incorporation (expressed as % basal) was as follows: age 1--10 years = 184 +/- 28 (SE), N = 9; 12--17 years = 436 +/- 101 (11); 18--30 years = 231 +/- 49 (8); and for 35S-sulfate incorporation was 1--10 years = 389 +/- 100 (8); 12--17 years = 824 +/- 273 (11); and 18--30 years = 572 +/- 56 (8). The increased response of cartilage in the 12--17 year group suggests that a greater sensitivity to the somatomedins may contribute to the increased skeletal growth during adolesence.

Summary Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures). More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women. Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non‐pregnant state. Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥ 50 µg/g) signifies a need for further diagnostic evaluation. Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy. Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes.

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