Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion / 소아알레르기및호흡기학회지

PURPOSE: Determination of adenosine deaminase (ADA) in pleural fluid has been suggested as another tool to establish early diagnosis of tuberculous pleural effusion. However, there are few studies concerning its usefulness in children. The objective of this study was to evaluate the utility of the determination of ADA level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and Mycoplasma pneumonia with pleural effusion (MP) in children. METHODS: We retrospectively reviewed the clinical records of 13 TPE patients and 21 MP patients with pleural effusion. Also, we analyzed ADA levels, and clinical, biochemical, microbiologic and cytologic findings in the pleural fluid. RESULTS: The pleural fluid of all the subjects revealed exudative rather than transudate characteristics. The mean ADA level in the TPE group was significantly higher than that in the MP group (106.27+/-43.71 IU/L vs. 65.28+/-26.27 IU/L, P=0.003). The area under the curve in receiver operating characteristic analysis was 0.810. With a cut-off level for ADA of 60 U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 61.9%, 60.0%, and 92.9%, respectively. As many as 38.9% of patients with MP were false-positive with this ADA cut-off setting. CONCLUSION: Although the measurement of ADA activity in pleural fluid can help TPE diagnosis, we should consider that some cases of MP with pleural effusion showed high ADA activities. Accordingly, the utility of the ADA level in pleural fluid for the differentiation of TPE from MP declines and additional relevant studies are required.

The Usefulness of Measuring the Second Metacarpal Length as a Predictive Index for Growth Velocity during GnRH Agonist Treatment in Girls with Central Precocious Puberty

PURPOSE: The growth velocity in patients with central precocious puberty during treatment cannot be predicted. There is a positive correlation in growth among the long bones of the body and the length of the femur and tibia may determine individual height. We want to determine whether the second metacarpal bone can be used as a predictive index for growth velocity during gonadotropin-releasing hormone (GnRH) agonist treatment. METHODS: Thirty-four female children who were diagnosed with precocious puberty at our clinic and treated with GnRH agonist for about 1 year were included in this study. Patients who had growth-related disease, such as growth hormone deficiency and thyroid diseases were excluded. We reviewed their medical records retrospectively. We measured their height and the second metacarpal length from the X-ray film (left hand Anterior-Posterior at the time of their diagnosis and about a year after their GnRH agonist treatment. RESULTS: The age of the subjects was 8.5+/-0.6 years. The growth velocity during treatment was 4.9+/-1.2 cm/yr. There was a positive correlation between height and the second metacarpal length at diagnosis (P = 0.000, r = 0.666) and at one year after treatment (P = 0.000, r = 0.654). There was no correlation between the second metacarpal length at diagnosis and growth velocity during treatment for 1 year. CONCLUSION: We could not find the correlation between the second metacarpal length and growth velocity during GnRH agonist treatment for 1 year. However, the second metacarpal length showed a positive correlation with height before and after treatment. Therefore further study should be done to discovering the mechanisms working during GnRH agonist treatment including bone age, midparental height and so on.

The Usefulness of Measuring the Second Metacarpal Length as a Predictive Index for Growth Velocity during GnRH Agonist Treatment in Girls with Central Precocious Puberty

PURPOSE: The growth velocity in patients with central precocious puberty during treatment cannot be predicted. There is a positive correlation in growth among the long bones of the body and the length of the femur and tibia may determine individual height. We want to determine whether the second metacarpal bone can be used as a predictive index for growth velocity during gonadotropin-releasing hormone (GnRH) agonist treatment. METHODS: Thirty-four female children who were diagnosed with precocious puberty at our clinic and treated with GnRH agonist for about 1 year were included in this study. Patients who had growth-related disease, such as growth hormone deficiency and thyroid diseases were excluded. We reviewed their medical records retrospectively. We measured their height and the second metacarpal length from the X-ray film (left hand Anterior-Posterior at the time of their diagnosis and about a year after their GnRH agonist treatment. RESULTS: The age of the subjects was 8.5+/-0.6 years. The growth velocity during treatment was 4.9+/-1.2 cm/yr. There was a positive correlation between height and the second metacarpal length at diagnosis (P = 0.000, r = 0.666) and at one year after treatment (P = 0.000, r = 0.654). There was no correlation between the second metacarpal length at diagnosis and growth velocity during treatment for 1 year. CONCLUSION: We could not find the correlation between the second metacarpal length and growth velocity during GnRH agonist treatment for 1 year. However, the second metacarpal length showed a positive correlation with height before and after treatment. Therefore further study should be done to discovering the mechanisms working during GnRH agonist treatment including bone age, midparental height and so on.