ABSTRACT
CONTEXT: Recombinant human GH (rhGH) improves growth and body composition in glucocorticoid-treated children. Its effects on muscle strength are poorly evaluated. OBJECTIVES: Our objective was to evaluate rhGH effects on muscle strength in children receiving long-term glucocorticoid therapy; effects on height SD score (SDS) and body composition were assessed also. DESIGN AND SETTING: A randomized, controlled, delayed-start study of rhGH for 12 months was started after randomization (baseline) or 6 months later (M6). PATIENTS: Patients included 30 children with various diagnoses. INTERVENTION: rhGH was administered at 0.065 mg/kg/d for 6 months and then in the dosage maintaining serum IGF-I levels below +2 SDS for chronological age. MAIN OUTCOME MEASURES: The primary criterion was the between-group difference in composite index of muscle strength (CIMS) change at M6. Secondary criteria included between-group differences in CIMS SDS(height), lean mass (LM), thigh muscle area (MA), and height SDS changes at M6; these parameters were also assessed in the overall population after 1 year of rhGH therapy. RESULTS: At M6, rhGH therapy did not significantly affect changes in CIMS or CIMS SDS(height) (+17.6% vs +7.5% and +0.14 ± 0.38 vs +0.11 ± 0.62, respectively); the rhGH-treated group had significantly larger changes in height SDS (+0.2 [0.3] vs -0.2 [0.3]; P = 0.003), LM (+7.3% [+3.7%; +21.6%] vs 0% [-4.7%; +3.2%]; P = 0.002), and MA (+8.8% [+5%; +15.6%] vs. -0.6% [-6.3%; +7.7%]; P = 0.01) compared with the untreated group. After 1 year of rhGH, height SDS, LM, and MA increased significantly, CIMS increased by 24.7% (+5.8%; +34.2%), and CIMS SDS(height) remained within the normal range. CONCLUSIONS: rhGH increased height, LM, and MA. However, muscle strength did not improve significantly.
Subject(s)
Adolescent Development/drug effects , Body Composition/drug effects , Child Development/drug effects , Chronic Disease/drug therapy , Glucocorticoids/adverse effects , Human Growth Hormone/therapeutic use , Muscle Strength/drug effects , Adolescent , Body Height/drug effects , Child , Drug Monitoring , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Growth Disorders/chemically induced , Growth Disorders/etiology , Growth Disorders/prevention & control , Human Growth Hormone/administration & dosage , Human Growth Hormone/adverse effects , Humans , Insulin-Like Growth Factor I/analysis , Male , Muscle Weakness/etiology , Muscle Weakness/prevention & control , Pilot Projects , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Recombinant Proteins/therapeutic useABSTRACT
Extensive venous thrombosis is usually seen postmortem in amebic liver abscess because of its dismal prognosis. Herein, we describe amebic liver abscess, whose late diagnosis led to multiple deep thromboses, pulmonary embolism, and right atrial thrombosis, in this patient with patent foramen ovale.
