Growth hormone treatment of osteoporotic postmenopausal women - a one-year placebo-controlled study.

OBJECTIVES: To study the effect of 12 months of growth hormone (GH) treatment on bone markers, bone mineral density (BMD), lean body mass (LBM) and body fat mass (BF) in postmenopausal osteoporotic women. DESIGN: Sixteen patients were randomised to a double-blind randomised placebo-controlled one-year study with daily s.c. injections of GH or placebo. After the first year 14 patients (8 placebo treated, 6 GH treated) were recruited to GH treatment during the second year. All patients were also supplemented with 0.5 g calcium per oral. METHODS: Bone mineral density and body composition were assessed by dual energy X-ray absorptiometry. Biochemical bone markers were analysed by RIA or HPLC techniques. Diurnal GH profiles were performed with continuous venous blood sampling. RESULTS: Sixteen patients started in the placebo-controlled study. In all, twelve patients completed one year and only four patients completed two years of GH treatment. At baseline 3 patients had serum insulin-like growth factor-I (S-IGF-I) levels below -2 S.D. for age. Maximal diurnal GH levels tended to correlate negatively with S-IGF-I (P=0.076). S-IGF-I was unrelated to BMD. Serum IGF-binding protein-1 (S-IGFBP-1) correlated negatively with femoral neck BMD (r=-0.61, P=0.012). The intended GH dose of 0.05U/kg/day or a maximum of 3U/day s.c. was reduced to 0.024+/-0.004U/kg/day, equal to 0.5-2.7U/day due to frequent side effects, and four patients were excluded. After one year of GH treatment BF increased slightly, LBM and BMD in total body and lumbar spine were unchanged but femoral neck BMD had decreased 3.4+/-1.6% (P<0.05). The mean S-IGF-I increase was 32% (range -38-138%). Mean levels of the bone formation markers S-osteocalcin and S-procollagen type I propeptide increased maximally by 88 and 36% respectively after 9-12 months while the bone resorption markers were unchanged. In the placebo-treated group there were no significant alterations. CONCLUSIONS: The effects on S-IGF-I, bone markers and LBM were small although GH-related side effects were common. The reason for this apparent partial resistance to the anabolic effects of GH is not clear but nutritional deficits may be involved. Assessment of the effects of GH on bone mass and fracture rate requires longer study periods than one year.

Hallux valgus in ballet dancers: a myth?

Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Factors related to renal haemodynamics in young type-1 diabetes mellitus patients.

The influence of metabolic control (HbA1c), noradrenaline (NA) and insulin-like growth factors (IGF-I and IGF-II) on renal function and size was investigated in 11 insulin-dependent diabetes mellitus patients aged 11-17 years. Renal function was evaluated in terms of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal size was determined as renal parenchymal volume (RPV) by ultrasonography. The patients' HbA1c values ranged from 8.2% to 12.9% (normal range 5.5-8.5%) and their GFR and ERPF were higher than normal. Their IGF-II values were higher, and NA and IGF-I levels were lower than those of healthy controls. Inverse correlations between NA and GFR (r = -0.66) and NA and ERPF (r = -0.63) were found. No correlation was found between serum IGF-I and renal functional parameters. The IGF-II values correlated with GFR and HbA1c (r = 0.63, r = 0.70 respectively). There were linear correlations between RPV and GFR, RPV and ERPF, HbA1c and GFR, and ERPF and RPV. Decreased NA concentrations and increased IGF-II values appear to be factors contributing to renal hyperfunction in these patients.

Renal parenchymal volume during and after acute pyelonephritis measured by ultrasonography.

A total of 47 children with acute pyelonephritis were investigated using water delay ultrasonographic equipment (Octoson) for determination of renal parenchymal volume by the stepped section technique. Thirty two patients were repeatedly investigated every to every other week up to seven weeks. Median renal parenchymal volume during acute pyelonephritis of the right kidney was 2.70 cm3/kg body weight and of the left kidney 3.10 cm3/kg; this was significantly larger than the volume of control kidneys, which was 1.82 and 2.07 cm3/kg, respectively. The most enlarged kidneys were found among the youngest children. A significant successive decrease in renal size was found during the first four to five weeks after the acute pyelonephritis. Because of enlargement of the kidneys during acute pyelonephritis we suggest that the first renal size determination to be used for following renal growth should be performed after at least four to six weeks.

Urographic renal size in acute pyelonephritis in childhood.

Eighteen children with acute pyelonephritis were investigated by urography at the time of and about two months after the acute infection. Renal size was evaluated as renal length and parenchymal area. During the acute infection renal size was larger than at the follow-up examination two months later. In conclusion, urography performed in close connection with the acute pyelonephritic infection gives an overestimation of renal size.

Comparison between renal parenchymal sonographic volume, renal parenchymal urographic area, glomerular filtration rate and renal plasma flow in children.

A comparison of renal size, expressed as ultrasonographic renal parenchymal volume and urographic renal parenchymal area, and renal function, measured as glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), was made in two groups of children: (1) 21 patients with normal urograms and no signs of current disease and (2) 26 children with recurrent urinary tract infections or asymptomatic bacteriuria. Renal parenchymal volume was calculated using a water delay ultrasonographic device (Octoson). Renal parenchymal area was measured urographically. GFR and ERPF were determined from the clearances of inulin and PAH, respectively. In both groups a good correlation was found between both GFR and ERPF and total renal parenchymal volume as well as renal parenchymal area. The determination of renal parenchymal volume could possibly replace the determination of GFR and ERPF in healthy children and in children with urinary tract infections with normal and abnormal urograms.

Renal parenchymal volume in children. Normal values assessed by ultrasonography.

Forty-three children with normal urograms and with kidneys of normal size regarding length, area and parenchymal thickness were examined using a water-delay computerized ultrasonographic equipment. Renal parenchymal volumes were calculated and related to body weight. The correlation coefficient was 0.92. The renal parenchymal volume of the left kidney was significantly larger than that of the right kidney (p less than 0.001). For practical purposes they should, however, be assumed to be of equal size, 2.0 +/- 0.3 cm3/kg body weight.

Relation between clinical and roentgenological scores and measures of lung function in cystic fibrosis, with special reference to pulmonary Xenon133 elimination.

Regional lung function (RLF) with Xenon133 was investigated in 40 patients with cystic fibrosis (CF) aged 5-28 years (mean 13) at 1-5 occasions during a 3-year period. The RLF was determined with a 4-collimator system and evaluated with a score based on the following parameters: (1) time of elimination of injected isotope and (2) of inhaled isotope, (3) regional ventilation, (4) regional perfusion and (5) ventilation-perfusion ratios. The results were related to spirometry, X-ray score (according to a modification of Chrispin and Norman) and clinical score (according to Shwachman and excluding X-ray), which were all assessed in the same day. RLF correlated to clinical (P less than 0.01) and radiological score (P less than 0.01) and to residual volume (P less than 0.001) and the ratio between one second forced expiratory volume to vital capacity (FEV%) (P less than 0.01), but much higher correlations were found between X-ray score, clinical score and different spirometric variables. We therefore conclude that RLF can be used in patients too young to cooperate in spirometry but that it is of less clinical value in older patients with CF.

The value of diaphanography as an adjunct to mammography in breast diagnostics.

Histologically classified carcinoma and benign breast disorder was present in 100 respectively 163 cases of symptomatic women. The results of diaphanography were correlated with those obtained by clinical examination, mammography and histology. A false negative diagnosis was made in 17 cases (15.5%) using diaphanography and in 13 cases (11.8%) using mammography. A false positive diagnosis was made in 15 cases (9.2%) with diaphanography and in 33 cases (20.2%) with mammography. The use of both mammography and diaphanography reduced the number of false negatives from 11.8 per cent to 5.5 per cent. In conclusion, diaphanography has been demonstrated to be a useful adjunct to mammography.

Diaphanography in benign breast disorders. Correlation with clinical examination, mammography, cytology and histology.

Histologically classified benign breast disorder was present in 163 breast of 158 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palpable in 108 cases (66.3%). A false positive diagnosis, i.e. possibly malignant, probably malignant or malignant was made in 15 cases (9.2%) with DPG, and in 33 cases (20.2%) with M. Use of both M and DPG reduced the number of false positives to 1.8 per cent. In 8 cases (4.9%) false positive diagnosis was made with C. During a mean observation time of 58.5 months (range 44-72 months, one case of breast carcinoma was diagnosed.

Diaphanography in breast carcinoma. Correlation with clinical examination, mammography, cytology and histology.

Histologically classified carcinoma was present in 110 breasts of 108 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palpable in 87 cases (79.1%). A false negative diagnosis was made in 17 cases (15.5%) using DPG, in 13 cases (11.8%) using M and in 15 cases (13.6%) using C, but in 12 of the latter cases (10.9%) the specimen was not representative. The validity of the findings using DPG and M was also analysed. The calculations were based on the results obtained from the present investigation and from a study of diaphanography in 163 cases of benign breast disorders. For DPG the sensitivity was 85 per cent, the specificity 91 per cent, the positive predictive value 86 per cent and the negative predictive value 90 per cent. For M the sensitivity was 86 per cent, the specificity 80 per cent, the positive predictive value 75 per cent and the negative predictive value 91 per cent. The specificity for diaphanography was significantly different from mammography (p less than 0.05). The use of both M and DPG reduced the number of false negatives from 11.8 per cent to 5.5 per cent. In conclusion, DPG has been demonstrated to be a useful adjunct to CE and M.

Ultrasonographic renal parenchymal volume related to kidney function and renal parenchymal area in children with recurrent urinary tract infections and asymptomatic bacteriuria.

A comparison of the relationship that might exist between ultrasonographically calculated renal parenchymal volume and renal parenchymal area assessed from urography and also between renal parenchymal volume and kidney function was conducted in a series of 26 children with recurrent urinary tract infection or asymptomatic bacteriuria. Glomerular filtration rate (GFR) was determined by the clearance of inulin, renal parenchymal area was measured from urography and renal parenchymal volume was calculated from sequential longitudinal scans of the kidney using an automated water-delay ultrasonographic equipment (Octoson). High correlation was found between 1) renal parenchymal volume and GFR, 2) renal parenchymal volume and renal parenchymal area and 3) renal parenchymal area and GFR. Octoson ultrasonographic determination of renal parenchymal volume is a reliable method to evaluate glomerular filtration rate and renal parenchymal area in children with recurrent urinary tract infections and asymptomatic bacteriuria.

Teratologic congenital dislocation of the hip. Report of two cases.

The incidence of teratologic dislocation of the hip is about 0.04 per thousand. Teratologic CDH is usually described together with other anomalies, such as arthrogryposis. Quite different opinions about the diagnostic criteria are found in the literature; some of these are reviewed in this report. Two cases of teratologic CDH with no other anomalies are also reported. Computer tomography was used to confirm reduction in plaster when conventional radiologic examination gave ambiguous results.

Prospective study of fatty acid supplementation over 3 years in patients with cystic fibrosis.

Intravenous fatty acid supplementation (10% Intralipid, 10 ml/kg body weight) was given to 10 patients with cystic fibrosis (CF), in intervals for 3 years. One year of intensive treatment with supplementation every fortnight was followed by 1 year of intermission and then 1 year of the same treatment given for 2 days every 2 months. Compared with matched CF patients, the clinical course, evaluated by Shwachmann scoring, showed less deterioration in the treated group, especially during the year of intensive treatment. Single parameters, such as pulmonary function tests, pulmonary X-ray films, clinical infections, bacterial growth of sputa, and sweat electrolyte concentration, showed no differences. It is concluded that if there is any benefit of this kind of treatment in CF, it has to be very intensive. At present, the psychological stress involved in repeated parenteral administrations over long periods prevents its use in clinical routine.

Diagnosis in utero of congenital hydrocephalus by sonography and computerized tomography.

Four patients with suspected fetal hydrocephalus in utero were examined by means of sonography and computerized tomography (CT). The diagnosis was confirmed in 3 cases, while the fourth was found to be normal. The mean radiation dose absorbed by the maternal ovaries was estimated by phantom measurements.