Post graft development of short children treated with growth hormone before kidney graft

Sixteen prepubertal patients with chronic renal failure (CRF) were given daily recombinant human growth hormone (rhGH) treatment (1.2 IU/kg per week) for 2.6±1.6 years until kidney transplant. Therapy was then discontinued and the patients followed for a further 3.5±1.4 years. During treatment, mean height increased from –3.0±0.9 standard deviation score (SDS) to –1.9±1.4 SDS (P<0.001) at the time of transplantation, corresponding to a mean height gain of +1.2±0.9 SDS. After discontinuation of rhGH therapy, prepubertal children continued a partial catch-up growth with a height gain of +0.5±0.8 SDS for the follow-up period. Conversely, negative changes of height were observed in pubertal transplanted children: –0.5±0.4 SDS in patients grafted at early stages of puberty (P2–P3) and –0.15±0.9 SDS in patients grafted at late stages of puberty (P4–P5). These data confirmed the benefit of rhGH therapy in CRF patients. Nevertheless, only early initiation of rhGH treatment led some of these patients to their target height at transplantation, thus preserving their potential growth. Reinitiation of rhGH therapy after transplantation should be considered in order to complete catch-up growth to target height in prepubertal children. Received: 23 July 1998 / Revised: 8 December 1998 / Accepted: 13 December 1998     

Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair

Introduction and hypothesis  This study aimed to document intraoperative and postoperative complications associated with the use of transvaginal polypropylene mesh in the repair of pelvic organ prolapse (POP). Methods  This is a retrospective review of 127 cases of transvaginal repair of POP using synthetic mesh. Results  Mean postoperative value (±SD) for pelvic organ prolapse quantification (POPQ) measurements Aa, Ap, and C were: −2.4 ± 1.1 (cm), −2.4 ± 0.9 (cm), and −7.7 ± 1.2 (cm), respectively. The difference between preoperative and postoperative values of these points was significant (p < 0.0001). Mesh erosion rate was 13/127 (10.2%) with significant correlation between mesh erosion and concurrent vaginal hysterectomy (p = 0.008). Combined anterior and posterior vaginal mesh surgery increased the risk of intraoperative bleeding and blood transfusion (p < 0.05). Conclusions  Concurrent vaginal hysterectomy is associated with increased risk of vaginal mesh erosion. Combined anterior and posterior vaginal mesh repair is an increased risk factor for intraoperative bleeding and blood transfusion.     

Residual renal function and nutrition in young patients on chronic hemodialysis

Residual renal function (RRF) has been associated with a better nutritional status in adult patients on chronic dialysis, but there is as yet no data available for young patients on chronic hemodialysis (HD). We have retrospectively analyzed 3-day dietary reports and simultaneous urea kinetic monitoring data (n = 179) of 30 children, adolescents and young adults on chronic HD. The protein catabolic rate (PCR) was calculated and normalized by body weight (nPCR). The HD dialysis dose (Kt/VHD), RRF (calculated by urea clearance, Ku, and expressed as residual Kt/V) and total Kt/V (Kt/Vtot) were evaluated. In all patients, nPCR was correlated with dietary protein intake (nDPI) (p < 0.0001) and Kt/Vtot (p < 0.0001) but not with Kt/VHD (p = 0.11). In patients with RRF, Ku was associated with nPCR (p < 0.0001), while Kt/VHD was not (p = 0.10), and nPCR was higher than in patients without RRF (1.46 ± 0.41 vs. 1.03 ± 0.33 g/kg/day; p < 0.0001). Patients on recombinant growth hormone (rhGH) treatment showed higher nPCR values than those without rhGH (1.34 ± 0.41 vs. 1.01 ± 0.39 g/kg/day; p < 0.0001). In a multiple regression model including age, rhGH treatment, RRF, Kt/Vtot and Kt/VHD, and nPCR showed the best correlation with RRF (β = 0.128; p < 0.0001). In conclusion, in children, adolescents and young adults on chronic HD treatment, RRF positively affects nutrition independently of HD efficiency and rhGH treatment.     

Is Lean Body Mass Decreased after Obesity Treatment by Adjustable Gastric Banding?

Background There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size. Methods Body composition was assessed by dualenergy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7 ± 8.4 years, BMI 36.4 ± 5.9 kg/m², mean ± SD), and in 117 control women (age 44.5 ± 7.5 years; BMI 36.7 ± 5.5 kg/m²) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM). Results 1 year after LAGB, body weight loss (−23.7 ± 11.6 kg, P < 10⁻⁶) was mainly due to decreased fat mass (−21.2 ± 11.2 kg, P < 10⁻⁶), and total LBM was modestly, although significantly, decreased (−2.1 ± 4.2 kg, P = 0.01). Appendicular LBM (−0.7 ± 2.7 kg) and total SMM (−0.9 ± 3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM. Conclusions Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.     

Bisphosphonates in children with hypercalciuria and reduced bone mineral density

Previous studies have demonstrated reduced bone mineral density (BMD) and biochemical changes of excessive bone resorption in some patients with idiopathic hypercalciuria (IH). Consequently, bisphosphonates have been successfully employed in research animals and adults with IH and reduced BMD. We evaluated the effect of treatment with bisphosphonates in seven patients ages 10–16 years with persistent IH and reduced BMD. In five children, preceding traditional therapy failed. All children received oral alendronate and one also IV Zoledronic acid for 6–18 (median 9.0, mean 10.7) months. With treatment, BMD Z scores in the lumbar spine improved from −2.0 ± 0.3 to −0.8 ± 0.8 (p = 0.002) and in the femoral neck from −1.8 ± 0.4 to −0.7 ± 0.9 (p = 0.01); urine N-telopeptides/creatinine decreased from 372 ± 289 to 72 ± 39 nmol/mmol (p = 0.05) and calcium/creatinine from 0.29 ± 0.12 to 0.13 ± 0.06 mg/mg (p = 0.009). Height Z scores, normal at baseline in all, remained unaffected, and no new stones or fractures were documented throughout the treatment period. Serum creatinine, electrolytes, calcium, phosphorus and parathyroid hormone remained normal as well. In summary, in children with IH and decreased BMD, treatment with bisphosphonates normalized urine calcium excretion, eliminated urinary symptoms, and significantly improved reduced BMD. These short-term beneficial effects indicate the need for larger prospective studies on the potential of bisphosphonates to serve as a new tool in treating children with IH and reduced BMD.     

Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial

Introduction The purpose of this study was to investigate the effect of a 12-month Balance Training Program on balance, mobility and falling frequency in women with osteoporosis. Methods Sixty-six consecutive elderly women were selected from the Osteometabolic Disease Outpatient Clinic and randomized into 2 groups: the ‘Intervention’, submitted for balance training; and the ‘Control’, without intervention. Balance, mobility and falling frequency were evaluated before and at the end of the trial, using the Berg Balance Scale (BBS), the Clinical Test Sensory Interaction Balance (CTSIB) and the Timed “Up & Go” Test (TUGT). Intervention used techniques to improve balance consisting of a 1-hour session each week and a home-based exercise program. Results Sixty women completed the study and were analyzed. The BBS difference was significant higher in the Intervention group compared to Control (5.5 ± 5.67 vs −0.5 ± 4.88 score, p < 0.001). Similarly, the number of patients in the Intervention group presented improvement in two conditions of CTSIB compared to Control (eyes closed and unstable surface condition: 13 vs one patient, p < 0.001 and eyes open, visual conflict and unstable surface condition: 12 vs one patient, p < 0.001). Additionally, the differences between the TUGT were reduced in the Intervention group compared to Control (−3.65 ± 3.61 vs 2.27 ± 7.18 seconds, p< 0.001). Notably, this improvement was paralleled by a reduction in the number of falls/patient in the Intervention group compared to Control (−0.77 ± 1.76 vs 0.33 ± 0.96, p = 0.018). Conclusion This longitudinal prospective study demonstrated that an intervention using balance training is effective in improving functional and static balance, mobility and falling frequency in elderly women with osteoporosis.     

Effect of peak inspiratory flow on gas exchange, pulmonary mechanics, and lung histology in rabbits with injured lungs

Purpose The aim of this study was to evaluate, using a rabbit model, the little-known effect of different levels of peak inspiratory flow on acutely injured lungs. Methods Fourteen male rabbits (body weight, 2711 ± 146 g) were anesthetized and their lungs were injured by alveolar overstretch with mechanical ventilation until Pa_O2 was reduced below 300 mmHg. Injured animals were randomly assigned to: the P group—to receive pressure-regulated volume-control ventilation (PRVCV; n = 7); and the V group—to receive volume-control ventilation (VCV; n = 7). Other ventilator settings were: fraction of inspired oxygen (FI_O2), 1.0; tidal volume, 20 ml·kg⁻¹; positive end-expiratory pressure (PEEP) 5 cmH₂O; and respiratory rate, 20 min⁻¹. The animals were thus ventilated for 4 h. Throughout the protocol, ventilatory parameters and blood gas were measured every 30 min. After the protocol, the lung wet-to-dry ratio and histological lung injury score were evaluated in the excised lungs. Results Throughout the protocol, peak inspiratory flow and mean inspiratory flow values in the P group were significantly higher than those in the V group (26.7 ± 5.0 l·min⁻¹ vs 1.2 ± 0.2 l·min⁻¹, and 4.3 ± 0.3 l·min⁻¹ vs 1.1 ± 0.1 l·min⁻¹; P < 0.05). The wet-to-dry ratio in the P group was also significantly higher than that in the V group (7.7 ± 0.9 vs 6.3 ± 0.5; P < 0.05). More animals in the P group than in the V group had end-of-protocol Pa_O2/FI_O2 ratios below 200 mmHg (43% vs 0%; P = 0.06). Conclusion In rabbits with injured lungs, high peak inspiratory flow with high tidal volume (V_T) reduces the Pa_O2/FI_O2 ratio and increases the lung wet-to-dry ratio.     

Evaluation of certain constituents of antioxidant defense in youth treated in the past for steroid-sensitive idiopathic nephrotic syndrome

Disorders of lipid metabolism and antioxidant defense capacity reported during idiopathic nephrotic syndrome (INS) exacerbations are known. The aim of this study was to evaluate constituents of antioxidant defense [total antioxidant potential: ferric-reducing antioxidant power (FRAP), paraoxonase-1 (PON-1), tocopherols, ascorbic acid] in patients formerly treated for INS. The studied group consisted of 30 patients (20 males and 10 females) treated 4–15 years ago for INS. The control group consisted of 30 healthy teenagers. There were no statistically significant differences in PON-1 activity (156.4 ± 97.1 vs 137.7 ± 80.2 U/l), α-tocopherol levels (23.9 ± 7.3 vs 22.4 ± 3.2 μmol/l) and sum of β- and γ-tocopherols (2.1 ± 1.0 vs 2.3 ± 0.6 μmol/l), and in FRAP (484.9 ± 87.2 vs 452.8 ± 76.9 μmol/l) between groups. In the study group, a significantly lower concentration of ascorbic acid (53.0 ± 20.8 vs 69.4 ± 16 μmol/l; p < 0.002), decreased values of α-tocopherol/cholesterol (4.9 ± 0.7 vs 5.5 ± 1.2; p = 0.03), and total tocopherol/cholesterol (5.3 ± 0.8 vs 6.1 ± 1.4; p = 0.016) ratios were observed. A positive correlation between tocopherol/total cholesterol (TCh) (r = 0.41; p < 0.05) and α-tocopherol/TCh (r = 0.50; p < 0.001) ratios and INS relapse frequency was reported. The relationship between the study parameters and group of variables (relapse frequency, duration of the last remission, age, gender) was tested using the multiple linear regression analysis. The results of this study suggest that the nonenzymatic antioxidant defense in young persons formerly treated for INS is weaker than in their healthy counterparts.     

Vitamin D deficiency during pregnancy and lactation stimulates nephrogenesis in rat offspring

There is increasing evidence of vitamin D insufficiency in women of child-bearing age and their infants. This study examined the effect of maternal vitamin D deficiency on nephron endowment in rat offspring (n = 7 per group). Sprague–Dawley dams were fed either a vitamin D deplete diet or a vitamin replete (control) diet prior to pregnancy, during pregnancy and throughout lactation. At 4 weeks of age the offspring were weaned and maintained on their respective diets until they were killed at 7 weeks. In the fixed right kidney, kidney volume, renal corpuscle volume and nephron number were stereologically determined. There was no difference between groups in body weight, kidney weight or kidney volume. There was a significant 20% increase in nephron number in kidneys of vitamin D deplete offspring (vitamin D deficient, 29,000 ± 1,858, control, 23,330 ± 1,828; P = 0.04). This was accompanied by a significant decrease in renal corpuscle size in the vitamin D deplete group compared with the controls (6.125 ± 0.576 × 10⁻⁴ mm³ and 8.178 ± 0.247 × 10⁻⁴ mm³, respectively; P = 0.03). We concluded that maternal vitamin D deficiency in rats appears to stimulate nephrogenesis. Whether this confers a renal functional advantage or not is unknown.     

Serum uric acid is associated with high blood pressure in pediatric hemodialysis patients

Serum uric acid (UA) is positively associated with hypertension (HTN). HTN is common in pediatric patients receiving hemodialysis (HD) and peritoneal dialysis (PD). We assessed the relationship between UA and BP in 63 pediatric dialysis patients by measuring pre-treatment UA levels and BP in HD patients and in-center UA levels and blood pressure (BP) in PD patients. UA levels were similar in both groups [6.8 ± 0.2 (HD) vs. 6.5 ± 0.3 (PD), p = 0.6]. Pre-treatment systolic BP percentile was associated with a high UA level [91.9 ± 2.3 (>6.0 mg/dL) vs. 79.3 ± 5.8 mm Hg (≤6.0 mg/dL), p = 0.01] in HD patients only. There was a negative relationship between UA and dialysis vintage (r = −0.31, p = 0.01). In both groups, there was no relationship between UA and Kt/V. In HD patients, fluid overload was unrelated to UA level [4.2 ± 0.6% (≤6.0 mg/dL) vs. 4.3 ± 0.3% (>6.0 mg/dL), p = 0.9]. Moreover, pre-HD treatment systolic BP percentile correlated with UA (beta 0.36, p = 0.02) independent of volume. UA levels were higher in patients receiving anti-hypertensive medications [6.3 ± 0.2 (No Meds] vs 7.0 ± 0.2 (BP Meds) mg/dL,  p= 0.01]. Finally, there was no relationship between serum UA and normalized protein catabolic rate (r = 0.14; p = 0.4). In summary, serum UA impacts BP in pediatric HD patients, independent of volume, nutritional and weight status.     

Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants

The aim of this study was to determine the incidence, risk factors, and outcome of acute kidney injury (AKI) in extremely low birth weight (ELBW) infants. In a case–control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) between 1 January 2000 and 31 January 2008 were reviewed. During the study period, 12.5% (59/472) of all ELBW infants developed AKI. Forty-six infants with available medical records were matched to 46 controls. The mean gestational age and birth weight of infants with AKI and their controls were 24.7 ± 1.8 vs. 24.9 ± 1.9 weeks (p = 0.61) and 614 ± 128 vs. 616 ± 127 g (p = 0.93), respectively. Infants with AKI had a higher mean airway pressure, a lower mean arterial blood pressure, and higher exposure to cefotaxime than their controls. Infants with AKI also had an increased mortality in comparison to their controls [33/46 (70%) vs. 10/46 (22%), respectively; p < 0.0001), and oliguric patients had a higher mortality than nonoliguric patients [31/38 (81%) vs. 2/8 (25%), respectively, p = 0.003]. Based on our results, we conclude that a high mean airway pressure, low blood pressure, and the use of cefotaxime are associated with renal failure in ELBW infants. AKI in ELBW infants is also associated with an increased mortality, especially in the presence of oliguria.     

LCT 13910 C/T polymorphism, serum calcium, and bone mineral density in postmenopausal women

Summary  LCT 13910 CC genotype is associated with lactose intolerance, a condition often resulting in reduced milk intake. Women with the CC genotype were found to have decreased serum calcium and reduced bone mineral density. Introduction  The CC genotype of the 13910 C/T polymorphism of the LCT gene is linked to lactose intolerance and low calcium intake. Methods  We studied 595 postmenopausal women, including 267 osteoporotic, 200 osteopenic, and 128 healthy subjects. Genotyping, osteodensitometry, and laboratory measurements were carried out. Results  Frequency of aversion to milk consumption was 20% for CC genotype and 10% for TT + TC genotypes (p = 0.03). The albumin-adjusted serum calcium was 2.325 ± 0.09 mmol/L for CC genotype and 2.360 ± 0.16 mmol/L for TT + TC genotypes (p = 0.031). Bone mineral density (BMD; Z score) was lower in the CC than TT + TC genotypes, respectively, at the radius (0.105 ± 1.42 vs 0.406 ± 1.32; p = 0.038), at the total hip (−0.471 ± 1.08 vs −0.170 ± 1.09; p = 0.041), and at the Ward’s triangle (−0.334 ± 0.87 vs −0.123 ± 0.82; p = 0.044). Conclusion  LCT 13910 C/T polymorphism is associated with decreased serum calcium level and lower BMD in postmenopausal women. Péter Lakatos and Gábor Speer contributed equally to this work.     

Differences in Salivary Habituation to a Taste Stimulus in Bariatric Surgery Candidates and Normal-Weight Controls

Background  Previous studies show that slower habituation to taste stimuli is associated with reduced rates of satiation and greater energy intake. This study compared rates of salivary habituation to gustatory presentations of lemon juice in 34 severely obese bariatric surgery candidates [48.8 ± 7.9 years, 85% female, body mass index (BMI) = 47.4 ± 7.5 kg/m²] and 18 normal-weight controls (48.4 ± 9.5 years, 88.9% female, BMI = 22.7 ± 1.2 kg/m²). Methods  Parotid saliva was collected from cotton rolls positioned in the oral cavity during two baseline water trials and ten lemon juice trials. Data were condensed into trial blocks, representing mean values for the two baseline water trials and each of five pairs of lemon juice trials (i.e., blocks 1–5). Salivary change across lemon juice trials was calculated by subtracting values for blocks 1 through 5 from baseline. Results  A significant interaction of group (bariatric surgery candidates/normal-weight controls) by blocked trials [F (4, 200) = 3.0; p < 0.05] indicated that the groups differed in their pattern of salivary responding, with bariatric surgery candidates’ salivation (grams) failing to decrease significantly over the five blocked trials (−0.47 ± 0.18, p = 0.12), unlike that of the normal-weight controls (−1.30 ± 0.25, p < 0.001). Conclusion  These findings suggest that severely obese participants’ rate of salivary habituation to a taste stimulus is delayed compared to normal-weight controls. This provides support that satiation in bariatric surgery candidates is impaired, possibly leading to increased energy intake and positive energy balance.     

Carbonic-adsorbent AST-120 reduces overload of indoxyl sulfate and the plasma level of TGF-β1 in patients with chronic renal failure

Background We previously reported a significant increase in plasma TGF-β1 in patients with chronic renal failure (CRF). Progression of CRF may be caused by persistent renal production of TGF-β1. In CRF rat models, an oral carbonic absorbent (AST-120) reduces the expression of the TGF-β1 gene in the kidney, and delays the progression of CRF, in part by alleviating the overload of indoxyl sulfate. The aim of this study was to evaluate the effect of AST-120 on plasma levels of indoxyl sulfate and TGF-β1 in CRF patients. Methods Ten CRF patients (aged 59.3 ± 9.5 years, 5 men, serum creatinine 4.37 ± 1.72 mg/dl) were enrolled in this study. All patients maintained a regular dietary therapy and the same medication throughout the study. AST-120 was added at a dose of 6 g/day. Parameters including the slope of the reciprocal of the serum creatinine – time plot, plasma indoxyl sulfate level, and plasma and urinary levels of TGF-β1 were compared before and after the treatment with AST-120. The mean observation periods before and after the treatment were 9.7 ± 2.8 and 6.5 ± 2.9 months, respectively. Results Administration of AST-120 significantly reduced the plasma levels of indoxyl sulfate (1.42 ± 1.50 vs. 1.26 ± 1.40 mg/dl, P < 0.05) and TGF-β1 (17.9 ± 7.2 vs. 10.6 ± 4.7 ng/ml, P < 0.05) and improved the slope of the reciprocal of serum creatinine (−0.061 ± 0.041 vs. −0.032 ± 0.055 dl/mg/year, P < 0.05). Conclusions These results support the notion that indoxyl sulfate and TGF-β1 may be involved in the progression of CRF, and that the oral adsorbent AST-120 may suppress the progression, at least in part, by reducing overproduction of TGF-β1.     

Regression of target organ damage in children and adolescents with primary hypertension

We assessed the effects of 12 months of non-pharmacological and pharmacological therapy on 24-h ambulatory blood pressure, regression of target organ damage (TOD) and metabolic abnormalities in 86 children (14.1 ± 2.4 years) with primary hypertension. Twenty-four hour systolic and diastolic blood pressure (BP) decreased (130 ± 8 vs 126 ± 8, 73 ± 7 vs 70 ± 7, p = 0.0001 and 0.004 respectively). Body mass index (BMI) did not change, but waist-to-hip (0.85 ± 0.07 vs 0.83 ± 0.05, p = 0.01) and waist-to-height ratio (WHtR; 0.49 ± 0.07 vs 0.48 ± 0.05, p = 0.008) decreased. Left ventricular mass index (LVMi; 38.5 ± 10.7 vs 35.2 ± 7.5 g/m^2.7, p = 0.0001), prevalence of left ventricular hypertrophy (46.5% vs 31.4%; p = 0.0001), carotid intima-media thickness (cIMT; 0.44 ± 0.05 vs 0.42 ± 0.04 mm, p = 0.0001), wall cross sectional area (WCSA; 7.5 ± 1.3 vs 6.9 ± 1.2 mm², p = 0.002), hsCRP (1.1 ± 1.0 vs 0.7 ± 0.7 mg/l, p = 0.002), and LDL-cholesterol (115 ± 33 vs 107 ± 26 mg/dl, p = 0.001) decreased. Patients who had lowered BP had a lower cIMT at the second examination (0.41 ± 0.04 vs 0.43 ± 0.04 mm, p = 0.04) and lower initial hsCRP values (0.9 ± 0.7 vs 1.5 ± 1.3 mg/l, p = 0.04) in comparison to non-responders. Regression analysis revealed that the main predictor of LVMi decrease was a decrease in abdominal fat expressed as a decrease in waist circumference (WC) (R ² = 0.280, β = 0.558, p = 0.005), for WCSA-SDS a decrease in WC (R ² = 0.332, β = 0.611, p = 0.009) and for a cIMT-SDS decrease the main predictor was a decrease in hsCRP concentrations (R ² = 0.137, β = 0.412, p = 0.03). Standard antihypertensive treatment lowered BP and led to regression of TOD in hypertensive children. Lean body mass increase and decrease in abdominal obesity correlated with TOD regression.     

Laser Florence 2008

Patients sustaining acute myocardial infarction (AMI) often require urgent percutaneous revascularization within the first 24 h from onset of the infarction due to continuous ischemia and hemodynamic instability. Upon arrival to the cardiac catheterization, the electrocardiogram of AMI patients may exhibit acute ST-elevation (STEMI) with or without accompanying Q-wave or depression of the ST segment (non-STEMI or non-Q-wave infarction). Data comparing acute outcome of device application in patients presenting for urgent revascularization with established Q-wave myocardial infarction (QWMI) versus those with non-STEMI (NQMI) are sparse. Excimer laser is a revascularization modality applied for debulking of atherosclerotic plaque and vaporization of associated thrombus in the setting of AMI. One hundred fifty-one AMI patients with continuous chest pain and ischemia who enrolled into a multicenter study and underwent urgent revascularization were divided for the purpose of a retrospective analysis into two groups. One group presented with established electrocardiographic Q-wave, whereas the other had ST-depression (NQMI). In comparison with the NQMI group, the QWMI patients had a higher incidence of failed thrombolytic therapy (17% vs 3, p = 0.006), cardiogenic shock (20 vs 6%, p = 0.01), left anterior descending as a culprit infarct-related vessel (46 vs 14%, p < 0.0001), a higher incidence of TIMI 0 flow (48 vs 24%, p = 0.04), a heavier thrombus burden (grade 4 TIMI thrombus, 58 vs 23%; p = 0.0001), and higher CPK (1272 ± 2180 vs 404 ± 577, p = 0.001) and troponin levels (62 ± 95 vs 14 ± 48, p = 0.0003). Both groups underwent laser angioplasty and stenting for relief of continuous chest pain and ischemia within 24 h of infarction onset. Quantitative coronary arteriography in an independent core laboratory measured similar improvement in baseline minimal luminal diameter and percent diameter stenosis by application of laser energy in both groups. Among the QWMI patients, a significantly higher acute gain was recorded with the laser treatment in lesions containing a large/extensive thrombus burden as compared with lesions containing only a small clot burden (1.2 ± 0.7 vs 0.8 ± 0.5, p = 0.01). Such a phenomenon was not detected among the NQMI patients (1.0 ± 0.5 vs 0.8 ± 0.6, p=ns). Baseline TIMI flow grade (0.9 ± 1.0 for QWMI vs 1.5 ± 1.2 for NQMI, p = 0.0001) increased with laser emission to 2.8 ± 0.5 and subsequently reached a final level of TIMI 3 in both groups. In comparison with the QWMI patients, there was a trend toward a reduced rate of major adverse coronary events among the NQMI patients (12% QWMI vs 4% NQMI, p = 0.09). Significant differences in baseline clinical characteristics, extent of myocardial damage, location of infarct related vessel, thrombus burden, and TIMI flow exist between QWMI and NQMI patients who require urgent intervention. However, application of excimer laser results in similar high procedural success and low complication rates in both groups. Maximal acute laser gain is achieved among QWMI patients whose lesions are laden with a heavy thrombus burden.     

Improvement of left ventricular mass with antihypertensive therapy in children with hypertension

There is paucity of data on the regression of left ventricular hypertrophy (LVH) in hypertensive children. This study assessed the effects of antihypertensive therapy on left ventricular mass in children with and without LVH. Medical records of hypertensive patients who had a baseline and follow-up echocardiogram (echo 1, echo 2) were reviewed. Fifteen of 22 treated patients had LVH at echo 1. Enalapril alone or combined was used in 21/22 cases. Echo 2 was performed at a mean interval of 15 ± 7 months. The LVH group showed significant decrease in systolic blood pressure z-score (SBPZ) (2.89 ± 1.61 to 1.40 ± 1.19; p = 0.01), diastolic blood pressure z-score (DBPZ) (1.44 ± 0.90 to 0.26 ± 0.82; p < 0.001), and LV mass index (LVMI) (56.2 ± 12.50 to 43.7 ± 8.30; p = 0.001), but no significant change in body mass index z-score (BMIZ) (1.79 ± 0.75 to 1.69 ± 0.69; p = 0.74). In the no-LVH group, SBPZ (3.03 ± 1.68 to 2.27 ± 1.81; p = 0.356), DBPZ (1.00 ± 0.87 to 0.63 ± 0.68; p = 0.409), BMIZ (1.08 ± 0.98 to 1.27 ± 0.89; p = 0.672), and LVMI (29.47 ± 5.51 to 33.89 ± 3.06; p = 0.374) did not change significantly. Simple linear regression demonstrated that the change in LVMI in the combined group had a significant correlation (r = 0.477; p = 0.025) with the percentage change in SBPZ. This study demonstrates that LVH in hypertensive children improves with effective blood pressure control.     

Intensive Insulin Therapy and Bone Mineral Density in Type 1 Diabetes Mellitus: A Prospective Study

To determine the effect of metabolic control on bone mineral density (BMD) in type 1 diabetes mellitus (type 1 DM), we studied BMD (by dual-energy X-ray energy absorptiometry) and bone remodeling parameters in 62 patients with type 1 DM both before and 7 years after commencement of intensive insulin therapy. Overall outcomes after the 7-year treatment included the stabilization of BMD at all sites, as well as a significant decrease in tartrate-resistant acid phosphatase (TRAP) (4.302 ± 2.62 vs 2.65 ± 0.97 IU/l; p = 0.0001) and increase in intact parathyroid hormone (PTHi) (28.05 ± 15.7 vs 39.78 ± 22.41 ng/l; p = 0.005). Presence of diabetic retinopathy (RTP) versus its absence (non-RTP) was associated with lower BMD in femoral neck (FN) (0.831 ± 0.142 vs 0.756 ± 0.153 mg/cm²; p = 0.03) and Ward’s triangle (WT) (0.736 ± 0.165 vs 0.632 ± 0.172 mg/cm²; p = 0.03), and with a lower T-score in FN (–0.93 ± 1.34 vs –1.70 ± 1.46; p = 0.04) and WT (–0.72 ± 1.42 vs –1.540 ± 1.55; p = 0.04) and Z-score in FN (–0.591 ± 1.23 vs –1.132 ± 1.46; p = 0.01). The percentage of patients with osteopenia or osteoporosis in the RTP group was significantly higher than in the non-RTP group (72% vs 53%, p = 0.05; RR= 3.2) and the glycosylated hemoglobin (HbA1c) levels of the RTP group were also higher (8.53 ± 1.6% vs 7.1 ± 1.1%; p = 0.05). The improvement in metabolic control, increase in body mass index and decrease in resorption parameters could contribute to the stabilization of bone mass in type 1 DM but the presence of retinopathy is a critical factor in the progression of diabetic osteopenia. Received: 4 June 1999 / Accepted: 16 November 1999     

Growth and PTH in prepubertal children on long-term dialysis

Growth failure is an important complication for children on dialysis. One possible influence on growth is renal bone disease. We reviewed the case notes of 35 children (23 boys), mean (range) age at inclusion 2.8 (0.25–8.9) years (17 children age <2 years), on dialysis for 2.0 (1–4.8) years, for growth, PTH, calcium and phosphate levels and medications. Data collection ended at age 10 years, commencement of growth hormone (rhGH) or renal transplantation. The mean (range) height standard deviation score (HtSDS) at the start of dialysis was −2.06 (−5.90 to 0.63). No change in HtSDS per year was observed; the median was −0.06 (−1.07 to 2.39). Children aged <2 years showed catch-up growth in the first year on dialysis; median change in HtSDS was 0.31 (−0.78 to 3.13). Mean plasma calcium and ionised calcium were approximately at the mid-point and phosphate just above the mid-point of the respective normal ranges. The median PTH level was 1.52 times the upper limit of normal and levels did not correlate with growth. Our results indicate that intensive nutritional therapy and phosphorus control aiming to keep PTH within the normal range prevents further loss of HtSDS in short children on dialysis. In some children under 2 years of age catch-up growth can be observed in the first dialysis year.     

Osteocalcin Gene Polymorphism is Related to Bone Density in Healthy Adolescent Females

Recently a polymorphism was found in the human osteocalcin gene, and its association with bone mass was investigated in healthy postmenopausal Japanese women. The osteocalcin gene allelic variant HH was found to be overrepresented in women with osteopenia. The purpose of this study was to investigate whether the previously demonstrated polymorphism of the osteocalcin gene was related to bone mineral density (BMD; g/cm²) or osteopenia in a group of 97 healthy Caucasian adolescent females (aged 16.9 ± 1.2 years, mean ± SD). BMD of the left humerus, right femoral neck, lumbar spine and total body was measured using dual-energy X-ray absorptiometry. The relation between the allelic variants and bone density was analyzed as presence or absence of the H allele. Presence of the H allele was found to be related to a lower BMD of the humerus (0.97 vs 1.02, p = 0.03). There was also a strong tendency towards significance at the femoral neck (p = 0.06) and total body (p = 0.11). Using a multiple linear regression and including physical activity, weight, height and years since menarche, presence of the H allele was found to be an independent predictor of humerus BMD (β=−0.21, p<0.05) and femoral neck BMD (β=−0.23, p<0.01). Using logistic regression, presence of the H allele was also independently associated with a 4.5 times increased risk of osteopenia (p = 0.03) in the whole group. Osteopenia was defined as at least 1 SD lower bone density than the mean for the whole group of at least one of the BMD sites measured. We have demonstrated that the osteocalcin HindIII genotype is independently related to bone density in healthy adolescent females. The present study also suggests that presence of the H allele is predictive of osteopenia at an early age. Received: 31 January 2000 / Accepted: 25 April 2000