Comparison of two dose regimens of growth hormone (GH) with different target IGF-1 levels on glucose metabolism, lipid profile, cardiovascular function and anthropometric parameters in gh-deficient adults

ObjectiveTo compare the effects of two regimens of GH therapy with different target IGF-1 levels on anthropometric parameters, glucose metabolism, lipid profile and cardiac function in adults with GH deficiency (GHD).Patients and methodsRetrospective analysis of 14 GHD adults from Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil, who were treated with a GH regimen aimed at maintaining serum IGF-1 levels between the median and upper reference limit (high dose group — HDGH) and 18 GHD adults from Federal University Hospital, Curitiba, Brazil, who received a fixed GH dose of 0.2 mg/day in the first year of treatment, followed by titration to maintain serum IGF-1 levels between the median and lower reference limit (low dose group — LDGH). All patients were followed for 2 years with analysis of anthropometric parameters, serum levels of IGF-1, glucose, insulin, HOMA-IR, lipid profile, and transthoracic echocardiography.ResultsChanges on weight, BMI and waist circumference were similar between the two groups. Insulin levels increased and HOMA-IR worsened in the LDGH group at 1 year and improved thereafter. Total cholesterol and triglycerides did not change with therapy. LDL cholesterol reduced in both groups, while HDL-cholesterol significantly increased only in the HDGH group (p = 0.007 vs LDGH). No significant variations on echocardiographic parameters were observed.ConclusionThe HDGH and LDGH regimens resulted in similar changes on anthropometric, echocardiographic, glucose and lipid parameters in GHD adults, except for increase in HDL cholesterol that was only observed in the HDGH regimen.     

Plexiform schwannoma of the duodenum accompanying pyloric stenosis: Report of a case

Plexiform schwannoma is a benign peripheral nerve sheath tumor and is composed of Schwann cells arranged in a plexiform pattern. Most plexiform schwannomas are skin tumors, and there has been no case report of this tumor originating in the duodenum. We describe the first known case of plexiform schwannoma of the duodenum. A 60-year-old man presented with a short history of food intolerance, epigastric discomfort, fullness and bloatedness, sometimes vomiting, and weight loss, without any clinical picture of neurofibromatosis. Upper gastrointestinal endoscopy revealed pyloric stenosis with normal mucosal lining. The computed tomography demonstrated circumferentially and concentrically thickened pylorus up to 18 mm with narrowed lumen and limited contrast passage. Antrectomy and gastrojejunostomy were performed due to unknown etiology of the obstruction. The cut surface of the lesion revealed thickened pylorus up to 15 mm in a circumferential manner. It contained a 5 mm tumor consisted of multiple white nodules in the submucosal and subserosal layers with overlying duodenal mucosa. Microscopic examination revealed nodular structures composed of spindle cells within fascicular pattern without any atypia or mitosis. Immunohistochemical examination revealed that the cells diffusely and strongly expressed S100 proteins in a nuclear and cytoplasmic pattern, but not CD117, smooth muscle actin, desmin, or CD34, confirming plexiform schwannoma.     

Urinary osteocalcin and serum pro-C-type natriuretic peptide predict linear catch-up growth in infants

Preterm (PT) infants are at risk of growth failure despite advanced early care and nutrition. In addition to poor weight gain, slow postnatal linear growth also is associated with adverse neurological outcome. Markers distinguishing infants at risk for impaired catch-up growth are needed. The aim of this longitudinal study was to determine the extent to which postnatal levels of circulating cartilage (serum pro-C-type natriuretic peptide [S-proCNP]) and urinary bone metabolic markers (urinary osteocalcin [MidOC] and two forms of C-terminal cross-linked telopeptide of type I collagen [U-α-CTX-I and U-β-CTX-I]) predict catch-up growth in infancy in 67 PT and 58 full-term (FT) infants. PT infants were significantly shorter than FT infants during the first 6 months of life, but no statistically significant difference was found at the corrected age of 14 months (M14). At the age of 3 months (M3), S-ProCNP and U-MidOC levels, but not U-α-CTX-I and U-β-CTX-I levels, correlated positively with prospective growth velocity from M3 to M14 (ρ = 0.460, p < 0.001 and ρ = 0.710, p < 0.001, respectively). In predicting slow linear growth (growth velocity at the lowest quartile), the area under the S-ProCNP ROC curve was 0.662 and that of U-MidOC 0.891. Thus, U-MidOC, and to lesser extent S-ProCNP at M3 are predictors of catch-up growth in infancy.     

Impact of body image on quality of life and mood in mastectomized patients and amputees in Turkey

Background: The aim was to investigate the impact of loss of the breast on body image, as well as the relationship of the body image with quality of life and severity of the depression, comparing mastectomized patients with those with an apparent limb loss (extremity amputation). Methods: Demographic data, and the side of the tissue/limb loss for mastectomy and transtibial amputation patients were recorded. Postoperative shoulder range of motion limitations of the operated-side in mastectomized patients, and postoperative knee flexion contracture in patients with amputation were evaluated. All patients were asked to complete Body Image Scale, Beck Depression Inventory, and Short Form-36. Results: All of the 40 patients in the mastectomized group were female. In the amputation group, 4 (10.8%) patients were female and 33 (89.2%) were male. Body-image scores in mastectomized and amputation groups were 98.7±26.5, and 77.2±19.7, respectively (p<0.05). Physical-function scores of quality-of-life were significantly lower in the amputation group. For both groups, a significant positive relationship was evident between body-image and depression (r=0.327 and r=0.574, respectively). There were also significant negative relationships between body-image and physical role limitations (r=-0.395) and mental health (r=-0.335) in the mastectomized group, and between body-image, and emotional role limitations in the amputation group (p<0.05). Conclusions: Although mastectomy does not result in loss of physical function, distortion of body image perception is worse than that caused by extremity amputation, and distortion of the body image affects the quality of life and mood negatively in mastectomized patients.