Can some growth hormone (GH)-deficient children benefit from combined therapy with gonadotropin-releasing hormone analogs and GH? Results of a retrospective study

Recombinant GH (rGH) treatment does not invariably correct height deficits in GH-deficient children once puberty has begun. The addition of GnRH analogs (GnRHa) to delay puberty has been advocated, but published results are few and sometimes conflicting. We retrospectively compared GH-deficient children treated with rGH and GnRHa for at least 1 yr after entering puberty and having attained their final height (n = 23) with a matched control group treated only with rGH. Overall, combined therapy did not significantly increase final height relative to rGH alone. However, the shortest girls at the onset of puberty (<25th percentile) benefited more than the tallest (>75th percentile) in both final height relative to predicted height and pubertal catch-up growth. In the control group, patients having experienced intrauterine growth retardation (IUGR) attained a lower mean final height than patients without IUGR (difference significant in boys, but not in girls). In the combined therapy group, IUGR did not affect the final height of either sex. Our results suggest that two populations might benefit most from combined GnRHa and rGH therapy: girls particularly short at the onset of puberty and patients who had experienced IUGR. Further prospective studies are required to confirm these preliminary hypothesis.     

Hepatic and pancreatic involvement in hereditary hemorrhagic telangiectasia: quantitative and qualitative evaluation with 64-section CT in asymptomatic adult patients

Purpose  

To analyse quantitatively and qualitatively asymptomatic hepatic and pancreatic involvement in hereditary haemorrhagic telangiectasia (HHT) using 64-section helical CT.     

In vitro and in vivo activities of levofloxacin against Mycobacterium tuberculosis.

In tests with 18 drug-susceptible strains of Mycobacterium tuberculosis, the MIC at which 50% of the strains are inhibited by levofloxacin (LVFX) was one dilution less than that at which 50% of the strains are inhibited by ofloxacin (OFLO), but the MICs at which 90% of the strains are inhibited were similar. The in vivo activity of LVFX against M. tuberculosis was compared with the activities of isoniazid, OFLO, and sparfloxacin (SPFX). Mice were inoculated intravenously with 1.74 x 10(6) CFU of H37Rv, and treatments began the next day and were carried out six times weekly for 4 weeks. The severity of infection and effectiveness of treatment were assessed by survival rate, spleen weights, gross lung lesions, and enumeration of CFU in the spleen. In terms of CFU counts, the ranking of the anti-M. tuberculosis activities of the treatments used ran in the following order: LVFX (300 mg/kg of body weight) = SPFX (100 mg/kg) > isoniazid > SPFX (50 mg/kg) > OFLO (300 mg/kg) = LVFX (150 mg/kg) > OFLO (150 mg/kg) = LVFX (50 mg/kg). It seems, therefore, that the in vivo activity of LVFX is comparable to that produced by a twofold-greater dosage of OFLO. It is assumed that the maximal clinically tolerated dosage of LVFX is similar to that of OFLO, i.e., 800 mg daily, which is equivalent to 300 mg of LVFX per kg in mice. Because LVFX displayed powerful bactericidal activity, promising effects against human tuberculosis may be achieved if patients are treated with the maximal clinically tolerated dosage of LVFX.     

Detection of colorectal tumors with water enema-multidetector row computed tomography

Purpose

To retrospectively determine the diagnostic capabilities of water enema-multidetector row computed tomography (WE-MDCT) in the detection of colorectal tumors.

Materials and methods

One hundred and one patients (55 male, 46 female) who had WE-MDCT and videocolonoscopy because of suspected colorectal tumors were included. Results of complete videocolonoscopy, surgery, and histopathologic analysis were used as standard of reference. Sensitivity, specificity, and accuracy, and positive and negative predictive values of WE-MDCT for the diagnosis of colorectal tumors were estimated with 95% confidence intervals (CIs).

Results

Ninety-two colorectal tumors (64 malignant, 28 benign) were confirmed in 71 patients (prevalence, 71/101; 70%). Overall sensitivity for colorectal tumor detection was 87% (80/92; 95%CI: 78%?C93%) on a per lesion basis. For malignant and benign tumor detection, sensitivity was 100% (64/64; 95%CI: 94%?C100%) and 57% (16/28; 95%CI: 37%?C76%), respectively. For colorectal tumors ??10?mm, sensitivity was 99% (76/77; 95%CI: 93%?C100%). Seventy-nine of the 83 colorectal tumors ??6?mm were detected, yielding a sensitivity of 95% (79/83; 95%CI: 88%?C99%) for this specific size category. On a per patient basis, WE-MDCT had a sensitivity of 100% (71/71; 95%CI: 94%?C100%), a specificity of 100% (30/30; 95%CI: 88%?C100%), an accuracy of 100% (101/101; 95%CI: 96%?C100%), a positive predictive value of 100% (71/71; 95%CI: 94%?C100%), and a negative predictive value of 100% (30/30; 95%CI: 86%?C100%) for the diagnosis of colorectal tumor.

Conclusion

Our results suggest that WE-MDCT is a promising imaging technique for the detection of malignant colorectal tumors. However, our results should be validated by larger and prospective studies.     

In Vitro and In Vivo Activities of Moxifloxacin and Clinafloxacin against Mycobacterium tuberculosis

On 10% oleic acid–albumin–dextrose–catalase-enriched 7H11 agar medium, the MIC at which 90% of the isolates are inhibited for 20 strains of Mycobacterium tuberculosis was 0.5 μg of sparfloxacin (SPFX) or moxifloxacin (MXFX) per ml and 1.0 μg of clinafloxacin (CNFX) per ml, indicating that the in vitro activities of SPFX and MXFX were virtually identical and were slightly greater than that of CNFX. However, the in vivo activities of these drugs in a murine tuberculosis model differed considerably. Female Swiss mice were infected intravenously with 6.2 × 10⁶ CFU of the H37Rv strain and treated for 4 weeks, beginning the next day after infection, with isoniazid (INH) serving as the positive control. By the criteria of 30-day survival rate, spleen weight, gross lung lesion, and mean number of CFU in the spleen, treatment with CNFX at up to 100 mg/kg of body weight six times weekly displayed no measurable effect against M. tuberculosis, whereas both SPFX and MXFX were effective; administration six times weekly of either of the latter two drugs demonstrated dosage-dependent bactericidal effects, as measured by enumeration of CFU in the spleens, and MXFX appeared more bactericidal than the same dosage of SPFX. Of the three fluoroquinolones, only MXFX at 100 mg/kg six times weekly appeared as bactericidal as INH at 25 mg/kg six times weekly. Thus, MXFX may be an important component of the newer combined regimens for treatment of tuberculosis.     

Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients

PURPOSE: To prospectively evaluate multi-detector row helical computed tomographic (CT) enteroclysis for the depiction of small-bowel diseases. MATERIALS AND METHODS: The study group included 107 patients who were suspected of having small-bowel tumor (n = 8), active inflammatory small-bowel disease (n = 18), unexplained gastrointestinal bleeding (n = 36), refractory celiac sprue (n = 14), and low-grade small-bowel obstruction (n = 31). A nasoenteric tube was positioned into the duodenojejunal junction by using fluoroscopic guidance and water was infused with a pressure-controlled pump. After intravenous administration of 120 mL of iodinated contrast material, multi-detector row helical CT enteroclysis images were obtained with 4 x 2.5 mm collimation (four detector rows and 2.5-mm section thickness). Multi-detector row helical CT enteroclysis findings were analyzed by two readers working in consensus. Findings were compared with the results of endoscopy, enteroscopy, videocapsule endoscopy, histopathologic analysis, or clinical follow-up. RESULTS: Multi-detector row helical CT enteroclysis was well tolerated in 106 patients; one patient complained of abdominal pain after the examination. Multi-detector row helical CT enteroclysis allowed the diagnosis of small-bowel masses (n = 21), active Crohn disease (n = 9), small-bowel tuberculosis (n = 2), small-bowel lymphoma complicating celiac disease (n = 4), and confirmed low-grade small-bowel obstruction (n = 12). Multi-detector row helical CT enteroclysis demonstrated normal findings in 60 patients. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of multi-detector row helical CT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. CONCLUSION: Multi-detector row helical CT enteroclysis allows depiction of small-bowel diseases in patients suspected of having small-bowel conditions.     

Comparative activities of amikacin against Mycobacterium avium complex in nude and beige mice.

After 4 weeks of treatment, clarithromycin (CLAR) and amikacin showed similar antimicrobial activities against the Mycobacterium avium complex in mice. There was a difference, however, in the effectiveness of the drugs in different types of mice: both drugs displayed bactericidal effects in beige mice but only bacteriostatic effects in nude mice. Because the effectiveness of CLAR is less in nude mice than in beige mice, the predictive value of the nude mouse model for the efficacy of chemotherapy is less than that of the beige mouse model.