Risk factors associated with veterinary attrition from clinical practice: a descriptive study.

A sustainable workforce is important for the veterinary profession to meet the demands of society. To maintain a sustainable workforce, it has been recommended to retain veterinary clinicians. However, there seems to be an increasing issue with retention of veterinarians in clinical practice. In the following study, the researchers sought to understand the associations between demographic and work-related factors and attrition of veterinarians from clinical practice. Responses to an online cross-sectional survey of 881 current and former Australian veterinary clinicians were analysed. A logistic regression model was used to identify and describe associations between attrition from veterinary clinical practice and salary, working hours, role in practice, years of experience, field of work, interaction with regulatory authorities, region of work and on-call duties. Lower salary, longer working hours, having on-call duties and having worked in both rural and metropolitan regions were found to significantly (P < 0.05) increase the likelihood of leaving clinical practice. The results may inform intervention strategies to assist the industry to retain veterinarians in clinical practice.

Animal Welfare Worldwide, the Opinion of Practicing Veterinarians.

The objective of this study was to investigate the animal welfare issues considered the most important by companion animal veterinarians worldwide. For this purpose, a global survey of several potential animal welfare issues was distributed via SurveyMonkey® in multiple languages. The distribution of survey responses differed by region. The main animal welfare concern reported worldwide was obesity, although there were differences across regions, possibly due to cultural and socioeconomic factors. Anthropomorphism (attributing human qualities or characteristics to an animal) was an issue in western countries but less so in Asia, Africa, and Oceania. There were significant differences between Asia and Europe, Africa, and Oceania in the importance and prevalence of convenience euthanasia. There were also age and sex differences in participant responses, with older veterinarians reporting fewer welfare problems than younger veterinarians, and female veterinarians reporting more welfare issues than their male counterparts.

A pilot study of Australian pet owners who engage in social media and their use, experience and views of online pet health information.

OBJECTIVE: The aim of this study was to gain a better understanding of Australian pet owners' use of the internet for pet health; how trustworthy they rate various pet health information sources and the use of online information in subsequent veterinary consultations. METHOD: An anonymous questionnaire was developed, consisting of 30 questions, and distributed between March 2018 and May 2018 using convenience sampling through social media venues including Facebook and Twitter. All respondents were over the age of 18, lived in Australia and owned a pet animal. RESULTS: A total of 228 responses were received. The most common sources of pet health information were veterinarians (88.2%) and internet websites (81.1%). Most respondents reported using the internet 'many times per day' at either home or work. The majority of respondents used the internet to seek pet health information either 'not weekly but at least once a month' or 'less than once a month'. Nearly half of the respondents stated that they only 'sometimes' discuss their online findings with their veterinarian. Approximately one half of respondents agreed with the statement that online pet health information had affected their decision about whether to take their pet to the veterinarian. CONCLUSION: This study assesses how pet owners use the internet for pet health information and the role veterinarians can play in helping to facilitate these searches with tools such as information prescriptions. Further large-scale research is needed to help further understand this increasingly important aspect of pet health.

Pilot study of Australian veterinarians and their perceptions and experiences related to online pet health information.

OBJECTIVE: Investigate Australian veterinarians' perceptions of clients' use of the internet to find pet health information. METHODS: An anonymous online survey was distributed using social media, e-newsletters and veterinary magazines. RESULTS: A total of 85 complete responses were obtained from Australian veterinarians. Most (80%) reported believing that > 80% of their clients have access to the internet at home or work, but 68% thought that the majority of their clients do not understand what they read online. Attitudes regarding the impact of online pet health information on the veterinarian-client relationship were mixed (56% reported negative impact and 33% a positive impact), as well as for clients' use of the internet for information on companion animal health (47% reported negative impact and 38% a positive impact). When asked how often they suggest specific websites to their clients ('information prescriptions'), the majority of veterinarians reported that this is done infrequently. CONCLUSION: This pilot study highlighted the perception of Australian veterinarians of their clients' use of the internet to find pet health information. It also highlighted the need for a large-scale, detailed survey of Australian veterinarians and their views in relation to pet owners and their use of online information. This should include evaluation of information prescriptions and their potential benefits for clients and patients.

Facilities, breed and experience affect ease of sheep handling: the livestock transporter's perspective.

An understanding of the perceived importance of a variety of factors affecting the ease of handling of sheep and the interactions between these factors is valuable in improving profitability and welfare of the livestock. Many factors may contribute to animal behaviour during handling, and traditionally these factors have been assessed in isolation under experimental conditions. A human social component to this phenomenon also exists. The aim of this study was to gain a deeper understanding of the importance of a variety of factors affecting ease of handling, and the interactions between these from the perspective of the livestock transporter. Qualitative interviews were used to investigate the factors affecting sheep behaviour during handling. Interview transcripts underwent thematic analysis. Livestock transporters discussed the effects of attitudes and behaviours towards sheep, helpers, facilities, distractions, environment, dogs and a variety of sheep factors including breed, preparation, experience and sex on sheep behaviour during handling. Transporters demonstrated care and empathy and stated that patience and experience were key factors determining how a person might deal with difficult sheep. Livestock transporters strongly believed facilities (ramps and yards) had the greatest impact, followed by sheep experience (naivety of the sheep to handling and transport) and breed. Transporters also discussed the effects of distractions, time of day, weather, dogs, other people, sheep preparation, body condition and sheep sex on ease of handling. The concept of individual sheep temperament was indirectly expressed.

[Primary liver cell carcinoma as complication of alpha 1-antitrypsin deficiency in a 67 year old man]. / Primair levercelcarcinoom als complicatie van alpha 1-antitrypsinedeficiëntie bij een 67-jarige man.

A 67-year-old male patient with pulmonary emphysema was diagnosed with liver cirrhosis. Further investigations revealed an alpha 1-antitrypsin deficiency caused by a PiZZ mutation. The liver cirrhosis was complicated by the development of a hepatocellular carcinoma. The patient died from the consequences of mesentary vein thrombosis. The protease inhibitor alpha 1-antitrypsin controls the tissue damaging effects of proteases which are produced by granulocytes. In the case of alpha 1-antitrypsin deficiency, progressive damage of the lung tissue occurs, resulting in emphysema. The accumulation of abnormal alpha 1-antitrypsin in hepatocytes can result in cirrhosis, with an increased chance of carcinoma. The deficiency is caused by a mutation in the Pi-gene on chromosome number 14. Although treatment options are at present limited, making an early diagnosis has important implications for the prognosis and intended management with respect to the prevention of complications, both in the patient as well as in first degree relatives (children and siblings).

Prospective risk assessment of endoscopic retrograde cholangiography in patients with primary sclerosing cholangitis. Dutch PSC Study Group.

BACKGROUND AND STUDY AIMS: Direct endoscopic retrograde cholangiopancreatography (ERCP) has become the standard for establishing the diagnosis of primary sclerosing cholangitis (PSC), while endoscopic procedures play an increasingly important therapeutic role. However, many believe that this procedure carries a significant risk of infection and other complications. We assessed the incidence of complications within 1 week of ERCP in patients with PSC. PATIENTS AND METHODS: In a multicenter study, patients who underwent ERCP for (suspected) PSC were prospectively followed for the occurrence of complications after the procedure. RESULTS: A total of 106 ERCPs performed in 83 patients were evaluated. Complications occurred on ten occasions (9%): pancreatitis (n = 3), cholangitis (n = 2), increase of cholestasis (n = 2), postsphincterotomy bleeding (n = 1), cystic duct perforation (n = 1), and venous thrombosis (n = 1). All complications resolved quickly with proper therapy. Complications were more likely when ERCP was done to evaluate specific complaints such as jaundice or recurrent cholangitis (9/59) than after a purely diagnostic ERCP (1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to 153). Therapeutic interventions performed during ERCP (e.g. placement of endoprosthesis, dilation of strictures) also increased the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to 30). CONCLUSIONS: ERCP is a safe method for establishing the diagnosis of PSC in asymptomatic patients (2 % complication rate). Although ERCP in symptomatic patients carries a higher risk (14%), this can be justified by the benefits of endoscopic therapy.

A randomized trial of polyurethane and silicone percutaneous endoscopic gastrostomy catheters.

BACKGROUND: No data are available on differences in complication rate and long-term functioning between polyurethane and silicone percutaneous endoscopic gastrostomy (PEG) catheters. METHODS: We randomized patients who qualified for PEG placement to receive either a polyurethane or silicone PEG catheter. Patients were prospectively monitored for 28 days after placement for the occurrence of complications. Data on long-term PEG survival were obtained retrospectively from the Hospital and general practitioner's medical records. RESULTS: One hundred and six patients were randomized (polyurethane 50, silicone 56). During the first four weeks of follow-up, major complications occurred twice with both polyurethane and silicone PEGs (relative risk 1.1, 95% confidence interval: 0.11-11). Overall complications occurred four times with polyurethane and 17 times with silicone PEGs (relative risk 3.8, 95% confidence interval: 1.37-10.5). Long-term follow-up was available in 96 patients. Seven polyurethane PEGs and 10 silicone PEGs were removed because of PEG malfunctioning, the remainder functioned well until death or the reinstitution of oral feeding. The median complication-free survival was 916 days for the polyurethane PEG and 354 days for the silicone PEG (Log rank test: P=0.24). CONCLUSION: Polyurethane PEG catheters were associated with less short-term complications than silicone catheters, but major complications and long-term function were comparable.

Regulation of insulin-like growth factor-binding protein-3 ternary complex in feline diabetes mellitus.

The 140 kDa ternary complex of insulin-like growth factor-binding protein-3 (IGFBP-3), IGFs and an acid-labile subunit (ALS) has previously been shown to be decreased in diabetes mellitus in humans and rats. We have studied IGF-I levels and ternary complex formation in normal and diabetic cats. Total IGF-I concentrations, measured by RIA using des(1-3)-IGF-I as tracer were (+/-s.e.m.) 54+/-13 nmol/l in eight normal and 227+/-57 nmol/l in eight diabetic cats (P<0.01). The size-distribution of IGFBPs in the cat circulation was determined by incubation with (125)I-IGF-II and Superose 12 chromatography. In normal animals 26+/-2% of the (125)I-IGF-II were in a 140 kDa form compared with 48+/-5% in diabetic cats (P<0.01). When samples from normal and diabetic animals were co-incubated 52+/-3% were at 140 kDa. A similar shift was seen when normal cat and normal human serum were co-incubated. A 2-fold increase in the 140 kDa form in diabetic cats was confirmed first by size-fractionating samples and then performing a ligand-binding assay with (125)I-IGF-I or -II and charcoal separation. SDS-PAGE and Western ligand blotting demonstrated a 45 kDa doublet (presumably IGFBP-3) and 30-35 kDa forms. There were no apparent differences between normal and diabetic profiles on SDS-PAGE, suggesting that a proportion of IGFBP-3 which circulates 'free' in normal cats forms a ternary complex in the diabetic circulation. We conclude that (i) in contrast to humans and rats, ALS is the limiting factor for ternary complex formation in normal cats, (ii) ALS concentrations increase in feline diabetes mellitus and, by promoting ternary complex formation, this leads to an increase in total IGF-I concentrations, and (iii) total IGF-I concentrations may not be reliable in the diagnosis of acromegaly in diabetic cats.

Effect of protein intake on plasma and erythrocyte free amino acids and serum IGF-I and IGFBP-1 levels in rats.

Amino acid (AA) levels in plasma and erythrocytes (RBC) were determined in rats (n = 29) fed diets with 6, 21, and 35% protein, and their association with insulin-like growth factor I (IGF-I), insulin, or IGF-binding protein (IGFBP)-1 levels was studied. Free AA in plasma and RBC were determined by reversed-phase high-pressure liquid chromotography, and IGF-I, IGFBP-1, and insulin plasma levels were determined by RIA. Rats fed the low-protein (6%) diet were growth-retarded and had lower serum IGF-I levels and higher serum IGFBP-1 levels than the other two groups (P < 0.0001). In rats fed the low-protein diet, most of the nonessential AA (NEAA) in both plasma and RBC increased, whereas the essential AA (EAA), with the exception of threonine, decreased. When the groups were combined, both RBC and plasma EAA-to-NEAA ratios were positively correlated to IGF-I (r = 0.76 and 0.80, respectively; P < 0.0001) and inversely correlated to IGFBP-1 levels (r = -0.67, P < 0.001 and r = -0.78, P < 0.0001, respectively). A significant inverse correlation was found between RBC glutamate and IGF-I (r = -0.85, P < 0.0001, n = 25) and insulin (r = -0.72, P < 0.001, n = 21), and a positive correlation was found for IGFBP-1 (r = 0.78, P < 0.0001, n = 24). In multiple regression analysis, only IGF-I remained as an independent variable. Threonine was the only EAA with a significant inverse correlation to insulin (r = -0.66, P < 0.001). We hypothesize that AA metabolism is associated to changes in IGF-I, insulin, and IGFBP-1 levels in rats on different protein intakes.

[Intraluminal therapy for Zenker's diverticulum]. / Intraluminale Therapie des Zenker-Divertikels.

A Zenker's diverticulum (ZD) is a posterior diverticulum with its neck proximal to the cricopharyngeal muscle. Patients typically present after the age of 60 with symptoms ranging from weeks to years. The classical treatment in the past was surgical, which is still the case in the US. They treat them in general with open myotomy and diverticulectomy. Since the 1950s ENT physicians treat them with rigid endoscopes and cut the bridge between the ZD and the esophagus. This method is widely used throughout western Europe. However, many symptomatic elderly patients are poor surgical/ENT candidates. In 1995, two groups from Brazil and The Netherlands reported their first results with a gastroscopic treatment, in which the ZD bridge is cut with a precut needle/monopolar forceps. Recently, argon plasma coagulation has also been introduced in this field. All these treatments seem effective. Comparative trials between these approaches are now long overdue, since all these modalities will work in the hands of experienced "Zenker specialists".

Drug therapy: dose-response relationship of oral mesalazine in inflammatory bowel disease.

Mesalazine is widely used in the treatment of inflammatory bowel disease. Little is known about the dose-response relationship and about possible dose related side effects. In ulcerative colitis higher dosages of mesalazine (3 g) are more effective in maintaining a remission than lower dosages (1.5 g). In mild to moderately active ulcerative colitis, studies also indicate that higher dosages might be more effective in inducing remission. Dose-comparing studies in Crohn's disease are even more sparse, but the available results indicate higher efficacy at higher dose levels. None of the known side effects of mesalazine are clearly dose-related. A pH-dependent release system, however, can cause a sudden release of high doses of mesalazine. Consequent peak levels in serum have been implicated in mesalazine induced nephrotoxicity. In conclusion, despite the current practice of using increasing dosages of mesalazine in inflammatory bowel disease, both efficacy and safety have been established tentatively.

Differential expression of IGF-I and IGF-binding protein-1 and -2 in periportal and perivenous zones of rat liver.

IGF-I has important roles in regulating growth and metabolism. Circulating IGF-I is bound to specific binding proteins (IGFBP-1 to -6), with hepatocytes containing IGF-I, IGFBP-1 and -2 mRNA. Although many hepatic proteins are regionally expressed in the liver acinus, no studies have reported zonation of IGF protein expression. In this study we investigated the pattern of hepatic mRNA for the IGF proteins, vs the previously reported pepriportal gradient of phosphoenolpyruvate carboxykinase (PEPCK) expression. In situ hybridisation was used to analyse IGF-I, IGFBP-1, -2 and PEPCK mRNA in female Sprague-Dawley rats fed diets containing low (6%), normal (21%) or high (35%) protein. We report for the first time that IGFBP-1 and -2 and IGF-I are differentially expressed in the liver acinus. In the normal- and high-protein groups, levels of IGFBP-1 mRNA were higher in the perivenous region, i.e. the opposite gradient to PEPCK, with a higher gradient of IGFBP-1 expression in the high-protein group. In contrast, IGFBP-2 had a similar pattern to PEPCK, and a periportal gradient of IGF-I mRNA was also seen in the low-protein group. Using computerised image analysis, levels of IGFBP-1 and -2 mRNA were elevated 2- and 10-fold respectively, in the low- vs normal-protein groups. The level of IGF-I mRNA was reduced to 65% of normal, with circulating IGF-I levels at 30% and insulin levels 39% of normal. These results demonstrate that hepatocytes are a heterogeneous population with respect to regulation of IGF proteins, having specific expression patterns dependent on the position of the hepatocyte within the liver acinus.

Glutamate concentration in plasma, erythrocyte and muscle in relation to plasma levels of insulin-like growth factor (IGF)-I, IGF binding protein-1 and insulin in patients on haemodialysis.

Elevated insulin-like growth factor binding protein (IGFBP) levels, including IGFBP-1, occur in renal failure, and may contribute towards reduced IGF bioactivity in uraemia. The reduced IGF bioactivity may, in turn, contribute towards the disturbances in protein metabolism present in renal failure. In this study, the relationships between intra- and extracellular amino acid (AA) levels and IGF-I and/or IGFBP-1 levels were studied in 30 adult patients (aged 24-70 years) on haemodialysis who had no clinical signs of malnutrition. Blood samples (n = 30) and muscle biopsies (n = 13) were collected for determination of free AA in erythrocytes (RBC), plasma and muscle by reverse-phase HPLC while IGFBP-1, IGF-I and insulin plasma levels were determined by radioimmunoassay The patients on haemodialysis had elevated glutamate concentrations in RBC and plasma compared with healthy controls (524 +/- 26 vs 448 +/- 17 mumol/l, P < 0.05 and 45 +/- 4 vs 32 +/- 4 mumol/l, P < 0.01 respectively), although glutamate levels in muscle were within the normal range. The mean IGF-I level was slightly increased (s.d. score +0.74 +/- 0.30) but insulin levels were within the normal range. IGFBP-1 levels, which were inversely correlated to insulin (r = -0.40, P < 0.02), were elevated threefold compared with controls. No plasma AA level displayed a significant correlation with IGF-I, IGFBP-1 or insulin levels. However, glutamate concentrations in RBC were positively correlated to IGFBP-1 (r = 0.51, P < 0.01) and inversely correlated to IGF-I (r = -0.46. P < 0.01), although unrelated to insulin. Muscle glutamate, which was inversely related to RBC glutamate, displayed an opposite pattern with an inverse relation to IGFBP-1 levels (r = - 0.73, P < 0.01) and a positive correlation to IGF-I levels (r = 0.64, P < 0.02). Glutamate was the only AA to display an inverse correlation between RBC and muscle (r = -0.65, P < 0.02, n = 12). These findings lead us to propose that, in uraemia, the elevated IGFBP-I levels, which reduce the bioavailability of IGFs, are linked to glutamate uptake in muscle, resulting in accumulation of RBC glutamate. Whether there is a causal relationship or the correlation is due to some common regulator is not clarified in the present study.

Biliary excretion of ciprofloxacin and piperacillin in the obstructed biliary tract.

Biliary excretion of ciprofloxacin and piperacillin was determined in cholestatic patients who had undergone endoscopic cholangiography. The median concentration of ciprofloxacin (n = 9) was 2.36 micrograms/ml (range, 0.29 to 19.8 micrograms/ml) in bile compared with 1.66 micrograms/ml (range, 0.73 to 2.69 micrograms/ml) in serum. The median concentration of piperacillin (n = 7) was < 5 micrograms/ml (range, < 5 to 26) in bile compared with 14.3 micrograms/ml (range, 5.3 to 80) in serum. Ciprofloxacin, but not piperacillin, can be actively excreted into bile in the presence of a biliary tract obstruction.

Effects of chronic renal failure on plasma clearance of insulin-like growth factor I, des-(1-3)IGF-I, and LR3IGF-I.

Using a rat model of chronic renal failure (CRF), we examined insulin-like growth factor I (IGF-I) clearance, degradation, organ distribution, and IGF binding profiles in plasma. The effects of IGF-binding proteins (IGFBP) on IGF clearance and degradation in CRF were studied using the IGF-I analogues des-(1-3)IGF-I and LR3IGF-I, which bind poorly to IGFBP. Although total clearance of IGF-I was not significantly altered in CRF, half-life and area under the curve were increased in the rapid distribution phase and were reduced in the slow elimination phase. Total clearance of LR3IGF-I was significantly increased. Reduced binding of IGF-I in the 150-kDa complex and increased binding to smaller-molecular-weight IGFBP were observed in CRF. Increased degradation of both IGF-I and LR3IGF-I was associated with reduced IGF binding in the 150-kDa complex. The results suggest that the accumulation of lower-molecular-weight IGFBP with reduced IGF binding in the 150-kDa complex, associated with increased degradation of peptide, may explain, at least in part, the reduced bioactivity of IGF-I observed in CRF.

Piperacillin to prevent cholangitis after endoscopic retrograde cholangiopancreatography. A randomized, controlled trial.

BACKGROUND: Cholangitis does not often occur after endoscopic retrograde cholangiopancreatography (ERCP), but it can be a serious complication of this procedure. Antibiotic prophylaxis is therefore frequently used in patients having ERCP, but existing data are insufficient to allow evaluation of the effectiveness of this practice. OBJECTIVE: To determine the efficacy of single-dose antibiotic prophylaxis with piperacillin for ERCP-induced cholangitis. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Tertiary referral center for ERCP. PATIENTS: Patients who had ERCP for suspected biliary tract stones or distal common bile duct stricture were eligible. Major exclusion criteria were previous ERCP within 7 days, biliary endoprosthesis in situ, and use of antimicrobial agents or presence of fever within 7 days before the procedure. INTERVENTION: Piperacillin, 4 g, or placebo was given intravenously approximately 30 minutes before ERCP. MEASUREMENTS: Duration of follow-up was 1 week. Acute cholangitis was diagnosed if a patient had a body temperature greater than 38 degrees C, a clinically apparent need for antibiotic treatment, and no symptoms indicating infection outside of the biliary tree. RESULTS: 551 consecutive patients were enrolled. During ERCP, stones were found in 147 patients, malignant distal strictures were found in 203 patients, other pathologic findings were seen in 88 patients, and normal biliary tracts were seen in 113 patients. Seventeen of the 281 patients who received placebo (6.0%) and 12 of the 270 patients who received piperacillin (4.4%) developed acute cholangitis (relative risk, 0.73 [95% CI, 0.36 to 1.51]). The absolute risk reduction was 1.6% (CI, -5.3% to 2.1%). All cases of cholangitis (with the exception of one case seen in a patient in the piperacillin group) were mild or moderate in severity. CONCLUSION: Single-dose prophylaxis with piperacillin is not associated with a clinically significant reduction in the incidence of acute cholangitis after ERCP in patients suspected of having biliary tract stones or distal common bile duct stricture.

Successful treatment of recurrent cholangitis with antibiotic maintenance therapy.

The impact of antibiotic maintenance therapy on the incidence of biliary tract infection was evaluated in patients with recurrent cholangitis after resection of a malignancy at the hepatic confluence. Thirty-eight of 54 patients (70%) experienced episodes of cholangitis. In 14 of the 38 patients recurrent episodes of cholangitis caused a severe interruption of their daily life. These 14 were selected for antibiotic maintenance therapy. During maintenance therapy six patients experienced no further episodes of cholangitis and five patients a marked decrease in the frequency of episodes, while in three patients no improvement was seen. Antibiotic maintenance therapy can be highly successful in the treatment of recurrent cholangitis after resection of a malignancy at the hepatic hilum.

Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis.

Cholangitis is usually the consequence of a combination of factors: impairment of the flow of bile and bacterial colonization of the biliary tract. Although reestablishing biliary drainage is the mainstay of treatment, antibiotics play an important role in the management of cholangitis. In this review, the use of antibiotics for treatment, prophylaxis, and maintenance therapy is discussed. Antibiotics for the treatment of acute cholangitis should be given for 7-10 days in therapeutic dosages and may allow a more selective timing of further interventions. Antibiotic prophylaxis for cholangitis ought to be given as a single (high) dose shortly before surgical or nonsurgical manipulations of the biliary system. Patients with a compromised biliary system (e.g., on account of an endoprosthesis in situ or hepaticojejunostomy) who are prone to develop recurrent bouts of cholangitis may benefit from antibiotic maintenance therapy, given daily in lower-than-therapeutic dosages.

Enhanced body growth in uremic rats treated with IGF-I and growth hormone in combination.

The efficacy of seven days treatment with IGF-I (1.7 mg/kg/day), growth hormone (GH) (2 mg/kg/day), IGF-I+GH (1.7 mg/kg/day + 2 mg/kg/day) or vehicle, in promoting growth was investigated in female Sprague-Dawley rats with 5/6 nephrectomies (N = 8 per group). Treatment commenced after chronic renal failure had been present for seven weeks. Significant increases in body weight gain were found in all groups versus control, with IGF-I+GH causing the greatest response, and increased body weight gains correlating with increased nitrogen retention. GH treatment alone significantly stimulated food intake. IGF-I+GH resulted in close to additive increases in food conversion efficiency (18.8%, 21.5% and 39.6% increases with IGF-I, GH and IGF-I+GH, respectively, over control levels) and longitudinal bone growth (39%, 37% and 67% increases with IGF-I, GH and IGF-I+GH, respectively, vs. control). Serum insulin and cholesterol levels significantly decreased with IGF-I and IGF-I+GH treatment. Creatinine clearance did not change, suggesting there were no effects of treatment on kidney function. Although IGF-I at the doses used did not result in a greater anabolic response than GH, IGF-I+GH caused significantly enhanced growth while reducing serum insulin and cholesterol levels.