Effect of recombinant growth hormone on leptin, adiponectin, resistin, interleukin-6, tumor necrosis factor-α and ghrelin levels in growth hormone-deficient children.

BACKGROUND: Treatment with GH promotes linear growth and decreases body fat in patients with isolated GH deficiency (GHD). However, few studies have analyzed how GH replacement modifies ghrelin levels and the adipokine profile and the relationship of these modifications with the metabolic changes. AIMS: To analyze the eventual differences between serum levels of leptin, leptin soluble receptor (sOBR), resistin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total (TG) and acylated ghrelin (AG) and lipid and glycemic profiles in children with GHD, as well as to determine the effect of GH replacement on these parameters during the first year of therapy. SUBJECTS AND METHODS: Thirty pre-pubertal (Tanner stage I) GHD children and 30 matched controls were enrolled. Children with GHD were studied before and after 6 and 12 months of GH treatment. Weight, height, BMI, fasting glucose, insulin, lipid profile and serum levels of adipokines and ghrelin were studied at every visit. Adi - pokines, insulin and ghrelin levels were determined by using commercial radio- and enzymoimmunoassays. RESULTS: At baseline children with GHD had significantly higher sOBR (p<0.01) and adiponectin (p<0.01) levels than controls. Treatment with GH resulted in a decline in leptin (p<0.05) and TG (p<0.001) levels, an increase of homeostasis model assessment index and restored IGF-I levels (p<0.001). CONCLUSIONS: These data indicate that GH replacement has a negative effect on leptin levels and may also produce a slight unfavorable effect on carbohydrate metabolism. In addition, the changes observed in the adipokine profile appear to be independent of body mass index.

Seed removal in a tropical North American desert: an evaluation of pre- and post-dispersal seed removal in Stenocereus stellatus.

To determine seed removal influence on seed populations, we need to quantify pre- and post-dispersal seed removal. Several studies have quantified seed removal in temperate American deserts, but few studies have been performed in tropical deserts. These studies have only quantified pre- or post-dispersal seed removal, thus underestimating the influence of seed removal. We evaluated pre- and post-dispersal seed removal in the columnar cactus Stenocereus stellatus in a Mexican tropical desert. We performed selective exclosure experiments to estimate percentage of seeds removed by ants, birds and rodents during the pre- and post-dispersal phases. We also conducted field samplings to estimate abundance of the most common seed removers. Birds (10-28%) removed a higher percentage of seeds than ants (2%) and rodents (1-4%) during pre-dispersal seed removal. Melanerpes hypopolius was probably the main bird removing seeds from fruits. Ants (62-64%) removed a higher percentage of seeds than birds (34-38%) and rodents (16-30%) during post-dispersal seed removal. Pogonomyrmex barbatus was probably the main ant removing seeds from soil. Birds and ants are the main pre- and post-dispersal seed removers in S. stellatus, respectively. Further studies in other S. stellatus populations and plants with different life forms and fruit types will contribute to evaluate seed removal in tropical American deserts.

Rubella in Panama: still a problem.

In 1986 there were 3795 cases of acquired rubella reported in the Republic of Panama (177/100,000 population) of which 1550 were from the Metropolitan Region (261/100,000 population). Fifty-four neonates (218/100,000 of those born alive), born predominantly in two medical centers within the capital, were identified with compatible or confirmed congenital rubella manifesting as cardiopathies and neurologic defects in 68.5%; low birth weight in 61%; ocular defects in 48%; muscular tone alterations and psychomotor retardation in 35 and 33%, respectively; and hearing loss and purpura in 29.6%. It is estimated that the annual direct cost of care for these 54 patients would be close to $123,730, and this confirms the high cost of continuing care compared with the use of a safe, economical and efficient vaccine.

New surgical approach to palliate tricuspid atresia in infants.

An experimental surgical technique is proposed to increase pulmonary blood flow in tricuspid atresia with normally related great arteries. The method consists of the creation of ventricular septal defect in the infundibular septum by means of a closed surgical procedure. The expected advantage would be the growth of the right ventricular cavity. This would permit performance of a Fontan's procedure later, using the right atrium and the right ventricle. Microscopic sections from the hearts of 4 infants showed no damage in the conduction system. When performed in the beating hearts of dogs, the feasibility of the procedure was tested repeatedly without production of rhythm disturbances.

[Endocarditis due to Pseudomonas aeruginosa (author's transl)]. / Endocarditis por Pseudomonas aeruginosa.

A case of pseudomonas endocarditis of biliary origin with impairment of the mitral and tricuspid heart valves is reported. Former history of the patient did not reveal narcotic addiction or previous open-heart surgery. Osteomyelitis is an uncommon complication of pseudomonas endocarditis. Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. The poor prognosis of cases with left valvular heart disease which are resistant to medical treatment is emphasized. Differential count of the colonies did not localize the affected heart valve in this case.

[Paroxysmic anarthria in multiple sclerosis]. / Anartria paroxística en la esclerosis múltiple.

INTRODUCTION: The paroxystic clinical features of multiple sclerosis (MS) include trigeminal neuralgia, itch, transient diplopia, Lhermitte's sign, akinesia, dystonia, Uhthoff's phenomenon and others which are very characteristic, such as paroxystic ataxia and dysarthria. CLINICAL CASE: We present the case of a 30 year old man who consulted for multiple episodes lasting only a few seconds, of complete inability to speak. This symptom recurred several times a day and in many different situations. It was often triggered off by external stimuli such as having to speak in front of several people. The disorder disappeared without treatment seven days after onset. Magnetic resonance using fast spin echo image sequences showed multiple hyperintense lesions in mid right cerebellar peduncle, right pons, left temporal lobe, white substance of both internal capsules, periventricular and semioval centres. Biochemical study of the cerebrospinal fluid showed that there were 9 cells/microliter (mainly lymphocytes), proteins 45 mg/dl and a normal glucose level. The Tibling-Link level was 0.73. Cortical somestesic evoked potentials showed slowed conduction after stimulation of the right median nerve and both peroneal nerves. Acoustic evoked potentials of the brain stem were conducted more slowly by the right acoustic pathway at intraxial level. The patient was diagnosed as having clinically defined MS. CONCLUSIONS: We consider that our patient's symptom was a kind of paroxystic dysarthria which we call paroxystic anarthria. Differential diagnosis of this symptom should be basically with phonatory or dysphasic simple partial seizures.

[Mean velocity and pulsatile index in primary headaches]. / Velocidad media e ndice de pulsatibilidad en las cefaleas primarias.

INTRODUCTION: Several authors have used transcranial Doppler studies (DTC) in the study of changes occurring in migraine. They found an increase in mean velocity (VM) as compared with controls. However there are few studies of this in tension headache. OBJECTIVE: To determine possible differences in VM and pulsatility index (IP) between patients with migraine and those with episodic tension headache by means of DTC. PATIENTS AND METHODS: We studied 26 patients with migraine, 30 with episodic tension headache (criteria of the IHS) and 21 controls using DTC (Multi Dop P/TCD DWL). We determined the VM and IP of the middle cerebral arteries at a depth of 50 60 mm. Uni bivariate statistical analysis was done using the computer programme SPSS. RESULTS: The VM were: 75.92 cm/s in migraine; 65.96 cm/s in episodic tension headache and 72.28 cm/s in the control group (the differences were not statistically significant: NS). The IP were: 0.80 in migraine and 0.76 in control and tension headache groups (NS). No differences were found either when the VM of migraine and tension headache were compared directly (p=0.067). The theoretical number of patients necessary for a study with results giving statistically significant tendencies was calculated as 44 in each group. CONCLUSIONS: 1. No statistically significant differences were found, probably due to lack of statistical power, since the migraine group showed a tendency to a higher velocity. 2. Further studies on larger numbers of patients are necessary to evaluate the differences between migraine and episodic tension headache.

[Cerebrovascular reactivity by means of the breath holding index (voluntary apnea): the reliability of early repetition]. / Reactividad cerebrovascular mediante el índice breath holding (apnea voluntaria): fiabilidad de la repetición precoz.

INTRODUCTION: The Breath Holding Index (BHI) is a non-invasive method for evaluation of cerebrovascular reactivity, the results of which correlate with those obtained by using intravenous acetazolomide and CO2 inhalation, so that it can be used as an alternative method to these in cooperative patients. However, the technique is not completely defined. Therefore Markus et al make a second measurement of the BHI 2-3 minutes later and take the arithmetical mean of the two readings as the final result. OBJECTIVES: To assess the intra-observer concordance between two BHI obtained with less than two minutes difference, and therefore whether the second index obtained may be used as an indicator of cerebrovascular reactivity. PATIENTS AND METHODS: Our study included 18 patients (7 men and 11 women; average age: 28.8 years; limits 17-50 years) with primary headache and no known cerebrovascular disease, diabetes mellitus or arterial hypertension. Using transcranial Doppler 28 measurements of the BHI (BHI1) were made in the middle cerebral arteries (right and/or left) in a similar way to that described by Markus. Once the average arterial velocity returned to basal levels the procedure was repeated in the first two minutes (BHI2) after the first index. Statistical analysis was done using the Student's t test and the kappa index between the two BHI after taking 0.8 as the cut-off point. RESULTS: The BHI2 (average +/- DT: 0.79 +/- 0.34) was significantly lower than that of BHI1 (average +/- DT: 1.04 +/- 0.44) (p < 0.005, t = 3.683). The kappa index between the two indices was very low: 0.058 +/- 0.158. CONCLUSION: The BHI2 is not a reliable index of cerebrovascular reactivity since it under-estimates it in relation to the previous index, even when the average arterial velocity has returned to basal levels.

[Evaluation of anthropometric development in patients with enuresis]. / Evaluación del desarrollo antropométrico en pacientes enuréticos.

INTRODUCTION: An epidemiological study was conducted to assess the anthropometric development in children diagnosed with primary monosymptomatic nocturnal enuresis, depending on the treatment option selected. PATIENTS AND METHODS: A longitudinal series of cases including 548 children aged 5-10 years. Anthropometric parameters of children were assessed at diagnosis, and after one and two years of treatment. RESULTS: Children with primary monosymptomatic nocturnal enuresis showed no anthropometric changes when their data were compared to the standard deviation score of height, weight, and body mass index (BMI). Overall, no changes were seen in the above mentioned parameters after two years of treatment for enuresis (except for a weight standard deviation score (SDS) decrease in boys). We only found a decrease in the size and weight in those children undergoing behavioral therapy with or without an alarm, findings that, given the limitations of the study, were not considered significant. The odds ratio for cure after one and two years of treatment was 1.41 (95% CI: 0.85-2.34) and 1.52 (95% CI: 0.86-2.70) for desmopressin (and watchful waiting) as compared to all other options. CONCLUSIONS: In this study, children had SDS values of height, weight, and BMI similar to healthy children of the same age and sex before and after treatment for primary monosymptomatic nocturnal enuresis. Desmopressin appeared to increase the probability of cure after one and two years of treatment, however these data should be corroborated in future randomized clinical trials.

[Temporary and permanent tissue conditioners]. / Acondicionadores de tejidos temporales y permanentes.

This paper reviews the different materials currently used as resilient rebasing liners in total posthodoncy, as aids for conditioning lining tissues for dentures, and describes a technique for manufacturing tissue conditioners, aimed at providing more comfort and well-being to the edentate patient.