Growth hormone response to a growth hormone-releasing hormone stimulation test in a population-based study following cranial irradiation of childhood brain tumors.

Children with brain tumors are at high risk of developing growth hormone deficiency (GHD) after cranial irradiation (CI) if the hypothalamus/pituitary (HP) axis falls within the fields of irradiation. The biological effective dose (BED) of irradiation to the HP region was determined, since BED gives a means of expressing the biological effect of various irradiation treatment schedules in a uniform way. Hypothalamic versus pituitary damage as cause of GHD was distinguished in 62 patients by comparing the growth hormone (GH) peak response to an insulin tolerance test (ITT)/arginine stimulation test and the GH response to a growth hormone-releasing hormone (GHRH) stimulation test. Peak GH response to a GHRH test was significantly higher (median 7.3 mU/l; range: 0.5--79.0 mU/l) than that of an ITT/arginine test (median 4.7 mU/l; range: 0.01--75.0 mU/l) (p = 0.017). Peak GH after a GHRH test was significantly inversely correlated to follow-up time (r(s) = -0.46, p < 0.0001) and to BED (R(s) = -0.28, p = 0.03), and both were found to be of significance in a multivariante regression analysis. We speculate that a significant number of patients developed hypothalamic radiation-induced damage to the GHRH secreting neurons, and secondary to this the pituitary gland developed decreased responsiveness to GHRH following CI in childhood.

Dosimetry and growth hormone deficiency following cranial irradiation of childhood brain tumors.

BACKGROUND: Dosimetry of the hypothalamus-pituitary (HP) region could allow prediction of the risk of growth hormone deficiency (GHD) following cranial irradiation. PROCEDURE: Nineteen children (15 boys) with a median age of 6.3 years (range 1.7-16.5) at the time of irradiation of a brain tumor not involving the HP axis were followed for 1.2-6.3 years (median 3.4) from radiotherapy (RT). The dose to a standardized anatomical model including the HP region was calculated from dose-volume histograms of 10% to 100% in steps of 10% of the HP model based on data from a computer-based treatment planning system. If GHD was suspected from insulin-like growth factor-I, serum insulin-like growth factor binding protein-3, and/or height velocity measurements, an arginine stimulation test was performed. GHD was defined by a peak GH <15mU/liter. RESULTS: Ten patients developed GHD 10-26 months from irradiation. Cox regression analysis identified the 90% dose-volume of the HP box as the strongest predictor of development of GHD (P = 0.03). The median dose to the 90% dose-volume of the HP region was 37.5 Gy (range 2. 3-55.3). The cumulated risk of GHD 2.5 years after radiotherapy for children receiving more than and less than 37.5 Gy to the HP region was 87% and 33%, respectively (P = 0.036). CONCLUSIONS: Dosimetry of a defined HP volume provides the opportunity to 1) calculate the exact dose delivered to this region, 2) predict the risk of GHD and, 3) in the future revise the treatment planning and thus reduce the risk of endocrine adverse effects.

Childhood leukemia following phototherapy for neonatal hyperbilirubinemia (Denmark).

To test the hypothesis that exposure to high intensity lightning (around 400 nanometers) in neonatal nurseries increases the incidence of childhood leukemia, over 55,120 newborn children treated with phototherapy for hyperbilirubinemia were identified from the Danish Hospital Discharge Register for 1977-89. Linkage of the roster with the national cancer registry through 1991 revealed 87 childhood cancers, whereas 85 were expected from the rates for the general population. The incidence of leukemia in 34 children was not unusual (standardized incidence ratio [SIR] = 1.2, 95 percent confidence interval [CI] = 0.8-1.7). Subgroup analyses revealed no remarkable patterns for any category of leukemia subtype, gender, or age at diagnosis. We conclude that whole-body exposure to phototherapy (420-470 nm) shortly after birth is not a significant risk factor for childhood leukemia.

Changes in T1 relaxation processes in the bone marrow following treatment in children with acute lymphoblastic leukemia. A magnetic resonance imaging study.

Magnetic resonance imaging (MRI) and T1 relaxation time measurements of the vertebral bone marrow were performed in 11 children with acute lymphoblastic leukemia (ALL) at diagnosis. Nine of the children were re-examined after chemotherapeutic treatment. The results were compared with histological data from bone marrow biopsies obtained in close association to the MR examinations. Ten age matched children were examined as a control group. A 1.5 Tesla whole body scanner was used for the measurements. The pretreatment T1 relaxation times of the bone marrow were significantly prolonged, compared to the age matched controls. After chemotherapy the T1 relaxation times of the children with ALL decreased significantly towards or into the normal range. A significant correlation was found between the T1 relaxation time and the content of malignant blast cells in the bone marrow.

[Electrotherapy of pain relief using the Tenzcare stimulator. A clinico-experimental study]. / Elektrotherapie zur Schmerzbekämpfung unter Verwendung des Tenzcare-Stimulators. Eine klinisch-experimentelle Studie.

Electrotherapy was introduced into the aftercare programme for patients with serial rib fractures in the acute stage, shoulder injuries or fractures of the radius. Electrical stimulation was carried out with the Tenzcare Nr. 6240 apparatus. The results were significantly better in each of the three groups than in the respective control group. Patients after thorax trauma complained less of pain in the acute phase: there was less pulmonary secretion on X-ray and, on average, their blood gas values returned to normal three days earlier. None of them required assisted respiration. Patients with shoulder injuries or fractures of the radius complained less frequently of pain during physio-therapy after removal of their plaster casts. They attained their optimum range of movement on average ten and eight days earlier, respectively than the controls.

[The effect of standardized acupuncture programs in the after-care of accident patients]. / Die Wirkung von standardisierten Akupunkturprogrammen in der Nachbehandlung von Unfallpatienten.

153 patients suffering from pain, edematous conditions, and impaired movement following traumas sustained in accidents were treated or after-treated with acupuncture. Acupuncture was applied in adherence to a standardized program according to the individual types of injury. The stimulus was applied by means of steel needles inserted into body as well as ear acupuncture points. In all 9 groups, improvement of the painful condition was significant to highly significant as it was regarding improvement of the movement impairment, the latter not having been emphasized in the other 3 groups. Remaining complaints of long standing following accident traumas could also be positively influenced. Acupuncture proved itself to be an effective form of therapy for after-treatment of accident patients, presenting a valuable supplement to the field of rehabilitation, especially when combined with other physical therapeutic measures.

[Testing the effect of acupuncture in accident patients using skin temperature measurements]. / Prüfung zur Wirkung der Akupunktur bei Unfallpatienten mittels Hauttemperaturmessung.

Skin temperature was studied on a group of 54 patients suffering from accident traumas and 20 healthy probands during and after treatment. In all patients there was a very significant rise in skin temperature in the area of the lesion which persisted beyond the treatment period, and in some cases even increased. This effect was also observed to a lesser extent on the contralateral, untreated extremity. No change in skin temperature was observed in the healthy probands who were treated in the same manner. This leads to the conclusion that needle stimuli in the area of lesions have not only a local, hyperemic effect, but also demonstrate superregional actions; this is, however, dependent on the integrity of the organism.

[Treatment of whiplash injuries of the cervical spine with acupuncture]. / 'Zur Behandlung des Schleudertraumas der HWS mit Akupunktur'.

30 patients with whiplash injuries were treated with aural-acupuncture. The points were chosen according to a special programme. Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation.