Correlations between bone mineral density, insulin-like growth factor I and auxological variables.

Recent studies have shown growth-related changes in spinal bone mineral density (BMD) in children; however, there is less information available on the relationship between BMD and insulin-like growth factor I (IGF-I). The aim of this study was to relate the BMD of the spine and radius with serum IGF-I levels and auxological variables in normally growing children. We used dual X-ray absorptiometry to measure the BMD in the lumbar spine (L1-L4) and distal radius of 121 children (69 boys, 52 girls) aged 3-18 years whose growth velocity was normal. Lumbar and radial BMD increased with age (p < 0.001) and puberty (p < 0.001) and was highly correlated to age, weight, height, body surface and bone age (r = 0.70-0.89 and p < 0.001 for all variables). Partial correlation, with age held constant, was weaker but still significant for most auxological variables. Serum IGF-I concentrations increased slowly during childhood and markedly during early stages of puberty, and correlated with lumbar and radial BMD (r = 0.55 and 0.45, respectively; p < 0.001) and with the auxological variables (p < 0.001). When age was held constant, IGF-I levels still correlated significantly with the auxological variables and with BMD, except in the case of radial BMD in boys. By multiple regression analysis IGF-I, unlike auxological variables, did not reach significance in the ability to predict BMD. Therefore, in healthy children, serum IGF-I levels show a weaker relationship to BMD than do auxological variables.

Bone mineral status in prepubertal children with constitutional delay of growth and puberty.

OBJECTIVE: We wished to clarify whether the osteopenia reported in adult men with a history of constitutional delay of growth and puberty (CDGP) could be due to the delayed puberty or an independent predisposition to osteoporosis in this condition. DESIGN: Short prepubertal children with CDGP and children with familial short stature (FSS) were matched for height and other auxological variables. The FSS children served as a control group. METHODS: We measured spinal (L1-L4) bone mineral content (BMC) and bone mineral density (BMD) by dual energy X-ray absorptiometry (Hologic QDR 1000/w) in 56 children aged 5-11 years. All children had height below the 10th percentile for chronological age (CA), and bone age (BA) less than 10 years, 29 of them with clinical diagnosis of possible CDGP and 27 of them with FSS. The BMD standard deviation scores (SDS) relative to the values for normal height children were obtained. RESULTS: The mean (+/-S.D.) spinal BMD was significantly lower in the children with CDGP than in the FSS group (0.534+/-0.059 vs 0.623+/-0.060 g/cm2, P< 0.001). Both groups had negative mean lumbar BMD SDS, but in the CDGP group it was significantly lower than in the FSS group as well when the SDS was based on the CA (-1.41+/-0.61 vs -0.38+/-0.51, P< 0.001) and when it was related to BA (-0.78+/-0.64 vs -0.17+/-0.52, P< 0.01). BMC was significantly lower in the CDGP than in the FSS group, when multiple regression analysis was performed by using scanned bone area, body weight and height, sex and BA as independent variables (P = 0.0005). CONCLUSION: The finding of decreased mineralization in prepubertal children with CDGP before the age of puberty suggests that they may have an inherent predisposition to osteopenia.

Comparison between spinal and radial bone mineral density in children measured by X-ray absorptiometry.

Several studies have analyzed the correlation between axial bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) and growth parameters. However, little is known about the growth-related changes in appendicular BMD measured by this technique. We used DXA to measure BMD in the lumbar spine (L1-L4) and distal radius in 121 normal growing children (69 boys, 52 girls), aged 3 to 18 yr. Both lumbar and radius BMD showed a steady increase with age and a steeper increment during puberty. There was a good correlation between spinal and radial BMD (r = 0.83; p < 0.001) and both were highly correlated with growth parameters; their respective correlation coefficients did not differ significantly for chronological age (r = 0.70 vs 0.80), weight (r = 0.77 vs 0.76), height (r = 0.73 vs 0.79), body surface (r = 0.78 vs 0.80), body mass index (r = 0.54 vs 0.49) and bone age (r = 0.77 vs 0.79). By multiple regression analysis the best predictors for spinal BMD were bone age, pubertal stage and weight, while for radial BMD the best predictors were chronological age and weight. We have shown that the measurement of BMD by DXA at distal radius, an easily accessible bone, has a correlation with growth parameters as good as lumbar spine BMD measurements in children.

Evaluation of radial bone mineral content in prepubertal children with constitutional delay of growth.

We have previously reported that children with constitutionally delayed growth (CDG) have significantly lower spinal bone mineralization than children with familial short stature (FSS). The aim of the present study was to evaluate whether the decreased bone mineralization in children with CDG also affects the radius, which has a lower bone turnover than the spine. To avoid the possibility of size-related artifacts in the assessment of bone mineral data, data were corrected for bone and body size. Radial bone mineral content (RBMC) and radial bone mineral density (RBMD) were measured by dual energy X-ray absorptiometry (Hologic QDR 1000/w) in 56 short prepubertal children aged 5-11 years. All children had height below the 10th percentile for chronological age (CA), and bone age (BA) less than 10 years, 29 of them with clinical diagnosis of CDG and 27 of them with FSS. The mean (+/- SD) RBMD was significantly lower in the children with CDG than in the FSS group (0.361 +/- 0.035 vs 0.385 +/- 0.033 g/cm2, p<0.05). RBMC was significantly lower in CDG than in FSS, when multiple regression analysis was performed by using radial scanned bone area (RSBA), body weight and height, sex and BA as independent variables (p = 0.03). These data indicate that the decreased bone mineralization in children with CDG also affects peripheral bone, and that this finding is not due to bone or body size artifacts.

Bone loss and turnover in patients with liver transplantation.

We have studied bone turnover markers and bone mineral density (BMD) in 82 patients (26 females and 56 males) that underwent orthotopic liver transplantation in our center. Follow-up was for a median of 19.2 months (range 1-60 months). During this period they were treated with prednisone, azathioprine and cyclosporine in accordance with protocols. Spinal bone loss was measured with a dual energy X-ray densitometer (precision 1.3%), and, depending on Z score and BMD values, two groups were distinguished: A) Without osteoporosis: 47 patients, Z = -0.98 +/- 0.09 and BMD 0.899 +/- 0.098 g/cm2, and B) With osteoporosis: 35 patients, Z = -2.71 +/- 0.55 and BMD 0.739 +/- 0.080 g/cm2 (X +/- SD). Serum bone markers such as osteocalcin (BGP) 10.0 +/- 0.8 ng/ml and procollagen-I (pColl-I) 268.1 +/- 32.1 micrograms/ml, were found to be increased. Serum PTH was within the normal range. No significant differences were found between the etiologic subgroups studied with respect to bone loss. Also, no correlation was found between bone loss and duration of follow-up or other factors, such as immunosuppressant drugs or acute rejection. Our study confirms an increased prevalence of bone loss in patients with liver transplantation, which is associated with a high bone turnover, indicating that earlier diagnosis and treatment is necessary to improve survival and quality of life in these patients.

[Association of acromegaly and a cerebral arterial aneurysm disclosed by a subarachnoid hemorrhage]. / Association d'une acromégalie et d'un anévrysme artériel cérébral révélé par une hémorragie sous-arachnoïdienne.

The association of acromegaly and cerebral aneurysm is an infrequent clinical finding, being few the cases reported in literature. A major incidence of cerebral aneurysm in patients with other pituitary adenoma and cerebral tumour has been described, in relation to the general population. We have studied a male patient, aged 37 years old, with an acromegaly disease initiated 5 years before, that came to our hospital because of subarachnoid hemorrhage symptomatology. A right middle cerebral aneurysm was found in surgery. Hormonal studies confirmed a high basal Growth Hormone (64 ng/ml) that was not suppressed during an Oral Glucose Tolerance Test (75 g). A triple stimulus test (Insulin, TRH, LHRH) demonstrated non-response of GH to TRH and hypoglycemia others hormones were normal. Radiological studies were suggestive of Acromegaly disease. Computed axial tomography showed an intra-sellar tumour. The patient was operated (Transsphenoidal surgery) and a GH pituitary secreting tumour found, without suprasellar extension. The clinical significance and importance of the coexistence of the Acromegaly and Cerebral Aneurysm is discussed, with a review of hypothesis implicated.

A review of issues in hospital technology acquisition.

The past decade has seen the restriction of reimbursement and increasing pressures for cost-containment mandate vast improvements in technology assessment. Because no single source of evaluative data exists, individual hospitals must develop their own assessment programs. Medical, monetary, legal and supplier issues must all be considered in response to any request for the acquisition of technology. This can be accomplished through a coordinated effort by a diverse grouping of the medical and technical talent found in any hospital. This paper reviews the important issues described in the literature and offers background and guidance for assessment concerns, in an attempt to assist the individual hospital in becoming a successful technology evaluator.

[Budd-Chiari syndrome in childhood by hipoplasia of suprahepatic veins. Clinical and pathological study of a case (author's transl)]. / Síndrome de Budd-Chiari por hipoplasia de las venas suprahepáticas. Estudio clínico y anatomopatológico de un caso

A case of Budd-Chiari syndrome with hypoplasia of suprahepatic veins is reported. A bibliographic review is made. Etiologic and anatomic factors are analyzed. Its clinical, analytic, pathological and embryologic findings are compared with those of other authors. The rarity of this case, for the age of presentation as much as for its etiology is pointed out.

Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women.

No single anthropometric parameter has yet been generally accepted as being superior to others in assessing the metabolic risk associated with abdominal obesity. To compare waist circumference (WC) with waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), regarding their association with serum lipids, we studied 166 women aged 20 to 48 yr; 53 were obese [body mass index (BMI) 30-39.9 Kg/m2], 50 were overweight (BMI 25-29.9 Kg/m2) and 63 normal weight (BMI 18.5-24.9 Kg/m2). Height, body weight, waist and hip circumferences, total serum cholesterol (Ch), low (LDL) and high density lipoprotein (HDL)-Ch and triglyceride (TG) concentrations were measured. The correlation coefficients between the concentration of serum lipid fractions and each anthropometric parameter did not differ significantly for any lipid variable when WC, WHR and WHtR were compared in the 166 women. The same applied for the obese and the overweight group, whereas in normal weight women there was significant association only between WC and LDL-Ch and between WHR and Ch/HDL-Ch ratio. Stepwise regression analysis showed that the proportion of variance in serum lipids did not change significantly when WHR or WHR+WHtR were added to WC into the regression model (18%, 18% and 18% for Ch; 13%, 18% and 18% for HDL-Ch; 18%, 18% and 12% for LDL-Ch; 35%, 35% and 37% for TG, respectively). These results indicate that WC is the main parameter associated with serum lipid levels and that the ratios studied do not provide additional substantial information in women who need weight management.