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.

Monogenic and polygenic models detected in steroid 21-hydroxylase deficiency-related paediatric hyperandrogenism.

AIMS: Hyperandrogenism, although mostly due to polygenic interactions, is monogenic for some enzymatic adrenal deficiencies. This study evaluates mono- and biallelic 21-hydroxylase deficiency (21OHD)-related hyperandrogenism in pediatric patients. Sensitizing and protective polymorphisms were investigated in carriers and cryptic forms of 21OHD. METHODS: The study involved a monogenic analysis of CYP21A2 in patients (375 nonclassical 21OHD [NC21OHD] children; 306 hyperandrogenic 21OHD carriers, n = 306) and a polygenic association study (CAPN10-UCSNP44, PON1-108, TNFR2-M196R, IGF2-ApaI and IRS1-G972R polymorphisms) of 170 hyperandrogenic carriers plus 277 family members (control groups). The metabolic marker 17OH progesterone defined the degree of deficiency; clinical expressivity was determined by pediatric endocrinologists. RESULTS: The group of 21OHD carriers manifesting hyperandrogenism was enriched in the CAPN-UCSNP44 rare variant in homozygosity (4.9 vs. 0.4%, NCBI data for the general population; p = 0.004). In our patients and controls, contrasting distributions were observed for this and another polymorphism, TNFR2-196R. In a recessive model, their rare variants were more frequently detected among the forms with high (p = 0.048) and low (p = 0.034) expressivity respectively. CONCLUSIONS: 21OHD-related pediatric hyperandrogenism follows monogenic and polygenic models. The opposite behaviors in terms of clinical expressivity detected for CAPN-UCSNP44 and TNFR2-M196R rare variants suggest these variants to be sensitizing and protective factors respectively in adrenal hyperandrogenism.

Association of idiopathic retroperitoneal fibrosis, rapidly progressive glomerulonephritis and antiproteinase 3 antineutrophil cytoplasmic antibodies (anti PR3-ANCA).

We report a case of idiopathic retroperitoneal fibrosis and rapidly progressive glomerulonephritis with serum antiproteinase 3 antineutrophil cytoplasmic antibodies (anti-PR3-ANCA), without clinical or histological signs of Wegener's granulomatosis, in a 46-year-old man. Our case and previously reported cases showing the same association support the hypothesis that the association is not fortuitous, but reflects a common immunological mechanism.

[Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary]. / Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido.

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

[Outcome of community-acquired bacteremia admitted to an Internal Medicine Department]. / Pronóstico de las bacteriemias adquiridas en la comunidad ingresadas en un Servicio de Medicina Interna.

OBJECTIVE: To analyze mortality and associated factors in community-acquired bacteremia admitted to an Internal Medicine Department. PATIENT AND METHODS: Prospective study of bacteremia admitted in 1 year (May 1999-April 2000). We have collected demographic data, previous comorbid conditions, functional status, source of infection, complications, vital signs, laboratory values, APACHE II and SOFA scores, blood cultures, therapy and 28-day mortality. In bivariate analysis, we have used Chi-square, Student-t test and Mann-Whitney U as needed. Significant variables have been introduced in a stepwise backward logistic regression model with mortality as the dependent variable. RESULTS: We have observed 115 episodes of bacteremia in 114 patients. The source of bacteremia was urinary tract in 57.4% episodes and the most common isolate was Escherichia coli (54.4%). 28-day mortality was 15.3%. Factors independently associated with mortality were septic shock (OR 10.4), non-urinary source of bacteremia (OR 9.3), APACHE II score higher than 20 (OR 5.5), and previous dependent functional status (OR 4.8). CONCLUSIONS: Mortality risk factors were septic shock, non-urinary source of bacteremia, APACHE II score and dependent functional status.

[Local thrombolysis in renal artery embolism]. / Fibrinolisis local en el embolismo de la arteria renal.

Renal artery embolism is an infrequent entity that occurs in patients with underlying cardiac diseases. Diagnosis is usually difficult unless the index of suspicion is high. Local thrombolysis with low-dose fibrinolytic agents is an useful therapeutic intervention. We present 2 cases of renal artery embolism treated with intra-arterial urokinase and review clinical features and therapeutic options.

[Inguinal tumor as the first manifestation of a pancreatic pseudocyst]. / Tumoración inguinal como primera manifestación de un seudoquiste pancreático.

We report a case of pancreatic pseudocyst in alcoholic pancreatitis, that presented as a mass in the inguinal region. The mechanism of this peculiar clinical presentation was the dissemination of the content of the pseudocyst along the psoas muscle. We review the involvement of psoas muscle in pancreatic pathology, giving emphasis to reports of inguinal or thigh masses as initial manifestations.

[Pyogenic sacroiliitis. Presentation of 10 cases]. / Sacroileítis piógena. Presentación de diez casos.

We report the clinical, radiological and microbiological features of ten patients diagnosed of pyogenic sacroiliitis in an Internal Medicine Department during a 13 years period. Clinical signs and radiological or scintigraphical findings were present in every case. Staphylococcus aureus was isolated in blood cultures in eight cases. We remark mean age (26.2 years), male predominance and the high prevalence of intravenous drug abuse as the main epidemiological data in our patients. Onset was acute in 60% of the cases, and subacute in the others. Erythrocyte sedimentation rate and a high white blood cell count were uniformly elevated among laboratory tests. Initial roentgenograms were normal in 60%. Bone scans were the most sensitive diagnostic aid. All the patients were treated with intravenous cloxacilin between two and eight weeks; aminoglycosides were added in four patients. We have observed two cases of psoas abscesses that required surgical drainage.