Study of the column efficiency using gradient elution based on Van Deemter plots.

Performance of chromatographic columns is of major importance in the development of more efficient separation methods. So far, a common practice is to study the column behavior in isocratic elution by modifying the flow rate and fitting the theoretical plate height values versus the mobile phase linear velocity, according to the Van Deemter equation. In this work, an approach is presented to extend the measurement of efficiency to linear gradient elution, where the mean retention factor is kept constant at each assayed flow. This avoids a possible source of uncertainty due to the change in the distribution equilibria profile, and makes the mean interactions with the stationary phase in gradient elution similar to those in isocratic elution. The approach was applied to Zorbax Eclipse XDB C18 and Chromolith SpeedROD C18 columns, using four sulphonamides as probe compounds. The results are compared with those obtained in isocratic elution, and gradient elution where the gradient program is kept constant while the flow is varied, giving rise to changes in the mean retention factor at each flow rate. The mean compression factor obtained experimentally was higher than expected, with mean values of 0.98 and 1.02 for the Zorbax and Chromolith columns, whereas the predicted values were 0.87 and 0.92, respectively. Better efficiencies were obtained at lower flow and higher gradient slope. The resolution shows similar values in isocratic and gradient elution when the mean retention factor is kept constant. When the gradient slope is constant, the resolution is usually smaller, although it improves at higher flows.

Fluctuating rodent populations and risk to humans from rodent-borne zoonoses.

The fluctuations in abundance of a wildlife reservoir are an attractive explanation for temporal variation in primary human cases of a zoonosis. This is because high abundance may lead to more contact between humans and animals, but also to outbreaks of disease within the reservoir population. We propose a mathematical framework that sets out the consequences of correlation between reservoir abundance and reservoir prevalence for how numbers of human cases are related to reservoir abundance. The fluctuations of rodent populations are well studied and often dramatic. A review of field studies of rodent reservoirs for plague, hantaviruses, and other zoonoses shows that, at a seasonal time scale, a positive correlation between host abundance and host prevalence is rarely observed. More commonly, there is an inverse relationship or negative correlation such that a seasonal increase in rodent abundance is not accompanied by a corresponding increase in the abundance of infectious animals. Seasonal changes in rodent abundance are hence unlikely to fully explain seasonal variation in primary human cases. The few longer field studies (>5 years) show a positive but delayed relationship between reservoir abundance and reservoir prevalence.

An approach to evaluate the information in chromatographic fingerprints: Application to the optimisation of the extraction and conservation conditions of medicinal herbs.

A new approach is reported for high-performance liquid chromatography to measure the level of information in fingerprints. For this purpose, the concept of peak prominence, which is the protruding part of each visible peak with regard to the valleys that delimit it, was used. The peaks in the fingerprints are ranked according to the areas of the peak prominences, and a threshold is established to discriminate between the significant peaks and those that are irreproducible. The approach was applied to evaluate the impact of several extraction conditions (solvent nature and composition, time and temperature of the treatment, amount of sample, and time and temperature of conservation of the extracts) on the number of significant peaks found in the fingerprints of a medicinal herb (a green tea sample), using Plackett­Burman designs. Acetonitrile, ethanol and methanol were used for the extraction, and a linear gradient for chromatographic analysis, where the acetonitrile content was increased from 5.0% to 42.5% (v/v) in 45 min. The maximal number of significant peaks in the fingerprints was obtained using a methanol­water mixture as extraction solvent, high ultrasonication time and high temperature. The reported approach can be generalised to other complex samples and situations.

Spontaneous, but not induced, puberty permits adequate bone mass acquisition in adolescent Turner syndrome patients.

Lumbar L2-L4 bone mineral density (BMD) values were measured in 37 adolescent and young adult Turner syndrome patients. Nine had developed spontaneous puberty and had had regular menses since menarche (12.55 years +/- 1.17 years) to the time of BMD evaluation (14.96 years +/- 1.26 years). In the other 28, puberty was induced with increasing doses of oral ethinyl estradiol (2.5-10.0 microg/day, for 2 years) and later administration of estrogen/gestagen therapy up to the time of BMD evaluation. In 18, the adolescent group, menarche appeared at 14.68 years +/- 0.63 years and BMD was evaluated at 17.77 years +/- 0.70 years, and in the other 10, the young adult group, menarche appeared at 14.47 years +/- 0.53 years and BMD was evaluated at 20.90 years +/- 0.68 year. BMD values were in the normal range in those who had developed spontaneous puberty (Z score values, -0.24 +/- 0.22) and in the osteopenia range in those in whom puberty was induced (Z score values, -2.09 +/- 0.79 and -2.18 +/- 0.32 for the adolescent and young adult groups, respectively) p < 0.0001. Height Z score values were similar in all three groups (-3.45 +/- 0.77, -3.15 +/- 0.83, and -3.08 +/- 0.33, respectively). No significant differences in calcium intake or physical activity were found among groups. Neither the karyotype distribution nor growth hormone (GH) therapy (five in the spontaneous puberty and six in the induced puberty groups had been treated for a 3.5- to 4.4-year period) explained the differences in BMD values. Because the main difference between groups was the availability of estrogens to bone tissue from infancy to menarche and of estrogens/gestagens from then on up to the time of BMD evaluation, our results suggest that normal gonadal function from infancy to adulthood may be required for adequate bone mass peaking. Early detection of osteopenia and improvement in general measures for adequate bone mass peaking (calcium intake and physical activity) should be considered mandatory in the health care of these patients.

Hyperinsulinemia in postpubertal girls with a history of premature pubarche and functional ovarian hyperandrogenism.

Previous studies have documented the association of insulin resistance and hyperandrogenism in adult women with functional ovarian hyperandrogenism (FOH) or polycystic ovary syndrome (a form of FOH). However, the possible impact of adrenal hyperandrogenism development during childhood in premature pubarche (PP) patients on postpubertal insulin secretion patterns remains unclear. The fasting insulin to glucose ratio, C peptide, early insulin response to glucose (IRG), mean blood glucose, mean serum insulin (MSI), glucose uptake rate in peripheral tissues (M), and insulin sensitivity indexes (SI) in response to a standard oral glucose tolerance test were evaluated in 13 PP girls with FOH (group A; age, 17.2 +/- 0.5 yr), 11 eumenorrheic nonhirsute PP girls (group B; age, 16.6 +/- 0.5 yr), and 21 age-matched controls (group C). Body mass indexes (BMI) were similar in the 3 groups (group A, 23.3 +/- 0.8; group B, 22.5 +/- 0.6; group C, 20.6 +/- 0.5 kg/m2). MSI values were significantly higher in FOH patients than in controls (74.7 +/- 17.6 vs. 45.7 +/- 4.1 mU/L; P < 0.01), but were not different from those in group B (63.3 +/- 11.1 mU/L). Thirty-eight percent of FOH patients (group A) and 27% of non-FOH patients (group B), all of whom had normal BMI, showed MSI levels well above the upper normal limit for controls (> 83.3 mU/L). MSI correlated with the degree of ovarian hyperandrogenism [defined by an abnormal 17-hydroxyprogesterone response to challenge with the GnRH analog leuprolide acetate; group A] and with the free androgen index [testosterone (nanomoles per L)/sex hormone-binding globulin (nanomoles per L) x 100; groups A and B)]. Although IRG, glucose uptake rate in peripheral tissues, mean blood glucose, and SI values were not significantly different in the 3 groups, 3 patients in group A and 1 patient in group B showed decreased insulin sensitivity and/or an enhanced early IRG. Among others, significant correlations between MSI and free androgen index values (r = 0.6; P < 0.002; groups A and B) and between BMI and SI (r = -0.53; P < 0.05; groups A and B) were found. Peak 17-hydroxyprogesterone responses to ACTH at PP diagnosis correlated positively with SI in both groups of patients (r = 0.53; P < 0.007). Hyperinsulinemia is a common feature in adolescent PP patients with FOH and appears to be directly related to the degree of androgen excess. Long term follow-up of PP patients into adulthood is warranted to ascertain whether hyperinsulinemia actually precedes FOH development and whether overt insulin resistance ensues.

Natural history of premature pubarche: an auxological study.

The natural history of girls with premature pubarche is reported to be normal, but the effects on puberty and on final height are not well documented. We assessed the outcome of a group of girls with premature pubarche from two Latin populations in whom 21-hydroxylase deficiency had been ruled out by an ACTH test. Patients comprised 127 girls (70 Northern-Italian and 57 Northern-Spanish), of whom 69 had entered puberty and 38 had attained adult height. Height, bone age, onset and progression of puberty, height prognosis, adult height, and baseline plasma androgen levels were evaluated. Advanced skeletal maturation and tall stature were constant features during the first years of follow-up and subsequently declined. Puberty began at 9.7 +/- 0.9 yr, and age at menarche (12.0 +/- 1.0 yr) was comparable to maternal and population menarcheal ages. The appearance and chronology of pubertal milestones in both populations were very similar. Adult heights correlated with the height prognosis at diagnosis and at onset of puberty, and were above midparental heights. Premature pubarche produces a transient acceleration in growth and bone maturation with no negative effects on the onset and progression of puberty and final height.

Source localization of androgen excess in adolescent girls.

Functional ovarian hyperandrogenism (FOH) is characterized by an abnormal ovarian response to challenge with the GnRH analogs nafarelin and leuprolide acetate, similar to that observed in women with well defined polycystic ovary syndrome, regardless of whether elevated LH levels or polycystic ovaries are present. We studied an unselected group of 42 hyperandrogenic adolescents (age range, 14-22 yr; mean, 18.1 +/- 2.5 yr) 1) to determine FOH incidence through the assessment of ovarian-steroidogenic response to a single dose of leuprolide acetate, 2) to assess the clinical characteristics of patients according to their responses to GnRH analog stimulation, and 3) to evaluate adrenal steroidogenic function and its relation to ovarian hyperandrogenism in patients with either normal or abnormal responses to leuprolide acetate challenge. All patients underwent leuprolide acetate and ACTH testing, dexamethasone and ovarian suppression tests, and pelvic ultrasonography. Twenty-four (58%) patients had supranormal plasma 17-hydroxyprogesterone (17-OHP) responses to leuprolide acetate characteristic of FOH, and in 18, the 17-OHP response was similar to that of controls (n = 24; age, 17.1 +/- 2.3 yr). Seven patients (5 with FOH and 2 with normal responses to leuprolide acetate) had an abnormal response to ACTH, but only 1 had conclusive evidence of 21-hydroxylase deficiency. In 16 patients, the response to both stimulation tests was normal. Only 13 (54%) of the 24 FOH patients had polycystic ovaries on ultrasonography, and in 11 (46%), basal plasma LH levels were elevated. In FOH patients, reduction in testosterone and androstenedione plasma levels was significantly greater after ovarian suppression than after dexamethasone challenge (P < 0.0005 and P < 0.02, respectively). Peak plasma 17-OHP levels postleoprolide acetate simulation correlated with dexamethasone-suppressed plasma testosterone concentrations, dexamethasone-suppressed plasma androstenedione levels, and the free androgen index postdexamethasone treatment (r = 0.4, P = 0.01; r+ 0.4, P < 0.05; and r = 0.41, P = 0.007, respectively), Plasma sex hormone-binding globulin levels after dexamethasone administration correlated negatively with the baseline free androgen index (r = -.0.67; P < 0.0001). Considering our diagnostic criteria, 26 (62%) of our collective of 42 patients had abnormal responses to one or both stimulation tests, whereas 16 (37%) had normal response. FOH is the most common cause in (58%) of androgen excess in adolescence. Short term leuprolide acetate stimulation is a reliable tool fro identification of the ovary as the source of their hyperandrogenism.

Use of leuprolide acetate response patterns in the early diagnosis of pubertal disorders: comparison with the gonadotropin-releasing hormone test.

The effects of a single injection (500 micrograms sc) of the GnRH agonist leuprolide acetate on gonadotropin secretion and those induced by a GnRH test were analyzed in 32 children (11 males and 21 females) referred for possible pubertal developmental disorders and in 9 prepubertal controls [group C; 4 males and 5 females; chronological age (CA), 7.4 +/- 1.2 yr]. The pituitary-gonadal secretory responses to the GnRH agonist were characterized in all subjects and in a control group in early puberty [10 females (Tanner breast stage II; CA, 11.3 +/- 1.1 yr) and 6 males (Tanner pubertal stage II; CA, 13.5 +/- 0.4 yr); group D]. Twelve girls (CA, 7.1 +/- 0.7 yr) presented with precocious breast development, 11 patients [6 boys (CA, 10.9 +/- 0.4 yr) and 5 girls (CA, 9.3 +/- 0.5 yr)] had advanced puberty and predicted adult heights below -2.0 SD score, and 9 patients [5 boys (CA, 14.6 +/- 0.3 yr) and 4 girls (CA, 14.4 +/- 1.1 yr)] had delayed puberty. Less than 6 months had elapsed since the appearance of pubertal signs in all patients with pubertal development. After a follow-up period of 12.9 +/- 2.0 months, 20 patients showed progression of pubertal signs (group A, progressive puberty), and in 12, puberty regressed or did not progress (group B, nonprogressive puberty). The results of hormonal tests in all patients were analyzed retrospectively according to their clinical outcome. Patients in group A had a mean plasma peak LH response significantly higher after leuprolide acetate stimulation than after GnRH challenge (13.1 +/- 0.2 vs. 7.3 +/- 0.9 IU/L; P < 0.003). Those in groups B and C had similar peak LH responses after both tests (3.3 +/- 0.2 vs. 3.1 +/- 0.4, and 1.5 +/- 0.1 vs. 1.8 +/- 0.4 IU/L, respectively). No differences in basal and poststimulated LH levels were found between boys and girls in the same group. In patients in groups A and D, LH consistently peaked 3 h postleuprolide acetate challenge; in those in groups B and C, the LH peak occurred 3-6 h postinjection. Maximal gonadal responses were elicited 24 h poststimulation. No overlap in poststimulated estradiol or testosterone values occurred between patients in groups A and D and those in groups B and C.(ABSTRACT TRUNCATED AT 400 WORDS)

Postpubertal outcome in girls diagnosed of premature pubarche during childhood: increased frequency of functional ovarian hyperandrogenism.

The postpubertal outcome of a group of girls diagnosed of premature pubarche during childhood was assessed 1) to determine the incidence of functional ovarian hyperandrogenism (FOH) through the ovarian-steroidogenic response to the GnRH agonist leuprolide acetate, 2) to validate leuprolide acetate stimulation in FOH diagnosis, and 3) to ascertain whether FOH-predictive biochemical markers exist at the diagnosis of premature pubarche. Of 35 patients (age, 15.4 +/- 1.5 yr), 16 showed hirsutism, oligomenorrhea, and elevated baseline testosterone and/or androstenedione (delta 4-A) levels. Subcutaneous administration of leuprolide acetate (500 micrograms) produced similar increases in gonadotropin levels in oligomenorrheic patients, regularly menstruating patients (n = 19), and controls (n = 12; age, 15.3 +/- 1.3 yr) when tested at 6 h. Of all of the steroids measured, 17-hydroxyprogesterone (17-OHP) and delta 4-A levels 24 h postleuprolide acetate stimulation were significantly higher in oligomenorrheic patients than in the other two groups (P < 0.0001). No overlapping in 17-OHP responses occurred between oligomenorrheic patients and the other groups. Baseline dehydroepiandrosterone sulfate and delta 4-A levels at the diagnosis of premature pubarche correlated with 17-OHP values postleuprolide acetate challenge (r = 0.47; P < 0.005 and r = 0.67; P < 0.0001, respectively). These results show a distinct leuprolide acetate challenge response in 45% of the postpubertal premature pubarche girls studied, suggestive of an increased incidence of FOH, and support the need for continued routine postmenarcheal evaluation of this group of patients. Responses of 17-OHP to leuprolide acetate challenge facilitate the identification of FOH patients, establish this test as a reliable diagnostic tool in FOH diagnosis, and confirm the ovaries as the source of hyperandrogenemia in most patients with androgen excess. Although increased 17-OHP responses after leuprolide acetate stimulation seem to occur more frequently in girls with elevated dehydroepiandrosterone sulfate and/or delta 4-A levels at the diagnosis of premature pubarche, specific biochemical markers predictive of FOH in this group of patients are still lacking.

Longitudinal study of the pubertal growth spurt in children born small for gestational age without postnatal catch-up growth.

Most children born small for gestational age (SGA) experience extensive catch-up growth during the first months of life (87%) and by the age of 2 years only 13% are below -2 SDS for height. The long-term outcome, including pubertal growth spurt, of the subset of children born SGA without postnatal catch-up (SGAWPC) has been evaluated in very few surveys, and in none of them was the landmarks of puberty well described. Thus, a longitudinal study was conducted in these children throughout puberty since this is the only reliable way to accurately evaluate the pubertal growth spurt. In an observational, retrospective and multicenter collaborative study, from an initial group of 553 SGA children, a subset of 15 boys (BW = 2,070 +/- 379.6 g) and 16 girls (BW = 2,244 +/- 331.1 g) SGAWPC whose data were recorded regularly during puberty were selected. Growth standards for growth and maturity during puberty were Tanner and Whitehouse and Spanish Hernandez and Sobradillo charts. In pubertal growth spurt, 'take-off' occurred later than in the reference populations with a height SDS deficiency of -2.3 and -2.2 for boys and -2.0 and -1.9 for girls, compared with Spanish and Tanner references, respectively. Peak height velocity was normal in chronology and intensity, but the total pubertal gain was smaller. However, considering their growth from the same chronological age at which the reference populations took off until adulthood, the total gain was not significantly different in the three cohorts (32.5 +/- 5.4 cm vs 30.9 +/- 4.4 in boys, and 23.3 +/- 4.1 vs 25.7 +/- 5.4 cm in girls - Spanish reference - and 27.2 +/- 6.3 vs 27.6 +/- 3.5 cm in boys - Tanner charts), except in the case of girls (21.1 +/- 3.9 vs 25.3 +/- 4.1 cm, p <0.005 - Tanner charts). Adult height was significantly reduced (161.9 +/- 3.9 cm in males and 147.0 +/- 2.6 cm in females). Therefore, although the pubertal growth was smaller in these children, puberty probably did not modify their short final height.

[The effectiveness of recombinant growth hormone in height deficiency due to intrauterine growth retardation]. / Efectividad de la hormona de crecimiento recombinante en el déficit de talla debido a retraso de crecimiento intrauterino.

BACKGROUND: Intrauterine growth retardation (IUGR) is considered to be responsible for approximately 20% of short stature in adulthood. Although GH secretion is normal in the majority of cases, excellent results have been published by some authors using GH to treat children with height deficiency due to IUGR. PATIENTS AND METHODS: Thirty children with a history of IUGR with chronological ages between 2 and 7 years and height less than 2 SD were randomized in two groups for one year: a) control group, no treatment, 14 cases, and b) treatment group, 1 U/kg/week of recombinant GH, 16 cases. Growth and maturation were analysed periodically in both groups. In addition, serum levels of GH, IGF-I, IGFBP3 and GHBP were measured before and under treatment and adverse events were assessed in treatment group. RESULTS: In the treated group significant increments in growth rate, cm/year (median = 6.91 vs 9.94), improvement in height SDS (median = -2.19 vs -1.63) and positivation of growth rate (median = -0.13 vs 3.17) were observed compared with the control group. Bone age evolved parallelly to chronological age and the height age/bone age ratio increased throughout the study under GH therapy. Hormonal findings in the treated group showed a significant increase in IGF-I and IGFBP3 values. Glycaemia levels increased without exceeding upper normal levels in the treated group. CONCLUSION: GH was effective in promoting growth in this short-term study in children with height deficiency due to IUGR. Close follow-up is required to detect any adverse event, particularly those related to carbohydrate metabolism.

[Adult height, pattern of growth and pubertal development in patients with congenital adrenal hyperplasia, salt losing form]. / Talla adulta, patrón de crecimiento y desarrollo puberal en pacientes con hiperplasia suprarrenal congénita, forma perdedora de sal.

BACKGROUND: The height growth pattern in 24 patients with the salt-wasting from of congenital adrenal hyperplasia was retrospectively evaluated from the neonatal period to attainment of adult height. PATIENTS AND METHODS: All patients were on mineralcorticoid therapy and received hydrocortisone (mg/m2 body surface and day. Mean +/- SD): 34.53 +/- 8.2 during the first year of life, 22.83 +/- 4.1 from then to the puberty onset and 21.83 +/- 3.6 during puberty. Height was measured every 3-4 months and compared with that of the normal age- and sex-matched controls. RESULTS: Height differences with respect to reference population (M +/- SD) were: +0.38 +/- 0.82 in the neonatal period; -2.21 +/- 1.1 at one year of age; -0.76 +/- 1.25 at three years of age; -0.45 +/- 0.99 at the onset of puberty and -1.34 +/- 0.79 at attainment of adult height. Adult height differed significantly (p < 0.01) from control values and in girls from those of their mothers (p < 0.05). Hyperandrogenism, evaluated through urinary 17-ketosteroids, testosterone, delta 4 androstenedione and DA-S, was not documented during prepuberty and puberty. CONCLUSIONS: Our patients showed a lower growth rate than those of the control population during the two periods of higher growth potentiality: the first year of life and puberty, and this results in adult height impairment.

Frenkelia parasites in a small mammal community. Dynamics of infection and effect on the host.

A community of small mammals, Clethrionomys glareolus, Arvicola terrestris, Microtus arvalis, M. agrestis, M. subterraneus, Apodemus spp. and Sorex spp., was studied as hosts of Frenkelia glareoli and F. microti in Fronche-Comté (France). They were monitored in spring, summer and autumn on an area of about 1,350 ha comprising open field, hedgerow network and forest. Among 1,714 small mammals examined between July 1992 and October 1993, 47% (178/376) of C. glareolus, 9.9% (14/139) of A. terrestris and 1.3% (4/311) of Apodemus spp. were infected by F. glareoli. The prevalence of infection with F. microti was 9.2% (66/716) in M. arvalis and 8.2% (6/73) in M. agrestis. M. subterraneus and Sorex spp. were not infected. The maintenance of each parasite in a rural landscape is assured both by a forest and a grassland host. Multiple logistic regression showed that prevalence was highly age-dependent, with an apparent seasonal pattern. Prevalence varied between 30% in summer and 60% in early spring for F. glareoli in C. glareolus and between 3% in autumn to 30% in early spring for F. microti in M. arvalis. The year, habitat, host sex, relative density had no impact on prevalence. In M. arvalis only, sexually active voles were preferentially uninfected, indicating a possible impact of this parasitism on fertility.

Insights into the evolutionary history of the X-linked sex reversal mutation in mus minutoides: clues from sequence analyses of the Y-linked Sry gene.

The African pygmy mouse, Mus minutoides, is one of the very few mammal species that deviates from the classical mammalian XX/XY sex chromosome system by presenting a high proportion of fully fertile sex-reversed females. Since the still unknown sex reversal mutation is X-linked (X*), they are designated as X*Y females. Until now, X*Y females had only been identified in Southern Africa, but data were lacking for the rest of the vast sub-Saharan distribution range of this species. In this study, the PCR genotyping of the Y-linked Sry gene on 72 females from Western Africa (Guinea, Ivory Coast and Ghana) uncovered 10 sex-reversed females distributed in the 3 countries. This expands our understanding of the geographical distribution and temporal origin (dated at 0.9 mya) of the sex reversal mutation. In addition, we sequenced and analyzed a fragment of the Sry gene (including the complete high-mobility group, i.e. HMG box, and the partial C-terminal region). The results demonstrate the presence of multiple polymorphic copies of the gene as reported in other rodent species and reveal, more unexpectedly, an extremely high proportion of amino acid replacement within the HMG box. In effect, the predicted HMG box protein sequence similarity between some populations of M. minutoides is as low as 94.9%, and at the interspecific level (within genus), it drops to only 91.1% between M. minutoides and M. musculus.

Novel (60%) and recurrent (40%) androgen receptor gene mutations in a series of 59 patients with a 46,XY disorder of sex development.

BACKGROUND: Androgen receptor (AR) gene mutations are the most frequent cause of 46,XY disorders of sex development (DSD) and are associated with a variety of phenotypes, ranging from phenotypic women [complete androgen insensitivity syndrome (CAIS)] to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). OBJECTIVE: The aim of the study was to characterize the contribution of the AR gene to the molecular cause of 46,XY DSD in a series of Spanish patients. SETTING: We studied a series of 133 index patients with 46,XY DSD in whom gonads were differentiated as testes, with phenotypes including varying degrees of undervirilization, and in whom the AR gene was the first candidate for a molecular analysis. METHODS: The AR gene was sequenced (exons 1 to 8 with intronic flanking regions) in all patients and in family members of 61% of AR-mutated gene patients. RESULTS: AR gene mutations were found in 59 individuals (44.4% of index patients), of whom 46 (78%) were CAIS and 13 (22%) PAIS. Fifty-seven different mutations were found: 21.0% located in exon 1, 15.8% in exons 2 and 3, 57.9% in exons 4-8, and 5.3% intronic. Twenty-three mutations (40.4%) had been previously described and 34 (59.6%) were novel. CONCLUSIONS: AR gene mutation is the most frequent cause of 46,XY DSD, with a clearly higher frequency in the complete phenotype. Mutations spread along the whole coding sequence, including exon 1. This series shows that 60% of mutations detected during the period 2002-2009 were novel.

[L.D.H. and isoenzymes in C.S.F. of children with neurological diseases (author's transl)]. / Enzimas en líquido cefalorraquídeo. II. Interés de la determinación de lactato deshidrogenasa y sus isoenzimas en diversas enfermedades neurológicas.

Authors studied L.D.H .and Isoenzymes of L.D.H. activities in 254 C.S.F. corresponding to 112 children affected with different diseases. The purpose was to discover its diagnostic utility and possible etiological explanation. Results have been compared with reference values found in a previous study. Highest enzymatic activities of L.D.H. are observed, in decreasing order, in tumours, terminal process, endocranial hipertension plus meningitis, and meningitis. Referring to different types of meningitis, highest enzymatic activity of L.D.H. was found in bacterial type, especially those caused by a germen different from "Neisseria meningitidis". An inversion of isoenzymatic pattern is observed with an increase of L.D.H.-4 and L.D.H.-5 in detriment of L.D.S.-1 and L.D.S.-2, in tumours, endocranial hipertension plus meningitis and in all infections of central nervous system in the initial phase, returning to normal in recuperation phase of disease. A possible enzymatic etiology in different pathological diseases is suggested. In conclusion, it is of interest to determine L.D.H. and its isoenzymes as control of disease but not as differential diagnosis.

[Reference values of A.S.T., L.D.H., isoenzymes of L.D.H. and A.D.A. in cerebrospinal fluid of children (author's transl)]. / Enzimas en líquido cefalorraquídeo I. Valores de referencia de aspartato adminotransferasa, adenosina desaminasa, lactato deshidrogenasa e isoenzimas de lactato deshidrogenasa en una población infantil.

From 230 C.S.F., authors found the reference values of A.S.T., L.D.H., isoenzymes of L.D.H. and A.D.A. in children from the area of Barcelona. The reference values obtained were: A.S.T.: n, 208; mean, 6.91 U/l., and s, +/- 2.71 U/l. A.D.A.: n, 175; percentil 50, 0.388 U/l.; percentil 97.5, 1.64 U/l., and percentil 2.5, 0 U/l. L.D.H.: n, 148; percentil 50, 9.54 U/l.; percentil 97.5, 24.96 U/l., and percentil 2.5, 3.81 U/l. Isoenzymes of L.D.H.: n, 82; L.D.H.-1: mean, 41.31 per cent and s, +/- 5.41 per cent. L.D.H.-2: mean, 30.79 per cent, and s, +/- 2.84 per cent. L.D.H.-3: mean, 20.3 per cent, and s, +/- 4.11 per cent. L.D.H.-4: mean, 6.02 per cent, and s, +/- 2.48 per cent. L.D.H.-5: mean, 2.47 per cent, and s, +/- 1.7 per cent. Higher activities of A.S.T. and L.D.H. were found in newborns, also varying the distribution of isoenzymes of L.D.H. The A.D.A didn't show variations.

Spanish multicentre trial of recombinant somatropin. Spanish Collaborative Group.

A total of 42 patients (22 previously untreated and 20 previously treated) with GH deficiency were included in a Spanish multicentre trial of recombinant somatropin, 0.5 IU/kg/week. In previously untreated patients typical catch-up growth was observed and the height velocity increased from 3.3 +/- 0.6 cm/year to 9.8 +/- 2.4 cm/year during 1 year of therapy. In previously treated children, the height velocity was maintained (7.2 +/- 2.0 cm/year at the start and 7.9 +/- 1.6 cm/year after 1 year). No anti-GH antibodies were detected in previously untreated patients, and they disappeared from previously treated ones. No adverse reactions were reported.

Spanish multicentre trial on somatrem (1985-1986).

In an open multicentre trial, the safety and efficacy of somatrem, 4 IU i.m. three times weekly for 12 months, were evaluated in children with hGH deficiency with or without previous treatment with pituitary hGH. Patients were divided into young and prepubertal groups according to chronological age, and catch-up growth after treatment was greater in the former. Bone age evolved at the same rate as chronological age, irrespective of whether patients were previously untreated (naïve) or previously treated. Fewer previously treated patients exhibited anti-hGH antibodies than naïve patients. Somatrem appears to be a safe, efficient product for treating different degrees of hGH deficiency.

Chronic growth retardation with normal growth hormone response to provocative stimuli and low somatomedin activity. Long-term therapy with human growth hormone.

Four prepubertal children with chronic growth retardation (growth velocities less than or equal to 4 cm/yr), normal growth hormone (GH) response to provocative stimuli and low basal but increased somatomedin activity values after GH administration, received continuous GH-therapy (4 IU/three times a week) for an 18-24-month period. Growth velocity doubled during the first 12 months of therapy and remained 4-6 cm/yr until the end. Bone age progressed according to chronological age and adult height predictions improved. No thyroid function or carbohydrate and lipid metabolism anomalies were observed. After completion of this GH-therapy period, patients remained off treatment during the following six months. Growth velocities were similar to pre-GH-treatment values in two patients, lower in the third and higher in the fourth, who was by then pubertal. Thus, in these patients, long-term GH-therapy promoted growth and improved adult height prediction.