British journal of clinical practice. Supplement最新文献

{"title":"The influence of growth hormone treatment on bone metabolism in dialysis patients.","authors":"M Sieniawska,&nbsp;M Pañczyk-Tomaszewska,&nbsp;H Ziólkowska","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bone formation markers, PTH intact, and bone mineral density were evaluated in 12 children with end stage renal disease during recombinant human growth hormone (rhGH) treatment. Bone biopsies before rhGH therapy revealed: osteitis fibrosa in one patient, mild lesions in eight, adynamic bone disease in one, and a normal histology in two. PTH intact increased after six months of rhGH in seven children, and was significantly higher in them than in the control group. A positive correlation between PICP concentration after one month and growth velocity within 12 months of rhGH was found. Higher doses of vitamin D are needed in growing children treated with rhGH.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"61-3"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19957762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the 2nd Novo Nordisk workshop on chronic renal insufficiency. Rome, Italy, October 26-28, 1995.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"1-68"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19966718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provocative growth hormone testing is not required before initiation of rhGH treatment in children with renal and liver transplants.","authors":"S Sarna,&nbsp;K Ronnholm,&nbsp;I Sipila,&nbsp;C Holmberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>GH provocative testing does not predict subsequent growth response, and is not therefore required before initiation of rhGH treatment in children with renal and liver transplants. However, therapeutic doses of glucocorticoids may potentially inhibit GH secretion in some patients, and determining GH secretory status by provocation tests and measuring spontaneous GH secretion is advisable at some point after organ Tx to exclude GH deficiency.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"41-3"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19957755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the response to rhGH in peritoneal dialysis patients less effective than in patients with chronic renal insufficiency.","authors":"F Perfumo,&nbsp;E Verrina,&nbsp;A Edefonti,&nbsp;A Trivelli,&nbsp;A Canepa,&nbsp;R Gusmano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Data on the effects of rhGH treatment in children on peritoneal dialysis are limited. In general rhGH therapy seems to be less effective compared with results on patients with chronic renal failure on conservative treatment. Our experience suggests that rhGH can stimulate growth in children on CPD, and that the efficacy of such therapy is reduced after the first year of treatment, although the rhGH is still active.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"18-20"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19955338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of failure to respond to recombinant human growth hormone (rhGH).","authors":"L Rees","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"32-3"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19955342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can provocative growth hormone testing predict the response to recombinant human growth hormone (rhGH) treatment?","authors":"M Greco,&nbsp;M Cappa,&nbsp;I Perruzza,&nbsp;G Rizzoni","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Treatment with rhGH has been proven to be useful in children with chronic renal insufficiency and stunted growth. The aim of this study was to assess the usefulness of endocrinological provocative testing in predicting results to rhGH treatment. Endocrinological investigations performed in 14 children on renal replacement therapy did not correlate with increment of height velocity in the first year of rhGH therapy. It is concluded that no endocrinological testing is useful before starting rhGH treatment; other predictors of the response to rhGH administration are needed.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"38-40"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19957754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the clinical benefits of correcting the catabolic state in haemodialysis patients?","authors":"P B Jensen,&nbsp;T B Hansen,&nbsp;H Oxhøj,&nbsp;K Froberg,&nbsp;B Ekelund,&nbsp;F T Nielsen,&nbsp;F B Pedersen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In a double-blind, placebo-controlled trial of recombinant human growth hormone (rhGH) comprising 20 chronic enfeebled haemodialysed patients, the clinical benefit of daily growth hormone treatment for six months was evaluated. Nine patients (five male, four female) were treated with rhGH 4 i.u./m2/day and eleven with placebo (seven male, four female). Their mean age was 46.5 years (range 18-68). No difference in mean age was found between the groups. A significant increase in insulin-like growth factor I (IGF-I) was observed in the rhGH-treated group (200 to 527ng/ml, p = 0.01), while a decrease was noticed in the placebo group (285 to 219ng/ml, p = 0.02). S-GH did not change significantly in either group, and there were no differences between the two groups in terms of weight, haemoglobin, s-albumin, -urea or -creatinine, which all remained unchanged during the trial. Patients' lean body mass, as measured by DXA-scanning, increased significantly in the rhGH-treated group (43.4 to 46.7kg, p = 0.004), while no change was observed in the placebo group (44.9 to 45.2kg, p = 0.76). The changes in lean body mass between the two groups were significant, p = 0.001. Left ventricular muscle mass increased significantly (227 to 286g, p = 0.03) in the rhGH-treated group, but not in the placebo group (292 to 253g, p = 0.3). The changes in left ventricular muscle mass between the two groups were significant (p = 0.02). The maximal working capacity decreased slightly and insignificantly in both groups, when measured by bicycle ergometry. Isometric muscle contraction force and endurance did not change significantly in either group. Patients' opinion about the influence of the treatment on their general well-being and working capacity, evaluated blindly on a subjective scale, improved significantly in the rhGH-treated group (9.7 to 12.6, p = 0.02), while no change was experienced in the placebo group (9.9 to 10.7, p = 0.2). No difference was however demonstrable between the two groups (p = 0.4). Thus we conclude that adult patients in long-term haemodialysis treated with rhGH experienced an increase in their lean body mass and left ventricular muscle mass. This increase in muscle mass did not, however, improve muscle contraction force or endurance when measured objectively. The rhGH-treated patients nevertheless had a subjective feeling of a slight improvement in their general wellbeing.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19957757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can glucose intolerance and/or diabetes be predicted in patients treated with rhGH?","authors":"A C Hokken-Koelega","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Various studies have convincingly shown that recombinant human growth hormone (rhGH) therapy accelerates growth significantly in children with growth retardation secondary to chronic renal insufficiency (CRI) and after renal transplantation (RTx). rhGH therapy appeared remarkably safe intermediate-term, but paediatricians are concerned about the potential adverse effects on glucose homeostasis and insulin action. Particularly in children with CRI and after RTx, pre-existing insulin resistance may be aggravated by exogenous rhGH therapy. Patients after RTx had significantly higher pretreatment insulin levels than controls (p < 0.001). Various studies in both patient groups showed that one year of rhGH therapy at 4 i.u./m2/day did not impair glucose tolerance but significantly increased plasma insulin levels (p < 0.001). No patients developed impaired glucose tolerance or permanent diabetes mellitus (DM), but from these studies, it was concluded that euglycemia was maintained at the expense of increased insulin levels. The long-term consequences of the compensatory hyperinsulinaemia are not yet known. Although permanent DM has not been reported in any of the rhGH trials in renal patients, it cannot be excluded that some patients with CRI or after RTx may develop impaired glucose tolerance and/or permanent DM during long-term rhGH therapy, particularly those with risk factors such as familial type II DM and obesity. Long-term studies, including careful monitoring of carbohydrate metabolism, are required.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"56-8"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19957760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenic mechanisms underlying the variable response to recombinant human growth hormone in children with chronic renal failure.","authors":"F Schaefer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As with spontaneous growth, the height gain achieved by stimulation with recombinant human growth hormone (rhGH) in children with chronic renal failure appears to be inversely related to the degree of renal dysfunction. The secondary complications of CRF that may independently interfere with growth, such as metabolic acidosis, anaemia, and secondary hyperparathyroidism, do not explain the poorer response to rhGH in children with end-stage renal failure. Certain abnormalities of the somatotropic hormone axis, the severity of which is related to the degree of renal dysfunction, are more likely to explain the dependence of the rhGH treatment response on glomerular filtration rate. These derangements include partial GH receptor deficiency, increased plasma binding of IGF-I, and accumulation of non-competitive inhibitors of IGF-I action. Strategies to optimise growth-promoting treatment in end-stage renal failure will depend on the relative contribution of these different somatotropic hormone axis alterations to uraemia.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"23-5"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19955340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of the response to growth hormone in short prepubertal children post-renal transplant. German Study Group for Growth Hormone Treatment in Children Post Renal Transplantation Study Group Members.","authors":"B Tönshoff,&nbsp;D Haffner,&nbsp;N Albers,&nbsp;G Offner,&nbsp;O Mehls","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The growth response to recombinant human growth hormone (rhGH) in post-renal transplantation children is variable. We sought to determine predictive factors of this variable effect of rhGH by analysis of a homogeneous group of 16 prepubertal children with a median age of 12.4 years (range 7.7-18.0 years). rhGH was given at 30 i.u./m2/week for at least one year. All children remained prepubertal during the study period. Height velocity increased from 2.5 +/- 0.4cm/year to 7.4 +/- 0.5cm/year after one year of treatment (p < 0.001). The growth response to rhGH (height velocity after one year of rhGH) was not significantly correlated with the dose of prednisolone administered (range 2.3-9.1mg/m2/day), graft function as estimated by creatinine clearances (range 19-88ml/min/1.73m2), the degree of stunting at baseline, baseline height velocity, or chronological age. However, a relatively tight inverse correlation was found between the growth response to rhGH and the degree of bone age delay (r = 0.73, p < 0.005). Hence, the degree of bone age delay appears to be a helpful clinical predictor of response to rhGH in short prepubertal children post-renal transplantation.</p>","PeriodicalId":77500,"journal":{"name":"British journal of clinical practice. Supplement","volume":"85 ","pages":"34-7"},"PeriodicalIF":0.0,"publicationDate":"1996-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19955343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}