Prospective studies

In this prospective randomized study on 1380 consecutive in-vitro fertilization (IVF) treatments, the results were compared of culture of human oocytes and embryos for the first 2 or 3 days of development in microdroplets of medium under oil using a gas phase containing either atmospheric (~20%) or reduced (5%) O 2 concentrations. No significant differences were found between the two groups cultured under either 5% or 20% O 2 in rates of fertilization (60 versus 61%, respectively), embryo development at day 2 or 3, pregnancy (26.6 versus 25.4%, respectively), and implantation (13.4 versus 14.0%, respectively). Culture of surplus embryos under 5% O 2 resulted in a significantly higher mean incidence of blastocyst formation per cycle as compared to the 20% O 2 group (25.8 ⍨ 2.0 versus 20.4 ⍨ 1.9, respectively). The mean number of cells of embryos classified as blastocysts by microscopic observation of a blastocoel was significantly higher in the 5% O 2 group as compared to the 20% O 2 group, both in blastocysts fixed on day 5 (39.8 ⍨ 1.7 versus 31.9 ⍨ 1.9, respectively), as well as those fixed on day 6 (45.6 ⍨ 2.6 versus 33.7 ⍨ 3.4, respectively). This difference was due to the fact that significantly more blastocysts of the 20% O 2 group had an abnormal low cell number of < 25 as compared to the 5% O 2 group, both in blastocysts fixed on day 5 (39 versus 22%, respectively), as well as those fixed on day 6 (43 versus 22%, respectively). To conclude, although culture under 5% O 2 leads to slightly improved preimplantation embryonic viability, this effect is either too marginal to result in higher pregnancy rates, or low O 2 concentrations exert an effect during the later stages of preimplantation development only.

Purpose A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (iv) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop™) is now commercially available. The aim of this study was to compare EMLA and Ametop™ with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of iv cannulation. Methods Thirty two ASA 1 adult volunteers had a # 16 gauge iv cannula inserted on two separate occasions using EMLA and Ametop™ applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: 1 = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. Results The mean VAPS ± SD after cannulation with Ametop™ M was 12 ± 9.9 and with EMLA was 25.3 ± 16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop™ (P = 0.001). The grade of difficulty of cannulation was 1.44 ± 0.88 following EMLA and 1.06 ± 0.25 with Ametop™ (P = 0.023). Conclusions Intravenous cannulation was less painful following application of Ametop™ than EMLA. In addition, Ametop™ caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when iv access may be problematic. Objectif Un mélange eutectique d’anesthésiques locaux (MEAL) est souvent utilisé pour l’anesthésie topique lors d’une canulation intraveineuse (iv). La vasoconstriction, qui est l’un des effets secondaires du MEAL, peut compliquer la mise en place d’une canule. Une présentation en gel d’améthocaïne (Ametop™) est maintenant offerte dans le commerce. Le but de la présente étude était de comparer le MEAL et l’Ametop™ en regard du degré d’anesthésie topique fourni, de l’incidence de la vasoconstriction et de la facilité de la canulation iv. Méthode: On a inséré, en deux occasions séparées chez 32 volontaires adultes d’état physique ASA 1, une canuleiv de calibre 16 en utilisant en double aveugle le MEAL et Ametop™ pour réaliser l’anesthésie topique. Après chaque canulation, on a enregistré les paramètres suivants: les scores de douleur à l’échelle visuelle analogue (EVA), la présence de vasoconstriction et la facilité de canulation notée 1 = facile, 2 = modérément difficile, 3 = difficile et 4 = impossible. Résultats Les scores moyens à l’EVA ± l’écart type ont été de 12 ± 9,9 à la suite de la canulation avec Ametop™ M et de 25,3 ± 16,6 après le MEAL (P = 0,002). La vasoconstriction est survenue en 17 occasions après l’application du MEAL et deux fois plus souvent après Ametop™ (P = 0,001). Le degré de difficulté de canulation a été de 1,44 ± 0,88 après le MEAL et de 1,06 ± 0,25 après Ametop™ (P = 0,023). Conclusion La canulation intraveineuse est moins douloureuse après l’application d’Ametop™ que celle du MEAL. De plus, l’Ametop™ a provoqué moins de vasoconstriction et a facilité l’introduction d’une canule. Son usage comme anesthésique topique est recommandé, surtout lorsqu’une action rapide est nécessaire ou que l’accèsiv peut être problématique.

Methods Three hundred and twenty-eight IUGR fetuses (abdominal circumference < 5th percentile, elevated umbilical artery (UA) pulsatility index (PI)) had concurrent surveillance with UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasonography and BPS (fetal tone, movement, breathing, maximal amniotic fluid pocket and fetal heart rate). Patients were stratified into three groups according to their Doppler examination: (1) abnormal UA alone; (2) brain sparing (MCA-PI > 2 SD below mean for gestational age); and (3) abnormal DV (PI > 2 SD above the mean for gestational age) and BPS groups: (1) normal (> 6/10);

Objective: To evaluate the ability of two cryopreservation methods and three cryoprotectants to preserve sperm quality. Design: A prospective clinical study. Setting: Male infertility clinic at a tertiary healthcare center. Patient(s): Twenty infertile men and 10 healthy donors. Intervention(s): In the first experiment, semen was cryopreserved by either the Irvine Scientific method (IS) or the Cleveland Clinic Foundation (CCF) method. In the second experiment, semen was cryopreserved by the IS method and one of three cryoprotectants: TES and Tris yolk buffer, Sperm Freezing Medium, or Enhance Sperm Freeze. Main Outcome Measure(s): Postthaw sperm motility, cryosurvival, and kinematics. Result(s): Percentages of postthaw sperm motility and cryosurvival were higher in the IS cryopreservation method compared with in the CCF method (15.94 Ϯ 9.19 vs. 12.07 Ϯ 7. 31 and 47.42 Ϯ 17.44 vs. 35.76 Ϯ 17.56). However, the CCF method resulted in significantly better sperm kinematics. Postthaw motility in the donors and patients was highest in the samples frozen in TES and Tris yolk buffer medium.

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past year gambling and gambling frequency among college students. Results from this research support the utility of the TPB to explain gambling behavior in this population. Specifically, in TPB models to predict gambling behavior, friend and family subjective norms and perceived behavioral control predicted past year gambling and friend and family subjective norms, attitudes and perceived behavioral control predicted gambling frequency. Intention to gamble mediated these relationships. These findings suggest that college responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations.

Background. Perioperative myocardial injury is a major determinant of postoperative cardiac dysfunction for congenital heart disease, but its assessment during this period is difficult. The objective of this study was to determine the suitability of using postoperative serum concentrations of cardiac troponin I (cTnI) for this purpose.

• Drooling is a common problem in disabled individuals and has significant physical, psychosocial and aesthetic repercussions. Scopolamine has been used to treat drooling in a number of medical specialities, including otorhinolaryngology, neurology and palliative care. This study evaluates the efficacy of this treatment in severely disabled patients.

Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure pro¢le was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three di¡erent pressure components were de¢ned in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H 2 O in ¢ve cases of severe incontinence. No signi¢cant di¡erence was observed for these patients on urethral pro¢le components 6 months later. In contrast, in cases of signi¢cant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence.

Background: An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.

One hundred seventy adult patients with acute lymphoblastic leukemia (ALL) or acute undifferentiated leukemia (AUL) were entered into a prospective multicenter therapy trial at 25 hospitals. The aim of the trial was to improve remission duration by using a modified form of an intensified induction regimen that was successful in childhood ALL, to define immunologic subtypes of ALL by use of cell-surface markers, and to extract other possible prognostic factors. The overall complete remission rate was 77.8%. The median overall survival time was 26 months, being 4 months for nonresponders and 32 months for responders. The median remission duration for the 126 patients with complete remission was 20 months. Prognostically favorable factors for remission duration were response to chemotherapy within 4 weeks, age less than 35 years, a low initial leukocyte count, and the immunologic subtypes c-ALL with early response to therapy and T-ALL, where 61% and 58%, respectively, are still in comp...

Background-Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis. Aims-To analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis. Patients and methods-Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III). After admission serum samples were drawn daily for two weeks. Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8).

The aim of the present study was to examine an adapted integrated psycho-social model to predict sport injury rehabilitation adherence. A longitudinal prospective design was used whereby 70 patients attending private physiotherapy clinics completed a battery of questionnaires both pre- and post-rehabilitation treatment based on the adapted framework. All participants were receiving treatment for tendonitis-related injuries. Adherence was monitored prospectively over the entire rehabilitation program using an observational measure of clinic adherence, a self-report measure of home-based adherence, in addition to monitoring attendance at rehabilitation sessions. In the initial phase of rehabilitation learning goal orientation, attitudes and perceived severity were found to predict rehabilitation intention. Intentions were also found to mediate the relationship between the aforementioned variables and clinic rehabilitation. Self-efficacy and self-motivation were predictors of clinic rehabilitation and attendance but not home rehabilitation. During the maintenance phase of rehabilitation coping ability and social support were predictors regarding all three measures of adherence. Implications for practitioners rehabilitating injured athletes are discussed.

The aim of this study was to assess the effects of replacement with recombinant human growth hormone (rhGH) in patients with GH deficiency (GHD) after treatment of acromegaly. Intervention study. Sixteen patients (8 men, age 56 years), treated for acromegaly by surgery and radiotherapy, with an insufficient GH response to insulininduced hypoglycaemia, were treated with 1 year of rhGH replacement. Study parameters were assessed at baseline and after 1 year of rhGH replacement. Study parameters were cardiac function, body composition, bone mineral density (BMD), fasting lipids, glucose, bone turnover markers, and Quality of Life (QoL). During rhGH replacement IGF-I concentrations increased from -0.4 ± 0.7 to 1.0 ± 1.5 SD (P = 0.001), with a mean daily dose of 0.2 ± 0.1 mg in men and 0.3 ± 0.2 mg in women. Nonetheless, rhGH replacement did not alter cardiac function, lipid and glucose concentrations, body composition or QoL. Bone turnover markers (PINP and b crosslaps) levels increased (P = 0.005 and P = 0.021, respectively), paralleled by a small, but significant decrease in BMD of the hip. The beneficial effects of rhGH replacement in patients with GHD during cure from acromegaly are limited in this study.

Reimplantation of the right internal thoracic artery, as a free graft, into the left in situ internal thoracic artery (Y procedure) has enabled us to bypass more distant marginal vessels, which was not possible by the bilateral technique alone. This prospective study was aimed at evaluating the clinical state of the patients and the degree of patency of grafts within 16 months of follow-up. All 80 patients who underwent the Y procedure between January 1988 and January 1992 were included. This group represented 10% of the 840 patients having coronary bypass during the same period. A total of 202 coronary anastomoses were performed in this series. Early postoperative (30 days) complications included three deaths (3.75%), eight myocardial infarctions (10%), one case of phrenic nerve paralysis (1.25%), two cases of respiratory failure (2.5%), and six wound infections (7.5%). At 3 months' follow-up, 96% of patients were free of symptoms. During the follow-up period, four patients died of noncardiac causes (lung, pancreatic, and brain cancer and rupture of an abdominal aortic aneurysm). At 1 year, 71 patients were free of symptoms (97%). Sixty-one patients underwent coronary angiography between 12 and 24 months. Six patients with peripheral arterial disease were not suitable for coronary angiography, and six refused to be tested. These 12 patients had normal thallium test results in the bypassed area (stress or dipyridamole test). The patency rate of the left internal thoracic artery was 98.3% (n = 60), occlusion rate 1.6% (n = 1), and incidence of threadlike arteries 4.9% (n = 3). Thus the rate of perfect patency was 93.4%. The patency rate of the right internal thoracic artery as a free graft was 93.4% (n = 57), occlusion rate 6.5% (n = 4), and the incidence of threadlike arteries 8% (n = 5). Thus the rate of perfect patency was 85.2%. A total of 169 anastomoses were studied. The rate of patency of the anastomoses to the left anterior descending coronary artery was 96% (n = 58) and the occlusion rate, 4% (n = 2). The patency rate of sequential anastomoses (side to side) to diagonal arteries was 100% (n = 16). Patency rate of anastomoses to obtuse marginal arteries was 95% (n = 58) and the rate of occlusion, 4.9% (n = 3). The patency rate of anastomoses to the posterior descending artery or distal branches of the right coronary artery was 80% (n = 4/5). We conclude that the Y procedure is a ~safe technique with an acceptable morbidity and a good patency rate. This procedure can be used when the in situ technique is not possible because of far-reaching distal marginal coronary arteries. (J THORAC CARDIOVASC SURG 1995;109:1042-8)

Objectives: To compare the absolute latencies of peaks I, III and V and interpeak intervals of premature and full-term children. Methods: Prospective, comparative cohort study. Study subjects were premature and full-term children with auditory brainstem response (ABR) measured at ages 4, 12 and 20 months. The children had previously undergone otorhinolaryngolic and audiologic evaluations to exclude those with altered hearing. Results: One hundred and twenty-four children were included in the study (73 premature). No differences were found between children of different sexes nor between the right and left ears of the individual children, so the statistical unit sed for the study was the ear. Using the t-test for independent samples, the absolute latencies of peaks I, III and IV and the interpeak intervals I-III, I-IV and III-V presented statistically significant differences between the groups at ages 4 and 12 months. At 20 months, only peak I failed to show a difference in absolute latency. Strong inverse correlation was found (Pearson's coefficient) between gestational age and absolute peak latency, as well as for interpeak intervals. Conclusions: Maturation of the auditory system, as measured by ABR, occurs differently between premature and full-term children, suggesting that gestational age be taken into consideration when using ABR in premature children younger than 20 months old.

In 1987 William Huss and Edward Honton published the paper “Scenario Planning—What style should you use?”, in which they distinguish three types of scenario development approaches, namely ‘Intuitive Logics’, ‘Trend-Impact Analysis’ and ‘Cross-Impact Analysis’.
In 2002, Heijden, Bradfield, Burt, and Wright (Heijden et al., 2002: 128-129; Bradfield, et al.: 805) stated that the categorization presented above had two problems: the first one relates to the omission of the “La Prospective” methodology which it is for these authors a true school of Scenario Planning; the second one relates to the fact that the “Trend Impact Analysis” and the “Cross Impact Analysis”, although being standalone techniques, share the same foundations, which are anchored in the mathematical improvement of extrapolated time series data. In this sense, these two techniques must be viewed as a coherent group of techniques which, for convenience, those authors called `probabilistic modified trends' (PMT) methodology (Heijden, et al., 2002).
In this article we will present and characterize the three major schools or techniques of Scenario Planning identified by Bradfield et al. (20052): “Intuitive Logics”, the “Probabilistic Modified Trends” and the “La Prospective” methodologies.

5331 Right liver lobe/albumin ratio: Contribution to non-invasive assessment of portal hypertension Alempijevic T, 5336 Liver biopsy in a district general hospital: Changes over two decades Syn WK, Bruckner-Holt C, Farmer A, Howdle S, Bateman J 5343 Effects of a 24-week course of interferon-a therapy after curative treatment of hepatitis C virus-associated hepatocellular carcinoma 5351 Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches Lee SE, Yang SH, Jang JY, Kim SW 5357 Type 2 dıabetes mellıtus and CA 19-9 levels Uygur-Bayramiçli O, Dabak R, Orbay E, Dolapçıoğlu C, Sargın M, Kılıçoğlu G, Güleryüzlü Y, Mayadağlı A 5360 Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating Ouyang A, Xu L CLINICAL RESEARCH VIRAL HEPATITIS REVIEW World Journal of Gastroenterology 

Pathologic conditions involving the temporal bone in infants and children are now commonly diagnosed by computed tomography (CT). The importance of utilizing high resolution computed tomography (HRCT) with magnified, thin (1.5 mm) scans in both the axial and coronal planes is stressed in order to obtain the maximal anatomic information that is critical for proper diagnosis. A retrospective analysis of 388 cases reveals a positive diagnostic yield ranging from 65% in temporal bone trauma to 20% in clinically suspected neoplasm. Selected case reports of congenital abnormalities, inflammatory processes, traumatic lesions, and tumors will be presented. We conclude that HRCT is an excellent diagnostic modality and should be used liberally to evaluate the temporal bone in children.

Objective: To evaluate the efficacy of Qigong in rehabili tation for patients with burnout. Design: Prospective, randomized controlled trial. Subjects: Eighty-two patients (68 women and 14 men, mean age 44.3 (standard deviation 9.1) years) diagnosed with burnout. Methods: Basic care was offered to both the intervention and the control group. Patients in the intervention group received basic care and, in addition, performed Qigong twice a week for 12 weeks. Psychological variables, health-related quality of life, perceived relaxation and physical measurements were assessed at baseline and after the intervention period. Results: No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per-protocol analyses. Both groups improved significantly over time, with reduced levels of burnout, fatigue, anxiety and depression, and increased dynamic balance and physical capacity. Conclusion: In this study, a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout.

Objective: Splitting of the liver at the line of Cantlie of otherwise healthy people is accepted worldwide as a reasonable procedure for the donors in adult living donor liver transplantation. A similar operation is still considered as experimental if performed in the deceased donor liver. The aim of this study is to evaluate the technical evolution and the results of this variant splitting technique. Patients and Methods: From January 1999 to August 2004, a total of 35 transplants of hemilivers from deceased donors (segments V-VIII: n ϭ 16 and segments (I)II-IV: n ϭ 19) were performed in our center. Seven splits were performed in situ and 12 ex situ. Splitting of the vena cava was applied in 18 splits and splitting of the middle hepatic vein in 8. Seven adults and 12 adolescents received the left hemiliver with a mean age of 12 years (range, 3-64 years), of whom 21% were UNOS status 1. Recipients of right hemilivers were exclusively adults with a mean age of 48 years (range, 31-65 years), none of them were high urgent. The outcome of these 35 recipients of hemilivers was prospectively evaluated. Results: Mean deceased donor age was 27 years (range, 12-57 years), the donor's body weight ranged between 55 kg and 100 kg. The mean weight of the right and left hemilivers was 1135 g (range, 745-1432 g) and 602 g (range, 289 -1100 g), respectively. The mean graft recipient weight ratio in left and right hemiliver group was 1.46% (range, 0.88%-3.54%) and 1.58% (range, 1.15%-1.99%), respectively. Median follow-up was 27.4 months (range, 1-68.3 months). Four patients died (actual patient survival FR group: 87.5% versus FL group: 89.5%), 3 due to septic MOF and 1 due to graft versus host disease. In each of the 2 groups, 2 recipients had to undergo retransplantation, which resulted in an actual right and left hemiliver survival rate of 75% and 84%, respectively. The causes for retransplantation were primary nonfunction in 2 left hemilivers, chronic graft dysfunction in 1 right hemiliver, and recurrence of the primary disease in 1 recipient of a right hemiliver. Primary poor function was observed in 1 recipient of a right hemiliver. Early and late biliary complications occurred in both right and left hemiliver groups at the rate of 37.5% (n ϭ 6) and 21% (n ϭ 4), respectively. Arterial, portal, and venous complications were not observed in either group. Conclusion: The technical development of splitting along Cantlie's line is almost complete with the last challenge being the reduction of biliary complications. The key to success is the choice of adequate deceased donors and recipients. Full-right full-left splitting is safely possible and should be considered as a reasonable instrument to alleviate mortality on the adult waiting list and to reduce the need for adult and adolescent living donation. (Ann Surg 2005;242: 802-813) From the *Numbers indicate the consecutive number of the splitting procedure. L indicates left hemiliver; R, right hemiliver.

Esta publicación es producto de la selección y edición de los mejores trabajos presentados durante las Terceras Jornadas de Planificación para el Desarrollo, que se celebraron en paralelo con el seminario internacional “Los Objetivos de Desarrollo Sostenible y la Construcción de Futuros para América Latina y el Caribe”, organizado en Santiago de Chile, del 18 al 20 de mayo de 2016, por el Instituto Latinoamericano y del Caribe de Planificación Económica y Social (ILPES) de la Comisión Económica para América Latina y el Caribe (CEPAL). Este seminario se desarrolló en el marco de las actividades del convenio de cooperación técnica entre la CEPAL y la República de Corea.

Objective Little is known of the long-term effects of GH replacement therapy on muscle strength in elderly adults with adult onset GH deficiency (GHD). In this study, the effects of 5 years of GH replacement therapy on muscle function were determined in adults over 60 years of age with adult onset GHD. Design A prospective, open-label, single-centre study. Patients Twenty-six (12 male and 14 female) consecutive hypopituitary adults with adult onset GHD, mean age 65·0 (range 61-74) years. Measurements Upper leg muscle strength was measured using a Kin-Com dynamometer. Right and left handgrip strength were measured using an electronic grip force instrument.

The aim of this study was to assess the effects of replacement with recombinant human growth hormone (rhGH) in patients with GH deficiency (GHD) after treatment of acromegaly. Intervention study. Sixteen patients (8 men, age 56 years), treated for acromegaly by surgery and radiotherapy, with an insufficient GH response to insulininduced hypoglycaemia, were treated with 1 year of rhGH replacement. Study parameters were assessed at baseline and after 1 year of rhGH replacement. Study parameters were cardiac function, body composition, bone mineral density (BMD), fasting lipids, glucose, bone turnover markers, and Quality of Life (QoL). During rhGH replacement IGF-I concentrations increased from -0.4 ± 0.7 to 1.0 ± 1.5 SD (P = 0.001), with a mean daily dose of 0.2 ± 0.1 mg in men and 0.3 ± 0.2 mg in women. Nonetheless, rhGH replacement did not alter cardiac function, lipid and glucose concentrations, body composition or QoL. Bone turnover markers (PINP and b crosslaps) levels increased (P = 0.005 and P = 0.021, respectively), paralleled by a small, but significant decrease in BMD of the hip. The beneficial effects of rhGH replacement in patients with GHD during cure from acromegaly are limited in this study.

Although GH replacement improves the features of GH deficiency (GHD) in adults, it has yet to be established whether cessation of GH at completion of childhood growth results in adverse consequences for the adolescent with GHD. Effects of continuation or cessation of GH on body composition, insulin sensitivity, and lipid levels were studied in 24 adolescents (13 males, 11 females, aged 17.0 ؎ 0.3, yr, mean ؎ SE, puberty stage 4 or 5) in whom height velocity was less than 2 cm/yr. Provocative testing confirmed severe GHD [peak GH < 9 mU/liter (3 g/liter)] in all cases and was followed by a lead-in period of 3 months during which the pediatric dose of GH continued unchanged. Baseline investigations were then performed using dual-energy x-ray absorptiometry (body composition), lipid measurements, and assessment of insulin sensitivity by both homeostasis model assessment and a short insulin tolerance test. Twelve patients remained on GH (0.35 U/kg⅐wk), and 12 patients ceased GH treatment. The groups were followed up in parallel with repeat observations made after 6 and 12 months.