[Delivery, and anal incontinence later in life]

OBJECTIVE

Evaluation of the mutual relationship between delivery and late anal incontinence.

DESIGN

Review.

SETTING

Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen.

SUMMARY

Anal incontinence is a symptom often referred to by women between the ages of 40 and 60. However, it seems, that only a small number of such cases might be related to obstetric perineal trauma. According to recent data, elective Caesarean section only plays a small protective role. Its effect is restricted to the first few years after delivery. With time, the function of the anal sphincter gradually deteriorates. Subsequent deliveries might contribute to this functional impairment. The long-term effect of forceps delivery is still not clear. The extent of anal sphincter trauma (particularly the defect of the internal anal sphincter) seems to have an impact on the development of anal incontinence, even years after the event. Overlooking defects of the anal sphincter is a cause of problems long after delivery. Given the unsatisfactory results of secondary overlapping, and also, relatively good preliminary effect of primary repair, careful observence of the recommended steps leading to the correct diagnostics of obstetric perineal trauma is crucial, as is adequate repair.

[Mediolateral episiotomy and anal sphincter trauma]

OBJECTIVE

A summary of recent knowledge of the correlation between mediolateral episiotomy and anal sphincter injury.

DESIGN

Review.

SETTING

Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen.

CONCLUSIONS

The methodology of most studies is not well managed. Four problematical points were identified: definition of the mediolateral episiotomy, practical execution of the mediolateral episiotomy, diagnostics of perineal trauma and classification of the perineal trauma. Mediolateral episiotomy is often deficiently defined. Definitions differ depending on individual textbooks or departments. The majority of studies gives no definition and no description of the practical execution of an episiotomy or describes it inadequately. To the current knowledge there is no international consensual definition, which is used universally. Until 2003, there was no study evaluating adequate implementation of the mediolateral episiotomy. It appears that most of executed mediolateral episiotomies are not truly mediolateral. The angle of inclination between 40-60 degrees was suggested. According to the latest study, the lower limit of the mediolateral episiotomy definition (40 degrees) appears to be insufficient. At the present time, the correlation between mediolateral episiotomy and perineal trauma cannot be precisely evaluated. Before analyzing the benefits and risks of mediolateral episiotomy, an international consensus must be found, that would establish an exact definition of mediolateral episiotomy.

[Algorithm of treatment of glucocorticoid induced osteoporosis--search for criteria]

Epidemiological data indicate twofold increase of low impact fractures (spine, hip, ribs, distal forearm, and shoulder) in patients on glucocorticoid treatment compared with untreated subjects. These risks are mainly independent of BMD and prevalent fracture. Early direct inhibitory effect ofglucocorticoid on bone formation and promotion of apoptosis of bone cells are thought to be the major mechanism of glucocorticoid-induced osteoporosis (GIO). Despite differences in pathogenesis of postmenopausal osteoporosis, GIO, and other types ofosteoporosis, the algorithm of treatment of GIO should be based on the assessment of the individual absolute risk of fracture (FRAX) according to the WHO recommendations. Glucocorticoid-induced bone loss should be prevented, and if present, should be treated. Considering long-term character of GIO, the bone anabolic therapy should be used at absolute risk of hip fracture of > or = 3%.

[Osteoporosis: whom, when and how to treat?]

Osteoporosis is a chronic disease of mass appearance and should be defined as a disease of decreased bone strength rather than a disease of decreased bone mass. Osteoporosis related fractures are of particular interest due to their high burden on the individual and society and also their importance as a target of pharmacological intervention. Bone mineral measurement (BMD), which is an established tool to diagnose osteoporosis (W.H.O., 1994) is not sufficient as a tool for treatment decisions. Currently, assessment of quality of bone is costly, technically demanding and/or invasive. In clinical practice, the W.H.O. recommendation (2007) enables a more advantageous assessment of individual absolute risk of fracture based on BMD and clinical risk factors independent of BMD (sex, age, prevalent fracture, parent fractured hip, use of glucocorticoids, rheumatoid arthritis, secondary osteoporosis, smoking, and excessive alcohol intake). Modern regimens of anticatabolic (antiresorption) therapies not only maintain bone microarchitecture but enable a sufficient bone renewal in majority of patients. However, even with anticatabolic treatments, aging is associated with decrease in new bone formation and mechanical competence of bone. Performance of bone osteoblasts and osteocytes, bone volume and quality and architecture of bone is improved in patients treated with bone anabolic agents. Teriparatide treatment considerably reduces risk of vertebral and nonvertebral fracture, back pain and different aspects of quality of life. However, use of the bone anabolic drugs is limited to 18-24 months. To prevent subsequent increase in risk of fracture, sequential treatments with anabolic and anti-catabolic drugs offer benefits needed for the long-term compliance. In conclusion, selection of drugs with the highest antifracture efficacy should be guided by the underlying mechanisms of osteoporosis, and by expectations of the treatment (safety and efficacy). Anti-catabolic drugs are most appropriate in patients with high bone turnover. Anabolic treatment is indicated in patients with low bone formation in the elderly, in glucocorticoid induced osteoporosis, and where preservation of bone mass and bone architecture by anti-catabolic drugs is not sufficient to efficiently reduce high absolute risk of fracture.

Molecular diagnostics of clinically important staphylococci

Bacterial species of the genus Staphylococcus known as important human and animal pathogens are the cause of a number of severe infectious diseases. Apart from the major pathogen Staphylococcus aureus, other species until recently considered to be nonpathogenic may also be involved in serious infections. Rapid and accurate identification of the disease-causing agent is therefore prerequisite for disease control and epidemiological surveillance. Modern methods for identification and typing of bacterial species are based on genome analysis and have many advantages compared to phenotypic methods. The genotypic methods currently used in molecular diagnostics of staphylococcal species, particularly of S. aureus, are reviewed. Attention is also paid to new molecular methods with the highest discriminatory power. Efforts made to achieve interlaboratory reproducibility of diagnostic methods are presented.

[Mono-follicular development--the objective of ovulation induction with follitropin beta combined with intrauterine insemination]

OBJECTIVE

To assess the effect of different starting follitropin's beta dose (50 IU, 75 IU and 100 IU daily) for ovulation induction combined with intrauterine insemination on mono-follicular development.

SUBJECT

Prospective study.

SETTING

Centre for Assisted Reproduction SANUS, Pardubice.

SUBJECT AND METHOD

From March 2005 to November 2007 we performed a total number of 111 ovarian stimulations for patients with unexplained infertility, anovulatory disorder or mild male factor. We divided patients into groups based on patient's response to clomifen citrate treatment. We examined follicular growth day 9 by transvaginal ultrasound and if necessary we adjusted gonadotropins's dose.

RESULTS

We performed 104 intrauterine inseminations (94% of cycles with ovulation induction). We proved mono-follicular development in 36%, 37% and 36% (ns), number of follicles 1,9 +/- 0,8, 2,2 +/- 1,2 and 2,5 +/- 1,8 (ns), endometrial thickness (mm) 8,5 +/- 1,2, 8,6 +/- 1,7 and 9,1 +/- 1,8 (ns), total dose of rFSH (IU) 440 +/- 156, 583 +/- 154 and 830 +/- 268 (p < 0.001) in 50 IU, 75 IU and 100 IU follitropin's beta groups. We achieved a total of 18 pregnancies (pregnancy rate 17%).

CONCLUSIONS

50 IU follitropin beta daily offers 36% probability of mono-follicular development. The disadvantage may be an increased risk of cycle cancellation due to low ovarian response. Daily doses 75 IU or 100 IU increase total consumption of rFSH.

[Clinical utility of bone markers in the evaluation and follow-up in patients with neoplastic bone diseases]

The biochemical markers of bone remodeling reflect the rates of bone resorption and bone formation in the whole body rather than in segments of the skeleton. The markers cannot be used for a diagnosis of bone disease. However, they are a valuable tool in the differential diagnosis, in the assessment of fracture risk independent of bone mineral density and, in the monitoring treatments of metabolic and neoplastic bone diseases as well as the side effects of some drugs on bone (e.g., adjuvant treatment with selective inhibitors of aromatase). This review provides characteristics of the markers currently used to assess neoplastic bone diseases and, their clinical values for stratification and monitoring treatments. Currently used markers provide sufficient specificity. However, their sensitivities under various clinical situations have to be respected. The clinical utility of the markers requires their standardization and availability.

[Ovulation induction increases pregnancy rate during intrauterine insemination compared with natural cycles]

OBJECTIVE

To evaluate the pregnancy rate in natural cycle, in ovarian stimulation by clomifene citrate, combination clomifene citrate with gonadotropins and gonadotropins alone.

DESIGN

A prospective study.

METHODS

From January 2001 to December 2004 we performed a total of 1747 AIH's cycles (1124 in natural cycles, 296 cycles with clomifene citrate, 122 cycles clomifene citrate with gonadotropins and 205 cycles gonadotropins alone) and a total of 198 AID's cycles (140 in natural cycles, 22 cycles with clomifene citrate, 13 cycles clomifene citrate with gonadotropins and 23 cycles gonadotropins alone).

RESULTS

In AIH's cycles we achieved a total of 151 pregnancies (71 in natural cycles, 37 in cycles with clomifene citrate, 20 in cycles clomifene citrate with gonadotropins and 23 pregnancies in cycles with gonadotropins alone). The total pregnancy rate in AIH's cycles was 8.6% (6.3% in natural cycles, 12.5% in cycles with clomifene citrate, 16.4% in cycles clomifene citrate with gonadotropins and 11.2 % in cycles with gonadotropins alone). Statistical difference was p<0.001, p<0.05 a p<0.05 respectively. In AID's cycles we achieved a total of 40 pregnancies (27 in natural cycles, 5 in cycles with clomifene citrate, 5 in cycles clomifene citrate with gonadotropins and 3 pregnancies in cycles with gonadotropins alone). The total pregnancy rate in AIH's cycles was 20.2% (19.3% in natural cycles, 22.7% in cycles with clomifene citrate, 38.5 % in cycles clomifene citrate with gonadotropins and 13% in cycles with gonadotropins alone). Statistical difference we didn't reach.

CONCLUSIONS

In AIH's cycles we confirmed statistical difference between pregnancy rate in natural cycle, ovarian stimulation by clomifene citrate, combination clomifene citrate with gonadotropins and gonadotropins alone. Ovulation induction increases pregnancy rate compared with natural cycle. In AID's cycles we didn't confirmed statistical difference in pregnancy rate. Ovarian stimulation by clomifene citrate and intrauterine insemination remains the first choice treatment for ovulatory dysfunction, unexplained infertility, endometriosis, or male subfertility. Combination clomifene citrate with gonadotropins or gonadotropins alone may individualize ovarian stimulation.

[How exact is the performance of mediolateral episiotomy]

OBJECTIVE

Evaluation of correctly performed mediolateral episiotomies in vaginal deliveries.

METHODS

A cohort study of 253 primigravid women after their first vaginal delivery. The main parameter followed was the angle of episiotomy. This is defined as the angle formed by midline and the line of epidermal suturing of the episiotomy.

RESULTS

137 women had deliveries performed by a doctor and 116 by a midwife. There was no significant difference between groups. The number of adequately performed mediolateral episiotomies was 100 (40%) altogether, from them 48 (41%) among midwives and 52 (40%) among doctors. Other parameters were: the length of perineum, the length of episiotomy, and the shortest distance between episiotomy and the centre of the anus.

CONCLUSION

This study shows that majority of episiotomies are cut in the wrong direction. The difference in technique between doctors and midwives was not observed.

[Maternal position at the delivery and perineal trauma]

OBJECTIVE

Summary of the relation between of maternal position at the delivery and obstetrical perineal trauma.

DESIGN

Review.

SETTING

Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen.

SUMMARY

Positions of mother at the delivery are divided in to: supine, semi-recumbent, lithotomy, lateral and upright positions - standing, sitting, squatting and kneeling. Birthing chair or stool might be applied. Outlined potential benefit of upright positions. So far there was not observed any consented negative impact of upright position on a mother or a child. Its potential positive effect has not been proved. A reduction of episiotomy, a slight increase in the second degree tears and more frequent blood lost over 500 mls has been described. The risk of anal sphincter trauma has been studied insufficiently. It appears, the different positions might involve different risks of the third degree tear. Up to now there is no reason to discourage woman from some of upright positions. Anyway she must be fully informed of a limited support and protection of perineum in an effort to reduce the risk of anal sphincter injury.

[Occult anal sphincter tear--up-to-date knowledge]

OBJECTIVE

Summary of the current knowledge of sonographically and clinically detectable anal sphincter injury.

DESIGN

Review.

SETTING

Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen.

SUMMARY

Review of the current international literature covering the given problem. Occult anal sphincter tear is defined as an injury, which is clinically undetectable and recognizable just on endoanal ultrasonography. Total frequence of anal sphincter defects detected by sonography varies between 19-67%. At any rate majority of them likely seem to be injuries which are clinically detectable, however undiagnosed and missed. Isolated defect of internal anal sphincter is an example of real occult anal sphincter injury. This is found in around 2% of all vaginal deliveries. A diligent digital examination of perineum after the delivery and a proper education of perineal anatomy is the cornerstone in improving of the diagnostics. Endoanal ultrasound may serve as a tool in facilitation of the diagnosis.

[The leukemia inhibitory factor gene mutations in the population of infertile women: the heterozygote transition G to A on the position 3400 does not affect the outcome of the infertility treatment]

OBJECTIVE

The leukemia inhibitory factor (LIF) is one of the most important signaling factors in the embryo-maternal cross talk during the embryo implantation. We investigated the prevalence of the LIF gene mutations in the population of infertile women and their impact on infertility treatment.

DESIGN

A cohort study.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital of Charles University, Pilsen.

SUBJECTS AND METHODS

The population to screen consisted of 399 infertile women. The control population was comprised of 202 healthy fertile subjects. For the mutational analysis, the temperature gradient gel electrophoresis (TGGE) followed by subsequent sequencing of the positive samples, had been used. The groups of fertile controls and infertile patients were compared for statistically significant difference using the Fisher's 2 by 2 Exact test.

RESULTS

Twelve potentially functional LIF gene mutations, the G to A transversion at the position 3400 leading to the valin to methionin exchange at codon 64 (V64M) were detected in the group of infertile women. No mutations were identified in the control group, which means that the frequency of functionally relevant mutations of the LIF gene in infertile women is significantly enhanced in comparison with controls (P = 0.01, Fisher's 2 by 2 Exact test ). Seven of these patients were successfully treated by in vitro fertilization (IVF).

CONCLUSION

The results suggest that the LIF gene mutation, the heterozygote G to A transition on the position 3400, affects fertility but the infertility treatment can succeed. Even though LIF gene mutations occur infrequently and can be overcome by infertility treatment, their impact on molecular events during early phases of pregnancy should be further elucidated.

[Influence of early postnatal nutrition in preterm infants on their anthropometric and hormonal characteristics at the age of 10 years]

BACKGROUND

[corrected] A protective effect of breast feeding on the development of obesity has been clearly demonstrated. Several studies associated higher protein intake in postnatal period with the earlier "adiposity rebound" and the higher BMI in later life.

METHODS AND RESULTS

Twenty eight girls born at 34th week of pregnancy (weight: 2.22+/-0.31 kg, length: 45.2+/-2.5 cm, BMI: 11.0+/-1.5 kg/m(2)), were subdivided in two groups differing in protein intake during the first postnatal month due to either breast feeding or formula feeding (113.5+/-18.7 g/month vs. 174.00+/-14.3 g/month; p<0.0001). Groups did not differ in average body weight, height and BMI at birth. Anthropometric and hormonal characteristics, body composition, energy and macronutrient intakes were determined at the age of 10 years in girls together with parental BMI. Association between the early postnatal nutrition and anthropometric and hormonal indexes at 10 years was evaluated. No significant differences between the groups in anthropometric and hormonal characteristics were found at 10 years except for IGF-1 which was significantly higher in the group with increased postnatal protein intake. Protein intake during the first postnatal month was not related to fat mass and leptin levels at 10 years. Protein intake during the first postnatal month significantly correlated with IGF-l level, BMI and body circumferences at 10 years. Postnatal fat intake correlates with body circumferences and IGF-1 and also with sagital diameter and leptin at 10 years.

CONCLUSIONS

Early postnatal nutrition could encode IGF-1 in later life and this way may be involved in body size programming. Factor analysis revealed IGF-1 as a link between the postnatal energy and macronutrient intake and anthropometric indices and leptin at the age of 10 years.

Identification of Staphylococcus aureus based on PCR amplification of species specific genomic 826 bp sequence derived from a common 44-kb Sma I restriction fragment

Primers were designed for polymerase chain reaction (PCR)-amplification of a genomic sequence specific to Staphylococcus aureus strains. The sequence corresponds to a part of the 44-kb Sma I fragment (fragment L on the S. aureus NCTC 8325 restriction map) which was found to be common to strains of the S. aureus species (Pantůcek et al 1996, International Journal of Systematic Bacteriology, 46: 216-222). The labelled 44-kb Sma I restriction fragment derived from S. aureus NCTC 8325-4 was hybridized to the Eco RI restriction patterns of genomic DNA from 13 strains representing different macrorestriction types of S. aureus subsp. aureus. This made it possible to reveal the 2052 bp Eco RI restriction subfragment and to demonstrate its presence in all the tested strains. From the sequence of this subfragment, primers were designed by means of which the 826 bp amplicons were obtained in all 216 tested strains of S. aureus. No hybridization and PCR-products were observed in 40 collection strains of other staphylococcal species and subspecies as well as in 45 clinical strains of coagulase-negative staphylococci. These results lead us to the conclusion that the use of the above primers makes it possible to identify rapidly and reliably S. aureus strains of various provenance and different genotypes.

Bone mineral density in patients with apolipoprotein E type 2/2 and 4/4 genotype

The peak bone mass and the rate of bone loss are in part genetically determined. It has been suggested that bone mineral density (BMD) may be related to allelic variation in the apolipoprotein E (ApoE) gene locus. ApoE is important in the receptor-mediated clearance of chylomicron particles from the plasma, Apo E4 having the highest and Apo E2 the lowest receptor affinity. Chylomicrons are the main carrier of vitamin K in the plasma; vitamin K plays an important role in the carboxylation of osteocalcin. We have tested the hypothesis that persons with E4 variant would have lower BMD and increased bone turnover than those with E2 variant. A total of 18 ApoE 2/2 and ApoE 4/4 homozygotes were selected from 873 patients who were examined for the ApoE genotype. BMD in lumbar vertebral, femoral neck and distal forearm was measured and plasma concentrations of osteocalcin and C-terminal fragments of collagen (CTx) were determined. BMD values (expressed as T-score) at the three specified sites were -0.12+/-1.72, -0.52+/-1.32 and -0.52+/-0.81 in ApoE 2/2 group and -0.24+/-1.22, 0.00+/-0.84 and -0.17+/-1.07 in the ApoE 4/4 group. Plasma osteocalcin and CTx were within normal limits in both groups. In conclusion, we did not observe any association of ApoE genotype with BMD and biochemical markers of bone metabolism in ApoE 2/2 and ApoE 4/4 homozygotes.

Bone mineral density in patients with phenylketonuria

Dual energy X-ray absorptiometry was performed in 44 patients with phenylketonuria (PKU) aged 6-29 y. The phenylalanine-restricted diet was based on a low-protein diet in combination with phenylalanine-free amino acid mixtures and phenylalanine-low casein hydrolysate in 32 patients. The 10 oldest patients were supplemented only with casein hydrolysate, and the youngest child received only the amino acid mixture. One patient has recently come off the diet. Bone mineral density (BMD) of the lumbar spine and total BMD were measured and expressed as Z-score, i.e. the difference between the BMD of the patient and the average BMD of sex- and age-matched controls divided by the standard deviation of the control group. Normal BMD was found in 24 (54%) patients. Lumbar spine BMD was decreased in 20 patients and total BMD was decreased in 14 patients. Z-scores of -1to 2.5 were found in 14 patients (32%) and Z-scores of <-2.5 in 6 patients (14%). No significant correlation was found between total or lumbar spine BMD and daily intake of phenylalanine from natural sources in the low-protein diet or the amount of phenylalanine-free amino acid mixtures per kg of body weight. A significant negative correlation was observed between both total and lumbar spine BMD Z-scores and the amount of casein hydrolysate supplementation per kg of body weight (r = - 0.45; y = 0.07 - 0.69x; p < 0.01). Long-lasting dietary restriction in patients with PKU may increase the risk of late complications of dietary therapy, such as osteoporosis or trace element deficiency. O Bone mineral density, osteoporosis, phenylalanine-low diet, phenylketonuria

Circular dichroism spectroscopy analysis of conformational transitions of a 54 base pair DNA duplex composed of alternating CGCGCG and TATATA blocks

CD spectroscopy was used to analyze conformational properties of a self-complementary 54-mer DNA composed of alternating (CG)3 and (TA)3 hexamers. NaCl induced the Z-form in poly(GC), but the 54-mer remained the B-form under the same conditions. The B-Z transition was induced only after the addition of NiCl2. However, the Z-form was adopted by the whole molecule, not by the (CG)3 blocks alone. Two orders of magnitude higher concentrations of NiCl2 were required to induce the Z-form in poly(AT). The Z-form was also induced in poly(GC) by CsF that switched poly(AT) into the X-form, which seems to be a solution counterpart of D-DNA. Under these conditions the CD spectrum of the 54-mer was consistent with the (TA)3 blocks being in the X-form and the (CG)3 blocks in the B-form. At high concentrations of ethanol or trifluoroethanol, poly(AT) was an A-form, while poly(GC) adopted either Z-form, A-form or Z'-form. At the high trifluoroethanol concentrations the 54-mer cooperatively switched into a conformation whose CD spectrum was most consistent with the A-form in the (TA)3 blocks and the Z'-form in the (CG)3 blocks. This suggests that the base pairs are tilted in the Z'-form as in the A-form. The present article illustrates that CD spectroscopy can provide interesting pieces of information about conformational isomerizations and coexistence of multiple conformations in DNA molecules containing blocks of different simple sequence repeats.

Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group

This randomized, double-masked, placebo-controlled trial evaluated the safety, tolerability and effects on bone mineral density (BMD) of alendronate in a large, multinational population of postmenopausal women with low bone mass. At 153 centers in 34 countries, 1908 otherwise healthy, postmenopausal women with lumbar spine BMD 2 standard deviations or more below the premenopausal adult mean were randomly assigned to receive oral alendronate 10 mg (n = 950) or placebo (n = 958) once daily for 1 year. All patients received 500 mg elemental calcium daily. Baseline characteristics of patients in the two treatment groups were similar. At 12 months, mean increases in BMD were significantly (p</=0.001) greater in the alendronate than the placebo group by 4.9% (95% confidence interval 4.6% to 5.2%) at the lumbar spine, 2.4% (2.0% to 2.8%) at the femoral neck, 3.6% (3.2% to 4.1%) at the trochanter and 3.0% (2.6% to 3.4%) for the total hip. The incidence of nonvertebral fractures was significantly lower in the alendronate than the placebo group (19 vs 37 patients with fractures), representing a 47% risk reduction for nonvertebral fracture for alendronate-treated patients (95% confidence interval 10% to 70%; p = 0.021). Incidences of adverse events, including upper gastrointestinal adverse events, were similar in the two groups. Therefore, for postmenopausal women with low bone mass, alendronate is well tolerated and produces significant, progressive increases in BMD at the lumbar spine and hip in addition to significant reduction in the risk of nonvertebral fracture.

Body composition in children receiving recombinant human growth hormone after renal transplantation

BACKGROUND

Recombinant human growth hormone (rhGH) is an anabolic hormone promoting protein synthesis in various tissues. Therefore, changes in body composition may be expected during rhGH treatment.

METHODS

We studied changes in body composition during two years of rhGH treatment in 21 children after at least one year with a functioning renal transplant. The mean +/- SD age was 12.9+/-2.5 years at the start of rhGH therapy. A whole body, dual energy X-ray absorptiometry (DEXA) exam was performed before the initiation of rhGH therapy (T0), and was repeated at one and two year intervals after initiation of the therapy (T1 and T2, respectively).

RESULTS

Lean body mass increased by a median of 0.48 SDS during the first year of treatment (P = 0.022), and the median increase during two years of therapy was 0.36 SDS (P = 0.061). On the contrary, the median fat body mass decreased by 2.17 SDS during the T0 to T1 period (P = 0.04) and by 1.99 SDS during the T0 to T2 period (P = 0.055). The index for fat body mass/lean body mass (FBM/LBM) decreased by a median of 5.3% during T0 to T1 (P < 0.001), however, a slower but still significant decrease by a median of 4.2% was noted at T2 (P < 0.05). Bone mass content did not change significantly during rhGH treatment. The medians in caloric and protein intakes were stable during rhGH treatment.

CONCLUSION

A significant increase of lean body mass and a decrease of fat body mass was noted during rhGH therapy in children after renal transplantation.

Metabolic bone status in young women with juvenile chronic arthritis

A group of 26 young women (18-36 years of age) with juvenile chronic arthritis (JCA, duration 8-33 years) was investigated for bone metabolism and mineral status. Six of the patients were receiving longterm corticosteroid therapy, and 5 had received corticosteroid treatment in the past. Serum osteocalcin and urinary hydroxyproline were significantly elevated in 17 and 14 of the 26 patients, respectively, compared with healthy controls. Compared to controls, bone mineral density (BMD) in the lumbar spine was significantly lowered in 6 of 26 patients, all of whom were in the corticosteroid treated subgroup. No correlation was evident between any of the variables measured, except for the association of corticosteroid therapy with low BMD.