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Biomedical subjects

S Bernasconi

Publications and source records attributed to S Bernasconi.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Sensitivity and specificity of body mass index and skinfold thicknesses in detecting excess adiposity in children aged 8-12 years.

PRIMARY OBJECTIVE: The study aimed to evaluate the sensitivity (SN) and specificity (SP) of body mass index (BMI) and skinfold thicknesses in detecting excess adiposity in children. RESEARCH DESIGN: Cross-sectional. MATERIALS AND METHODS: 986 children (500 females and 486 males) aged 10 +/- 1 years (mean +/- SD; range: 8-12 years) were studied. All underwent anthropometric measurements and bioelectrical impedance analysis (BIA). Dual-energy X-ray absorptiometry (DXA) was performed in 52 children to develop a population-specific algorithm for the assessment of fat-free mass (FFM) from BIA. The algorithm was applied to the remaining 934 children to estimate their FFM. Fat mass (FM) was obtained by subtracting FFM from weight (Wt). Values of FM:Wt were transformed in Z-scores and converted into 19 percentile categories (from 5 to 95 in steps of 5). The same procedure was performed with BMI and the log-transformed sum of four skinfold thicknesses (triceps, biceps, subscapular and suprailiac; lt-4SF). Excess adiposity was defined as a level of FM:Wt greater than the internally derived 85th percentile. SN and SP of each internally derived percentile of BMI and lt-4SF in detecting excess adiposity were calculated. RESULTS: In the pooled sample (n = 934), SN and SP were 0.39 and 0.99 for the 95th percentile of BMI, 0.65 and 0.95 for the 85th percentile of BMI, and 0.75 and 0.94 for the 85th percentile of lt-4SF. CONCLUSIONS: BMI percentiles employed in the present study have a high SP but a low SN in detecting excess adiposity in 8-12-year-old children. The use of the sum of four skinfolds has the potential to increase the SN of a screening programme for excess adiposity in children of this age.

Absorptiometry, Photon↗
PubMedDate not supplied

Relationship between body mass index and insulin measured during oral glucose tolerance testing in severely obese children and adolescents.

PRIMARY OBJECTIVE: The study evaluated the accuracy of body mass index (BMI) in detecting hyperinsulinaemia during oral glucose tolerance testing (OGTT) in severely obese children. RESEARCH DESIGN: A cross-sectional study was carried out. MATERIALS AND METHODS: A total of 118 obese children and adolescents (49 females and 69 males) aged 6-19 years were consecutively studied at an outpatient paediatric clinic. Hyperinsulinaemia was defined as a value of log-transformed fasting insulin >/= 80th percentile and OGTT hyperinsulinaemia as a value of the log-transformed area under the curve (AUC) of insulin >/= 80th percentile. The study hypothesis was tested using a logistic regression model with hyperinsulinaemia as the outcome variable and the z-score of BMI corrected for age (z-BMI(age)) as the predictor variable. Receiver-operator characteristic (ROC) curves were used to evaluate accuracy. RESULTS: The mean (SD) BMI for age of the children was 28.6 (4.0) kg m(-2), corresponding to 2.2 (0.5) standard deviation scores. The odds ratio (OR) of OGTT hyperinsulinaemia was 2.0 (95% CI 1.2-3.3; p = 0.007) for each unit increase of z-BMI(age) and the corresponding ROC-AUC was 0.74 (95% CI 0.61-0.86; p = 0.0001). In comparison, the OR of fasting hyperinsulinaemia was 1.1 (95% CI 0.7-1.7; p = 0.716) for each unit increase of z-BMI(age) and the corresponding ROC-AUC was 0.49 (95% CI 0.35-0.62; p = 0.863). CONCLUSION: BMI is reasonably accurate in detecting OGTT hyperinsulinaemia in severely obese children.

Adolescent↗
PubMedDate not supplied

Effects of phenylalanine, histidine, and leucine on basal and GHRH-stimulated GH secretion and on PRL, insulin, and glucose levels in short children. Comparison with the effects of arginine.

Of the amino acids arginine is the most potent GH secretagogue in man. It potentiates the GH response to GHRH, exerts a weaker PRL-releasing effect, stimulates insulin and glucagon and induces a biphasic glucose variation. The potency and effects of other amino acids on pituitary and pancreatic hormones need to be clarified. In 43 children with normal short stature (5.3-14.0 yr; 30 M and 13 F) the effects of the infusion of phenylalanine (Phe, 0.08 g/kg), histidine (His, 0.1 g/kg), and leucine (Leu, 0.08 g/kg) on basal and GHRH-stimulated GH secretion and on PRL, insulin and glucose levels were studied and compared with those of arginine at high (hArg, 0.5 g/kg) or low dose (lArg, 0.2 g/kg). Phe increased basal (p < 0.05) but not GHRH-stimulated GH levels, induced PRL and insulin rises (p < 0.03 and p < 0.03), and did not change glycemia. Though a trend toward an increase in basal GH levels was found after His, His and Leu did not significantly modify either basal or GHRH-induced GH secretion nor basal PRL, insulin and glucose levels. Both hArg and lArg increased basal (p < 0.0001 and p < 0.05, respectively) and GHRH-stimulated GH levels (p < 0.006 and p < 0.006). hArg increased both PRL (p < 0.002) and insulin levels (p < 0.005) more (p < 0.0005 and p < 0.004) than lArg (p < 0.005 and p < 0.005), while glucose levels showed a similar increase followed by a similar decrease. We conclude that in childhood: a) Phe significantly increases GH secretion but, differently from Arg, does not potentiate the response to GHRH, suggesting different mechanisms of action of these amino acids; b) differently from His and Leu, Phe is a PRL and insulin secretagogue but is less potent than Arg; c) Arg has the highest stimulatory effect on pituitary and pancreatic hormones.

Adolescent↗
PubMedDate not supplied

Traumatic hypopituitarism associated with bitemporal hemianopia in a prepuberal child.

The case of a boy affected by post-traumatic hypopituitarism associated with bitemporal hemianopia is described. While traumatic bitemporal hemianopia is not an extraordinary occurence, traumatic injuries have been rarely reported among the causes of hypopituitarism. This may be because the cranial trauma in most of the cases is too severe to permit survival. After having considered the diagnostic problems the authors briefly review the peculiar vascular supply to the chiasma and anterior diencephalon and try to consider the pathogenetic mechanism of the syndrome. Direct contusion necrosis and direct intraparenchymal hemorrage in the chiasma and in the hypophysis or hypothalamus are considered the most probable causal factors; however, the concomitant occurence of chiasmal and hypopituitary injury might be explained by a single transient compressive mechanism either on the tubero-hypophysial arteries or on the smaller vessels of the infundibular network. The difficulty of ascertaining both the pathogenetic mechanism and the seat of the endocrine lesions on the basis of the clinical signs is stressed.

Adolescent↗
PubMedDate not supplied

Oral health in children and adolescents with IDDM--a review.

Children with insulin-dependent diabetes mellitus have a lower salivary flow rate, pH and buffer capacity, but a higher glucose content and peroxidase, IgA, magnesium and calcium concentration, in comparison with healthy children. Nevertheless the incidence of caries is lower than normal in diabetic children with good metabolic control. Periodontal disease usually starts at puberty as mild gingivitis with bleeding and gingival recession, and it may develop into severe periodontitis, especially in children with poor control of diabetes. Microangiopathy, impaired immune response, different bacterial microflora and collagen metabolism are involved in the pathogenesis of diabetic periodontal disease. The gingival flora is mostly composed of Gram-negative, anaerobic bacteria, while collagen has a lower solubility and is atrophic and inadequate to support the occlusion forces. For these reasons, prevention of periodontitis is important in diabetic children; they should receive oral hygiene instruction and visit a dentist at least twice a year.

Adolescent↗
PubMedDate not supplied

Genetics and molecular biology of the GHRH-GH-IGF-I axis.

In this paper, the genetics and molecular biology of the GHRH-GH-IGF-I (Growth Hormone Releasing hormone-Growth Hormone-Insulin like Growth Factor I) axis involved in the pathogenesis of short stature are reviewed. Short stature associated with GH deficiency is estimated to occur in about 1/4000-10,000 live births; 3-30% of cases affect first-degree relatives, suggesting a genetic aetiology. Identification of such molecular defects is very recent and dependent on new findings on the physiology of GHRH-GH-IGF-I axis: for example the pituitary-specific transcription factors and their mutations have only been described in the last few years. The epidemiological importance of the identified molecular defect depends on the level of the axis involved, but the prevalence of some of these genetic defects is probably underestimated. Time will tell what the practical relevance of these findings is and what the clinical features of the new mutations are; we will probably learn something more about the GHRH-GH-IGF-I axis: to date, no mutations have been reported regarding the GHRH gene or the IGF-I receptor.

Adult↗
PubMedDate not supplied

The surgical treatment of intra-articular fractures of the calcaneus using a new multiple-hole Tra.Ma plate. The long-term results in relation to gait analysis.

Intra-articular fractures of the calcaneus have always represented a controversial subject; numerous surgical methods involving synthesis have been proposed, but none of these is without complications. The authors describe the use of new multiple-hole Tra.Ma plate in 25 patients between 1997 and 1999; all of the fractures were classified based on routine CT scan and X-ray evaluation and the Bohler, DeLangre and Preiss preoperative angles were measured 2 and 4 months later. All of the patients were also evaluated clinically and each of them underwent gait analysis using an electronic baropodometer. The Tra.Ma plate allows us to obtain satisfactory results both clinically and radiographically, also reducing the local complications related to the cumbersome nature of previous instrumentation; gait analysis also revealed the distribution of load comparable to that of the contralateral limb.

Adult↗
PubMedDate not supplied

[Peripheral androgen resistance syndrome].

Two main topics of 5 alpha reductase deficiency and androgen receptors defects have been considered. Particularly, the differential diagnosis among the different syndromes of androgen resistance and the important issue of sex assignment are discussed.

Cholestenone 5 alpha-Reductase↗
PubMedDate not supplied

[Home-coming diarrhea. Presentation of a clinical case].

The Homing Diarrhea, described by Duhamel and Rey in 1980, represents a gastrointestinal disease which affects children of emigrants coming back from a trip to their country of origin and may become so serious to cause death secondary to dehydration or septicemia. The poor nutritional conditions at the beginning of the trip (secondary to low socioeconomic situation) and the onset of acute enteritis during the travel, caused by Salmonella or Shigella, E. Coli, Campylobacter, Myceti, Giardia Lamblia, Rotavirus, are considered the main and triggering factors of the homing diarrhea. Intensive care can be necessary to interrupt the sequence constituted by diarrhea-malnutrition-dehydration. Therefore prophylaxis, including good basal nutritional conditions and the use of p.o. glucose-electrolyte solutions at the beginning of the acute enteric episode appears to be the most effective measure to prevent the onset of the disease. A case of homing diarrhea is reported.

Diarrhea, Infantile↗
PubMedDate not supplied

[Varicocele in childhood].

The Authors analyze 20 cases of left varicocele, treated surgically, in boys from 10 to 16 years with the mean age of 12 years. During the operation a testicular biopsy was carried out alternatively in both testicles, showing, mostly, a growth arrest of the spermatogenesis. A blood sample from the left internal spermatic vein was taken for the measurement of the testosterone. The Authors discuss the results and emphasize an early correction of the varicocele.

Adolescent↗
PubMedDate not supplied

Electroretinography and diagnosis of the Laurence-Moon-Bardet-Biedl syndrome in childhood.

The cases of two children affected from LMBB syndrome are reported. The first child was six years old, suffering from obesity and mild mental retardation; the other was two years old, suffering from hexadactyly and obesity. In both children the suspected diagnosis of LMBB syndrome was verified by the electroetinographic evidence of a tapetoretinal degeneration although the fundi were atypical. A third child, the younger brother of the second case, presented an atypical pigmentation of the retina and the electroretinographic changes of a tapeto-retinal degeneration. Since tapeto-retinal degeneration, which is the most common of the main signs of the syndrome, is not always recognized by ophthalmoscopy in early childhood, the clinical value of electroretinography in making an early diagnosis is emphasized.

Adult↗
PubMedDate not supplied

[Leydig cell function in cryptorchid boys (author's transl)].

Testicular endocrine function was assessed in 54 cryptorchid boys, 9 of whom had previously been treated with human chorionic gonadotrophin (HCG). Two different HCG tests were used, the first being short (5,000 IU/m2) and the second more prolonged (3 x 1,500 IU). The testosterone response to the two tests is both quantitatively and qualitatively different. HCG therapy abolishes the differences between cryptorchid boys and controls, which may explain the conflicting results of HCG tests in literature. The results also suggest that the absence of the late testosterone response during the short test in the cryptorchid boys not treated with HCG is due to a reduced and exhaustable Leydig cell function.

Child↗
PubMedDate not supplied

[Treatment by human chorionic gonadotropin in maldescended testes. (Synthesis of our experience)].

87 prepuberal children, 2-15 years old, 58 with unilateral and 29 with bilateral cryptorchidism, were treated intramuscularly with Human Chorionic Gonadotropin (HCG). HCG was administered in 16 children in single dose (5.000 IU/m2), in 11 children every other day for one week (3 x 1,500 IU) and in 60 children twice a week (2 x 1,000 IU) for 3-7 weeks. Treatment was successful in 31% of children. The most effective HCG dosage ranged between 10,000 and 14,000 IU (2 x 1,000 IU once a week for 5-7 weeks). The best therapeutic response was obtained in inguinal cryptorchid testes (39,3%), in unilateral cryptorchidism (34,5%) and in children aged 5-10 years (42,3%). The observed androgenic side effects (32%) subsided within 3-12 months after therapy suspension. The HCG therapy appears of particular value in cryptorchidism treatment. Surgical management is indicated in cases of true ectopic testes and after failure of HCG therapy.

Adolescent↗