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Biomedical subjects

S R Rose

Publications and source records attributed to S R Rose.

At least 19 recordsLinked to original sources
PubMed1998

Melatonin accelerates metamorphosis in Xenopus laevis.

Delayed metamorphosis associated with large body size has been observed in Woodhousei fowleri tadpoles reared in continuous dark (DD). To evaluate the mechanism by which DD delayed metamorphosis, light-cycle exposure was controlled and thyroxine (T4), melatonin, or drugs that alter prolactin (Prl) concentrations were given to Xenopus laevis tadpoles. It was hypothesized that exogenous melatonin would delay metamorphosis and increase body size, and that elevation of Prl concentrations would have effects similar to melatonin exposure. Xenopus laevis tadpoles were randomized to three light conditions [light/dark (LD, 12 h/12 h), DD, and continuous light (LL)] and subgroups in each light condition were treated with T4, melatonin, bromocriptine (Bro), haloperidol (Hal), or no drug. Each subgroup included 12 tadpoles. Drugs were administered in the water either continuously or daily from 07.00 to 19.00 h (Intermittent). Measurements of total length, leg length, and stage of metamorphosis were obtained at regular intervals. DD resulted in delayed metamorphosis, while LL did not. T4 accelerated metamorphosis as expected, countering the delaying effects of DD. In contrast to the hypothesis, melatonin accelerated metamorphosis and impaired body size compared to controls. Intermittent Hal also accelerated metamorphosis, while Bro delayed it. In DD, both T4 and melatonin led to increased tadpole size in contrast to their counterparts in LD or LL. Delayed metamorphosis in DD is not caused by increased melatonin production. Melatonin and Hal (as given in this study) accelerate metamorphosis. Melatonin acceleration of metamorphosis may occur through alteration of the concentration of prolactin.

Animals↗
PubMed1997

Papillary thyroid carcinoma: demographics, treatment, and outcome in eleven pediatric patients treated at a single institution.

We describe 11 cases (8 females, 3 males) of papillary thyroid carcinoma in children treated at St. Jude Children's Research Hospital over a 33-year period, and review the literature. Ages ranged from 7-25 years (median, 16 years). Six patients had primary papillary thyroid carcinoma. Five patients had secondary papillary thyroid carcinoma after treatment of Hodgkin's disease (n = 2), acute lymphoblastic leukemia (n = 2), and neuroblastoma (n = 1) with chemotherapy and cervical radiation. The typical presentation was either cervical lymphadenopathy or a thyroid mass of short duration. Treatment consisted of thyroidectomy, cervical lymph node dissection, and postoperative thyroid hormone replacement (n = 1), parathyroid reimplantation (n = 1), 131I ablation (n = 4), external-beam irradiation (n = 1), and chemotherapy with doxorubicin (n = 1) or carboplatin and topotecan (n = 1). Nine patients are alive without evidence of disease 3.0-22.4 years from diagnosis. One patient has persistent but stable disease 17.3 years after diagnosis. One patient relapsed with metastatic lung disease 0.3 years after the initial diagnosis. He continues to do well after a brief but unsustained complete radiographic remission of disease to combination chemotherapy with carboplatin and topotecan. Our review supports excellent long-term outcome for primary or secondary papillary thyroid carcinoma in pediatric patients although complications may require close follow-up in a multidisciplinary setting.

Adolescent↗
PubMed1997

Prospective multicenter study of sulfonylurea ingestion in children.

OBJECTIVE: Sixty-eight percent of pediatric sulfonylurea ingestions reported to poison centers do not result in laboratory or behavioral effects. Consequently, if all exposed children are admitted overnight or for 24 hours for these exposures, it will result in 600 to 700 hospital admissions per year of children who will remain free of symptoms. We prospectively studied exposures reported to 10 regional poison centers to determine if it were possible to differentiate those patients who would have symptoms from those who would remain symptom free. METHODS: We analyzed all sulfonylurea exposures in children < or = 12 years old reported to the participating poison centers. Hypoglycemia was defined as blood glucose (BG) concentration < 60 mg/dl. RESULTS: Hypoglycemia developed in 56 (30%) of 185 exposed patients. Fifty-four of the 56 (96%) hypoglycemic patients had development of hypoglycemia within 8 hours of ingestion. Eighty-seven of the patients were initially managed with oral supplementation only; in 13 cases, treatment advanced to intravenous administration of glucose or glucagon with the onset of hypoglycemia. There was no statistical difference in medical outcome between patients monitored during oral supplementation versus during intravenous infusion of dextrose. Ingestions analyzed by time of day did not predict risk of hypoglycemia. Sufficient data were available for 103 (58%) of the 177 patients who ingested glyburide or glipizide to calculate a toxic dose/weight ratio. Of these 103 patients, 31 of 36 patients who ingested < or = 0.3 mg/kg remained symptom free, whereas 31 of 67 who ingested more than 0.3 mg/kg had BG concentrations < 60 mg/dl (p < 0.005, 95% confidence interval 0.05 to 0.58; sensitivity 86%, specificity 46%). CONCLUSION: A lack of onset of hypoglycemia (BG > 60 mg/dl) in the first 8 hours after ingestion is predictive of a benign outcome in accidental pediatric sulfonylurea ingestion. Clinical observation of children for onset of hypoglycemia during oral feeding alone appears safe. Some children with symptoms of hypoglycemia need to receive intravenous dextrose therapy. Time of day of ingestion is not predictive of risk of hypoglycemia. Finally, at this time it appears inappropriate to use a milligram per kilogram body weight dose as a guide for management decisions.

Accidents↗
PubMed1997

Pregnancy and travel.

Travel is not generally contraindicated during pregnancy, but there are some risks. The pregnant traveler needs a careful predeparture evaluation, and her itinerary should not take her far from available medical and obstetric care. The pregnant traveler must avoid diseases (such as malaria and hepatitis E) that can have devastating effects. Travel must be curtailed when there would be potential exposure to certain infectious diseases or extreme environmental conditions.

Contraindications↗
PubMed1997

Effects of luteinizing hormone-releasing hormone analog-induced pubertal delay in growth hormone (GH)-deficient children treated with GH: preliminary results.

To study the effect of delaying epiphyseal fusion on the growth of GH-deficient children, we studied 14 pubertal, treatment naive, GH-deficient patients (6 girls and 8 boys) in a prospective, randomized, placebo-controlled trial. Chronological age was 14.5 +/- 0.5 yr, and bone age was 11.6 +/- 0.3 yr (mean +/- SEM) at the beginning of the study. Patients were assigned randomly to receive GH and LH-releasing hormone (LHRH) analog (n = 8) or GH and placebo (n = 6) during 3 yr, with planned continuation of GH treatment until epiphyseal fusion. Patients were measured with a stadiometer and had serum LHRH tests, serum testosterone (boys), serum estradiol (girls), and bone age performed every 6 months. Patients treated with GH and LHRH analog showed a clear suppression of their pituitary-gonadal axis and a marked delay in bone age progression. We observed a greater gain in height prediction in these patients than in the patients treated with GH and placebo after 3 yr of treatment (mean +/- SEM, 14.0 +/- 1.6 vs. 8.0 +/- 2.4 cm; P < 0.05). These preliminary findings suggest that delaying epiphyseal fusion with LHRH analog in pubertal GH-deficient children treated with GH increases height prediction and may increase final height compared to treatment with GH alone.

Adolescent↗
PubMed1996

Jacobsen syndrome: report of a patient with severe eye anomalies, growth hormone deficiency, and hypothyroidism associated with deletion 11 (q23q25) and review of 52 cases.

We have evaluated a patient with Jacobsen syndrome. The patient presented with growth retardation, hypotonia, trigonocephaly, telecanthus, downward slanting palpebral fissures, bilateral inferior colobomas (of the iris, choroid, and retina), hydrocephalus, central nervous system (CNS) abnormalities, and an endocardial cushion defect, features commonly seen in Jacobsen syndrome. Endocrine evaluation showed growth hormone deficiency and central hypothyroidism. Chromosome analysis showed a 46,XX,del(11)(q23q25) de novo karyotype. Cytogenetically, the deletion appeared to include most of bands 11q23 and q24 and a portion of q25. Using chromosome specific paint probe, a combination of chromosome 11 centromere, telomere, and region specific cosmid probes from 11q14.1-14.3, 11q23.3, and 11q24.1, we have localised the deletion breakpoint to q24.1. Phenotype-karyotype correlation of patients with Jacobsen syndrome and specific deletions of chromosome 11q has enabled us to suggest that the critical region for this syndrome lies in close proximity to cytogenetic band 11q24. Although growth retardation is a consistent finding in 11q deletion syndrome, the presence of hypothalamic-pituitary hormone deficiency has not been reported previously.

Abnormalities, Multiple↗
PubMed1996

Overnight growth hormone concentrations are usually normal in pubertal children with idiopathic short stature--a Clinical Research Center study.

To estimate the incidence of low growth hormone (GH) concentration in children and adolescents with idiopathic short stature, overnight GH levels were measured in 167 subjects. The results were compared with data from 132 normal children of similar pubertal stage, bone age, or body mass index. The majority of short children had normal overnight GH concentrations in a distribution not significantly different from that observed in normal children. However, in 6% of children grouped by pubertal stage and in 13% of children grouped by bone age, overnight GH levels were below the 95% confidence limits of normal. The overnight GH levels were above normal in 6%. The observed frequencies of both low and high GH levels were significantly greater than expected (P < 0.001). However, when body mass index was included in the analysis, only 5% of the children had low GH measures, and only 4% had high GH measures (both not significant). This frequency of low overnight GH levels in short children is considerably less than that reported by others. Thus, these data do not support the hypothesis that a deficiency of spontaneous GH secretion is a common cause of short stature. We conclude that standard GH stimulation tests, despite their limitations, remain the best definitive test of GH secretion. Subsequent overnight GH studies may be useful, however, in selected clinical settings such as previous cranial irradiation or other central nervous system disorder.

Adolescent↗
PubMed1996

Insulin-like growth factor I (IGF-I) and IGF-binding protein-3 concentrations compared to stimulated and night growth hormone in the evaluation of short children--a clinical research center study.

To evaluate the relative usefulness of insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) in screening for GH status, GH stimulation (arginine-insulin/L-DOPA) tests and overnight GH studies (every 20 min sampling) were performed in 104 healthy short children (32 girls), aged 3-16 yr (height, -1.8 or more SD). IGFBP-3 had no advantage over IGF-I in screening sensitivity or specificity. IGF-I correlated with mean nighttime GH. Both IGF-I and IGFBP-3 correlated with peak stimulated GH. To identify more than 90% of children with GH deficiency (GHD) and borderline GHD, the mean values for age for IGF-I and IGFBP-3 were required as the cut-off criterion. However, at this criterion, 70% or more of idiopathic short stature (ISS) children would have to undergo testing to identify 90% of GHD or borderline GHD. More stringent criteria (-1.0, -1.64, and -2.0 SD) were more specific, but lost sensitivity. A practical application is suggested. Screening use of IGF-I with criterion of -1.0 SD would identify a subgroup that includes 88% of GHD, 71% of borderline GHD, and 46% of ISS. Both IGF-I and IGF-BP-3 higher than -1.0 SD would accurately identify 68% of ISS as not needing GH testing. Evaluation of growth velocity would identify the remaining children requiring definitive testing. Thus, combined screening for GHD using both IGF-I and IGFBP-3 has no better sensitivity than either test alone. However, such combined screening will improve the specificity and thus decrease the number of normal but short children who might otherwise undergo unnecessary testing.

Adolescent↗
PubMed1995

Tracheal rupture following blunt chest trauma presenting as endotracheal tube obstruction.

In this report, we describe a patient in whom a tracheal tear followed blunt thoracic trauma. The diagnosis was made late resulting in problems with ventilation, endotracheal tube obstruction and cardiac arrest. Difficulties with early recognition of tracheobronchial injuries may be caused by non-specific findings as well as the lack of exposure of physicians to patients with these injuries. The signs and symptoms of tracheobronchial injuries are described, as well as their differential diagnoses. A review of airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries of the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.

Airway Obstruction↗
PubMed1995

Isolated central hypothyroidism in short stature.

Mild hypothyroidism can be difficult to diagnose, particularly when it is caused by deficiency of TSH or TSH-releasing hormone (TRH). Such central hypothyroidism occurs most often in association with growth hormone deficiency (GHD). Isolated central hypothyroidism has been considered rare. The TSH surge test is the most sensitive test currently available for confirming the diagnosis. Results are abnormal in many cases where response to TRH is normal. Short children referred between 1986 and 1994 for evaluation (n = 235, 74 girls; height 2 or more SD below mean for age; no history of radiation therapy) were selected for study. TSH samples were obtained hourly for study of TSH surge (1400-1800 h and 2200-0400 h). Growth hormone (GH) samples were obtained every 20 min (2000-0800 h). GH stimulation tests included arginine, insulin, and L-dopa. Thirty-nine children were found to have GHD (peak GH < or = 7 micrograms/L) and 15 had mild primary hypothyroidism (TSH 5-15 mU/L). Of the remaining 181 children with apparent idiopathic short stature (ISS), 30 had a blunted TSH surge. All 30 had free thyroxine (FT4) in the lowest third of the normal range, consistent with values seen in documented central hypothyroidism. They were 13% of the total group, 16% of the ISS children, and 32% of the ISS children with FT4 in the lowest third of normal. (In comparison, diagnosis of GHD was made in 16% of the total group.) In conclusion, use of a direct FT4 assay to screen short children for possible subtle hypothyroidism (along with other appropriate testing) identifies a subgroup with a one in three possibility of an easily treated cause--isolated central hypothyroidism.

Analysis of Variance↗
PubMed1995

Thyroid function in non-growth hormone-deficient short children during a placebo-controlled double blind trial of recombinant growth hormone therapy.

GH treatment in GH-deficient children has been reported to cause decreases in serum T4 and TSH and an increase in serum T3. We sought to determine whether GH treatment alters thyroid function in non-GH-deficient short children. Twenty children (18 boys) were followed for 12 months while receiving either GH (Humatrope, Eli Lilly; 0.074 mg/kg, sc, 3 times/week; n = 9) or placebo (n = 11). Total T4, free T4, T3, and TSH were measured every 6 months and in 12 children also at 1, 2, 3, and 9 months. A TRH test and measurement of nocturnal TSH surge were performed at baseline and after 6 months of treatment in 19 subjects. There were no significant differences at baseline in the clinical features between the placebo and GH groups. Total T4, free T4, T3, and TSH levels did not significantly differ between the placebo and GH groups at baseline and at 1, 2, 3, 6, 9, and 12 months. There were no significant differences between the two groups in TSH response to TRH or nocturnal TSH surge. Although an early transient effect of GH treatment could not be excluded, we conclude that GH treatment for 12 months does not produce sustained alterations in thyroid function in non-GH-deficient children.

Body Height↗
PubMed1995

Effects of early cysteamine therapy on thyroid function and growth in nephropathic cystinosis.

Primary hypothyroidism is a known complication of nephropathic cystinosis, a lysosomal storage disorder characterized by renal failure as well as deterioration of other organs. The drug cysteamine depletes lysosomes of cystine and helps preserve renal function and enhance growth in cystinosis patients. To determine whether cysteamine also prevents hypothyroidism, we retrospectively divided 101 patients into group A (n = 28; well treated), group B (n = 26; partially treated), and group C (n = 47; poorly treated). Lifetable analysis indicated a significantly higher probability of remaining free of L-T4 replacement in group A vs. group B (P = 0.09) or group C (P = 0.004). Cysteamine therapy also improved mean height z-scores (-2.17 in group A, -3.04 in group B, and -4.07 in group C) and reduced the bone age deficit (i.e. chronological age minus bone age) by 1.5 yr for every 10 yr of previous cysteamine therapy. We conclude that in addition to its other salutary effects, oral cysteamine therapy helps prevent hypothyroidism and enhances growth in patients with nephropathic cystinosis.

Adolescent↗
PubMed1994

Thyroid function and attention-deficit hyperactivity disorder.

OBJECTIVE: To examine thyroid indices in a community referred sample of boys with attention-deficit hyperactivity disorder (ADHD) for evidence of generalized resistance to thyroid hormone (GRTH). METHOD: TSH, T3, and T4 values were gathered prospectively in 53 physician, school, and/or parent referred ADHD subjects, and in 41 age and gender-matched normal controls. RESULTS: None were in the range suggestive of global or pituitary thyroid hormone resistance. CONCLUSIONS: GRTH is rare, and thyroid function should not be measured routinely in nonfamilial ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing's disease before and after surgical cure.

Growth retardation to complete growth arrest is the hallmark of Cushing's syndrome in children. The major mechanism for this has been considered the glucocorticoid-induced resistance of target tissues to insulin-like growth factor-I (IGF-I) and other growth factors. The purpose of this study was to examine the GH secretory dynamics of patients with Cushing's disease before and up to 12 months after their cure by transsphenoidal adenomectomy. In 14 patients, blood sampling every 20 min over 24 h for determination of plasma GH was performed before and 10-11 days and 3, 6, and 12 months after therapy. These patients also underwent arginine infusion and L-dopa stimulation tests and had measurements of morning baseline GH-binding protein (GHBP), IGF-I, and IGF-binding protein-3 (IGFBP-3) plasma concentrations. Fourteen sex- and pubertal stage-matched normal volunteers were used as controls. Before therapy, the patient group had an increased body mass index (31.5 +/- 5 kg/m2) and markedly decreased plasma mean 24-h GH concentration, mean peak height, and peak area values, with pulse frequency (mean number of peaks) similar to that in the controls. GH values after arginine and L-dopa stimulation were also subnormal in many of these patients, with 2 of 8 and 8 of 10 failing to show GH responses greater than 7 ng/mL in the respective test. In spite of these findings, plasma concentrations of IGF-I, IGFBP-3, and GHBP were within the normal range in these patients. Surprisingly, a pattern of GH suppression similar to that observed in patients with active disease was also seen in patients who were studied 10-11 days and 3, 6, and 12 months after their cure, when their body mass indexes were progressively normalizing, being relatively stable at 10 days, 26.9 +/- 3.8 kg/m2 at 3 months, and 24.8 +/- 3.3 kg/m2 at 12 months. In these patients, plasma IGF-I and GHBP remained normal, whereas IGFBP-3 decreased significantly, albeit within the normal range. The growth rate of 4 patients who were Tanner stage III or below and had not completed their growth at the time of the study increased the year after surgical cure. These findings suggest that patients with Cushing's disease have marked GH suppression during their illness, which, however, does not appear to be a major contributor to the growth suppression observed in this condition. GH hyposecretion continues for at least a year during convalescence, in spite of significant increases in the growth rate in all growing patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Emergency department response to hazardous materials incidents.

Emergency physicians must stay alert to situations that involve toxic chemical exposures. An appropriate response to victims of chemical contamination is important for the victim's outcome and the safety of hospital personnel. Successful management of such a situation requires managing information, resources, and patients with complex medical conditions. Chemical contamination may affect one or hundreds of victims. Community planning is essential for an effective response to toxic chemical accidents (Haz-Mat).

Decontamination↗
PubMed1993

Effect of deslorelin-induced pubertal delay on the growth of adolescents with short stature and normally timed puberty: preliminary results.

LH-releasing hormone agonist (LHRHa) treatment slows bone maturation and improves adult height in children with LHRH-dependent precocious puberty. To determine whether pubertal delay induced by LHRHa can enhance final height in patients with short stature and a normally timed puberty, we enrolled 43 short children (28 girls and 15 boys) in a double blind, placebo-controlled trial. Patients were assigned randomly to receive either placebo or LHRHa (deslorelin), administered sc at a dose of 4 micrograms/kg.day for a period of 4 yr. This report describes the preliminary results in 16 children who have completed 4 yr of treatment (9 patients in the deslorelin group and 7 patients in the placebo group). Predicted adult height increased significantly in the deslorelin-treated patients, by 7.6 cm compared to the pretreatment baseline and by 10.3 cm compared to that in the placebo-treated patients (P < 0.005). Four of the 16 patients received concurrent GH treatment (3 among the deslorelin-treated patients and 1 among the placebo-treated patients). Omitting these patients from the analysis did not materially affect the results: predicted adult height in the deslorelin-treated patients increased by 7.2 cm compared to the pretreatment baseline and by 10.9 cm compared to that in the placebo-treated patients (P < 0.005). We conclude that pubertal delay induced by deslorelin significantly increases predicted adult height in adolescents with short stature and a normally timed puberty. Whether deslorelin treatment will increase the final height of these patients cannot be determined until they have stopped growing.

Adolescent↗
PubMed1992

Myalgia and elevated creatine kinase activity associated with subcutaneous injections of diluent.

A 16-year-old boy with short stature and mild primary hypothyroidism received subcutaneous injections of either recombinant human growth hormone or placebo in diluent that contained glycerol and m-cresol as a preservative. While he was receiving the study drug, myalgia developed and serum creatine kinase values were elevated. Both resolved when injections were stopped and recurred when injections of diluent alone were given. The myalgia and elevated creatine kinase activity were apparently caused by a component of the diluent.

Adolescent↗