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At least 451 records · Page 25Linked to original sources
PubMed2006

Human T cells armed with Her2/neu bispecific antibodies divide, are cytotoxic, and secrete cytokines with repeated stimulation.

PURPOSE: Cancer immunotherapy has been limited by anergy of patient T cells, inadequate numbers of precursor tumor-specific CTL, and difficulty in producing therapeutic doses of CTL. To overcome these limitations, bispecific antibodies have been used to create artificial antibody receptors that direct polyclonal activated T cells (ATC) to target tumor antigens. Studies reported herein were designed to characterize bispecific antibody-armed ATC functions during multiple rounds of targeted cell stimulation. EXPERIMENTAL DESIGN: ATCs were generated from human peripheral blood mononuclear cells (PBMC) by culture with anti-CD3 and interleukin 2 for 14 days and armed with anti-CD3 x anti-Her2 bispecific antibody (Her2Bi). In vitro, Her2Bi-armed ATC were examined for a range of functions after repeated stimulation with the Her2/neu-expressing breast cancer cell line SK-BR-3. PBMC isolated from cancer patients treated with Her2Bi-armed ATC were tested ex vivo for cytotoxicity against SK-BR-3. RESULTS: In vitro, armed ATC divided, maintained surface Her2Bi, and expressed a range of activities for extended periods of time. Perforin-mediated cytotoxic activity by armed ATC continued for at least 336 hours, and cytokines and chemokines (i.e., IFN-gamma and regulated on activation, normal T-cell expressed and secreted protein [RANTES]) were secreted during successive rounds of stimulation. Furthermore, PBMC isolated from patients over their courses of immunotherapy exhibited significant cytolytic activity against SK-BR-3 as a function of Her2Bi-armed ATC infusions. CONCLUSIONS: These studies show that armed ATC are specific, durable, and highly functional T-cell populations in vitro. These previously unappreciated broad and long-term functions of armed ATC are encouraging for their therapeutic use in treating cancer.

Antibodies, Bispecific↗
PubMed1998

The use of one-arm crank ergometry in the prediction of upper body aerobic capacity.

OBJECTIVE: To determine whether a submaximal one-arm cranking test could be used to predict an individual's upper body aerobic capacity. This issue has potential importance for the fitness assessment of individuals with neurological disease or damage who have hemiplegia. METHODS: Nine healthy male volunteers (33+/-2.4 years) and nine female volunteers (27+/-1.9 years) performed a two-arm maximal, two-arm submaximal test and a one-arm submaximal arm crank ergometry test. Heart rate (HR) was monitored via a three-lead electrocardiogram (ECG) and expired air was analysed every 30 seconds throughout Prediction of peak oxygen consumption (Vo2peak) was calculated by linear extrapolation to an age-adjusted HRpeak. RESULTS: Heart rate and Vo2 were highly correlated in each test, and there were no significant differences between the Vo2peak values obtained from maximal crank ng and Vo2peak predicted from one- and two-arm submaximal tests for males and females. As expected, males were found to have significantly (p<0.001) higher actual and predicted Vo2peak values, indicating that separate regression equations should be used for males and females. CONCLUSIONS: Heart rate values obtained during one-arm submaximal cranking have the potential to predict arm cranking Vo2peak, and therefore provide an estimation of an individual's aerobic capacity, in addition to those obtained from the more traditional two-arm tests.

Adult↗
PubMed1983

Gerbils in space: performance on the 17-arm radial maze.

In Experiment 1 six hungry gerbils received six trials per day on a 17-arm radial maze. During each trial the subjects were allowed to choose freely among the arms, each of which contained a food pellet, until each arm had been visited once or until eight minutes had elapsed. An error was recorded when the subject entered a previously visited arm. The gerbils quickly learned not to re-enter previously visited arms and generally made errors on fewer than 15% of entries, performance comparable to that of the rat and superior to that of other species tested in the radial arm maze. The intertrial-interval duration did not affect accuracy of arm choices during acquisition but did influence asymptotic accuracy. Accuracy did not change systematically over the six trials. A high proportion of arm entries were to nearby arms. Errors occurred most often towards the end of a trial. Odor cues were not important. When the number of trials per day was reduced from six to one, accuracy deteriorated slightly. In Experiment 2 neither the transposition of extramaze cues nor the placement of the maze in a different room had large disruptive effects on accuracy. In Experiment 3 the addition of three explicit intramaze brightness cues aided accuracy, perhaps by permitting the subjects to decompose the large maze into three smaller mazes, although there was no direct evidence that this was the case. Implications of a number of these results for models of spatial maze performance were discussed.

Animals↗
PubMed2005

Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures.

BACKGROUND: The use of mobile fluoroscopic devices during orthopaedic procedures is associated with substantial concern with regard to the radiation exposure to surgeons and support staff. The perceived increased risks associated with large c-arm devices have been well documented. However, no study to date has documented the relative radiation risk associated with the use of a mini-c-arm device. The purpose of the current study was to determine the amount of radiation received by the surgeon during the use of a mini-c-arm device and to compare this amount with documented measurements associated with the large c-arm device. METHODS: With use of a radiation dosimeter, measurements were carried out with tissue-equivalent anthropomorphic phantoms to quantitatively determine exposure rates at various locations and distances from the mini-c-arm for two common upper and lower extremity procedures. RESULTS: Regardless of position, distance, or relative duration of exposure, exposure rates resulting from the use of the mini-c-arm device were one to two orders of magnitude lower than those reported in the literature in association with the use of the large c-arm device. CONCLUSIONS: The mini-c-arm device should be utilized whenever feasible in order to eliminate many of the concerns associated with use of the large c-arm device, specifically those related to cumulative radiation hazards, positioning considerations, relative distance from the beam, and the need for protective shielding.

Diagnostic Imaging↗
PubMed2006

Patterns of motor activity in the isolated nerve cord of the octopus arm.

The extremely flexible octopus arm provides a unique opportunity for studying movement control in a highly redundant motor system. We describe a novel preparation that allows analysis of the peripheral nervous system of the octopus arm and its interaction with the muscular and mechanosensory elements of the arm's intrinsic muscular system. First we examined the synaptic responses in muscle fibers to identify the motor pathways from the axial nerve cord of the arm to the surrounding musculature. We show that the motor axons project to the muscles via nerve roots originating laterally from the arm nerve cord. The motor field of each nerve is limited to the region where the nerve enters the arm musculature. The same roots also carry afferent mechanosensory information from the intrinsic muscle to the axial nerve cord. Next, we characterized the pattern of activity generated in the dorsal roots by electrically stimulating the axial nerve cord. The evoked activity, although far reaching and long lasting, cannot alone account for the arm extension movements generated by similar electrical stimulation. The mismatch between patterns of activity in the isolated cord and in an intact arm may stem from the involvement of mechanosensory feedback in natural arm extension.

Animals↗
PubMed2001

The use of the amplification refractory mutation system (arms) in the detection of rare beta-thalassemia mutations in the Malays and Chinese in Malaysia.

Molecular characterization and prenatal diagnosis for beta-thalassemia can be carried out using the Amplification Refractory Mutation System (ARMS). The ARMS is a rapid and direct molecular technique in which beta-thalassemia mutations are visualized immediately after DNA amplification by gel electrophoresis. In the University of Malaya Medical Center, molecular characterization and prenatal diagnosis for beta-thalassemia is carried out using ARMS for about 96% of the Chinese and 84.6% of the Malay patients. The remaining 4% and 15.4% of the uncharacterized mutations in the Chinese and Malay patients respectively are detected using DNA sequencing. DNA sequencing is an accurate technique but it is more time-consuming and expensive compared with the ARMS. The ARMS for the rare Chinese beta-mutations at position -29 (A-->G) and the ATG-->AGG base substitution at the initiator codon for translation in the beta-gene was developed. In the Malays, ARMS was optimized for the beta-mutations at codon 8/9 (+G), Cap (+1) (A-->C) and the AATAAA-->AATAGA base substitution in the polyadenylation region of the beta-gene. The ARMS protocols were developed by optimization of the parameters for DNA amplification to ensure sensitivity, specificity and reproducibility. ARMS primers (sequences and concentration), magnesium chloride concentration, Taq DNA polymerase and PCR cycling parameters were optimized for the specific amplification of each rare beta-thalassemia mutation. The newly-developed ARMS for the 5 rare beta-thalassemia mutations in the Chinese and Malays in Malaysia will allow for more rapid and cost-effective molecular characterization and prenatal diagnosis for beta-thalassemia in Malaysia.

Base Sequence↗
PubMed1993

Self-assembly and calcium-binding sites in laminin. A three-arm interaction model.

Laminin, a four-arm glycoprotein, polymerizes in vitro into networks similar to those found in basement membranes. We have dissected this calcium-dependent assembly by analyzing proteolytic fragment binding using equilibrium gel filtration, ultracentrifugation, and electron microscopy. The cathepsin G fragment C1-4 (three short arms) was found to aggregate with a critical concentration similar to that for laminin. Like laminin polymerization, this assembly was inhibited by the smaller elastase short arm fragments E4 (B1 domains VI and V) and E1' (A-B2 short arm complex). Fragment E4 bound directly to E1' in a calcium-dependent manner (KD = 1.4 microM). In contrast, homologous self-interactions of short arm fragments and all interactions of long arm fragments were considerably weaker or nonexistent. While electron micrographs of E1' or E4 alone contained mostly monomers, those of E1'/E4 mixtures contained dimers and oligomers with E1' dimers connected to each other through their A and B2 arms, often with visible E4 molecules at their junctions. 45Ca2+ bound principally to fragment E1' with localization to the end of the B2 chain. These data support a model in which polymerization requires the interaction of all three ligands, one from each short arm, with calcium activating assembly by binding to the B2 short arm.

Amino Acid Sequence↗
PubMed1989

Saccadic reaction times, eye-arm coordination and spontaneous eye movements in normal and MPTP-treated monkeys.

The oculomotor performance of monkeys was investigated before and after destruction of nigrostriatal dopamine neurons by MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine). Stimulus-triggered saccades and their relationships to arm movements were measured in a reaction time task. Spontaneous eye movements were recorded while monkeys sat in a primate chair and looked around the laboratory without performing any task. In the reaction time task, saccades and arm movements were commonly triggered by the rapid, visible and audible opening of a small food-containing box which was located at a constant position in front of the animal at eye level. Median saccadic latencies ranged from 68 to 118 ms in intact animals. Saccades were followed by onset of electromyographic (EMG) activity in the extensor digitorum communis and the biceps brachii, the prime mover muscles for the following arm reaching movement. Latencies of stimulus-triggered saccades showed an absence of linear relationship to EMG or arm movement reaction time in intact animals (correlation coefficients of 0.15-0.56). This suggests that eye and arm movements were initiated independently from each other in this experimental situation. Treatment with MPTP resulted in 98-99.5% loss of striatal dopamine in both monkeys. This induced a 29-93% increase in saccadic latency in the reaction time task. The sequential occurrence of saccade, EMG activity and arm movement in each trial was preserved, although intervals between onset of saccades and onsets of EMGs and arm movements were prolonged by 53-173% and 33-679% respectively. Onsets of individual saccades remained uncorrelated with onsets of EMG activity or arm movement. Spontaneous eye movements were strongly reduced in frequency and amplitude after MPTP. Administration of the dopamine precursor L-Dopa increased spontaneous eye movements for less than two hours. The severe deficits in stimulus-triggered and spontaneous saccadic eye movements are oculomotor components of hypokinesia arising after MPTP-induced lesions of the nigrostriatal dopamine system in primates. The data are further evidence for a role of midbrain dopamine neurons in behavioral responsiveness and spontaneous activity.

Animals↗
PubMed2006

Physiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease.

OBJECTIVES: To evaluate the effects of arm exercise with or without support of mechanical ventilation on breathing pattern, respiratory muscle pressure output, and ratings of dyspnea and arm discomfort in difficult-to-wean patients with COPD. DESIGN AND SETTING: Prospective, controlled, physiological study in a respiratory ICU. PATIENTS: Eight tracheostomized difficult-to-wean patients. INTERVENTION: Patients performed an incremental and an endurance arm exercise while breathing through a trach collar or while receiving pressure support ventilation. MEASUREMENTS AND RESULTS: Breathing pattern, mechanics, arterial saturation, heart rate, and subjective ratings of dyspnea and arm discomfort were measured at baseline, at the end, and 30 min after exercise. Exercise during pressure support ventilation was found to result in higher peak workload (incremental testing) than exercise during trach collar. Moreover, compared to incremental and endurance testing during trach collar, incremental and endurance testing during pressure support ventilation resulted in greater tidal volume, and lower respiratory rate, lower pressure output from the respiratory muscles, and lower work of breathing. Exercise-induced worsening of dyspnea and arm discomfort during trach collar was similar to the corresponding values recorded during pressure support ventilation. CONCLUSION: In tracheostomized difficult-to-wean patients with COPD arm exercise performed during unassisted respiration (trach collar) causes greater increases in respiratory rate and in respiratory muscle pressure output than arm exercise performed during pressure support ventilation. Exercise-induced dyspnea and arm discomfort are similar during assisted and nonassisted respiration.

Aged↗
PubMed2001

Three-dimensional head and upper arm orientations during kinematically redundant movements and at rest.

The three rotational degrees of freedom of the head and the upper arm exceed the number needed in a two-dimensional (2-D) facing or pointing task, respectively. Previous studies reported a reduction of the number of degrees of freedom from three to two, with one degree of freedom being a unique function of the other two (Donders' law). This study investigated whether three-dimensional (3-D) orientations of the head and arm are the same at rest and during movement for corresponding pointing or facing directions. Two separate experiments were performed: one focused on head orientations, the other focused on upper arm orientations. We instructed subjects to direct the nose or to point the extended arm in the direction of targets, which appeared in a quasi-random order at 2-s intervals. The head and upper arm orientations at rest were described by a 2-D surface with a scatter less than 3 or 4 degrees, respectively. Both for the arm and the head, orientations started and ended near the 2-D surface, but for a number of the target pairs, the orientations deviated from those predicted by the 2-D surface during movement in a way that was consistent and reproducible for movements between each target pair. For upper arm movements, we often found that deviations of arm orientations from the 2-D surface increased with increasing movement velocity. Such a positive correlation between deviation and movement velocity was not found for head movements. These results clearly indicate violations of Donders' law during movement and argue against several models for movement control found in the literature.

Adult↗
PubMed2002

Hemispheric specialization in the co-ordination of arm and trunk movements during pointing in patients with unilateral brain damage.

During pointing movements involving trunk displacement, healthy subjects perform stereotypically, selecting a strategy in which the movement is initiated with either the hand or trunk, and where the trunk continues after the end of the hand movement. In a previous study, such temporal co-ordination was not found in patients with left-hemispheric brain lesions reaching with either their dominant paretic or with their non-dominant non-paretic arm. This co-ordination deficit may be associated in part with the presence of a lesion in the dominant left hemisphere. If so, then no deficit should be observed in patients with stroke-related damage in their non-dominant right hemisphere moving with their ipsilesional arm. To verify this, 21 right-hand dominant adults (7 who had had a stroke in the right hemisphere, 7 who had had a stroke in the left hemisphere and 7 healthy subjects) pointed to two targets located on a table in front of them in the ipsilateral and contralateral workspace. Pointing was done under three movement conditions: while not moving the trunk, while bending the trunk forward and while bending the trunk backwards. The experiment was repeated with the non-paretic arm of patients with stroke and for the right and left arms of healthy subjects. Kinematic data were recorded (Optotrak). Results showed that, compared to healthy subjects, arm-trunk timing was disrupted in patients with stroke for some conditions. As in patients with lesions in the dominant hemisphere, arm-trunk timing in those with lesions in the non-dominant hemisphere was equally more variable than movements in healthy subjects. However, patients with dominant hemisphere lesions used significantly less trunk displacement than those with non-dominant hemisphere lesions to accomplish the task. The deficit in trunk displacement was not due to problems of trunk control or sitting balance since, in control experiments, all subjects were able to move the trunk the required distance, with and without the added weight of the limb. Results support the hypothesis that the temporal co-ordination of trunk and arm recruitment during pointing movements is mediated bilaterally by each hemisphere. However, the difference in the range of trunk displacement between patients with left and right brain lesions suggests that the left (dominant) hemisphere plays a greater role than the right in the control of movements involving complex co-ordination between the arm and trunk.

Adult↗
PubMed2003

Early activation of arm and leg muscles following pulls to the waist during walking.

Many studies have investigated the compensatory reactions in humans elicited during walking when the support surface is perturbed. This has led to the description of characteristic responses generated in the muscles of the legs and torso, and recently the arms. The present study aimed to investigate the compensatory reactions elicited when balance was challenged by a perturbation applied to the waist, to determine to what extent balance corrective responses are generalized across perturbation modalities. A second aim was to characterize the arm responses elicited by the perturbations applied to the waist. We measured muscle activity of the left arm and leg following application of backward pulls of the waist while the subjects walked on a motorized treadmill. This resulted in robust activation of tibialis anterior and vastus lateralis, with co-activation of soleus and biceps femoris also evident when perturbations were applied at heel strike. These early responses occurred with a distal to proximal temporal organization. The responses in the leg muscles displayed a phase-dependent modulation in amplitude, decreasing in amplitude later in the stance phase. Leg muscle responses were not evident during the swing phase, except for the end of swing, just prior to heel strike. Arm muscle responses were observed in all subjects; however, the pattern of the arm responses varied considerably between subjects. Generally, shoulder muscles were more likely to respond than elbow muscles, at latencies consistent with the leg responses. Two important conclusions are drawn from the present study. First, the responses evoked in the legs with a pull to the waist are very similar to what has been reported for perturbations of the support surface, despite the very different locus of the perturbation. This suggests that balance control during walking may be achieved by preprogrammed reactions or synergies, which are triggered by multiple sensory cues. Second, rapid arm actions are integrated with these leg responses. However, the arm responses are more flexible, likely reflecting the fewer constraints imposed upon the actions of the arms, compared to the legs, during normal locomotion.

Abdominal Muscles↗
PubMed2005

Concurrent adaptations of left and right arms to opposite visual distortions.

Previous research has shown that subjects can adapt with either arm to an opposite visual distortion, and the two adaptive states can then be used in sequence to control the respective arm. To extend this finding, we exposed the left and right arms of our subjects to opposite-directed rotations of the visual field alternately for 20 s each, and determined the time-course of adaptation, as well as aftereffects without visual feedback under uni- and bimanual conditions. Our data confirm that two adaptive states can co-exist in the sensorimotor system, one for each arm. We further found that the time-course of adaptive improvement was similar for both arms, that the improvement was present as early as the first movement after a change of arm and discordance, and that the magnitude of adaptation was similar to control data yielded by a single arm and discordance. Taken together, these findings suggest that the two adaptive states were formed concurrently, and without mutual interference. We also observed significant aftereffects. They were smaller but still appreciable under bimanual conditions; the two arms moved at the same time in different directions even though they were aimed at a common visual target. This outcome indicates that the two adaptive states were not merely of a strategic nature, but rather changed the rules by which sensory information was transformed into motor outputs; it also suggests that the two states not only co-exist, but can also be engaged concurrently in movement control. The reduced aftereffects observed under bimanual conditions can be attributed to the well-known phenomenon of bimanual coupling, which is unrelated to adaptation.

Adaptation, Physiological↗
PubMed2005

On the nature of the vestibular control of arm-reaching movements during whole-body rotations.

Recent studies report efficient vestibular control of goal-directed arm movements during body motion. This contribution tested whether this control relies (a) on an updating process in which vestibular signals are used to update the perceived egocentric position of surrounding objects when body orientation changes, or (b) on a sensorimotor process, i.e. a transfer function between vestibular input and the arm motor output that preserves hand trajectory in space despite body rotation. Both processes were separately and specifically adapted. We then compared the respective influences of the adapted processes on the vestibular control of arm-reaching movements. The rationale was that if a given process underlies a given behavior, any adaptive modification of this process should give rise to observable modification of the behavior. The updating adaptation adapted the matching between vestibular input and perceived body displacement in the surrounding world. The sensorimotor adaptation adapted the matching between vestibular input and the arm motor output necessary to keep the hand fixed in space during body rotation. Only the sensorimotor adaptation significantly altered the vestibular control of arm-reaching movements. Our results therefore suggest that during passive self-motion, the vestibular control of arm-reaching movements essentially derives from a sensorimotor process by which arm motor output is modified on-line to preserve hand trajectory in space despite body displacement. In contrast, the updating process maintaining up-to-date the egocentric representation of visual space seems to contribute little to generating the required arm compensation during body rotations.

Adaptation, Physiological↗
PubMed2006

Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs).

BACKGROUND: PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move. OBJECTIVE: To evaluate the influence of arm movement on the central tip location of PICCs placed in children. MATERIALS AND METHODS: The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement. RESULTS: The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90 degrees . CONCLUSION: Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.

Adolescent↗
PubMed2004

Kinetics of oxygen uptake during arm cranking with the legs inactive or exercising at moderate intensities.

The purpose of this study was to compare the kinetics of oxygen uptake (VO(2)) during arm cranking with the legs inactive or exercising. Each subject (n = 8) performed three exercise protocols: 6-min arm cranking at an intensity of 60% of peak oxygen uptake (VO(2peak), AC(60)) and 6-min combined arm cranking and leg cycling in which AC(60) was added to on-going leg cycling at an intensity of 20% or 40% of VO(2peak) (LC(20) and LC(40): AC(60)LC(20) and AC(60)LC(40), respectively). After the onset of arm cranking, VO(2) tended to increase until the end of arm cranking in all of the three exercise modes. The amplitudes of this increase in VO(2) were 0.98 (0.18), 0.93 (0.16) and 0.84 (0.12) l.min(-1) during AC(60), AC(60)LC(20) and AC(60)LC(40), respectively, and there were significant differences between values for each exercise. The data are presented as means and standard deviations. There were no significant differences in the effective VO(2) time constant, partial O(2) deficit, and the difference between the values of VO(2) measured at 3 and 6 min in the three exercise modes. The present results indicate that the amplitude of the increase in VO(2) is reduced during arm cranking with the legs exercising, that this reduction becomes greater with increases in the intensity of leg cycling, and that the rate of increase in VO(2) is not affected by the additional muscle mass of the legs exercising below moderate intensities. The decrease in the amplitude of increase in VO(2) might be caused by reduction in oxygen supply to the exercising arms due to large muscle mass and/or overlaps of activity of stabilizing muscles during combined arm and leg exercise.

Adult↗
PubMed1999

Relative contribution of arms and legs in humans to propulsion in 25-m sprint front-crawl swimming.

Eight male subjects were asked to swim 25 m at maximal velocity while the use of the arm(s) and legs was alternately restricted. Four situations were examined using one arm (1A), two arms (2A), one arm and two legs (1A2L) and both arms and legs (2A2L, normal swim) for propulsion. A significant mean increase of 10% on maximal velocity was obtained in 1A2L and 2A2L compared to 1A and 2A. A non-significant 4% effect was obtained in 1A. This study focused on the actual contribution of leg kick in the 10% gain in maximal velocity. It was clear that the underwater trajectory of the wrist was modified by the action of the legs (most comparisons P < 0.001). Therefore it was thought that the legs enhanced the generated propulsive force by improving the propulsive action of the arm. The arm action was quantified by selecting typical phases from the filmed trajectory of the wrist, namely forward (F), downwards (D) and backwards (B). Although there was a tendency for individual changes in kinematic parameters (F, D and B) to occur with individual changes in velocity when 2A was compared to 2A2L, no relationship was found between the relative changes in F, D and B and relative changes in velocity. This was illustrated by describing the responses of three individuals who could represent three patterns of contribution by legs and arms to propulsion in high speed swimming.

Arm↗
PubMed1998

Arm span, serum IGF-1 and IGFBP-3 levels as screening parameters for the diagnosis of growth hormone deficiency in patients with myelomeningocele--preliminary data.

UNLABELLED: Short stature is a common problem in patients with myelomeningocele (MMC) and hydrocephalus. We evaluated auxological and laboratory parameters to differentiate short stature due to neurological defect from short stature additionally caused by growth hormone deficiency (GHD). In a group of 38 prepubertal patients with MMC and hydrocephalus aged 3.8-11.0 years, auxological parameters, including arm span and bone age, and serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were measured. Patients with normal supine length (n = 15) had normal arm span. Serum IGF-1 and IGFBP-3 levels were normal (> or = 10th percentile) in 14/15 patients. Twenty-three MMC patients had short stature (height SDS < -2), 11/23 patients had reduced arm span (SDS < -2), and 12/23 had normal arm span. Serum IGF-1 and IGFBP-3 levels were normal in 10/12 of short statured patients with normal arm span, but low (< 10th percentile) in those patients with reduced arm span (IGF-1: 8/11 patients, P < 0.05; IGFBP-3: 9/11 patients, P < 0.005). In 7/11 short statured MMC patients with reduced arm span and low serum IGF-1 and IGFBP-3 levels, growth hormone secretion was investigated. All had a disturbed growth hormone secretion (GHD: n = 4; neurosecretory dysfunction: n = 3). CONCLUSION: Arm span, serum IGF-1 and IGFBP-3 levels are estimated to be appropriate screening parameters for GHD in patients with MMC. Initiating growth hormone therapy should be considered not only according to endocrine findings but also with respect to neurological and orthopaedic anomalies.

Arm↗