Improvement of scleredema associated with IgA multiple myeloma after chemotherapy

The presence of a monoclonal gammopathy in patients with chronic scleredema is a recently described, unusual association of unknown significance. There have been very occasional reports of multiple myeloma in such patients. We now report a patient with long-standing scleredema who developed an IgA-kappa multiple myeloma. Once chemotherapy for the myeloproliferative disorder was instituted, scleredema improved significantly, suggesting a pathogenetic link between the two conditions.

Sclerosteosis in a Spanish male: first report in a person of Mediterranean origin

We report the first observation of sclerosteosis in Spain. To the best of our knowledge, this is the first case of sclerosteosis in a person of Mediterranean origin with no known Dutch ancestors. He has the characteristic phenotype of the disease with right facial nerve palsy and syndactyly and the typical radiological features, including generalised bone sclerosis and cortical widening of the tubular bones.

Priming with GHRH (1-29) NH2: an aid in differential diagnosis between hypothalamic and pituitary deficiencies

More than 80% of children with growth hormone deficiency (GHD) respond with a rise in growth hormone levels when given 1 microgram/kg body weight of growth hormone-releasing hormone (GHRH) in an i.v. bolus. We conducted a study to determine whether the failure of the remaining 20% to respond to GHRH is due to a pituitary deficiency or a secondary effect associated with chronically understimulated somatotrophs. We administered GHRH to "prime" 16 short-statured children (> 2 SD) presenting delayed growth (< 4 cm/year), who had not responded initially when given a single dose of GHRH. Priming consisted of administering GHRH (1-29) NH2 (5 micrograms/kg body weight, s.c.) for six consecutive days. Plasma GH response was studied again after an i.v. injection of 1 microgram/kg body weight of GHRH (1-29) NH2 on the seventh morning. On the basis of these results we were able to separate our patients into two groups: a) responders to priming (n = 8), whose GH responses to pharmacological and acute GHRH tests were < 10 ng/ml, with a 12-hour sleep secretion < 3 ng/ml/min. Priming increased the plasma GH response to acute GHRH in all the children in this group (6.0 +/- 2.1 ng/ml to 18.0 +/- 5.4 ng/ml; p < 0.001); b) non-responders to priming (n = 8), whose GH responses to pharmacological and acute GHRH tests were also < 10 ng/ml, with 12-hour sleep secretion < 3 ng/ml/min, but in whom priming with GH did not increase the plasma GH response (5.5 +/- 2.8 ng/ml to 6.2 +/- 2.9 ng/ml; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[The costs for a health center in relation to its activities]

OBJECTIVE

To establish a system of attributing costs of Health Centres (HC) in the Primary Care network in function of health care activity.

DESIGN

Crossover study with a descriptive component.

SETTING

Management. Primary Care.

PATIENTS OR OTHER PARTICIPANTS

22 Health Centres open during December 1991 within the Health Area.

MEASUREMENTS AND MAIN RESULTS

Two groups for cost attribution per Health Centre were agreed: articles from Chapter II relating to health care activity and Pharmacy spending-->costs relating to activity (CRA); the remaining articles from Chapter II and Chapter I (staff payments)-->costs not relating to activity (CNRA). Costs relating to activity made up 62.51% of the total cost per HC (2.72% articles from Chapter II and 59.79% Pharmacy). The remaining 37.49% corresponded to costs not relating to activity (1.38% to the remaining articles from Chapter II and 36.11% to staff payments).

CONCLUSIONS

We consider that the attribution of costs in function of the activity per HC is useful for the planning and management of Area resources and assists the application of efficiency criteria in Health Centres.

[Magnetic resonance in Hallevorden-Spatz disease]

The Hallevorden-Spatz disease should be suspected in children or young people with motor, pyramidal or extrapyramidal symptomatology and deterioration of superior functions specially upon the existence of family history. Pathognomonic diagnosis may only be obtained by necropsy but magnetic resonance images, although not pathognomic, are sufficiently characteristics to strongly support the diagnosis. Four cases of Hallevorden-Spatz disease are presented with special emphasis on the MR images characteristic of this disease.

Usefulness of serum apolipoprotein B levels for screening children with primary dyslipoproteinemias

OBJECTIVE

To assess the use of serum apolipoprotein B levels for screening children with primary dyslipoproteinemia (those with elevated levels of low-density lipoprotein cholesterol [LDL-C]) and to know the types of dyslipoproteinemias we can identify.

DESIGN

Criterion standard.

SETTING

Referral center.

PARTICIPANTS

We have studied 267 children. Of these, 31 had parents with dyslipoproteinemia, 38 had parents with ischemic heart disease, and 43 had hypercholesterolemia detected by routine analyses. One hundred fifty-five were considered healthy children and comprised the control group.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Sensitivity was 87% for total serum cholesterol levels and 73% for serum apolipoprotein B levels. Of the children studied, 31 had elevated levels of serum LDL-C. The types of dyslipoproteinemia in children with both elevated levels of serum LDL-C and apolipoprotein B consisted of heterozygous familial hypercholesterolemia, found in 12 (50%) of 24 patients; familial combined hyperlipidemia, found in 11 (46%) of 24 patients; and polygenic hypercholesterolemia, found in one (4%) of 24 patients.

CONCLUSIONS

Serum apolipoprotein B level appears to be a good tool for screening children with elevated levels of LDL-C and is equivalent to using total serum cholesterol levels. In children with elevated serum LDL-C and apolipoprotein B levels, we can identify not only patients with heterozygous familial hypercholesterolemia but also those with familial combined hyperlipidemia or polygenic hypercholesterolemia.

[Arterial pressure in the pediatric population of Zaragoza (Spain) between the ages of 3 and 14]

A study has been performed on the arterial pressure (AP) in a population of healthy children aged 3-14. The study sample was formed by 837 subjects (394 boys and 443 girls) belonging to a middle, middle-low class level according to Graffar methods. Systolic and diastolic arterial pressure data (IV Korotkoff noise) in lie down position, sitting and standing, are obtained and related for both sexes with age, weight and height. Systolic and diastolic AP increased with weight and height in both sexes, specially in children above 6, and in all 3 positions. These values were respectively higher in standing position, being lowest in lie down position. We conclude with the interest of obtaining our own data given the already known influence of geographic, climatic as socioeconomic factors on arterial pressure values.