Normal bone mineral content but unfavourable muscle/fat ratio in Klinefelter syndrome

OBJECTIVE

To evaluate body composition and bone mineral content (BMC) in children and adolescents with Klinefelter syndrome (KS).

DESIGN

Retrospective cross-sectional study.

SETTING

Tertiary endocrine clinic at the University Hospital, Copenhagen.

PATIENTS

Eighteen untreated boys with KS and six boys with KS receiving androgen substitution with a median age of 11.0 years (range 4.3-18.6) participated in the study.

INTERVENTION

Dual energy x ray absorptiometry and anthropometric measurements were analysed.

MAIN OUTCOME MEASURES

Lumbar and whole body BMC, lean body mass (LBM), body fat mass (BFM), body fat percentage (BF%), height and body mass index (BMI) were compared between treated and untreated boys with KS and compared to normal age-matched boys.

RESULTS

LBM (untreated -0.3 (-2.4 to +2.1) and treated +1.1 (-1.6 to +2.1)) was normal, while BFM (untreated +0.5 (-1.0 to +2.3), p = 0.02 and treated +1.6 (-0.2 to +2.4), p = 0.01) was significantly increased, all expressed as standard deviation scores. Lumbar bone mineral density (BMD; untreated -0.4 (-3.1 to +0.9) and treated +1.0 (-1.4 to +3.0)) and whole body BMC (untreated +0.1 (-1.8 to +3.3) and treated +1.5 (-1.1 to +2.5)) were normal.

CONCLUSION

We found significantly increased BFM and BF% despite normal LBM, suggesting the presence of an unfavourable muscle/fat ratio. Lumbar BMD and whole body BMC were normal. These findings suggest that the unfavourable metabolic profile seen in adult KS may already be present in childhood as evidenced by the increased fat mass, whereas the reported low BMD seems to develop after puberty.

Bone mineral status in 134 patients with cystic fibrosis

AIM

To investigate bone mineral status in patients with cystic fibrosis (CF).

PATIENTS AND METHODS

Whole body bone mineral content (BMC), projected bone area, and bone mineral density (BMD) were determined by dual energy x ray absorptiometry in 134 patients with CF and compared with 396 healthy controls.

RESULTS

In patients </= 19 years of age, BMD for age was normal in boys and marginally reduced in girls, whereas BMC for age was significantly reduced in both sexes. Height for age and bone area for height were significantly reduced, indicating "short" and "narrow" bones, whereas BMC for bone area was increased, indicating increased size corrected BMC. In patients > 19 years of age, BMD and BMC for age were significantly reduced.

CONCLUSION

Short and narrow bones were the main reasons for reduced BMC for age in patients </= 19 years of age, indicating that treatment to prevent osteoporosis in younger patients should be directed at increasing bone size, whereas conventional treatment with calcium and vitamin D supplementation alone might not be as effective. Because of the significant decrease in BMD and BMC in adult patients, we fear that these patients may develop osteoporotic fractures prematurely.

Breast cancer histology in Caucasians, African Americans, Hispanics, Asians, and Pacific Islanders

STUDY OBJECTIVES

To investigate the association between race/ethnicity and histologic types of breast cancer.

DESIGN

Cross-sectional study.

SETTING

Population-based data from the Northern California Tumor Registry, which is part of the National Cancer Institute's Surveillance, Epidemiology and End Results Program.

PARTICIPANTS

A total of 2759 breast cancer cases diagnosed in 1988.

MAIN RESULTS

Tumors were classified as ductal, lobular, and mixed/unspecified carcinoma. Ductal carcinoma was the most common (83.6%) and lobular carcinoma was the rarest. Most cases were diagnosed in the localized stage (56.3%). Caucasian women had the highest rates of total breast cancer (240.9/100,000), ductal and lobular. In African-American women, the odds of ductal carcinoma were twice that of lobular carcinoma, compared with Caucasian women (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.0-3.9) after adjusting for age, site, and stage at diagnosis. Similarly, Asian and Hispanic women also had higher, non-statistically significant odds of ductal versus lobular carcinoma compared with Caucasians (OR = 1.8 [95% CI 0.9-3.7] and 1.6 [95% CI 0.8-3.4], respectively).

CONCLUSIONS

Future studies should investigate how racial/ethnic differences in histology among breast cancer patients will influence life expectancy, against a backdrop of health care access, sociocultural issues, lifestyle habits, reproductive history, family history, and tumor characteristics.

Trauma among Hispanic children: a population-based study in a regionalized system of trauma care

We studied 1164 injured Hispanic and 2560 injured non-Hispanic White children newborn through 14 years triaged to the San Diego County Regionalized Trauma System from 1985 through 1990. Incidence rates did not differ by ethnic group. Hispanic children were more likely to be struck as pedestrians (odds ratio [OR] = 1.5) and less likely to be injured in falls (OR = 0.7) than non-Hispanic White children. For motor vehicle and pedal cycle injuries, Hispanic children were more likely not to have been restrained by seatbelts (OR = 4.0) or car seats (OR = 3.7).

Validation of a new instrument for determining migraine prevalence: the UCSD Migraine Questionnaire

To provide a reliable instrument for use in large population surveys, we developed a short questionnaire based on existing International Headache Society diagnostic criteria and administered the questionnaire to 50 consecutive patients seeking evaluation at a university-based headache clinic. A single neurologist subsequently examined all patients. Based only on the questionnaires, reviewers scored each patient as having migraine with aura, migraine without aura, or nonmigrainous headache. High predictive validity and low interobserver variability between the examining neurologist and the independent reviewers suggest that the questionnaire may be quite useful as a survey instrument.

A comparative study of the psychosocial assets of adults with cystic fibrosis and their healthy peers

Psychosocial assets of 37 adults with cystic fibrosis (CF) and 46 of their healthy peers were assessed by mailed questionnaire. Major sociodemographic variables did not differ significantly between the two groups, nor did indices of emotional social support, social network density, self-esteem, or current life satisfaction. This study revealed adults with CF to function on a par with their healthy peers in nearly all respects, a finding at odds with those from uncontrolled studies and which suggests to us that many previous conclusions about the psychosocial health of adults with CF have been unwarranted. Future psychosocial studies involving patients with CF should include control groups and inferences about the effect of these patients' physical illness on their psychosocial health should not be made in the absence of normative data.