Growth Rate In Patients Research Articles

A hypothesis about the potential role of statin administration as adjuvant treatment in the management of Merlin-deficient tumors

Merlin, a tumor suppressor protein, controls essential steps of cell cycle, and its deficiency results in cellular overgrowth, proliferation, angiogenesis, invasion and metastasis. Lack of Merlin is responsible for neurofibromatosis-2, most schwannomas, and many meningiomas and ependymomas. We hypothesize that there is a role for statins to ameliorate Merlin's deficiency in this set of tumors by inhibiting a number of Merlin's downstream effectors, the small Rho-GTP-ases, and we present the relevant data. The ultimate goal is to offer a medical therapy promising to halt or reduce the tumor growth-rate in patients harboring Merlin-deficient neoplasms and to provide an adjuvant systemic therapy for patients undergoing stereotactic radio-surgery and partial tumor resection.

Volumetric tumor growth in advanced non‐small cell lung cancer patients with EGFR mutations during EGFR‐tyrosine kinase inhibitor therapy

BACKGROUNDThe objective of this study was to define the volumetric tumor growth rate in patients who had advanced nonsmall cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations and had initially received treatment with EGFR‐tyrosine kinase inhibitor (TKI) therapy beyond progression.METHODSThe study included 58 patients with advanced NSCLC who had sensitizing EGFR mutations treated with first‐line gefitinib or erlotinib, had baseline computed tomography (CT) scans available that revealed a measurable lung lesion, had at least 2 follow‐up CT scans during TKI therapy, and had experienced volumetric tumor growth. The tumor volume (in mm3) of the dominant lung lesion was measured on baseline and follow‐up CT scans during therapy. In total, 405 volume measurements were analyzed in a linear mixed‐effects model, fitting time as a random effect, to define the growth rate of the logarithm of tumor volume (logeV).RESULTSA linear mixed‐effects model was fitted to predict the growth of logeV, adjusting for time in months from baseline. LogeV was estimated as a function of time in months among patients whose tumors started growing after the nadir: logeV = 0.12*time + 7.68. In this formula, the regression coefficient for time, 0.12/month, represents the growth rate of logeV (standard error, 0.015/month; P < .001). When adjusted for baseline volume, logeV0, the growth rate was also 0.12/month (standard error, 0.015/month; P < .001; logeV = 0.12*months + 0.72 logeV0 + 0.61).CONCLUSIONSTumor volume models defined volumetric tumor growth after the nadir in patients with EGFR‐mutant, advanced NSCLC who were receiving TKI, providing a reference value for the tumor growth rate in patients who progress after the nadir on TKI therapy. The results can be studied further in additional cohorts to develop practical criteria to help identify patients who are slowly progressing and can safely remain on EGFR‐TKIs. Cancer 2013;119:3761–3768. © 2013 American Cancer Society.

Results of growth hormone substitution therapy in children with brain tumours

Aim of the study. To estimate the effectiveness and safety of substitution therapy with growth hormone (GH) in children with various brain tumours. Materials and methods. The study involved 68 patients admitted to N.N. Burdenko Institute of Neurosurgery between 2001 and 2011 including 35 ones with craniopharyngioma, 18 with medulloblastoma, and 15 with germ cell tumours (GCT) in the chiasmosellar region. All patients suffered growth hormone insufficiency and received GH replacement therapy. Their antropometric characteristics (height and growth rate) and IGF-1 levels were measured before, 6 and 12 months after the onset of the treatment. The doses of GH varied from 0.03 to 0.034 mg/kg/day. Results. The substitution therapy with GH resulted in an increase of the growth rate in patients with craniopharyngioma from 2.3±1.6 to 9.4±1.9 cm/year (p<0.001), in those with GCT from 1.2±0.9 to 7.4±2.6 cm/year (p=0.01), and in patients with medulloblastoma from 2.3±1.5 to 6.2±2.6 cm/year (p<0.01). The growth rate in patients treated by spinal irradiation was lower than that in those given no such treatment (6.0±2.3 cm/year and 9.2±2.1 cm/year respectively; p<0.001). The tumour recurred in eight of 35 (23%) patients with craniopharyngioma during GH therapy. The frequency of relapses was not significantly different from that in patients who did not receive growth hormone. Patients with medulloblastoma and GCT did not develop relapses. No adverse reactions to GH therapy were documented in this study.

Abstract 4571: Autologous TARP peptide vaccination is associated with slowing in PSA velocity and a decrease in tumor growth rate in patients with Stage D0 prostate cancer.

Abstract Background: T-cell receptor alternate reading frame protein (TARP) is a novel, immunogenic 58 amino acid protein that is over-expressed in ∼95% of prostate cancer and ∼50% of breast cancer specimens and hence is a good candidate for therapeutic vaccination. In mice the immunogenicity of HLA-A*0201 binding TARP peptides can be improved through epitope-enhancement achieved by amino acid substitutions that result in increased HLA binding affinity. We conducted a first-in-human study to determine the safety and immunogenicity of TARP peptide vaccination and its impact on the velocity of PSA rise (expressed as slope log (PSA) or PSA doubling time (PSADT)) and tumor growth rate in men with Stage D0 prostate cancer. Methods: HLA-A*0201 positive men were randomized to receive epitope-enhanced (29-37-9V) or wild type (27-35) TARP peptides administered as a peptide emulsion with Montanide ISA 51VG plus GM-CSF (Arm A) or as an autologous peptide-pulsed dendritic cell vaccine (Arm B). Vaccines were administered q 3 weeks for a total of 5 vaccines with an optional 6th dose of vaccine at 36 weeks based on immune response or PSADT criteria and a booster dose of vaccine for all patients at 48 and 96 weeks. Results: A total of 41 patients (n = 21 Arm A, n = 20 Arm B) enrolled, with a median on study duration of 75 weeks as of 07/31/12. Baseline cohort characteristics (median): age 62 yrs, PSA 3.44, Gleason Score 7, ALC 1270, CD4%/absolute 42.5%/547 cells/mm3, 25-OH vitamin D level 28, with 30 of 41 (73%) s/p radical prostatectomy and 26 of 41 (63%) s/p EBRT for PSA biochemical recurrence. TARP vaccination was safe and well tolerated with adverse events limited to local injection site reactions < Grade 2. Twenty-eight of 39 patients (72%) reaching 24 weeks and 23 of 31 (74%) reaching 48 weeks were documented to have a decreased slope log PSA compared to their pre-vaccination baseline (p=0.0012 and p=0.0004 for overall changes in slope log PSA, respectively); there was no statistically significant difference between the two arms, although only the DC arm was significant at 48 wks on its own. TARP vaccination also resulted in a 50% decrease in calculated tumor growth rate constant: pre-vaccine g = 0.0042/day, post-vaccine g = 0.0021/day (p=0.003). TARP-specific IFN-γ ELISPOT responses were detected in the majority of subjects but did not correlate with observed decreases in slope log (PSA). Citation Format: Lauren V. Wood, William L. Dahut, Antonio Fojo, James L. Gulley, Ravi Madan, Philip Arlen, Howard L. Parnes, Brenda D. Roberson, Seth M. Steinberg, Masaki Terabe, Julia Wilkerson, Ira Pastan, Jay A. Berzofsky. Autologous TARP peptide vaccination is associated with slowing in PSA velocity and a decrease in tumor growth rate in patients with Stage D0 prostate cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4571. doi:10.1158/1538-7445.AM2013-4571

1067 DELAYED INTERVENTION AND SURVEILLANCE FOR SMALL RENAL MASSES: UPDATE FROM A PROSPECTIVE REGISTRY OF ACTIVE SURVEILLANCE

INTRODUCTION AND OBJECTIVES: A growing body of retrospective literature has emerged regarding active surveillance (AS) for select patients with small renal masses 4.0 cm (SRM). Herein we present interim results of the prospective ‘Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry’ comparing active surveillance and intervention for small renal masses (SRMs). METHODS: Patients were prospectively enrolled into the multiinstitutional IRB approved DISSRM registry study following consultation and choice of AS or intervention. A scoring system (DISSRM score) for suitability of AS was developed based on existing literature and early experience with this registry and includes added points for higher age, ECOG performance status, Charlson Comorbidity Index (CCI), chronic kidney disease (CKD), and smaller tumor size ( 3cm). DISSRM score was calculated for all patients and compared between AS and intervention patients. Disease specific (DSS) and overall survival (OS) data is presented along with growth kinetics of tumors on AS and analysis of cross-over from AS to intervention. RESULTS: At 46 months, 327 patients have enrolled: 226 (69.1%) elected immediate intervention and 101 (30.9%) elected AS; among the latter 16 (4.9%) crossed-over to delayed intervention. Patients undergoing AS were older, had a higher ECOG performance status, worse Charlson Comorbidity Index scores, more hematuria and smaller tumors. DISSRM Score was significantly different between patients undergoing intervention and AS (p 0.015): 84% of patients undergoing intervention had a DISSRM Score 4, 45% of patients undergoing AS had a score 3. At a median follow-up of 18 months (6-42 months), four patients undergoing AS have died (none related to RCC) and none have developed metastases. Average growth rate for patients with 6 months follow-up is 0.10 cm/year ( 2.23 to 2.24). Four patients undergoing immediate intervention have died; one patient undergoing intervention died of RCC recurrence. CONCLUSIONS: This study represents one of the largest prospectively assembled disease registries for patients with a small renal mass. Over 65% of patients with SRM select immediate intervention versus AS in a multi-institutional registry. Progression-free survival and CSS are excellent with intermediate follow-up. The DISSRM Score helps to differentiate patients suitable for AS from those suitable for immediate intervention.

The effect of idursulfase on growth in patients with Hunter syndrome: Data from the Hunter Outcome Survey (HOS)

Hunter syndrome (mucopolysaccharidosis type II) is a rare and life-limiting multisystemic disorder with an X-linked recessive pattern of inheritance. Short stature is a prominent feature of this condition. This analysis aimed to investigate the effects of enzyme replacement therapy with idursulfase on growth in patients enrolled in HOS — the Hunter Outcome Survey which is a multinational observational database. As of Jan 2012, height data before treatment were available for 567 of 740 males followed prospectively after HOS entry. Cross-sectional analysis showed that short stature became apparent after approximately 8years of age; before this, height remained within the normal range. Age-corrected standardized height scores (z-scores) before and after treatment were assessed using piecewise regression model analysis in 133 patients (8–15years of age at treatment start; data available on ≥1 occasion within +/−24months of treatment start; growth hormone-treated patients excluded). Results showed that the slope after treatment (slope=−0.005) was significantly improved compared with before treatment (slope=−0.043) (difference=0.038, p=0.004). Analysis of covariates (age at treatment start, cognitive involvement, presence of puberty at the start of ERT, mutation type, functional classification), showed a significant influence on growth of mutation type (height deficit in terms of z-scores most pronounced in patients with deletions/large rearrangements/nonsense mutations, p<0.0001) and age (most pronounced in the 12–15-year group, p<0.0001). Cognitive involvement, pubertal status at the start of ERT and functional classification were not related to the growth deficit or response to treatment. In conclusion, the data showed an improvement in growth rate in patients with Hunter syndrome following idursulfase treatment.

Abstract 180: The Growth Rate of Early DWI Lesions is Highly Variable and Associated with Penumbral Salvage and Clinical Outcomes Following Endovascular Reperfusion

Background: The degree of variability in the rate of early DWI expansion has not been well characterized. We hypothesized that Target Mismatch patients with slowly expanding DWI lesions have more penumbral salvage and better clinical outcomes following endovascular reperfusion than Target Mismatch patients with rapidly expanding DWI lesions. Methods: This substudy of DEFUSE 2 included all patients with a clearly established time of symptom onset. The initial DWI growth rate was determined from the baseline scan by assuming a volume 0 ml just prior to symptom onset. Target Mismatch patients who achieved reperfusion (&gt;50% reduction in PWI after endovascular therapy), were categorized into tertiles according to their initial DWI growth rates. For each tertile, penumbral salvage (comparison of final volume to the volume of PWI (Tmax &gt; 6 sec)/ DWI mismatch prior to endovascular therapy), favorable clinical response, and good functional outcome (see figure for definitions) were calculated. We also compared the growth rate in patients with the Target mismatch vs. Malignant Profile. Results: 64 patients were eligible for this study. Target mismatch patients (n=44) had initial growth rates (range 0 to 43 ml/hr, median of 3 ml/hr) that were significantly less than the growth rates in Malignant profile (n=7) patients (12 to 92 ml/hr, median 39 ml/hr; p &lt; 0.001). In Target mismatch patients who achieved reperfusion (n=30), slower early DWI growth rates were associated with better clinical outcomes (p&lt;0.05) and a trend toward more penumbral salvage (n=27, p=0.137). Conclusions: The growth rate of early DWI lesions in acute stroke patients is highly variable; Malignant profile patients have higher growth rates than other MRI profiles. Among Target Mismatch patients, a slower rate of DWI growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.

Natural history of multiple meningiomas

Background:Asymptomatic solitary meningiomas are typically managed with clinical and radiographic follow-up. Multiple meningiomas represents a clinical entity distinct from solitary meningiomas and can be sporadic, radiation-induced, associated with neurofibromatosis, or exhibit other familial inheritance. The growth rate for multiple meningiomas is not known and therefore management of these complicated patients can be difficult.Methods:A retrospective chart review was performed on 12 patients with a total of 55 meningiomas. Patients with neurofibromatosis were not included. Serial enhanced magnetic resonance imaging was used to determine tumor growth rates. Treatment history was also reviewed and included for analysis.Results:Analysis of all 55 tumors demonstrated an average rate of growth of 0.46 cm3/year (range: −0.57-2.94 cm3/year). In the 23 tumors that received no treatment, the average rate of growth was 0.34 cm3/year (range: −0.03-1.8 cm3/year). Ten of the 23 tumors that received no treatment had no history of cranial irradiation. This group demonstrated a growth rate of 0.44 cm3/year (range: −0.01-1.8 cm3/year). Linear regression analysis did not yield any significant relationship between tumor burden and rates of growth.Conclusion:Tumor growth rates in patients with multiple meningiomas did not appear to be higher than reported rates for incidentally found solitary meningiomas. As such, asymptomatic multiple meningioma patients should be managed with clinical and radiographic follow-up.

Serial 3-Dimensional Volumetric Computed Tomography Evaluation of Lung Cancer Growth Rate in Patients With Chronic Obstructive Pulmonary Disease Findings

The objectives of this study were to compare volume doubling time (VDT) of lung cancer with chronic obstructive pulmonary disease (COPD) findings with that without COPD findings using serial 3-dimensional (3D) volumetric computed tomography (CT) and to investigate the association between VDT and COPD findings. This study included 45 patients with surgically diagnosed non-small cell lung cancer with serial preoperative follow-up CT. Volume doubling time of the nodule was calculated by using 3D volumetric computer software. Volume doubling time of lung cancer with COPD findings (n = 26) tended to be shorter than that without COPD findings (n = 19) (998 ± 2178 vs 2226 ± 6748 days; P = 0.066). Among COPD findings, severity and pattern of emphysema were significantly correlated with VDT (P < 0.001). Volume doubling time of lung cancer with COPD findings on 3D volumetric CT tended to be shorter than that of lung cancer without COPD findings. Severe or paraseptal emphysema may be associated with short VDT of lung cancer with COPD findings.

Growth of breast cancer recurrences assessed by consecutive MRI

BackgroundWomen with a personal history of breast cancer have a high risk of developing an ipsi- or contralateral recurrence. We aimed to compare the growth rate of primary breast cancer and recurrences in women who had undergone prior breast magnetic resonance imaging (MRI).MethodsThree hundred and sixty-two women were diagnosed with breast cancer and had undergone breast MRI at the time of diagnosis in our institution (2005 - 2009). Among them, 37 had at least one prior breast MRI with the lesion being visible but not diagnosed as cancer. A linear regression of tumour volume measured on MRI scans and time data was performed using a generalized logistic model to calculate growth rates. The primary objective was to compare the tumour growth rate of patients with either primary breast cancer (no history of breast cancer) or ipsi- or contralateral recurrences of breast cancer.ResultsTwenty women had no history of breast cancer and 17 patients were diagnosed as recurrences (7 and 10 were ipsi- and contralateral, respectively). The tumour growth rate was higher in contralateral recurrences than in ipsilateral recurrences (growth rate [10-3 days-1] 3.56 vs 1.38, p < .001) or primary cancer (3.56 vs 2.09, p = 0.01). Differences in tumour growth were not significant for other patient-, tumour- or treatment-related characteristics.ConclusionsThese findings suggest that contralateral breast cancer presents accelerated growth compared to ipsilateral recurrences or primary breast events.

The Association of Metabolic Syndrome and Its Components with Serum Prostate-Specific Antigen Levels in a Korean-Screened Population

Metabolic syndrome plays a potential role in the etiology of prostate cancer and is associated with the increase in prostatic growth rate in patients with benign prostatic hyperplasia. However, the influence of metabolic syndrome on prostate-specific antigen (PSA) level remains unclear. Data were obtained from 23,601 men ages 40 years or older without a history of prostate cancer who underwent general health screening tests between 2006 and 2007 at Asan Medical Center. The criteria for metabolic syndrome were consistent with those defined by the NCEP-ATPIII-AHA/NHLBI statement. Multivariate linear regression analysis was used to determine the independent effects of age, body mass index (BMI), metabolic syndrome, and each component of metabolic syndrome, on PSA level. Geometric mean PSA level increased linearly and significantly with increasing age and decreasing BMI (P < 0.001). Although the geometric mean PSA levels were lower in men with metabolic syndrome than in those without the condition, metabolic syndrome no longer retained a statistically significant association with PSA after the adjustment for age and BMI (P = 0.850). Among five metabolic components, higher waist circumference and fasting plasma glucose level were significantly associated with lower PSA (P = 0.021 and P = 0.001), whereas hypertension was significantly associated with higher PSA (P < 0.001), after complete adjustment for age, BMI, and other metabolic components. In our screened population, metabolic syndrome was not associated with PSA level. The lack of association between metabolic syndrome and PSA level may reflect the heterogeneous relationship between each metabolic risk factor and PSA level.

Effect of topical and systemic antibiotics on bacterial growth kinesis in generalized peritonitis in man.

Quantitative bacteriology in peritoneal exudate was studied in 40 patients with generalized peritonitis of small intestinal, appendicular or colonic origin. Bacterial growth kinesis was measured in 28 of the patients. Systemic antibiotics given before operation resulted in a significant reduction in both the concentration and growth rate of viable bacteria in the peritoneal fluid. Lavage of the peritoneal cavity with saline resulted in a further reduction in growth rate in patients given pre-operative systemic antibiotics by an effect attributable to simple dilution. In contrast, peritoneal lavage with tetracycline (1 mg/ml) resulted in complete inhibition of bacterial growth in the residual peritoneal fluid. These observations support the policy of giving systemic antibiotics to patients with generalized peritonitis as soon as the diagnosis has been made and provide bacteriological evidence for the value of peroperative antibiotic peritoneal lavage.

Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal

Extraadrenal paragangliomas of the head and neck are tumors with variable clinical behavior. Because tumor growth as well as surgery can cause disabling loss of function, knowledge of the natural history of paragangliomas is important for the development of treatment strategies. The tumor volume, growth rate, and tumor doubling time of 48 paragangliomas at different anatomic locations in the head and neck region were estimated retrospectively using sequential radiologic imaging. During a mean follow-up period of 4.2 years, a volume increase of > 20% was observed in 60% of the paragangliomas. In these cases the median growth rate was 1.0 mm/year and the median tumor doubling time was 4. 2 years. More growing tumors were observed in intermediate size tumors than in very small or large paragangliomas, suggesting a biphasic growth pattern. The majority of head and neck paragangliomas have a very low growth rate. Although management of paragangliomas also is determined by other parameters, preoperative estimation of the tumor doubling time may influence the treatment proposal. A "wait and scan" policy must be considered in all cases.

Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal

BACKGROUND Extraadrenal paragangliomas of the head and neck are tumors with variable clinical behavior. Because tumor growth as well as surgery can cause disabling loss of function, knowledge of the natural history of paragangliomas is important for the development of treatment strategies. METHODS The tumor volume, growth rate, and tumor doubling time of 48 paragangliomas at different anatomic locations in the head and neck region were estimated retrospectively using sequential radiologic imaging. RESULTS During a mean follow-up period of 4.2 years, a volume increase of > 20% was observed in 60% of the paragangliomas. In these cases the median growth rate was 1.0 mm/year and the median tumor doubling time was 4.2 years. More growing tumors were observed in intermediate size tumors than in very small or large paragangliomas, suggesting a biphasic growth pattern. CONCLUSIONS The majority of head and neck paragangliomas have a very low growth rate. Although management of paragangliomas also is determined by other parameters, preoperative estimation of the tumor doubling time may influence the treatment proposal. A “wait and scan” policy must be considered in all cases. Cancer 2000;88:2811–6. © 2000 American Cancer Society.

Mapping tumor growth rates in patients with malignant gliomas: A test of two algorithms

Mapping tumor growth rates in patients with malignant gliomas: A test of two algorithms

Effect of long-term recombinant growth hormone therapy in children--the National Cooperative Growth Study, USA, 1985-1994.

Over a 9-year period (1985-1994) approximately 20,000 children received recombinant human growth hormone (rhGH) while enrolled in the National Cooperative Growth Study (NCGS), an observational, longitudinal study designed to monitor the long term efficacy and safety of rhGH administered to children in North America. Forty-four percent of the patients had idiopathic growth hormone deficiency (IGHD), 13.8% organic GHD (OGHD), 25% idiopathic short stature (ISS), 9.9% Turner's syndrome (TS), and 7.3% miscellaneous disorders. Eighty-five percent of the patients enrolled were Caucasian, and approximately two-thirds of the non-Turner patients were male. For the subset of patients treated for at least 4 years and who were prepubertal throughout this period (IGHD N=308, OGHD N=93, ISS N=169, TS N=82), mean growth rates increased in all patient categories and remained at or above pretreatment growth rates through 4 consecutive years of therapy with rhGH. Growth rates during administration of rhGH were greater in children in whom the pretreatment maximum stimulated GH concentration was < or =3 microg/l. Patients treated with 6 or 7 doses of rhGH each week grew more rapidly than did those receiving thrice weekly dosages, although the ratios of the increment in bone age to the increment in height age after two years of therapy were similar in the two treatment regimens. For patients treated with rhGH for 7 consecutive years, the mean height standard deviation scores increased by 2.5 in IGHD (N=169), 2.0 in OGHD (N=50), 1.9 in ISS (N=69), and 1.3 in TS (N=19), but remained below target heights in all categories. It is concluded that administration of rhGH increases growth rates in patients with IGHD, OGHD, ISS, and TS, and that this stimulatory effect can persist for at least 4 years.

HIV-1 dynamics after transient antiretroviral therapy: Implications for pathogenesis and clinical management

Simple models of CD4 lymphocyte interactions with human immunodeficiency virus (HIV) lead to the hypothesis that progression of HIV infection involves an increase in viral replicative capacity, due either to changes in the virus or in the host environment, or both. In order to consider how changes in plasma virus load after transient, potent antiretroviral therapy can be used to test the above hypothesis--a simple mathematical model that encompasses the processes of (1) arrival of new CD4 lymphocytes, (2) death/removal of these cells by HIV-independent mechanisms, (3) infection of susceptible CD4 lymphocytes by HIV, and (4) death/removal of infected cells was investigated. This showed that the in vivo rate of increase in plasma virus load immediately after transient therapy provides a measure of the viral replicative capacity. Thus, the hypothesis that progression of HIV infection involves an increase in viral replicative capacity can be tested by measuring this viral growth rate in patients with high CD4 counts and in patients with low CD4 counts. Studies should thus investigate dynamics of changes in virus levels after stopping antiretroviral therapy and, in particular, measure rates of increase in virus in patients at high and low CD4 counts. In practice, such data may assist in therapeutic management of patients with HIV infection.

Age related bladder capacity and bladder capacity growth in children with myelomeningocele.

Currently the relationship between bladder capacity and age in children with myelomeningocele is inadequately understood, such that nomograms derived from neurologically normal children are inappropriately applied to the myelodysplastic population. The aim of the present study was to evaluate age related bladder capacity and bladder capacity growth in children with myelomeningocele, and compare them to those of age matched, neurologically intact children. Bladder capacity was determined by cystometrography in children with myelodysplasia. Regression analysis was used to derive a relationship between bladder capacity and patient age. Data were stratified by sphincter activity, bladder sensation and uninhibited contractions, and regression analysis was repeated. To evaluate serial growth change in bladder capacity divided by time yielded a yearly bladder capacity growth rate in patients who underwent 2 cystometrograms done at least 3 months apart before age 9 years. A total of 506 children satisfied study inclusion criteria. Bladder capacity (BC) was related to age for the first 9 years by the linear equation, BC = 24.5 (age) + 62. This equation is approximately 25% less steep than published age related bladder capacity in neurologically intact children using the formula, 32 (age) + 73. After data stratification bladder capacity in children with sphincter activity, bladder sensation or no uninhibited contractions approached that of neurologically intact children. In contrast, children without sphincter activity or bladder sensation, or with uninhibited contractions had markedly smaller age related bladder capacity. Bladder capacity growth in the subgroup of 55 children in whom 2 cystometrograms were performed at least 3 months apart before age 9 years confirmed a mean gain in capacity of 24 cc per year. Normal bladder capacity in children with myelodysplasia is approximately 25% less than in age matched, neurologically intact children. The bladder grows approximately 24 cc per year until age 9 years. When there is failure to store urine, bladder capacity is much smaller, while children with good storage features may attain the bladder capacity expected of age matched, neurologically intact children.

Age Related Bladder Capacity and Bladder Capacity Growth in Children With Myelomeningocele

Purpose Currently the relationship between bladder capacity and age in children with myelomeningocele is inadequately understood, such that nomograms derived from neurologically normal children are inappropriately applied to the myelodysplastic population. The aim of the present study was to evaluate age related bladder capacity and bladder capacity growth in children with myelomeningocele, and compare them to those of age matched, neurologically intact children. Materials and Methods Bladder capacity was determined by cystometrography in children with myelodysplasia. Regression analysis was used to derive a relationship between bladder capacity and patient age. Data were stratified by sphincter activity, bladder sensation and uninhibited contractions, and regression analysis was repeated. To evaluate serial growth change in bladder capacity divided by time yielded a yearly bladder capacity growth rate in patients who underwent 2 cystometrograms done at least 3 months apart before age 9 years. Results A total of 506 children satisfied study inclusion criteria. Bladder capacity (BC) was related to age for the first 9 years by the linear equation, BC = 24.5 (age) - 62. This equation is approximately 25% less steep than published age related bladder capacity in neurologically intact children using the formula, 32 (age) - 73. After data stratification bladder capacity in children with sphincter activity, bladder sensation or no uninhibited contractions approached that of neurologically intact children. In contrast, children without sphincter activity or bladder sensation, or with uninhibited contractions had markedly smaller age related bladder capacity. Bladder capacity growth in the subgroup of 55 children in whom 2 cystometrograms were performed at least 3 months apart before age 9 years confirmed a mean gain in capacity of 24 cc per year. Conclusions Normal bladder capacity in children with myelodysplasia is approximately 25% less than in age matched, neurologically intact children. The bladder grows approximately 24 cc per year until age 9 years. When there is failure to store urine, bladder capacity is much smaller, while children with good storage features may attain the bladder capacity expected of age matched, neurologically intact children.

Fetal growth rates in patients with preterm prolonged rupture of membranes

Fetal growth rates in patients with preterm prolonged rupture of membranes