Mean Height Gain Research Articles

Guided maxillary sinus floor elevation using deproteinized bovine bone versus graftless Schneiderian membrane elevation with simultaneous implant placement: Randomized clinical trial.

The aim of this study is to evaluate the analytical difference between the use of xenograft (control group) and graftless tenting (test group) technique after sinus lift procedure with simultaneous implant placement. Seventeen patients and 20 sinuses where operated for sinus lift procedures using lateral window approach with simultaneous implant placement. Deproteinized bovine bone (Xenograft) was used as a filling material in control group while nongrafted sinus lifting was performed in the test group. Multislice CT was obtained preoperatively and CBCT were obtained immediately postoperative and 6 months after operation. Osstell readings were taken at the time of implant placement and implant exposure (6 months) RESULTS: Mean bone height gain in the xenograft group was 8.59 ± 0.74 while that of the tenting group was 4.85 ± 0.5 and it was statistically significant (P < .05). Mean bone density values in the xenograft group was 375.59 ± 49.38 while that of the tenting group was 269.08 ± 16.27 and it was statistically significant (P < .05). Mean ISQ values for the xenograft group was 78.3 ± 5.08 while that of the tenting group was 74 ± 3.19 and it was statistically significant (P < .05). Within the limitation of this study, sinus lift procedures with simultaneous implant placement using xenograft as a filling material or graftless technique are considered reliable procedures, however, the use of xenograft provide better results in all aspects regarding (bone height gain, bone density, and implant stability).

Crestal Sinus Floor Elevation with Autogenous Press-Fit Dowel Bone Harvested Using Trephine Drills: A New Method.

The aim of this study was clinical and radiographic evaluation of sinus floor lifting from the alveolar crest with trephine bur and autogenous bone graft. In this research, a press-fit dowel bone technique with application of an autogenous bone block was used for elevating the sinus floor. Ten closed sinus lift surgeries were performed on 10 patients; all patients possessed atrophic ridges in an edentulous maxilla. Bone height of the ridge ranged between 3 and 5 mm. Surgery included forming a bony cylinder with a trephine bur to reach the sinus cortical floor and then elevating the sinus floor bone with anosteotom and placing an autogenous bone block at the site and fitting it with strikes of a hand mallet. The amount of an osteotom sinus floor height gain was measured during implant placement and via radiography before surgery and four months postsurgery. Average height of the sinus floor bone after surgery was 8.33 mm with SD = 1.39 mm. Mean bone height gain after surgery in evaluated patients was 3.47 mm with SD = 1.4 mm. As a result, bone sinus floor height following surgery was significantly increased (P value = 0.044), with a significant difference between sinus floor bone height before and after surgery (P value = 0.041). No significant difference was observed between sinus floor bone height gain and sex, age, and smoking before and after the operation. The sinus floor lift method by trephine and autogenous bone graft is a practical and simple way to reduce the time needed for implantation in patients with moderate atrophy of the posterior maxilla.

Variable response to growth hormone therapy in growth hormone deficient patients and role of insulin like growth factor one in monitoring response to therapy

Background and objectives: To find out the response to growth hormone therapy among growth hormone deficiency patients with different causes and to find out the role of insulin-like growth factor one in monitoring response. Methods: This retrospective study was done on fifty patients who received growth hormone for short stature due to different causes. The patients were enrolled in the study that was conducted from June 2015 to December 2015 in Helina center- Erbil. All details including history, examination, investigations, treatment and follow-up were revised. Investigations that have been sent for each patient were full blood count, thyroid function tests, bone age assessment, growth hormone stimulation and insulin like growth factor one. Follow-up for their response clinically and by investigations have been done after 3, 6 and 12 months and after two years from initiating growth hormone therapy. Patients were divided to three groups, patients on 25 mcg/kg/day therapy (Group One), patient on 30 mcg/kg/day (Group Two) and patients on 35 mcg/kg/day (Group Three). The response to growth hormone therapy of the three groups was compared. Results: Among those fifty patients, only five patients discontinued their treatment. Significant height gain was observed after two years of regular growth hormone therapy. We found that with increasing the dose of growth hormone, the patient gain more height, and had higher insulin-like growth factor one, with p&lt;0.05 between the groups. The mean height gain over 2 years of growth hormone therapy was 11.16 cm in Group One and 16.25 cm in Group Three. Conclusions: We conclude that by giving growth hormone to short children for a period not less than two years, height will increase significantly. Giving higher allowed doses gives higher increment compared to lower doses and insulin like growth factor one is a good tool for follows-up response to therapy.

Evaluating the Effect of Nutritional Supplementation Combined with Counseling on Nutritional Recovery in Immune-Compromised Indian Children

Background: Malnutrition in an HIV-infected child leads to muscle wasting, micronutrient deficiency, impaired immune system and reduced ability to fight infections. It also increases the susceptibility to infections due to an increased oxidative stress. Chronic oxidative state can weaken immune systems fight against HIV. Aim: The present study was undertaken to assess the impact of nutritional supplementation on the HIV progression. Methods: This open, prospective, interventional, case control pilot study was conducted in 100 HIV infected children, age between 6 months to 15 years, fulfilling criteria of Moderate Acute Malnutrition (MAM) and criteria of thinness based on Body Mass Index as per WHO definition, either not on ART and/or on ART but failing to gain weight as observed in 2 consecutive visits. Study and control group had 50 subjects each. Intervention comprised of multigrain-micronutrient-rich laddus along with counseling for a period of 6 months for cases. Controls received nutritional counseling along with standard care. Results: The male to female ratio was 2:1, median age being 132 months in cases and 120 months in controls. The mean weight was 24.53 kg in cases and 21.46 kg in controls after 6 months (p=0.03). The mean gain in height after 6 months of intervention was 2.96 cm in cases and 2.19 cm in controls (p=0.007). The CD4 counts and antioxidant levels were statistically non-significant but showed improving trends. Conclusions: Energy dense micronutrient rich supplementation will prevent the HIV progression.

Growth Hormone Treatment in Turner's Syndrome: A Real World Experience.

Objective:Short stature is a universal clinical feature of Turner's syndrome (TS). Growth failure begins in fetal life, and adults with TS are on an average 20 cm shorter than the normal female population. Since there is a paucity of data from India regarding the effect of growth hormone (GH) on TS patients, we retrospectively analyzed the data of TS patients who are on GH treatment.Methods:This hospital-based observational retrospective study was conducted in a tertiary care hospital of Hyderabad. The data such as height, weight, and bone age of 16 patients who are diagnosed with TS on GH therapy for at least 6 months were included in the study. All the patients were treated with human recombinant GH at the dose of 0.3 mg/kg/week administered as daily subcutaneous injections.Results:The mean age at diagnosis was 12.7 years. The mean height at the start of GH therapy was 1.26 m, and mean height standard deviation score (HSDS) was-0.61 when compared to Turner's specific reference data. With a mean duration of GH therapy of 25 months, the mean height at the end of therapy was 1.37 m and the mean height as per HSDS was + 0.37 resulting in a mean height gain of + 0.99 HSDS.Conclusion:Our observation shows that girls with TS benefit from early diagnosis and initiation of treatment with GH.

Testosterone Treatment of Pubertal Delay in Duchenne Muscular Dystrophy.

The outlook for adolescents with Duchenne muscular dystrophy (DMD) has improved greatly as a result of corticosteroid use, but treatment will compromise growth and delay puberty. Whether exogenous testosterone can promote growth, development, and skeletal health is unclear. We collected data retrospectively on growth and pubertal response in 14 adolescents with DMD who were treated with testosterone between 2008 and 2014. A total of 14 boys were treated at a median age of 14.5 years. Eight have finished treatment after a mean age of 3.1 years and the feedback from families was generally positive. The mean testicular volume pretreatment was 2.4 and 3.9 mL posttreatment. The mean baseline testosterone concentrations were < 1.0 and 5.4 nmol/L postintervention. Median height velocity increased from 0.45 cm/y before treatment to 3.6 cm/y after the treatment. The mean height gain was 14.2 cm. A broad range of testosterone preparations was used. Testosterone was generally well-liked, but side effects were experienced by some patients and the pubertal growth increment appears to be compromised. Few subjects had adult endogenous testosterone levels posttreatment. Controlled studies are required to determine the most appropriate treatment regimen and the precise impact of testosterone on key outcomes, such as muscle function and bone integrity. Clinicians will then be better placed to advise families about likely benefits and risks.

Growth and sexual maturity pattern of girls with mental retardation

Background:Growth of mentally retarded children differs from that of normal children. However, the adolescent growth and development of Indian mentally retarded children has not been studied.Aim:This study was conducted to evaluate the physical growth and sexual development of adolescent mentally retarded girls in North Indian population and to compare it with that of normal girls of same age group.Materials and Methods:One hundred mentally retarded (intelligence quotient (IQ) less than 70) and 100 normal girls between 10 and 20 years of age were categorized into 1-year age groups. Their height was measured and the sexual development was assessed based on breast development (BD) and pubic hair growth (PH) stages 1-5 on the basis of Tanner scale. The data was then compared between the two groups using Student's t-test. The mean age of menarche was calculated by applying Probit analysis.Results:The mean height of mentally retarded girls was significantly retarded as compared to normal girls at all ages; however, the mean height gain during 11-20 years was same in both the groups. The mentally retarded girls also showed significant retardation in PH growth at 15-17 years and in BD at 15-16 years of age.Conclusions:The physical growth and sexual development of adolescent mentally retarded girls was retarded as compared to the normal girls. The physical growth retardation occurred during early childhood (before 11 years), however the retardation in sexual maturity occurred during middle adolescence, between 15-17 years of age.

Adult and Near-Adult Height in Patients with Severe Insulin-Like Growth Factor-I Deficiency after Long-Term Therapy with Recombinant Human Insulin-Like Growth Factor-I

Background: Treatment with recombinant human insulin-like growth factor-I (IGF-I) stimulates linear growth in children with severe IGF-I deficiency (IGFD). Aims: To evaluate the efficacy and safety of treatment with IGF-I in patients with severe IGFD treated until adult or near-adult height. Methods: Twenty-one children with severe IGFD were treated until adult or near-adult height under a predominantly open-label design. All patients were naive to IGF-I. Recombinant human IGF-I was administered subcutaneously in doses between 60 and 120 µg/kg twice daily. Nine patients received additional therapy with gonadotropin- releasing hormone (GnRH) analog for a mean period of 2.9 ± 1.8 years. Results: Mean duration of treatment was 10.0 years. Mean height velocity increased from 3.1 cm/year prior to treatment to 7.4 cm/year during the first year of treatment. Height velocities during the subsequent years were lower, but remained above baseline for up to 12 years. Cumulative mean Δ height SD score at (near) adult height was +2. The observed mean gain in height was 13.4 cm more than had been expected without treatment. The adult height achieved by the patients also treated with GnRH analog was not different from those who received IGF-I therapy alone. There were no new safety signals identified in these patients, a subset of those previously reported. Conclusion: Long-term therapy with IGF-I improves adult height of patients with severe IGFD. Most patients did not bring their heights into the normal adult range.

The Efficacy and Safety of Long-term Norditropin® Treatment in Children with Prader-Willi Syndrome

Prader-Willi syndrome is a genetic disorder that is associated with short stature, partial growth hormone deficiency, small hands and feet, learning and behavioural problems, and hyperphagia leading to severe, often morbid, obesity. Growth hormone therapy is associated with an improvement in height and body composition. We evaluated the efficacy and safety of long-term growth hormone treatment in a retrospective observational multinational study of 41 prepubertal children (mean age 3.8±3.0 years) with genetically diagnosed Prader-Willi syndrome treated with growth hormone (0.03-0.06 mg/kg/day) for >12 months [mean duration 4.1 (range 0.9-9.5) years]. Height, weight, and body composition measurements were recorded at baseline and at 6 month intervals until last observation. Mean (SD) gain in height at 12 months was 0.9 (0.2) SD score (p<0.0001). At last observation (after approximately 6 years) mean gain in height was 1.3 (0.3) (p=0.0001) with 85% of children achieving height>- 2 SD score. Body composition improved during treatment with an estimated 9.1% increase in lean body mass and 9.1% decrease in fat mass at last observation (p=0.019). Scoliosis was reported in 3 patients at baseline and 8 patients at last observation. Sleep apnoea was recorded in 3 (7.3%) patients. There were no other severe adverse events reported. Long-term growth hormone treatment of prepubertal children with Prader-Willi syndrome was associated with significant improvements in height and body composition. Treatment was well tolerated. The development of scoliosis warrants monitoring by an orthopaedic specialist.

Physical growth during adolescence in mentally retarded children

Abstract Background and aims : Growth in children with mental retardation differs from that of normal children, but majority of studies have been performed in western countries and have focused on the early years of life. The purpose of this study therefore was to evaluate the growth pattern of male mentally retarded adolescents from North India and compare it with that of normal male children. Materials and methods : Two hundred institutionalized intellectually disabled (I.Q. less than 70) and two hundred normal male children between 10-20 years of age from North India were selected and the physical growth parameters i.e. height and weight were measured and Body Mass Index (BMI) was calculated in all subjects. The mentally retarded and normal groups of boys were categorized separately on the basis of their age into one-year age groups. The data was then compared between the two groups using 2 sample't' test. Results : The results indicated that the mean height and weight of mentally retarded boys during adolescence was significantly retarded as compared to normal subjects. However, the intellectually disabled and the normal group do not show any significant difference in their body fat during adolescence. The mean height and weight gain of mentally retarded children during adolescence (11-20 years) however did not vary from that of normal children. Conclusions : Thus, the physical growth retardation in children with intellectual disabilities occurs during early childhood i.e. before 11 years of age.

Growth hormone for short children – whom should we be treating and why?

The objective of this paper was to determine systematically the impact of growth hormone (GH)therapy on adult height of children with (so-called) 'idiopathic short stature' (ISS) using the Cochrane Central Register of Controlled Trials, Medline, and the bibliographic references from retrieved articles of randomised controlled trials (RCTs) and non-RCTs from 1985 to April 2010. Inclusion criteria were initial short stature (defined as height >2 standard deviation[SD] below the mean), peak growth hormone responses>10 micrograms per litre (μg/L), prepuberty, no previous growth hormone therapy, and no comorbid conditions that would impair growth. Data extracted were adult height and overall gain in height from baseline measurement in childhood.Three RCTs (115 children) met the inclusion criteria.The adult height of the GH treated children exceeded that of the controls by 0.65 SD score (~4 cm). The mean height gain in treated children was 1.2 SD score compared with 0.34 SD score in untreated children. A difference of ~1.2 cm in adult height was observed between two GH dose regimens. In the seven non-RCTs, adult height of the GH-treated group exceeded that of controls by 0.45 SD score (~3 cm).The authors conclude that 1) GH therapy in children with ISS seems effective in partially reducing the deficit in height as adults, although less so than in other conditions for which GH is licensed; treated individuals remain relatively short compared with normal height peers. 2)Individual responses to therapy are highly variable; further studies are needed to identify responders. 3) High quality evidence from long-term RCTs of GH therapy that continue until adult height is necessary to determine the ideal dosage and long-term safety.

Physical growth during adolescence in mentally retarded children

Background and aims : Growth in children with mental retardation differs from that of normal children, but majority of studies have been performed in western countries and have focused on the early years of life. The purpose of this study therefore was to evaluate the growth pattern of male mentally retarded adolescents from North India and compare it with that of normal male children. Materials and methods : Two hundred institutionalized intellectually disabled (I.Q. less than 70) and two hundred normal male children between 10- 20 years of age from North India were selected and the physical growth parameters i.e. height and weight were measured and Body Mass Index (BMI) was calculated in all subjects. The mentally retarded and normal groups of boys were categorized separately on the basis of their age into one-year age groups. The data was then compared between the two groups using 2 sampleti test. Results : The results indicated that the mean height and weight of mentally retarded boys during adolescence was significantly retarded as compared to normal subjects. However, the intellectually disabled and the normal group do not show any significant difference in their body fat during adolescence. The mean height and weight gain of mentally retarded children during adolescence (11-20 years) however did not vary from that of normal children. Conclusions : Thus, the physical growth retardation in children with intellectual disabilities occurs during early childhood i.e. before 11 years of age.

Transcrestal sinus lift and implant placement using the sinus balloon technique

Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. Results: One patient was excluded due to Schneider’s membrane perforation as confirmed by endoscopy. Trans-crestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. Conclusions: Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone. Key words: Sinus lift, balloon, sinus complications.

Efficacy of Leuprolide Acetate 1-Month Depot for Central Precocious Puberty (CPP): Growth Outcomes During a Prospective, Longitudinal Study.

IntroductionGonadotropin-releasing hormone analogs (GnRHa) are the treatment of choice for CPP. We investigated growth in GnRHa-naïve subjects, treated with leuprolide acetate 1-month depot for CPP.MethodsThis prospective, open-label study had a long-term, observational, follow-up period. Forty-nine females and 6 males were enrolled. Leuprolide acetate depot was administered intramuscularly every 28 days. Height and growth rate during and after treatment until adulthood were measured.ResultsAmong 30 of 49 females having an adult height (AH) measurement, 29 had target heights available (mean = 163.8 cm) and 27 had pretreatment predicted adult heights (PAHs; mean = 157.4 cm). After treatment, the mean AH at mean age 21.8 years [range 13.7-26.7 years] was 162.5 cm, a mean height gain over baseline PAH of 4.0 cm. The mean height standard deviation score was -0.1 at AH.ConclusionsTreatment of CPP with leuprolide acetate 1-month depot had beneficial effects on growth rate and preservation of AH.Trial RegistrationClinicalTrials.gov: NCT00660010

Final Adult Height in Children with Congenital Adrenal Hyperplasia Treated with Growth Hormone

Patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency typically reach a final adult height well below their mid-parental target height. The objective of this study was to examine whether GH alone or in combination with an LHRH analog (LHRHa) improved the final adult height in patients with CAH. The study was a nonrandomized prospective study. The study was conducted at two university hospitals in New York City, NY. Thirty-four patients with CAH treated with GH participated in this study. Nineteen males and 15 females who were predicted to be more than 2 SD below their mid-parental target height or more than 2 SD below the population mean received GH until reaching final adult height. In addition to GH, 27 patients (16 males, 11 females) were also treated with an LHRHa. The mean duration of GH treatment was 5.6 ± 1.8 yr in males and 4.5 ± 1.6 yr in females. The mean duration of LHRHa therapy was 3.7 ± 1.7 yr for both sexes. The primary endpoint variables were final adult height, final height discrepancy, and gain in height. Males reached a significantly higher final adult height (172.0 ± 4.8 cm) than their initial predicted height (162.8 ± 7.7 cm) (P < 0.00001). Females also reached a significantly higher final adult height (162.2 ± 5.3 cm) than initially predicted (151.7 ± 5.2 cm) (P < 0.0000001). Mean gain in height was 9.2 ± 6.7 cm in males and 10.5 ± 3.7 cm in females. Our results indicate that GH alone or in combination with LHRHa improves final adult height in patients with CAH.

Impact of growth hormone therapy on adult height of children with idiopathic short stature: systematic review

Objective To systematically determine the impact of growth hormone therapy on adult height of children with idiopathic short stature.Design Systematic review.Data sources Cochrane Central Register of Controlled Trials, Medline, and...

Response to growth hormone therapy in Indian patients

To analyse response to growth hormone therapy on Indian patients with short stature. Data were collected on 71 patients of short stature on GHT. All patients underwent clinical and hormonal evaluation. GHD was diagnosed in the presence of short stature (height SDS < 2) and peak GH levels < 10 ng/ml. Bone age was estimated using Tanner Whitehouse 3 method (TW3). Primary GHD (73%) was the commonest diagnosis among patients on GHT, followed by organic GHD (12.6%), genetic syndromes (8.4%) and systemic diseases (5.4%). Mean chronological age at presentation was 10.07+/-3.26 years (median-11 years, range 3-15 years), mean height age was 6.98+/-2.82 years (median 7.5 years, range 1-13 years) and mean bone age (available for 55 patients) was 7.19+/-3.1 years (median 8.2 years, range 1.3-13 years). Patients with systemic diseases (6.75+/-3.5 years) presented earlier, compared to patients with GHD (10.27+/-3.16 years) and genetic syndromes (10.18+/-3.20 years) (p=0.349). Most of the patients on GHT were in the age group 9-15 years (60.6%). Mean height gain with GHT was 8.7+/-2.7 cm (median 8.3 cm, range 3.0-13 cm) during 1st year then decreased to 6.9+/-2.4 cm (median 7.0 cm, range 3.0-12.5 cm) in the second year, and was maintained through the third year (mean 7.1+/-3.0 cm, median 7.0, range 3.0-13 cm). Among patients with GHD, those with primary deficiency had significantly better response to GHT in 1st year than secondary deficiency (9.0+/-2.65 vs 6.8+/-3.03 cm, p = 0.026). Response to GHT was negatively correlated with CA (r-0.27, p = 0.05), HA (r-0.47, p = 0.027) and BA (r-0.31, p=0.022) at presentation. Four patients (5.6%) developed hypothyroidism and one patient each developed disseminated tuberculosis and rickets. One patient of Turner's syndrome died of adrenal carcinoma. Short follow up and absence of measurement of IGF-1 and IGFBP3 were major limitations of this study. Response to GHT in Indian patients is comparable to western counterparts. Maximum height gain on GHT is during the first year than decreases in second year, but is maintained through third year. Patients with primary GHD had better response than secondary GHD. Response to GHT is negatively correlated with chronological, height and bone age at presentation.

Asian ancestry and birth length are associated with height among females during adolescence

Greater rate of height gain during adolescence and greater attained height in adulthood have been identified as risk factors for later breast cancer risk. The Female Adolescent Maturation studies (FAM1, 2, 3) examined adolescent diet, physical activity, maturation and their relationship with body size. We examined the association of early life factors with mean height gain between FAM1 to 2 (9–16yrs, n=99), and FAM2 to 3 (11–19yrs, n=63) and attained height in girls at FAM3 (13–19yrs, n = 63). Attained height was defined as height in girls at FAM3. Information on birth parameters (weight, length, gestational age) and type of infant feeding were obtained via questionnaire. Mean height gain was 4.66 cm/yr (FAM1 to 2) and 2.4 cm/yr (FAM2 to 3). Although mean height gain was not significantly different between Asian and white ancestral groups, mean attained height was different (p = 0.0002). Lower % Asian ancestry predicted greater FAM 2 to 3 height gain (p=0.02, R= 0.52) adjusting for age and birth parameters. Attained height was regressed on age, % Asian ancestry, birth parameters, and age at menarche. Longer birth length was associated with greater attained height in girls at FAM3 (p=0.002, R=0.33). No effect of feeding or gestational age was observed on height gain or attained height. In conclusion, birth length and Asian ancestry are associated with attained height and gain in height during adolescence, respectively. USDA Grant # 99‐00700; NIH/NCRR/RCMI P20 RR119091 award; CRCH Developmental Funds; DOD Grant # BC032028

Maturity Status and Injury Risk in Youth Soccer Players

To investigate the association of relative skeletal age and other risk factors with injury in elite schoolboy footballers (soccer players). Prospective cohort study, with players participating for varying numbers of years. Manchester United Football Club Academy, 2001 to 2007. Players were recruited to the club by scouts. At intake, the boys were medically screened to ensure they could be fully involved in the training and games program. Computerized medical records for the boys were maintained for the entire study period. The investigation included boys 9 to 16 years of age. Numbers varied between 98 and 144 per year (mean n/y = 130) over 6 years. Overall, 292 players were represented in the sample. Mean drop out per season was 21%. Each year consenting players had a radiograph of the left wrist and hand for the assessment of skeletal age (SA), using the Fels method. Eighty-five players had at least 1 radiograph and 12 players had 6 radiographs, 1 in each year of the study. Early and late maturers were those with an SA >1 year older or younger, respectively, than their chronologic age (CA). Information on demographics, height and weight, playing and training times, and position played was collected. The main outcome measure was the relation of maturity status to the occurrence of injuries. For the total sample across all the age groups the incidence of injuries was 1.44 per 1000 hours of training (n = 244 injuries), and 10.5 per 1000 match hours (n = 169 injuries). The mean number of injuries per season was 79.3, with a mean loss of 12.5 injury days per player per season. Boys aged <14 years were most vulnerable. Most injuries resulted from overuse rather than from trauma. Most common injury type and location were, respectively, soft tissue and knee joint. Mean SA for the total sample was in advance of mean CA (12.08y vs 11.74y; P < 0.05). Injury incidence did not differ significantly among late, normal, and early maturing players (1.4, 1.5, and 1.8, respectively) when training time, playing time, height, and playing position were statistically controlled as covariates (P = 0.73). However, results of general log linear analysis of mean data over the 6 seasons indicated a relationship between injury occurrence and training time, match-play time, and the CA-SA difference (P < 0.05). The 3 variables together explained 48% of the variance in injury incidence. Position played, foot dominance, and mean height gain were not related to injury occurrence. Maturity status and time spent in match play and training were significant predictors of injuries in 9- to 16-year-old elite male soccer players.

Impact of Growth Hormone Therapy on Adult Height of Children Born Small for Gestational Age

Use of growth hormone (GH) therapy to promote growth in short children born small for gestational age (SGA) was recently approved in the United States and Europe, but there is still disagreement about the magnitude of effectiveness of GH. To determine the impact of GH therapy on adult height in short SGA children by a meta-analysis of randomized, controlled trials (RCTs). We performed a systematic review of controlled studies using as data sources the Cochrane Central Register of Controlled Trials, Medline, and the bibliographic references from all retrieved articles describing RCTs up to November 2008. A meta-analysis of all RCT studies conducted up to the achievement of adult height was performed. Inclusion criteria were birth weight and/or length below -2 SD score (SDS), initial height less than -2 SDS, and GH dose range of 33 to 67 microg/kg per day. Adult height SDS and overall height gain SDS were the primary outcome measures. Four RCTs (391 children) met the inclusion criteria. The adult height of the GH-treated group significantly exceeded controls by 0.9 SDS. Mean height gain was 1.5 SDS in treated versus 0.25 SDS in untreated SGA subjects. No significant difference in adult height was observed between the 2 GH dose regimens. GH therapy seems to be an effective approach to partially reduce the adult height deficit in short SGA children. However, the response to therapy is highly variable, and additional studies are needed to identify the responders.