Background: Traditionally, measurement of plasma IGF-I and more recently of IGFBP-3 are used to distinguish GHD from idiopathic short stature in slowly growing children, using a single blood sample. In earlier studies it was claimed that IGFBP-3 was superior to IGF-I, but more recently doubts around this claim have arisen. The role of serum IGF-II has never been studied extensively. On theoretical grounds, it can also be hypothesized that molar ratios of these peptides might be of additional value. Design: Retrospective, multicentre, cohort study. Patients: 96 children evaluated for short stature. Methods: Serum IGF-I, IGF-II, IGFBP-3 and various molar ratios were, after correction for age and sex using SD scores, compared to the maximum serum GH peak after two standard provocation tests using four different methods (t-test, χ², likelihood ratios and ROC curves). In addition, the correlations between these parameters and the short-term (1 year) and long-term (3 years) response to GH therapy were calculated. Results: IGF-I performed better than IGFBP-3, but the best results were achieved by the molar ratio IGF-I:IGF-II. However, IGFBP-3 correlated better with the short-term response to GH therapy than IGF-I or the ratios, and none of the parameters investigated was found to be related to the response of long-term GH therapy.

Objective-To study the resumption of puberty and the final height achieved in children with central precocious puberty (CPP) treated with the GnRH agonist triptorelin. Patients-31 girls and five boys with CPP who were treated with triptorelin 3.75 mg intramuscularly every four weeks. Girls were treated for a mean (SD) of 3.4 (1.0) years and were foliowed up for 4.0 (1.2) years after the treatment was stopped. Results-The rate of bone maturation decreased during treatment and the predicted adult height increased from 158.2 (7.4) cm to 163.9 (7.5) cm at the end of treatment (p<0.001). When treatment was stopped bone maturation accelerated, resulting in a final height of 161.6 (7.0) cm, which was higher than the predicted adult height at the start of treatment (p<0.001). Height at the start of treatment was the most important factor positively influencing final height (r = 0.75, p<0.001). Bone age at cessation of treatment negatively influenced final height (r = -0.52, p = 0.03). A negative correlation between bone age and height increment after discontinuation of treatment was observed (r = -0.85, p = 0.001). Residual growth capacity was optimal when bone age on cessation of treatment was 12 to 12.5 years. Body mass index increased during treatment and remained high on cessation. At final height, the ratio of sitting height to subischial leg length was normal. Menarche occurred at 12.3 (1.1) years, and at a median (range) of 1.1 (0.4 to 2.6) years after treatment was stopped. The ovaries were normal on pelvic ultrasonography. Conclusions-Treatment of CPP with triptorelin increases final height, with normal body proportions, and seems to increase body mass index. The best results were achieved in girls who were taller at the start of treatment. Puberty was resumed after treatment, without the occurrence of polycystic ovaries.(Arch Dis Child 1996;75:292-297)

A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP.

Study Type – Therapy (RCT)
Level of Evidence 1b OBJECTIVE To compare the effect on the recovery of incontinence after retropubic radical prostatectomy (RRP) of intensive physiotherapist‐guided pelvic floor muscle exercises (PG‐PFME) in addition to an information folder, with PFME explained to patients by an information folder only (F‐PFME), and to determine independent predictors of failure to regain continence after RRP. PATIENTS AND METHODS We postulated that a 10% increase in the proportion of men who regained continence at 6 months with PG‐PFME compared with men treated with F‐PFME only would constitute a clinically relevant effect. To show statistical significance of this difference with a power of 80%, 96 men should be randomized to each of the two arms. One day before operation, all patients received verbal instruction and an information folder on PFME. Patients randomized to the F‐PFME arm received no further physiotherapist guidance, whereas those in the PG‐PFME arm received a maximum of nine sessions with the physiotherapist. The men underwent a 1‐h pad‐test at 1, 12 and 26 weeks, and a 24‐h pad‐test at 1, 4, 8, 12 and 26 weeks after catheter removal. We defined ‘continence’ as urine loss of <1 g at the 1‐h and <4 g at the 24‐h pad‐test. RESULTS During the 2‐year recruitment period, the number of patients randomized fell short of the target determined by the sample size calculation, because of limitations of resources and unexpected changes in treatment preferences. Despite this, we analysed the data. Of the 82 randomized patients, 70 completed the study. Of these, 34 and 36 men had been assigned to the PG‐PFME and the F‐PFME group, respectively. At 6 months after RRP, 10 (30%) and nine (27%) men were completely dry on both the 1‐h and 24‐h pad‐test in the PG‐PFME and the F‐PFME group, respectively (difference not significant). In a multivariate analysis the amount of urine loss at 1 week after catheter removal seemed to be an independent prognostic factor for failure to regain continence. CONCLUSION PG‐PFME seems to have no beneficial effect on the recovery of continence within the first 6 months after RRP, over an instruction folder‐guided approach. However, due to under‐powering there is a high risk of type II error. Nevertheless, these findings add to the knowledge base for availability in meta‐analyses and can serve as a starting point for the design of new randomized studies.