Knemometry

Abstract: Short-term growth was studied during the grass pollen season with weekly knemometry in 44 schoolchildren with allergic rhinitis. The design was a randomized, parallel group study. After a four-weeks run-in period, the children were allocated to six weeks' treatment with either a single im injection of methylprednisolone acetate 60 mg at the beginning of the period, intranasal budesonide 200 micrograms bid (aerosol spray) or terfenadine tablets 60 mg daily. Treatment with methylprednisolone acetate was open, whereas treatment with budesonide and terfenadine was double-blinded. Twelve children in the methylprednisolone acetate group, 11 in the budesonide group and 12 in the terfenadine group completed the study. Compared with the run-in period, treatment with methylprednisolone acetate and budesonide (run-in growth velocities 0.46 and 0.59 mm/week, respectively) was associated with a reduction in mean lower leg growth velocity of 0.28 and 0.54 mm/week (p < 0.01, t = 3.3, 95% confidence interval 0.09-0.47 mm/week; and p < 0.001, t = 6.1, 95% confidence interval 0.34-0.72 mm/week, respectively). Terfenadine (run-in and treatment mean growth velocity 0.35 and 0.51 mm/week) did not influence lower leg growth significantly. Short-term lower leg growth is suppressed in children with allergic rhinitis treated with intranasal and depot steroids in the doses investigated. No conclusions can be drawn with respect to long-term statural growth.

Abstract: A rigorously designed auxological study was carried out to assess the operational characteristics of the knemometer and the value of short term lower leg and height measurements in estimating and predicting rates of linear growth. Measurements were made on 18 normal children monthly for six months and on six normal children weekly for six weeks. Six other children measured weekly underwent tonsillectomy after three weeks to determine the effect of stress on growth. The measurement protocol permitted estimations of both inter- and intraobserver variation. Knemometry is a sensitive, precise, and robust technique that enables accurate measurements to be made of the lower leg by interchangeable observers. The lower leg does not grow smoothly and variations in growth rate seen in both healthy children and children with transient intercurrent stress limit the practical clinical value of knemometry to the measurement of linear growth in the short term.

Abstract: SummaryRecently, a new anthropometric method of accurate lower leg length measurement (knemometry) was introduced. The present study was performed to investigate rigorously its strengths and weaknesses for auxological purposes, and to promote a standardized method of use. The data are based on 6 × 2200 single estimations of the lower leg length in 90 children of both sexes with normal, tall or short stature aged between 2·4 and 17·1 years. The overall technical error of this measurement was found to be 0·16 mm, which is reduced to 0·13 mm if the first estimation within each series of six is ignored.The following sources of systematic error could be detected: intra-daily variation, dependency on physical pressure put on or removed from the leg, vigorous physical activity prior to the measuring procedure, and a slow but significant correlation between day-to-day variation of lower leg length and body weight (r = 0·299, b = 0·372 mm/kg). There was no covariation with atmospheric parameters such as outside te...

Abstract: Objective The purpose of this study was to evaluate the effects of triamcinolone acetonide (TAA) and fluticasone propionate (FP) aqueous nasal sprays on short-term lower-leg growth velocity and hypothalamic-pituitary-adrenal (HPA)–axis function in pediatric subjects. Methods In this controlled, double-blinded (TAA) or single-blinded (FP), four-way crossover trial, 59 subjects (mean age: 7.2 years) were randomized to receive each of four 2-week treatments in random order: TAA nasal spray 110 μg, TAA nasal spray 220 μg, FP nasal spray 200 μg, and placebo, administered by a third party once daily with a 2-week washout period between treatments. Lower-leg growth velocity was measured by knemometry, and HPA–axis function was measured using 12-hour overnight urinary cortisol levels. Results Forty-nine subjects completed all four treatments and were included in the analyses. Mean growth velocity (± standard error) was 0.46 (± 0.06) mm/week for placebo, 0.37 (± 0.06) and 0.31 (± 0.06) mm/week for TAA nasal spray 110 and 220 μg, respectively, and 0.37 (± 0.06) mm/week for FP nasal spray. The treatment effect on mean growth velocity compared with placebo was −19.6% with TAA 110 μg, −32.6% with TAA 220 μg, and −21.7% with FP; none of these effects was considered statistically or clinically significant according to predefined criteria. No significant differences in changes in urine cortisol/creatinine ratios were observed between TAA 110 μg or 220 μg and placebo (4.38, 3.60, and −0.67, respectively, P ≥ 0.157). In contrast, the change in mean urine cortisol/creatinine ratio values for FP (−3.59) were significantly lower compared with TAA 220 μg ( P = 0.033) and placebo ( P = 0.003). Knemometry exhibited less time-dependent variability than overnight urinary cortisol measurements. Conclusions Neither TAA nor FP had a clinically significant effect on lower-leg growth velocity. In contrast to FP, TAA nasal spray did not significantly affect HPA–axis function when used over a 2-week interval.