Symptoms of eating disorders among female distance runners: can the inconsistencies be unraveled?

Research on eating disorders among female distance runners has produced a modest, but inconsistent body of findings. To unravel the confusion, we hypothesized a model whereby studies finding greater symptomatology have involved obligatory runners or elite national/international competitors. Studies not finding greater symptomatology have involved a more typical group of athletes. To test our hypothesis, we used the Eating Disorders Inventory-2 (EDI-2) to compare 20 typical female collegiate distance runners to 35 female undergraduate psychology students. Comparisons were also made with norms in the EDI-2 Manual. Consistent with our model, the distance runners showed no enhanced symptomatology. Indeed, they seemed to be comparatively healthy. Operational definitions to further test the model are discussed.

Control of lipid disorders in patients with atherosclerotic vascular disease.

The primary dyslipidemias are associated with an increased incidence of atherosclerotic vascular disease in coronary, cerebral, and peripheral vessels. If nonpharmacologic therapy, such as dietary changes and aerobic exercise, fails to achieve the therapeutic goal levels for serum low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides suggested by the National Cholesterol Education Program Adult Treatment Panel, pharmacologic intervention is indicated. The choice of the class of lipid-lowering drug(s) for initial therapy and subsequent therapy depends on the nature of the dyslipidemia, e.g., hypercholesterolemia, hypertriglyceridemia, suppressed HDL cholesterol levels, or combinations of these disturbances in lipid metabolism. Appropriate therapy with the highly efficacious agents currently available significantly reduces the associated morbidity and mortality related to atherosclerosis. The clinical applications of these classes of agents are discussed here.

Longitudinal measurement of amniotic fluid index in postterm pregnancies and its association with fetal outcome.

OBJECTIVE: Our purpose was to study the association between dynamic changes in serial amniotic fluid index measurements and adverse fetal outcome in postterm pregnancies. STUDY DESIGN: Serial amniotic fluid index values were obtained semiweekly in 139 reliably dated, uncomplicated, singleton pregnancies at > 41 weeks' gestation. Adverse fetal outcome was defined by the presence of moderate or thick meconium, fetal heart rate decelerations, cesarean delivery for fetal distress, neonatal intensive care unit admission, and perinatal mortality. RESULTS: Prominent changes in the amniotic fluid index (i.e., > 50% increase or decrease) had no association with adverse fetal outcome irrespective of rate of change, provided the final value remained > 5.0 cm. A significant association with fetal heart rate decelerations and the presence of meconium was detected only in patients whose final amniotic fluid index was < or = 5.0 cm (p = 0.007 and p = 0.003, respectively). CONCLUSION: Irrespective of the rate of change in amniotic fluid index, postterm pregnancies are significantly associated with potential complications such as fetal heart rate decelerations and meconium staining when the final amniotic fluid index is < or = 5.0 cm.

Longitudinal study of the amniotic fluid index in post-dates pregnancy.

Amniotic fluid (AF) was measured in 511 post-dates pregnancies (at least 41 weeks of gestational age) with the use of the AF index. Ultrasonographic evaluations were conducted on a semiweekly basis. Only patients with reliable gestational ages calculated from certain last menstrual period and confirmed by early sonographic estimates participated in the study. Oligohydramnios (AF index of 5.0 cm or less) was detected in 11.5% of the study population. Longitudinal data were available from 121 patients who demonstrated a mean 25% decrease in AF index per week beyond 41 weeks' gestation. The longitudinal change in AF index was statistically significant (P less than .0005). Amniotic fluid index measurements ranged from 1.7-24.6 cm, with a mean of 12.4 at 41 weeks' gestation. Compared with previous cross-sectional studies, this longitudinal study provides a more accurate estimate of changes in AF levels as a function of gestational age.

Bone mineral density in postmenopausal women treated with L-thyroxine.

PURPOSE: To determine if bone mineral density is decreased in postmenopausal women treated with 1-thyroxine, and, if any decrease is observed, whether it is related to overtreatment with thyroid hormone, to deficiency of calcitonin, or to other factors. PATIENTS AND METHODS: The study consisted of 19 postmenopausal women between 50 and 75 years of age treated with 1-thyroxine for 5 years or longer, and 19 matching control subjects with no thyroid disease. Bone mineral density of the spine and hip was measured by dual-photon absorptiometry. Plasma calcitonin concentrations and serum thyroid hormone levels were determined by radioimmunoassays. RESULTS: The 1-thyroxine-treated women had lower bone density in the lumbar spine (1.013 g/cm2 [95% confidence interval, 0.945 to 1.081] versus 1.134 g/cm2 [1.026 to 1.242], p = 0.043); in the femoral neck (0.736 g/cm2 [0.694 to 0.778] versus 0.809 g/cm2 [0.747 to 0.872], p = 0.040); in Ward's triangle (0.576 g/cm2 [0.530 to 0.623] versus 0.694 g/cm2 [0.617 to 0.770], p = 0.011); and in the trochanteric area (0.626 g/cm2 [0.581 to 0.672] versus 0.722 g/cm2 [0.651 to 0.794], p = 0.027). The maximal increase in calcitonin following calcium infusion was 1.37 ng/L (95% confidence interval, -0.44 to 3.17) in the 1-thyroxine-treated patients versus 18.8 ng/L (95% confidence interval, 10.0 to 27.5) in normal women, p less than 0.001. The average dose of 1-thyroxine was 120 micrograms/day; 16 of the 19 patients had normal serum thyroxine levels. However, TSH levels were low in 13 of the 19, suggesting that 1-thyroxine treatment was supraphysiologic. Seven of the 19 patients had a history of hyperthyroidism in the distant past; these patients, considered separately, had significantly reduced bone density in the hip. The other 12 patients, considered separately, did not have a statistically significant loss of bone density. CONCLUSIONS: Long-term 1-thyroxine therapy is associated with decreased density of the spine and hip. Since subclinical hyperthyroidism, decreased calcitonin responsiveness, and a history of hyperthyroidism were demonstrated in some or all of these patients, these factors must be considered as possible causes of the decreased bone density.

Oral clonidine for rapid control of accelerated hypertension.

Thirty emergency-room patients, 15 men and 15 women, from 27 to 64 years old with diastolic blood pressures (DBP) greater than 115 mm Hg, were admitted to an open-label, oral loading trial of clonidine. At this time, their supine mean arterial pressures (MAP) averaged 150 +/- 2 mm Hg. An initial clonidine dose of 0.1 to 0.2 mg was to be followed every hour by another 0.1 mg until the DBP had been lowered to a level allowing treatment to be continued on an ambulatory basis or until a total of 0.5 mg had been given. A satisfactory response--defined as a reduction of the supine DBP to 105 mm Hg or lower if the baseline was between 115 and 135 mm Hg, or reduction of a baseline DBP greater than 135 mm Hg by at least 30 mm Hg--was achieved in all but one of the patients in an average of 118 minutes; the mean dose required was 0.26 mg. The mean reduction from the baseline MAP was 23.1 +/- 0.9%. Drug-related adverse experiences comprised drowsiness and dry mouth in 13 patients. Thereafter, 28 of the patients were chronically treated with clonidine for an average of 73 days. In 24 patients treated for at least 80 days, the daily clonidine dose averaged 0.375 mg. All the patients required concurrent diuretic therapy. A satisfactory response (as defined above) to this maintenance treatment was shown by 85% of the patients, and full blood-pressure control (supine DBP less than 95 mm Hg) was attained in 78%.(ABSTRACT TRUNCATED AT 250 WORDS)

An office-based primary care trial of pindolol ('Visken') in essential hypertension.

A large, open, multi-centre study was performed by physicians in general practice to evaluate the efficacy and tolerance of pindolol (10 to 20 mg per day) in the treatment of patients with essential hypertension. The records of 7324 patients who completed the 6-week protocol with pindolol alone or in combination with a diuretic were analyzed by computer. Substantial reductions in both systolic and diastolic blood pressure were obtained in the majority of patients regardless of age, sex or race. No difference in blood pressure response was found between patients taking diuretics concurrently and those on pindolol alone. Side-effects were generally not troublesome and a trend toward a reducing incidence of side-effects was noted in all patients as the duration of therapy increased. Black patients tended to complain of fewer side-effects than did white patients.

Chronic thyroiditis and mitral valve prolapse.

Mitral valve prolapse is more prevalent in patients with autoimmune diffuse toxic goiter, suggesting a possible etiologic association. The prevalence of mitral valve prolapse was determined in 75 patients with chronic lymphocytic thyroiditis, another autoimmune thyroid disorder, and in 50 healthy control subjects. Mitral valve prolapse was found in 31 of 75 (41%) patients with chronic lymphocytic thyroiditis and in 4 of 50 (8%) controls (odds ratio, 8.10; 95% confidence interval, 2.64 to 24.83; p less than 0.0005). The age-race adjusted odds ratio was 9.26 (95% confidence interval, 2.83 to 30.26; p less than 0.0005). No correlation between the prevalence of mitral valve prolapse and the presence of hypothyroidism, serum antithyroid antibodies, or the duration of chronic lymphocytic thyroiditis was found. The prevalence of mitral valve prolapse is substantially increased in patients with the autoimmune thyroid disorders.

Long-term follow-up of patients with Grave's disease treated by subtotal thyroidectomy.

This long-term follow-up study of 83 patients with Grave's disease who were treated by subtotal thyroidectomy reemphasizes the fact that postoperative hypothyroidism occurs primarily in the first postoperative year (27 percent of the study patients). In addition, there was no evidence of progressive increase in the incidence of hypothyroidism in subsequent years. Patients treated with radioactive iodine have a reported incidence of hypothyroidism of 70 percent 10 years postoperatively [4]. The 6 percent incidence of recurrent hyperthyroidism is much less than a reported incidence of 90 percent in patients treated with long-term antithyroid drugs [7]. Subtotal thyroidectomy continues to be an excellent method of treatment for patients with Grave's disease and compared favorably with both radioactive iodine and long-term antithyroid drugs.

Intermittent fluid retention in women. Is it idiopathic edema?

When a capillary or renal disturbance is not apparent in a woman of reproductive age who presents with edema, a disorder referred to as idiopathic edema should be considered. This disorder, which is often intermittent, causes fluid to accumulate when the patient is upright. Because of this postural relationship, research into pathogenesis has focused on homeostatic adjustments to changes in posture. A number of mechanisms have been proposed, the most tenable of which seem to be increased capillary permeability, increased mineralocorticoid activity, and a faulty "escape mechanism." The diagnosis of idiopathic edema is established by documenting an excessive intradiem weight gain (greater than 1 kg) and performing a water-loading test. Because the pathogenesis remains obscure, no specific or uniformly successful therapy yet exists. Besides recumbency, restriction of calories, sodium, and fluids may be tried. If these measures do not bring adequate relief, diuretics or sympathomimetics may be prescribed.

Racial difference in salivary sodium-potassium ratio in low renin essential hypertension.

We have studied the relationship between plasma renin activity (PRA) and the salivary sodium-potassium (Na-K) ratio, an index of mineralocorticoid effect, in 223 patients with essential hypertension. In 24 white patients with low PRA, the median Na-K ratio was 0.74, which was significantly lower than the ratio of 1.40 in 54 normal white subjects and the ratio of 1.10 in 34 white hypertensive patients with normal PRA. The Na-K ratio in 71 black patients with low PRA was 1.06, which was not significantly lower than the ratio of 1.50 in 38 black normal subjects or the ratio of 1.56 in 94 black hypertensive patients with normal PRA. These findings indicate a difference in salivary Na-K ratios between white and black patients with low renin essential hypertension and suggest a racial difference in the pathophysiology of this form of hypertension.

The salivary sodium/potassium ratio in hypertension: relation to race and plasma renin activity.

We have studied the relationship between plasma renin activity (PRA) and the salivary Na:K ratio, an index of mineralocorticoid effect, in 223 patients with essential hypertension. In 24 white patients with low PRA the median Na:K ratio was 0.74, which was significantly lower than the ratio of 1.40 in 54 normal white subjects (P less than .005) and the ratio of 1.10 in 34 white hypertensive patients with normal PRA (P less than .005). The Na:K ratio in 71 black patients with low PRA was 1.06, which was not significantly lower than the ratio of 1.50 in 38 black normal subjects or the ratio of 1.56 in 94 black hypertensive patients with normal PRA. These findings indicate a difference in salivary Na:K ratios between white and black patients with low renin essential hypertension, and suggest that mineralocorticoid excess may be a more frequent cause of low renin essential hypertension in white than in black patients.

A comparison of chlorthalidone-reserpine and hydrochlorothiazide-methyldopa as step 2 therapy for hypertension.

Two fixed-combination drugs commonly used in the step 2 treatment of hypertension, chlorthalidone plus reserpine and hydrochlorothiazide plus methyldopa, were compared in an evaluation of efficacy and adverse reactions. Ninety-one percent of the chlorthalidone-reserpine group achieved diastolic blood pressures of 90 mmHg or lower compared with 55% of the hydrochlorothiazide-methyldopa group. The incidence of adverse reactions in the chlorthalidone-reserpine group was 31% compared with an incidence of 64% in the hydrochlorothiazide-methyldopa group.

Serum immunoglobulins in hypertension.

We measured serum immunoglobulins in 52 persons whose blood pressure was higher than 140/90 mm Hg, and 52 normotensive controls matched for age, sex and race. All were selected from a population of actively employed persons undergoing a routine health evaluation. Contrary to previous reports, the hypertensive subjects did not have higher levels of IgG or IgA than the controls. Sixteen hypertensive subjects with mean blood pressure higher than 115 mm Hg did not have elevated IgG or IgA levels when analyzed separately. Serum IgM was significantly lower in the 52 hypertensive subjects (125 +/- 67 mg/dl vs 171 +/- 85 mg/dl, p less than 0.01). Our subjects failed to show the increase in immunoglobulins reported by others. The most likely reasons for this is the mildness of their blood pressure elevation, although the absence of immunoglobulin elevation in the small number with more marked hypertension does not support this explanation.

Enhanced adrenal responsiveness to angiotensin II in patients with low renin essential hypertension.

The plasma aldosterone response to infused angiotensin II was determined in normal controls and in patients with normal renin and with low renin essential hypertension. The patients with low renin essential hypertension showed an enhanced plasma aldosterone response when compared to the other two groups. This finding may explain why plasma aldosterone levels remain within normal limits in the face of suppressed plasma renin and angiotensin II concentrations in low renin essential hypertension.

The pressor response to angiotensin II in patients with low renin essential hypertension.

The etiology of low renin essential hypertension (LREH) has not been established with certainty, but mineralocorticoid excess has been implicated frequently in its pathogenesis. The finding of several investigators of a normal exchangeable sodium space and extracellular fluid volume, however, does not support this hypothesis. To evaluate the possible role of sodium and water retention in LREH, the pressor response to infused angiotensin II (A II) was determined and compared to that of normal subjects and that of subjects with normal renin essential hypertension (NREH). This approach was based on the known suprasensitivity of vascular receptors to A II in situations in which sodium and water compartments are expanded as they are, for example, in proven hypermineralocorticoid states such as primary aldosteronism. In this study, we found that subjects with LREH demonstrated no increased pressor response to graded doses of A II; this suggests that LREH is not primarily mediated by sodium and water retention.