Relationship of physical exercise and ageing to growth hormone production.

OBJECTIVE: The normal decline in physiological function with ageing is associated with a decrease in bioavailable growth hormone. Growth hormone has been shown to alter body composition and increase fat-free mass in older men. Increased physical fitness is accompanied by an increase in 24-h growth hormone release. The purpose of this study was to examine the effect of exercise on declining growth hormone concentrations with increasing age. DESIGN AND PATIENTS: The growth hormone production of 10 male subjects running over 40 miles per week was compared to 10 healthy age-matched sedentary males (controls 57.7 +/- 2.8 vs. runners 60.5 +/- 3.4 years). All subjects underwent a basal assessment including a two-hour serum growth hormone profile followed by estimation of maximal exercise capacity on a cycle ergometer with growth hormone estimations at peak exercise activity and every five minutes whilst cycling at 40% of maximal exercise capacity. RESULTS: Maximal exercise capacity confirmed the lifestyles of the two groups (VO2 max controls 22.36 +/-6.05 vs. runners 34.91 +/- 13.13 l/min/kg, P = 0.01). The runners had lower body-mass indices than controls (BMI 22. 3 +/- 1.5 vs. 25.5 +/- 2.0 kg/m2, P = 0.002). Peak growth hormone level during a two-hour resting profile was higher in the runners (median (range) controls 2.10 (0.20-12.20) vs. runners 5.25 (0.80-21. 00) mU/l, P = 0.03) as was the average growth hormone level during the two hour profile (mean growth hormone per 2 h median (range): controls 0.54 (0.03-4.88) vs. runners 2.17 (0.25-7.45) mU/l, P = 0. 04). Growth hormone production at maximal exercise capacity was similar. Sex hormone binding globulin and testosterone were significantly higher in the runners. CONCLUSIONS: The results suggest that regular intensive exercise in older male subjects is associated with higher growth hormone and testosterone levels and that exercise may have a role in counteracting the normal decline in growth hormone with ageing.

Maternally inherited diabetes and deafness: prevalence in a hospital diabetic population.

Maternally inherited diabetes and deafness (MIDD) is a new sub-type of diabetes and results from an A to G substitution at position 3243 of the mitochondrial tRNA(leu(UUR)) gene. This mutation is also associated with a neurological syndrome (MELAS). Recent studies have screened carefully selected diabetic populations and have reported MIDD prevalence rates ranging from undetectable to 60%. The aim of this work was to determine the importance of this sub-type in clinical practice by screening a routine hospital diabetic population. A total of 1440 patients (IDDM and NIDDM) of North European extraction attending two hospital diabetes services were initially screened by questionnaire. This identified 445 patients with one or more features of MIDD and/or MELAS and these subjects were then genotyped. Two patients were identified with the mutation giving a prevalence rate of 0.13% for the whole study population, and 0.45% for the sample with phenotypic features of MIDD. In conclusion, therefore, the 3243 mutation is associated with the phenotypically distinct MIDD sub-type, but this is rare in the routine hospital diabetic population.

Effects of an engineered human anti-TNF-alpha antibody (CDP571) on insulin sensitivity and glycemic control in patients with NIDDM.

Inhibition of tumor necrosis factor (TNF)-alpha action has recently been shown to reverse insulin resistance dramatically and to improve glycemic control in obese rodents. This double-blind study was designed to assess the effects of a recombinant-engineered human TNF-alpha-neutralizing antibody (CDP571) on glucose homeostasis in obese NIDDM patients. Glycemic control and insulin sensitivity were monitored in 21 NIDDM subjects for a 2-week run-in and then for 6 weeks after treatment in a randomized fashion with a single intravenous dose of either CDP571 (5 mg/kg) or an equivalent volume of normal saline. The prolonged half-life of the antibody ensured adequate plasma levels as measured throughout the study. Concentrations of fasting glucose (CDP571: 10.0 +/- 0.8, 10.1 +/- 0.8, 10.0 +/- 1.0; placebo: 8.5 +/- 0.6, 8.1 +/- 0.5, 8.7 +/- 0.8 mmol/l at baseline, day 1, and week 4, respectively), fasting serum insulin (CDP571: 21.2 +/- 2.8, 21.0 +/- 2.8, 24.8 +/- 3.3; placebo: 19.0 +/- 2.8, 20.8 +/- 2.9, 17.5 +/- 2.2 pmol/l, respectively), and C-peptide remained unaffected by the type of treatment throughout the study. The percentage rate of glucose clearance per minute (KITT) during intravenous insulin sensitivity tests was identical in the CDP571 and placebo groups at baseline and also at 1 and 4 weeks after treatment (mean +/- SE; CDP571: 1.33 +/- 0.21, 1.44 +/- 0.25, 1.26 +/- 0.18; placebo: 1.38 +/- 0.15, 1.47 +/- 0.20, 1.52 +/- 0.20; P = 0.85, 0.93, and 0.36, respectively). TNF-alpha neutralization over a period of 4 weeks had no effect on insulin sensitivity in obese NIDDM subjects.

Linfopatía angioinmunoblástica con hipogammaglobulinemia / Angioimmunoblastic lymphadenopathy with hypogammaglobulinemia

La linfopatía angioinmunoblástica es una proliferación ganglionar con una histología particular, habiendo numerosos reportes en la literatura desde 1974. Hipergammaglobulinemia policlonal se encontró en el 80% de los casos relatados. La hipogammaglobulinemia ha sido descripta excepcionalmente en esta entidad, y cuando ésta ocurre se debe sospechar transformación linfomatosa. Sin embargo, hay escasas referencias de linfopatía angioinmunoblástica con hipogammaglobulinemia desde el comienzo de la enfermedad (hipogammaglobulinemia total o déficit selectivo de IgA). El mecanismo de la hipogammaglobulinemia en la linfopatía angioinmunoblástica no está aclarado. Probablemente, estos pacientes representen un subgrupo cuyo pronóstico debe ser definido. Presentamos en este trabajo un caso de linfopatía angioinmunoblástica con hipogammaglobulinemia

Linfopatía angioinmunoblástica con hipogammaglobulinemia / Angioimmunoblastic lymphadenopathy with hypogammaglobulinemia

La linfopatía angioinmunoblástica es una proliferación ganglionar con una histología particular, habiendo numerosos reportes en la literatura desde 1974. Hipergammaglobulinemia policlonal se encontró en el 80% de los casos relatados. La hipogammaglobulinemia ha sido descripta excepcionalmente en esta entidad, y cuando ésta ocurre se debe sospechar transformación linfomatosa. Sin embargo, hay escasas referencias de linfopatía angioinmunoblástica con hipogammaglobulinemia desde el comienzo de la enfermedad (hipogammaglobulinemia total o déficit selectivo de IgA). El mecanismo de la hipogammaglobulinemia en la linfopatía angioinmunoblástica no está aclarado. Probablemente, estos pacientes representen un subgrupo cuyo pronóstico debe ser definido. Presentamos en este trabajo un caso de linfopatía angioinmunoblástica con hipogammaglobulinemia (AU)

A surgical approach to the treatment of fetal hydrocephalus.

Untreated fetal hydrocephalus results in gross cranial and facial abnormalities and profound brain damage. In an attempt to prevent both, a ventriculoamniotic shunt was implanted in a fetus with probable X-linked aqueductal stenosis and hydrocephalus. Performed at 24 weeks' gestation, the procedure used techniques similar to those used for intrauterine transfusion. After shunt placement, the fetal head size grew normally until after the 32d week, when the shunt failed. A cesarean delivery was performed at 34 weeks' gestation. The infant received a standard ventriculoperitoneal shunt after delivery, and his neonatal course has been evaluated through the first three months of life. In selected cases, the ventriculoamniotic shunt may be an acceptable treatment for fetal hydrocephalus.

Endolymphatic sac valve implant surgery. II: The unidirectional inner ear valve implant.

A unidirectional inner ear valve implant was developed to direct excess endolymph out of the inner ear in the hydropic state (Ménière's disease) into the mastoid cavity. A detailed technical description of the valve implant is presented as well as some technical aspects of the valve implant based on the surgical anatomy of the endolymphatic sac.

Unidirectional inner ear valve implant for endolymphatic sac surgery in Meniere's disease.

In five patients with long-standing Meniere's disease, a unidirectional inner ear valve was implanted into the endolymphatic sac (ELS) to facilitate removal of excess endolymph in the hydropic state. These patients were all candidates for ablative surgery. They all had intractable vertigo and severe hearing losses. Four out of five patients had positive preoperative glycerol tests. In the patients with positive glycerol tests, the group averages before surgery were as follows: pure-tone average (PTA), 63 dB; speech reception threshold (SRT), 79 dB; and discrimination score, 27%. All of the patients, except a patient with a negative glycerol test, benefited from the surgery, including exceptional hearing improvements, averages of 21 dB in PTA, 30.5 dB in SRT, and 48% in discrimination, which remained so for at least a one-year minimum follow-up. All patients with preoperative positive glycerol tests had a class A result according to the criteria set forth by the American Academy of Ophthalmology and Otolaryngology. The cumulative follow-up exceeded the minimal requirements by a factor of 39 times. The only failure was in a patient with a negative glycerol test, which was predictable. Results of tomography confirmed the correct position of the valve without evidence of migration or extrusion even in the failure. This new valve appears to be a safe and more effective implant than Silastic sheeting alone or any other ELS implant in patients with a positive glycerol test.

Relaxation measured by EMG as a function of vibrotactile stimulation.

The present study investigated the effect of vibrotactile stimulation on relaxation as measured by EMG recording. Forty-eight subjects from three age groups were randomly divided into 8 experimental groups: (1) simultaneous footrest vibration and back vibration (A1C1); (2) simultaneous footrest vibration and back roller (A1C2); (3) simultaneous footrest vibration, back vibration and back roller (A1C3); (4) footrest vibration alone (A1C4): (5) back vibration alone (A2C1); (6) back roller alone (A2C2); (7) simultaneous back vibration and back roller (A2C3); and (8) control group (no vibration/stimulation) (A2C4). The three major variables studied were footrest vibration (A1 and A2), pre- and post-EMG measures (B1 and B2), and back vibration (C1C2C3C4). Results showed that footrest vibration had a significant effect on relaxation. Other conditions (except the control) produced a decrease in EMG levels, but did not reach significance. Pre- and postmeasures by experimental conditions were also significantly different. Application of vibration as an aid in relaxation is discussed.

Valve implants in filtering surgery.

A valve implant for glaucoma incorporated upper and lower intraocular pressure limits for outflow. The device consisted of an open Supramid tube sealed to a Silastic tube with a slit valve. The valve implants had opening pressures of 11 to 16 mm Hg and closing pressures 1 to 3 mm Hg lower. A surgical technique was developed in monkey eyes and applied later in modified form to three patients with glaucoma. In four of seven monkey eyes the implants remained in place and were patent for over one year. Follow-up studies were carried out for over six months in the three patients. In two patients the valve implants were functioning with controlled intraocular pressures. In one patient the implant migrated posteriorly. This was replaced by using a new valve and a buried fixation suture and has since functioned without problem. The valve implants were well tolerated and offered possibilities for predictable intraocular pressures after glaucoma surgery.