Maternal child-rearing behavior in three groups: cystic fibrosis, insulin-dependent diabetes mellitus, and healthy children.

Compared child-rearing behaviors among mothers of children (ages 4-14) with cystic fibrosis (CF) (N = 26), insulin-dependent diabetes mellitus (IDDM) (N = 26), and mothers of physically healthy children (N = 26), on six domains, including involvement, limit setting, responsiveness, reasoning and guidance, free expression, and intimacy using the Iowa Parent Behavior Inventory. Maternal Reports of their child-rearing behavior were comparable across the three groups with one exception: Mothers of children with chronic illnesses (CF and IDDM) were significantly less likely to set limits than mothers of healthy children. The present findings are consistent with those of other studies that have identified few differences in child-rearing practices between mothers of children with chronic illnesses and mothers of healthy children. Future research should identify situation-specific parenting tasks unique to childhood chronic illness.

Nodular hyperplasia, black thyroid, and chronic minocycline ingestion in a teenager.

An 18-year-old man with left-lobe thyroid hemiagenesis underwent isthmectomy for management of a nodule that failed to take up radioactive iodine during a nuclear scan. The resected tissue, which demonstrated nodular hyperplasia, and the remaining right lobe, were black. The association between deep staining and chronic minocycline ingestion was subsequently recognized. Twelve years later, the patient remained asymptomatic, suggesting that complete resection of tetracycline-stained thyroid tissue is unnecessary.

An update in diabetes mellitus.

Type I diabetes mellitus, also called insulin-dependent diabetes mellitus or IDDM, is a significant chronic condition with implications for dental treatment. Advances in management include intensified therapy, highly purified insulins, and insulin pumps. Periodontal tissues are affected by IDDM, with resultant increases in disease in children affected with IDDM.

Urea synthesis, nitrogen balance, and glucose turnover in growth-hormone-deficient children before and after growth hormone administration.

We measured the effect of human growth hormone (hGH) on urea synthesis, nitrogen retention, and glucose turnover in ten euthyroid growth hormone (GH)-deficient children before and after seven daily injections of 0.1 U/kg hGH. The patients were fed a weight-maintaining diet with 9% of energy derived from protein. Following an overnight fast, urea synthesis and glucose turnover were determined using a primed constant infusion of [15N2] urea and a constant infusion of [6,6-2H2] glucose. Human growth hormone produced a decrease in urea nitrogen synthesis from 6.8 +/- 0.5 to 4.2 +/- 0.4 mg/kg.h; (P less than .01), while plasma urea nitrogen decreased from 13.1 +/- 0.8 to 7.4 +/- 0.8 mg/dL; (P less than .01). The decrease in urea synthesis was reflected in a corresponding decrease in urine urea nitrogen excretion (-2.8 mg/kg.h). There was a significant correlation between plasma urea nitrogen and urea synthesis rate both before (r = 0.85, P less than .01) and after (r = 0.79, P less than .01) hGH treatment. In response to hGH, there was a rise in both plasma glucose (81.4 +/- 2.2 v 89.8 +/- 2.3 mg/dL; P less than .05) and insulin (5.7 +/- 0.8 v 13.1 +/- 3.0 microU/mL; P less than .05), however, glucose turnover remained unchanged (4.7 +/- 0.3 v 4.6 +/- 0.6 mg/kg.min). After seven days of growth hormone treatment, the patients were placed on 0.1 U/kg of hGH three times a week for 6 months, and their growth rate was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

The Prader-Willi syndrome: a study of 40 patients and a review of the literature.

Forty patients with the Prader-Willi syndrome have been examined. The typical features begin in gestational life with poor fetal vigor and difficulties with birth and post-partum feeding. The classical features of hypotonia, small hands and feet, cryptorchidism can be identified at this time. The delayed milestones, mental retardation and obesity become more prominent later. The average height of the patients in this series who were admitted to the Clinical Study Center was 149 cm and their weight was 114 kg. The weight and height curves show that Prader-Willi individuals are consistently shorter and heavier than normal children. Tests of endocrine function showed normal glucose tolerance. Insulin secretion was increased in relation to obesity. The rise in growth hormone (hGH) after injecting insulin to induce hypoglycemia and after the infusion of arginine was comparable to other obese individuals but was low in comparison to normal weight subjects. There was no rise in growth hormone with L-dopa administration, but there was a rise in hGH with the administration of 2-deoxy-D-glucose. The hypoglycemia produced by insulin was greater in the Prader-Willi patient than in obese controls. The rise in TRH (thyrotropin-releasing hormone) following the injection of TSH (thyrotropin stimulating hormone) was greater in the Prader-Willi patients than in the obese controls. Hypogonadism was routine in this series, and the response to LRH (luteinizing releasing hormone) was absent in all tested subjects. Treatment with clomiphene for 30 to 90 days significantly increased the response to LRH in three adult individuals who had not been treated with gonadal steroids previously and who were hypogonadal. Rectal temperature declined in three of the five Prader-Willi patients during exposure to an ambient temperature of 4 degrees C, but none of the three obese controls showed a decline. Food intake averaged 5167 kcal/d when six patients were given trays containing more food than they could eat. Food intake was not reduced when tryptophan was added to the diet. Salivary secretion was reduced in the Prader-Willi patients. A number of pulmonary function tests were significantly reduced in the study patients compared to obese or normal weight controls. The anatomic findings in four autopsied patients with the Prader-Willi syndrome showed no significant differences from those of obese subjects without this syndrome. The chromosomal pattern showed a deletion or translocation at chromosome 15 in 3 of 12 patients in whom this test was performed. These findings in 40 patients with the Prader-Willi syndrome have been compared with the information contained in 159 reports published in the medical literature.

Adrenergic modulation of glucagon and insulin secretion in obese and lean humans.

The adrenergic modulation of immunoreactive insulin (IRI) and glucagon (IRG) secretion was studied in 5 massively obese subjects hospitalized ion a metabolic ward. Epinephrine was infused alone or in combination with propranolol, a beta adrenergic blocking drug, or with phentolamine, an alpha adrenergic blocking drug. Epinephrine infusion produced a significant (p less than .02) rise in IRG levels which was blocked by addition of either phentolamine or propranolol. Pure alpha adrenergic stimulation with propranolol-epinephrine infusion inhibited IRG secretion (p less than .02). IRI levels decreased with propranolol-epinephrine infusion (p less than .02), increased with phentolamine-epinephrine infusion, and were not affected by infusion of epinephrine alone. Glucose concentrations rose with all 3 infusions but were less with phentolamine-epinephrine. A control group of 4 lean outpatients on a ad lib diet demonstrated a similar pattern but the changes of IRG secretion were smaller than in the obese subjects and were not statistically significant. We conclude that in obese humans IRI secretion is increased by beta adrenergic stimulation, is decreased by alpha adrenergic stimulation, and is unaffected by combined alpha and beta adrenergic stimulation. In contrast, IRG secretion is stimulated by combined alpha and beta adrenergic stimulation, is inhibited by pure alpha adrenergic stimulation, and is unaffected by pure beta adrenergic stimulation.

Lipoprotein lipase activity in adipose tissue from obese human beings.

The activity of lipoprotein lipase (LPL) released from human adipose tissue was measured before and after an oral glucose load in obese (n = 8) and normal (n = 7) weight subjects. The enzymatic activity of LPL release from fat tissue by heparin rose significantly one hour after glucose in the normal subjects. There was no such rise in LPL in adipose tissue from obese subjects. Serum triglyceride, insulin and glycerol were higher in the obese than in the lean subjects.

Metabolic and behavioral differences between dieting and intestinal bypass.

The present studies were designed to compare physiological and behavioral changes produced by weight loss induced with dieting and the weight loss which follows intestinal bypass. A group of 7 grossly obese individuals were hospitalized in a metabolic unit and studied at their initial weight after 4 weeks on a hypocaloric diet and again following a comparable weight loss after intestinal bypass surgery. The score indicating depression increased after dieting, but returned to initial levels after bypass. A number of other behavioral changes were recorded including a reduction in the time spent thinking about food, the time when the individual felt hungry and a greater percentage of time when they felt "full". After bypass, the patients also selected and ate smaller quantities of food. There were no metabolic differences following the period of dieting. Among the metabolic changes after bypass were an increase in glycerol and a decrease in insulin. The possible relationships between the metabolic and behavioral changes have been reviewed.

Body fat at puberty in rats: alteration by changes in diet.

The body composition (percent body fat) at vaginal opening of groups of rats fed different diets was determined. Serial changes in body composition prior to vaginal opening were also measured to assess the temporal relationship between first achievement of the body composition subsequently found at puberty and the actual onset of puberty (vaginal opening). The body weight at vaginal opening and the total carcass fat at vaginal opening were significantly different among the three dietary groups (F = 43.06 and 44.60, respectively; P less than 0.001). In addition, the percent body fat at vaginal opening was also significantly different among the three dietary groups (F = 30.30; P less than 0.001). In one group, the percent body fat was the same at the age of 31 days as it was at vaginal opening (mean age 41 days). In a group where food intake was restricted, the percent body fat prior to and at vaginal opening remained lower than that seen at vaginal opening in a group fed the same diet ad libitum. Thus, attainment of a critical level of body weight, total body fat stores, or percent body fat does not trigger puberty in rats.

Plasma zinc and copper in obesity and after intestinal bypass.

Plasma concentrations of zinc and copper were measured in 15 obese patients before intestinal bypass surgery, in 27 patients after intestinal bypass surgery, and in 52 lean control subjects. Preoperatively, the obese patients had zinc concentrations that were significantly lower than in the lean control subjects (76 +/- 3 versus 89 +/- 2 microgram/dl) (+/- SEM) and copper levels that were significantly higher (147 +/- 10 versus 119 +/- 3 microgram/dl). After intestinal bypass, plasma zinc and copper concentrations were significantly lower (zinc, 62 +/- 2 microgram/dl; copper, 90 +/- 5 microgram/dl; P less than 0.001) than in prebypass patients. One patient developed leukopenia associated with a plasma copper concentration of 36 microgram/dl. Leukocyte count and plasma copper level rose with oral copper sulfate replacement therapy. Intestinal bypass surgery may produce clinically significant decreases in plasma concentrations of zinc and copper. Careful observation and replacement therapy are indicated in all patients who develop deficiences after intestinal bypass surgery.

Secondary amenorrhea in obesity: etiologic role of weight-related androgen excess.

A massively obese, amenorrheic young woman had elevated levels of plasma androgens which could be reduced either acutely by dexamethasone administration or chronically by weight loss. Normalization of plasma androgen levels in both instances led to resumption of ovulation, suggesting that weight-related hyperandrogenism is a cause of amenorrhea in obesity.

Occult thyroid disease in an elderly hospitalized population.

Measurements of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), and T3 talc uptake (T3TU) were performed on 425 hospitalized patients over 60 years of age. Unsuspected thyroid disease was found in 10 patients (2.4%); 9 were hypothyroid and 1 hyperthyroid. Another 11% of the population had abnormal T4 or TSH levels but were not proved to have thyroid disease. Repeat measurements in 10 of 40 patients with low serum T4 concentrations showed a return of the tests to normal. The low T4 levels occurred in patients who were seriously ill and were usually associated with low T3TU values. Low serum T3 concentrations were observed in 32 of the patients. Although we found TSH to be the most useful test in the diagnosis of hypothyroidism, it is a relatively expensive test and is not helpful in screening for hyperthyroidism. The present results suggest that the best single test for screening for occult thyroid disease is a serum T4 measurement. We recommend a T4 test on all hospitalized patients over age 60 years. Serum should be held in the laboratory for measurement of TSH concentration if the T4 result is below 6.5 micrograms/dl. A T3 resin or talc uptake and a serum T3 measurement should be performed to rule out hyperthyroidism if the serum T4 concentration is elevated. This regimen will identify virtually all cases of occult thyroid disease.

Treatment of obesity: cost-benefit assessment of behavioral therapy, placebo, and two anorectic drugs.

Mazindol, diethylpropion, and a placebo were compared with behavioral therapy for effectiveness in producing weight reduction in an outpatient obesity clinic. Each method was also compared in cost and harmful side effects. The patients were recruited from the middle and lower socioeconomic groups. Of the 120 patients beginning treatment, only 33 completed the entire 14-week study. There was no statistically significant difference in the weight loss among the treatment groups. The program of behavioral therapy was administered by a dietitian who as experienced in the techniques of behavior modification; the drug treatment groups were seen by physicians. We conclude that behavioral therapy may be the treatment of choice in an outpatient obese population since it requires little physician time, is less expensive, and avoids the side effects of anorectic drugs.