Lower dosages of phentermine-fenfluramine given in the afternoon: five cases with significant weight loss.

Phentermine and fenfluramine are widely used in the treatment of obesity. Despite the fact that primary pulmonary hypertension and mitral valve insufficiency have been associated with fenfluramine use, many of these patients need medication to achieve weight loss. Small degrees of weight loss have been shown to significantly improve obesity-related medical conditions such as hypertension, hypercholesterolemia, and noninsulin-dependent diabetes mellitus. Current practice is to give phentermine and fenfluramine in the morning and afternoon. Doses for phentermine have ranged from 15 to 37.5 mg and for fenfluramine from 20 to 120 mg per day. We report five cases of severely obese women with medical complications who were treated with phentermine 8 mg twice per day (at 1:00 p.m. and 4:00 p.m.) and fenfluramine 20 mg per day (at 4:00 p.m.). Because many obese patients skip breakfast and eat more in the afternoon and evening, medication was dosed in order to cover these high-risk eating periods. Overall, these patients lost a mean of 22.4% of their initial weight (range 18.6% to 32.8%) over an average of 8.4 months (range 3.5 to 16 months). These cases suggest that short-term weight loss can be achieved with a low dose of fenfluramine when both medications are given in the afternoon to better target the eating patterns of obese subjects.

A role for Helicobacter pylori in the gastrointestinal complaints of eating disorder patients?

UNLABELLED: Eating disorder patients frequently present with gastrointestinal complaints. Helicobacter pylori is an etiologic factor in type B gastritis, gastric and duodenal ulcers, and may cause nausea and anorexia. OBJECTIVE: To determine whether or not there is an increased prevalence of H. pylori infection in patients with eating disorders. METHOD: Serum H. pylori IgG antibody and gastrointestinal symptoms were assessed in 32 patients admitted for inpatient treatment of anorexia nervosa and/or bulimia nervosa. RESULTS: Eating disorder patients did not have an increased rate of detectable serum H. pylori IgG antibody. DISCUSSION: There is not an increased prevalence of H. pylori infection in eating disorder patients. Thus, the increased frequency of gastrointestinal complaints in eating disorder patients cannot be attributed to H. pylori infection.

Microfabrication and array technologies for DNA sequencing and diagnostics.

It is now possible to miniaturize numerous 'macroscale' processes and develop microfabricated devices to replace conventional equipment. Such advances have lead to the development of arrays of immobilized oligonuceotides useful for basic research, diagnostic studies, sequence analysis and a number of novel applications. Additionally, standard laboratory equipment has been redesigned on a microscale level to increase efficiency; many processes have been integrated onto one chip since miniaturization can be readily achieved.

The development of microfabricated arrays for DNA sequencing and analysis.

Microfabricated arrays of immobilized oligodeoxynucleotide probes are proving to be a powerful tool for rapidly generating sequence data via hybridization. These arrays are made either by immobilization of the probe post-synthetically, or by in situ synthesis of the probe. Hybridization of the target is easily achieved on the arrays, with analysis proceeding either by direct detection, or through enzyme-mediated detection; analysis of the hybridization pattern yields sequence information about the target. Such facile and rapid data acquisition will assist the challenging task of sequencing the human genome, and also will lead to a new generation of diagnostic assays.

A controlled study of type A behavior and psychophysiologic responses to stress in anorexia nervosa.

Adolescents and young adults meeting DSM-III criteria for anorexia nervosa (n = 13) and atypical eating disorders (n = 7) were compared with weight-recovered anorectics (n = 6) and normal weight controls (n = 11) using a type-A structured interview and a computerized stress procedure. Heart rate, blood pressure, and electrocardiographic changes were monitored. Anorexia nervosa subjects demonstrated significantly more type-A characteristics than controls. The emaciated and weight-recovered anorectics had elevated hostility scores on the type-A interview, which has been shown in recent studies of type-A behavior to be a risk factor for cardiovascular disease. This pilot study is the first to demonstrate a significant relationship between anorexia and the type-A behavioral pattern. Also the anorectic subjects showed significantly more cardiovascular reactivity than controls as measured by failure of stressed anorectic subjects to lower their systolic blood pressure to baseline levels as controls did. These results support the importance of monitoring stress reactions and personality traits as well as traditional biological measures.

Dieting behavior and eating attitudes in children.

Many studies document the high prevalence of dieting and abnormal eating behaviors in adolescents and young adults. The age of onset of eating disorders remains unclear because there are no published surveys of voluntary dieting and eating attitudes in young children. A total of 318 girls and boys were surveyed from two randomly chosen schools in middle-income neighborhoods. The children were equally distributed among grades 3 through 6. The survey included a children's version of the Eating Attitudes Test and a demographic and dieting questionnaire. Results showed that 45% of the children wanted to be thinner, 37% had already tried to lose weight, and 6.9% scored in the anorexia nervosa range, closely matching the published results concerning teenagers and young adult women. Several questions were isolated by univariate and multiple regression analyses that accurately (P less than .05) predicted children's Eating Attitude Test scores. The fact that young children admit having diet preoccupation and atypical eating attitudes is shown in this study. It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children.

Comparison of inhaled metaproterenol, inhaled atropine sulfate, and their combination in treatment of children with acute asthma.

The separate and combined effects of inhaled metaproterenol and atropine sulfate were evaluated in the treatment of 44 episodes of acute asthma occurring in 35 children ranging in age from 13 months to 13 years. Peak expiratory flow rate and pulmonary index were measured before and after each of up to three inhalation treatments. Significant improvement in peak flow rate (P less than .04) was noted after the second inhalation of metaproterenol both with and without the combination of atropine sulfate compared with the effects of atropine alone. Patients treated with metaproterenol and metaproterenol combined with atropine also experienced fewer therapeutic failures (2/15 and 2/16, respectively) compared with those treated with atropine (6/13, P less than .02). Pulmonary index scores did not differ among the treatment groups. Inhaled metaproterenol appears to be more effective than inhaled atropine sulfate in the treatment of children with acute asthma. The addition of inhaled atropine sulfate appears to offer no advantage over treatment with inhaled metaproterenol alone.

Effect of an electronic air cleaner and negative ionizer on the population of indoor mold spores.

We evaluated the ability of an electrostatic air cleaner and negative ionizer (Bionaire 1000, Biotech Electronics, Ltd) to cleanse indoor air of mold spores. Significant reductions in the number of mold colonies were observed when the air cleaner was operated alone. We found no significant decrease in the circulating amounts of mold spores over baseline with the additional use of the negative ionizer. Though there were day-to-day variations in the numbers of spores, these changes remained significant.

Desensitization to factor VIII in a patient with classic hemophilia and C2 deficiency.

Factor VIII therapy has been reported to cause anaphylactic reactions in patients with hemophilia. Desensitization attempts have been complicated by severe allergic reactions that have prevented the achievement of protective factor VIII levels. We report successful administration of factor VIII by a graded dose desensitization protocol in a 36-year-old man with hemophilia A who had previously experienced anaphylactic reactions to factor VIII infusions. The reactions were manifested by urticaria, choking, and bronchospasm and were not prevented by pretreatment with antihistamines and corticosteroids. Intradermal skin test with factor VIII was positive. Serum levels of circulating immune complexes were slightly elevated. Persistently low serum C2 levels were consistent with genetic C2 deficiency. These findings suggest the possibility of Type I (IgE mediated) and Type III (immune complex) immunopathogenic mechanisms. Our experience suggests that administration of factor VIII by graded dose desensitization protocol may offer a practical therapeutic approach for management of hemorrhage in patients with classic hemophilia who are allergic to factor VIII.

Concomitant psychological and cardiac improvement during successful treatment of anorexia nervosa.

A patient with anorexia nervosa in whom concurrent nutritional, psychological, and cardiovascular assessments were obtained sequentially during successful treatment is presented. At the time of diagnosis, severe multisystem dysfunction was present including depression, low self-esteem, hypotension, bradycardia, exercise intolerance, and abnormalities of systolic and diastolic cardiac function. Treatment resulted in weight gain and increased skinfold thickness and arm circumference. There were concomitant improvements in the psychometric indices of depression and self-esteem as well as decreased anorectic tendencies. During her recovery, working capacity increased and diastolic function improved. However, echocardiographic evidence of impaired systolic function persisted. Despite the apparent treatment success in this patient, this report suggests a potential need for further studies to determine the extent, if any, of long-term cardiac sequelae.