The effect of weight gain on gonadotrophins and prolactin in anorexia nervosa

Serum levels of gonadotrophins and prolactin and their response to luteinizing hormone/follicle stimulating hormone--releasing hormone (LRH) and thyrotrophin releasing hormone (TRH) were measured in 14 females with anorexia nervosa when at low body weight and again in 6 cases during, and 12 cases after weight gain. Mean serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were low initially and whereas FSH increased significantly with weight gain, LH levels remained subnormal in most patients. LH responses to LRH were grossly impaired or absent in patients whose weight was below 75% of the ideal, but increased dramatically above this weight over-shadowing the more modest increase in FSH response. In three patients, however, impaired LH responses persisted as ideal weight was approached. Basal prolactin levels were well within the normal range in all patients. During weight gain there was no change in basal levels but the prolactin level 20 min after TRH was significantly increased.

Psychometric rating in the assessment of progress in anorexia nervosa

Personality variables and psychiatric symptoms were each assessed by inventory in 42 patients with anorexia nervosa: as in-patients initially, and during a three-year follow up. The results were used to distinguish primary from secondary cases and to monitor the clinical progress of the disorder.

New technique for prevention of brain damage during surgery of the aortic arch

In this paper we present the design and characteristics of a new shunting cannula for prevention of brain ischemia during surgery of the aortic arch. The preliminary results in animals show the validity of this cannula, that shortens the time of the operating procedure and reduces some of the technical difficulties.

Hypothyroidism, psychotropic drugs and cardiotoxicity

The effects of hypothyroidism are protean, involving many systems. Electrocardiographic changes are almost invariable, and include bradycardia, low QRS voltage and flattened T waves: these are usually reversible with replacement therapy (McDonald, 1978). Psychiatric disturbances are also well known, although they are seldom the presenting feature and are notorious for mistakes in diagnosis (Lishman, 1978; Whybrow and Ferrell, 1974). Most such disturbances comprise apathy and depression, some an organic reaction and a few manifest as an acute schizophrenia-like psychosis. Phenothiazines, the most generally used neuroleptic medication, may interfere with cardiac conduction. When hypothyroidism presents as acute psychosis and the patient is hypersensitive to phenothiazines a dangerous situation can arise.

Capgras: case study and reappraisal of psychopathology

A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.

Dietary zinc intake of low-income pregnant women of Mexican descent

Zinc intakes of low-income pregnant women of Mexican descent were estimated by the use of 24-hr dietary recalls. Recalls were obtained during the first two trimesters for 344 women and again during the third trimester of pregnancy for 279 of the same women. The daily mean zinc intake was calculated as 9.4 +/- 3.8 mg during the first two trimesters and as 10.0 +/- 4.3 mg during the third trimester. For about 85% of the women, the reported intakes were below two-thirds of the Recommended Dietary Allowance for zinc. In a subsample of the women, no significant correlation was shown between low dietary zinc intakes and low serum zinc levels during either early or late pregnancy. Zinc and protein intakes were highly correlated in both early and late pregnancy (r = 0.83 and 0.89, respectively). Diets that provided 90 to 100 g of protein (about 125% of the Recommended Dietary Allowance) provided a mean of 13.6 g of zinc (67% of the Recommended Dietary Allowance).

Effects of somatostatin on gastric mucosal histamine and serotonin content in restrained rats

The effects of continuous intravenous perfusion of somatostatin on the incidence of ulcers and the histamine and serotonin gastric mucosal content in rats subjected to 12 h of restraint were studied. 51 sets of Sprague-Dawley male rats (102 animals) were divided at random into two groups. Those in group I were immobilized and treated with an intravenous infusion of isotonic saline solution. Animals in group II were also immobilized and given intravenous cyclic somatostatin dissolved in isotonic saline solution; the initial dose was 25 microgram and a continuous infusion of 2.5 microgram/kg/h was administered thereafter. A decrease in the ulcer index was observed in the rats perfused with somatostatin (p less than 0.01) as well as a decrease in the histamine (p less than 0.001) and serotonin (p less than 0.01) gastric mucosal contents. These effects of somatostatin on restraint-induced stress ulcer in rats are probably to be explained by microcirculatory changes in the gastric mucosa determined by the vasoactive amines (histamine and serotonin). They constitute an important factor in the pathogenesis of these lesions.

Hypothalamo-pituitary-thyroid function in anorexia nervosa: influence of weight gain

The functional state of the hypothalamo-pituitary-thyroid axis was assessed in 14 women and girls with anorexia nervosa when at low body weight and again in 12 cases after they had gained weight. Mean serum thyroxine concentrations were low before and after weight gain. Mean serum triiodothyronine (T3) concentrations were substantially reduced at low weight and doubled after weight gain, the absolute values being linearly correlated with body weight expressed as a percentage of the ideal. Concentrations of reverse T3 were greatly increased in some patients initially and fell with weight gain. Basal concentrations of thyroid-stimulating hormone (TSH) were unchanged after weight gain but the TSH response to thyrotrophin-releasing hormone was significantly augmented; delayed patterns of response were found in seven out of 12 patients tested before and three out of 12 patients tested after weight gain. Changes in the hypothalamo-pituitary-thyroid axis are common in anorexia nervosa and probably represent both peripheral and central adaptations to the altered nutritional state.

Psychologically mediated abdominal pain in surgical and medical outpatients clinics

Ninety-six patients complaining of recurrent or persistent abdominal pain were referred consecutively to a surgical clinic and a medical clinic, respectively. They were examined psychiatrically after their initial physical investigation. The psychiatric examination included rating scales for depression and anxiety, a personality inventory, life-events schedule, scale of verbal expressivity, and family and personal patterns of pain and invalidism. Only 15 patients (15-6%) had organic disorders that could be responsible for their symptoms. In the remainder, psychiatric factors were considered primarily responsible for their abdominal pain: 31 were depressed; 21 had chronic tension; in 17 hysterical mechanisms were prominent; and 12 were found to be unrecognised alcoholics. Follow-up at three and six months and recognition by 80% of the psychogenic group that a psychological explanation was plausible, confirmed the diagnoses, and over half responded favourably to psychiatric management. Features distinguishing the organic and psychogenic groups were delineated. Psychiatric assessment has a place among the investigations of non-acute abdominal pain; certainly it should not be condisered simply as "a last resort."