Prevalence and type of psychiatric disorder and developmental disorders in three speech and language groups

Six hundred children with communication disorders presenting to a community clinic were evaluated for psychiatric and developmental disorders. The 600 children fell into three subgroups: those with "pure speech disorders," those with "speech and language disorders," and those with "pure language disorders." The two subgroups with language involvement had higher rates of both psychiatric and developmental disorders than the children with pure speech involvement. Those children with language involvement also had a different pattern of psychiatric diagnoses than the children with pure speech disorders. Possible etiological factors and clinical significance of these findings are discussed.

Insulin-like growth factor binding protein-1 levels in the diagnosis of hypoglycemia caused by hyperinsulinism

The diagnosis of hypoglycemia caused by hyperinsulinism may be difficult because insulin levels are not uniformly elevated at the time of hypoglycemia. Insulin-like growth factor binding protein-1 (IGFBP-1) is a 28 kd protein whose secretion is acutely inhibited by insulin. We hypothesized that serum levels of IGFBP-1 would be a useful marker of hyperinsulinism. We measured IGFBP-1 levels during the course of standardized fasting studies in hospitalized children; 36 patients became hypoglycemic during the fasting studies, and samples obtained at the point of hypoglycemia were analyzed. On the basis of the currently used diagnostic criteria, 13 children had hyperinsulinism, 16 had ketotic hypoglycemia or no disorder, 3 had hypopituitarism or isolated growth hormone deficiency, 2 had glycogen storage disease type 1 and 2 had fatty acid oxidation disorders. In control subjects (children with ketotic hypoglycemia or no disorder), IGFBP-1 levels rose during fasting to a mean of 343.8 +/- 71.3 ng/ml in the sample drawn at the time of hypoglycemia. Mean IGFBP-1 levels at hypoglycemia for the entire group with hyperinsulinism were 52.4 +/- 11.5 ng/ml, significantly different from levels seen in control subjects (p < 0.0001). In children with moderately controlled hyperinsulinism (fasting tolerance > 4 hours), mean IGFBP-1 levels at the time of hypoglycemia were 71.5 +/- 16.9 ng/ml. IGFBP-1 levels in the children with poorly controlled hyperinsulinism (fasting tolerance < 4 hours) failed to rise during fasting, with a mean of 30.1 +/- 10.4 ng/ml in the final sample. IGFBP-1 levels were inversely correlated with serum insulin and C-peptide levels (r = -0.71 and -0.72, respectively; p < 0.0001). Patients with other endocrinologic or metabolic diseases that result in fasting hypoglycemia demonstrated a rise in IGFBP-1 levels similar to that seen in ketotic hypoglycemia. Low serum levels of IGFBP-1 at the time of hypoglycemia provide an additional marker of insulin action that might help to differentiate hyperinsulinism from other hypoglycemic disorders.

Pleural effusion in cancer patients. A prospective randomized study of pleural drainage with the addition of radioactive phsophorous to the pleural space vs. pleural drainage alone

Sixty-seven patients with disseminated cancer were randomly allocated to treatment with continuous closed chest drainage removing all fluid for 72 hours (PD) or pleural drainage for 72 hours with the instillation into the pleural space of radioactive colloidal chromic phosphate (PD + 32P). Forty-nine patients had breast carcinoma, and the remaining 18 patients had other cancers. Four of 49 patients with breast cancer and 13 of 18 with other cancer were dead in 8 weeks from the onset of effusion. In the group of patients with breast cancer PD + 32P controlled the effusion in 12 of 22 (54%) and PD alone in 15 of 30 episodes (50%). In the nonbreast group of patients PD + 32P controlled the effusion in five of six evaluable episodes (83%), and PD alone was successful in two of nine (22%). In 33% of breast cancer patients and 25% of the nonbreast-cancer patients, systemic chemotherapy produced objective remissions. Pleural effusion did not recur in any of these patients.

Diabetic glycemic control and retinal blood flow

The effect of strict glycemic control on retinal volumetric blood flow rate (Q) was investigated in 13 insulin-dependent diabetic patients with laser Doppler velocimetry and monochromatic fundus photography. Strict glycemic control was achieved by glucose monitoring and four daily insulin injections. Q was determined in a major retinal vein at baseline and then 5 days, 2 mo, and 6 mo after the institution of strict control. Level of retinopathy was assessed from stereocolor fundus photographs taken at baseline and 6 mo. After 6 mo of strict diabetic control, five eyes demonstrated progression (P) by one or more retinopathy levels, and eight eyes showed no progression (NP). At 5 days, there was a significant decrease in Q of 1.4 +/- 0.9 microliters/min (P less than 0.005) in NP eyes and a nonsignificant increase in Q of 1.2 +/- 1.7 microliters/min in P eyes. Changes in Q from baseline observed at 5 days were strongly correlated with changes in retinopathy level at 6 mo (r = 0.79, P less than 0.005). No significant changes in Q from baseline were observed at 2 and 6 mo. A lack of decrease in Q at 5 days was associated with the progression of retinopathy that occurs in some patients after the institution of strict glycemic control and may serve as a predictor for progression of retinopathy.

Psychiatric disorders in children with speech and langauge retardation. Factors associated with development

One hundred children (mean age, 5 to 6 years) who were seen consecutively at a suburban speech and hearing clinic were systematically evaluated for speech and language disorders and psychiatric disorders. Fifty-three were found to have a psychiatric illness. The three groups were compared with the psychiatrically well group to ascertain factors associated with the presence of a psychiatric disorder. Significantly differentiating the ill group were more academic and classroom behavior problems and the presence of both speech and language problems. The two groups were not significantly different in intellectual retardation, hearing impairment, medical factors, nonlanguage development disorders, and a variety of family and demographic factors. Common in both groups were psychiatric illness in parents and first-degree relatives. The data indicate that children with speech and langauge disorders are highly at risk for the development of significant psychiatric problems, which suggests the need for proper screening and multimodal treatment planning.

Dual hormonal replacement with insulin and recombinant human insulin-like growth factor I in IDDM. Effects on glycemic control, IGF-I levels, and safety profile

OBJECTIVE

To examine if dual replacement with insulin and rhIGF-I, recombinant human insulin-like growth factor I (rhIGF-I) may be safe and result in improved metabolic control and reduced insulin usage.

RESEARCH DESIGN AND METHODS

Forty-three patients with IDDM were randomized to receive a daily injection of rhIGF-I (80 mcg/kg s.c.) or placebo while on conventional insulin therapy for 4 weeks. Insulin was adjusted in the attempt to achieve predetermined goal glycemic values. Free and total IGF-I, four daily blood glucoses, and HbA1c were measured.

RESULTS

Before randomization, placebo and rhIGF-I groups exhibited low plasma levels of free and total IGF-I, which increased toward normal levels during the treatment period only in the rhIGF group. The regression curve obtained from the average of daily blood glucose measurements indicated that the glycemic profile, overlapping in the lead-in period, exhibited a downward trend in the rhIGF-I group during the treatment period. Mean blood glucose level during the last 10 days of treatment was lower in the rhIGF-I groups (174 +/- 37 vs. 194 +/- 32 mg/dl). HbA1c level was reduced by more than one-half percent more in the rhIGF-I group (-1.85%) than in the control group (-1.3%). The dose of regular insulin was significantly lower in the rhIGF-I group (0.2 +/- 0.1 vs. 0.28 +/- 0.1 U. kg-1. 10 days-1 in the placebo group; P < 0.05).

CONCLUSIONS

rhIGF-I in combination with conventional insulin treatment ameliorated the low plasma total and free IGF-I levels and was well tolerated in IDDM. There was a trend toward improved glycemic control, while the regular insulin dose was significantly decreased.

Serum myoinositol concentrations in premature infants fed human milk, formula for infants, and parenteral nutrition

Myoinositol concentration was studied in serum of 65 neonates and their mothers at the time of birth, in samples of various types of feedings for infants, and in serial serum samples of 15 premature infants receiving human milk, formulas for infants, or parenteral nutrition over a 3-wk period. At birth the serum concentration of myoinositol was greater in neonates than in their mothers (108 +/- 10 vs 52 +/- 6 mumol/L, respectively, means +/- SEM, p less than 0.01). In feedings for infants, the concentrations of myoinositol were significantly greater in human milk than in formulas or parenteral nutrition solutions (1840 +/- 451 vs 420 +/- 110 vs 100 +/- 8 mumol/L, respectively, p less than 0.001). Over a 3-wk period the serum concentration of myoinositol increased in infants receiving human milk but not in those receiving formulas or parenteral nutrition. Serum concentrations of myoinositol in neonates are greater than in adults and are directly influenced by myoinositol intake.

Children's methods of coping with stress: a twin study of genetic and environmental influences

The relative importance of environmental and hereditary factors in how children cope with stress was examined. Emotion-focused, problem-focused, and additional coping variables were assessed in 44 monozygotic (MZ) and 30 dizygotic (DZ) twin pairs, aged 9-16 years. The effects of heritability, shared environment, and unshared environment were examined in structural modelling analyses. Genetic factors accounted for a majority of the reliable variance in four of seven coping variables, while effects of twins' shared environment were negligible for all but one coping variable. Environmental factors important to individual differences in coping strategies were primarily unique to each child (unshared between the twins), highlighting the importance of individual experiences in shaping coping behaviors.

'Competition' among employers offering health insurance

Most employees contribute towards the cost of employer-sponsored insurance, despite tax laws that favor zero contributions. Contribution levels vary markedly across firms, and the average contribution (as a percentage of the premium) has increased over time. We offer a novel explanation for these facts: employers raise contribution levels to encourage their employees to obtain coverage from their spouses' employer. We develop a model to show how the employee contribution required by a given firm depends on characteristics of the firm and its work force, and find empirical support for many of the model's predictions.

Isolation, characterization and evolution of ovine major histocompatibility complex class II DRA and DQA genes

Four full-length ovine major histocompatibility complex (MHC) class II A cDNA clones coding for new alleles of DRA, DQA1 and DQA2 genes were isolated from two ovine lambda gt10 cDNA libraries. The derived amino acid sequences of these clones resemble class II A molecules from other species in both size and structure. Restriction fragment length polymorphism analysis, using an Ovar-DRA probe on DNA from Merino and Romney sheep revealed only limited polymorphism in contrast to the high levels of polymorphism revealed by Ovar-DQA probes. Comparison of the predicted amino acid sequences for the three ovine A genes with class II A genes from five other species revealed that the most variable region of the molecule is the signal peptide. Although virtually every amino acid site shows variation, within or between species, there are some blocks of highly conserved residues. Within gene comparisons of nucleotide differences reveal that the greatest number of changes is found between the alleles of Ovar-DQA1 and -DQA2 genes and the least between Ovar-DRA1 alleles. Phylogenetic analysis of class II A sequences from several species place DRA and DQA genes on two distinct branches, with Ovar-DRA1 and BOLA-DRA, and Ovar-DQA1 and BOLA-DQA being most similar on their respective branches.

Factors associated with the development of psychiatric illness in children with early speech/language problems

This paper reports on the correlates of psychiatric illness in children with speech and language disorders. Of 600 children selected from a community speech clinic, 50% were found to have diagnosable psychiatric disorders according to DSM-III criteria. These "psychiatrically ill" children were compared to the "psychiatrically well" children in the sample on a variety of developmental, socioeconomic, medical, and psychosocial factors. Although some differences were found between the well and ill children in other factors, the majority of the differences, and the most highly significant differences, were found in areas of linguistic functioning. It is hypothesized that this finding may be relevant not only to understanding the association between linguistic and psychiatric functioning but also to predicting the outcome and planning treatment for childhood speech and language disorders.

Morphine-6beta-glucuronide and morphine-3-glucuronide, opioid receptor agonists with different potencies

Using heterologous expression in Xenopus laevis oocytes, we compared the potencies of morphine, morphine-6beta-glucuronide (M6G), and morphine-3-glucuronide (M3G) for cloned human mu- (hMOR), kappa- (hKOR), and delta-opioid receptors (hDOR). Each receptor subtype was individually co-expressed with heteromultimeric G-protein coupled inwardly rectifying K(+) (GIRK) channels, consisting of GIRK1 and GIRK2 subunits, and RGS4, a regulator of G-protein signaling. The two-microelectrode voltage clamp technique was used to measure the opioid receptor-activated GIRK1/GIRK2 channel responses. Compared with morphine, M6G had higher potency at the hMOR, lower potency at the hKOR, and similar potency at the hDOR, while M3G showed a 1000-fold lower and non-selective potency via opioid receptors. In contrast to naloxone, M3G did not antagonize the effects of morphine at the hMOR. We also investigated whether Trp318 and His319 provide the molecular basis for mu/delta selectivity and mu/kappa selectivity of morphinan alkaloids by mutating these residues to their corresponding residues in kappa- and delta-opioid receptors. A single-point mutation (W318L) on hMOR completely conferred delta-like potency for morphine and M6G on the mutant mu-receptor. Double mutation at Trp318 and His319 positions (Trp318Y/His319Y) only partially conferred kappa-like potency for morphine and M6G; the decrease in potency for M6G was significantly larger than for morphine. The results of our study show that both M6G and M3G are opioid receptor agonists with different potencies and that the potency of morphinan receptor ligands can be changed by selective mutations of hMOR at the Trp318 and His319 positions.

Diabetes mellitus affects prostaglandin E2 levels in mouse embryos during neurulation

The arachidonic acid cascade leading to prostaglandins has been implicated in diabetic embryopathy. Both arachidonic acid and prostaglandin E2 reverse the teratogenic effects of high glucose concentrations on neural tube development in mouse embryos in culture. Arachidonic acid supplementation also protects against diabetes-induced neural tube defects in vivo. In the present study, prostaglandin E2 was measured directly in embryos from normal and diabetic mice. In normal mice a clear developmental pattern was seen. Prostaglandin E2 levels were high during early formation of the cranial neural folds (day 8), declined during convergence and fusion of the cranial neural folds to form the neural tube (day 9), and were low after neurulation was complete (days 10 and 11). In addition, evidence in this study indicates that embryos have cyclooxygenase activity capable of generating prostaglandin E2 during a brief developmental period preceding neural tube closure. In embryos from mice made diabetic (> 13.9 mmol/l glucose) with streptozotocin, prostaglandin E2 levels were significantly lower than normal during early development of the cranial neural folds (day 8), but similar to normal after the cranial neural tube had closed (late day 9 and day 10). The findings suggest that diabetes mellitus, as ascertained by high blood glucose, promotes cranial neural tube malformations by causing a functional deficiency of prostaglandin E2 during early neurulation. Whether the altered PGE2 pattern in the embryo indicates a diabetic effect on the arachidonic acid-prostaglandin cascade in cells of the embryo or in cells of extraembryonic or maternal tissues is uncertain.

Prevalence, clinical significance, and strain specificity of neutralizing antibody to the human immunodeficiency virus

A semiautomated microtiter assay has been developed to quantitate neutralizing antibody to the human immunodeficiency virus. This assay has been found to be highly specific. Forty-four sera that were negative by enzyme-linked immunosorbent assay (ELISA) were tested under code: 42 were negative (less than 1:2), and 2 had titers of 1:2. By contrast, of 178 sera positive by western blot, 92.7% had detectable neutralizing antibody, and 12.5% had titers greater than or equal to 1:128. Neutralizing antibody titers correlated poorly with clinical diagnosis and T4/T8 ratios. Different isolates differed quantitatively in their sensitivity to neutralization by antibodies obtained from different patients; however, all strains tested so far have been neutralizable by all the sera tested. Neutralizing antibody titers correlated weakly, if at all, with direct or competition ELISA titers.

The relationship of attachment theory and perinatal loss

Perinatal loss has recently received attention in the literature that presents it as different from other types of losses. Perinatal loss, or the loss of an infant due to miscarriage, stillbirth, or neonatal death, is a significant problem that may be best understood when viewed through the framework of attachment theory. Recent advances in medical technology, including prenatal diagnostic procedures and resulting decisions have influenced issues of both perinatal attachment and loss, and have provided challenges for the clinician. This article presents a review of current theories and research on attachment and perinatal loss, and discusses how knowledge gained from this research may be integrated into clinical practice.

Diabetes-like renal glomerular disease in Fanconi-Bickel syndrome

The Fanconi-Bickel syndrome is a rare inherited disorder of metabolism characterized by hepatic glyconeogenesis, galactose intolerance, renal Fanconi syndrome with nephromegaly, and glycogen accumulation in proximal renal tubular cells. An 8-year-old patient with this disease and severe rickets due to medically resistant hypophosphatemia was found to have the previously unrecognized complication of renal glomerular hyperfiltration, microalbuminuria, and diffuse glomerular mesangial expansion. Similar to patients with glucose-6-phosphatase deficiency, the glomerular disease in this patient resembles incipient diabetic nephropathy. The Fanconi syndrome may be due to the defective transport of glucose at the proximal tubular basolateral membrane, which results in accumulation of glucose and secondarily glycogen within tubular cells. Since the metabolic defect, as evidenced by glycogen accumulation, selectively involves proximal renal tubular cells in the kidney of patients with Fanconi-Bickel syndrome and glucose-6-phosphatase deficiency, the abnormalities in renal glomerular hemodynamics and mesangial construct in these rare diseases are likely due to renal tubular factors, if the mechanism originates in the kidney. A delineation of these phenomena may further our understanding of the pathogenesis of diabetic nephropathy.

A wire-sheath system for MR-guided biopsy and drainage: laboratory studies and experience in 10 patients

On the basis of laboratory experiments, we devised a wire-sheath system for MR-guided biopsy and drainage and then evaluated that system in 10 patients. The localizing system consisted of a 20-gauge plastic sheath into which a stainless-steel alloy wire had been inserted. In laboratory studies, we compared this wire-sheath assembly with other materials to determine its optimal visualization on MR images. We then used the same wire-sheath system to perform 16 procedures (in 10 patients), including six biopsies, five diagnostic fluid aspirations, and five catheter drainages of infected and noninfected fluid collections. The laboratory results showed that the wire-sheath assembly cast a 7-mm artifact, was visualized well on all pulse sequences, and was safe within the magnet (minimal attraction). The assembly was visualized well in each patient and provided adequate localization. MR-guided biopsy and drainage can be performed with high-resolution detail by using this wire-sheath system. Potential uses of this system include (1) treatment of lesions that can be seen on MR images only (or that can be seen to significantly better advantage on MR images than on sonograms or CT scans), and (2) treatment of patients in whom avoidance of the radiation delivered by CT is imperative.