A Null mutation in the vasopressin V2 receptor gene (AVPR2) associated with nephrogenic diabetes insipidus in the Hopewell kindred

Congenital nephrogenic diabetes insipidus (DIR) is a rare X-linked hereditary disorder in which the renal collecting duct is unresponsive to arginine vasopressin; thus, the urine is consistently hypotonic to plasma. Recently, the association between the V2 receptor gene (AVPR2) and DIR has been proven. We have determined the gene sequence of four family members, from three generations, of a large North American family with CNDI who were originally part of the study used to formulate the Hopewell hypothesis. It had been proposed that a single DIR gene defect was introduced to North America by a member of an Ulster Scot kindred arriving on the ship Hopewell in 1761. DNA sequencing of the AVPR2 has identified a single base transversion from G-->A which changes tryptophan 71 to a stop codon in affected patients. This point mutation causes a truncation of the receptor leading to an essentially null allele. These data and other recently described mutations in the AVPR2 in North American pedigrees, descended from Ulster Scot ancestors and other origins, make the assertion of a founder effect proposed in the Hopewell hypothesis invalid.

Central auditory neurophysiology of a sound-producing fish: the mesencephalon of Pollimyrus isidori (Mormyridae)

This paper describes the auditory neurophysiology of the mesencephalon of P. isidori, a sound-producing mormyrid fish. Mormyrids have a specialized pressure-sensitive auditory periphery, and anatomical studies indicate that acoustic information is relayed to the mesencephalic nucleus MD. Fish were stimulated with tone bursts and clicks, and responses of MD neurons were recorded extracellularly. Auditory neurons had best frequencies (BF) and best sensitivities (BS) that fell within the range of frequencies and levels of the natural communication sounds of these fish. BSs were in the range of 0 to -35 dB (re. 1.0 dyne/cm2). Many of the neurons were tuned (Q10 dB: 2-6), and had BFs in the range of 100-300 Hz where the animal's sounds have their peak energy. A range of different physiological cell types were encountered, including phasic, sustained, and complex neurons. Some of the sustained neurons showed strong phase-locking to tones. Many neurons exhibited non-monotonic rate-level functions. Frequencies flanking the BF often caused a reduction in spontaneous activity suggesting inhibition. Many neurons showed excellent representation of click-trains, and some showed a temporal representation of inter-click-intervals with errors less than 1 ms.

Tertiary hyperparathyroidism during high phosphate therapy of familial hypophosphatemic rickets

We report the development of severe tertiary hyperparathyroidism in three girls treated for familial hypophosphatemic rickets and characterize parathyroid function in vivo and in vitro. All patients had been previously treated with relatively large doses of inorganic phosphorus (125 mm/day) and ergocalciferol or calcitriol for several years and had radiographic evidence of long-standing hyperparathyroidism. Even in the presence of extremely elevated PTH levels, oral phosphate lowered serum calcium levels in vivo and further stimulated PTH secretion. Profound multiglandular parathyroid hyperplasia was found in each patient at surgery. Examination of the secretory characteristics of the excised parathyroid tissue revealed that either relatively high calcium concentrations were generally needed to suppress PTH secretion or PTH secretion was not suppressible. Caution is recommended when relatively large doses of phosphate are used to treat familial hypophosphatemic rickets.

Rotation of Listing's plane during vergence

When visually fixating targets on an isovergence surface, the position of each eye was constrained to a plane. Thus, Listing's law holds during vergence. The planes were, however, rotated temporally with respect to those when viewing distant targets. The effect of this rotation was to produce a torsion which depended on eye elevation; extorsion of the two eyes for downward gaze and intorsion for upward gaze. The saccadic velocity command was relatively unaffected during vergence. Computer simulations suggest that the saccadic tonic command and the vergence command interact multiplicatively in three dimensions.

The conjugacy of human saccadic eye movements

Binocular measurements of instantaneous velocity vectors in normal human subjects during saccades showed: (1) considerable trial to trial variation in peak velocity, saccade duration, and saccade curvature despite saccade accuracy; (2) variations in one eye were mirrored by similar variations in the other eye, with a high positive correlation. The high correlation between the peak velocities suggest that saccades in the two eyes are driven by a common saccade generator. Assuming that a local feedback loop guides saccades, the high correlation between saccade durations and between saccade curvatures suggests that both eyes are guided by common feedback. If so, monocular adaptation must occur downstream from the saccade generator.

Symmetry of oculomotor burst neuron coordinates about Listing's plane

1. The purpose of this investigation was to determine the axes of eye rotation generated by oculomotor burst neuron populations and the coordinate system that they collectively define. In particular, we asked if such coordinates might be related to constraints in the emergent behavior, i.e., Listing's law for saccades. 2. The mesencephalic rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) was identified in four monkeys with the use of single-unit recording, and then explored with the use of electrical microstimulation and pharmacological inactivation with the inhibitory gamma-aminobutyric acid (GABA) agonist muscimol. Three-dimensional (3-D) eye positions and velocities were recorded in one or both eyes while alert animals made eye movements in response to visual stimuli and head rotation. 3. Unilateral stimulation of the riMLF (20 microA, 200 Hz, 300-600 ms) produced conjugate, constant velocity eye rotations, which then stopped abruptly and held their final positions. This is expected if the riMLF produces phasic signals upstream from the oculomotor integrator. 4. Units that burst before upward or downward saccades were recorded intermingled in each side of the riMLF. Unilateral stimulation of the same riMLF sites produced eye rotations about primarily torsional axes, clockwise (CW) during right riMLF stimulation and counterclockwise (CCW) during left stimulation. Only small and inconsistent vertical components were observed, supporting the view that the riMLF carries intermingled up and down signals. 5. The torsional axes of eye rotation produced by riMLF stimulation did not correlate to external anatomic landmarks. Instead, stimulation axes from both riMLF sides aligned with the primary gaze direction orthogonal to Listing's plane of eye positions recorded during saccades. 6. Injection of muscimol into one side of the riMLF produced a conjugate deficit in saccades and quick phases, including a 50% reduction in all vertical velocities and complete loss of one torsional direction. CW was lost after right riMLF inactivation, and CCW was lost after left inactivation. 7. The plane that separated the intact torsional axes from the missing axes correlated with the orientation of Listing's plane. Thus, during left or right riMLF inactivation, the vertical axes of intact horizontal saccades were abnormally aligned with Listing's plane. The orientation of these axes was not correlated with external anatomic landmarks. 8. As suggested by their alignment with Listing's plane, the intact vertical axes of horizontal saccades following riMLF inactivation were orthogonal to torsional riMLF stimulation axes.(ABSTRACT TRUNCATED AT 400 WORDS)

Individual and sex specificity in the electric organ discharges of breeding mormyrid fish (Pollimyrus isidori)

I monitored the electric organ discharges (EODs) of 14 Pollimyrus isidori, (Cuvier and Valenciennes) during an artificially induced breeding season, to examine sex and individual differences in reproductive fish. EODs were repeatedly recorded over an 11-day period to ascertain the stability of each individual's EOD and to make a quantitative assessment of sex differences. Within days, I found the individual's EOD to be constant from one EOD to the next. Over the 11-day sampling period, individuals were also quite stable and exhibited only slight changes in EOD duration and relative amplitude of the phases of the waveform. I found that the differences between individuals of the same sex were highly significant in measures of EOD duration and in measures of the relative amplitude of the phases. Differences between the sexes were also highly significant in relative amplitude but were not significant in duration. In a multivariate discriminant function analysis, I have found that individual fish can be correctly classified on the basis of temporal, relative amplitude and spectral cues in the EOD, despite slight changes in these parameters with time. The EOD exhibits characteristics of a good signature in the context of an information system.

Osteopenia in men with a history of delayed puberty

BACKGROUND AND METHODS

The effect of delayed puberty on peak bone mineral density in men is unknown. To determine whether such a delay reduces normal peak bone density and leads to osteopenia during adulthood, we measured radial bone mineral density by single-photon absorptiometry and spinal bone mineral density by dual-energy x-ray absorptiometry in 23 men who had a history of constitutionally delayed puberty and 21 men who underwent normal puberty. Their mean ages were 26 and 24 years, respectively. The groups were matched for other factors known to affect bone mass.

RESULTS

The mean (+/- SD) radial bone mineral density was significantly lower in the men with a history of delayed puberty than in the normal men (0.73 +/- 0.07 vs. 0.80 +/- 0.05 g per square centimeter; P less than 0.0002). Spinal bone mineral density was also significantly lower in the men with delayed puberty than in the normal men (1.03 +/- 0.10 vs. 1.13 +/- 0.11 g per square centimeter; P less than 0.003). Radial bone density was at least 1 SD below the mean value for the normal men in 15 of the 23 men with a history of delayed puberty, and spinal bone density was similarly decreased in 10 of the 23.

CONCLUSIONS

Adult men with a history of constitutionally delayed puberty have decreased radial and spinal bone mineral density. These findings suggest that the timing of puberty is an important determinant of peak bone density in men. Because the peak bone mineral density achieved during young adulthood is a major determinant of bone density in later life, men in whom puberty was delayed may be at increased risk for osteoporotic fractures when they are older.

Generation of torsional and vertical eye position signals by the interstitial nucleus of Cajal

The neural integrator, which converts eye velocity signals into position signals, is central to oculomotor theory. Similar integrators are probably necessary in any neural system that changes and maintains muscular tension. The integrator for horizontal eye position is in the pons, but the locations of the vertical and torsional integrators have not been clearly defined. Recording three-dimensional eye movements in alert monkeys during microstimulation and pharmacological inactivation of midbrain sites showed that the interstitial nucleus of Cajal generates both the torsional and vertical eye position signals. Up and down signals are linked with clockwise signals in the right brain and counterclockwise signals in the left brain. This three-dimensional coordinate system achieves orthogonality and bilateral symmetry without redundancy and optimizes energy efficiency for horizontal visual scanning.

Axes of eye rotation and Listing's law during rotations of the head

1. The vestibuloocular reflex (VOR) was examined in four alert monkeys during rotations of the head about torsional, vertical, horizontal, and intermediate axes. Eye positions and axes were recorded in three dimensions (3-D). Visual targets were used to optimize gaze stabilization. 2. Axes of eye rotation during slow phases showed small but systematic deviations from collinearity with the axes of head rotation. These noncollinearities apparently resulted from vector summation of torsional, vertical, and horizontal VOR components with different gains. 3. VOR gain was lowest about a head-fixed torsional axis that was correlated with the primary gaze direction, as determined by Listing's law for saccades. As a result, rotation of the head about a partially torsional axis produced noncollinear slow phases, with axes that tilted toward Listing's plane. 4. During slow phases, eye position changed not only in the direction of rotation, but also systematically in other directions. Even axes of eye rotation within Listing's plane caused eye position to move out of the plane to a torsional position that was then held. Thus Listing's law for saccades cannot be a product of plant mechanics. 5. VOR slow phases were simulated with the use of a model that incorporated 3-D rotational kinematics into the indirect path and the oculomotor plant. This demonstrated that the observed pattern of position changes is the expected consequence of rotating the eye about a fixed axis and that to hold these positions the indirect path must employ a 3-D velocity-to-position transformation. 6. Quick phases not only corrected the violations of Listing's law produced by slow phases but anticipated them by directing the eye toward a plane rotated in the direction of head rotation. This was modeled by inputting the vestibular signal to a Listing's law operator that is shared by the quick phase and saccadic systems.

Altered patterns of pituitary secretion and renal excretion of free alpha-subunit during gonadotropin-releasing hormone agonist-induced pituitary desensitization

Intact LH and free alpha-subunit (FAS) are differentially regulated during GnRH agonist (GnRHa)-induced pituitary desensitization; circulating levels of FAS rise, while LH levels decline. Increased steady state alpha and decreased LH beta mRNA levels in desensitized rat pituitaries suggest that differential regulation occurs at the level of subunit transcription. We assessed a renal contribution to these changes in serum hormone concentrations by studying LH and FAS levels in serum and urine in 15 pubertal children before and during long term GnRHa administration. Before GnRHa, serum LH and FAS were secreted in concordant pulses, and both responded briskly to exogenous GnRH. During GnRHa-induced pituitary desensitization, mean (+/- SEM) serum and urinary LH levels fell [11 +/- 3 vs. 2 +/- 0.2 IU/L (P less than 0.01) and 39 +/- 15 vs. 5 +/- 1 IU/g creatinine (P less than 0.05), respectively), and the LH response to exogenous GnRH was ablated (117 +/- 20 vs. 1 +/- 0.3 IU/L; P less than 0.01). In contrast, despite suppression of FAS pulsatility, mean serum FAS levels rose during GnRHa treatment (204 +/- 23 vs. 405 +/- 50 ng/L; P less than 0.01), and responsiveness to exogenous GnRH was maintained. Paradoxically, urinary FAS levels fell (3.2 +/- 0.9 vs. 1.7 +/- 0.4 micrograms/g creatinine; P less than 0.05) as did its renal clearance (3.1 +/- 0.5 vs. 1.3 +/- 0.1 mL/min.m2; P less than 0.05). We conclude that during GnRHa-induced pituitary desensitization, the gonadotrope maintains the ability to respond to GnRH with FAS release, and the rise in serum FAS is due in part to its diminished renal clearance.

Sex recognition by electric cues in a sound-producing mormyrid fish, Pollimyrus isidori

This paper evaluates the role of electric cues in the sex recognition behavior of an African electric fish, Polimyrus isidori, during courtship behavior observed in the laboratory. I examined the importance of the electric organ discharge (EOD: waveform of the stereotyped electric organ discharge) and the sequence of pulse intervals (SPI: temporal pattern formed by sequences inter-EOD intervals) experimentally by presenting caged fishes, and electric playbacks (models) to male residents. In this species males court females with sounds, and I used this sonic behavior to measure sex recognition. Resident males produced many more grunt sounds when females were introduced onto their territories, compared with caged males, revealing that residents discriminated the sex of the caged fish. Response rates were correlated with characteristic patterns in the SPI of the introduced fish, suggesting that discrimination was based on electric cues. Moreover, I noted several significant sex differences in the SPIs of caged fishes. Residents also discriminated between electric signals from female and male fishes, played to them through electrodes, indicating that electric cues alone were sufficient for sex recognition. An ANOVA was used to ascertain the role of the SPI and the EOD, by analyzing responses to natural female and male models, as well as responses to male EODs combined with female SPIs, and to female EODs combined with male SPIs (hybrid models). I found that discriminating residents used SPI cues alone, with no dependence on the EOD. Taken together with new data showing that females generate a highly regular SPI during natural courtship encounters with singing males, these result show that SPIs are important in sex recognition in P. isidori.

Sleep modulation of neuroendocrine function: developmental changes in gonadotropin-releasing hormone secretion during sexual maturation

To assess sleep-associated changes in gonadotropin-releasing hormone secretion during sexual maturation, we studied nighttime and daytime patterns of LH and FSH secretion in two groups with qualitatively similar sex steroid levels: girls with central precocious puberty and young adult women in the early follicular phase of an ovulatory menstrual cycle. In the girls with central precocious puberty, all indices of LH secretion were significantly higher at night than during the day (mean LH levels, 12 +/- 2 versus 5 +/- 1 IU/L, p less than or equal to 0.01; LH pulse amplitude 16 +/- 2 versus 7 +/- 1 IU/L, p less than or equal to 0.01; and LH pulse frequency 0.70 +/- 0.05 versus 0.35 +/- 0.08 pulse/patient-h, p less than or equal to 0.01). Girls with a history of menses, who were presumably the most mature, lacked this diurnal variability. Mean nocturnal FSH levels were only slightly higher than daytime levels (7.6 +/- 0.5 versus 7.2 +/- 0.5 IU/L, p less than or equal to 0.05) resulting in alternating periods of LH (nighttime) and FSH (daytime) predominance in this pubertal population.(ABSTRACT TRUNCATED AT 250 WORDS)

Gonadotrophin-releasing hormone agonist treatment of central precocious puberty: an analysis of growth data in a developmental context

Growth and skeletal maturation was assessed in 83 girls with central precocious puberty (CPP) during pituitary-gonadal suppression induced by treatment with a gonadotrophin-releasing hormone agonist (GnRHa). The mean pretreatment chronological age (CA) was 6.3 years and the mean bone age (BA) was 10.6 years. During the suppression of gonadal sex steroid secretion, mean height velocity (HV) decreased from a pretreatment value of 10.8 cm/year to 5.9 (year 1, n = 83), 4.9 (year 2, n = 72), 4.2 (year 3, n = 45), and 4.4 (year 4, n = 23) cm/year. During each interval, there was a negative correlation between HV and the pretreatment BA. In addition, the rate of skeletal maturation was reduced during GnRHa treatment (delta BA/delta CA = 0.6 +/- 0.1 over 3 years, n = 45). The rate of skeletal maturation during therapy was also negatively correlated with pretreatment BA. Predicted adult stature, based upon zeta-scores of height for BA, increased significantly and progressively during therapy but the changes in height SDS for BA varied significantly. Since HV, delta BA/delta CA, and the change in height SDS for BA (delta HT SDS for BA) during pituitary-gonadal suppression all correlated with the initial degree of skeletal maturation, the effect of GnRHa therapy on final adult height in children with CPP will be best understood if growth data are assessed within a developmental framework.

Impact of sex steroids and their suppression on skeletal growth and maturation

Forty girls with central precocious puberty (CPP) were studied before and during 1-3 yr of luteinizing hormone-releasing factor (LHRH) agonist (LHRHa) administration to examine the impact of gonadal steroid secretion and its suppression on skeletal growth and maturation. Pubertal growth velocity (GV) was 10.1 +/- 0.7 (SE) cm/yr and, when normalized for chronological age (CA) and bone age (BA), demonstrated that the effects of sex steroids were most profound in patients with the youngest CA and BA. GV decreased significantly to 5.8 +/- 0.3 (n = 40), 4.6 +/- 0.3 (n = 30), and 3.2 +/- 0.6 cm/yr (n = 12) during 3 yr of gonadal suppression and correlated negatively with starting BA. Skeletal maturation was markedly accelerated by premature sex steroid secretion (BA/CA = 1.8 +/- 0.1), was slowed significantly with gonadal suppression (mean delta BA/delta CA less than 1), and also was negatively correlated with the starting BA. Cumulative increases in predicted adult height were observed regardless of starting BA and averaged +2.0 +/- 0.4, +5.2 +/- 0.5, and +6.7 +/- 1.2 cm after 1, 2, and 3 yr of gonadal suppression. The comparable changes in height predictions across all BAs despite highly variable GVs underscore the need for use of developmental (i.e., BA-based) rather than CA-based standards in the analysis of growth during gonadal steroid exposure and suppression in childhood.

Dynamics of bioactive luteinizing hormone-human chorionic gonadotropin during the first 7 days of life

Serum luteinizing hormone-human chorionic gonadotropin bioactivity (B-LH) was measured daily in seven male and four female full-term newborns during the first 7 days of life. The B-LH levels were elevated in both sexes during the 1st day of life; subsequently, values decreased in both sexes. In males, they reached a nadir on the 4th day of life. A gradual secondary rise was then observed with B-LH levels on the 7th day significantly higher than on day 4 (p less than 0.025). By contrast, the B-LH levels in the females continued a gradual decline to levels significantly lower on day 7 as compared to day 4 (p less than 0.05). To determine whether pulsatile B-LH secretion occurs in newborns, serum concentrations were measured every 20 min for 2 h in eight male and seven female full-term neonates on the 7th day of life. Pulsatile secretion of B-LH was detected in six males and six females. This study demonstrates that pulsatility of gonadotropin secretion is characteristic of neonates as early as 7 days of life and that there is a dichotomy between the levels of B-LH in males and females; levels in females decline progressively from day 1 through 7, whereas in males, a nadir is reached on day 4 with a secondary rise developing thereafter. This male sex-specific rise is presumably the drive responsible for the characteristic postnatal increase in testosterone which peaks at 1 to 2 months of age.

The relationship of gonadal activity and chemotherapy-induced gonadal damage

We tested the hypothesis that chemotherapy-induced gonadal damage is proportional to the degree of gonadal activity during treatment. Thirty studies that evaluated gonadal function after cyclophosphamide therapy for renal disease or combination chemotherapy for Hodgkin's disease or acute lymphocytic leukemia provided data for analysis. Data were stratified according to sex, illness, chemotherapeutic regimen and dose, and pubertal stage at the time of treatment. Chemotherapy-induced damage was more likely to occur in patients who were treated when sexually mature compared with those who were treated when prepubertal. Males were significantly more frequently affected than females when treated for renal disease or Hodgkin's disease. Chemotherapy-induced damage was also more likely to occur when patients were treated with large doses of alkylating agents. These data suggest that chemotherapy-induced damage is proportional to gonadal activity. Further efforts are needed to test whether induced gonadal quiescence during chemotherapy will reduce the strikingly high incidence of gonadal failure following chemotherapy.

Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature

It has been suggested that complete catch-up growth is achieved with treatment in patients with juvenile acquired hypothyroidism. We tested this assumption by examining long-term growth in 18 girls (mean [+/- SD] age, 11.4 +/- 2.7 years; bone age, 6.2 +/- 3.1 years) and 6 boys (age, 10.6 +/- 4.7 years; bone age, 6.4 +/- 2.7 years) with severe primary hypothyroidism (serum thyroxine level 1.1 +/- 0.3 micrograms per deciliter [13 +/- 4 nmol per liter]). At diagnosis, heights were 4.04 +/- 0.5 and 3.15 +/- 0.4 SD below the mean heights for age of normal girls and boys, respectively. The patients were treated with levothyroxine (3.4 +/- 0.3 micrograms per kilogram of body weight per day) to maintain normal thyroid function. During the first 18 months of therapy, the children's skeletal maturation exceeded the maturation expected for their statural growth, regardless of whether or not they were undergoing pubertal development. Predictions of decreased adult height were based on these observations. At maturity, girls and boys stood approximately 2 SD below normal adult stature, at 149 +/- 5.0 cm and 168 +/- 5.1 cm, respectively. Heights at maturity were also lower than midparental heights (P less than 0.01) and lower than pre-illness standard-deviation scores for height (P less than 0.01). The deficit in adult stature was significantly related to the duration of hypothyroidism before treatment (P less than 0.01). We conclude that despite treatment, prolonged juvenile acquired hypothyroidism results in a permanent height deficit related to the duration of thyroxine deficiency before treatment.

Changes in growth and serum growth hormone and plasma somatomedin-C levels during suppression of gonadal sex steroid secretion in girls with central precocious puberty

Suppression of gonadal sex steroid secretion in children with central precocious puberty (CPP) by LHRH analogs affords an opportunity to study sex steroid modulation of GH and somatomedin-C (Sm-C) secretion and to examine the role of GH and Sm-C in pubertal and prepubertal statural growth. Nocturnal serum GH and plasma Sm-C levels were measured in 10 preadrenarchal girls [mean age, 3.0 +/- 0.6] ( +/- SEM) yr with CPP before and during 2 yr of LHRH analog-induced gonadal suppression. Their mean height velocity, initially 4.6 +/- 0.6 ( +/- SEM) SD above the mean for chronological age, decreased to -0.1 +/- 0.4 SD during 12-24 months of ovarian suppression (P less than 0.00005). The mean peak nocturnal plasma GH level was 22.5 +/- 5.4 ( +/- SEM) micrograms/L during puberty, and it decreased to 10.2 +/- 2.1 micrograms/L after 3 months of suppression of gonadarche. This decrease persisted throughout the 2 yr of gonadal suppression (P less than 0.05). The reduction in GH secretion was accompanied by a decrease in mean plasma Sm-C levels from 3.5 +/- 0.7 to 1.5 +/- 0.2 U/mL after 3 months of suppression of gonadal sex steroids, which persisted during 2 yr of gonadal suppression (P less than 0.01). Suppression of ovarian function in girls with CPP results in decreased height velocity. This slowing of growth occurs in association with decreased nocturnal serum GH and plasma Sm-C levels, suggesting that acceleration of growth during puberty is partially mediated by sex steroid-induced augmentation of GH secretion.

Hypoglycemia pathogenesis in children with dumping syndrome

Three children with severe hypoglycemic reactions secondary to dumping syndrome were studied to discern the mechanism by which hypoglycemia occurred. Symptoms in patient 1 developed after fundoplication, generalized autonomic dysfunction occurred in patient 2, and dumping syndrome developed in patient 3 after malplacement of a feeding gastrostomy tube. Average blood glucose levels studied during and after two to seven meals in each child were 375 +/- 97 mg/dL (mean +/- SD) 30 minutes postprandially and 35 +/- 10 mg/dL greater than 120 minutes later. Swings in glucose values were proportional to the volume of meals. Insulin and glucagon levels were followed during a single meal challenge test in each patient; the average glucose concentration increased to 356 +/- 59 mg/dL 30 minutes postprandially and decreased to 32 +/- 11 mg/dL at 150 +/- 30 minutes. Hormonal analyses indicated (1) inappropriate early release of glucagon (300 pg/mL at 15 minutes) in patient 1, (2) exuberant early release of insulin (maximum 190 +/- 15 microU/mL) resulting in rapid decrease in glucose concentration in all patients, (3) development and/or persistence of hypoglycemia after the decline in circulating insulin to undetectable levels, and (4) inadequate glucagon response to hypoglycemia resulting in sustained hypoglycemia. These data indicate that gross disturbances of the insulin-glucagon axis attend childhood dumping syndrome.

Stress management for multiple sclerosis patients

The purpose of the study was to explore the utility of stress-reduction techniques within a population of hospitalized multiple sclerosis patients. Four stress-management groups, each composed of 8 to 10 patients, were formed with each participant receiving a pre- and posttest battery focusing on emotional/mood factors (the Profile of Mood States). Group sessions were held once/weekly for 13 wk. Relaxation, cognitive, and behavioral strategies were incorporated into the program. The findings indicate that stress-management techniques were effective in the reduction of psychological distress. Significant decreases were noted in scores on depression and anxiety and significant increase on vigor.