Behaviour therapy of obese children and results 21 months after treatment

Two groups of pre-pubescent obese children were given modified behaviour therapy. A shaping procedure was used to bring about changes in quantity and quality of food eaten, physical activities, and eating behaviour. In addition, attempts were made to get the children to distinguish better between hunger and satiation and to improve the interactions between children and parents. The children were trained to effect desired behavioural changes themselves on the basis of their own observations. Four of the 11 children displayed a substantial weight reduction which was maintained in follow-up. In the case of the other children it appeared that psychopathological and constitutional factors prevented them from making use of the strategy offered.

Reinstitution of mineralocorticoid therapy in congenital adrenal hyperplasia. Effects on control and growth

The results of reintroduction of mineralocorticoid substitution therapy (9-alpha-fluorohydrocortisone) in five children with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency are described. All children had shown a salt-losing syndrome in infancy, but were off mineralocorticoids during several years; at the start of this study they all had elevated plasma renin activity (PRA). Four of them had increased and fluctuating pregnanetriol excretion during the year preceding reintroduction of mineralocorticoids, indicating poor control despite substantial substitution with hydrocortisone: 26 +/- 1.9 mg/m2/day (mean +/- S.E.M.). Reintroduction of mineralocorticoid therapy at ages 5.0-9.4 years resulted in a marked improvement of control, significant reduction in hydrocortisone requirements (to 17.6 +/- 1.4 mg/m2/day) and improvement in linear growth. The data suggest that, in all children with CAH and elevated PRA, continuation throughout childhood of mineralocorticoid therapy in addition to glucocorticoid therapy is necessary for optimal control and linear growth.

Serum somatomedin activity and cartilage metabolism in acutely fasted, chronically malnourished, and refed rats

Serum somatomedin activity (SM-act) and cartilage metabolism were compared in acutely fasted, marasmic (M), and marasmic kwashiorkor (MK) rats. SM-act was estimated in the porcine bioassay. In vitro uptake of [35S]sulfate and [3H]methylthymidine in costal cartilage of the experimental animals during an incubation in medium immediately after sacrifice, called endogenous activity, and the effect of incubation in 20% normal human plasma after a preincubation of 22 h in medium only, called plasma responsiveness", were determined. Acutely fasted rats had lowered SM-act and a circulating heat-labile inhibitor. Endogenous activity and responsiveness of cartilage were depressed. MK rats (fed ad libitum a 0.5% casein, isocaloric food) showed a profound depression of growth and cartilage endogenous activity despite only partially reduced SM-act and increased responsiveness. M rats received normal food and were pair-fed with MK rats, consuming approximately 0.08 g/g BW . day. They showed very depressed SM-act and low endogenous activity, and responsiveness was increased, though less than in the MK rats. On refeeding M rats, SM-act and cartilage responsiveness increased, followed by an increase of endogenous activity. Catch-up growth was best related to [3H]methylthymidine incorporation by cartilage (endogenous activity). In conclusion, these two types of experimental chronic malnutrition induce a more diversified pattern than does acute fasting. During malnutrition, cartilage metabolism does not reflect bioassayable SM-act of serum but rather the other effects of the nutritional insult. On refeeding, the expected relationship of SM-act and cartilage metabolism is rapidly restored.