Reduced cerebrospinal fluid levels of immunoreactive pro-opiomelanocortin related peptides (including beta-endorphin) in anorexia nervosa.

The discovery that the endogenous opioid peptides contribute to the modulation of appetitive behavior and neuroendocrine function has raised questions as to whether disturbances of opioids contributes to the pathophysiology of eating disorders. To assess central nervous system (CNS) beta-endorphin in patients with anorexia nervosa we measured cerebrospinal fluid (CSF) beta-endorphin concentrations before, and at intervals after weight correction. In addition, we measured three sister peptides (beta-lipotropin, adrenocorticotropic hormone (ACTH), and the N-terminal fragment) derived from the same precursor molecule, pro-opiomelanocortin (POMC) to determine whether possible disturbances might extend to sister peptides.

New ceramics-related industry implicated in elevated blood lead levels in children.

Elevated lead levels have been implicated as a cause of a variety of health problems in children. Blood lead, erythrocyte protoporphyrin, and hemoglobin levels were measured for family members of workers exposed to lead borosilicate dust in a capacitor and resistor plant in Colorado. Previous studies in other lead-related industries have shown an increased risk of lead poisoning among workers' children through exposure to dust brought home on work clothes.

Body cell mass in cancer-bearing and anorexic patients.

We used a sensitive whole body counter which measures potassium-40 (40K) to determine total body potassium and to estimate body cell mass (BCM) in 104 previously untreated patients with upper gastrointestinal malignancies, 233 normal volunteers, and 18 patients with anorexia nervosa. BCM was greater in normal males than in females. In both normal males and females, the BCM tended to decrease with age, both as an absolute measure and as a percentage of body weight.

Elevated cerebrospinal fluid levels of immunoreactive corticotropin-releasing hormone in anorexia nervosa: relation to state of nutrition, adrenal function, and intensity of depression.

To study the pathophysiology of hypercortisolism in anorexia nervosa, we measured the cerebrospinal fluid (CSF) levels of corticotropin-releasing hormone (CRH) in patients when they were underweight and at intervals after weight restoration. CSF CRH levels were significantly elevated in hypercortisolemic underweight patients. Both CSF CRH levels and pituitary-adrenal function normalized after weight recovery.

Advanced cardiac life support refresher course using standardized objective-based Mega Code testing.

The American Heart Association (AHA) recommends that those whose daily work requires knowledge and skills in advanced cardiac life support (ACLS) not only be trained in ACLS, but also be given a refresher training at least every 2 yr. However, AMA offers no recommended course for retraining; no systematic studies of retraining have been conducted on which to base these recommendations. In this paper we review and present our recommendation for a standardized approach to refresher training.

Acquired defect in interleukin-2 production in patients with type I diabetes mellitus.

Deficient production of interleukin-2 has been reported in Type I diabetes, but its cause has not been elucidated. We therefore measured interleukin-2 production in 27 patients with Type I diabetes, 20 patients with Type II diabetes (6 requiring insulin), 5 monozygotic twin pairs discordant for Type I diabetes, and 10 nondiabetic persons with islet-cell antibodies. Interleukin-2 production was decreased in patients with Type I diabetes as compared with controls (35.

Relationship of mood alterations to bingeing behaviour in bulimia.

Twelve women with bulimia participated in a study in which they binged and vomited on the day after hospital admission. Caloric intake, time spent bingeing and vomiting, and self-reported mood ratings demonstrated much variation from subject to subject. Both subjective and objective ratings of mood indicated that anxiety decreased more frequently and to a greater extent than depression, both during and after bingeing and vomiting.

Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics.

In the past decade, patients with anorexia nervosa have been subdivided by the presence or absence of binging-and-purging behavior. Psychologic, physiologic, and premorbid weight differences have also been discovered between these subgroups. We now report that nonbulimic anorectics required 30-50% more caloric intake than bulimic anorectics to maintain a stable weight.

Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public.

To evaluate retention of CPR skills by medical residents (MDs), registered nurses (RNs), we tested single-rescuer CPR skills of 21 MDs, 17 RNs, and 21 laypersons using recording manikin and American Heart Association criteria. All study participants had been trained from 4 to 12 months before testing. No MD or RN and only one layperson performed each step correctly and in proper sequence.

Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients.

To study the pathophysiology of hypercortisolism in patients with anorexia nervosa, we examined plasma ACTH and cortisol responses to ovine corticotropin-releasing hormone before and after correction of weight loss. We also studied patients with bulimia whose weight was normal, since this disorder has been suspected to be a variant of anorexia nervosa. Before their weight loss was corrected, the anorexic patients had marked hypercortisolism but normal basal plasma ACTH.

Comparison of calculated estimates and laboratory analysis of food offered to hospitalized eating disorder patients.

Estimation of caloric intake is an integral part of a comprehensive research/treatment program for patients with eating disorders at the National Institute of Mental Health. Caloric intakes are estimated by recording daily food intake and calculating calories using food exchange lists and food composition tables. To evaluate the validity of that method, caloric intake estimates were compared with laboratory analysis data over a 15-day period.

Sleep EEG in Korsakoff's psychosis and Alzheimer's disease.

All-night sleep EEGs were compared in the following age-equivalent groups: seven men with Korsakoff's psychosis (KP), six men and two women with presumptive Alzheimer's disease, and six healthy men and three healthy women. KP patients had significantly increased intermittent time awake than both controls and Alzheimer patients, and shorter REM latency minus time awake than controls. Alzheimer patients had significantly reduced delta sleep than controls.

Use of the Mega Code to evaluate team leader performance during advanced cardiac life support.

The Mega Code is a simulated cardiac arrest during which students practice as members of a team and learn to integrate the knowledge and skills of advanced cardiac life support (ACLS). This study used the Mega Code and American Heart Association (AHA) standards to evaluate 32 medical residents (MDs) and nine critical care nurses (RNs) in the role of ACLS team leader. All had been previously trained in ACLS.

Cognitive processing in anorexia nervosa. A disturbance in automatic information processing.

Anorexia nervosa patients were found to perform as well or better than control subjects on cognitive tasks that both require considerable cognitive effort and 'direct' the subject to the information that will be tested, but do more poorly than controls on tests that assess automatic or incidental processing of information. The implications of this particular pattern of cognitive alterations for theories concerning the etiology of anorexia nervosa are discussed.

Can better basic and advanced cardiac life support improve outcome from cardiac arrest?

The effect of basic and advanced cardiac life support (BLS and ACLS) on long-term survival is dependent upon both the response time and the quality of intervention. Retention research using the results of classroom testing as indirect indicators has shown that performance of BLS and ACLS skills is poor. This suggests that BLS and ACLS courses do not teach the knowledge and skills well, the information is too difficult to retain, testing procedures are faulty, and/or the performance standards are unrealistic.

Adrenocorticotropin-stimulated adrenal androgen secretion in anorexia nervosa: impaired secretion at low weight with normalization after long-term weight recovery.

Adrenal androgen secretion is decreased in patients with anorexia nervosa. To assess the reversibility of the decreased secretion with recovery of body weight, we measured ACTH-stimulated adrenal androgen levels at different stages of recovery. Basal plasma GH and somatomedin-C levels also were measured, because both have been proposed as potential stimuli for adrenal androgen secretion.

Altered norepinephrine metabolism following long-term weight recovery in patients with anorexia nervosa.

This study evaluated the relationship between noradrenergic function and long-term weight recovery in patients with anorexia nervosa. Eleven patients with long-term weight maintenance (6 to 72 months) had lower plasma and cerebrospinal fluid concentrations of norepinephrine and 3-methoxy-4-hydroxy-phenylglycol than did healthy controls. Reduced noradrenergic activity may be associated with long-term stability of weight recovery in patients with anorexia nervosa.

The effect of time since training on house officers' retention of cardiopulmonary resuscitation skills.

Currently, the American Heart Association (AHA) recommends that physicians be certified in cardiopulmonary resuscitation (CPR) every two years. This study was undertaken to determine the effects of time since training on retention of CPR skills of physicians and to identify at what point performance deteriorates to a level requiring retraining with supervised practice. The physicians' performance of CPR one year or less after training was compared with that of more than one year after training.

Biological alterations in the primary affective disorders and other tricyclic-responsive disorders.

Noradrenergic function was studied in patients with primary affective disorder and other tricyclic-responsive disorders including obsessive-compulsive disorder, anorexia nervosa and panic attack/agoraphobia in medication-free states. Pre-synaptic noradrenergic activity was assessed by assaying plasma concentrations of norepinephrine (NE) and its metabolite 3-methoxy,4-hydroxyphenylglycol (MHPG). Noradrenergic receptor responsiveness was evaluated by measuring plasma growth hormone (GH), MHPG, and NE responses to clonidine.