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We present a 27-year-old woman with hypoparathyroidism following total thyroidectomy for papillary carcinoma, who presented postpartum during lactation with several vertebral osteoporotic fractures, increase in bone turnover markers, and measurable parathyroid hormone-related protein (PTHrP) levels. Cessations of lactation led to gradual decrease in bone turnover markers and PTHrP and improvement in bone mineral density. Pregnancy- and postpartum-associated osteoporosis is an uncommon condition characterized by the occurrence of fractures during late pregnancy or the puerperium. The patient presented postpartum with severe back pain and multiple vertebral fractures. Metabolic evaluation performed at presentation revealed hypercalcemia, hypercalciuria, increased alkaline phosphatase, vitamin D insufficiency, normal serum protein immunoelectrophoresis, and a detectable level of PTHrP. Serum levels of bone turnover markers were markedly increased. Bone mineral density at the lumbar spine was severely reduced. After cessation of lactation, the PTHrP level became undetectable. Bone turnover markers gradually decreased to normal and bone mineral density improved. Several factors contributed to the reduced bone mass in this patient, including amenorrhea treated with oral contraceptives, suppressive levothyroxine treatment, and lactation of twins with increased PTHrP. Patients with severely reduced bone mass need surveillance during pregnancy and lactation and should possibly consider avoiding breastfeeding. Patients with hypoparathyroidism should temporarily reduce their alphacalcidiol dose while lactating. [ABSTRACT FROM AUTHOR]

Hypothalamic obesity (HyOb) was first defined as the significant polyphagia and weight gain that occurs after extensive suprasellar operations for excision of hypothalamic tumours. However, polyphagia and weight gain complicate other disorders related to the hypothalamus, including those that cause structural damage to the hypothalamus like tumours, trauma, radiotherapy; genetic disorders such as Prader-Willi syndrome; side effects of psychotropic drugs; and mutations in several genes involved in hypothalamic satiety signalling. Moreover, 'simple' obesity is associated with polymorphisms in several genes involved in hypothalamic weight-regulating pathways. Thus, understanding HyOb may enhance our understanding of 'simple' obesity. This review will claim that HyOb is a far wider phenomenon than hitherto understood by the narrow definition of post-surgical weight gain. It will emphasize the similarity in clinical characteristics and therapeutic approaches for HyOb, as well as its mechanisms. HyOb, regardless of its aetiology, is a result of impairment in hypothalamic regulatory centres of body weight and energy expenditure. The pathophysiology includes loss of sensitivity to afferent peripheral humoral signals, such as, leptin on the one hand and dysfunctional afferent signals, on the other hand. The most important afferent signals deranged are energy regulation by the sympathetic nervous system and regulation of insulin secretion. Dys-regulation of 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) activity and melatonin may also have a role in the development of HyOb. The complexity of the syndrome requires simultaneous targeting of several mechanisms that are deranged in the HyOb patient. We review the studies evaluating possible treatment strategies, including sympathomimetics, somatostatin analogues, triiodothyronine, sibutramine, and surgery. [ABSTRACT FROM AUTHOR]

Aims/hypothesis. To determine if the haptoglobin 2 allele is associated with an increased risk for the development of diabetic nephropathy. Methods. This study included 110 consecutive normotensive subjects with Type I (insulin-dependent) diabetes mellitus and Type II (non-insulin-dependent) diabetes mellitus seen in two outpatient clinics in Israel. Diabetes duration was greater than 10 years for Type I diabetes and more than 5 years for Type II diabetic subjects. Microalbuminuria was defined as urinary protein excretion of 30 to 300 mg/24 h, and macroalbuminuria was defined as urinary protein excretion of greater than 300 mg/24 h. Serum was taken from subjects for haptoglobin typing by gel electrophoresis. Results. Of the participating subjects 54 had Type I and 56 had Type II diabetes. None (0/18) of the subjects homozygous for the haptoglobin 1 allele (1–1) showed any sign of diabetic nephropathy, as compared with 34 % (19/55) of subjects homozygous for the haptoglobin 2 allele (2–2) and 27 % (10/37) of heterozygous subjects (2–1) (p < 0.04). Of the subjects 29 showed macroalbuminuria. The risk of developing macroalbuminuria was found to be greater in subjects with two haptoglobin 2 alleles (22 %) (12/55) as compared with one haptoglobin 2 allele (8 %) (3/37) or no haptoglobin 2 alleles (0 %) (0/18) (p < 0.03). Conclusion/interpretation. By showing a graded risk relation to the number of haptoglobin 2 alleles in Type I and Type II diabetic subjects, these studies further support our hypothesis that the haptoglobin phenotype is a major susceptibility gene for the development of diabetic nephropathy. [Diabetologia (2001) 44: 602–604] [ABSTRACT FROM AUTHOR]

This study investigated the development of psychoacoustic behavior in normal children between 4 and 12 years of age. Three psychoacoustic tasks-difference limen for intensity (DLI), difference limen for frequency (DLF), and temporal integration-as well as pure tone sensitivity were evaluated among groups of children aged 4, 6, 8, 10, and 12. Results showed (a) significant increase in pure tone sensitivity, (b) significant decrease in DLI size and (c) significant decrease in DLF size between 4 and 12 years. The configurations of the functions were similar to those of normal adults, and approached adult values with increasing age. The threshold-duration functions for temporal integration were similar to adult norms-10 dB threshold shift for every decade change in duration-but fell at increasingly lower intensity levels-dB SPL-between 4 and 12 years. In general, there was an improvement in psychoacoustic performance with increased age. The data were also reconstructed with reference to a predicted performance model. [ABSTRACT FROM AUTHOR]

A closed response nonsense syllable test was developed to assess the reception of gross phonemic contrasts by deaf children. Test items were composed of V, VC, and CV syllables with the vowels /i,a,u/ and the consonants /m,s,g/. The test was administered over a two-year period (1975 and 1976) to one hundred 12-14 year old deaf children enrolled in schools for the deaf throughout New York State. Percentile plots showed improvement in overall performance over the two-year period. Greatest improvements were for vowels. Results indicated a pattern of errors similar to those reported by previous investigators for adults and adolescents [Pickett et al., in Speech Communication Ability and Profound Deafness, 119-133 (1970)]. These included: (1) scores for vowels were consistently higher than those for consonants, (2) scores for /u/ and /a/ were roughly the same and were in turn higher than the scores for /i/, (3) scores for the initial consonants were higher than scores for final consonants except for the nasal in which the reverse was true. [Work supported by Cooperative Research Endeavors in Education of the Deaf (CREED), Bureau for Special School Supervision, Office for Education of Children with Handicapping Conditions]. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the clinical utility of adaptive methodology in measuring speech discrimination performance of CNC words in 18 persons (24 ears) with varying degrees of sensorineural hearing loss. Ss were 18 to 82 years and included average hearing levels (500, 1000, and 2000 Hz) from 35 to 85 dB HTL (ANSI-1969). Speech reception thresholds (SRT), loudness discomfort levels (UCL), and most comfortable loudness (MCL) levels for spondees were obtained for all subjects. A simple-up-and-down procedure was used to determine the 50% response level for all target levels, whereby two test words, one 5 dB above and one 5 dB below the target level, were employed. The initial target level was designated approximately midway between the SRT and UCL. Three performance-intensity configurations were observed: a steeply rising curve that plateaued for two or more estimation points; a rising curve that plateaued for two estimation points and rolled over; and a rising curve that reached PB-max at only one estimation point and then rolled over. The latter function characterized 16 of 24 ears (66%). PB-max scores were determined by adaptive testing and at MCL for spondees. Twenty-two ears (91%) obtained higher PB-max scores with adaptive testing than at MCL (Mean difference of 20%; range of 17% to 33%). The further advantages of flexibility of test procedure, shorter testing time, and fewer test trails suggest that adaptive methodology appears most suitable for evaluating speech discrimination performance in hearing impaired individuals. [ABSTRACT FROM AUTHOR]

The effects of reverberation time (RT) upon monaural and binaural speech discrimination were investigated for normal-hearing and hearing-impaired subjects. After preliminary tests, the Modified Rhyme Test was administered through headphones at RTs of 0, 1, 2 and 3 sec, monaurally and binaurally. For all conditions, the normals performed significantly better than the impaired group, although a similar trend was evident for both groups. Binaural scores were significantly higher at each RT for both groups (in spite of homophasic conditions). For both groups, monaural and binaural scores decreased with increasing RT. Monaural scores decreased at a faster rate with RT than binaural (this effect was more marked for normals). Increasing the monaural presentation levels to simulate binaural loudness gain did not result in higher scores. It was concluded that speech discrimination under reverberation is superior binaurally to monaurally for both normal and hearing-impaired persons. This is due, at least partly, to the ability of the binaural system to squelch the effects of reverberation. A theoretical model is suggested for the binaural squelch of reverberation. [ABSTRACT FROM AUTHOR]