Search

Although estradiol (E2) is thought to facilitate PRL secretion under certain conditions in female primates, the role of E2 or other ovarian products in the control of PRL secretion during puberty is unknown. The present study examined the influence of gonadal status on serum PRL levels in prepubertal monkeys housed in an outdoor environment. Basal levels of PRL were examined in three groups of spring-born females that were studied from 12 to 28 months of age (May 1982 to September 1983): gonadally intact (INT; n = 8), ovariectomized (OVX; n = 5), and ovariectomized and treated chronically with E2 (E2OVX; n = 5). All groups exhibited a significant annual rhythm in PRL levels with peaks (10-20 ng/ml) at 14 and 26 months (June to July) and a nadir (less than 2 ng/ml) at 19 months (November to December). Basal PRL levels were significantly higher from 12 to 15 months (May to August) in E2OVX subjects, with OVX having significantly greater concentrations than INT females. Group differences were not evident during the period of minimal secretion from 16 to 20 months (September to January). Finally, levels were again significantly higher in both E2OVX and OVX subjects during the subsequent period from 21 to 27 months (February to August). Although serum levels of E2 were lower in INT (30.9 +/- 2.3 pg/ml) than E2OVX females (51.4 +/- 4.0 pg/ml), group differences in PRL could not be attributed to E2 since OVX females, with no measurable levels of E2 (less than 15 pg/ml), had intermediate levels of PRL. These data suggest that during primate maturation serum PRL levels are dampened by some product of the ovary. Furthermore, whether age specific or environmentally mediated, this rhythm indicates an annual alteration in PRL release, with absolute levels enhanced by E2 replacement after ovariectomy, for prepubertal monkeys housed outdoors. In addition, a significant maturational increase in PRL levels was observed only in INT females when serum levels of PRL were compared for the ages 12-16 months to 24-28 months corresponding to the period between May and September for 2 successive years. These changes in PRL were not related to age-dependent changes in serum E2. Acute treatment of both E2OVX and OVX females with a single injection of E2-benzoate at three different ages did not induce any changes in serum PRL.(ABSTRACT TRUNCATED AT 400 WORDS)

In the present study, baboon fetal adrenal cells were obtained at mid- and late gestation and incubated for various intervals to determine simultaneously the effects of length of incubation and stage of development on the pattern of adrenal steroidogenesis. Cells were treated with adrenocorticotropic hormone (ACTH) from 0 to 48 h of incubation, and the concentrations of dehydroepiandrosterone (DHA), DHA-sulfate (DHAS), and androstenedione (delta 4A) were determined in the medium. The secretion of DHA and DHAS by untreated or ACTH-treated cells of midgestation increased linearly throughout the 48-h incubation period. In fetal adrenal incubates of late gestation, however, DHA and DHAS concentrations peaked at 3 h and declined thereafter, suggesting that the DHA secreted into the medium was further metabolized by this tissue. Baboon fetal adrenal cells formed similar amounts of DHAS and DHA at midgestation, but greater quantities of DHAS were formed at term. In fetal adrenal incubates of midgestation, DHA concentrations exceeded those of delta 4A by threefold, a relationship which was reversed at late gestation, probably due to the increase in the activity of 3 beta-hydroxy-steroid dehydrogenase with advancing gestation. Because the decline in DHA with time of incubation was also associated with a concomitant decrease in DHAS and no change in delta 4A, it does not appear that formation of these steroids account for the loss of DHA. We conclude that the pattern of androgen metabolism exhibited by fetal adrenal cells obtained at midgestation is different from that at term.(ABSTRACT TRUNCATED AT 250 WORDS)

The carbon dioxide (CO2) laser is a microsurgical instrument to be used in conjunction with good neurosurgical technique. Laser surgery has special applications in pediatric neurosurgery because of the type and location of many pediatric tumors as well as the laser qualities of precision and decreased tissue trauma. The CO2 laser has proven to be a valuable surgical tool in this series of pediatric spinal cord and brain tumor patients. The areas of most effective laser treatment were the posterior fossa, ventricles, spinal cord and the suprasellar area. The laser was least helpful in tumors of the hemispheres and the hypothalamus. Criteria need to be developed for absolute and relative indications for CO2 laser use.

This two-part study evaluated the reliability of inexpensive devices for isometric muscle testing on patients. First, the relationship between gauge readings of the devices and known weights was evaluated. Coefficients of determination and regression lines were used to determine the strength and nature of this relationship, which was determined to be linear. Second, intratester reliability for force measurements of isometric knee extension and flexion motions was determined for 30 patients with connective tissue diseases. Right knee extensor and flexor muscle forces were measured during two sessions. The measurements between sessions were compared for degree of agreement using intraclass correlation coefficients. Intraclass correlation coefficients ranged from .90 to .95 for knee flexor force measurements and from .75 to .85 for knee extensor force measurements. Based on the results of this study, this measuring device can be used reliably to measure knee extensor muscle force at 50 degrees and knee flexor muscle force at 30 and 70 degrees.

Stereotactic biopsy has been popularized over the last decade since the advent of newer, more sophisticated instrumentation and technology. However, less than 300 cases of pediatric stereotaxy are recorded in the literature and few reports emphasize the necessary modifications required in children. Sixty-six stereotaxic procedures were performed on 62 children using the Brown-Roberts-Well (BRW) apparatus at our institutions. The mean age was 9.0 years (range 5 months to 18 years). The indication for the technique was diagnostic in 36 cases and therapeutic in 9 cases; location was a factor in 21 children with the lesion involving a 'deficit-prone' area of the brain. The BRW technique was applicable in 61 procedures (93%). Inability to enter cysts or biopsy of necrotic tissue and tumor capsule occurred in 5 cases. One patient had a transient increase in cerebral edema, for an overall complication rate of 2%. It appears that the BRW stereotactic technique is equally effective in children and adults and will no doubt play an ever increasing role in the future of pediatric neurosurgery.

Lenses from rat or calf were exposed in vitro to UV radiation from a nitrogen laser operated at 337.1 nm or from an excimer laser operated at 3.8 nm. Visible light transmission was monitored during calf lens irradiations at 308 nm and found to decrease. Proteins were extracted from the irradiated rat or calf lenses, separated into water soluble and insoluble fractions, and analysed using SDS-PAGE. Comparison of these gels with dark controls showed that, following photolysis, there was loss of polypeptide material in the 20-30 kDa region and concomitant formation of polymers at 40 and 60 kDa, and at greater than 100 kDa in calf lens (308 nm irradiation) and rat lenses (337.1 nm irradiation) in vitro. In addition, there was evidence for formation of lower molecular weight polypeptides at 10 kDa in the protein from irradiated rat lenses. The rat SDS-PAGE gels were challenged against anti-calf gamma crystallin serum. There was clear evidence that the polymeric material, in the water insoluble protein fraction from the 337.1 nm photolyzed rat lenses was derived in part from gamma crystallin. The macromolecular changes detected in these photolyzed rat and calf lens proteins were similar to those previously reported to accompany aging in the human lens. Biochemical changes of the type observed in UV irradiated rat and calf lenses may be responsible for the loss of visible light transmission seen in calf lenses.

Surgical lasers have definite limitations. They are best at removing small tumors in delicate brain locations. They are useful for extrinsic lesions and have been found to be helpful in pediatric neurosurgery. They are not useful for many intrinsic hemisphere tumors, especially glioblastoma. The laser does not make a surgeon better; it may, however, allow the surgeon to dissect the tumors in a more delicate and precise way.

To assess severity of illness or injury in pediatric patients undergoing air transport, we prospectively evaluated 636 patients during 29 months of service. All patients were classified by age, diagnosis, and method and distance of transport. Therapeutic intervention scoring system (TISS) scores were calculated in all patients, Glasgow coma scale (GCS) scores were used in patients with altered level of consciousness, and Modified Injury Severity Scale (MISS) scores were used in patients with multiple trauma. A total of 57.5% of patients were transported by helicopter, 37.5% by fixed-wing aircraft, and 5% by ground transport. Mean distance of transport was 207 miles. Age ranged from 3 weeks to 16 years, with 45% of children under 1 year of age. Trauma (24.6%), neurologic disease (24.2%), and respiratory failure (20%) were the most common diagnoses. Eighty-one percent of patients were taken to surgery or admitted to the intensive care unit immediately on arrival at the regional children's hospital. Mean TISS score was 36.7, with 51% of patients having TISS scores greater than 30. The mean MISS score was 34.5, and 75% of patients had MISS scores greater than 25. Nineteen percent of patients had GCS scores less than or equal to 8. Overall mortality was 7%, with 9% mortality in patients with trauma versus 6.3% in nontraumatic diseases. TISS scores greater than 30, MISS scores greater than 25, and GCS scores less than or equal to 8 were associated with increased mortality (P less than .01).

Neurologic injury is a significant source of morbidity and mortality in pediatric patients. In order to clarify the factors influencing outcome in pediatric patients with severe head injury, we studied 200 consecutive patients with Glasgow Coma Scale (GCS) scores of 8 or less. The following data were collected: age, GCS score, presence of mass lesions, oculovestibular reflexes (OVR), pupillary size and reactivity, intracranial pressure (ICP), apnea, presence of hypotension, hypoxia (PO2 less than 60 torr), or hypercarbia (PCO2 greater than or equal to 35 torr), presence of multiple trauma, and Modified Injury Severity Scale (MISS) score. Outcome was assessed by the Glasgow Outcome Scale at a minimum of six months following recovery. Of the 200 patients in the study, 86 (43%) had isolated head injury (IHI) and 114 (57%) had head injury plus multiple trauma (HI + MT). Overall, 26% of patients had mass lesions; 28% had altered OVR; 33% had fixed, dilated pupils; 79% had increased intracranial pressure; and 29% had hypotension, hypoxia, or hypercarbia. Overall mortality was 21.5%. Severity of injury (as judged by presence of mass lesions, GCS, OVR, fixed pupils) was more pronounced in patients with IHI, although increased ICP was more common in patients with HI + MT; however, death was almost three times more common in patients with HI + MT (30% versus 10.5%). In the IHI group, two of nine patients who died (22%) had hypotension, hypoxia, or hypercarbia; all but four patients (88%) in the HI + MT group had hypotension, hypoxia, or hypercarbia.(ABSTRACT TRUNCATED AT 250 WORDS)

A short term incubation of baboon fetal adrenal cells obtained at midgestation and near term was used to determine whether a change in the regulation of androgen formation occurs with advancing gestation. Adrenal glands were removed from baboon (Papio anubis) fetuses on day 100 (mid; n = 7) or day 170 (late; n = 5) of gestation, and cells were dispersed with 0.2% collagenase. Cells (10(5] were incubated at 37 C for 3 h in medium 199 in the presence or absence of 10 nM ACTH, 10 nM ovine PRL, 10 nM ovine GH, 50 nM hCG, or 50 nM human chorionic somatomammotropin. Dehydroepiandrosterone (DHA), DHA sulfate (DHAS), cortisol (F), and androstenedione concentrations were determined in the medium by RIA. At midgestation, ACTH, PRL, and GH elevated (P less than 0.05) DHA (168%, 169%, and 178%, respectively) and DHAS (142%, 210%, and 197%, respectively) formation. Near term, ACTH and PRL retained their ability to stimulate (P less than 0.05) DHA (307% and 220%, respectively), but not DHAS, synthesis. The fetal adrenal at late gestation, however, lost its ability to respond to treatment with GH. hCG and human chorionic somatomammotropin did not stimulate steroidogenesis at either time of gestation. F formation at midgestation was less (P less than 0.05) than that at term and not responsive to ACTH. ACTH stimulated (P less than 0.05) F secretion by 68% in fetal adrenal cells obtained near term. The secretion of androstenedione was not affected by any peptide treatment at either stage of gestation. These data indicate that the responsivity of the baboon fetal adrenal to various pituitary peptides is different at two developmentally distinct stages of gestation. We conclude, therefore, that the regulation of fetal adrenal steroidogenesis changes with advancing gestation.

The effect of a high-fat diet on growth, sexual maturation, and developmental changes in serum levels of estradiol (E2), growth hormone (GH), somatomedin-C (Sm-C), and insulin were examined in outdoor-housed premenarchial rhesus monkeys. From 16 to 32 months of age, females were fed either a high-fat diet (HFD, N = 5) with 31% calories from fat or a control diet (commercial laboratory chow, N = 10) with 12% of the calories from fat. Maintenance on a HFD did not accelerate physical growth, as all animals exhibited similar increments in body weight, crown-rump length, and weight/height ratios. In contrast, the HFD group exhibited an earlier onset of perineal swelling and menarche despite lower body weights during that time. Moreover, 80% of the HFD animals exhibited an early first ovulation (31-32 months of age) compared with 40% of control animals. These reproductive changes were associated with significant differences in the endocrine profiles of HFD animals. Fasting serum levels of insulin were significantly elevated within 2 months of diet treatment and remained elevated throughout the study period. Levels of Sm-C were elevated relative to those of controls after 3 months of diet treatment, but not thereafter. Serum GH increased after 6 months on the HFD and, overall, concentrations were higher in HFD animals. A significant rise in E2 was observed after only 45 days on the HFD treatment. These concentrations did not differ from 18 to 21 months of age but again were elevated at 27 months in the HFD females. Since these endocrine and physical changes associated with reproductive physiology occurred in the absence of enhanced growth, these data suggest that a high-fat diet may influence the rate of sexual maturation through changes in certain metabolic factors which may act on the developing neuroendocrine system.

In a two-year period, we studied 160 patients with multiple trauma (injury to at least two body areas) and graded severity of neurologic injury according to the Glasgow Coma Scale. Injuries to other body areas were categorized by the Modified Injury Severity Scale. Neurologic injury was present in nearly 80% and constituted the most severe injury in 60%. Chest (40%) and extremity (30%) injuries were next most frequently encountered. Overall mortality was 13.8%, with 11.3% disability and 74.3% of patients achieving good recovery. There was some degree of neurologic injury in all patients who died or were disabled. Among all patients with head injuries (126), mortality was 16%, vs 6% in those without head injury (34). Other deaths were caused by chest (9%) or abdominal (14.5%) injuries.

Recent reports have characterized force measurements obtained with hand-held dynamometers from brain-damaged patients as being highly reliable. The purposes of this two-part study were to replicate essential parts of those studies and to further examine the reliability of these measurements in a clinical context. Repeated force measurements were taken from the nonparetic and paretic limbs of brain-damaged patients during the same testing session (Part 1) and during two testing sessions separated by two days (Part 2). The intratester intraclass correlation coefficients (ICCs) for all measurements taken during a single session ranged from .88 to .98. The ICCs for repeated measurements taken two days apart from the paretic limbs ranged from .90 to .98. The ICCs for repeated measurements taken two days apart from the nonparetic limbs ranged from .31 to .93. The ICCs for repeated measurements taken two days apart from the combined data for all limbs ranged from .79 to .97. Hand-held dynamometer measurements taken on brain-damaged patients appear to be highly reliable when taken during the same testing session. When repeated measurements are separated by a longer time interval, the measurements taken from the paretic limbs continue to be highly reliable, whereas most measurements taken on the nonparetic limbs exhibit poor reliability.

In a 5-year period of prospective study, 369 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a Modification of Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except that the classification of neurological injuries are scored by the Glasgow Coma Scale (GCS) and other neurological findings (presence of a surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 23.8 with 33% of MISS scores greater than 25 and 67% less than 25. Among those with MISS scores greater than 25 there was a 44% mortality and 31% disability. In the group with MISS scores less than 25, there were no mortalities, and a 1% disability (p less than 0.001). Overall mortality was 14% with 9% disability. Mean MISS scores for death and disability were 35.1 and 29.6, respectively. Neurologic injuries were present in 274 patients (74%). 163 patients had severe head injury (coma greater than 6 h duration). 86% of all deaths were due to head injury and all but 2 deaths had some degree of head injury. The remaining 14% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 74% mortality, while those with grades 4 and 3 injury had 8 and 1.5% mortality. In a comparison with pediatric patients with head injury only (coma greater than 6 h, no multiple trauma) there was found to be a 12% mortality in the head injury only group versus a 33% mortality in the multiple trauma plus head injury group. The MISS serves as an accurate predictor of morbidity and mortality in pediatric trauma. The best predictors of outcome were a MISS less than 25 and the degree of neurological injury.

The purpose of this study was to examine the relationships between measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance during normal standing. In addition, the reliability of the measurements used in this study was examined. Measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance were taken of 31 healthy adults aged 20 to 33 years. Each measurement was taken twice, and the measurements were shown to be reliable. The Spearman's rho correlation of the abdominal muscle performance measurements with pelvic tilt was .18 and with lordosis was .06. The Pearson product-moment correlation of lordosis with pelvic tilt was .32. The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related. This study demonstrates the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance, pelvic tilt, and lordosis.