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Phentermine and fenfluramine are widely used in the treatment of obesity. Despite the fact that primary pulmonary hypertension and mitral valve insufficiency have been associated with fenfluramine use, many of these patients need medication to achieve weight loss. Small degrees of weight loss have been shown to significantly improve obesity-related medical conditions such as hypertension, hypercholesterolemia, and noninsulin-dependent diabetes mellitus. Current practice is to give phentermine and fenfluramine in the morning and afternoon. Doses for phentermine have ranged from 15 to 37.5 mg and for fenfluramine from 20 to 120 mg per day. We report five cases of severely obese women with medical complications who were treated with phentermine 8 mg twice per day (at 1:00 p.m. and 4:00 p.m.) and fenfluramine 20 mg per day (at 4:00 p.m.). Because many obese patients skip breakfast and eat more in the afternoon and evening, medication was dosed in order to cover these high-risk eating periods. Overall, these patients lost a mean of 22.4% of their initial weight (range 18.6% to 32.8%) over an average of 8.4 months (range 3.5 to 16 months). These cases suggest that short-term weight loss can be achieved with a low dose of fenfluramine when both medications are given in the afternoon to better target the eating patterns of obese subjects. [ABSTRACT FROM AUTHOR]

Eating disorder patients frequently present with gastrointestinal complaints. Helicobacter pylori is an etiologic factor in type B gastritis, gastric and duodenal ulcers, and may cause nausea and anorexia. OBJECTIVE: To determine whether or not there is an increased prevalence of H. pylori infection in patients with eating disorders. METHOD: Serum H. pylori IgG antibody and gastrointestinal symptoms were assessed in 32 patients admitted for inpatient treatment of anorexia nervosa and/or bulimia nervosa. RESULTS: Eating disorder patients did not have an increased rate of detectable serum H. pylori IgG antibody. DISCUSSION: There is not an increased prevalence of H. pylori infection in eating disorder patients. Thus, the increased frequency of gastrointestinal complaints in eating disorder patients cannot be attributed to H. pylori infection. [ABSTRACT FROM AUTHOR]

Access to pediatric surgical care is limited in low- and middle-income countries. Barriers must be identified before improvements can be made. This pilot study aimed to identify self-reported barriers to pediatric surgical care in Guatemala. We surveyed 78 families of Guatemalan children with surgical conditions who were seen at a pediatric surgical clinic in Guatemala City. Spanish translators were used to complete questionnaires regarding perceived barriers to surgical care. Surgical conditions included hernias, rectal prolapse, anorectal malformations, congenital heart defects, cryptorchidism, soft tissue masses, and vestibulourethral reflux. Average patient age was 8.2 years (range, 1 month to 17 years) with male predominance (62%). Families reported an average symptom duration of 3.7 years before clinic evaluation. Families traveled a variety of distances to obtain surgical care: 36 per cent were local (less than 10 km), 17 per cent traveled 10 to 50 km, and 47 per cent traveled greater than 50 km. Other barriers to surgery included financial (58.9%), excessive wait time in the national healthcare system (10. 2%), distrust of local surgeons (37.2%), and geographic inaccessibility to surgical care (10.2%). The majority of study patients required outpatient procedures, which could improve their quality of life. Many barriers to pediatric surgical care exist in Guatemala. Interventions to remove these obstacles may enhance access to surgery and benefit children in low- and middle-income countries.

Allergic rhinitis (AR) is a common chronic condition in children and may impact a child's quality of life. Increasing treatment compliance may improve quality of life. An oral suspension of fexofenadine hydrochloride (HCl) has been developed to ease administration to children and may, therefore, improve treatment compliance. The purpose of this study was to assess the pharmacokinetic behavior, safety, and tolerability of a single dose of fexofenadine HCl oral suspension administered to children aged 2-5 years with allergic rhinitis. Children (aged 2-5 years) with AR were recruited in a multicenter, open-label, single-dose study. Fexofenadine HCl (30 mg) was administered as a 6-mg/mL suspension (5 mL). Plasma samples were collected up to 24 hours postdose. Adverse events (AEs); electrocardiograms (ECGs); vital signs; and clinical laboratory tests for hematology, blood chemistry, and urinalysis were analyzed to evaluate safety and tolerability. Fifty subjects completed the study. Mean maximum plasma concentration of fexofenadine was 224 ng/mL, and mean area under the plasma concentration curve was 898 ng . hour/mL. Treatment-emergent AEs were mild in intensity and reported in a total of seven subjects. No trends or clinically meaningful changes in mean ECG, vital sign, or clinical laboratory test data occurred during the study. In children aged 2-5 years, the exposure after a 30-mg dose of fexofenadine HCl suspension was similar to the exposures previously seen after a 30- and 60-mg dose of fexofenadine HCl in children aged 6-11 years and in adults, respectively. The suspension was also well tolerated.

Microfabricated arrays of immobilized oligodeoxynucleotide probes are proving to be a powerful tool for rapidly generating sequence data via hybridization. These arrays are made either by immobilization of the probe post-synthetically, or by in situ synthesis of the probe. Hybridization of the target is easily achieved on the arrays, with analysis proceeding either by direct detection, or through enzyme-mediated detection; analysis of the hybridization pattern yields sequence information about the target. Such facile and rapid data acquisition will assist the challenging task of sequencing the human genome, and also will lead to a new generation of diagnostic assays.

Factor VIII therapy has been reported to cause anaphylactic reactions in patients with hemophilia. Desensitization attempts have been complicated by severe allergic reactions that have prevented the achievement of protective factor VIII levels. We report successful administration of factor VIII by a graded dose desensitization protocol in a 36-year-old man with hemophilia A who had previously experienced anaphylactic reactions to factor VIII infusions. The reactions were manifested by urticaria, choking, and bronchospasm and were not prevented by pretreatment with antihistamines and corticosteroids. Intradermal skin test with factor VIII was positive. Serum levels of circulating immune complexes were slightly elevated. Persistently low serum C2 levels were consistent with genetic C2 deficiency. These findings suggest the possibility of Type I (IgE mediated) and Type III (immune complex) immunopathogenic mechanisms. Our experience suggests that administration of factor VIII by graded dose desensitization protocol may offer a practical therapeutic approach for management of hemorrhage in patients with classic hemophilia who are allergic to factor VIII.

To assist pediatricians in the early, accurate diagnosis of conversion reactions, a biopsychosocial profile of index patients and families was established. Utilizing a chart audit, all pediatric inpatients with conversion reactions at Children's Hospital Medical Center from July, 1976, through June, 1979, were compared wih controls matched for age and socioeconomic status. Data on the medical history, physical examination, and hospital course were uniformly collected for 105 cases and contrasted with those in 105 controls. The mean age was 12.1 years; 47% were male and 53% were female. Compared to controls, the children with conversion reaction had a higher frequency of recent family stress (97%), unresolved grief reactions (58%), and family communication problems (77%). Three case reports describe the pediatrician's use of the medical history, physical examination, and hospital course to diagnose conversion symptoms.

Although the sisters of anorexia nervosa patients may have an increased risk for this disorder, there are no controlled studies of the eating patterns and attitudes of the normal sisters of anorexic patients. Twenty-one sister pairs (anorexics and their normal sisters) were interviewed and given the Eating Attitude Test (EAT) to compare their eating attitudes and behaviors. The mean scores on the EAT and its three subscales (measuring "Dieting," "Bulimia and Food Preoccupation," and "Oral Control") were significantly correlated with criterion group membership (p less than 0.0001). The normal sisters as a group did not demonstrate anorexic eating attitudes. However, two normal sisters did score in the anorexic range and are being followed prospectively. The EAT questionnaire could be used to screen vulnerable siblings of patients with anorexia nervosa for early signs of this disorder.

Many studies document the high prevalence of dieting and abnormal eating behaviors in adolescents and young adults. The age of onset of eating disorders remains unclear because there are no published surveys of voluntary dieting and eating attitudes in young children. A total of 318 girls and boys were surveyed from two randomly chosen schools in middle-income neighborhoods. The children were equally distributed among grades 3 through 6. The survey included a children's version of the Eating Attitudes Test and a demographic and dieting questionnaire. Results showed that 45% of the children wanted to be thinner, 37% had already tried to lose weight, and 6.9% scored in the anorexia nervosa range, closely matching the published results concerning teenagers and young adult women. Several questions were isolated by univariate and multiple regression analyses that accurately (P less than .05) predicted children's Eating Attitude Test scores. The fact that young children admit having diet preoccupation and atypical eating attitudes is shown in this study. It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children.

Serum levels of 16 proteins, including 11 component and control proteins of the complement system were determined before and after nutritional repletion in five female patients with severe malnutrition secondary to anorexia nervosa. Before parenteral alimentation significantly decreased serum levels were found for IgG, IgM, transferrin, Clq, C2, C3, factor B, beta lH, C3b inactivator, properdin, and C4 binding protein. A significant increase in posttreatment serum levels compared with pretreatment levels were found for transferrin, C3, factor B, beta lH, and C3b inactivator. Of the proteins measured, the C3b amplification loop control and component proteins, beta lH, C3b inactivator, C3, and factor B rose to the normal range in response to therapy most rapidly. In the absence of an acute phase reaction, these proteins appear to be particularly good indices of malnutrition and its response to therapy.

A patient with anorexia nervosa in whom concurrent nutritional, psychological, and cardiovascular assessments were obtained sequentially during successful treatment is presented. At the time of diagnosis, severe multisystem dysfunction was present including depression, low self-esteem, hypotension, bradycardia, exercise intolerance, and abnormalities of systolic and diastolic cardiac function. Treatment resulted in weight gain and increased skinfold thickness and arm circumference. There were concomitant improvements in the psychometric indices of depression and self-esteem as well as decreased anorectic tendencies. During her recovery, working capacity increased and diastolic function improved. However, echocardiographic evidence of impaired systolic function persisted. Despite the apparent treatment success in this patient, this report suggests a potential need for further studies to determine the extent, if any, of long-term cardiac sequelae.

Hyperalimentation is a feeding technique in which all essential nutrients are infused intravenously to sustain patients who cannot eat. Although no panacea for anorexia nervosa, hyperalimentation can provide calories for intractable, malnourished patients. The authors describe the psychiatric and hyperalimentation treatment for four severely anorectic patients who had lost up to 44% of their body weight before entering the study. With treatment their percentage of ideal weight rose from a mean of 59% to a mean of 81% during hospitalization, and to a mean of 94% on outpatient follow-up of 5--16 months. The authors discuss the indications, limitations, and need for interdisciplinary collaboration in this treatment.

Adolescents and young adults meeting DSM-III criteria for anorexia nervosa (n = 13) and atypical eating disorders (n = 7) were compared with weight-recovered anorectics (n = 6) and normal weight controls (n = 11) using a type-A structured interview and a computerized stress procedure. Heart rate, blood pressure, and electrocardiographic changes were monitored. Anorexia nervosa subjects demonstrated significantly more type-A characteristics than controls. The emaciated and weight-recovered anorectics had elevated hostility scores on the type-A interview, which has been shown in recent studies of type-A behavior to be a risk factor for cardiovascular disease. This pilot study is the first to demonstrate a significant relationship between anorexia and the type-A behavioral pattern. Also the anorectic subjects showed significantly more cardiovascular reactivity than controls as measured by failure of stressed anorectic subjects to lower their systolic blood pressure to baseline levels as controls did. These results support the importance of monitoring stress reactions and personality traits as well as traditional biological measures.

We evaluated the ability of an electrostatic air cleaner and negative ionizer (Bionaire 1000, Biotech Electronics, Ltd) to cleanse indoor air of mold spores. Significant reductions in the number of mold colonies were observed when the air cleaner was operated alone. We found no significant decrease in the circulating amounts of mold spores over baseline with the additional use of the negative ionizer. Though there were day-to-day variations in the numbers of spores, these changes remained significant.

The separate and combined effects of inhaled metaproterenol and atropine sulfate were evaluated in the treatment of 44 episodes of acute asthma occurring in 35 children ranging in age from 13 months to 13 years. Peak expiratory flow rate and pulmonary index were measured before and after each of up to three inhalation treatments. Significant improvement in peak flow rate (P less than .04) was noted after the second inhalation of metaproterenol both with and without the combination of atropine sulfate compared with the effects of atropine alone. Patients treated with metaproterenol and metaproterenol combined with atropine also experienced fewer therapeutic failures (2/15 and 2/16, respectively) compared with those treated with atropine (6/13, P less than .02). Pulmonary index scores did not differ among the treatment groups. Inhaled metaproterenol appears to be more effective than inhaled atropine sulfate in the treatment of children with acute asthma. The addition of inhaled atropine sulfate appears to offer no advantage over treatment with inhaled metaproterenol alone.

Ballet dancers have an increased risk of developing anorexia nervosa, perhaps because of their preoccupation with appearance and body shape related to their career. The author lists the early warning signs of anorexia nervosa and bulimia in dancers. Techniques are described to assist the practitioner in differentiating the normal dieting dancer from the anorectic dancer. The author emphasizes strategic treatment planning with anorectic dancers who initially deny the severity of their illness.