Biomedical subjects
Publications and source records attributed to J L Salinas.
OBJECTIVE: To report a case of male pseudohermaphroditism. METHODS: A 45 day-old infant was referred for ambiguity of external genitalia. The anatomy of the external and internal genitalia and chromosomal and gonadal sex were analyzed. RESULTS/CONCLUSIONS: Female sex was assigned and labioscrotal reduction and orchidectomy were performed at age 6 months with good adaptation to gender role.
OBJECTIVE: We examined the functional status of the hypothalamic-opioid system involved in LH secretion and the pituitary LH sensitivity and reserve in patients with anorexia nervosa were studied during body weight loss and weight recovery. We measured the temporal relationship between weight recovery, expression of hypothalamic-opioid activity and pituitary GnRH responsiveness, and resumption of ovulatory cycles. DESIGN: Five patients with anorexia nervosa were prospectively studied during weight loss and amenorrhoea, subsequently when they reached their ideal body weight but still remained amenorrhoeic and thereafter every 6 months until resumption of ovulatory cycles; one patient was studied only during weight loss, two during ideal body weight and amenorrhoea and one during ideal body weight and ovulatory cycles. Blood was sampled every 10 minutes over a 16-hour period on two alternate days. On study day 1 (control day), patients received two sets of saline infusion every 6 hours and one saline bolus at the beginning of the seventh hour; on study day 3 (experimental day), they received a saline infusion during the first 6 hours, an intravenous bolus of naloxone (20 mg) at the beginning of the seventh hour and then a continuous naloxone infusion (1.6 mg per hour) during the ensuing 6 hours. Pituitary LH sensitivity and reserve were assessed on both study days by the subsequent administration of 5 and 95 micrograms of GnRH 4 hours before the completion of each sampling period. Patients in ideal body weight and ovulatory cycles as well as five normal menstruating women included in the study for comparative purposes, were studied during the midluteal phase of a cycle. MEASUREMENTS: LH, oestradiol and progesterone were determined by radioimmunoassay. Areas under the LH curve were calculated by the trapezoid method; LH pulse detection was carried out by the program Cluster. RESULTS: Naloxone administration to patients with anorexia nervosa in the weight loss phase, did not significantly modify their serum LH levels nor the characteristics of its pulsatile secretion. Administration of the opioid blocker induced a significant increase in serum LH concentrations only in those patients in ideal body weight and amenorrhoea who resumed ovulatory cycles within the 6 months following the last study as well as in patients with an ideal body weight and ovulatory cycles and in normal controls. All patients and subjects who responded to naloxone administration exhibited significant increases in the area under the LH curve, mean LH pulse amplitude and peak area. Patients in ideal body weight and amenorrhoea who did not resume ovulatory cycles within the 6 months following the study days, did not respond to naloxone administration. There were no significant correlations between the magnitude of LH response to naloxone administration and the baseline levels of serum oestradiol and progesterone. All patients exhibited significant pituitary LH responses to both GnRH doses, regardless of the stage of the disease; however, the pituitary responsiveness shown by patients in ideal body weight was significantly higher than that presented by patients in weight loss. There were no significant differences between the responses to GnRH exhibited by patients in ideal body weight and amenorrhoea who responded to naloxone administration and those shown by patients in the same clinical condition but who were insensitive to opioid blockade. CONCLUSIONS: The re-establishment of hypothalamic-opioid inhibitory activity involved in LH secretion in patients with anorexia nervosa during the phase of weight gain predicts imminent restoration of ovulatory cycles. Pituitary LH response to exogenous GnRH during weight recovery does not accurately predict the outcome of the disease regarding reinitiation of menstrual cycles; however, it might be an indicator that the normal function of the hypothalamic-pituitary axis is being restored.
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In this paper a family evaluation instrument called systemic-psychodynamic family evaluation model is described. Also, the second stage of the validation study of this instrument is presented (which deals with the inter-observers variation). Twenty families were studied. They were assessed always by the same interviewers designated as experts. They are all family therapy specialists and their assessment was used as the evaluation reference standard or "gold standard". The observers were psychiatrists without previous training in family therapy. For the purpose of the interview, both experts and observers were blind to the medical diagnosis of the patients. During the first stage of the validation study the observers did not have a reference guide which resulted in a low concordance rating. For the second stage, a 177 item guide was used and a considerable increase in the concordance rating was observed. Validation studies like the one used here are of considerable value to increase the reliability and further utilisation of evaluation instruments of this type.
In the present study, we investigated the endocrine status of patients with anorexia nervosa during weight loss (WL), as well as, after weight recovery (WR). A comparison between our findings and those obtained from other populations previously described was made. We studied 12 female patients during WL; 7 of them were reevaluated after WR. Stimulation tests with LRH, TRH, ACTH and insulin-induced hypoglycemia were performed in all cases. During the WL phase, basal serum levels of LH and estradiol, as well as the LH response to LRH, were diminished in comparison with normal values. Basal serum levels of FSH were low or normal. The function of the hypothalamic pituitary-ovarian axis was recovered in all patients restudied; six out of seven returned to ovulation within the first 4 months after WR. The remaining patient presented hypothalamic amenorrhea because of excessive physical activity. Four patients exhibited basal low T3 and T4 levels with normal TSH and a retarded response to TRH during WL. At WR some patients completely recovered their thyroid function while others developed clinical hypothyroidism. Six months after WR all patients were euthyroid. Prolactin response to TRH was unaffected in 10 patients. One patient had basal hyperprolactinemia and hyperesponsiveness to TRH, and the remaining one had only a PRL hyperesponsiveness; this latter finding persisted in one of these patients during the WR phase. This abnormality was attributed to changes in the dopaminergic tone secondary to stress. Although serum growth hormone concentrations were normal in all patients during WL, two of them had basal hypersecretion and hyperesponsiveness to hypoglycemia during WR, which was attributed to protein deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
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