Avinoam Galatzer

Paternity in Klinefelter's Syndrome—A Case Report

A boy diagnosed to have Klinefelters syndrome (KS) with a karyotype of 47XXY, at the age of 12 years underwent normal puberty and at age 17 years had a testicular volume of 10 ml. At age 22 he married and fathered a normal child. His paternity was proven by HLA typing of the parents and child. It is suggested that testosterone therapy in KS be given only when testicular failure has been definitely established.

A Multidisciplinary, Comprehensive, Ambulatory Treatment Scheme for Diabetes Mellitus in Children

A study has been carried out on 262 children with juvenile diabetes and their parents, treated up to 10 yr on an ambulatory basis by a multidisciplinary team composed of pediatric endocrinologist, nurse, dietitian, psychologist, and social worker. Comparison of the findings with those of a study performed before inception of the Counselling Center for Juvenile Diabetics revealed the following positive influences: the degree of control attained was both higher and sustained with greater regularity; there were fewer complications with no episodes of coma, brittle diabetes, or severe ketoacidosis and almost no need for hospitalization; the attitude of the affected child, his parents, and his teachers was found to be considerably improved; there was better understanding of the nature of the disease and its requirements; the childs motivation to maintain the diabetic regimen was greater and conflicts within the family circle were markedly reduced; the childs self-concept was much higher; and both scholastic achievements and social adjustment were greater. We concluded that psychological stability is a basic factor in the control of diabetes, and the value of the multidisciplinary approach in the treatment of this chronic disease is indicated.

Crisis Intervention Program in Newly Diagnosed Diabetic Children

A group of 223 insulin-dependent diabetic patients, aged 7–24 yr, who had been under the regular care of our clinic up to 15 yr, were rated by two independent judges on a two-level scale of adjustment and maladjustment. The patients were divided into two groups. Group A (N = 107) comprised those who had been under care from diagnosis of the disease and had been subjected to the special crisis intervention program offered to every family upon referral of a newly diagnosed patient. Group B (N = 116) comprised patients who were diagnosed and treated initially in a clinic that had no crisis intervention program. Significant differences between the two groups were found in respect to three of the four aspects studied, i.e., compliance, familial relationships, and sociability, with group A showing a better adjustment than group B. There was no significant difference in the fourth aspect studied, i.e., school achievement and work performance. It was found that it took three times the effort, i.e., the time invested in counseling and psychotherapeutic measures, to bring group B to a good level of adjustment than it did to achieve similar results with group A. It is suggested that the initial period after diagnosis of diabetes in a child should be considered a period of crisis, requiring special muitidisciplinary services to reduce future psychosocial maladjustments and improve compliance.

Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections in Adolescents with Type I Diabetes Mellitus: A Randomized Open Crossover Trial

Intensive therapy for type 1 diabetes mellitus (DM) is usually provided by either multiple daily injections of insulin (MDI) or by insulin pump (continuous subcutaneous insulin infusion CSII). We designed an open, randomized, crossover trial to compare CSII with MDI for glycemic control, dose requirements, weight change, incidence of adverse events, quality of life and satisfaction in adolescents.

Growth hormone, somatomedin and prolactin — Relationship to brain function —

In recent years it has been found that the brain of several mammals including have receptors for somatomedin both IGF-I and II and measurable hGH has been identified in human brain tissue. IGF-II has been determined in CSF. The presence of these hormones in brain tissue seems to be of developmental and functional importance as experimental studies in frogs, tadpoles and rats showed that injection of growth hormone enhanced brain growth and increased the ratio of neurons to glia. In man early initiation of hGH therapy to children with hGH (who have a less than normal head circumference) induced a fast catch-up growth of the head and improved their IQ. The data available seems to indicate that growth hormones and/or the somatomedins play an important role in the early brain development, maturation and function. In case of hereditary or congenital GH-RH, hGH or somatomedin deficiency, the effectiveness of therapy seems age limited similar to hypothyroidism. The finding of prolactin receptors in human brain and the report of a child with congenital hypoprolactinemia who had mild mental retardation raises the possibility that also prolactin plays a role in brain function.

EFFECT OF hGH ON HEAD CIRCUMFERENCE AND IQ IN ISOLATED GROWTH HORMONE DEFICIENCY

Abstract Repeated testing of IQ and head circumference in 4 children with isolated growth hormone deficiency (IGHD) revealed a catch-up in both parameters in 2 patients treated at ages 3312 and 4512, but in 2 patients treated at ages 9112 and 13512, no improvement was found.

Self-Image in Adolescents with Delayed Puberty and Growth Retardation.

Fifty-six adolescents with varying combinations of pubertal delay and growth retardation were given the Offer Self-Image Questionnaire. Delay in sexual maturation by itself had no significant deleterious effect on self-image; however, growth retardation did. These results have important implications in determining indications for the endocrinological treatment of pubertal disorders.

Psychological Aspects of Childhood Diabetes

The diagnosis of diabetes mellitus, a life‐long disease with many possible complications, has a dramatic impact upon the entire family, precipitating a state of “shock.” We have studied for 17 years various psycho‐social aspects of “having diabetes mellitus” or having “a child with diabetes mellitus” in 550 families. The findings led to changes in the therapeutic approach and structure of the treating team. The psychological problems in diabetes should be divided in 3 periods: at diagnosis (other diseases or tension existing in the family and not related to diabetes, socioeconomic state); initial adaptation period (acceptance to be “different,” adjustment to rules of control such as daily injection of insulin, self blood glucose monitoring or urine testing, changing of nutritional habits, etc.), and long‐term coping (self image, family dynamics, social activities, school achievements, vocational rehabilitation and continuing compliance). Counselling of the psychological problems is an ongoing need and is best delivered when the treating team includes psychologists and social workers. We found evidence that this approach imptoves the quality of diabetes control, permits the young diabetic to live a normal life and diminishes the development of complications.

Psycho-social aspects of children and adolescents with diabetes.

The diagnosis of diabetes mellitus, a life-long disease with many possible complications, has a dramatic impact upon the entire family, precipitating a state of “shock”. The psychological problems in diabetes should be divided in 3 periods : at diagnosis (other diseases or tension existing in the family and not related to diabetes, socio-economic state); initial adaptation period (acceptance to be “different”, adjustment to rules of control such as daily injection of insulin, self blood glucose monitoring or urine testing, changing of nutritional habits, etc.), and long term coping (self-image, family dynamics, social activities, school achievements, vocational rehabilitation and continuing compliance. Counselling of the psychological problems is an ongoing need and is best delivered when the treating team included psychologists and social workers