Michael Nussbaum

Cerebral atrophy in anorexia nervosa

ANOREXIA NERVOSA is primarily seen in young girls and is characterized by severe emaciation associated with amenorrhea, constipation, loss of appetite, slowed pulse and respiration, absence of somatic pathology, and excessive body movements. The incidence and prevalence of this ~yndrome appears to be increasing? Abnormal laboratory findings may include disorders of the hematologic, endocrine, and cardiovascular systems. Abnormal neurologic findings are rare. ~, :~ MATERIAL Fourteen patients with anorexia nervosa seen during the past year were studied by Utilizing computerized tomography of the brain. Patients had a weight loss of at least 10%, but usually over 20% O f their total body weight. All either refused or failed .to eat. All females had amenorrhea. All patients had a desire to be thin; all had

Short stature in anorexia nervosa patients

In the treatment of many anorexia nervosa (AN) patients, we observed clinically that these girls were short in stature. In order to test this hypothesis, we reviewed the height records of all patients seen with a previous diagnosis of AN in an eight-year period. Of 104 patients, 85 were suitable for study and were compared to a control group of 85 age-matched subjects. Seventy-six percent of the AN patients (mean age 15.8 years) were below the 50th height percentile for age; 14.1% were below the 5th percentile; and 25.8% were between the 25th and 49th percentile. Parental height was available for 35 subjects. The AN patients were significantly shorter than their parents, and comparison suggests an impairment of growth rather than a familial etiology. As 80% of subjects developed AN after menarche, malnutrition does not appear to be responsible for the observed height deficits.

Altered exercise performance and abnormal sympathetic responses to exercise in patients with anorexia nervosa

We evaluated the cardiovascular and sympathetic responses to exercise in patients with anorexia nervosa to determine whether their bradycardia results from a high level of physical fitness. Twenty adolescent patients with anorexia nervosa underwent maximal exercise tests, and the results were compared with those in 15 age-matched adolescent girls. In the patients with anorexia, maximal values were heart rate 174 +/- 2.8 bpm, systolic blood pressure 127 +/- 3.4 mm Hg, oxygen consumption 31 +/- 1.1 ml/kg/min, and plasma norepinephrine concentration 1581 +/- 238 pg/ml (n = 16). In the controls, corresponding values were significantly higher (P less than 0.025): heart rate 193 +/- 2.1 bpm, systolic blood pressure 163 +/- 4.4 mm Hg, oxygen consumption 39.3 +/- 1.6 ml/kg/min, and plasma norepinephrine 2695 +/- 413 (n = 10). Anaerobic threshold occurred at the same percent of maximal work in patients and controls. Results of exercise ECGs in all controls were normal, but five patients with anorexia nervosa developed significant ST segment depression. Thus, in patients with anorexia nervosa there is abnormal working capacity and cardiovascular responses to exercise and abnormal sympathetic responses to the stimulus of exercise, and a myocardial abnormality manifested as ST segment depression during exercise in some.

Follow-up investigation in patients with anorexia nervosa

Sixty-three female patients with anorexia nervosa were assessed for outcome, on average 27.5 months after treatment. The treatment program, in a general adolescent medical service, is multidisciplinary, stressing appropriate weight gain in conjunction with various therapeutic modalities. Half the group required at least one hospitalization; the remainder received treatment as outpatients. Mean weight of the patients was 41.8 kg at first contact, 46.2 kg at conclusion of treatment, and 52.2 kg at follow-up. Average height at the time of follow-up was in the 38th percentile. Average weight was in the 15th percentile at first contact, and in the 29th percentile at follow-up. Current weight is 8% below ideal. Ninety-three percent of the patients had amenorrhea at diagnosis, and 9.5% at follow-up. Vomiting declined from 59% of patients to 16%. Vomiting was significantly associated with poor outcome. The majority function successfully, academically and vocationally. Most continue to restrict diet, and 79% consider themselves overweight. Forty percent report chronic feelings of depression, and 22% have unsatisfactory social relationships. The data suggest no difference in outcome between those receiving psychotherapy (65%) and those who did not (35%). Type and duration of therapy were also not associated with long-range improvement.

Health habits and depression in adolescence

In a study of the relationship between health habits and depression, 80 high school students, selected on an availability basis, were administered a Health Behaviors Questionnaire (HBQ) and the Beck Depression Inventory (BDI). The HBQ and the BDI significantly correlated (r=0.43p<0.01). Those who smoked were more frequently depressed than those who did not (X2=10.5p<0.05), and those who used drugs other than marijuana were depressed more frequently than those who did not (X2=9.2p<0.01). Mildly overweight boys (overweight by more than 5% of their ideal weight) and mildly under-weight boys (underweight by more than 5% of their ideal weight) were more

Gallbladder disease in children and adolescents

A 20-year experience with gallbladder disease in 85 children and adolescents was reviewed. Sixty-five patients had idiopathic cholelithiasis and cholecystitis (group I); 20 patients had cholelithiasis and cholecystitis secondary to a predisposing disease or other pathologic diagnoses (group II). For group I patients, 100% were greater than age 12, 92.3% were female, 60% were overweight, 20% had a positive family history, and 27.7% had had a previous pregnancy. For group II patients, 60% were less than age 13, 45% were female, 15% were overweight, 5% had a positive family history, and none had previously been pregnant. Symptomatology in group I, but not group II, patients matched that seen in adults. Group I, but not group II, patients experienced delays in diagnosis. These data indicate that children and adolescents with gallbladder disease constitute two distinct populations and that idiopathic cholelithiasis and cholecystitis must be considered as a potential cause of chronic abdominal pain in otherwise healthy adolescents.

Intractable paroxysmal sneezing: A conversion reaction of adolescence

A case of recurrent paroxysmal sneezing in an adolescent girl is reported with a review of the literature. The mechanisms of sneezing are described. Most cases appear to have a psychogenic etiology. We postulate that this is a conversion symptom in which the patient received secondary gain and probably represents a pre-oedipal conflict.

Long-term follow-up of obesity in adolescents

Fifty adolescents, 12-17 years of age, were treated for obesity from 1967 to 1972. They were contacted in 1977 to obtain follow-up data. Each subject had been treated in a program of dietary counseling and behavior modification. Mean weight on follow-up was 18.1 lb (8.2 kg) lower than mean initial weight (P less than 0.05). The mean decrease over desired weight was 29.5%. Twenty-two patients reported a weight loss of greater than 20 lb (P greater than 0.001). (9.1 kg) and 15 patients reported a weight loss of 0-20 lb (9.1 kg). Thirty-eight percent of the patient were no longer obese (greater than 20% over ideal body weight) and an additional 22% were no longer overweight (10-20% over ideal body weight). These results suggest that a dietary and behavior modification program offered to adolescents may show beneficial results in young adulthood.

On-Field Physician Assessment of High School Football Injuries

In brief: This study analyzed junior and senior high school football injuries with on-the-field evaluation and data collection by physicians. More injuries occurred during varsity than freshman games, and contusions, sprains, strains, and other orthopedic injuries to the extremities were the most common. There was only one concussion in 31 games. This low incidence may be due to more effective football helmets. More injuries occurred on rainy days and muddy fields in this study, which contrasts with previous reports. The authors conclude that the average of one significant injury every five games suggests the need for continued medical coverage at football games.

Gonococcal Arthritis-Dermatitis (GADS) as a Complication of Gonococcemia in Adolescents

A sexually active 15-year-old black girl was hospitalized because of a painful left wrist preceded by migratory arthritis of both hands. She had been well until one week previously when she experienced pain and swelling of her left wrist and a yellowish vaginal discharge. She had an IUD in place which was not removed. A presumptive diagnosis of gonococcemia was made despite negative cultures, and she was treated with intra-