Effects of peer-group intervention on metabolic control of adolescents with IDDM. Randomized outpatient study.

In children with insulin-dependent diabetes mellitus (IDDM), deterioration in metabolic control frequently occurs during early adolescence. To prevent this predictable increase in blood glucose levels, we randomly assigned young adolescents with IDDM to an intervention based on problem solving with self-monitoring of blood glucose (SMBG) integrated into standard outpatient care or to standard care only for an 18-mo period. At follow-up, 50% of the standard-care adolescents exhibited greater than 1% increase in glycosylated hemoglobin (HbA1) levels over baseline values, indicating a deterioration in metabolic control, compared to only 23% of the intervention group. Follow-up HbA1 means +/- SD were 10.10 +/- 2.00% for intervention and 11.04 +/- 2.28% for standard-care adolescents, indicating a significantly lower value in the intervention group (P = .04). At follow-up, a greater percentage of intervention than standard-care adolescents reported using SMBG information when they exercised (60.0 vs. 33.3%, chi 2 = 4.29, P = .04). Our data suggest that clinic-based problem-solving groups can be more effective with young adolescents with IDDM than conventional treatment in preventing the expected deterioration in blood glucose.

Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis.

The effects of intravenous administration of potassium phosphate in the treatment of diabetic ketoacidosis were studied in nine children, ages 9 9/12 to 17 10/12 yr. During phosphate infusion (20--40 meq/L of fluid), all children maintained normal serum concentrations of phosphorus. Transient hypocalcemia occurred in six and transient hypomagnesemia in five patients. One child developed carpopedal spasms refractory to intravenous infusion of calcium gluconate but responsive to intramuscular injection of magnesium sulfate. In three patients, serum levels of intact parathyroid hormone were low at the time of hypocalcemia, an observation that suggests transient hypoparathyroidism. This study indicates that the use of potassium phosphate as the sole source of potassium replacement might potentiate ketoacidosis-induced hypocalcemia through multiple mechanisms.

Plasma corticoids in the respiratory distress syndrome and in normal infants.

Serial plasma samples for corticoid determination were obtained during the neonatal period in 16 infants with RDS (eight of whom died) and 44 healthy babies. The median corticoid level in the eight infants with RDS who was considerably higher than that of patients with RDS who survived, or the normal babies. The median corticoid level in the surviving RDS infants was statistically greater than that of the normal controls, but the actual difference was only 1.9 mug/100 ml. Simultaneous pH, PCO2, PO2, HCO3- and corticoid measurements were obtained serially in five patients with fatal RDS. However, the correlation between plasma corticoids and the acid-base determination was poor in all but one infant. It is concluded that infants are able to respond to severe physical stress in the neonatal period with an appropriate rise in plasma corticoid concentration, but lesser degrees of illness may cause only minimal changes in corticoid levels.

Anabolic steroids and growth hormone in the Texas Panhandle.

We conducted a survey of family physicians and general pediatricians in the Texas Panhandle to learn about patient interest in anabolic steroids and growth hormone. Responses were anonymous. Fifty-five percent of those surveyed responded. Of these, 48.5% had received inquiries about anabolic steroids, 29% had seen patients they felt were taking steroids, and 15% had received inquiries concerning growth hormone. All inquirers about steroids and growth hormone and all perceived steroid users were male, and almost all were white. Adolescents (from 13 to 17 years old) accounted for 48% of the inquiries, young adults (18 to 25 years old) 48%, and adults 4%. Twenty percent of the inquiries were made by parents. Adolescents accounted for 31% of the perceived steroid users, young adults 68%, and adults 1%. Weight lifters and body builders comprised 60% of this group, football players 26%, and those taking steroids primarily for psychological reasons 13%. Nearly all inquiries about growth hormone were made by parents, and 44% were made on behalf of children for purposes of augmenting their normal height or for athletic enhancement.

The dependence of human bone texture on life style.

Neutron diffraction has been used to determine the preferred orientation of the hydroxyapatite crystals at the lower front edge of the tibia. The bones are compared for two Neolithic Orkney tribes. At Isbister, a muscular tribe on a hilly site engaged in heavy uphill work, whereas a tribe at Quanterness lived on level ground. The two sets are contrasted with the texture of present-day amputations. Values of 16, 8 and 3 are found for an 'index of manoeuvrability' for the Isbister, Quanterness and modern ankles, respectively.

Neutron anatomy.

The familiar extremes of crystalline material are single-crystals and random powders. In between these two extremes are polycrystalline aggregates, not randomly arranged but possessing some preferred orientation and this is the form taken by constructional materials, be they steel girders or the bones of a human or animal skeleton. The details of the preferred orientation determine the ability of the material to withstand stress in any direction. In the case of bone the crucial factor is the orientation of the c-axes of the mineral content-the crystals of the hexagonal hydroxyapatite- and this can readily be determined by neutron diffraction. In particular it can be measured over the volume of a piece of bone, utilising distances ranging from 1 mm to 10 mm. The major practical problem is to avoid the intense incoherent scattering from the hydrogen in the accompanying collagen; this can best be achieved by heat-treatment and it is demonstrated that this does not affect the underlying apatite. These studies of bone give leading anatomical information on the life and activities of humans and animals-including, for example, the life history of the human femur, the locomotion of sheep, the fracture of the legs of racehorses and the life-styles of Neolithic tribes. We conclude that the material is placed economically in the bone to withstand the expected stresses of life and the environment. The experimental results are presented in terms of the magnitude of the 0002 apatite reflection. It so happens that for a random powder the 0002, 1121 reflections, which are neighbouring lines in the powder pattern, are approximately equal in intensity. The latter reflection, being of manifold multiplicity, is scarcely affected by preferred orientation so that the numerical value of the 0002/1121 ratio serves quite accurately as a quantitative measure of the degree of orientation of the c-axes in any chosen direction, for a sample of bone.

The orientation of the mineral crystals in the radius and tibia of the sheep, and its variation with age.

The direction of preferred orientation of the hydroxyapatite crystals in both the tibia and radius of the sheep is close to the long axis of the bone, notwithstanding the angle of about 30 degrees which, for the tibia, exists between the long axis and the direction of principal dynamic strain during locomotion. For both bones the orientation of the cranial cortex, which is a tension surface during locomotion, is about 40% larger than the caudal. The variation with age of the magnitude of the preferred orientation for the sheep bones is contrasted with what has been reported earlier for the human femur. Notably, for the sheep, both bones show substantial orientation at birth--having increased steadily during gestation--so that the animal is able to stand and walk at the outset.