Repetitive infusion of gonadotropin-releasing hormone distinguishes hypothalamic from pituitary hypogonadism.

Patients who have severe hypogonadotropic hypogonadism caused by presumed hypothalamic disease often have a subnormal LH response to a bolus dose of gonadotropin-releasing hormone (GnRH). To determine if this subnormal response is the result of lack of exposure of the pituitary gonadotroph cells to GnRH, five such men were given daily infusions of 500 microgram GnRH, for 7 days. A standard 250-microgram bolus test dose of GnRH was administered before and again immediately after the week of GnRH infusions. Five men who had severe hypogonadotropic hypogonadism as a result of presumed pituitary disease also received daily GnRH infusions for 1 week. The mean incremental LH responses (+/- SE) to GnRH of the men with presumed hypothalamic disease were 5.0 +/- 1.9 mIU/ml before and 56.9 mIU/ml after the week of infusions. The mean incremental LH responses of the men with presumed pituitary disease were 2.4 +/- 0.7 mIU/ml before and 3.7 +/- 2.9 mIU/ml after the week of infusions. These data suggest that the normal gonadotroph requires prolonged exposure to GnRH for LH responsiveness to become normal, but that the severely damaged gonadotroph cannot be stimulated to release LH normally even by the same prolonged stimulation with GnRH.

Effects of respiratory exercises on the vital capacity and forced expiratory volume in children with cerebral palsy.

The purpose of this study was to determine if breathing exercises can increase the vital capacity in children with cerebral palsy. Ten children with spastic cerebral palsy, five in the experimental group and five in the control group, were the subjects for the study. A spirometer was used to measure vital capacity and the forced expiratory volume before and after the children performed a breathing exercise program. The pretest values for all 10 youngsters indicated a vital capacity lower than the normal predicted values. The breathing exercises selected emphasized strengthening of the muscles of inspiration and the muscles of expiration. In the breathing exercise program, the physical therapists also attempted to follow the Bobath treatment approach by inhibiting the abnormal breathing patterns and by teaching the child proper ways of breathing control. The results seem to indicate that a breathing exercise program can increase the vital capacity in youngsters with cerebral palsy. The vital capacity of the experimental group was increased by 0.46 liters after exercising for five to seven minutes each day for a period of eight weeks. The mean increase of the vital capacity was 31 percent over the pretest values. The control group showed no change in vital capacity. The pretest and posttest forced expiratory volumes of both groups were within normal limits.

Renal-cell carcinoma metastatic to the thyroid. Aspiration cytology and histologic findings.

A case of renal-cell carcinoma metastatic to the thyroid eight years after the removal of the primary tumor is presented, with the aspiration cytologic and histologic findings described. This unusual presentation and the incidence and behavior of renal-cell carcinomas and tumors metastatic to the thyroid are discussed.

Understanding order of movement in youngsters with cerebral palsy.

A theoretical controversy exists over the role of early physical experience and motor activity in cognitive development. The purpose of this study was to contribute information to help clarify this relationship by comparing the understanding of order of movement of 30 nonambulatory youngsters with cerebral palsy and 30 nonhandicapped youngsters. Half were boys; half girls; equal numbers were in three age groups of 4 to 5 yr., 7 to 8 yr., and 10 to 11 yr. The order of movement task was designed by Piaget to describe the child's understanding of movement. Statistical analyses showed that youngsters with cerebral palsy were significantly delayed in their understanding of order of movement. These results indicated that the children's physical handicap interfered with their cognitive development.

Understanding of conservation of substance in youngsters with cerebral palsy.

Consistent research reports in the literature have shown that youngsters born with a severe physical handicap are delayed in cognitive functions that are based upon spatial concepts. The purpose of this study was to determine whether youngsters born with cerebral palsy are delayed in their understanding of a nonspatial task. The task chosen was conservation of substance, designed by Piaget to determine if the child understands that a mass will remain the same after its physical appearance has been altered. The sample consisted of 30 nonambulatory youngsters with cerebral palsy and 30 nonhandicapped youngsters. Half were boys; half girls; equal numbers were in three age groups of 4 to 5 years, 7 to 8 years, and 10 to 11 years. Statistical analysis showed youngsters with cerebral palsy were not delayed in their understanding of conservation of substance. These results indicated that the children's physical handicap did not interfere with their cognitive development of a nonspatial concept. These results have implications for therapists treating children with severe physical handicaps.