Effect of synthetic gonadotropin-releasing hormone (GnRH) in a patient with the "fertile eunuch" syndrome

A patient with isolated LH deficiency ("fertile eunuch" syndrome) was given synthetic gonadotropin releasing hormone (GnRH) by a single intravenous injection and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and dihydrotestosterone were measured. A significant rise in both gonadotropins was found after GnRH and the increase was similar to that reported for normal men. No significant change was noted in the serum androgen levels. The patient was re-tested with another single intravenous injection after a 6-h infusion of GnRH two days later. The rise in serum Fsh and LH levels during the infusion was greater than with the initial bolus. A further increase in LH but not FSH concentration was noted when a 150 mug bolus was given at the end of the infusion. Acute (4 day) treatment with human chorionic gonadotropin (hCG) resulted in an increase in the serum testosterone and dihydrotestosterone levels to those observed in normal adult males. The "fertile eunuch" syndrome thus appears to be a hypothalamic disorder. It is consistent with the concept of more than one hypothalamic factor controlling gonadotropin secretion. Other possibilities would be deficient or defective production of a releasing factor affecting one or both gonadotropins. The lack of a definite response of serum androgens to GnRH would appear to be secondary to a decreased number of differentiated Leyding cells.

The epidemiology of self-poisoning in Hobart, 1968-1972

Continued monitoring of the rates for treated self-poisoning in Hobart over a five year period has revealed a marked increase in this behaviour. Attention is drawn to the load this places on medical and psychiatric services. The present study has shown that the rise in self-poisoning was statistically significant among young males and females of most age-groups. This rise was particularly notable in senior secondary schoolgirls. In terms of geographical distribution, significant increases were observed in the economically depressed central areas of Hobart and in satellite towns. The need for greater emphasis on primary prevention is discussed.

A study of peripheral leucocyte migration in agarose medium in inflammatory bowel disease

THE MIGRATION OF PERIPHERAL LEUCOCYTES FROM PATIENTS WITH INFLAMMATORY BOWEL DISEASE WAS INVESTIGATED USING AN AGAROSE PLATE TECHNIQUE AND THREE ANTIGENIC MATERIALS: (1) the enterobacterial common antigen of Kunin; (2) extract from germ-free rat faeces; and (3) Kveim suspension from a sarcoid spleen K19. Inhibition of migration was obtained only with Kunin antigen. It was present in 11 out of 20 patients with ulcerative colitis and in four out of 20 patients with Crohn's disease but in only one out of 33 control subjects. These findings suggest the possibility that a state of cellular immunity to enterobacterial common antigen may exist in inflammatory bowel disease. Lack of cellular reactivity to extract from germ-free faeces and Kveim suspension is in contrast with the results obtained by others by means of the capillary tube method and requires further investigation.

The effect of an irrelevant dimension on "same-different" judgements of multi-dimensional stimuli

Subjects made “same”-“different” judgements of simultaneously presented pairs of visual stimuli which could vary either in shape and colour independently, or in shape alone. In both conditions only shape was relevant to the “same”-“different” judgement. In the former condition “same” and “different” reaction times (RTs) were shorter when the states (“same” or “different”) of the relevant and the irrelevant dimension, colour, were the same. This result is interpreted as support for either a perceptual or a response interference hypothesis. The presence of an irrelevant dimension did not appear to affect differentially “same” and “different” judgements. The need for a re-evaluation of the results from other studies of multi-dimensional stimulus discrimination is discussed.

Removal of polyps with fibreoptic colonoscope: a new approach to colonic polypectomy

By using a colonoscope diathermy snare a total of 75 polyps have been removed from sites throughout the colon in 43 patients. There was some haemorrhage in four cases but no other morbidity, and all patients were discharged home within 24 hours. The ease of this procedure suggests that it should replace colotomy and surgical polypectomy in the management of polyps inaccessible to the rigid sigmoidoscope.

Examination of the whole colon with the fibreoptic colonoscope

During examination of the intact colon with the Olympus CF LB 185-cm colonoscope it has proved possible to reach the caecum or terminal ileum in 47 out of 50 cases (94%). Careful bowel preparation, moderately heavy sedation, and some x-ray screening are necessary for the procedure, but it was well tolerated by all patients and there was no morbidity. The average time taken to the caecum was 40 minutes and the average time to completion of examination 90 minutes. The long colonoscope was as convenient to use as the fibresigmoidoscope in examinations confined to the sigmoid colon or in patients with a colostomy, ileostomy, or ileorectal anastomosis. Of the two, the long colonoscope is the instrument of choice for clinical use.Because of the expense, time, and equipment involved colonoscopy appears to be best offered as a specialist service after x-ray studies. There is alo a limited place for colonoscopy during abdominal surgery, when it is technically an easier procedure. In this series 10 patients were saved exploratory laparotomy by examination with the colonocope, and we also diagnosed four resectable carcinomas not seen on double-contrast barium-enema studies. The colonoscope provides an effective new means of diagnosis of lesions throughout the colon.

Islet cell tumors and hypoglycemia

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Discrimination of checkerboard patterns by rats

Fifteen rats were trained to discriminate between a regular checkerboard pattern and a similar pattern containing a “mistake.” The animals subsequently transferred to many other pairs of regular and irregular patterns differing widely from the originals. The results suggest that rats can induce and store highly abstract rules describing input patterns.

The frontal plane vectorcardiogram in old inferior myocardial infarction. Criteria for diagnosis and electrocardiographic correlation

The early part of the frontal plane QRS loop (Frank lead system) was analyzed in 100 consecutive patients with an old inferior myocardial infarction. In order to be included in this study, all cases had to fulfill, at some time, Myers' classical ECG criteria for the diagnosis. The vectorcardiogram was made months to years after the patient's original acute episode.

Several scalar and planar parameters, pertaining to these frontal plane early QRS vectors, were analyzed. As a result of this analysis and in order to prevent overlap with values found in 315 normal control subjects, VCG criteria, based on the interrelationships of several of these parameters, were proposed for the diagnosis of old inferior myocardial infarction. Pitfalls in the use of only scalar or planar analyses were pointed out.

In 90 of the 100 cases the diagnosis was made on the basis of the proposed VCG criteria. However, the ECG made at the same time fulfilled Myers' or Goldberger's classical criteria in only 42 of the 100 cases. All cases diagnosed from the ECG were also diagnosed from the VCG.