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1/65. Access to TV contingent on physical activity: effects on reducing TV-viewing and body-weight.

    One child was recruited for a study assessing the effectiveness of a device aimed at reducing excessive television viewing and increasing exercising. The device was comprised of a control box which attaches to the electrical cord of a television set, and two sensors which attached to the wheel and corresponding wheel rim of a stationary bicycle. The child in this study was watching an excessive amount of TV (averaging over 4 hours per day), and she had a weight problem. An ABAB design was used in the study. After collecting baseline data, the child was required to ride a bicycle for 60 minutes to watch 60 minutes of TV, and this program successfully reduced TV viewing. Reductions in TV viewing and weight loss were found at a follow-up.
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2/65. Early onset of hypernatraemic dehydration and fever in exclusively breast-fed infants.

    Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in hong kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications.
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3/65. fertility and body composition after laparoscopic bilateral adrenalectomy in a 30-year-old female with congenital adrenal hyperplasia.

    Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is caused by an inborn defect in the 21-hydroxylase gene (CYP21), leading to virilization of female patients and causing ambiguous genitals in the majority of female infants. adult women may suffer from loss of libido, irregular or absent cycles, and reduced fertility, despite intensive medical treatment. These problems have stimulated the search for alternative treatment modalities. We present an adult female patient, who was difficult to treat medically and whose clinical situation markedly improved after laparoscopic bilateral adrenalectomy. The procedure was well tolerated and without side effects. Postoperatively the elevated serum progesterone and 17-hydroxyprogesterone levels, as well as the undetectable LH levels, normalized. The procedure resulted in marked clinical improvement. Within 12 months after surgery she lost 11 kg in weight. This weight loss consisted mainly of adipose tissue. Acne disappeared, and she had a regular 4-week menstrual cycle, with progesterone levels that are compatible with a luteal phase. The introduction of laparoscopic techniques may give an impulse to the application of surgical therapy at a larger scale in patients with 21-hydroxylase deficiency who are difficult to treat with adrenal suppression therapy.
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4/65. A case of obesity, diabetes and hypertension treated with very low calorie diet (VLCD) followed by successful pregnancy with intrauterine insemination (IUI).

    The patient was a 32-year-old obese woman with a history of type 2 diabetes and hypertension for 6 years. Although she was treated with antihypertensive agents and intensive insulin therapy, her hyperglycemia was difficult to control. She wanted to have a baby but pregnancy was not recommended because her diabetes was under poor control and the use of antihypertensive medication. To achieve good control of obesity, diabetes and hypertension, she was admitted to our clinical department for weight reduction using very low calorie diet (VLCD). During VLCD she had a 19.8 kg reduction in body weight and her blood glucose and blood pressure were in good control without the use of drugs. Five months later, she became pregnant after the fourth trial of intrauterine insemination (IUI) and gave birth to a female baby under insulin therapy. This is the first report that showed the usefulness of VLCD for prepregnant control of glucose metabolism and blood pressure in an obese hypertensive patient with type 2 diabetes mellitus.
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5/65. Long-term effects of topiramate on bipolar mood instability, weight change and glycemic control: a case-series.

    Topiramate is an antiepileptic agent, which is being investigated as a mood-stabilizer. Three obese individuals with DSM-IV bipolar I disorder and type II diabetes mellitus received topiramate treatment in combination with antipsychotics and valproate or carbamazepine. In addition to improved mood stability, these individuals lost between 16 to 20.5% of their pre-topiramate body weight and also achieved significant glycemic control.
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6/65. binge-eating disorder and obesity. A combined treatment approach.

    patients presenting with both obesity and BED face multiple challenges: normalizing their eating, improving their physical health, and working to enhance their own acceptance of their body image. In an effort to feel better about themselves, they often have become trapped in a cycle of desperately attempting to diet, then losing control, binge eating, and gaining even more weight. Several psychological and pharmacologic treatment approaches have been used in this population. Most suppress binge eating in the short term, and some seem promising in the long term as well. However, sustained weight loss remains a largely unrealized goal. More recently, BED treatment programs have attempted to address these goals sequentially or in combination. In either approach, it is clear that adopting a long-term focus and promoting enhanced self-acceptance, which have so often been missing from these patients' previous attempts at recovery, are important tasks of treatment that are likely to lead to beneficial lifestyle changes and long-term improvements in physical and psychological health.
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7/65. Treatment of devastating postgastrectomy symptoms: the potential role of jejunal pouch reconstruction.

    After gastrectomy a few patients develop severe symptoms and malnutrition. There are probably several reasons for this, such as insufficient gastric reservoir function, malassimilation, diarrhea and dumping. The patient presented here developed severe malnutrition after partial gastrectomy and his weight gradually decreased from 95 to 40 kg during the first 6 postoperative years. His major complaint was postprandial vomiting and early satiety. During the course of his illness, he was repeatedly investigated with computerized tomography scans, repeated endoscopies with biopsies, barium examinations, etc. Finally the only positive finding was bacterial intestinal overgrowth, but antibiotic treatment did not improve his condition. After repeated periods of parenteral nutrition or enteral tube feeding, an S-shaped jejunal pouch was attached to the gastric remnant. Dual-energy X-ray absorptiometry was used to examine the body composition and bone density in the immediate postoperative period and 1 year after the operation. During the first postoperative year he gained 11 kg weight and reported an essentially normal food intake. Both laboratory and clinical parameters improved and a gain in lean body mass was recorded. patients with severe postgastrectomy symptoms, with no other plausible explanation than nonexistent or insufficient gastric reservoir function, may benefit from re-reconstruction with a jejunal pouch.
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8/65. dermatitis, glossitis, stomatitis, cheilitis, anemia and weight loss: a classic presentation of pancreatic glucagonoma.

    Glucagonomas are rare tumors. They are predominantly located in the body or tail of the pancreas and display a constellation of signs and symptoms referred to as glucagonoma syndrome. The term necrolytic migratory erythema is used to characterize the distinctive rash associated with this syndrome. This report describes a classic presentation consisting of dermatitis, glossitis, stomatitis, angular cheilitis, anemia, and weight loss that was associated with the finding of a pancreatic mass and a markedly elevated plasma glucagon level. After pancreatic resection, the patient had complete resolution of the rash and normalization of plasma glucagon.
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9/65. An endocrinopathy characterized by dysfunction of the pituitary-adrenal axis and alopecia universalis: supporting the entity of a triple H syndrome.

    We demonstrate the rare disorder of triple H syndrome in a 25-year-old man. He was pointed out as having short stature, at -5.9 s.d., and diagnosed as GH deficient at 6 years old. Approximately a year ago, he noticed systematic hair loss. He lost body weight by 7 kg during the last half year. He was admitted to Jichi Medical School Hospital because of unconsciousness. Physical findings showed disturbance of consciousness with japan coma Scale I-3. He had emaciation and alopecia universalis. Laboratory findings showed plasma glucose was as low as 1.11 mmol/l. GH and ACTH deficiency with hypoadrenocorticism were clarified. His intelligence was in the low normal range with a WAIS IQ of 70, and anterograde amnesia was suggested in the presence of a little, but not significant, morphological change in the hippocampus on a magnetic resonance imaging scan. Replacement by a physiological dose of hydrocortisone normalized plasma glucose, and restored body weight and growth of hair during the 7 month therapeutic period. The present finding strongly supports a clinical entity of triple H syndrome, including ACTH deficiency, alopecia universalis and anterograde amnesia, and that there may be some variation of the triad among the subjects.
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10/65. Atypical presentation of churg-strauss syndrome: another "forme fruste" of the disease?

    vasculitis is a clinicopathologic process characterized by inflammation and damage to blood vessels. A broad and heterogenous group of syndromes may result from this process, because any type, size, and location of blood vessel may be involved. The cause of these conditions remains unclear, but an autoimmune inflammatory process, characterized by involvement of both neutrophils and endothelial cells, seems to play an important role. In 1951, Churg and Strauss described a clinical syndrome of severe asthma, hypereosinophilia with eosinophilic infiltrates, eosinophilic vasculitis, and granulomata in various organs. asthma may precede this vasculitis by many years. We report a case of anti-neutrophil cytoplasmic antibody-positive, pauci-immune, crescentic, necrotizing glomerulonephritis with peripheral and interstitial eosinophilia but without asthma. This is very unusual in churg-strauss syndrome.
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