Insulin-like growth factor binding protein-I levels are strongly associated with insulin sensitivity and obesity in early pubertal children

In conditions associated with insulin resistance, insulin-like growth factor binding protein-I (IGFBP-I) levels have been shown to correlate inversely with insulin levels. Puberty is associated with insulin resistance and thus provides a model for comparing the relationship of IGFBP-I to both insulin levels and measures of insulin sensitivity. Our study population consisted of 104 healthy pubertal children, age 9.8-14.6 yr. Each subject had his/her insulin sensitivity (Si) assessed by the modified minimal model of Bergman, which employs a frequently sampled i.v. glucose tolerance test. Results showed that IGFBP-I levels were significantly higher in boys than in pubertally matched girls (P < 0.01). There was a strong positive correlation between IGFBP-I levels and Si (r = 0.65, P < 0.0001) and a weaker negative correlation with fasting insulin levels (r = -0.38, P < 0.0001). An inverse relationship was also found between IGFBP-I levels and body mass index (r = -0.46, P < 0.0001) and with IGF-I levels (girls only, r = -0.41, P < 0.003). Consequently, insulin sensitivity, obesity, and IGF-I are important predictors of IGFBP-I levels in pubertal children. It is possible that insulin-mediated suppression of IGFBP-I in obese children may increase free IGF-I levels and thus contribute to somatic growth. The same mechanism may operate in pubertal children, where insulin resistance and growth acceleration occur simultaneously.     

Reversible esophageal motility disorder in a patient with sarcoidosis

Hysterosalpingo-contrast sonography was compared with sonographically controlled selective tubal catheterization (STC) in 26 infertile women who complained of infertility. Both procedures were carried out on a single examination date. A group of 10 patients first underwent hysterosalpingo-contrast sonography followed by STC, while 16 first had STC followed by hysterosalpingo-contrast sonography. The main outcome measure was tubal patency. A total of 52 Fallopian tubes was assessed. Hysterosalpingo-contrast sonography showed 39 tubes (75%) and STC 46 (89%) to be patent, 13 tubes (25%) and six tubes (12%) were diagnosed to be proximally occluded, by means of hysterosalpingo-contrast sonography and STC respectively. Concordant diagnosis with both methods was made in 43 of 52 tubes (83%). When hysterosalpingo-contrast sonography was followed by STC, the concordance rate was 85%. When STC was followed by hysterosalpingo-contrast sonography, the concordance rate was 81%. In one patient the diagnosis of proximal occlusion of one tube as determined by hysterosalpingo-contrast sonography and STC had to be correlated in laparoscopy. In a patient, who after hysterosalpingo-contrast sonography and STC, was suspected to have bilateral proximal occlusion of the tubes, considerable bilateral proximal stenosis and distal occlusion was documented at laparoscopy. In conclusion, sonographically controlled STC may correct a misdiagnosis in cases where hysterosalpingo-contrast sonography leads to the finding of proximal tubal obstruction. The combination of hysterosalpingo-contrast sonography and STC as an out-patient investigation method for tubal patency assessment in infertile women avoids anaesthesia and radiation. For this reason we recommend the combination of sonographically controlled STC with hysterosalpingo-contrast sonography, at least in cases where proximal tubal occlusion is suspected after hysterosalpingo-contrast sonography. The influence of the order in which the two methods are used on the results of both should be investigated in a randomized study.     

Transient memory impairment in monkeys with bilateral lesions of the entorhinal cortex

Performance on five behavioral tasks was assessed post-operatively in Macaca fascicularis monkeys prepared with bilateral lesions of the entorhinal cortex (E group). Three of the tasks were also readministered 9-14 months after surgery. Initial learning of the delayed nonmatching-to-sample (DNMS) task was impaired in the E animals relative to unoperated control monkeys. On the delay portion of DNMS, the performance of E animals was nearly at control levels at short delays (up to 60 sec) but was impaired at 10 min and 40 min retention intervals. On the retest of DNMS, the E animals performed normally at all retention intervals. The E animals were unimpaired on the four other memory tasks. Neuroanatomical studies revealed a significant transverse expansion of the terminal field of the perirhinal cortical projection in the CA1 region of the hippocampus. Compared to unlesioned, anatomical control monkeys, the transverse length of the perirhinal terminal field in CA1 increased approximately 70% in the E monkeys. Although this was a striking morphological alteration, it is not known whether the sprouting of this projection influenced the behavioral recovery. The results of these studies suggest that the entorhinal cortex may normally participate in the learning and performance of tasks that are dependent on the medial temporal lobe memory system. However, recovery of normal DNMS performance demonstrates that the entorhinal cortex is not, by itself, essential for learning and performance of such tasks.