Synthetic LRH was infused into normal women and women with obesity and anorexia nervosa to determine the distribution volume (DV), metabolic clearance rate (MCR) and half disappearance time (t\m=1/2\)of plasma LRH.In normal women, the DV of LRH was 12.1 \m=+-\0.9 (mean \ m=+-\se) 1, the MCR was 1478.9 \m=+-\39.8 ml/min (28.5 \m=+-\1.2 ml/min/kg body weight) and the initial t \ m=1/ 2\ was 5.6 \m=+-\0.4 min.In obese patients the DV (20.6 \ m=+-\ 1.5 1) was significantly higher than that in normal subjects (P < 0.005), but the MCR and t\m=1/2\were not significantly different from those in normal subjects.In patients with anorexia nervosa the DV and MCR were 6.5 \m=+-\1.1 l and 621.8 \m=+-\110.5 ml/min (17.9 \ m=+-\2.4 ml/ min/kg body weight), respectively, which were both significantly lower than those in normal subjects (P < 0.02), while the t\m=1/2\(7.3 \m=+-\0.1 min) was longer than in normal subjects (P < 0.02).These data suggest that 1) the abnormal responses of some hormones to provocation tests observed in obese patients and patients with anorexia nervosa should be evaluated in consideration of changes in the DV and metabolic clearance of hormones in these conditions, and 2) in patients with anorexia nervosa changes in MCR and t \ m=1/ 2\ may reflect low metabolism of LRH.Various endocrine and metabolic abnormalities have been found in obese subjects (Beck et al. 1964;Copinschi et al. 1967) and underweight subjects (Frankel & Jenkins 1975). As we previously reported, the release of some pituitary hormones in response to various stimuli is impaired in obese patients (Chikamori 1976), and elevation of the plasma growth hormone (GH) level and decrease in luteinizing hormone (LH) secretion are noted in many patients with anorexia nervosa (Nishimura et al. 1979). These abnormalities in hormone secre¬ tion have been considered as secondary changes due to change in the body weight or dysfunction of the hypothalamo-pituitary axis. However, the plasma concentration of a hormone reflects a ba¬ lance between the rates of its secretion and meta¬ bolism, and thus endocrine function should be evaluated on the basis not only of the plasma concentration but also of metabolic clearance of the hormone released from the endocrine gland.For investigation of this problem, it is necessary to study changes in the distribution volume (DV) and metabolic clearance rate of hypothalamic or pituitary hormones in patients with obesity and anorexia nervosa. At present few purified pituitary hormones are available for iv injection into hu¬ mans, but hypothalamic releasing hormone is read¬ ily available.The metabolic clearance of synthetic luteinizing hormone releasing hormone (LRH) in normal sub¬ jects has been studied (Miyachi et al. 1973;Keye et al. 1973), but litüe is known about changes in metabolic clearance of LRH in diseased states (Pimstone et al. 1977). Therefore, we studied the DV, metabolic clearance rate (MCR) and half disap-

BackgroundCentral airway obstruction (CAO) may be caused by various etiologies. However, conventional chest X-rays are rarely diagnostic for patients with CAO.Case presentationWe here described a 64-year-old asymptomatic female with tracheal mucosa-associated lymphoid tissue lymphoma discovered on spirometric findings during a complete physical examination. The plateau of forced expiratory flow was consistent with CAO. A decreased peak expiratory flow rate was noted at least 3 years before the diagnosis, and was attributed to an insufficient effort by the patient. Impulse oscillometric measurements, which were taken during quiet breathing and were effort-independent, suggested elevated respiratory resistance. These abnormalities completely disappeared after radiation therapy.ConclusionThe addition of impulse oscillometry to spirometry may be useful for screening CAO in routine health examinations.

Manipulation is adequate as an initial screening method for thyroid examination, and ultrasonography may not always be required. Moreover, it is necessary to consider gender when referring a patient to a specialist and when deciding on the indications for surgery to remove a thyroid tumor.

In order to investigate changes in endocrine function, various tests were performed on eleven patients with anorexia nervosa. In two of them, endocrine function before and after treatment was also studied. The responses of plasma LH and FSH to LH-RH were decreased in the patients as were plasma LH-RH, and LH and FSH responses to the oral administration of clomiphene citrate. In more than half of the cases, plasma TSH showed a delayed response to TRH. The basal levels of plasma GH were elevated, and plasma GH responses to hypoglycemia or 1-arginine were lowered in half of the patients. Plasma GH showed a paradoxical rise after glucose load in three out of six cases. Plasma IRI responses to 1-arginine load were decreased in some cases, but plasma IRG responses to 1-arginine were rather excessive. Plasma IRI after glucose load showed low or delayed responses in most of the cases. After the body weight was increased to normal levels by the treatment, pituitary and pancreatic endocrine functions were normalized. These findings indicate that hypothalamic function is primarily impaired in this disease and causes nutritional disorder followed by the dysfunction of some endocrine organs. Such a possibility could be supported by the improvement of endocrine function after body weight has been recovered.

Studies were made on changes in the level of plasma immunoreactive glucagon (IRG) in rats with lesions of the ventromedial hypothalamic area. In the rats with hypothalamic lesions (HTL) the basal level of plasma immunoreactive insulin was higher and its responses to intravenous injection of glucose and to intraperitoneal administration of arginine were significantly greater than those in control rats. The basal plasma IRG concentration was lower and its changes in response to 24 hr starvation or the arginine load were significantly less in rats with HTL than in controls at 1 and 10 weeks after the operation. Similar results were also obtained in the rats pair-fed for 4 weeks after the operation. A significant negative correlation was observed between the basal plasma IRG level and body weight or Lee's index in these rats. These data suggest that disturbance of the autonomic nervous system due to destruction of the hypothalamus, reduced secretion of pituitary hormones, increased insulin secretion and defect in humoral factors of the hypothalamus may be responsible for the decrease in plasma IRG levels observed in rats with HTL. It also seems likely that reduced glucagon secretion contributes at least in one part to the development of hypothalamic obesity.