Dietary peptides improve wound healing following surgery.

To determine if peptide-based enteral diets improve wound healing when compared to amino acid-based diets, a prospective randomized study was conducted using 38 male Sprague-Dawley rats. Following placement of a standardized abdominal wound, 20 animals were randomized to an isonitrogenous peptide-based (PEP) versus amino acid-based diet (AA) for 10 d. In addition, 18 animals were randomized to an amino acid-based diet supplemented with the peptide carnosine (CARN) or its constituent amino acids (Control). Diets were administered through small bowel feeding tubes. Wound bursting pressure was significantly higher in the PEP animals compared to the AA animals (179+/-9 versus 138+/-12 mmHg; P=0.02). In addition, wound bursting pressure was significantly greater in the CARN animals compared to the Control animals (143+/-10 versus 116+/-8 mmHg; P=0.005). Peptide-based enteral diets improve wound healing when compared to nonpeptide generating amino acid-based diets. We also conclude that the dietary peptide carnosine represents a dietary peptide that improves wound healing when administered as part of a complete enteral formula. This effect on wound healing may be clinically relevant because carnosine is not found in most enteral formulas.

Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) remains an important complication of AIDS. Advances have been made in establishing the taxonomy of the organism but the life cycle of the organism and pathogenetic mechanisms of disease remain obscure. In HIV patients the incidence of PCP has decreased because of widespread use of prophylaxis and survival of those with PCP has improved with use of adjunctive corticosteroid therapy. Less toxic drug therapies are still needed as well as better noninvasive diagnostic techniques.

Hand-held blood gas analyzer is accurate in the critical care setting.

OBJECTIVE: To determine the accuracy of a new, portable battery-powered blood gas analyzer when used by nonlaboratory-trained clinicians in the critical care setting. DESIGN: Prospective analysis of blood samples from critically ill patients. SETTING: Large tertiary critical care unit. PATIENTS: Heterogeneous group of medical and surgical critically ill patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred thirty-nine split blood samples from intensive care patients were analyzed by clinicians in the critical care environment using a new, portable, battery-powered blood gas analyzer (Immediate Response Mobile Analyzer [IRMA], Diametrics Medical, St. Paul, MN). Near-patient measurements were compared with measurements obtained by laboratory technologists using an IL-1312 blood gas analyzer (Instrumentation Laboratories, Lexington, MA) in an established near-patient critical care laboratory. Precision and coefficients of variation were also determined using repeated testing of quality control samples at three levels of pH, PO2, and PCO2. There was good agreement between IRMA determinations and the laboratory. Correlation coefficients ranged from 0.96 to 0.99. Bias and precision (+/-2 SD), respectively, were 0.02 and 0.036 units for pH, -0.3 torr (1.8 kPa) (-0.04 kPa) and 7.2 torr (0.96 kPa) for PCO2 and -3.9 torr (0.52 kPa) and 13.8 torr (1.8 kPa) for PO2. Precision on repeated testing of quality control samples ranged from 0.022 to 0.04 units for a pH of 7.2 to 7.6, 1.2 to 4.6 torr (0.16 to 0.61 kPa) for a PCO2 of 20 to 60 torr (2.7 to 8 kPa), and 3.0 to 7.4 torr (0.40 to 0.99 kPa) for a PO2 of 70 to 160 torr (9.3 to 21.3 kPa). Coefficients of variation ranged from 0.15% to 0.28% for a pH of 7.2 to 7.6, 2.0% to 3.7% for a PCO2 of 20 to 60 torr (2.7 to 8.0 kPa), and 1.7% to 3.6% for a PO2 of 70 to 160 torr (9.3 to 21.3 kPa). Mean turnaround time was 16.5 +/-10.1 mins for the near-patient laboratory and 2+/-0.5 mins for IRMA. CONCLUSIONS: IRMA is accurate and reproducible when used in the clinical setting by nonlaboratory-trained individuals. Nonlaboratory-trained individuals can obtain laboratory results in the critical care setting comparable with the results obtained by trained laboratory technologists. Bedside laboratory testing decreases turnaround time compared with a near-patient laboratory.

Respiratory infections in HIV-negative immunocompromised patients.

The number of immunosuppressed patients is increasing, with many being managed by community physicians. Encouraging success in vaccinating some patients with Hodgkin's disease against encapsulated organisms has been reported. The significance of and management of tuberculosis in solid organ transplants is being defined. Fungal infection remains a problem, but pathogenesis and treatment are being clarified. The overall incidence of Pneumocystis carinii pneumonia is low, but it is being seen in patients without malignant disease, especially those with Wegener's granulomatosis. Many authors have tried to establish risk factors that will allow development of clear indications for prophylaxis in these patients. New approaches to cytomegalovirus infection are discussed as well as the role of community-acquired viruses in causing disease in the immunosuppressed population.

Pulmonary infections in immunosuppressed patients.

Pulmonary infections continue to be a significant problem in patients immunosuppressed by cancer or by drugs given for malignancy, or rheumatologic or dermatologic problems. For the neutropenic patient, single-drug rather than combination antibiotic therapy is being increasingly used. The role of growth factors is also being defined. The availability of the new azoles and of alternative forms of amphotericin B have increased treatment options, particularly for invasive pulmonary aspergillosis. Pneumocystis carinii pneumonia continues to be a problem in this population, and controversy remains about the mode of transmission and the mechanism of disease caused by this infection. Exogenous infection rather than reactivation may play a small role. Appreciation of the role of community and opportunistic viruses in causing respiratory infection or other complications in the immunosuppressed population is also being further detailed.

Lung transplantation for chemotherapy-induced pulmonary fibrosis.

A 26-year-old man cured of childhood acute lymphoblastic leukemia underwent a single lung transplant for drug-induced pulmonary toxicity 9 years after the completion of chemotherapy. It is not known whether patients cured of a malignancy who undergo organ transplantation are at increased risk of malignancy as compared to other organ transplant recipients. There was no evidence of recurrent or secondary malignancy in this case. Since single lung transplantation has been effective for idiopathic pulmonary fibrosis, it should be considered for patients cured of a malignancy who develop chemotherapy-induced pulmonary fibrosis.