In utero intraventricular hemorrhage and growth discordancy in a quadruplet pregnancy.

With the advent of real-time ultrasonography, there have been a number of reported cases of in utero fetal intraventricular hemorrhage. The most frequent etiology for this uncommon event is iso/allo-immune thrombocytopenia; however, other risks have also been identified. This is the first report of an in utero diagnosis of intraventricular hemorrhage in a multiple gestation. Severe growth discordancy in this quadruplet pregnancy was an associated finding.

Pica in a rural obstetric population.

The incidence of pica during pregnancy has been reported to range from 0% to 68% depending on the patient population. This study was designed to define characteristics and factors influencing the practice of pica in a rural obstetric population. Our study group was 125 consecutive pregnant women who were interviewed at their initial antenatal visit about attitudes and behavior regarding pica practices. The prevalence of anemia was determined. Chi-square and t tests were used when appropriate. A pica was found in 18 (14.4%) patients. There were no significant differences between patients with a pica and those with none with respect to age, race, weight, or anemia. Substances ingested included white and red dirt, ice, cornstarch, laundry starch, soap, ashes, chalk, paint, and burnt-matches. Characteristics of patients with pica included cravings (6 of 18 or 33.3%), pica before pregnancy (10 of 18 or 56.6%), childhood pica (6 of 18 or 33.3%), and the presence of other household members with pica (56.6%). Our study data suggest that pica is frequently associated with similar practices during childhood and nonpregnant states. These patients also may be at risk for lead toxicity or other environmental toxin exposures.

Total nutrient admixture: a review.

The TNA system of nutritional support has become very popular and offers some unique advantages over the traditional method of administering TPN to hospitalized and home patients. However, these advantages as outlined in this review, must be carefully weighed against potential disadvantages before the TNA system is employed as a nutritional support modality. It should also be noted that the stability of TNA systems is not well established since many stability studies do not provide specific information regarding formulations tested. In addition, many studies do not utilize methods to determine the entire spectrum of particle size and distribution. Droplet size in TNA systems attain a diameter several times larger than the 0.2 to 0.4 micron of manufacturer's lipid emulsions and naturally occurring chylomicrons. Although the administration of the TNA system has not been associated with any acute toxicity, the long-term consequences of infusing droplets larger than 0.4 micron is not definitely known. In addition, the biological implications of using the TNA system need to be elucidated. Subtle differences in the properties of the lipid emulsion can affect the way it is metabolized by the body. Wretlind has mentioned that two apparently similar soybean oil emulsions, Intralipid, and Lipofundin are handled differently by the body. Minor differences in the phospholipid layer of the droplets were postulated as a cause. Certainly the nature of the emulsifying layer of phospholipid on TNA system droplets is modified and therefore may be metabolized differently. The recent report of enhanced growth of microorganisms in TNA systems is also worrisome.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriologic contamination of intravenous infusion delivery systems in an intensive care unit.

Seventy intensive care unit patients were admitted to a double-blind prospective study to determine the level of contamination associated with the admixture and administration of intravenous solutions and whether intravenous filtersets prevented bacteremia. Patients were randomly assigned a 0.22 micron filterset (real filter) or a filter cartridge without a 0.22 micron membrane (blank filter) on all possible intravenous lines. Forty-six (14.1 percent) real filtersets and 38 (11.3 percent) blank filtersets were found to be contaminated, and overall 30 patients (42.4 percent) were found to have extrinsically contaminated intravenous administration systems at least once during the study. Bacterial adherence to the plastic cartridge was demonstrated to be responsible for culture-positive blank filtersets. Staphylococcus epidermidis was the organism most frequently isolated from real and blank filtersets. Epidemiologic surveillance identified 10 patients with blank filtersets and three patients with real filtersets with clinically significant hospital-acquired bacteremias during the study period. It is concluded that a significant level of extrinsic contamination of intravenous infusion delivery systems occurred on the intensive care unit; documented clinically significant nosocomial bacteremias occurred less often in those patients who had a 0.22 micron bacterial retention filter on all possible intravenous lines.

Selenium deficiency and fatal cardiomyopathy in a patient receiving long-term home parenteral nutrition.

Fatal cardiomyopathy in a patient who received home parenteral nutrition (HPN) for eight years is reported, and the relationship of selenium deficiency to cardiomyopathy and other adverse effects is discussed. A 42-year-old white man with Crohn's disease who was receiving HPN was admitted to the hospital with severe chest pain and dyspnea. During the three days following admission, his symptoms of congestive heart failure and compensated metabolic acidosis persisted despite treatment. On hospital day 6, the patient developed increased ventricular irritability and refractory ventricular fibrillation and died. At autopsy, the heart weighted 500 g, all chambers were dilated, and the myocardium was grossly flabby. Extremely low concentrations of selenium (5-12% of normal) were found in plasma, heart, liver, and kidney tissue samples. The pathological findings in this patient were similar to those in two previously reported cases and strongly suggest that the fatal cardiomyopathy was secondary to selenium deficiency. Selenium is an integral part of the enzyme glutathione peroxidase, which plays an important role in the metabolism of tissues and organs. For metabolically stable patients receiving total parenteral nutrition, the suggested selenious acid dosage is 25-60 micrograms/day for adults and 1.4-30 micrograms/kg/day for pediatric patients. In selenium-depleted adults, a dosage of 100 micrograms/day administered intravenously for 21-31 days has been recommended to reverse symptoms. All HPN patients and hospitalized patients receiving extended parenteral nutrition should be monitored for selenium deficiency and given supplements if necessary.

Early experience with in situ saphenous vein grafts for severe ischemia of the lower extremity.

Based upon this group of 35 patients with a variety of vascular lesions, it would appear that the in situ saphenous vein technique is certainly, at least, a viable alternative to standard bypass techniques. It has been applied with equally encouraging results by several surgeons in a variety of clinical settings, all using the procedure for the first time in a learning phase. This technique may become the procedure of choice for the treatment of occlusive disease of the lower extremity in this difficult and challenging group of patients.