Verapamil and norverapamil in plasma and breast milk during breast feeding

Summary The concentrations of verapamil and norverapamil have been measured in milk and plasma samples from a 32year-old woman treated with verapamil 80 mg tds while breast-feeding her child.The average steady-state concentrations of verapamil and norverapamil in milk were, respectively, 60% and 16% of the concentrations in plasma.The breast-fed child received less than 0.01% of the dose of verapamil given to the mother. No verapamil or norverapamil (<1 ng/ml) could be detected in the plasma from the child.     

A patient with postoperative mercury contamination of the peritoneum

CASE REPORT: Peritoneal exposure to mercury has been rarely reported and long-term consequences of this type of exposure have not been documented. We report the clinical course of a patient who has survived almost eight years with a massive intraperitoneal load of mercury. She has suffered formication, pruritis, fatigue, irritiability, insomnia, alopecia, dizziness, a gait disturbance, loss of balance and multiple falls, abdominal pain, choking, and headaches. Two courses of chelation with dimercaptosuccinic acid using the standard protocol were undertaken, resulting in increased daily excretion, but without demonstrable objective or subjective benefit or lasting effect. She had multiple medical problems before the mercury intoxication, which complicates the attribution of all her problems to mercury intoxication. It is of particular interest that the patient survived and did not suffer any marked cognitive deterioration. She died in 2002 shortly after being diagnosed with lung cancer and declaring that she would fight it. Phasing out of mercury-weighted tubes is recommended.     

Olanzapine treatment during breast feeding: a case report

Postpartum psychosis constitutes a severe complication that entails risk for both mother and child. Little is known about the use of olanzapine in the treatment of postpartum psychosis. In previous studies, it has been reported on mothers receiving relatively low doses of olanzapine. We report a 38-year-old patient who was admitted to the hospital for an acute psychotic exacerbation. She was breast feeding her 5-month-old child, and she wished to continue breast feeding. Olanzapine treatment was started with a daily dosage of 15 mg. The weight-corrected maternal dose was 270 mug/kg. The olanzapine concentration in the mother's plasma was 24 ng/mL. The analysis of olanzapine in breast milk applying two different high-performance liquid chromatography procedures revealed similar results: 12.2 ng/g without and 11.5 ng/g with additional hydrochloric acid extraction, respectively. In addition, breast milk of an unmedicated mother was used for establishing the analytical procedure so that the validity of the results was better confirmed. The milk-plasma ratio arising from our data was 0.5, and the relative infant dose was 0.3%. The olanzapine concentration was below the limit of detection (<5 ng/mL) in the infant's plasma sample. No adverse effects were noticed, and the mother experienced a rapid improvement in her psychopathology during her hospital stay. In future studies, long-term follow-up of both mother and child would be useful.     

Evaluation of mercury contamination in Smilax myosotiflora herbal preparations

The DCA (Drug Control Authority) of Malaysia implemented phase 3 registration of traditional medicines in January 1992 with special emphasis on the quality, efficacy, and safety of all dosage forms of these medicines. For this reason, a total of 100 herbal products containing Smilax myosotiflora were purchased in the Malaysian market and analyzed for mercury content, as mercury is a recognized reproductive toxicant. The products were analyzed using cold vapor atomic absorption spectrophotometry. It was found that 89% of the above products do not exceed 0.5 ppm of mercury. Heavy metal poisoning such as mercury has been associated with traditional medicines. Therefore, it is important that doctors and health care practitioners are aware of these risks and finding ways to minimize them, including questions pertaining to the use of these remedies during the routine taking of a patient's history.     

Should the presence of carcinogens in breast milk discourage breast feeding?

Pollutant chemicals are commonly found in human milk at levels that would prevent its sale as a commercial food for infants. The chemicals found most commonly are dichlorodiphenyl-dichloroethene, polychlorinated biphenyls, dieldrin, chlordane, heptachlor, and polychlorinated dibenzodioxins. In general, the regulatory levels for these chemicals have been set to prevent cancer in adult humans from lifetime exposure. We compared lives saved in the postneonatal period by breast feeding to the estimated excess cancer deaths attributable to the contaminants in breast milk. The results of this analysis suggest that only extreme levels of contaminants in breast milk represent more of a hazard than failure to breast feed, but clinical considerations in individual cases might override this conclusion. Our analysis depends on assumptions about how the chemicals might cause cancer in humans and on whether breast feeding prevents some postneonatal mortality. Noncarcinogenic hazards from chemical exposure, other hazards from breast feeding such as transmission of viruses, and benefits of breast feeding other than reduction in mortality were not considered.     

广东省汕头市社区婴儿母乳喂养的现状调查

目的 调查汕头市社区婴儿母乳喂养的现状。方法 在汕头市金平、龙湖、濠江、潮阳、潮南5个社区中，每社区抽取200名10个月至2岁婴儿母亲．共1000名进行问卷调查，她们的年龄分布为19～43岁。结果 调查显示，93．25％母亲认为母乳喂养最好，4个月纯母乳喂养率为62．4％，婴儿4个月内开始添加辅食的占37．6％，并且随着月龄增加，添加辅食率及数量逐步增加。结论 母乳喂养好的知晓率较高，4个月纯母乳喂养率相对较低，其中有很多因素影响着母乳喂养。     

An investigation of enhanced mercury bioaccumulation in fish from offshore feeding

We investigated the dietary pathways of mercury transfer in the food web of Morency Lake (Canada) to determine the influence of carbon source and habitat use on mercury bioaccumulation in fish. Whole-body concentrations of methylmercury (MeHg) were significantly different in four fish species (white sucker, brown bullhead, pumpkinseed and smallmouth bass) and increased with both trophic position and greater feeding on offshore (versus littoral) carbon. An examination of fish gut contents and the depth distribution of invertebrates in Morency Lake showed that smallmouth bass and brown bullhead were supplementing their littoral diet with the consumption of either opossum shrimp (Mysis diluviana) or profundal amphipods in offshore waters. The zooplanktivore Mysis had significantly higher MeHg concentrations than zooplankton and benthic invertebrates, and it was an elevated source of MeHg to smallmouth bass. In contrast, profundal amphipods consumed by brown bullhead did not have higher MeHg concentrations than littoral amphipods. Instead, partitioning of benthic invertebrate resources likely explains the greater MeHg bioaccumulation in brown bullhead, associated with offshore feeding of amphipods. White sucker and brown bullhead had a similar trophic position but white sucker consumed more chironomids, which had one-third the MeHg concentration of amphipods. Our findings suggest that offshore feeding in a lake can affect fish MeHg bioaccumulation via two different processes: (1) the consumption of MeHg-enriched pelagic prey, or (2) resource partitioning of benthic primary consumers with different MeHg concentrations. These observations on the mechanisms of habitat-specific bioaccumulation highlight the complexity of MeHg transfer through lake food webs.     

Bacterial contamination of expressed breast milk.

In a study of breast milk collected into sterile bottles rinsed in 1% hypochlorite solution the hypochlorite solution adherent to the sides of the bottles apparently caused a large reduction in bacterial contamination of the milk after storage at 4 degrees C for up to four hours. Heating expressed breast milk at 62.5 degrees C for five minutes destroyed over 90% of the Escherichia coli, Staphylococcus aureus, and group B beta-haemolytic streptococci inoculated into the milk samples. Rinsing collecting bottles with hypochlorite solution may be valuable in collecting milk with a low bacterial content for human-milk banks. Furthermore, the currently accepted pasteurisation time of 30 minutes may be excessive.     

针对性干预在母乳喂养宣教中的作用探讨

目的：利用护理干预,针对性的进行母乳喂养宣教,以提高母乳喂养率,建立稳定的家庭支持系统。方法：将100例产妇分为对照组和干预组,分别采用常规的宣教方法和针对性干预的宣教方法,然后进行统计学分析。结果：干预组宣教效果明显优于对照组,两组数据比较,差异有统计学意义（P=0.01837）。结论：针对性干预在母乳喂养宣教中的作用是明显的,可以在一定程度上建立母乳喂养较稳定的家庭支持系统,较好地提高母乳喂养率。     

母乳喂养指导路径对产妇泌乳时间、泌乳量及母乳喂养成功率的影响分析

目的：探讨母乳喂养指导路径对产妇泌乳时间、泌乳量及母乳喂养成功率的影响,为产妇提供更优质的护理服务。方法选取本院产科于2011年6月～2012年5月收治的144例初产妇,设为对照组,采取常规产科护理方法与措施;选取本院产科于2012年6月~2013年5月128例初产妇,设为研究组,在对照组基础上采用母乳喂养指导路径指导母乳喂养。观察并比较两组产妇的泌乳时间、泌乳量及母乳喂养成功率。结果观察组产妇的泌乳始动时间短于对照组（P＜0.05）,观察组的产后1周泌乳量明显多于对照组（P＜0.05）,观察组的产后6个月母乳喂养成功率明显高于对照组（P＜0.05）。结论对产妇行母乳喂养指导路径的效果明显,可促进产妇早期泌乳,增加产后泌乳量,并帮助产妇树立母乳喂养的信心,提高产后6个月内的母乳喂养成功率,有利于保证产妇及婴儿的身心健康。     

Accumulation and tissue distribution of mercury in the guinea pig during subacute administration of methyl mercury

Female guinea pigs were dosed po daily for 71 days with 0.4, 4, 40, or 400 μg Hg/kg given as radiolabeled methyl mercuric chloride. The accumulation of total mercury was followed in 10 tissues at 6 time intervals. After dosing ceased, the decay profiles of mercury were followed for an additional 35 days. The accumulation pattern for mercury was similar for each dose level, and the tissue mercury concentration on day 71 increased in the following order: blood < cerebellum < hypothalamus < calcarine cortex < frontal lobe < occipital lobe < caudate nucleus < muscle < liver < kidney. Mercury accumulation in all tissues, except kidney at the 4-, 40-, and 400-μg/kg dose levels, approached steady-state values in the 35–71 -day dosing period. The accumulation curves could be fitted by an exponential equation incorporating the mercury half-life obtained from the decay profiles. As the dose level increased, tissue mercury concentrations increased to a greater extent than anticipated. Although doses increased 1000-fold from 0.4 to 400 μg Hg/kg, kidney concentrations increased 3300-fold after 71 days of dosing. At this time, inorganic mercury (Hg²⁺) comprised 42% of the total kidney mercury and 5% of the total liver mercury at the 400 μg/kg dose.Clinical signs of methyl mercury intoxication were induced in guinea pigs after dosing daily for 9 days at 5 mg Hg/kg. The activities of 6 enzymes were monitored and cholinesterase (serum), choline acetylase (caudate nucleus) and carboxylesterase (liver) were significantly lower than control values. The total mercury concentration in whole brain was 28 μg/g (wet weight). Animals dosed at 400 μg Hg/kg for 71 days showed no decrease in the activities of the selected enzymes, there was no change in weight gain when compared to the control and there were no signs of methyl mercury toxicity. The highest brain mercury concentration after 71 days dosing was 11 μg/g (wet weight) in the caudate nucleus.     

The corticosterone stress response and mercury contamination in free-living tree swallows, Tachycineta bicolor

We determined mercury concentrations in tree swallows, Tachycineta bicolor, from Massachusetts and Maine with different levels of contamination. Baseline and stress-induced plasma corticosterone concentrations from adults and nestlings (Massachusetts only) were compared with mercury concentrations. In Massachusetts, adult baseline corticosterone was negatively correlated with blood mercury, but showed a nearly-significant positive correlation with feather mercury. There was a negative relationship between baseline corticosterone and blood mercury in nestlings and between baseline corticosterone and egg mercury. There was no relationship between mercury and stress-induced corticosterone in any of the groups, or with baseline corticosterone in Maine sites where mercury levels were lower. The findings suggest blood and egg mercury may be a better indicator of current condition than feather mercury. Further, mercury contamination may not alter stress-induced corticosterone concentrations in tree swallows but appears to have a significant impact on baseline circulating corticosterone.     

756例产妇母乳喂养认知调查及干预

目的探讨产妇对母乳喂养的认知状况,并探讨干预方法及效果。方法选取2014年1月~2015年1月我院756例产妇,采用问卷调查形式了解产妇对母乳喂养的认知情况,并提出针对性的干预对策。结果本组756例产妇的平均认知得分为(9.3±1.4)分,产妇对初乳认知、母乳喂养优势、早吸吮好处、按需哺乳、正确哺乳姿势、促乳汁分泌方式、母乳保存、乳房胀痛预防、母乳喂养标准、婴儿大便判断等认知均存在不足,完全认知率均不足35.0%;影响母乳喂养的主要心理为担心乳汁不足无法满足婴儿需求、缺乏母乳喂养信心、通过广告认为配方奶粉营养好,分别占52.4%、41.3%和25.7%;干预前产妇的平均认知得分为(9.3±1.4)分,干预后上升为(16.7±1.9)分,显著高于干预前,差异具有统计学意义(P0.05)。结论部分产妇存在母乳喂养认知不足的现象,应当针对导致产妇母乳喂养不足的因素进行护理干预,全面提高产妇对母乳喂养的认知,促进优生优育,提高人口素质。     

The extent of breast feeding in Dunedin 1974-83

This study examined breast feeding practices in Dunedin, and aimed to identify determinants of breast feeding in this population. Infants' records were used for a 10 year period (1974-83) from the Royal New Zealand Plunket Society. An upward trend in breast feeding prevalence was observed. Breast feeding was more common in mothers of high socioeconomic status (p less than 0.001), in those who were living with a spouse (p less than 0.001) and when mothers attended parental classes (p less than 0.025). First time mothers tended to breast feed for a shorter time (p less than 0.05). Early introduction of other foods shortened the duration of breast feeding (p less than 0.001). The increase in breast feeding which has occurred in many parts of the western world was also found in Dunedin.