Feeding behaviors during home‐based treatment of moderate acute malnutrition using corn‐soy blends or lipid‐based nutrient supplements

Feeding behaviors have an important impact on children's nutritional status and are essential to consider when implementing nutrition programs. The objective of this study was to explore and compare feeding behaviors related to supplementary feeding with corn‐soy blends (CSB) and lipid‐based nutrient supplements (LNS) based on best practice feeding behaviors. The study was conducted as part of a randomized controlled trial assessing the effectiveness of new formulations of CSB and LNS and comprised 1,546 children from 6 to 23 months. The study included a mixed methods approach using questionnaires, focus group discussions and home visits and interviews with a subsample of 20 caretakers of trial participants. We found that LNS, compared to CSB, were more likely to be mixed into other foods (OR [95% CI] 1.7 [1.3–2.2], p = <.001), served with a meal (OR [95% CI] 1.6 [1.1–2.3], p = <.018)or between meals (OR [95% CI] 1.5 [1.1–1.9], p = <.005), and fed using an encouraging feeding style (mean difference in percentage points [95% CI] 23% [6%:40%], p = .01). CSB were more likely to be fed using a forced feeding style (mean difference in percentage points [95% CI] 18% [3%:33%], p = .02) and were often observed to be served unprepared. The main differences in feeding behaviors between the two diet groups were linked to how and when supplements were served. Educational instructions should therefore be adapted according to the supplement provided; when providing CSB, efforts should be made to promote an encouraging feeding style, and emphasis should be made to ensure preparations are made according to recommendations.     

Knee arthroscopy and arthrotomy under local anesthesia

We report our experience with knee arthroscopy in local anesthesia in 64 patients with subsequent arthrotomy in 14 of these. The effectiveness of the anesthetic method was evaluated by both the patient and the anesthetic personnel. There was no difference in pain assessment between arthroscopy alone and arthroscopy followed by arthrotomy. Half of the patients had no pain and only one regarded the procedure as very painful. Supplementary analgesia with 0.05 mg fentanyl was given to half of the patients not undergoing arthrotomy and to two thirds of those who had arthrotomy. It was not necessary to abandon any arthroscopic or surgical procedure because of pain. We conclude that local anesthesia is a safe and practical method for diagnostic arthroscopy, arthroscopic surgery, and minor arthrotomy.     

Platelet Stain Preventing Factor in Serum or Plasma -An Early Sign of Leiomyosarcoma?

A macromolecular component, platelet stain preventing factor (PSPF), possessing the capacity to prevent staining of platelets in the presence of EDTA, was found in the serum of an apparently healthy person. Two years later, leiomyosarcoma with liver metastases was diagnosed at laparatomy in that particular person. Extract from the patient's leiomyosarcoma exhibited very strong PSPF activity. The observations suggest that PSPF was synthesized in the patient's tumour and that test for PSPF may become a useful tool in early diagnosis of leiomyosarcoma.     

Prognostic Value of Renal Vein Renin Determination in Suspected Renovascular Hypertension

ABSTRACT. Surgical correction of unilateral renal artery stenosis was performed in 31 hypertensive patients. Preoperative renal vein renin ratios (RVRR) before and after dihydralazine stimulation were measured in all patients. Postoperative blood pressures were normal in 12, improved in 17 and unchanged in 2 patients. Six patients did not have renin lateralization, but all were cured or improved after surgery. RVRR was a poor predictor of the results of surgery in patients with unilateral renal artery stenosis.     

Proximal gastric vagotomy in dyspeptic patients without an ulcer

Proximal gastric vagotomy (PGV) was performed in 40 patients who had suffered from dyspepsia for several years, but who did not have any demonstrable ulcer. Great care was taken to obtain a thorough history of the disease. Patients with symptoms not likely to be caused by gastric hypersecretion were not treated surgically. There was a distinctive reduction of both basal and pentagastrin-stimulated acid secretion after the operation. The decrease in acid output was accompanied by a marked relief of symptoms. Most patients noted the improvement within 3 months after surgery. Thirty patients were interviewed after 5 years. Of these, 23 were either completely cured of dyspepsia or were at least much better than before the operation. Only 1 person reported no relief 5 years after PGV. It is concluded that surgical treatment may be of value in patients with chronic dyspepsia even in the absence of a peptic ulcer.

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Resumen La vagotomía gástrica proximal fué realizada en 40 pacientes que sufrían de dispepsia por varios años, pero quienes no poseían úlcera gástrica demostrable. Se prestó especial cuidado a la obtención de una meticulosa historia de la enfermedad. Aquellos pacientes con síntomas que posiblemente no eran causados por hipersecreción gástrica no fueron sometidos a tratamiento quirúrgico. La operación produjo una clara reductión tanto de la secreción ácida basai como de la secreción en respuesta a la estimulación con pentagastrina, y la disminución de la secreción ácida se acompa¯nó de marcada mejoría de los síntomas. La mayoría de los pacientes notó mejoría dentro de los primeros tres meses después de la cirugía. Treinta pacientes fueron entrevistados después de cinco años de la operación, y de éstos, 23 se hallaron completamente curados de la dispepsia, o por lo menos mucho mejor que antes de la cirugía; sólo una persona informó que no había mejoría 5 años después de la vagotomía gástrica proximal. Se concluye que el tratamiento quirúrgico puede tener valor en pacientes con dispepsia crónica aún en ausencia de úlcera péptica.

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Résumé Une vagotomie hypersélective a été practiquée chez 40 malades qui présentaient un état dyspeptique depuis plusieurs années mais qui n'étaient pas atteints d'ulcère duodénal. Leur histoire pathologique fut étudiée avec grand soin et les sujets qui n'accusaient pas de troubles identiques à ceux provoqués par l'hypersécrétion gastrique ne furent pas traités chirurgicalement.Apres l'intervention il fut possible de constater une réduction de la secrétion basale et de la secrétion stimulée par la Pentagastrine. La diminution de la secrétion acide s'accompagna d'une amélioration marquée des symptômes accusés antérieurement par les patients, 3 mois après l'intervention.Trente malades ont été revus 5 ans après avoir été opérés. Parmi eux 23 se considéraient comme guéris ou très améliorés. Un seul accusait le même état dyspeptique qu'avant l'opération.On peut conclure de ces faits que la vagotomie hypersélective est susceptible de contrôler les troubles dyspeptiques qui existent en l'absence d'ulcère.

     

Comparison of dysprosium DTPA BMA and superparamagnetic iron oxide particles as susceptibility contrast agents for perfusion imaging of regional cerebral ischemia in the rat

The aim of the study was to compare the first-passage profiles of dysprosium diethylenetriamine penta-acetic acid bis(methylamide) (DTPA BMA) and the superparamagnetic iron oxide particles NSR 0430 in regions with severe and moderate cerebral ischemia. In seven rats subjected to middle cerebral artery occlusion, two dynamic MR perfusion imaging series were acquired after intravenous bolus injections of .5 mmol/kg dysprosium DTPA BMA and .06 mmolFe/kg iron oxide particles, respectively. The doses were chosen to obtain similar maximum signal change in normally perfused brain. The first-passage profiles were compared in a region of interest (ROI) in the core area with severe ischemia and in a ROI in the penumbra area of moderate ischemia. The results were compared both as the calculated mean signal intensity versus time curves for all seven rats and statistically for an estimated mean transit time (MTT) after gamma variate fitting of the calculated concentration versus time curves. The first-passage profiles for the two contrast agents were similar, both in the core area of severe ischemia and in the penumbra area of moderate ischemia. In this rat stroke model, dysprosium DTPA BMA and the superparamagnetic iron oxide particles NSR 0430 were found to be equally efficacious for the diagnosis of the perfusion deficit, but if safe for human investigations, iron oxide particles would have an advantage as equal susceptibility effect may be achieved with smaller injection volumes.     

Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus

Infraclavicular techniques are often used to perform brachial plexus blocks. In our volunteer study we used magnetic resonance imaging to identify the brachial plexus and axillary vessels in a sagittal plane corresponding to the lateral sagittal infraclavicular block. In 20 volunteers, all cords were positioned within 2 cm from the artery approximately within 2/3 of a circle. We derived an injection site that was closest to all cords, cranio-posterior and adjacent to the axillary artery. We conclude that this knowledge may be useful for the performance of infraclavicular blocks aided by ultrasound. However, our proposals should be tested by clinical studies.