Bacterial growth in refrigerated human milk

Unprocessed breast milk is currently being used as a desirable feeding alternative for premature infants. To assess some of the potential risks of this practice, we studied the bacterial growth in 41 samples of unprocessed human milk for a period of five days. No bacteria were cultured in eight samples of milk; the bacteria that were cultured in the remaining 33 samples were similar to those found on the skin and nipple of the breast. With the exception of three samples, two with Klebsiella and one with Pseudomonas, all identified bacteria have been reported as normal skin flora. The initial concentration of bacteria found in milk was low, with a mean of 10,000 colonies (range, 1000 to 140,000 colonies). Bacterial colony counts progressively decreased throughout the five-day refrigeration period.     

Acyclovir resistant varicella zoster and HIV infection

A child infected with HIV who developed chronic varicella zoster virus infection resistant to acyclovir is presented. The clinical course of the infection, treatment, virological investigations, and relationship of the infection to the child's immunodeficient state are discussed.     

Toledo type brachyolmia

Brachyolmia is a form of spondylodysplasia that has not to the authors' knowledge been described in the UK. It may be a cause of short stature that is currently unrecognised. A case of an 11 year old boy with clinical, radiographic, and eye findings consistent with Toledo type brachyolmia is reported.     

Cortical bone metastases

The data on 26 patients with solitary metastatic lesions arising in cortical bone were studied. Nineteen patients were over 50 years of age. In 19 patients, the cortical metastasis was the first indication of the presence of a primary malignant condition. In seven cases, cortical metastases developed in patients with a known primary tumor. The primary tumors involved were eight renal cell carcinomas, six bronchogenic carcinomas, two carcinomas of the gastrointestinal tract, one osteosarcoma, one neuroblastoma, one melanoma, one hepatoma, one carcinoma of the breast, and one thyroid carcinoma. In four cases, the primary tumor remained unknown. A metastatic origin should be considered in the differential diagnosis of an osteolytic lesion arising in the cortex of a long bone, especially in older patients and in patients with a known primary malignant condition. The cortical bone metastases encountered in this study did not originate solely from bronchogenic carcinoma, as has been reported by other authors. Cortical metastases are probably less rare than has been hitherto assumed.     

Direct argon laser exposure for recanalization of peripheral arteries: early results

Direct laser light, in combination with percutaneous transluminal angioplasty (PTA), was used to recanalize atherosclerotic peripheral arteries. Argon laser energy was controlled with an optical assembly and aligned with a special centering/dilation balloon so that plaque tissue absorbed laser energy directly and was vaporized. A channel was thereby created with multiple 10-W laser exposures (2-10 seconds), and conventional angioplasty was then performed. Recanalization was achieved in 33 of 36 procedures (92%), in 23 femoropopliteal (mean length, 9 cm) and three iliac total occlusions and ten femoropopliteal high-grade stenoses, with the three failures occurring in the first group. Complications included two emboli, six moderate groin hematomas, and one laser perforation. While these results are preliminary (mean follow-up, 3 months), direct laser angioplasty appears to be a useful adjunct to PTA for treating atherosclerotic arteries.     

Infant feeding: formula, solids

This article discusses and evaluates current formulas, traces their continual improvement (based largely on new information on breast milk composition), and then discusses the question of supplemental feedings.     

Duplex carotid sonography: criteria for stenosis, accuracy, and pitfalls

Both carotid bifurcations were examined in 353 patients over a 20-month interval using a combination of real-time and pulsed Doppler ultrasound (duplex scanning). Angiographic correlation was available in 72 cases. Stenosis of the internal carotid was evaluated using a Doppler input frequency of 5 MHz and a scan angle of 60 degrees. A peak frequency shift of less than 3.5 kHz was found to be a sign of less than or equal to 30% stenosis; 3.5-4 kHz with moderate turbulence suggested 31-50% stenosis, 4-8 kHz 51-90% stenosis, and greater than 8 kHz greater than 90% stenosis. Subtotal stenosis (greater than 95%) was manifested by a frequency shift of less than 8 kHz, but the waveform was totally distorted. Overall accuracy improved from 77% for the first 6 months to 87% for the last 14 months. For stenosis greater than 50%, sensitivity improved from 82% to 97% during this period. Analysis of errors and suggestions for avoiding them are presented.     

Intracranial calcification in the infant and neonate: evaluation by sonography and CT

This study reports the sonographic and computed tomography (CT) findings in seven infants and neonates with intracranial calcifications and a spectrum of underlying disorders, including toxoplasmosis, cytomegalic inclusion disease, transverse/straight sinus thrombosis, and probable anoxia. Neurotropic infectious disease usually produced clumped or subependymal calcifications accompanied by sometimes bizarre ventricular configurations and prominent periventricular cystic encephalomalacia. Sonography failed to identify prospectively intracranial calcifications in two of the three patients without infection, although calcifications were visible in retrospect. Overall, CT provided optimum visualization of intracranial calcifications.