Delayed superficialization of brachiobasilic fistula: technique and initial experience

HYPOTHESIS: Angioaccess procedures for dialysis have varied patency rates with frequent need for intervention. A superficialized arteriovenous brachiobasilic fistula created as a 2-step procedure will have good long-term patency with minimal complication. DESIGN: Retrospective medical record review and patient interview. SETTING: Tertiary referral university hospital. PATIENTS: Twelve patients who underwent delayed superficialization of brachiobasilic fistula from September 1994 to April 2000. MAIN OUTCOME MEASURES: Patency of fistula for dialysis, and major and minor complications, including revisions. RESULTS: Delayed superficialization of brachiobasilic fistula was performed in 12 patients. Fistulas have been used for a mean duration of 22.4 months (range, 10-59 months). Two patients required alternate access owing to thrombosis of brachiobasilic fistula. CONCLUSIONS: The delayed superficialized brachiobasilic arteriovenous fistula has a good initial patency rate with minimal complications. It should be considered early in patients if radiocephalic fistula is unavailable.     

Breast milk supplementation for preterm infants: parental preferences and postdischarge lactation duration

Breast milk supplementation is frequently used to improve preterm infant growth and to achieve satisfactory intakes of minerals and vitamins. In the North American market there are commercial preparations: two powders and a liquid. The nutritional data available suggest these products are similar and their utilization is based on healthcare team choice. Parental perception about supplementation has not been previously evaluated although parental attitudes are known to impact on lactation success. The objectives of this paper are to determine parental preference and breastfeeding duration for very-low-birth-weight infants given commercial breast milk enrichment products. The study design is a randomized clinical trial with parental interviews. Sixty-three families with 71 infants were enrolled. Parents expressed their preference for the addition of a powder over a liquid preparation (p<0.01). Those mothers whose infants received the liquid enrichment had a shorter lactation relative to their goal, compared with the mothers of the infants who received the powder (p = 0.017). Parents prefer a powder product for breast milk supplementation and this choice positively impacts on the duration of breastfeeding for very-low-birth-weight infants.     

Whole body protein metabolism in children with cancer

Whole body protein synthesis and catabolism were measured using the [ring-2H5]phenylalanine and [1-13C]leucine primed constant infusion technique in 32 paediatric patients with cancer at different stages of treatment. Rates of synthesis (S) and catabolism (C) derived from the [ring-2H5]phenylalanine and [1-13C]leucine models were 4.7 (SD 1.3) (S) and 6.0 (1.5) (C) g/d/kg, and 5.5 (0.8) (S) and 6.8 (1.2) (C) g/d/kg, respectively. These results show that these two tracer techniques give similar results in this study population. Comparison of these values with results previously reported for groups of control children using the [ring-2H5]phenylalanine model (S = 3.69 and 3.93; C = 4.09 and 4.28 g/d/kg) and the [1-13C]leucine model (S = 4.32; C = 4.85 g/d/kg) show that rates of synthesis and catabolism were higher in cancer patients than in controls. Thus whole body protein turnover is increased in children under treatment for cancer. Other indices of metabolism such as plasma amino acids and intermediary metabolites were also measured and showed that, although subjects were in isotopic steady state, there were significant metabolic changes during the course of the primed constant infusions used to measure protein turnover.     

A Histopathologic Review of Temporal Bone Exostoses and Osteomata

It is widely accepted that external auditory canal exostoses and osteomata are separate clinical entities that differ in their gross appearance. Disagreement still exists as to whether external auditory canal exostoses and osteomata should be considered similar or separate histopathologic entities. A chart review was performed of all patients who had external auditory canal exostoses or temporal bone osteomata excised from January 1991 to November 1994 at St. Vincent's Hospital, Sydney. A histologic examination was undertaken with a blind study method of the patients whose pathological specimens were suitable for assessment. Eight exostoses and five osteomata were available for examination. The results of this study demonstrate that exostoses and osteomata of the external auditory canal cannot be reliably differentiated by routine histopathological examination. Laryngoscope, 106:624-628, 1996     

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.     

PAROXYSMAL TACHYCARDIA IN INFANCY AND CHILDHOOD I. Paroxysmal Supraventricular Tachycardia

A 1 to 30 year follow-up study of 54 infants and children with paroxysmal supraventricular tachycardia is presented. In 28 cases the first attack occurred in infancy, and in 18 of these already in the first months of life. Nine patients had organic heart disease. The WPW syndrome was diagnosed in 30 cases. When first seen, most of the infants presented signs of incipient or manifest congestive heart failure, which was very unusual in the children, most of whom had only minor symptoms. Four children had experienced brief syncopes during attacks. Digitalis was effective against congestive heart failure and, when continued, may have prevented failure during subsequent attacks. Whether digitalis and other anti-arrhythmic agents facilitated conversion to sinus rhythm could not be established in this study. Vagal stimulation was only rarely effective. Preventive treatment with digitalis or other antiarrhythmic drugs seemed to have little if any effect on the frequency of recurrent attacks. Out of 23 infants who were followed for at least 5 years, 17 had been free from attacks during the last 3 years and 13 of these had had their last attack before the age of 6 months. Out of 23 children followed for 5 years or more, only 3 had been free from recurrences during the last 3 years. Patients with the WPW-syndrome had a somewhat higher incidence of recurrent attacks.     

Prognostic factors following enucleation of 111 uveal melanomas.

Follow up information was retrieved on 111 patients who underwent enucleation for uveal melanoma between 1964 and 1987, allowing a minimum postoperative period of 5 years. Univariate survival analysis was carried out using Kaplan-Meier curves and the differences between the curves were analysed with the Mantel-Cox test. Multivariate analysis used the Cox proportional hazards model. Univariate analysis isolated each of the following as significant prognosticators: largest tumour diameter (LTD) (p < 0.002), presence of epithelioid cells (p < 0.03), and glaucoma (p < 0.001). A combination of cell type, glaucoma, and LTD (p < 0.0001) had strong and independent prognostic significance in multivariate analysis. The results of this series are compared with previous studies and the value of cell type information and new quantitative parameters is discussed.