Reducing bacterial contamination of enteral feeds

OBJECTIVE: It has previously been shown that microbial contamination of enteral feeds given to children in hospital and at home is common. This study therefore examined the effects of improvements in the enteral feeding protocol, coupled with an intensive staff training programme, on bacterial contamination. METHODS: The enteral feeding protocol was modified by: priming the feeding set on an alcohol treated metal tray, spraying the bottle opener and top with 70% alcohol, wearing non-sterile disposable gloves, and filling the feeding reservoir with feed for up to 24 hours' use rather than only four hours. Daily feeds samples were collected from 16 inpatients and home patients on enteral nutrition at the start and end of feeding. Seventy seven samples were cultured. Results were compared with previously published control data. RESULTS: Enteral feed contamination rates were reduced significantly from 62% to 6% of feeds given at home (p < 0.001), and from 45% to 4% of feeds given in hospital (p < 0.001). CONCLUSIONS: This study highlights the importance of using an appropriate enteral feeding protocol, and of regular staff training in reducing contamination rates of enteral feeds to an acceptable level.     

Collision metastasis of prostatic and colonic adenocarcinoma: report of 2 cases

Collision metastases of carcinomas in lymph nodes are rare. Carcinoma metastasizing to lymph nodes containing malignant lymphoma has also been reported. The literature contains 3 cases of collision metastasis of prostatic and urothelial carcinoma. To our knowledge, we report the first 2 cases of collision metastasis of prostatic and colonic adenocarcinoma, one involving a mesenteric lymph node and the other involving a perirectal lymph node, both from resections for colonic adenocarcinoma in patients with known metastatic prostatic carcinoma.     

Immunolocalization and heart levels of GRP94 in the mouse during post-implantation development

 Glucose-regulated proteins (GRPs), which belong to the highly conserved family of stress proteins, are resident to the endoplasmic reticulum and function as molecular chaperones. Heat shock proteins have been shown to be developmentally regulated, but little work has been done to investigate the expression of GRPs during embryogenesis. Therefore, this study examined the distribution of GRP94 within mouse embryos during the period of organogenesis and characterized levels of GRP94 within the developing heart during organogenesis and late fetal stages. Our results demonstrate that the GRP94 protein is constitutively expressed within mouse embryos during early stages of organogenesis and is localized particularly within the developing heart, neuroepithelium, and surface ectoderm tissues. Positive staining for GRP94 remains within developing heart tissues throughout organogenesis and is found primarily within the atrial and ventricular myocardial cells. Western blot analysis of GRP94 expression demonstrates a significantly higher level of GRP94 in embryonic hearts during early stages of organogenesis than in later stages of organogenesis or the fetal period. These results demonstrate that the stress protein GRP94 is constitutively expressed within specific tissues during post-implantation mouse development and suggest that GRPs may play an important role in the process of myocardial cell differentiation and heart development. Accepted: 9 June 1997     

Glucose-regulated protein 78 (GRP78) is elevated in embryonic mouse heart and induced following hypoglycemic stress

This study investigates the distribution and heart levels of glucose regulated protein (GRP) 78 during normal development and in response to hypoglycemia in the mouse. Results demonstrate that GRP78 is strongly expressed with in the heart, neural tube, gut endoderm, somites, and surface ectoderm of mouse embryos during early organogenesis, and GRP78 staining remains prominent in the heart from gestational days 9.5 through 13.5. Cardiac myocytes are the primary site of GRP78 expression within the heart. GRP78 levels are highest in the heart during early organogenesis and levels decrease significantly by the fetal period. GRP78 expression is increased after 24 h of hypoglycemia in the early organogenesis-stage heart. Considering the tissue specific pattern of GRP expression and changes during development of the heart, GRPs may play significant roles in the normal differentiation and development of cardiac tissue. GRP induction may also be involved in hypoglycemia-induced cardiac dysmorphogenesis. Accepted: 25 January 2000     

Sources of error in measurement of children's blood pressure in a large epidemiologic study: Bogalusa Heart Study

Accurate and reliable measurement of blood pressure is essential in the determination of early hypertensive disease. Multiple blood pressure measures were determined by well trained field observers on a large number of children representing a total pediatric community. Changes in children's blood pressure levels with multiple measurements, as well as differences between field observers, were examined. A random effects analysis of variance model was used to determine specific contributors to blood pressure variability in an epidemiologic survey of children. Observer differences were found to be the largest preventable contributor to blood pressure variation. In addition, systolic blood pressure levels decreased approx. 2.5 mmHg from the first to the third blood pressure station. More than 86% of systolic blood pressure readings and 90% of diastolic blood pressure readings by two different observers on the same child were within 15 mmHg. These data emphasize the importance of both adequate training of field observers and the use of replicate blood pressure measurements by multiple observers to determine blood pressure levels accurately in an epidemiologic survey.     

Elevated short chain fatty acid concentrations in anaerobic small bowel contamination

Viable bacteria were identified and counted, and short chain fatty acid concentrations measured in small intestinal fluid from 74 fasting children. In nine children with anaerobic small bowel contamination, individual and total short chain fatty acid concentrations were significantly higher than the remainder of the group (p less than 0.01). Using 100 mumol/l as the upper reference limit for total short chain fatty acid concentration, the sensitivity and specificity as a test for anaerobic small bowel contamination was 89% and 98%, respectively. Measuring luminal short chain fatty acid concentrations in proximal small intestinal fluid is an accurate method for detecting anaerobic small bowel contamination in children.     

Prevention of anaemia in inner city toddlers by an iron supplemented cows' milk formula

There are few data to support the use of follow-on formulas in infants from the age of 6 months. In a prospective trial in a deprived inner city area of Birmingham 100 infants who were already receiving pasteurised cows' milk by 6 months of age were enrolled and randomised either to receive a follow-on formula or to continue on cows' milk from 6 months until 18 months. At 18 months of age the follow-on formula group returned to cows' milk and both groups were followed up until 24 months. Iron status, growth, and nutritional status were analysed at intervals of six months. At enrollment, no differences in haematological status were evident. However, by 12 months of age, 31% of the cows' milk group were anaemic (haemoglobin concentration < 110 g/l) compared with only 3% of those receiving follow-on formulas. At 18 months, 33% of the cows' milk group were anaemic compared with only 2% of the follow-on formula group and by 24 months of age none of the follow-on formula group was anaemic, whereas 26% in the cows' milk group still had a haemoglobin of < 110 g/l. Mean corpuscular volume was significantly smaller and ferritin significantly lower in the cows' milk group at 12, 18, and 24 months. Dietary iron intake was higher in the follow-on formula group at 12 and 18 months but not at 24 months, when both groups were back on cows' milk. Infants and toddlers at high risk of iron deficiency are therefore unlikely to become anaemic if receiving a follow-on formula, although the relative merits of follow-on formula compared with an ordinary infant formula remain uncertain.     

Teratogenic effects of tolbutamide on early-somite mouse embryos in vitro.

The present study investigated the teratogenicity of the oral hypoglycemic agent, tolbutamide, using an in vitro approach, and evaluated the role of its main metabolic effect, hypoglycemia. Teratogenesis was evaluated by culturing early-somite mouse embryos for 24 h in serum from rats treated with tolbutamide (79-117 micrograms/ml) or normal rat serum supplemented with tolbutamide (110-152 micrograms/ml). Tolbutamide-treated serum was then supplemented with glucose to control for potential effects of hypoglycemia. Mouse embryos demonstrated high malformation rates following exposure to serum from tolbutamide-treated rats (79%) or normal rat serum supplemented with tolbutamide (85%) compared with controls (4%), and defects included cardiac, ocular, neural tube, and somite abnormalities. Overall growth was reduced in treated embryos and yolk sacs, as determined by total protein contents. Embryonic growth and malformation rates were not improved by glucose supplementation of hypoglycemic tolbutamide-treated serum. Thus, tolbutamide produces malformation in mouse embryos in vitro at concentrations comparable to those in human serum, and the effects do not appear to be mediated by hypoglycemia. The potential risk of tolbutamide on the developing embryo must be considered in the therapy of pregnant diabetic patients.