Spontaneous transpyloric passage and performance of 'fine bore' polyurethane feeding tubes: a controlled clinical trial

Certain groups of patients requiring enteral nutritional support are at increased risk of regurgitation and pulmonary aspiration of feed. Positioning of enteral feeding tubes distal to the pylorus has been advocated as a method of reducing such complications. Various techniques have been suggested to achieve postpyloric siting. Reports have indicated that lengthening the tube or altering the distal end tip configuration, by varying the tip profile or by the addition of a weight, may facilitate spontaneous transpyloric passage of the tube. This prospective controlled clinical study using three new polyurethane tubes demonstrates that the frequency of spontaneous transpyloric passage of the tube is not affected by tip profile or by the addition of a weight. Indeed, with all three tube designs only about one-third had passed spontaneously through the pylorus at 24 hr. Once through the pylorus the unweighted tube stayed in position significantly longer than the weighted tubes (p less than 0.005). We suggest that in those patients requiring post-pyloric feeding, endoscopic or fluoroscopic techniques should be used to position the tubes at the time of insertion, and that an unweighted tube should be used to prolong tube usage.     

Non-A,Non-B hepatitis; Factors involved in progression to chronicity

A cross-sectional, longitudinal study was undertaken on a group of acute non-A, non-B hepatitis patients, as well as on a control group of hepatitis B patients, in order to assess both the prevalence of the most important factors favoring infection, and the relevance of these factors in promoting evolution towards chronic liver disease. Exposures to unknown risk factors were present in 47.4% of acute non-A, non-B infections, followed by blood transfusions (17.9%), sporadic exposures (17.9%) and drug addiction (16.6%). Unknown as well as sporadic exposures showed a greater prevalence in control population if compared to non-A, non-B cases, while drug addiction was equally represented in the two groups, and blood transfusion nearly absent from control group. The risk of evolution to chronic liver disease was about 13 times greater in non-A, non-B group than in controls, with the greatest risk for drug addicts and the lowest for patients with unknown exposures. Among patients with known exposures, the lowest risk of chronic hepatitis was observed in post-transfusion and in sporadic cases, while the greatest was observed in drug addicts.Corresponding author.     

Sensitization to green coffee bean (GCB) and castor bean (CB) allergens among dock workers

Summary Dock workers (n = 218) occupationally exposed to green coffee beans (GCB) were studied, using a specific questionnaire for allergic symptoms and skin tests for common and occupational allergens. Thirty-one workers (14.3%) complained of allergic symptoms of the eye, nose and bronchial system at the workplace. The prick tests, using both commercial allergens and specific extracts prepared from the most common types of coffee and their corresponding sacks, confirmed a sensitization in 21 workers (9.6%). A positive skin reaction to castor beans (CB) was found in nearly all these cases; in ten workers there was also a positive reaction to GCB allergens and in 14 cases prick tests were positive to extracts of sacks. There was a good concordance between prick tests and specific IgE for CB (95.0%) and also, but to a lesser extent, for GCB. The authors concluded that there is a significant risk of sensitization to CB and GCB allergens in dock workers occupied in handling green coffee bean, despite the fact that the exposure is not continuous. CB emerged as a common contaminant of GCB from various countries. For effective prevention, a modification of the methods of transport is required to avoid CB contamination to other products. Eliminating environmental dust during shipping operations is the most important preventive measure and it can be achieved by the use of containers, as some exporting countries are already doing.     

Sentinel health events surveillance in diabetes. Deaths among persons under age 45 with diabetes

The pilot study for a sentinel health events surveillance system for deaths among persons under age 45 with diabetes was conducted in six states in 1984 and 1985. Two hundred and thirty-three events were identified. Information from death certificates, physicians, and families revealed that 22% died from acute complications of diabetes and 53% from chronic complications. Blood pressure measurement and urinalysis testing had been performed in the last year for almost all of the decedents, but other preventive practices were reported less frequently. Hypertension was present in 57% and of those, was not controlled in 73%. Forty-four percent were cigarette smokers at the time of death. Agreement between physicians and families was generally higher for clinical conditions than for care practices. This surveillance system appears to yield information about the health care of persons with diabetes not readily available from other sources, although modifications may be necessary before implementation.     

Internal eye wall resection in the management of uveal melanoma

Twenty patients with presumed uveal melanoma underwent internal eye wall resection. It was the primary procedure in 13 patients who had tumours within 2 disc diameters of the optic nerve head and was combined with external resection in the remainder. Malignant melanoma was confirmed histologically in 15 patients; the diagnosis was a benign tumour in the other 5. The length of follow-up ranged from 2 to 37 (mean 19) months. In all cases the retina was completely attached at the time of last examination. The visual acuity ranged from 20/40 to hand movements; nine patients had an acuity of 20/400 or better. At the time of writing no metastatic disease or local recurrence had developed in any of the 15 patients in whom malignant melanoma was diagnosed.     

Transconjunctival reopening of an occluded filtration fistula with the Q-switched Neodymium-YAG laser

The Q-switched neodymium-YAG laser was used via a transconjunctival approach to reopen a failed filtering bleb, 6 weeks after a primarily successful trabeculectomy had failed. One day after treatment, the intraocular pressure had decreased from 34 mm Hg to 17 mm Hg, and a conjunctival bleb had reformed.     

SPARC, an extracellular matrix glycoprotein containing the follistatin module, is expressed by astrocytes in synaptic enriched regions of the adult brain

Although extracellular matrix (ECM) glycoproteins play important roles in neural development, their levels are generally believed to decrease in the adult brain. Immunohistochemical analysis indicates that the anti-adhesive ECM glycoprotein SPARC/osteonectin, which contains a follistatin ‘module’, is expressed in the adult rabbit nervous system. In the cerebellum, SPARC is present in Bergmann glia, with a strong signal along their radial fibres. SPARC, while enriched in membrane fractions, is not a transmembrane protein. In the hippocampus, colocalization of SPARC is observed in cells which express the astrocytic marker GFAP. The expression of SPARC by a subset of astrocytes, particularly in synaptic enriched areas, suggests a continuing role for the ECM in the adult brain.