Folacin and iron status of adolescents from low-income rural households (1–3)

The folacin and iron status of 179 black and white adolescents from low-income rural households was evaluated. Red blood cell folacin concentrations were less than 140 ng/ml in 45% of the subjects and 56% of the serum folacin levels were less than 6 ng/ml. Twenty-five percent of all females had low (<16%) transferrin saturation levels in contrast to 12% of the males. Transferrin saturation increased as the male adolescents matured and decreased as the females matured (p<0.05). Anemia (Hb<12 g/dl) was identified in 13% of the black adolescents in contrast to 2% of the whites. Mean cell hemoglobin concentrations and mean cell volumes were lower (p<0.05) in the blacks than in the whites. These findings demonstrate that both folacin and iron inadequacies occur in a significant proportion of this low-income rural adolescent population group.     

Case report: epidural and bilateral retroorbital hematomas complicating sickle cell anemia

Early in the course of a painful crisis, a 19-year-old man with known sickle cell anemia (SCA) developed a clinical picture that resembled either early cavernous sinus thrombosis or retroorbital and bifrontal microinfarcts. A brain computer tomography scan demonstrated bilateral retroorbital hemorrhages along with a left frontal epidural hematoma. In the absence of trauma, thrombocytopenia, or any other detectable hemostatic defect, this type of hemorrhagic manifestation in the setting of SCA has not, to our knowledge, been previously reported in the literature.     

Operation for acute postinfarction mitral insufficiency using continuous oxygenated blood cardioplegia

Patients with acute-onset mitral insufficiency and cardiogenic shock after myocardial infarction have a high incidence of operative death and morbidity. Patients with ventricular dysfunction, myocardial ischemia, and limited cardiac reserve undergoing an urgent operation represent a challenge to modern methods of myocardial protection. To improve results of operation a new technique was devised with continuous infusion of cold oxygenated blood cardioplegia during the entire cross-clamp period. Between 1984 and 1988, 19 consecutive patients with severe mitral regurgitation and cardiogenic shock (systolic blood pressure less than 60 mm Hg) after myocardial infarction underwent urgent myocardial revascularization, mitral valve replacement, or both. Left ventricular ejection fraction was less than 40% in 16 of 19 patients. All patients had suffered myocardial infarction within 4 weeks of operation and underwent an urgent operation within 24 hours of the onset of hemodynamic compromise. Severe three-vessel coronary artery disease was present in 16 of the 19 patients. A continuous infusion of blood cardioplegia was instituted at aortic cross-clamping and continued throughout the cross-clamp period. Infusion of continuous blood cardioplegia was also instituted through each completed distal vein graft. Myocardial septal and left ventricular apical temperatures were maintained at 10 degrees +/- 2 degrees C throughout the cross-clamp period. There were two in-hospital deaths (mortality, 10.5%) and low output syndrome was present in 10 patients (53%). At a mean follow-up of 2.5 years, there was one late death and 14 of the 16 remaining patients were in New York Heart Association functional class I or II.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cord blood serum in newborns of diabetic mothers

Serum cholesterol, triglycerides and lipoprotein cholesterol were measured in cord bloods from 117 newborns. Group I consisted of 39 infants of diabetic mothers and Group II (control) consisted of 78 newborns of non-diabetic mothers. The most significant difference in serum lipids between the two groups was the higher levels of LDL cholesterol and lower levels of HDL cholesterol in the newborns of diabetic mothers. Cord blood serum cholesterol was slightly, but not significantly, higher in children born of diabetic mothers. Serum triglycerides were also not significantly different between the groups. While it remains to be established whether elevated levels of LDL cholesterol and decreased levels of HDL cholesterol at birth in these infants represent a transient phenomenon, this study suggests that newborns of diabetic mothers may be predisposed early in life to LDL hypercholesterolemia and thus may be at a greater risk of developing coronary heart disease later in life.     

Dietary energy density is associated with selected predictors of obesity in U.S. Children

Increasing rates of childhood overweight have been linked to the rising energy density of the diet. We sought to provide temporal profiles of dietary energy density (DED) in a nationally representative sample of U.S. children and adolescents < or = 19 y old and to describe associations between DED and predictors of overweight. We used a subset of data from the 1994-1996, 1998 Continuing Survey of Food Intake for Individuals (CSFII) and a multivariate regression model to determine independent associations between DED and socioeconomic and demographic variables after controlling for covariates. In this cross-sectional data set, DED was positively associated with total energy intakes and varied with both age and gender. DED increased from birth, peaked at 7-8 y of age, and then declined. Boys consumed more energy-dense diets than girls. Among children < or = 4 y old, higher DED was associated in the regression model with lower household incomes and with enrollment in the food stamp program. Among adolescents 12-19 y old, higher DED was associated with being African-American. In contrast, lower DED among children < or = 11 y old was associated with being Asian or Hispanic and with total daily consumption of fluid milk. The quality of the diet for young children, as indexed by high DED, may be adversely affected by limited household economic resources. Although food insecurity and WIC enrollment were not associated with DED in this study sample, milk consumption in children < or = 4 y old was associated with lower DED.     

A comparison of nitroglycerin and nitroprusside: I. Treatment of postoperative hypertension

Nitroglycerin improves perfusion to ischemic myocardial regions and therefore has theoretical advantages over sodium nitroprusside to treat hypertension (mean arterial pressure [MAP] greater than 95 mm Hg) following coronary bypass operation. Thirty-three hypertensive patients were randomized to an initial infusion of either nitroglycerin or nitroprusside in a crossover trial designed to reduce MAP to 85 mm Hg. Thermodilution cardiac output measurements permitted calculation of left ventricular stroke work index (LVSWI), and nuclear ventriculograms permitted estimation of left ventricular ejection fraction, left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). Coronary sinus blood flow was measured by the continuous thermodilution technique, and arterial and coronary sinus lactate measurements permitted calculation of myocardial lactate flux (MVL). Both nitroglycerin and nitroprusside reduced MAP (-25 +/- 12 mm Hg and -20 +/- 10 mm Hg, respectively; not significant [NS]). Nitroglycerin reduced LVSWI more than did nitroprusside (-15 +/- 13 gm-m/m2 and -7 +/- 9 gm-m/m2, respectively; p less than 0.01). Both agents increased left ventricular ejection fraction (nitroglycerin, +8 +/- 8%, and nitroprusside, +10 +/- 7%; NS), and decreased LVEDVI (-20 +/- 22 ml/m2 and -11 +/- 17 ml/m2, respectively; NS) and LVESVI (-13 +/- 14 ml/m2 and -10 +/- 12 ml/m2, respectively; NS). Coronary sinus blood flow decreased with both drugs (NS), but MVL increased with nitroglycerin (+0.02 +/- 0.14 mmol/min) and decreased with nitroprusside (-0.02 +/- 0.02 mmol/min) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Minimally invasive parathyroidectomy in patients with previous endocrine surgery

Objective:

Previous endocrine neck surgery (PENS) in patients with sporadic primary hyperparathyroidism (PHP) is considered a contraindication for minimally invasive parathyroidectomy (MIP). The purpose of our study was to determine the effectiveness of MIP in such patients.

Methods:

From January 2004 to December 2009, 270 patients with PHP were treated in our department; 30 had had PENS in the past. Eighteen were selected to have MIP, while the other 12 had traditional neck explorations. Selection criteria for MIP were unilateral single- or double-gland disease localized preoperatively with at least 2 concordant imaging techniques and patient informed consent. Imaging studies included high-resolution neck ultrasound and sestamibi scan in most patients, and CT scan, selective venous sampling, and MRI in 7 patients. Unilateral explorations via a lateral approach with the patients under local (UALA in 13 patients), general (MIP in 4 patients), or local followed by general anesthesia (1 patient) were performed.

Results:

Sixteen of the 17 patients became normocalcemic after the operation. There was no conversion to traditional exploration. A single adenoma was found in 16 patients and hyperplasia in one. One patient underwent a successful parathyroidectomy 8 months later via mesothoracoscopy, because the parathyroid gland was localized correctly but was beyond access via neck. There were no postoperative complications. Mean duration of the procedure and length of stay were similar to MIP in patients without PENS. Mean follow-up of 33 months (range, 4 to 70) did not reveal any recurrence.

Conclusion:

These results illustrate that MIP is a valuable option in select patients with sporadic PHP and PENS. Localization with 2 or more concordant imaging techniques could avoid intraoperative sestamibi or qPTH testing with low morbidity (0%), high biochemical cure rate (100% in this series), rapid recovery, and finally substantially lower the cost of the procedure.