Manganese in long term paediatric parenteral nutrition

The current practice of providing manganese supplementation to neonates on long term parenteral nutrition is leading to a high incidence of hypermanganesaemia. Magnetic resonance imaging (MRI) studies in adults on long term manganese parenteral nutrition have shown changes in TI weighted MRI images and similar findings in a neonate receiving trace element supplementation are reported here. Whole blood manganese concentration in the infant was 1740 nmol/l (or 8.3 times upper reference limit). In all neonates on long term parenteral nutrition with evidence of cholestatic liver disease so far investigated, the whole blood manganese concentrations were > 360 nmol/l (reference range 73-210). Manganese supplementation to patients on long term parenteral nutrition requires reappraisal, particularly in those who develop cholestatic liver disease associated with parenteral nutrition.     

Best Treatment Guidelines For Bronchial Asthma

Asthma is a common disease worldwide with significant ethnic and regional variations. An increasing morbidity and mortality, as well as health care burden from asthma have been recognized lately. Several evidence based guidelines have been developed with an aim to standardize and improve the quality of management. These guidelines seek to translate the advances in the understanding of pathogenesis of asthma and in the development of new agents and strategies into practical application at all levels of healthcare. These advocate an assessment of the patients to classify the severity of diseases followed by a step-wise approach to treatment. With the current management we hope to achieve minimum or nil day time and night time symptoms, prevent acute exacerbations and attain normal or near normal lung function, thus improving the overall quality of life.Key Words: Bronchial asthma     

Pre-assessment for children scheduled for day surgery

This article reports on an evaluation of a established pre-assessment clinic for children scheduled for day surgery. The results suggest that the pre-assessment clinic increases the efficiency and effectiveness of the admissions process for children. The authors discuss the results in detail and make recommendations for further research and nursing practice. They suggest, for example, that evaluative research can provide a framework for assessing new services.     

Angiotensin II activates distinct signal transduction pathways in astrocytes isolated from neonatal rat brain

In previous studies, we showed that angiotensin II (Ang II) and its congener peptides—angiotensin-(2–8) [Ang-(2–8)] and angiotensin-(1–7) [Ang-(1–7)]—activate 2 distinct signal transduction pathways in a mixed population of human cortical astrocytoma cells. This suggested that different populations of astrocytes could be heterogeneous with respect to their expression of Ang II receptors or the responses to which these receptors are coupled. To compare the responses which are activated by Ang II and its congener peptides in astrocytes from different brain regions, we measured phospholipase C (PLC) activity and prostaglandin release in isolated astrocytes from 4 different areas of neonatal rat brain. In medullary and cerebellar astrocytes, Ang II activated a phosphoinositide-specific PLC in a dose-dependent manner with EC₅₀s of 1.74 and 1.86 nM, respectively. Ang-(2–8) also caused an increase in inositol phosphate release. PLC activity was coupled to an AT₁ receptor in both medullary and cerebellar astrocytes, as demonstrated by the inhibition of Ang II-activation of inositol phosphate release by the AT₁ antagonist losartan. The AT₂ antagonist PD 123319 was ineffective. Ang II and Ang-(2–8) also released prostacyclin from medullary and cerebellar astrocytes, measured as the release of its stable metabolite 6-keto-PGF_1α. In contrast, Ang II did not activate PLC or release prostaglandins in astrocytes isolated from the cortex or hypothalamus. In addition, Ang-(1–7) did not stimulate the release of inositol phosphates or prostacyclin in astrocytes from any of the neonatal rat brain regions examined. However, bradykinin (1 μM) activated PLC or released prostacyclin in astrocytes isolated from all 4 brain regions. These results suggest that Ang II receptors on region-specific astrocytes activate distinct signal transduction mechanisms in response to different angiotensin peptides. GLIA 19:333–342, 1997. © 1997 Wiley-Liss, Inc.     

Dehydroepiandrosterone supplementation improves ovarian response and cycle outcome in poor responders

The effect of dehydroepiandrosterone (DHEA) supplementation on cycle outcome was assessed in patients with poor ovarian response. In total, 19 poor responder patients who were scheduled to undergo a second intracytoplasmic sperm injection (ICSI)/embryo transfer cycle were enrolled and first ICSI/embryo transfer cycles were taken as the control group. All subjects were given DHEA supplementation (25 mg t.i.d.) for at least 3 months prior to their second ICSI/embryo transfer cycle. In both cycles a fixed dose of rFSH (300 IU/day) and human menopausal gonadotrophin (HMG) (75 or 150 IU/day) along with a flexible gonadotrophin-releasing hormone (GnRH) antagonist protocol were administered. A favourable decrease was noted in mean day 3 serum oestradiol concentrations after DHEA supplementation (75.14 ± 28.93 versus 43.07 ± 11.77; P < 0.01). Increased number of >17 mm follicles (3 ± 0.7 versus 1.9 ± 1.3; P < 0.05), MII oocytes (4 ± 1.8 versus 2.1 ± 1.8; P < 0.05), top quality day 2 (2.2 ± 0.8 versus 1.3 ± 1.1; P < 0.05) and day 3 embryos (1.9 ± 0.8 versus 0.7 ± 0.6; P < 0.05) were achieved in DHEA-supplemented cycles. Cycle cancellation rates were reduced (5.3% versus 42.1%; P < 0.01), and the pregnancy rate per patient and clinical pregnancy rate per embryo transfer (47.4% versus 10.5%; P < 0.01 and 44.4% versus 0%; P < 0.01) were improved after DHEA supplementation. DHEA supplementation might enhance ovarian response, reduce cycle cancellation rates and increase embryo quality in poor responders.     

Diagnostic value of drain amylase for detecting intrathoracic leakage after esophagectomy

AIM: To investigate the value of elevated drain amylase concentrations for detecting anastomotic leakage (AL) after minimally invasive Ivor-Lewis esophagectomy (MI-ILE).METHODS: This was a retrospective analysis of prospectively collected data in two hospitals in the Netherlands. Consecutive patients undergoing MI-ILE were included. A Jackson-Pratt drain next to the dorsal side of the anastomosis and bilateral chest drains were placed at the end of the thoracoscopic procedure. Amylase levels in drain fluid were determined in all patients during at least the first four postoperative days. Contrast computed tomography scans and/or endoscopic imaging were performed in cases of a clinically suspected AL. Anastomotic leakage was defined as any sign of leakage of the esophago-gastric anastomosis on endoscopy, re-operation, radiographic investigations, post mortal examination or when gastro-intestinal contents were found in drain fluid. Receiver operator characteristic curves were used to determine the cut-off values. Sensitivity, specificity, positive predictive value, negative predictive value, risk ratio and overall test accuracy were calculated for elevated drain amylase concentrations.RESULTS: A total of 89 patients were included between March 2013 and August 2014. No differences in group characteristics were observed between patients with and without AL, except for age. Patients with AL were older than were patients without AL (P = 0.01). One patient (1.1%) without AL died within 30 d after surgery due to pneumonia and acute respiratory distress syndrome. Anastomotic leakage that required any intervention occurred in 15 patients (16.9%). Patients with proven anastomotic leakage had higher drain amylase levels than patients without anastomotic leakage [median 384 IU/L (IQR 34-6263) vs median 37 IU/L (IQR 26-66), P = 0.003]. Optimal cut-off values on postoperative days 1, 2, and 3 were 350 IU/L, 200 IU/L and 160 IU/L, respectively. An elevated amylase level was found in 9 of the 15 patients with AL. Five of these 9 patients had early elevations of their amylase levels, with a median of 2 d (IQR 2-5) before signs and symptoms occurred.CONCLUSION: Measurement of drain amylase levels is an inexpensive and easy tool that may be used to screen for anastomotic leakage soon after MI-ILE. However, clinical validation of this marker is necessary.     

The psychological burden of an initially unexplained illness: patients with sternocostoclavicular hyperostosis before and after delayed diagnosis

Background  

Sternocostoclavicular hyperostosis (SCCH) is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin. SCCH is largely underdiagnosed and often misdiagnosed. In individual cases it can remain unrecognized for years. The purpose of this study is twofold. Firstly, to evaluate the psychological condition of SCCH patients, both in the sometimes quite extended pre-diagnostic period between first manifestations and confirmed diagnosis of the disease, and in the current situation. Secondly, to investigate the relationships between the pre-diagnostic and the current psychological conditions of confirmed SCCH patients.