Decreased response of plasma immunoreactive erythropoietin to "available oxygen" in anemia of prematurity

Erythropoietin, hemoglobin, hematocrit, oxygen affinity (P50), and reticulocyte counts were measured weekly starting at 1 week of age in 10 very-low-birth-weight infants and on a single occasion in 15 healthy men. In the adults, "available oxygen" (derived from oxygen carrying capacity and P50) averaged 13.1 ml/dl blood and the mean erythropoietin level was 15.2 mU/ml. Erythropoietin levels in the infants were inversely related to concentration of hemoglobin, P50, and available oxygen. However, despite the much lower mean "available oxygen" of 9.3 ml/dl in the infants compared with that in adults (P less than 0.001), the mean erythropoietin value of 8.2 mU/ml in the infants was less than in adults (P less than 0.001). Furthermore, the erythropoietin response to decreased "available oxygen" was lowest in the least mature infants. VLBW infants often develop clinical evidence of hypoxia during the anemia of prematurity. The relatively low erythropoietin levels in relation to "available oxygen" are compatible with a decreased erythropoietin response to hypoxia compared with that in adults. Such a difference in response could be a contributing factor to the anemia of prematurity.     

The tangential excision of extensive or deep burns

This report contains our experience gained over 13 years of the tangential excision of burned tissue in 627 patients. We have discussed the indications for and timing of tangential excision, methods of determining the margin between viable and non-viable tissue using histological studies in some patients and the problem of wound coverage after tangential excision.     

Pelvic infections following gynecologic procedures in Bangladesh

Data were collected to establish the rate of pelvic infection following various gynecologic procedures, including postpartum intrauterine device (IUD) insertions, IUD insertion following menstrual regulation procecures, IUD insertion in women who were not recently pregnant, and induced and spontaneous abortions. The pelvic infection rate was only 1% in 97 women who underwent postpartum IUD insertions. The infection rate was related to the timing of IUD insertion and the type of IUD used. Finally, the pelvic infection rate was unacceptably high (10.3%) in women undergoing induced abortions vs. women having spontaneous abortions (1.1%).     

The disinfection of clinically contaminated Matburn suction pumps and baby incubators in an 'Aseptor' formalin cabinet

Fifty-millilitre washings from 53 used Matburn suction pumps contained up to 10⁹ organisms per ml. Of 93 isolates, 47 were Pseudomonas species. Apart from some enterobacteria and yeasts, manual washing failed to eliminate these organisms and occasionally introduced further contamination. Machine washing and oven drying greatly reduced the numbers of contaminating bacteria. Exhaust air from pumps was frequently contaminated but at a low level and usually with non-pathogens. Of 27 baby incubators, 19 were contaminated with up to 10⁶ organisms per ml of 50 ml washings despite the presence of residual chlorhexidine activity from ward disinfection.Apart from occasional probable post-disinfection contamination of the machines with diphtheroids, micrococci, coagulase-negative staphylococci and Bacillus spp., disinfection with formalin in an Aseptor 8800 yielded sterile cultures from 51 (96·2 per cent) and 26 (96·3 per cent) of suction pumps and incubators, respectively.     

A randomized, single blind comparative trial of norethindrone enanthate and depo-medroxyprogesterone acetate in Bangladesh

A randomized, single blind comparative trial of norethindrone enanthate (NET-ENT) and depo-medroxyprogesterone acetate (DMPA) was conducted in the Model Clinic, Decca, Bangladesh, to determine if there were differences in reported side effects, reasons for discontinuation and discontinuation rates of these two injectables. On all follow-up visits the proportion of women reporting no bleeding (amenorrhea) was higher for the DMPA clients compared to the NET-ENT clients. Concurrent with these findings, the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients. Concurrent with these findings, the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients compared to those receiving DMPA. By the fourth injection, less than 15% of the clients in both drug groups still reported having regular cyclic bleeding (4 of the 26 DMPA clients and 4 of the 28 NET-ENT clients). Five of the 133 women on DMPA and 6 of the 106 women on NET-ENT became pregnant while using the injectables. At the end of one year of follow-up, 14 of the 133 DMPA and 14 of the 106 NET-ENT clients were still continuing (came back for a fifth injection).     

Patterns of illness behaviour in patients with intractable pain.

A 52 item self-administered questionnaire was constructed to assess illness behaviour. It was administered to 100 patients referred for the management of pain that had not responded adequately to conventional treatment. Responses were factor analysed using principal component analysis and rotated to orthogonal structure. Seven meaningful factors accounting for 63·3% of the the variance were extracted and labelled as follows: general hypochondriacal factor, disease conviction factor, psychological vs somatic factor, affective inhibition factor, affective disturbance factor, denial factor and irritability factor. The significance of these dimensions of illness behaviour was discussed.     

Peutz-Jeghers syndrome and its complications. First case report from Malaysia with review of literature.

We report for the first time from Malaysia a patient with Peutz-Jeghers syndrome complicated by successive intussusceptions requiring extensive small bowel resection. Our experience is compared with that of other authors by a review of the literature highlighting important points in the diagnosis and management of complications in Peutz-Jeghers syndrome.     

A new topical agent (Debrisan) for the early treatment of the burned hand

In a prospective inpatient study 130 hands with dermal and subdermal burns in 80 patients were treated with a new topical agent, Debrisan (Pharmacia AB, Sweden), which is composed of dry, porous, hydrophilic beads, formed by a three-dimensional network of dextran polymers. When these beads are placed on discharging burns, they absorb the exudate and swell, to form a gelatinous layer removing bacteria, degradation products, inflammatory mediators etc. from the wound surface.

Our results indicate that it is a useful agent in burns of the hand, where it is easy to administer, prevents crust formation, reduces infection and allows maintenance of movement. Debrisan proved to be an effective treatment in all superficial and deep dermal burns of the hand and useful in already infected subdermal burns as a treatment before grafting. The healing time was shortened compared to open treatment and the pain in the hands of most patients rapidly decreased. The technique also offers an exceptional opportunity to perform studies on the content of burn exudate, since degradation and interaction are to a large extent prevented within the gel.