Serum lipids in total parenteral nutrition [TPN]: Effect of Fat

Serum lipids in total parenteral nutrition [TPN]: Effect of Fat

ABSTRACTS 97 GENERAL Umbilical Catheterization. CONSIDERATIONS Hematocrit Values and Blood Viscosity in the Newborn infant. C. W. Van Der Elst, ...

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Umbilical Catheterization.


Hematocrit Values and Blood Viscosity in the Newborn infant.

C. W. Van Der Elst, A. F. Malan, and H. de V. Heese. S Afr Med J 53:494-496 (April), 1978. The hematocrit values in 51 babies were studied to observe the possible variations due to the method and time of sampling and to relate these findings to blood viscosity. A good correlation between hematocrit values of warmed heel capillary blood and of central venous samples were found. A central venous hematocrit value of 65% or greater gave a 100% risk of the infants blood being hyperviscous.--M. R. Q. Davies Drugs, infections, and Congenital Abnormalities.



Smithells. Arch Dis Child 53:93-96 (February), 1978. This "annotation" describes the malformations and deformities resulting from both chemical and infective teratogens. Thalidomide, norethisterone and antimitotic drugs have definite associations with abnormalities, while alcohol, anticonvulsants, warfarin, and volatile anesthetic agents are less definitely associated. Intrauterine infections with rubella, cytomegalovirus, and toxoplasmosis produce congenital abnormalities, but Herpes and varicella/zoster viruses, though producing damage, may not be truly teratogenic. The mechanisms of these effects are discussed and the resulting syndromes described. Measures suggested to prevent these occurrences include discriminate use of drugs, reporting of possible associations to the Committee on Safety of Medicines and further development of the use of vaccines. P.A. M. Raine A Case of the Epigastrius. H. Takamatsu, T. Kitahara, and

K. Suruga. 1978.

Jap J Pediatr Surg 10:347 351, (March),

A case of asymmetrical conjoined twins (epigastrius) was reported. The autosite was a 6-day-old male baby with omphalocele. The parasite was a tumorous mass, 8.5 X 8.5 X 5.3 cm in size, attached to the epigastrium of the autosite. Omphalocele was treated conservatively, and the parasite was easily removed 19 days after birth. Diagnosis of the epigastrius was made, as the parasite had a skull, vertebrates, spinal cord, and intestine-like structures. The authors collected 12 cases of the epigastrius from the Japanese literature, including the patient reported here. Nine were males and three were females. Seven patients were stillbirths, 2 patients died immediately after the operation, and 3 patients survived. The parasite was connected with the autosite by abdominal cavity in 2, by esophagus in 1, by small intestine in 1, and by rectum in 2 cases. Associated malformations of the autosite were found in 9 patients; omphalocele in 6, cardiac malformations in 3 patients.--H. Suzuki Acrodermatitis Enteropathica--A Zinc Deficiency State. 1. L.

Rubin, J. D. L. Hansen, B. Goldberg, D. G. C. Presbury, and T. A. Kilroe-Smith. S Aft Med J 53:497 498, (April), 1978. Successful therapy with zinc sulphate is reported in three children suffering from acrodermatitis enteropathica. M. R. Q. Davies

A Teaching




Schreiner, E. L. Gresham, M. B. Escobedo, C. B. Gosling. Clin Pediatr 17:506-508 (June), 1978. Major complications from umbilical vessel catheterization are not uncommon in inexperienced hands. The development and use of a catheterization simulator is discussed.--Daniel Thomas Hemodynamic Findings During Treatment of Protein-Calorie Malnutrition. P. Viart. Am J Clin Nutr 31:911-926 (June),

1978. Nineteen African children, aged 1.5 to 8.3 yr with marasmic Kwashiorkor, were studied by cardiac catheterization at one or more times during recovery. No patient exhibited clinical evidence of congestive heart failure. Initial evaluation revealed a hematocrit of 31.3%, serum albumin of 1.47 g/dl, low plasma and blood volumes, low cardiac output and stroke volume, bradycardia, increased circulation time and increased peripheral vascular resistance, but normal cardiac output per unit of red cell volume. A-V saturation differences were high, but blood gases were normal. By day 20 when the hematocrit was 29.5 and albumin 2.01, heart rate, circulation time, and A-V 02 difference had normalized. By day 60 the albumin was 2.87 (normal for this population) and hematocrit 28.3. Red cell volume remained low and tachycardia was now present with lowered systemic vascular resistance and shortened circulation time. Stroke volume did not return to normal despite a hyperkinetic cardiovascular status. Comparison of these data with that for 15 nonsurviving patients with more severe PCM revealed that the difference in the non-survivors was the presence of higher vascular resistance and decreased cardiac output per unit red cell volume, and consequent abnormal blood gas values.--R. J. Merritt Digestion of Certain Fractions of Dietary Fiber in Humans.

W. D. Halloway, C. Tasman-Jones, and S. P. Lee. Am J Clin Nutr 31:927-930 (June), 1978. Ten normal and six postcolectomy ulcerative colitis patients were given diets of known fiber content and their feces collected for 10 days. Normal subjects digested 77.6% of cellulose and 96% of hemicellulose, lleostomy patients digested 15.5% of the cellulose and 72.5% of the hemicellulose. The tignin excretion as reported was greater than the intake. These data indicate the potential caloric value of hemicellulose and the potential for enteric degradation of certain dietary fibers. Such investigations have implications for the development of fiber-controlled diets and stool bulking agents.--R. J. Merritt Serum Lipids in Total Parenteral Nutrition [TPN]: Effect of Fat.

Ezra Steiger, Herbert K. Naito, Megan O'Neill, and Avram Cooperman. J Surg Res 24:527 531 (June), 1978. Parenteral fat emulsions are being used clinically, either in small amounts to prevent or treat essential fatty-acid deficiency states during total parenteral nutrition or in relatively larger amounts to replace, in part, dextrose as a major calorie source during TPN. In order to access the effects of fat-free versus fabcontaining TPN on serum lipid concentrations, 42 male Sprague-Dawley rats were studied. Ten rats were sacrificed immediately and used to obtain normal control



value for serum lipids. The remainder were subjected to 6 wk of a protein-free diet after which time they lost 30% of their original body weight. The rats were then randomly assigned to three groups and then underwent immediate sacrificed, protein repletion by fat-free intravenous hyperalimentation, or repletion with a fat-containing solution respectively. Serum was obtained for cholesterol, triglyceride, and phospholipid determinations. A small increase in serum total cholesterol concentration occurred in these animals due to an increase in esterified cholesterol. This hypercholesterolemic effect is in contrast to some previous reports of fat-free TPN and is attributed to the different amino solutions used. A significant increase in serum cholesterol and phospholipids occurred in protein-depleted rats who were refed with fatcontaining TPN solutions. The effects of induced hypercholesterolemia in patients receiving fat emulsions as a major source of calories for prolonged periods should be assessed clinically, and the patients serum cholesterol levels should be carefully monitored.--Richard J. Andrassy Fat Embolism in Infancy After Intravenous Fat Infusions. A. J.

Barson, M. L. Chiswick, and C. M. Doig. Arch Dis Child 53:218-223 (March), 1978.

Four cases of microscopic fat embolism are described in infants receiving long-term intravenous fat emulsion (Intralipid 20%). In 2 patients, transient increased rates of Intralipid infusion up to 3 to 4 times the recommended dose occurred, although the total daily dose was within established limits. Careful regulation of the fat infusion to insure steady infusion during the day is encouraged.--Randall W. Powell

ANESTHESIA AND INHALATION THERAPY Malignant Hyperthermia During Repair of a Cleft Lip in a

W. C. Dempsey, J. F. Mayhew, P. S. Metz, and T. E. Southern. Ann Plast Surg 1:315-318 (May), 1978.

6-Month-Old Infant With Survival.

Malignant hyperthermia is an autosomal dominant myopathy that is unmasked by anesthetic agents such as general anesthesia, muscle relaxants, and amide local anesthetics. It, therefore, may be called a true pharmacogenetic disease. Other causes of malignant hyperthermic crisis outside the operating room are listed. The paper deals with a case report of a 6-roD-old infant female, who had a second stage repair of a cleft lip under general anesthesia with resultant malignant hyperthermia. The emergent treatment is detailed, which led to a successful outcome of this condition in what appears to be the youngest reported patient in which there was survival. The discussion of the various types of hyperthermia is given in detail with the overall frequency listed as 1 in 15,000 children. Although the exact etiology is unknown, it appears to be related to a fundamental defect in calcium metabolism in the muscle cell. Enzyme changes, clinical findings, and treatment are detailed in the discussion. The article is recommended to all physician's dealing with infants, and provides an excellent view of this disease entity and its treatment.--A. B. Sokol

INTEGUMENT AND CONNECTIVE TISSUE Toxic Epidermal Necrolysis. G. Anhalt and C. F. T. Snelling.

Plast Reconstr Surg 61:905-910 (June), 1978. Toxic epidermal necrolysis (TEN) is also known as Lyell's disease or the scalded skin syndrome. The disease is described as acute dermatitis with erythema, extreme tenderness of the skin, which usually follows a minor infection or drug therapy. The disease progresses to extensive sloughing of the epidermis and a clinical picture similar to that of a second degree burn. The mortality in adults approaches 30% and in children 75%. Death is generally due to hypovolemic shock or secondary infection. A case report of a 17-yr-old female admitted with TEN following treatment for a urinary tract infection on a combination of trimethoprim and sulfamethoxazole. Her treatment and course, which led to a successful outcome, is well-documented. The manifestations of TEN are generally found on the body's surface and mucous membranes. In the survivors, skin generally regenerates after 3 wk without scarring. However, there may be hyperpigmentation, corneal scarring, and loss of nails and hair. Etiologic factors appear to be a toxin producing Staphylococcus aureus, drug hypersensitivity, miscellaneous causes, and recurrent episodes with no known factor. In children under 7 yr of age, the disease is generally preceded by Staphylococcus aureus of phage group 11. The histology of TEN is described, specifically that which differentiates drug induced, from staphylococcal induced disease. The treatment is generally for a partial thickness burn with replacement of crystaloid and colloid solutions. Topical antibiotics are advised, along with steriod therapy in nonstaphylococcal cases.--A. B. Sokol Deafness and Biochemical Imbalance After Burns Treatment With Topical Antibiotics in Young Children: Report of Six Cases. M. F. M. Bamford and L. F. Jones. Arch Dis Child

53:326 329 (April), 1978. Six children were found to be deaf following treatment of burns ranging from 10%-22% with topical antibiotic sprays containing neomycin, bacitracin, colistin, and polymyxin B. Three patients also developed a metabolic disorder characterized by hypocalcemia, hypomagnesemia, and hypokalemia. Follow-up of other infants treated in a similar manner is being done. Caution in the use of these antibiotics for the topical treatment of burns is urged.--Randall W. Powell F. G. Wolfort, K . . 4 . Marshall, and T. C. Cochran. Ann Plast Surg 1:294 297 (May), 1978.

Correction of the Inverted Nipple.

An historical review of correction in the inverted nipple is given by the authors. A new technique of correcting the inverted nipples by a liberation of the nipple through an intra-areolar approach is given. In addition, the postoperatively everted nipple is supported by both muscular and cutaneous supporting sutures. The advantage of this procedure is that the operation is entirely intra-areolar with the absence of noticeable scarring on the breast surface. In addition, there is an adequate blood supply to the areola and nipple area with this technique and