Total parenteral nutrition during pregnancy.

Parenteral hyperalimentation or total parenteral nutrition has become an established therapy for patients with a wide variety of conditions that preclude oral feeding. Because pregnancy is an infrequent event in poorly nourished women with acute or chronic illness, total parenteral nutrition has not been widely used for pregnant patients. Some obstetricians believe that total parenteral nutrition entails risks in excess of its potential benefit to pregnancy and demands skills and knowledge that are either not available or are in limited supply.

Onset of obesity in a 36 year birth cohort study.

A large national cohort of children studied from birth to 36 years was used to test the predictive value of childhood obesity for obesity in adult life. Only 21% (39) of obese 36 year olds had been obese at age 11 years, and even when associated social factors were taken into account the correctly predicted percentage was much lower than the prediction rate achieved using body mass data from age 26 years. The comparatively poor predictive value of childhood obesity and the association of adult obesity with educational achievements and socioeconomic circumstances of family of origin emphasise the need for encouraging good nutritional and exercise habits rather than placing undue emphasis on the control of childhood obesity.

The reliability and validity of PSE assessments by lay interviewers: a national population survey.

Studies employing psychiatric rating instruments administered by lay interviewers need to demonstrate the reliability and validity of subject classification. In a national population study utilizing the short form of the Present State Examination, audiotapes of interviews were used to demonstrate the reliability of ratings. The classification of 'cases' was found to be related to self-reports of nervous trouble and help-seeking for such problems.

Duodenal gangliocytic paraganglioma occurring in adolescence.

A 15-year-old boy complained of abdominal pain and massive upper gastrointestinal hemorrhage. Endoscopic evaluation demonstrated an ulcerated, submucosal mass involving the ampulla. This was locally excised and found to show the characteristic histologic and ultrastructural features of a gangliocytic paraganglioma.

Pediatric trauma associated with all-terrain vehicles.

The frequency of injuries secondary to use of all-terrain vehicles (ATV) is increasing at an alarming rate, and these injuries are usually multiple and severe. Between January 1, 1983, and February 28, 1985, 415 pediatric patients were admitted to the University of Virginia Hospital for care of injuries secondary to trauma; 66 of these patients required intensive care. Of the 415 patients, 12 were injured secondary to ATV use, and four of these required intensive care.

Bronchopulmonary foregut malformations. The spectrum of anomalies.

Ventral anomalies of accessory pulmonary tissue have been classified as "bronchopulmonary foregut malformations." Between July 1, 1981, and May 31, 1985, 10 children with bronchopulmonary malformations have been cared for on the Pediatric Surgical Service at the University of Virginia. Six patients had bronchogenic cysts, one in an extrathoracic location and one associated with a pulmonary sequestration.

The in situ saphenous vein bypass graft: radiologic aspects.

The use of the in situ saphenous vein for bypassing arterial occlusions in the lower extremities appears to have a higher patency rate than other bypass procedures but presents unique technical problems, such as lysing valves and occluding venous tributaries. Forty-four patients undergoing in situ bypasses had preoperative arteriograms. Special attention was paid to the small runoff vessels around the ankle, which are not suitable for reversed bypass procedures but may be adequate for in situ bypasses.

Cytomegalovirus - its cellular immunology and biology.

The biology of persistent virus infections presents many intriguing questions, which extend well beyond classical virology into molecular and cell biology and immunology. Here, Patrick Sissons and his colleagues review the current state of knowledge of the biology and immunology of one particular medically important persistent human virus - human cytomegalovirus (HCMV) and they discuss insights into the normal and pathological virus-host relationship provided by recent work both on HCMV itself, and on its murine counterpart mouse cytomegalovirus (MCMV).

Obstructive airway disease in infants and children.

Airway obstruction in infants and children can produce rapidly progressive life-threatening emergencies. An understanding of the common symptom complexes associated with regional obstructive abnormalities allows rapid evaluation and appropriate therapy. This article discusses the most common types of obstructive congenital and acquired airway anomalies, describes their symptomatology, and reviews the available diagnostic and treatment options.

Monoclonal antibodies recognizing early and late antigens of human cytomegalovirus: heterogeneity of polypeptides recognized between virus isolates.

The characteristics of four human cytomegalovirus (HCMV)-specific monoclonal antibodies as assessed by ELISA, immunofluorescence, immunoprecipitation and Western blotting are described. Two antibodies recognized a 67K late polypeptide of HCMV, one recognized 43K and 79K polypeptides present early and late in HCMV-infected cells, and the fourth identified a 72K early nuclear protein of HCMV. The antibodies recognized these antigens in all HCMV isolates tested by immunofluorescence and ELISA, but demonstrated inter-isolate variations in polypeptides recognized by Western blotting.

Monocyte-derived inhibitor of interleukin 1 induced by human cytomegalovirus.

It has previously been shown that human cytomegalovirus (HCMV) can exert immunosuppressive effects, and it has been suggested that these may be mediated by monocytes, although the mechanism is unclear. We showed that infection of human monocytes with the AD169 strain of HCMV abrogates their production of interleukin 1 (IL-1) activity. This was associated with the release from infected monocytes of an inhibitor of IL-1 activity which was also released after HCMV infection of the U937 macrophage-like cell line.

Triplication of the esophagus with gastric duplication.

A 2 1/2-year-old girl was seen with an upper abdominal mass. Evaluation by abdominal ultrasonography, esophagography, upper gastrointestinal series, and computerized axial tomography suggested the possibility of duplication of the esophagus, stomach, and duodenum. Surgery revealed a triplication of the esophagus with a gastric duplication, which was resected.

Lysis of human cytomegalovirus infected fibroblasts by natural killer cells: demonstration of an interferon-independent component requiring expression of early viral proteins and characterization of effector cells.

We investigated the susceptibility of cells infected with human cytomegalovirus (HCMV) to lysis by human natural killer (NK) cells, examining in particular its relationship to sequential viral protein expression, interferon (IFN), and the nature of the effector cells. HCMV-infected fibroblasts were lysed by peripheral blood mononuclear cells from normal seronegative individuals. The effector cells were large granular lymphocytes of Leu-7+, Leu-11+, and to a lesser extent Leu-7- phenotype.

Profound endoesophageal cryotherapy.

Studies are reported to define the tolerance of the feline esophagus to cryoinjury. Thirty-seven cats underwent endoesophageal cryotherapy to temperatures of -100, -120, -140 degrees C for 30 sec. Animals were sacrificed at 90 min, 4, 10, 14, and 20 days.

Chylothorax: an assessment of current surgical management.

The development of chylothorax is a serious and often life-threatening clinical entity. Optimal management of this problem has not been well defined to date. We reviewed our experience with chylothorax in patients of all ages during the past 10 years.

Assessment of human right ventricular cast volume by CT and angiocardiography.

Angiocardiographic methods available for cardiac chamber volume measurements have been shown to be less accurate although more practical than CT for the evaluation of the LV. To explore the capability of CT for RV volume measurements, silastic casts of seven normal RV were measured by a displacement method, conventional angiocardiographic biplane methods, and CT. The displacement method used degassing beneath vacuum to remove air trapped in the casts, and the actual volumes, which varied between 62 and 188 cc, were measured by Archimedes' principle.

Risk factors for microwave scald injuries in infants.

An infant sustained second- and third-degree scald burns of the oropharynx from drinking formula heated in a microwave oven. The circumstances leading to the scald injuries were recreated. Factors contributing to the injury included the volume of formula, the initial temperature of the formula, and the temperature gradient between the liquid core and the bottle surface after microwave heating.

Esophageal atresia with double fistula: the missed anomaly.

Of the various anatomical types of atresia, that of esophageal atresia and double fistula is said to be the least common. In most series, frequency is less than 1%. Seventy-eight patients with esophageal atresia were treated at the University of Virginia Medical Center between 1955 and 1983.

Uterine prolapse in the neonate.

The rare condition of neonatal uterine prolapse is usually associated with congenital spinal defects and is often resistant to simple reduction. Previously, treatment has been primarily surgical and often deforming. In this case report a silastic-ensheathed pessary fashioned from a rubber Penrose drain allowed a nonoperative, simple and permanent correction, permitting the more important, yet less obvious, associated defects to take therapeutic precedence.

Physiology of serum gastrin production in neonates and infants.

Conflicting data exist regarding the physiology of serum gastrin production in neonates and infants, and the response of the neonatal gastric antrum to feeding. Normal neonates and infants underwent serial determination of fasting and postprandial serum gastrin levels from birth to 4 months of age. The mean fasting serum gastrin levels in newborns and infants up to 4 months remained considerably higher than the mean maternal levels, the elevations being statistically significant until 2 months of age.

Home parenteral nutrition: principles and management.

The advent of parenteral nutrition techniques by Dudrick et al. (1968) has enabled the long-term survival of persons who would otherwise be unable to meet the nutritional needs necessary to sustain life. The Broviac catheter and subsequent modifications made it possible to continue such therapy on an ambulatory basis.