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Prevention of traveler's diarrhea (emporiatric enteritis)
ABSTRACTS
solution was changed to 2 solutions, one containing 60 mEq/liter of calcium for the first 12 hr of the day followed by a second one containing 40 mEq/liter phosphate. The bady died shortly afterward and there was pathologic evidence of subperiosteal new bone formation suggesting scurvy. They recommend giving 80 mg/kg per day of calcium rather than the 50 m g / k g / d a y supplied in the usual TPN solution. Such doses of calcium will require separation of the calcium and phosphate into two separate infusions daily.--David L. Collins Laboratory Monitoring of Parenteral Nutrition-Associated Hepatic Dysfunction in Infants. R. J. lnwood, R. A. Vileisis,
C. E. Hunt, et al. Isr J Med Sci 16:212, (March), 1980. Hepatic dysfunction in both cholestatic jaundice and hepatocellular damage, is a recognized complication of parenteral nutrition (PN). To define the temporal relationship of the development of cholestasis to hepatoce)lular damage, total and direct bilirubin, serum alanine aminotransferase (SGPT), serum aspartate aminotransferase (SGOT) and alkaline phosphatase were measured weekly in 60 consecutive neonates receiving PN. Elevation of direct bilirubin was the earliest indicator of hepatic dysfunction in infants receiving PN. Significant cholestatic jaundice, as defined by a direct bilirubin >_2.0 mg/dl, developed in 33% (11/33) of infants receiving PN for at least 2 wk, but in no infant receiving PN for less than 2 wk. Hepatocellular damage, as defined by significantly elevated SGOT and SGPT values, occurred only 2 wk following the onset of significant cholestatic jaundice. Although alkaline phosphatase values increased during the course of PN, there was no correlation with cholestasis. In summary, cholestatic jaundice is the earliest indication of PN-associated hepatic dysfunction. Thus, only direct bilirubin need be measured serially to evaluate hepatic dysfunction in infants receiving PN. SGOT and SGPT are helpful in characterizing dysfunction once cholestatic jaundice has occurred, but alkaline phosphatase levels are not helpful.--Shemuel Nissan Effects of Prolonged Use of Intravenous Fat Emulsion on Jejunal Mucosa. T. C. laneu, Y. Bujanover, Z. Freier, et al.
Isr J Med Sci 16:212, (March), 1980. This report describes ultrastructual abnormalities in the jejunal mucosa of four infants treated daily with a soy fat emulsion (Intralipid, Vitrum, Sweden) as part of a parenteral alimentation regimen. Light microscopic examination showed only mild, nonspecific changes, but electron microscopy disclosed a multitude of electron-dense, osmophilic lipid droplets located within the epithelium, lamina propria and in the intercellular spaces. Higher magnifications showed the droplets to be in relationship with membranous material forming typical phospholipid arrays. An excessive number of compound lysosomes containing lipid and membranous material was noted in the epithelial cells. After the intralipid infusions were discontinued, repeated biopsies showed normal mucosa without any evidence of lipid droplets or excessive compound lysosomes. The described lipid droplets were similar in size and appearance to those seen in the liver of patients receiving intravenous fat emulsions, but smaller than the so-called "intravenous fat pigment." Further studies are under way to establish the conditions under which
979
parenterally infused fat can accumulate within cells of the jejunal mucosa and possibly in other tissues as well.-Shemuel Nissan Prevention of Traveler's Diarrhea (Emporiatric Enteritis).
H. L. DuPont, P. Sullivan, D. G. Evans, et al. J A M A 243(3):237 241, (January), 1980. Although the subject to this article is not pediatric surgery, it is of interest to pediatric surgeons planning to journey to tropical climes for conventions or other activities. The study, which was supported by Norwich-Eaton Pharmaceuticals, the makers of Pepto-Bismol, consisted of 128 students traveling to Guadalajara, Mexico for summer classes in 1977 sponsored by the University of Arizona and the University of San Diego. A double-blind, randomized, placebo-controlled trial was done. Of 62 students, 23% drinking 8 oz of Pepto-Bismol daily developed diarrhea, whereas 61% of 66 students taking a placebo became afflicted. They felt that the protective effect of the subsalicylate bismuth became apparent in a day or two and became more obvious as the number of days at risk increased. If diarrhea did occur, enteropathogens were less commonly identified in the stools of students receiving subsalicylate bismuth (33%) compared to 71% in the placebo group.--Davi d L. Collins Evaluation of a New Product for Sutureless Skin Closure. S~
Westaby. Ann Royal Coil Surg R. C. S. 62(2):129-132, 1980. This report is based on observations of sutureless skin closure in 100 patients using Op-Site skin closure. Using this material an accurate skin edge apposition and fixation was easily achieved provided the underlying fat and muscle layers were closed meticulously to eliminate dead space. This method was used for a variety of abdominal (36) and thoracic (64) operations, in 94 cases the results were satisfactory with excellent cosmetic appearance. There were 6 wound infections, 3 thoracotomies, 2 laparotomies, and 1 appendicectomy. The author felt that as well as better cosmetic result there was a decrease rate of infection, the patients felt more comfortable and it was more convenient for them than the more conventional method of wound closures using sutures.--J. Lari Wound Infection: a Controlled Clinical and Experimental Demonstration of Synergy Between Aerobic (Escherichia co~i) and Anaerobic (Bacteroides fragilis) Bacteria. M . J.
Kelly. Ann Royal Coil Surg 62(1):52-59, 1980. Pathogenic synergy between Escherichia coil and Bacteroidesfragilis was suggested by clinical trials and proved to exist in an experimental guinea pig wound model. The clinical trial consisted of 214 patients undergoing transperitoneal operations. Positive operative wound swabs were obtained in 51 cases and 19 developed wound infection. The correlation between wound swab growth and later wound infection was as follows: Swab sterile 1%, anaerobes alone 13%, aerobes alone 22%, mixed aerobes and anaerobes 71%. The guinea pig experimental wound model consisted of inoculation of 2 cm skin wounds of guinea-pigs with bacterial suspension containing dilution of either E. coil or B. fragilis or their mixture. Guinea-pigs are relatively susceptible to E.
solution was changed to 2 solutions, one containing 60 mEq/liter of calcium for the first 12 hr of the day followed by a second one containing 40 mEq/liter phosphate. The bady died shortly afterward and there was pathologic evidence of subperiosteal new bone formation suggesting scurvy. They recommend giving 80 mg/kg per day of calcium rather than the 50 m g / k g / d a y supplied in the usual TPN solution. Such doses of calcium will require separation of the calcium and phosphate into two separate infusions daily.--David L. Collins Laboratory Monitoring of Parenteral Nutrition-Associated Hepatic Dysfunction in Infants. R. J. lnwood, R. A. Vileisis,
C. E. Hunt, et al. Isr J Med Sci 16:212, (March), 1980. Hepatic dysfunction in both cholestatic jaundice and hepatocellular damage, is a recognized complication of parenteral nutrition (PN). To define the temporal relationship of the development of cholestasis to hepatoce)lular damage, total and direct bilirubin, serum alanine aminotransferase (SGPT), serum aspartate aminotransferase (SGOT) and alkaline phosphatase were measured weekly in 60 consecutive neonates receiving PN. Elevation of direct bilirubin was the earliest indicator of hepatic dysfunction in infants receiving PN. Significant cholestatic jaundice, as defined by a direct bilirubin >_2.0 mg/dl, developed in 33% (11/33) of infants receiving PN for at least 2 wk, but in no infant receiving PN for less than 2 wk. Hepatocellular damage, as defined by significantly elevated SGOT and SGPT values, occurred only 2 wk following the onset of significant cholestatic jaundice. Although alkaline phosphatase values increased during the course of PN, there was no correlation with cholestasis. In summary, cholestatic jaundice is the earliest indication of PN-associated hepatic dysfunction. Thus, only direct bilirubin need be measured serially to evaluate hepatic dysfunction in infants receiving PN. SGOT and SGPT are helpful in characterizing dysfunction once cholestatic jaundice has occurred, but alkaline phosphatase levels are not helpful.--Shemuel Nissan Effects of Prolonged Use of Intravenous Fat Emulsion on Jejunal Mucosa. T. C. laneu, Y. Bujanover, Z. Freier, et al.
Isr J Med Sci 16:212, (March), 1980. This report describes ultrastructual abnormalities in the jejunal mucosa of four infants treated daily with a soy fat emulsion (Intralipid, Vitrum, Sweden) as part of a parenteral alimentation regimen. Light microscopic examination showed only mild, nonspecific changes, but electron microscopy disclosed a multitude of electron-dense, osmophilic lipid droplets located within the epithelium, lamina propria and in the intercellular spaces. Higher magnifications showed the droplets to be in relationship with membranous material forming typical phospholipid arrays. An excessive number of compound lysosomes containing lipid and membranous material was noted in the epithelial cells. After the intralipid infusions were discontinued, repeated biopsies showed normal mucosa without any evidence of lipid droplets or excessive compound lysosomes. The described lipid droplets were similar in size and appearance to those seen in the liver of patients receiving intravenous fat emulsions, but smaller than the so-called "intravenous fat pigment." Further studies are under way to establish the conditions under which
979
parenterally infused fat can accumulate within cells of the jejunal mucosa and possibly in other tissues as well.-Shemuel Nissan Prevention of Traveler's Diarrhea (Emporiatric Enteritis).
H. L. DuPont, P. Sullivan, D. G. Evans, et al. J A M A 243(3):237 241, (January), 1980. Although the subject to this article is not pediatric surgery, it is of interest to pediatric surgeons planning to journey to tropical climes for conventions or other activities. The study, which was supported by Norwich-Eaton Pharmaceuticals, the makers of Pepto-Bismol, consisted of 128 students traveling to Guadalajara, Mexico for summer classes in 1977 sponsored by the University of Arizona and the University of San Diego. A double-blind, randomized, placebo-controlled trial was done. Of 62 students, 23% drinking 8 oz of Pepto-Bismol daily developed diarrhea, whereas 61% of 66 students taking a placebo became afflicted. They felt that the protective effect of the subsalicylate bismuth became apparent in a day or two and became more obvious as the number of days at risk increased. If diarrhea did occur, enteropathogens were less commonly identified in the stools of students receiving subsalicylate bismuth (33%) compared to 71% in the placebo group.--Davi d L. Collins Evaluation of a New Product for Sutureless Skin Closure. S~
Westaby. Ann Royal Coil Surg R. C. S. 62(2):129-132, 1980. This report is based on observations of sutureless skin closure in 100 patients using Op-Site skin closure. Using this material an accurate skin edge apposition and fixation was easily achieved provided the underlying fat and muscle layers were closed meticulously to eliminate dead space. This method was used for a variety of abdominal (36) and thoracic (64) operations, in 94 cases the results were satisfactory with excellent cosmetic appearance. There were 6 wound infections, 3 thoracotomies, 2 laparotomies, and 1 appendicectomy. The author felt that as well as better cosmetic result there was a decrease rate of infection, the patients felt more comfortable and it was more convenient for them than the more conventional method of wound closures using sutures.--J. Lari Wound Infection: a Controlled Clinical and Experimental Demonstration of Synergy Between Aerobic (Escherichia co~i) and Anaerobic (Bacteroides fragilis) Bacteria. M . J.
Kelly. Ann Royal Coil Surg 62(1):52-59, 1980. Pathogenic synergy between Escherichia coil and Bacteroidesfragilis was suggested by clinical trials and proved to exist in an experimental guinea pig wound model. The clinical trial consisted of 214 patients undergoing transperitoneal operations. Positive operative wound swabs were obtained in 51 cases and 19 developed wound infection. The correlation between wound swab growth and later wound infection was as follows: Swab sterile 1%, anaerobes alone 13%, aerobes alone 22%, mixed aerobes and anaerobes 71%. The guinea pig experimental wound model consisted of inoculation of 2 cm skin wounds of guinea-pigs with bacterial suspension containing dilution of either E. coil or B. fragilis or their mixture. Guinea-pigs are relatively susceptible to E.