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Therapy and prevention of hemorrhage in hemophilia
730
of the risk of hepatitis, hemosiderosis, and development of red blood cell isoantibodies. If the hemoglobin level drops below sg/too ml, transfusion is permitted. Crises are treated with intravenous fluids, including Dextran 40, analgesics, and sedatives. Hyperbaric oxygen, urea, and potassium cyanate also have been employed. Because stress precipitates crises, every black child and adolescent should have a sickle cell preparation or hemoglobin electrophoresis prior to surgery.-Edward I. Berman Therapy and Prevention of Hemorrhage in Hemophilia. F. Keller. Schweiz. Med. Wschr. 1023310-814 (June), 1972.
Substitution therapy for hemophilia having made remarkable progress in recent decades, local therapy has become less important in comparison with general measures. Nevertheless, special precautions are still indicated for tonsillectomy (such as the cryosurgical technique) and tooth extraction (lobal therapy is recommended). General measures consist of alleviation of pain and substitution therapy. Aspirin and butazolidin are strictly contraindicated as analgeic treatment because of their inhibiting effect on platelet aggregation. Phenacetin has no coagulation-inhibiting action but should be given only for a short time. Prednisone favors hemostasis and is useful in hemorrhage that is not too protracted. Palfmm may be necessary. The use of E-aminocapronic acid is disputed. As a rule, substitution therapy is the more successful, the earlier it is given. Full blood transfusion should be given only in cases of severe blood loss. After describing a new method of factor VIII preparation, the author indicates detailed therapeutic methods for each type of hemorrhage. A case of perityphlitic abcess in a lb-yr-old hemophilic boy is reported.-C. Bretscher Hyperalimentation with Amino Acid and Casein Hydrolysate Solutions. J. C. M. Chan, M. J. Asch, S. Lin, and D. M. Hays. JAMA 220:1700-1705 (June 26), 1972.
Four premature infants, aged l-2 wk, and one lo-yr-old child who developed metabolic acidosis with continuous intravenous amino acid alimentation for extended periods, were studied before, during,
ABSTRACTS
and after the development of acidosis, to test the hypothesis that the acidosis was secondary to the excessive hydrogen iron intake from these casein hydrolysate and amino acid infusates. The conclusions revealed that the mechanism of the acidosis is not related to intrinsic renal tubular disease but simply results from the excessive exogenous hydrogen iron input from FreAmine or amigen, or both. It was also found that the maximal renal response to acidosis was achieved at a slower rate in the four infants studied than in the IO-yrold patient. Urinary bicarbonate loss was not an important mechanism in the development of acidosis. Bicarbonate infusion to correct acidosis was an effective therapy and did not cause hypernatremia, even in the low- birth-weight infant. Low-concentration amino acid solutions were found to be less acidogenic than full-strength solutions. Based on these findings, it would seem justified to recommend that acid-base determinations be performed regularly on all newborn and pediatric patients undergoing intravenous hyperalimentation. Rapid corcan be rection of metabolic acidosis achieved with sodium bicarbonate. LOWconcentration amino acid solutions should be used in premature infants, who are more prone to develop this form of acidosis. 7. E. Lewis, Ir. Continuous Parenteral Feeding by Intracaval Catheter in Children. R. RiCOUr, Cl. Nihoul-FBktM, P. Bertin, P. Royer, and D. Pellerin. Ann. Chir. Inf. 13:7-16. 1972.
Ten babies, aged 12 days to 10Y2 mo, all suffering from severe abdominal affections, were fed for periods of 7-60 days (average 3 wk) by intracaval catheter. Results were good to excellent in seven to ten cases. Three babies died (two from septicemia, one from superior vena cava thrombosis). Other complications were catheter displacement during nursing (one), superinfection of hematoma (one), venous thrombosis (two), and septicemia (five of 16 catheters). Prevention of these complications may be obtained by well-adapted catheters (caliber, fixation, position), strict aseusis by chancing filters and tubes, strict clinical and biological care, strict nursing, well-adapted sterile infusion solutions, aseptic rooms, and the taking of blood cultures
of the risk of hepatitis, hemosiderosis, and development of red blood cell isoantibodies. If the hemoglobin level drops below sg/too ml, transfusion is permitted. Crises are treated with intravenous fluids, including Dextran 40, analgesics, and sedatives. Hyperbaric oxygen, urea, and potassium cyanate also have been employed. Because stress precipitates crises, every black child and adolescent should have a sickle cell preparation or hemoglobin electrophoresis prior to surgery.-Edward I. Berman Therapy and Prevention of Hemorrhage in Hemophilia. F. Keller. Schweiz. Med. Wschr. 1023310-814 (June), 1972.
Substitution therapy for hemophilia having made remarkable progress in recent decades, local therapy has become less important in comparison with general measures. Nevertheless, special precautions are still indicated for tonsillectomy (such as the cryosurgical technique) and tooth extraction (lobal therapy is recommended). General measures consist of alleviation of pain and substitution therapy. Aspirin and butazolidin are strictly contraindicated as analgeic treatment because of their inhibiting effect on platelet aggregation. Phenacetin has no coagulation-inhibiting action but should be given only for a short time. Prednisone favors hemostasis and is useful in hemorrhage that is not too protracted. Palfmm may be necessary. The use of E-aminocapronic acid is disputed. As a rule, substitution therapy is the more successful, the earlier it is given. Full blood transfusion should be given only in cases of severe blood loss. After describing a new method of factor VIII preparation, the author indicates detailed therapeutic methods for each type of hemorrhage. A case of perityphlitic abcess in a lb-yr-old hemophilic boy is reported.-C. Bretscher Hyperalimentation with Amino Acid and Casein Hydrolysate Solutions. J. C. M. Chan, M. J. Asch, S. Lin, and D. M. Hays. JAMA 220:1700-1705 (June 26), 1972.
Four premature infants, aged l-2 wk, and one lo-yr-old child who developed metabolic acidosis with continuous intravenous amino acid alimentation for extended periods, were studied before, during,
ABSTRACTS
and after the development of acidosis, to test the hypothesis that the acidosis was secondary to the excessive hydrogen iron intake from these casein hydrolysate and amino acid infusates. The conclusions revealed that the mechanism of the acidosis is not related to intrinsic renal tubular disease but simply results from the excessive exogenous hydrogen iron input from FreAmine or amigen, or both. It was also found that the maximal renal response to acidosis was achieved at a slower rate in the four infants studied than in the IO-yrold patient. Urinary bicarbonate loss was not an important mechanism in the development of acidosis. Bicarbonate infusion to correct acidosis was an effective therapy and did not cause hypernatremia, even in the low- birth-weight infant. Low-concentration amino acid solutions were found to be less acidogenic than full-strength solutions. Based on these findings, it would seem justified to recommend that acid-base determinations be performed regularly on all newborn and pediatric patients undergoing intravenous hyperalimentation. Rapid corcan be rection of metabolic acidosis achieved with sodium bicarbonate. LOWconcentration amino acid solutions should be used in premature infants, who are more prone to develop this form of acidosis. 7. E. Lewis, Ir. Continuous Parenteral Feeding by Intracaval Catheter in Children. R. RiCOUr, Cl. Nihoul-FBktM, P. Bertin, P. Royer, and D. Pellerin. Ann. Chir. Inf. 13:7-16. 1972.
Ten babies, aged 12 days to 10Y2 mo, all suffering from severe abdominal affections, were fed for periods of 7-60 days (average 3 wk) by intracaval catheter. Results were good to excellent in seven to ten cases. Three babies died (two from septicemia, one from superior vena cava thrombosis). Other complications were catheter displacement during nursing (one), superinfection of hematoma (one), venous thrombosis (two), and septicemia (five of 16 catheters). Prevention of these complications may be obtained by well-adapted catheters (caliber, fixation, position), strict aseusis by chancing filters and tubes, strict clinical and biological care, strict nursing, well-adapted sterile infusion solutions, aseptic rooms, and the taking of blood cultures