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Total exchangeable sodium and potassium in non-pregnant women and in normal and pre-eclamptic pregnancy
Volume 78 Number 6
SELECTED ABSTRACTS
1361
The disinfection of blankets had no notable effect upon the spread of staphylococci. The use by the nurses of a hand lotion containing one per cent chlorhexidine reduced the number of staphylococci cultured from the nurses' hands but no effect upon the spread of these bacteria among infants could be demonstrated. However, the use of a dusting powder containing hexachlorophene on the umbilicus caused a pronounced reduction in staphylococcal colonization of the umbilicus. Though this needs further evaluation, the introduction of this dusting powder into a nursery was associated with a drop in staphylococcal lesions of the skin from 5.2 per cent to 2 per cent. DAVID M. KYDD Timbu...-y et a.l.:
A Staphylococcus Type-80 Epidenlic in a. l;[a.ternity Hospital, p. 1081.
An epidemic caused by staphylococcus phage Type 80 occurred in a Maternity Hospital with 120 beds divided into 3 separate units. The babies normally stayed beside their mothers' beds but were taken to the nursery attached to each unit for bathing, changing, or if they were noisy. Infants who became ill were transferred to a ''sick nursery,'' of which a pediatrician was in charge. Prior to the epidemic, mild infections due to Staphylococcus au;reus were common in the "sick nursery" and phage typing of the organisms that were isolated showed a variety of strains but no Type 80 was found before the epidemic. Type 80 was isolated from a submandibular abscess and during the 6 subsequent weeks, until the hospital was closed, this organism caused 14 of the 18 infections appearing in the ''sick nursery.'' Nine of these 18 infections were serious (abscesses, pneumonia, and one case of osteitis) and all of these serious infections were caused by Type 80. Five of these 9 in· fants died. In addition, 2 children who were treated in one of the units other than in the "sick nursery" died of Type 80 staphylococcus infections, and one child died a week after being discharged in apparent good health on the eighth day. The responsible organism in the last child, however, was Type 29/7 rather than 80. After the hospital was closed, 38 per cent of 475 hospital personnel were found to have Staphylococcus aureus in their nasal cultures but only 3 persons harbored the epidemic strain. Of these one was a maid who did not work in the wards, and 2 were nurses. The latter, because they developed boils after the start of the epidemic, were considered to be victims of Type 80 rather than the source. In the fifth week of the epidemic, nasal swabs were taken from 16 healthy babies in the units. \Vhen cultured, 13 of these were positive :for staphylococcus but only 3 of these were Type 80. When the hospital was closed, various fomites, including dust and furniture, were cultured. Staphylococci were found often enough but Type 80 only once (in a communal blanket). After discharge, 21 of 99 babies developed an infection but all but one of these were mild. Cultures of 20 lesions yielded only 4 Type 80 organisms and 12 other types of staphylococci ( 10 penicillin-resistant and 2 penicillin-sensitive). One month after discharge 17 of 18 babies had staphylococci in their noses but only 4 had Type 80. Four months after discharge only 7 of 16 babies harbored staphylococci and of these 2 were Type 80. After dosing, the whole hospital was disinfected by spraying with 10 per cent liquid formaldehyde and the textiles were all sterilized with steam under pressure. The hospital was reopened 18 days later and, although staphylococcus infections have occurred, no Type 80 has been found. This epidemic, thus, was caused by a virulent Type 80 strain of Staphylococcus au,reus. The strain appeared suddenly and spread rapidly despite its low power to colonize in the nasal passages of those who cared for the babies. Also, there was no indication that the strain tended to persist unduly in the noses of children who were known to harbor this type of staphylococcus. DAVID
M.
KYDD
MacGillivray and Buchanan: Total Exchangeable Sodium and Potassium in Non-Pregnant Women and in Normal and Pre-Eclamptic Pregnancy, p. 1090. With the method of Robinson, Arons, and Solomon (J. Clin. Invest. 34: 134, 1955), the exchangeable sodium and potassium was determined in 24 nonpregnant women and in four
1362
SELECTED ABSTRACTH
Am.
J. Ob't.
& Gynec, December, 1959
groups of primigravidas (8 with normal pregnancies in the first trimester, 16 with normal pregnancies in the last trimester, 16 with mild pre-eclampsia, and 16 with se,·ere preeclampsia). In these five groups the range of values obtained for exchangeable sodium were: nonpregnant 1,645-2,870 mEq. (average 2,265 mEq.), early pregnancy 2,035-:!_,655 mEq. (average 2,248 mEq.), late pregnancy 2,360-3,515 mEq. (average 3,021 mEq.), mild preeclampsia 2,600-3,730 mEq. (average 3,104 mEq.), severe pre-eclampsia 2,425-3,760 mEq. (average 3,126 rnEq.). The age, weight, height, and surface area were trieu as independent variables and weight was found to be the best single variable. The average results expresHed as mEq. Na• per kilogram body weight were: nonpregnant 41.5, early pregnaney ·Hi.2, late pregnancy 48.3, mild pre-eclampsia 44.0, anu some pre-eclampsia 43.8. These result~ wer•.• interpreted as showing tha.t in pregnanc.y the total exchangeable sodium is increa~t'<.l and in late pregnancy is increased still more. In both mild and severe pre-eclampsia, however, the exchangeable sodium is less than in normal pregnancy and no significant diffc·retwe was found between mild and severe pre-eclampsia. In these same five groups, the range of values obtained for excltange!tbl•l potassium were: nonpregnant 1,770-3,025 mEq. (average 3,370 mEq.), early pregnancy 1,465-2,275 mEq. (average 1,982 mEq.), late pregnancy 2,100-2,950 mEq. (average 2,541 mEq.), rnilU preeclampsia 1,970-3,·150 mEq. (average 2,602 mEq.), severe pre-eclampsia 2,005-2,795 mEq. (average 2,495 mEq.). 'I'he average results expressed as mEq. K• per kilogram body weight were: nonpregnant 43.6, early pregnancy 40.4, late pregnancy 40.8, mild pre-eclampsitn•atcd with atropine. DAVIll
M.
KYIJ!J
Aitken et al.: Oestrogen and Progesterone Levels in Foetal and Maternal Plasma at Parturition, p. 1096. Estrone, estradiol-17B, estriol, and progesterone were determined in the maternal and fetal cord plasma in two groups of patients: (A) 7 patients who were delivered by cesa.rean section for a variety of reasons between the thirty-fifth and forty-first weeks of gestation; (B) 8 patients who were delivered by normal labor between the thirty-eighth and forty-first weeks of gestation. In Group A the mean values obtained in maternal plasma for estrone, estradiol-17B, estriol, and progesterone, respectively, were: 26.6 (S.D. 13.5), 2.8 (S.D. 1.0), 24.4 (S.D. 10.1), and 13.0 (S.D. 5.4) p.g per 100 milliliters. In Group B the mean value~ were 12.0 (S.D. 5.5), 2.2 (S.D. 1.7), 17.8 (S.D. 1.7) 1 and 11.3 (S.D. 4.1). In fetal plasma
SELECTED ABSTRACTS
1361
The disinfection of blankets had no notable effect upon the spread of staphylococci. The use by the nurses of a hand lotion containing one per cent chlorhexidine reduced the number of staphylococci cultured from the nurses' hands but no effect upon the spread of these bacteria among infants could be demonstrated. However, the use of a dusting powder containing hexachlorophene on the umbilicus caused a pronounced reduction in staphylococcal colonization of the umbilicus. Though this needs further evaluation, the introduction of this dusting powder into a nursery was associated with a drop in staphylococcal lesions of the skin from 5.2 per cent to 2 per cent. DAVID M. KYDD Timbu...-y et a.l.:
A Staphylococcus Type-80 Epidenlic in a. l;[a.ternity Hospital, p. 1081.
An epidemic caused by staphylococcus phage Type 80 occurred in a Maternity Hospital with 120 beds divided into 3 separate units. The babies normally stayed beside their mothers' beds but were taken to the nursery attached to each unit for bathing, changing, or if they were noisy. Infants who became ill were transferred to a ''sick nursery,'' of which a pediatrician was in charge. Prior to the epidemic, mild infections due to Staphylococcus au;reus were common in the "sick nursery" and phage typing of the organisms that were isolated showed a variety of strains but no Type 80 was found before the epidemic. Type 80 was isolated from a submandibular abscess and during the 6 subsequent weeks, until the hospital was closed, this organism caused 14 of the 18 infections appearing in the ''sick nursery.'' Nine of these 18 infections were serious (abscesses, pneumonia, and one case of osteitis) and all of these serious infections were caused by Type 80. Five of these 9 in· fants died. In addition, 2 children who were treated in one of the units other than in the "sick nursery" died of Type 80 staphylococcus infections, and one child died a week after being discharged in apparent good health on the eighth day. The responsible organism in the last child, however, was Type 29/7 rather than 80. After the hospital was closed, 38 per cent of 475 hospital personnel were found to have Staphylococcus aureus in their nasal cultures but only 3 persons harbored the epidemic strain. Of these one was a maid who did not work in the wards, and 2 were nurses. The latter, because they developed boils after the start of the epidemic, were considered to be victims of Type 80 rather than the source. In the fifth week of the epidemic, nasal swabs were taken from 16 healthy babies in the units. \Vhen cultured, 13 of these were positive :for staphylococcus but only 3 of these were Type 80. When the hospital was closed, various fomites, including dust and furniture, were cultured. Staphylococci were found often enough but Type 80 only once (in a communal blanket). After discharge, 21 of 99 babies developed an infection but all but one of these were mild. Cultures of 20 lesions yielded only 4 Type 80 organisms and 12 other types of staphylococci ( 10 penicillin-resistant and 2 penicillin-sensitive). One month after discharge 17 of 18 babies had staphylococci in their noses but only 4 had Type 80. Four months after discharge only 7 of 16 babies harbored staphylococci and of these 2 were Type 80. After dosing, the whole hospital was disinfected by spraying with 10 per cent liquid formaldehyde and the textiles were all sterilized with steam under pressure. The hospital was reopened 18 days later and, although staphylococcus infections have occurred, no Type 80 has been found. This epidemic, thus, was caused by a virulent Type 80 strain of Staphylococcus au,reus. The strain appeared suddenly and spread rapidly despite its low power to colonize in the nasal passages of those who cared for the babies. Also, there was no indication that the strain tended to persist unduly in the noses of children who were known to harbor this type of staphylococcus. DAVID
M.
KYDD
MacGillivray and Buchanan: Total Exchangeable Sodium and Potassium in Non-Pregnant Women and in Normal and Pre-Eclamptic Pregnancy, p. 1090. With the method of Robinson, Arons, and Solomon (J. Clin. Invest. 34: 134, 1955), the exchangeable sodium and potassium was determined in 24 nonpregnant women and in four
1362
SELECTED ABSTRACTH
Am.
J. Ob't.
& Gynec, December, 1959
groups of primigravidas (8 with normal pregnancies in the first trimester, 16 with normal pregnancies in the last trimester, 16 with mild pre-eclampsia, and 16 with se,·ere preeclampsia). In these five groups the range of values obtained for exchangeable sodium were: nonpregnant 1,645-2,870 mEq. (average 2,265 mEq.), early pregnancy 2,035-:!_,655 mEq. (average 2,248 mEq.), late pregnancy 2,360-3,515 mEq. (average 3,021 mEq.), mild preeclampsia 2,600-3,730 mEq. (average 3,104 mEq.), severe pre-eclampsia 2,425-3,760 mEq. (average 3,126 rnEq.). The age, weight, height, and surface area were trieu as independent variables and weight was found to be the best single variable. The average results expresHed as mEq. Na• per kilogram body weight were: nonpregnant 41.5, early pregnaney ·Hi.2, late pregnancy 48.3, mild pre-eclampsia 44.0, anu some pre-eclampsia 43.8. These result~ wer•.• interpreted as showing tha.t in pregnanc.y the total exchangeable sodium is increa~t'<.l and in late pregnancy is increased still more. In both mild and severe pre-eclampsia, however, the exchangeable sodium is less than in normal pregnancy and no significant diffc·retwe was found between mild and severe pre-eclampsia. In these same five groups, the range of values obtained for excltange!tbl•l potassium were: nonpregnant 1,770-3,025 mEq. (average 3,370 mEq.), early pregnancy 1,465-2,275 mEq. (average 1,982 mEq.), late pregnancy 2,100-2,950 mEq. (average 2,541 mEq.), rnilU preeclampsia 1,970-3,·150 mEq. (average 2,602 mEq.), severe pre-eclampsia 2,005-2,795 mEq. (average 2,495 mEq.). 'I'he average results expressed as mEq. K• per kilogram body weight were: nonpregnant 43.6, early pregnancy 40.4, late pregnancy 40.8, mild pre-eclampsi
M.
KYIJ!J
Aitken et al.: Oestrogen and Progesterone Levels in Foetal and Maternal Plasma at Parturition, p. 1096. Estrone, estradiol-17B, estriol, and progesterone were determined in the maternal and fetal cord plasma in two groups of patients: (A) 7 patients who were delivered by cesa.rean section for a variety of reasons between the thirty-fifth and forty-first weeks of gestation; (B) 8 patients who were delivered by normal labor between the thirty-eighth and forty-first weeks of gestation. In Group A the mean values obtained in maternal plasma for estrone, estradiol-17B, estriol, and progesterone, respectively, were: 26.6 (S.D. 13.5), 2.8 (S.D. 1.0), 24.4 (S.D. 10.1), and 13.0 (S.D. 5.4) p.g per 100 milliliters. In Group B the mean value~ were 12.0 (S.D. 5.5), 2.2 (S.D. 1.7), 17.8 (S.D. 1.7) 1 and 11.3 (S.D. 4.1). In fetal plasma