[Intravenous administration of lipids in parenteral nutrition of preterm and newborn infants]

Total or supplementary parenteral nutrition is a main part of therapy of sick preterm and newborn infants. It becomes necessary when oral feeding is not or not completely possible. Administration of lipids for parenteral feeding has the following advantages: 1. well-balanced nutrition concerning calories, 2. high energy density in low volume, 3. blood isotonicity, 4. infusion into peripheral veins is possible, 5. lack of essential fatty acids is avoided. Before starting parenteral nutrition, acidosis, hypoxaemia, hyperglycaemia and insufficient circulation must have been treated. The fat supply is being increased step-wise up to a dosage of 2--3 g/kg bwt/day whilst controlling the serum triglyceride concentration. The fat emulsion is continuously applied for 24 h. Contraindications to this are shock, disturbances of blood coagulation and of fat metabolism. Complications are avoided by an appropriate and standardized nutritional programme and sufficient clinical and laboratory control.

Unilateral spondylolysis

Five vertebrae with unilateral spondylolysis are presented. The associated asymmetry of the posterior elements supports the concept of a localised form of growth deficiency. The defect is difficult to demonstrate radiologically, and is perhaps present more frequently than is recognised. It should be suspected clinically from asymmetry of the neural arch and from unilateral wedging of the vertebral body, and may be demonstrated by further radiographic examination. The clinical significance is uncertain, but one patient is presented in whom unilateral spondylolysis was associated with intermittent sciatic pain.

Adjuvant radiation therapy in colorectal carcinoma

A series of sixty-five patients with adenocarcinoma of the rectum and rectosigmoid is reviewed. Thirty-two patients had surgery alone, fourteen patients underwent postoperative radiation therapy, and nineteen patients underwent preoperative radiation therapy. A moderate dose program of 4,000 to 4,500 r was used. The postoperative treatment group had a higher incidence of stage C lesions and a higher recurrence rate, but there were no statistically significant differences in survival. Postoperative radiation therapy in patients with stage C lesions did not prolong life and is of little benefit. The preoperative treatment group tolerated the radiation very well, and there were no major complications. Eight patients underwent anterior resections in irradiated fields. Two minor anastomotic leaks subsequently healed spontaneously. There were no pelvic recurrences in the preoperative treatment group, and the incidence of lymph node metastases was 26% as opposed to 41% in controls. We conclude that preoperative moderate dose radiation is not associated with increased risk of morbidity or mortality. It may be useful in reducing the incidence of lymph node metastases and pelvic recurrence. The effect on survival is not determined in this study.

An acute abdomen: spontaneous rupture of liver during pregnancy

Spontaneous rupture of liver during pregnancy is presented as an example of an acute abdomen admitted to a casualty department of a general hospital. The literature is reviewed and emphasis is placed on clinical awareness and earlier diagnosis as a means to reduce the high mortality.

Regulation of cell cycle stage-specific transcription of histone genes from chromatin by non-histone chromosomal proteins

RNA transcripts from chromatin of S phase but not G1 cells contain histone-specific sequences. Chromatin reconstituted with S phase non-histone chromosomal proteins transcribes histone messenger RNA sequences whereas chromatin reconstituted with G1 non-histone proteins does not. These results suggest that transcription of histone genes is regulated during the cell cycle and that non-histone proteins have a key role in this regulation.

Clinical choriomatosis

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