Levels of dichlorodiphenyltrichloroethane and hexachlorocyclohexane in human adipose tissue of the Indian population

Concentrations of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) were determined in 313 human omental fat samples collected from subjects from all five zones of India during 1977-1980. The median concentration of 2,2-bis-(p-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), total DDT, beta HCH, and total HCH were 3.4, 6.0, 1.3, and 1.9 mg/kg, respectively. The calculated national mean levels for DDT and HCH were 11.1 and 3.5 mg/kg, respectively. Although the values of DDT and HCH were not as high as those reported earlier, there is still a need for close monitoring of the bioaccumulation of these chemical residues in the Indian population.

Pediatric parenteral amino acid mixture in low birth weight infants

A mixture of amino acids designed to maintain normal plasma amino acid concentrations in infants and children requiring parenteral nutrition was evaluated in 28 low birth weight (LBW) infants (birth weight, 750 to 1750 g; postnatal age, 1 to 4 weeks) who required parenteral nutrients for optimal nutritional management. Sixteen babies received only parenteral nutrients for five to 21 days. Ten of these received a typical regimen by peripheral vein (1.91 +/- 0.16 g/kg/d of amino acids and 44.7 +/- 4.4 kcal/kg/d) and six received a typical regimen through a central vein (2.39 +/- 0.11 g/kg/d of amino acids and 95.9 +/- 14.5 kcal/kg/d). Mean weight gain of the peripheral vein subgroup was 10.3 +/- 10.6 g/kg/d; mean nitrogen balance was 230 +/- 66 mg/kg/d. Both the mean rate of weight gain (17.2 +/- 5.1 g/kg/d) and the mean rate of nitrogen retention (267 +/- 49 g/kg/d) of the central vein subgroup were similar to intrauterine rates. In these two subgroups as well as the total population, plasma concentrations of all amino acids except phenylalanine were within the 95% confidence limits of the plasma concentrations observed in LBW infants fed sufficient amounts of human milk to result in a rate of weight gain similar to the intrauterine rate. However, although plasma tyrosine and cyst(e)ine concentrations were within the 95% confidence limits of the plasma concentrations goals, the LBW infant's ability to use N-acetyl-L-tyrosine and cysteine HCl appears to be even less than that of the term infant and older child. In toto, these data support the efficacy of the amino acid mixture evaluated for LBW infants. Of equal importance, they suggest that the LBW infant's ability to use parenterally delivered amino acids is not as limited as commonly thought.

Protein quality in feeding low birth weight infants: a comparison of whey-predominant versus casein-predominant formulas

Growth (delta weight, delta length, delta head circumference, and delta skinfold thickness), nitrogen retention, and chemical indices of metabolic tolerance (BUN concentration and acid-base status; plasma amino acid concentrations including free and bound cyst(e)ine; urinary excretion of sulfur amino acids) were determined serially in low birth weight infants (900 to 1,750 g) fed formulas differing only in protein quality. One contained unmodified bovine milk protein (a ratio of whey proteins to caseins of 18:82); the other contained modified bovine milk protein (a ratio of whey proteins to caseins of 60:40). Both provided protein and energy intakes, respectively, of approximately 3.4 g/kg/d and 120 kcal/kg/d. Neither weight gain nor the rate of increase in length, head circumference, and skinfold thickness differed between the two groups. Nitrogen retention of the two groups also did not differ. Although BUN concentration and blood acid-base status did not differ, there were differences in the plasma concentrations of some amino acids. Plasma tyrosine concentration was higher in infants fed the casein-predominant protein, and plasma threonine concentration was higher in infants fed the whey-predominant protein. Neither plasma-free nor bound cyst(e)ine concentration differed between the two groups, but the greater cyst(e)ine intake of the whey-predominant group resulted in greater cyst(e)ine retention; this was accompanied by greater urinary taurine excretion, a reflection of greater taurine stores.

Spontaneous rupture of the tibialis anterior tendon. A case report

Spontaneous rupture of the tibialis anterior tendon occurred in a 65-year-old man with diabetes mellitus. Treatment with sliding tendon lengthening of the proximal portion of the tibialis anterior tendon was successful. This unusual injury occurs in diabetics older than 45 years of age, following minor trauma. The condition can be misdiagnosed as peroneal nerve deficit. Tibialis anterior tendon deficit should be included in the differential diagnosis of patients with isolated weakness of foot dorsiflexion.

Effects of varying protein and energy intakes on growth and metabolic response in low birth weight infants

Growth (weight, length, head circumference, and skinfold thickness), retention of major nutrients (nitrogen, sodium, potassium, chloride, calcium, and phosphorus), and chemical indices of protein adequacy (plasma albumin and transthyretin concentrations) and excess (blood urea nitrogen concentration and acid-base status; plasma amino acid concentrations) were determined serially from the time desired intake was tolerated until discharge weight (2200 gm) was reached in low birth weight infants (birth weight 900 to 1750 gm) fed one of three formulas, which provided protein and energy intakes, respectively, of 2.24 gm/kg/day and 115 kcal/kg/day (group 1), 3.6 gm/kg/day and 115 kcal/kg/day (group 2), and 3.5 gm/kg/day and 149 kcal/kg/day (group 3). Weight gain and rate of increase in length and head circumference were less in group 1 than in groups 2 and 3. Retention of most major nutrients also was less in group 1, as was blood urea nitrogen concentration, plasma albumin and transthyretin concentrations, and plasma concentrations of several amino acids. The rate of weight gain was not significantly greater in group 3 than in group 2, but the rate of increase in skinfold thickness was greater in this group. Neither nutrient retention nor metabolic indices differed between groups 2 and 3. These results suggest that a protein intake of 2.24 gm/kg/day is inadequate for the type of LBW infants studied, that the higher protein intakes are well tolerated, and that an energy intake of 149 vs 115 kcal/kg/day does not enhance utilization of the higher protein intakes studied.

An analysis of the variability in estimates of bioenergetic variables in preterm infants

Estimates of average daily energy expenditure and minimal observed oxygen consumption are commonly used to characterize the energy metabolism of neonates. Yet, the errors inherent in these estimates have not been defined. Using measurements of oxygen consumption and carbon dioxide production made in healthy growing low birth weight infants during eight consecutive 3-h interfeeding epochs, we have determined the variability in the mean oxygen consumption, carbon dioxide production, respiratory quotient, total daily energy expenditure, and the minimal observed oxygen consumption among the feeding epochs. The coefficient of variation for oxygen consumption ranged from 3.1 to 9.1%, for minimal observed oxygen consumption from 3.7 to 16.7%, for carbon dioxide production from 3.3 to 7.4%, and for total daily energy expenditure from 2.9 to 7.6%. The SDs for respiratory quotient ranged from 0.008 to 0.066. From these 24-h data we have calculated the error in predicting daily estimates of the mean values for these variables if observations are made for less than 24 h. As expected, this error decreases with increasing duration of observation. These data should prove useful in the design and interpretation of investigations of neonatal energy expenditure.

Rapid controlled thawing of fresh-frozen plasma in a modified microwave oven

A microwave oven has been specifically modified to permit rapid thawing of fresh-frozen plasma (FFP) by using a rotating disc with a temperature sensor to hold the plasma bag. This modification makes it possible to mix the FFP continuously during thawing, and automatically shuts the oven off when the plasma reaches 21 degrees C. Comparisons were made between FFP thawed in the modified microwave oven and FFP thawed conventionally in a 37 degrees C waterbath. The following tests were done: total protein, albumin, and immunoglobulin concentrations; plasma fibrinogen, factor VIII, and factor IX activities; protein electrophoresis, albumin aggregation, hemolytic complement activity, and plasma particle count and size. In no case was there a significant difference between plasma thawed in the microwave oven compared with that thawed in the waterbath. Further, microwave thawing was reliable and rapid; all units of FFP thawed in less than 6 minutes, and the thawed plasma did not vary by more than 6 degrees C from the preselected final temperature of 21 degrees C. Thus, it appears that controlled thawing of FFP in a microwave oven specifically designed for this purpose is an effective and reliable method and has many advantages over conventional thawing of FFP.