Catheter-related sepsis in long-term parenteral nutrition with Broviac catheters. An evaluation of different disinfectants

From April 1976 to January 1988, 58 patients received home parenteral nutrition for 2-138 months, median 36 months, corresponding to a total treatment period of 233 patient years. Before 1980 and after 1985, 0.5-2% iodine tincture or 0.5% chlorhexidine in 70% ethyl alcohol were used to disinfect the exit site of the catheter and the connections of the infusion line. In these periods the sepsis incidence was 0.25-0.28 per catheter year, corresponding to one episode of sepsis per 3.6-4.0 catheter years. In the period 1980 to 1985, 10% povidone-iodine (Isobetadine) was used, and the incidence in this period was 0.58, corresponding to one episode of sepsis per 1.7 catheter year. This suggests that 10% povidone-iodine may be inferior to iodine-tincture and chlorhexidine alcohol in this type of catheter care. The incidence of catheter sepsis was 0.32 per catheter year when the catheter was placed on the chest and 0.86 per catheter year with the catheter on the thigh. Klebsiella pneumoniae was the most common microorganism grown when the catheter was placed on the thigh, while coagulase-negative staphylococci were most common when the catheter was placed on the chest.

Resolution, absolute stereochemistry, and enantiopharmacology of the GluR1-4 and GluR5 antagonist 2-amino-3-[5-tert-butyl-3-(phosphonomethoxy)-4-isoxazolyl]propionic acid

The phosphono amino acid, (RS)-2-amino-3-[5-tert-butyl-3-(phosphonomethoxy)-4-isoxazolyl+ ++]propio nic acid (ATPO), is a structural hybrid between the NMDA antagonist (RS)-2-amino-7-phosphonoheptanoic acid (AP7) and the AMPA and GluR5 agonist, (RS)-2-amino-3-(5-tert-butyl-3-hydroxy-4-isoxazolyl)propionic acid (ATPA). ATPO has been resolved into (S)-ATPO and (R)-ATPO using chiral HPLC, and the absolute stereochemistry of the two enantiomers was established by an X-ray crystallographic analysis of (R)-ATPO. (S)-ATPO and (R)-ATPO were characterized pharmacologically using rat brain membrane binding and electrophysiologically using the cortical wedge preparation as well as homo- or heteromeric GluR1-4, GluR5-6, and KA2 receptors expressed in Xenopus oocytes. (R)-ATPO was essentially inactive as an agonist or antagonist in all test systems. (S)-ATPO was an inhibitor of the binding of [(3)H]AMPA (IC(50) = 16 +/- 1 microM) and of [(3)H]-6-cyano-7-nitroquinoxaline-2,3-dione ([(3)H]CNQX) (IC(50) = 1.8 +/- 0.2 microM), but was inactive in the [(3)H]kainic acid and the [(3)H]-(RS)-3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid ([(3)H]CPP) binding assays. (S)-ATPO did not show detectable agonist effects at any of the receptors under study, but antagonized AMPA-induced depolarization in the cortical wedge preparation (IC(50) = 15 +/- 1 microM). (S)-ATPO also blocked kainic acid agonist effects at GluR1 (K(i) = 2.0 microM), GluR1+2 (K(i) = 3.6 microM), GluR3 (K(i) = 3.6 microM), GluR4 (K(i) = 6.7 microM), and GluR5 (K(i) = 23 microM), but was inactive at GluR6 and GluR6+KA2. Thus, although ATPO is a structural analog of AP7 neither (S)-ATPO nor (R)-ATPO are recognized by NMDA receptor sites.

[Laparoscopic ileocecal resection in Crohn disease]

Laparoscopic intestinal surgery has theoretical advantages compared with conventional intestinal surgery by minimizing the surgical trauma. The aim of the study was to examine the operative and postoperative course as well as the time for recovery after laparoscopic-assisted ileocoecal resection for Crohn's disease. Seventeen patients were operated on. The operations were assessed with regard to duration of operation, rate of conversion to open procedure, complications, time for discharge from hospital, and ability to take up work. Median operation time was 145 min. Two operations (12%) were converted to open procedure. Complications occurred in three patients (18%). Median postoperative time to discharge was five days. Median time to return to work was 26 days. In conclusion laparoscopic-assisted ileocoecal resection seems suited to Crohn's disease, but the benefit of the method needs confirmation in controlled, randomized studies.

[Bone loss and oral health status in patients on home parenteral nutrition]

The mandible and forearm bone mineral content and dental and periodental state were studied in 15 patients, aged 26 to 65 years, on home parenteral nutrition due to short bowel syndrome and compared to the findings in a normal population. The bone mineral content was measured by dual-photon absorptiometry. All patients were on free oral intake as a supplement to the parenteral nutrition. Forty-seven percent of the patients showed mandibular osteoporosis. Thirty-three percent had osteoporosis in the forearm and also radiographic signs of osteoporotic fractures of the columna. The dental and periodental state did not differ from that of the normal Danish population of the same age. Thus, patients on home parenteral nutrition due to short bowel syndrome seem to have a high risk of developing systemic osteoporosis, including the jaws, but apparently do not have a higher risk for deterioration of the dental or periodental state.

[Fulminant cytomegalovirus colitis without prior immune deficiency or colonic disease]

Fulminant primary Cytomegalovirus (CMV) colitis can occur in immunocompetent individuals and mimics inflammatory bowel disease. Cytomegalovirus inclusions are found in rectal or colonic biopsy specimens. Thus, careful histological evaluation of mucosa biopsies is essential for the diagnosis of this entity.

[Chronic radiation enteropathy. A retrospective study]

In the period 1968-1989 50 patients, 38 women and 12 men, aged 30-76 years, median 58 years, were referred to the Department of Gastroenterology, Rigshospitalet for severe chronic radiation enteropathy. Most women had received radiation for gynaecological cancer, and most men for urogenital cancer. The initial symptoms of the enteropathy were diarrhoea in 74%, abdominal pain in 62% and weight loss in 52%. Twelve per cent had visible blood in the stools. Ten per cent had fistulas. The symptoms occurred 0-37 years, median ten months after the radiation. The radiation enteropathy had necessitated one or more laparotomies in 35 patients, most often because of subileus/ileus, including resection of the small bowel or the colon in 25 patients, and establishment of an ileostomy or a colostomy in 11. Seven patients developed new fistulas postoperatively. In 32 patients one or more tests for malabsorption were performed as a guidance for therapy: stool mass (26 patients), faecal fat excretion (26 patients), Schilling test (22 patients), lactose absorption (11 patients) and bile acid breath test (seven patients). Half of the patients had diarrhoea, including one third of the patients without intestinal resection. Two thirds had steatorrhoea, including half of the patients without small bowel resection. Three fourths showed decreased absorption of vitamin B12, including half of the patients without ileal resection. All patients studied had abnormal deconjugation of bile acids and more than half of them had bile acid malabsorption. Malabsorption of lactose was found in only one patient. There was no correlation between the radiological and functional abnormalities of the small intestine.(ABSTRACT TRUNCATED AT 250 WORDS)