Breastfeeding knowledge and beliefs among adults in eastern Tobago

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breast-feeding in Tobago.

Magnetic-field-induced structural transitions in a ferrofluid emulsion

A ferrofluid emulsion, subjected to a slowly increasing magnetic field, exhibits a complicated structural behavior: a gas of Brownian particles changes to columnar solid structures due to induced dipole interaction. Two transition (intermediate) structural regimes are observed: (i) randomly distributed chains and particles and (ii) distinct thin columns and randomly distributed chains and particles. Three structural transition magnetic fields are found, one marking each structural transition, from the initial to the final structural regime. A structural diagram of the structural transition magnetic fields, H(C), versus particle volume fractions, straight phi, is constructed experimentally. Theoretical models of scaling calculations, based upon the dominant magnetic interaction in each structural regime, give the three structural transition magnetic-field relations as H(C1) proportional to straight phi(-1/2), H(C2) proportional to straight phi(-1/4), and H(C3) proportional to (straight phi(gamma)/G2)exp(piG/straight phi((gamma/2))), where gamma=0.39 and G=0.29 for our sample. The final end shape of columns and the relative position between columns show that the end-end repulsion between chains is important in the structural formation.

Two males with childhood disintegrative disorder: a prospective 14-year outcome study

A prospective 14-year outcome study of two children meeting DSM-IV criteria for childhood disintegrative disorder is presented. Their ages at first evaluation were 4 years 7 months and 6 years 3 months. Both are now adults and continue to have a severe pervasive developmental disorder, mental retardation, seizure disorder, and are non-verbal. Both require residential care.

Cryotherapy for postoperative pain relief following knee arthroplasty

Ninety consecutive patients undergoing primary knee arthroplasty received local cryotherapy 72 hours after surgery for pain relief. Thermal-pad circulating temperatures were randomly assigned to 50 degrees, 60 degrees, or 70 degrees F (room temperature). Pain relief was monitored using patient-controlled analgesia machines. The amount of morphine received and number of attempts per hour were statistically analyzed with relation to temperature group, age, sex, weight, side, and diagnosis. The amount of morphine injected was positively correlated to the number of attempts per hour and moderately correlated to body weight. There was no correlation between thermal-pad temperature or any other parameter and the amount of morphine injected after surgery.

Anatomic variations of the pes anserinus: a cadaver study

Both knees of 51 cadavers were dissected to identify anatomic variations of the pes anserinus. The tendons of the sartorius, gracilis, and semitendinosus were exposed through an inverted L subperiosteal incision beginning at the crest of the tibia. The upper border of the gracilis tendon was located an average of 5.5 cm from the anteromedial joint line. The tendons of the gracilis and semitendinosus fuse an average of 3.18 cm from their insertion and are firmly adherent to layer I (sartorius tendon). Forty-eight percent of the specimens demonstrated at least one of seven variations, ranging from fascial loops connecting the sartorius tendon with the medial collateral ligament to separate tendon slips from each of the three tendons inserting separately into the tibia or the crural fascia. This exposure is recommended to safely and efficiently dissect the tendons of the pes anserinus for use in reconstructive procedures of the knee.

Hypercapnic respiratory failure due to L-tryptophan-induced eosinophilic polymyositis

A 24-year-old man presenting with fever, rash, and myalgias subsequently developed hypercapnic respiratory failure and severe limb muscle weakness. Muscle biopsy revealed eosinophilic myositis, due to the ingestion of large quantities of L-tryptophan as a dietary supplement. Complete recovery occurred with corticosteroid administration. Significant involvement of the respiratory muscles can be a predominant feature of this newly described disease entity.

Reflex sympathetic dystrophy after clavicle fracture: case report

Reflex sympathetic dystrophy (RSD) of the anterior chest wall is a rare entity. A MEDLINE search in all languages of the world's literature from 1966 to the present yielded no report of the association of clavicle fracture with this pain syndrome. Two cases are presented and the anatomic variations of the supraclavicular nerves in relation to the clavicle are discussed.

Optical information storage and charge traps in PZT thin films

Storage of optical data in thin film PZT (lead zirconate titanate) has been demonstrated at a wavelength of 833 nm. A method for the storage and detection of simple optical-data images in thin PZT films is described. Dots and bars were stored in a 0.5-mum-thick 0/50/50 PZT using 488, 543, 633, and 833 nm wavelengths, and detected by measuring photocurrents while scanning a low-power read beam across the film. The data presented suggest that traps and related photoinduced charge carrier generation play an important role in this optical storage mechanism.

Prediction of whole blood selenium levels in patients on long-term parenteral nutrition

In an attempt to define clinical variables which might predict the whole blood selenium level prior to supplementation, whole blood selenium levels were determined in 21 home parenteral nutrition patients who were not receiving selenium supplementation. These levels were examined for possible correlations by single and multivariant analysis with the following clinical parameters: age at initiation of home parenteral nutrition, months of home parenteral nutrition received, hematocrit, albumin, estimated length of remaining small bowel, kilocalories per kilogram actual body weight infused per day, grams protein per kilogram actual body weight infused per day, and multiple of ideal body weight. Of all the combinations of variables examined, the best correlation obtained was between whole blood selenium levels and the total kilocalories per kilogram body weight per day delivered intravenously (r = -0.89, p less than 0.001). A statistically significant correlation (r = -0.67, p less than 0.01) was also observed between selenium levels and the grams protein per kilogram actual body weight infused per day. However, inclusion of this or additional variables did not increase the predictive value of the equation describing whole blood selenium levels as a function of the calories delivered. The implication of this study is that patients requiring more intensive nutritional support develop lower selenium levels during the course of treatment. Despite these correlations, no single clinical parameter or combination of parameters, however, was of sufficient predictive value to preclude laboratory determination of whole blood selenium values in deciding which patients might benefit from selenium supplementation.

Arthroscopic debridement of the knee for septic arthritis

Sixteen knees with hematogenous septic arthritis in 12 adult patients were treated by arthroscopic decompression, debridement, and irrigation with motorized instruments plus suction drainage. Infectious disease consultants supervised the administration of intravenous antibiotics, and range-of-motion exercises were instituted when the drains were removed 48 hours after surgery. Patients were protected from bearing weight for six weeks. There were no treatment complications, and no patient required a repeated drainage procedure. Two patients died of diseases unrelated to knee infection. The 11 infected knees of the ten surviving patients were evaluated subjectively, functionally, objectively, and roentgenographically. With an average 34-month follow-up evaluation, all patients regained their preoperative functional status without loss of motion or roentgenographic evidence of cartilage loss. Arthroscopic debridement of the knee for septic arthritis is a safe, efficient method of joint decompression with minimal morbidity.

Myositis ossificans of the thigh following manipulation of the knee. A case report

Myositis ossificans of the thigh produced severe limitation of knee motion in a 22-year-old man after passive manipulation of a knee on three separate occasions. Motion improved after excision of the bony mass and postoperative radiation to prevent recurrence. Caution is advised in passive manipulation of the knee, because repeated attempts can result in forced extension of the quadriceps muscle, periosteal damage, partial muscle tears, and interstitial hemorrhage.

Lateral tibial plateau fracture as a postoperative complication of high tibial osteotomy

Fractures associated with valgus producing high tibial osteotomy are generally reported as operative complications which involve the medial proximal segment. Factors associated with this fracture at the time of surgery include forceful closure of the osteotomy after an inadequately perforated medial cortex, a proximal segment being less than 1.5cm in thickness, and osteotomes entering the medial compartment due to excessive bone loss. Three patients are reported with postoperative fracture of the lateral tibial plateau after tibial osteotomy. One patient's fracture was clearly due to trauma and the other two occurred in patients with a thin proximal segment.

Effects of common radioiodination procedures on the binding of glycoproteins to immobilized lectins

Representative glycoproteins including fetuin, protein A, ovalbumin, alpha 1 acid glycoprotein, and the major glycoprotein of equine infectious anemia virus were labelled with 125I by the chloramine-T or Bolton-Hunter procedure and their binding to immobilized Con A or lentil lectin compared to untreated samples of each glycoprotein. Glycoprotein modification was no greater than one substituted residue per protein molecule. Yet the radioiodinated glycoproteins typically displayed only 0-50% of the lectin binding observed with untreated samples. These results indicate that lectin glycoprotein binding can be markedly altered by minor modifications in protein structure.

Teaching home parenteral nutrition to patients with limited compliance skills

Information gathered from psychological and behavioral assessment procedures was used to select a teaching approach for two home parenteral nutrition patients with limited abilities to learn--and therefore to comply with--their regimens. A "behavior shaping" procedure, involving the simplification of complex home parenteral nutrition tasks, resulted in significantly improved performance by both patients. Results suggest that these procedures may be applied to other home parenteral nutrition patients, including those without apparent skill deficits.

Experience with an indwelling right atrial catheter for home parenteral nutrition

In 94 patients, 137 permanent Silastic central venous catheters were inserted. Of these, 53 catheters were removed because of catheter related problems. The average duration of catheter use was 12 months. However, the catheter was only removed once every 31 patient months because of catheter dysfunction and once every 82 months because of catheter related sepsis. None of the patients died from catheter related septicemia. We believe this low complication rate of catheter related complications represents an acceptable risk for those patients who will benefit from home parenteral nutrition.

Home parenteral nutrition in treatment of severe radiation enteritis

Ten patients with radiation enteritis unresponsive to conventional medical and surgical therapy were put on long-term parenteral nutrition at home. Six of the patients are alive at home; four patients died, two from recurrent cancer. Some of the patients have been able to resume oral intake, but none have been able to discontinue parenteral nutrition. Fistulas healed or had a marked decrease in output. Two patients in our series were given prednisone and slinical improvement of radiation enteritis with this therapy.

Long-term parenteral nutrition in the home

A program to train patients to self-administer total parenteral nutrition solutions at home is described. The method of training, equipment used, results obtained and the role of the pharmacist in this program are discussed.

Communication techniques for patient instruction

The techniques of pharmacist-patient communication are discussed. Ways in which the pharmacist can identify the patient's information needs, control communication timing, define communication objectives, develop methods of communication and evaluate the effectiveness of his instructions are covered.