Nursing care in renal transplant patients with infection problems]

OBJECTIVES: To identify, from amongst drugs reported as causing lichenoid drug eruptions, those affecting the oral mucous membranes and to review the clinical, histological and immunological features of such oral lichenoid drug eruptions in comparison to oral lichen planus, amalgam contact lesions and lichen planus-like eruption in graft-versus-host disease (GVHD). DATA SOURCES: Ovid Medline data searches on CD-Rom were carried out for the years 1966-1996 to identify reports of oral lichenoid drug eruptions and their clinical, histological and immunological features. Articles retrieved were examined for further appropriate references in the period 1940-1996. DATA EXTRACTION AND SYNTHESIS: Each paper was critically examined for evidence of a clinically verifiable lichenoid drug-eruption affecting the oral mucous membranes and the effects of subsequent drug withdrawal. Available clinical, histological and immunological features were recorded. The papers examined were too diverse in nature to permit a structured criticism. The extracted data have been tabulated where appropriate. CONCLUSIONS: The reports of oral lichenoid drug eruptions are considerably fewer than those of cutaneous eruptions and fewer drugs have been reported as causing oral rather than cutaneous lichenoid eruptions. Histology and immunology cannot be used reliably to differentiate lichenoid drug eruptions from idiopathic lichen planus, amalgam contact lesions and lichen planus-like eruption in GVHD. Lichenoid drug eruptions may also show some histological characteristics of oral discoid lupus erythematosus. An accepted protocol agreed by a number of international centres would permit the gathering of substantial information on LDE and could lead to a greater understanding of the mechanisms involved.     

Conservative treatment for early breast cancer]

68 Cases of early breast cancer were divided into local resection group (33 cases) and local resection plus axillary dissection group (35 cases). The 3-, 5- and 10-year survival rate of the two groups were 97.0%, 78.8%, 72.7% and 94.3%, 80.0%, 77.1% respectively; The metastasis rate of the two groups were 6.1%, 12.1%, 3.0% and 8.6%, 17.1%, 8.6% respectively; and the local recurrence rate of the two groups were 6.1%, 6.1%, 3.0%, and 5.7%, 5.7%, 2.9% respectively ( P > 0.05). The cosmetic satisfaction rate of the two groups were 60.6% and 65.7% respectively ( P > 0.05). Factors relating to cosmetic results were type of breast, operative incision, age and postoperative radiotherapy. Conservative operation for early breast cancer was safe, provided incision margin was 2 cm approximately 3 cm. In all patients mammplasty was performed after tumor resection, and contralateral breast were treated by mammominification when it was necessary.     

Social problems encountered during prenatal care in a Paris maternity ward]

Post-renal-transplantation bone disease is a well known entity. Immunosuppressive agents and persistence of hyperparathyroidism have primarily been implicated in its etiology. Renal transplantation patients are unique in that the bone changes occur on a background of pre-existing renal osteodystrophy. This review focuses on post-renal-transplantation bone disease. Unfortunately, the existing data in the review period, besides being scanty, provide conflicting information. This is due to the diversity of immunosuppressive regimens employed, the patient populations studied, diagnostic tools and criteria used by different centers, and the lack of formal trials.     

Psychopharmacotherapy in pregnancy and breast feeding

The primary purpose of this article is to review critically the literature on the use of psychotropic medications in pregnancy and during breast feeding in order to suggest strategies for the clinical management of these periods. Use of psychotropic medications during pregnancy may cause three complications: 1. teratogenicity, 2. perinatal syndromes (neonatal toxicity), and 3. postnatal behavioural sequelae (behavioural toxicity). The literature features few well-controlled studies concerning these points, so that the available information allows only few conclusions. Exposure to certain psychotropic drugs in utero may increase the risk for some specific congenital anomalies; there is mostly no strong evidence for behavioural toxicity in children exposed to psychotropic medications. Use of psychotropic drugs during pregnancy and breast feeding may be appropriate in many clinical situations and should include thoughtful weighing of risk of pre- and postnatal exposure versus risk of relapse following drug discontinuation. The authors try to present disorder-based guidelines for psychotropic drug use during pregnancy and breast feeding and for psychiatrically ill women who wish to conceive.     

Study of neonatal immunological function in breast feeding and formula feeding

OBJECTIVE: To determine 4 immunoglobulins and soluble interleukin-2 receptor (sIL-2R) in maternal and neonatal serum, in order to study the immunological functions in the neonates. METHODS: 80 cases were divided into three groups: (1) breast feeding group (30 cases), (2) formula feeding group (20 cases), and (3) mixed feeding group (30 cases). Maternal serum was collected prior to delivery and on the sixth day after delivery. Neonatal serum was collected on the third and sixth day after delivery. Umbilical blood at birth was obtained also. Secretory immunoglobulin A (SIgA), IgA, IgG, IgM and sIL-2R levels in the sera were determined by radioimmunoassay and enzyme-linked immunosorbent assay. RESULTS: The SIgA, IgA, IgG, IgM and sIL-2R levels in maternal serum were not significantly different among 3 groups, while neonatal serum SIgA, IgA, IgG, IgM and sIL-2R levels on the sixth day after delivery in the breast feeding group were significantly higher than those in the formula breeding group (P < 0.001, P < 0.001, P < 0.05, P < 0.05). CONCLUSION: Breast feeding may improve neonatal humoral and cellular immunity.     

Antidepressive agents and breast feeding

Postpartum blues occurs in 50-80% of women. A few percent of the cases are classified as serious postpartum depression, requiring antidepressant treatment. There is a growing understanding that women should continue to breast-feed in this situation. Data concerning the transfer of antidepressants into breast milk has been researched. Calculations of the infant relative dose via breast milk were done for the drugs concerned. Few antidepressants have been studied at steady state conditions in nursing mothers. Nortriptyline and amitriptyline have minimal relative doses and can be used when breast-feeding. Doxepine should be avoided, as should lithium, which has a significant transfer. Among the serotonine-reuptake inhibitors fluoxetine has been well studied in breast milk. Since fluoxetine has a long half life and a high transfer, sertraline and possibly paroxetine are better alternatives, but the latter has not yet been studied in repeated doses. Moclobemide also lacks data from multiple dose studies, but extrapolation to steady state indicates that the relative dose is small. More observational studies should be carried out in infants breast-fed by mothers using antidepressants. In the meantime, doctors prescribing antidepressant drugs to nursing mothers should see that the infants are monitored for side effects.     

Utilization of nursing diagnosis according to Nanda's classification for the systematization of nursing care in breast feeding

The present study aimed at describing the reformulated instrument used in the puerperal woman nursing consultation based on the identified diagnoses classification according to the Taxonomy-I reviewed by NANDA, and the identification of the most frequent nursing diagnoses concerning maternal breastfeeding, based on the reformulated instrument. The diagnoses found as being over 50% were: knowledge deficit (100%); sleep pattern disturbance (75%), altered sexuality patterns (75%), ineffective breastfeeding (66.6%) and impaired physical mobility (66.6%).     

Nursing in lactation mastitis]

Nowadays, the pathogenic staphylococcus plays the most important part in the etiology of mastitis. Further in depth studies of this disease are still necessary. The presence of this disease raises the question of breast feeding. Lactation mastitis disturbs the function of the manmary glands and decreases the quality of the milk. The authors conducted a clinical and bacteriological study of 102 women with unilateral purulent mastitis and their newborns. 95 women went through an operation within 2 days of their admission. The operation for mastitis is a serious intervention which necessitates a good training. 20 healthy women and their newborns aged up to 2 months, served as a control group. Before the operation, the examinations had revealed that the milk from the unaffected breast also contained pathogenic staphylococcus. As a result, the newborns nursed from the healthy mammary gland were showing frequent signs of infection. It is concluded that mothers with purulent lactation mastitis should not breast feed their children as this creates a serious risk of infection for the baby.     

Enhancement of gut absorptive function by early enteral feeding enriched with L-glutamine in severe burned miniswines]

14 miniswines (with multiple catheterization and 30% TBSA full thickness burns) were randomly and equally divided into N-Gln group and GLN group. Animals of GLN group were supplied with L-glutamine by 0.64%/kg.d and N-GLN group received equal amount of non-glutamine amino acids. Portal venous blood flow and gut absorptions of glucose, amino acids as well as fat were determined on PBD (post burn day) 1, 4, 7 and 10. The results indicated that the gut absorption obviously decreased in both group on PBD1, but the absorption of glucose and amino acids were much higher in Gln group than that of N-Gln group (P < 0.01). The absorptions of glucose, fat amino acids quickly increased in Gln group from PBD4, and tended to reach the preburn level on PBD7 and PBD10, meanwhile N-Gln group exhibited a slow increase of gut absorption. The absorptions of glucose, fat and amino acids were obviously lower than those of preburn on PBD7 and PBD10 (P < 0.01). This result suggests that oral feeding of glutamine improves efficiently the gut absorptive function after severe burns.     

Common feeding problems in babies and children: 2

Weaning is the cause of much concern among first-time mothers. A milk-only diet is advised until 3-4 months of age. Health professionals should ensure the baby receives a sufficient and balanced diet during the weaning period, to meet the needs for energy and growth. Breast milk or infant formula should continue up to the age of at least one year. The weaning period is a good time to educate parents in good nutrition. A wide variety of foods should be the aim in child nutrition, but each different type needs to be started separately during weaning. Care is needed to ensure vegetarian babies receive enough proteins, vitamins and minerals (especially iron). Failure to thrive has a multitude of causes, and treatment must be that of the cause. Strictly vegan children who eat no dairy products will need added synthetic vitamin B12. Failure to thrive may be due to physical problems (eg choanal atresia), infection, vomiting, diarrhoea, anorexia, parental ignorance or poverty. Other causes include coeliac disease, cow's milk protein allergy, cystic fibrosis, severe eczema or asthma, or diabetes.