Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants

AIMS: To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis in preterm, very low birthweight infants. METHODS: A prospective, double blind, randomised, placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 140 very low birthweight infants consecutively admitted to the neonatal unit. The babies were randomly allocated to receive oral vancomycin (15 mg/kg every 8 hours for 7 days) or an equivalent volume of placebo solution. Prophylaxis was started 24 hours before the start of oral feeds. All suspected cases of necrotising enterocolitis were investigated with a full sepsis screen and serial abdominal radiographs. Necrotising enterocolitis was diagnosed and staged according to modified Bell's criteria. RESULTS: Nine of 71 infants receiving oral vancomycin and 19 of 69 infants receiving the placebo solution developed necrotising enterocolitis (p = 0.035). Infants with necrotising enterocolitis were associated with a significant increase in mortality (p = 0.026) and longer duration of hospital stay (p = 0.002). CONCLUSIONS: Prophylactic oral vancomycin conferred protection against necrotising enterocolitis in preterm, very low birthweight infants and was associated with a 50% reduction in the incidence. However, widespread implementation of this preventive measure is not recommended, as it would only be effective in necrotising enterocolitis caused by Gram positive organisms and could increase the danger of the emergence of vancomycin resistant or dependent organisms. Its use should be restricted to a high prevalence nursery for a short and well defined period in a selected group of high risk patients.     

Severe progressive deformities after limb lengthening in type-II fibular hemimelia

Until recently the accepted treatment of choice for severe type-II fibular hemimelia has been Syme's or Boyd's amputation. The alternative of distraction lengthening using the Ilizarov technique is now available. We report three patients (four limbs) with type-II fibular hemimelia who were treated by the Ilizarov technique and followed up for two to six years. Severe progressive procurvatum and valgus deformity of the tibia and valgus deformity and lateral subluxation of the ankle were found in all four limbs. Multiple additional soft-tissue and bony surgery was necessary. In view of these problems we feel that reappraisal of the indications for lengthening in type-II fibular hemimelia is necessary.     

Prevalence and role of anticardiolipin antibodies in Crohn disease

OBJECTIVES: Anticardiolipin antibodies belong to the group of antiphospholid antibodies, and may be seen in association with endothelial damage and recurrent vascular thrombosis. The aim of our study was to determine in patients with Crohn's disease the frequency of anticardiolipin antibodies, and to correlate their presence with clinical activity and treatment of the disease. METHODS: One hundred and thirty-eight sera from patients with Crohn's disease and 118 from age-matched controls were tested for IgG anticardiolipin antibodies. In the Crohn's disease group, we determined whether the patients had a past history of vascular thrombosis, a clinically active intestinal disease, or a current immunosuppressive therapy (steroids or azathioprine). RESULTS: Anticardiolipin antibodies were found significantly more often in patients with Crohn's disease than in controls: 11.0% versus 2.5%, P < 0.02. Three patients with Crohn's disease had a past history of vascular thrombosis, but none of them had anticardiolipin antibodies. The presence of anticardiolipin antibodies was not correlated with the fact that patients had a clinically active disease (P = 0.77), or a current immunosuppressive therapy at the time of the serological test (P = 0.95). CONCLUSIONS: There is a significantly high prevalence of patients with anticardiolipin antibodies during Crohn's disease. The positivity of the test does not seem to be correlated to the existence of a past history of vascular thrombosis, nor to the clinical activity of the disease.     

Cardiac dysrrhthmia in systemic disease

This is an ECG of a 6-year-old girl. She presented to us for management of epilepsy. Magnetic resonance imaging (MRI) of the brain showed multiple lesions consistent with cortical and subcortical tubers. There were also achromic spots on her skin and echocardiography demonstrated a rhabdomyoma near the right ventricular outflow tract. A diagnosis of tuberous sclerosis, an autosomal-dominantly inherited condition, was made. What is abnormal about the ECG?     

Dispersion in electroosmotic flow generated by oscillatory electric field interacting with oscillatory wall potentials

An analytical study is presented in this article on the dispersion of a neutral solute released in an oscillatory electroosmotic flow (EOF) through a two-dimensional microchannel. The flow is driven by the nonlinear interaction between oscillatory axial electric field and oscillatory wall potentials. These fields have the same oscillation frequency, but with disparate phases. An asymptotic method of averaging is employed to derive the analytical expressions for the steady-flow-induced and oscillatory-flow-induced components of the dispersion coefficient. Dispersion coefficients are functions of various parameters representing the effects of electric double-layer thickness (Debye length), oscillation parameter, and phases of the oscillating fields. The time–harmonic interaction between the wall potentials and electric field generates steady as well as time-oscillatory components of electroosmotic flow, each of which will contribute to a steady component of the dispersion coefficient. It is found that, for a thin electric double layer, the phases of the oscillating wall potentials will play an important role in determining the magnitude of the dispersion coefficient. When both phases are zero (i.e., full synchronization of the wall potentials with the electric field), the flow is nearly a plug flow leading to very small dispersion. When one phase is zero and the other phase is π,?the flow will be sheared to the largest possible extent at the center of the channel, and such a sharp velocity gradient will lead to the maximum possible dispersion coefficient.     

An improved cutting force and surface topography prediction model in end milling

During the milling operation, the cutting forces will induce vibration on the cutting tool, the workpiece, and the fixtures, which will affect the surface integrity of the final part and consequently the product's quality. In this paper, a generic and improved model is introduced to simultaneously predict the conventional cutting forces along with 3D surface topography during side milling operation. The model incorporates the effects of tool runout, tool deflection, system dynamics, flank face wear, and the tool tilting on the surface roughness. An improved technique to calculate the instantaneous chip thickness is also presented. The model predictions on cutting forces and surface roughness and topography agreed well with experimental results.     

A visual study of the breakdown of emulsions in porous coalescers

A two-dimensional photoetched glass flow cell was used to observe the process by which an emulsion was broken down by a granular porous coalescer. The effects of wettability, emulsion and collector zeta potentials, and emulsion droplet size on the coalescence phenomenon were studied. The possible use of a graded medium or a coalescer with mixed wettability to enhnce the coalescence process was also examined. Based on these visual studies, a set of guidelines was developed to aid in the selection of a porous coalescer for a given separation duty.     

Fractionation studies of palm oil by density gradient

The paper describes a method of fractionating vegetable, animal and fish oils, and in particular palm oil. The method involves addition of a medium comprising two common solvents to the semisolid oils. On centrifugation, the olein and stearin are separated by the medium in the middle. Thirteen media made up from binary combinations of nine solvents, viz. water, propylene glycol, glycerine, methanol, ethanol,n-propanol, isopropanol (IPA), acetone and butanone, are found to be effective in olein-stearin separation. However, only the water/IPA and water/methanol systems have been studied in detail. The aqueous IPA provides a higher yield of olein than water/ methanol but intersolubility between oil and medium is also greater. The fractionation process can be carried out at any suitable temperature. Fractionation of the special prime bleached (SPB) palm oil at 16 C yields an olein with a cloud point of 4.8 C. Some hybrid palm oils produce a large quantity of low cloud point olein which can be bleached readily. The process can be extended to include degumming and neutralization by using an alkaline medium for centrifugation. The olein fractions obtained have been found to be free of phosphatides and the free fatty acids reduced to as low as 0.02%. Metal-scavenging agents have also been added to the medium in an attempt to remove copper and iron. The development of this process into a continuous one has been demonstrated on the AlfaLaval LAPX 202 Separator. Fractionation of crude palm oil using a density gradient provides seven fractions of different characteristics. The iodine values vary from 37.5 to 57.4 and the unsaturated fatty acids range from 32.7% to 51.2%. Triglyceride analysis by carbon numbers shows great differences in the C₄₈ and C₅₂ constituents of the fractions. aThe volume ratio of oil to medium in each case was 1:1. The separation involved the oil and wax.     

The influence of sulfur dioxide on propane oxidation activity over supported platinum and palladium

Earlier studies have shown that sulfur dioxide and metal-support interaction can strongly influence propane oxidation over platinum. In particular, oxidation activity is enhanced when platinum is supported on sulfated -alumina or zirconia compared to -alumina. Therefore, it is of interest to compare the performance of palladium under the same experimental conditions. Four model catalysts were examined: Pt/-alumina, Pt/zirconia, Pd/-alumina and Pd/zirconia. The metal loading was kept at or below 0.05 wt% to emphasize changes in activity attributable to metal-support interaction. Reaction rates were measured with and without sulfur dioxide. Surface sulfation was analyzed by measuring acid strength and evaluating spectra obtained by Fourier-transform infrared spectroscopy. In contrast to platinum, sulfation does not promote propane oxidation on Pd/-alumina, and Pd/zirconia is less active than Pd/-alumina.     

Zeolite Formation in Class F Fly Ash Blended Cement Pastes

Zeolite formation in Class F fly ash blended cement pastes is under investigation. A Na–P type zeolite and Zeolite Y were synthesized from Class F fly ash and NaOH solution after 2 days of aging at room temperature and 6 days of curing at 80°C. However, no zeolites formed when KOH was used. In additional experiments, a Na–P type zeolite, Zeolite Y, and chabazite developed in cement pastes blended with Class F fly ash and NaOH solution which had been aged 2 days at room temperature and then cured 6 days at temperatures ranging from room temperature to 90°C. Seeding the pastes with natural zeolites was also investigated.