Placental transport of nutrients

The fetus is dependent upon the placenta for transport to it of all nutrients for energy and growth. The primary nutrients crossing the placenta are glucose, lactic acid, free amino acids, free fatty acids, and ketone bodies. Under normal circumstances, it appears that glucose is the primary energy source. In abnormal conditions there is the possibility that energy requirements may be met also by protein-amino acid oxidation and ketone body metabolism. The fetal brain may be quite adept in the use of ketone bodies. In all transport phenomena, the placenta intervenes by diverting nutrients into its own intermediary metabolism. For a more extensive consideration of these factors, several in-depth reviews are recommended. To better understand abnormalities of intrauterine growth, we need much more specific information about the mechanisms of placental transport and the intermediary metabolism of the placenta and fetus. When these are adequately in states of normal and abnormal intrauterine growth, we can then consider methods of metabolic intervention which will correct intrauterine growth failure and, hopefully, eliminate its hazards to the fetus and child.     

Disposition of nafcillin in patients with cirrhosis and extrahepatic biliary obstruction

Nafcillin, a semisynthetic penicillin effective against penicillinase-producing staphylococci, is eliminated largely in man via the liver. This study assessed the effect of cirrhosis and extrahepatic biliary obstruction in man on the pharmacokinetics of nafcillin. The plasma clearance of nafcillin controls was 583 +/- 144.2 ml per min (mean +/- SD) and fell strikingly to 291 +/- 147.6 and 163 +/- 56.3 ml per min in patients with cirrhosis and extrahepatic obstruction, respectively (P less than 0.001). In the latter two groups nafcillin excreted in urine increased from about 30 to 50% of administered dose (P less than 0.02), suggesting that renal disease superimposed on hepatic disease would further decrease over-all nafcillin clearance. The depression of nafcillin clearance with hepatobiliary disease did not correlate with any conventional liver laboratory test. The initial volume of distribution of nafcillin (V1) was unaltered but at steady state (Vd()) there was a significant reduction in the distribution volume in the patients with liver disease. Accordingly, the impairment in drug elimination, as assessed by its clearance from plasma, was underestimated by the prolongation of the nafcillin elimination half-life (t1/2(beta)) which was 1.02 +/- 0.20 hr in controls, and 1.23 +/- 0.31 (P greater than 0.05) and 1.73 +/- 0.44 hr (P less than 0.03), respectively, in patients with cirrhosis and extrahepatic obstruction.     

Postembolic colonic infarction

From a total of 23 cases from five hospitals, acute colonic mucosal necrosis developed in three patients following transcatheter embolotherapy for colonic hemorrhage. Although embolic therapy for lower gastrointestinal bleeding is associated with appreciable risk, these risks are less than those of emergency operation for hemorrhage. The alternative transcatheter therapeutic modality, vasopressin infusion, is often associated with continued or recurrent hemorrhage, is relatively contraindicated in patients with coronary disease, and produces numerous complications. Transcatheter embolotherapy is recommended for patients with colonic bleeding who have a contraindication to vasopressin administration, who are refractory to vasopressin, or who rebleed following treatment with vasopressin.     

Dental ethics in the culture of the 90s: from creed to action

There are six proven ways to integrate a healthcare financing program into your practice. Challenge yourself to maximize your financial service. You will see more people receive valuable care. You will grow your practice. You will reap financial reward. You will provide more of the quality dentistry that makes the art and science of your profession a joy.     

Quantitative assessment of auditory cortex responses induced by imager acoustic noise

A clustered volume acquisition functional MRI pulse sequence was modified to assess the response to the acoustic noise of echo-planar imaging in the auditory cortex and to determine whether it is possible to obtain data which is relatively free of acoustic contamination. The spatial location and strength (percent signal change) of cortical responses to the imager noise were examined by introducing extra gradient readouts, without slice excitation, to provide acoustic stimulation immediately prior to acquisition of a cerebral volume. The duration of acoustic stimulation was controlled by varying the number of extra gradient readouts. Slice acquisitions were clustered at the end of the repetition time (TR) period to prevent a response from being induced by the volume acquisition itself ("Intra-Acquisition Response"). The cerebral volumes were acquired using a long TR in order to limit the integration of the cortical response across volume acquisitions ("Inter-Acquisition Response"). Cortical responses were observed to be largest and most significant on the medial two-thirds of Heschl's gyrus, the location of primary auditory cortex. Mean signal changes induced by the imager noise were observed to be as high as 0.95%. A 2 sec delay prior to onset of the BOLD response was empirically determined. These results demonstrate that clustered volume acquisitions may be utilized for up to 2 sec of volume acquisition without inducing an appreciable Intra-Acquisition Response and can be used, with a sufficiently long TR, to provide data which are similarly free of any Inter-Acquisition Response.