Feeding practices for infants weighing less than 1500 G at birth and the pathogenesis of necrotizing enterocolitis

This article examines clinical issues regarding gut maturation, gut colonizatiion, gut luminal starvation, a germ-free gut, and the role of enteral intake in the pathogenesis of necrotizing enterocolitis (NEC) in very low birth weight neonates and micropremies. NEC is identified as the final common pathway for a variety of etiologic mechanisms, only one of which is consistent with the enteral-based theory of NEC. The technique of minimal enteral intake ("gut priming") is discussed as a strategy to maintain the normal ontological processes of the developing gut ex utero. A combination of enteral plus parenteral intake is described to achieve nutritional goals.     

Nodular goiter. Retrospective analysis of 608 cases

A retrospective study was carried out on a series of 608 patients, of whom 430 had undergone partial and 178 total thyroidectomy for single or multinodular goitre. Statistical analysis of data for the 532 women (88%) and 76 men (12%), mean age 45 and 39 years respectively, included clinical and operative features, specific morbidity of the exeresis, incidence of cancer on multinodular goitre and the frequency of recurrence of nodular lesions. The men were significantly younger at time of diagnosis (p < 0.0006). Bilateral multinodular forms (n = 577) and hypofixing lesions (n = 515) predominated. The incidence of unsuspected thyroid cancer in the multinodular cases was 3% (15/444). Carcinoma development on single nodules in our series during the same period was 8% (n = 15/195), the difference being statistically significant (p < 0.02). Mortality was nil and non specific morbidity 2% (n = 12/608). No compressive hematoma was reported and tracheotomy was never required. A clinically detectable alteration in the voice was noted in 10% (n = 67/608), this persisting in 0.5% (n = 3) beyond the 6th postoperative month. No significant difference existed between general and vocal morbidity as a function of the type of exeresis. Hypocalcemia was observed in 11% of patients (n = 67/608), 49% (n = 33/67) being asymptomatic and the anomaly spontaneously reversible. Four percent (n = 7/178) were permanent after total thyroidectomy (including 15 cancers on multinodular goitre discovered fortuitously, 8 of which received lymph node dissection) and 3% (n = 2/68) after a "wide" subtotal thyroidectomy.     

FLUID DYNAMIC BEHAVIOR OF HEAT EXCHANGERS WITH ACTIVE CAVITIES: A NUMERICAL STUDY

Numerical simulations have been performed on a series of cavities (called active cavities here) with a peculiar, purpose-fitted geometry, located on the external surface of tubular heat exchanger passages and on one side of the active wall in a flat plate heat exchanger. An incompressible fluid with a flow Reynolds number of 42,000 was considered and three turbulence models were compared: k- k , Spalart--Allmaras and large eddy (LES). The purpose of the cavities is to increase the heat transfer on the surface on which they are applied: some limited comparisons with an independent set of experimental data are also presented.     

Splenectomy for hematologic disease in patients over 70 years of age. Apropos of 38 cases

A retrospective series of 38 splenectomies performed in patients over 70 for haematology diseases is reported. There were no post-operative deaths and 8 patients (21%) had complications which resolved favourably. Paradoxically, mortality and morbidity were lower in elderly patients although the difference was not statistically significant. No factor predictive of post-operative outcome was found. It was concluded that age is not a contraindication although the clinical situation is a predominant factor in patient selection.