Murray H. Seltzer

Complications Occurring during Enteral Nutrition Support: A Prospective Study

A review of 253 patients treated with enteral nutrition support via tube feedings is presented for the purpose of evaluating the incidence of complications. Thirty patients, (11.7%) experienced either gastrointestinal, (6.2%) mechanical (3.5%), or metabolic (2.0%) complications. The recognition and treatment of such complications are discussed and it is concluded that tube feedings are safely tolerated by most patients; however, constant attention must be exerted to either avoid or recognize such complications.

Instant Nutritional Assessment

Instant nutritional assessment of the hospitalized patient is described based upon admission serum albumin levels and total lymphocyte counts. Abnormalities of these parameters are associated with markedly increased morbidity and mortality in a series of 500 consecutively admitted patient. It is suggested that instant nutritional assessment be performed on all hospitalized patients with appropriate alterations and therapy being made to allow for nutritional repletion.

Instant Nutritional Assessment in the Intensive Care Unit

Instant nutritional assessment of the critically ill patient using serum albumin level and total lymphocyte count is reported. When an intensive care unit population is compared to the general hospital population a 6-fold increase in albumin level depressions, a 2-fold increase in lymphocyte count depression, and an 11-fold increase in depression of both parameters was noted in the intensive care unit population. Surgical intensive care unit (SICU) patients with depressed albumin levels and total lymphocyte counts had twice the complication rate and 4.5 times the death rate of those SICU patients with normal albumin levels and lymphocyte counts. It is concluded that serum albumin levels and total lymphocyte count determinations are valuable tools for instant nutritional assessment of the critically ill patient.

Parenteral Nutrition Complications in a Voluntary Hospital

A prospective study analyzing the complications in 307 patients who had specialized nutrition support administered by their private practitioners was performed and compared to other series in which a nutrition support service exclusively provided such care of patients. The mechanical complication rate of 4.6%, septic complication rate of 2.9%, and metabolic complication rate of 4.2% compared favorably with the reported literature. A new category of complications, the judgmental complication, is described and was 12.7% in the reported series. The Saint Barnabas Medical Center experience suggests that individual practitioners can satisfactorily administer intravenous specialized nutrition support if in fact an involved nutrition support service functions administratively and supportively in the background.

Digital dermatoglyphics and breast cancer.

SummaryFingerprints of one hundred nineteen Caucasian females were obtained. Of these females, thirty-four had histologically proven breast cancer, fifty-three were at high risk for development of breast cancer, and thirty-two comprised a control group. The digital pattern frequencies and the pattern intensity index were significantly different between the three groups.The presence of six or more whorls appears significant as noted by 32.4% of breast cancer patients possessing this number of whorls as compared to 3.1% controls. Also of note is that 95% of subjects with six or more whorls either had cancer or were at high risk.

Parenteral nutrition in a pregnant cystic fibrosis patient.

This case report describes a 30-year-old pregnant woman with cystsic fibrosis who had marasmus as evidenced by clinical examination. The patient was maintained on central venous hyperalimentation for 18 days in her last trimester. The patient delivered a full-term infant via cesarian section with Apgar of 8 and 9, at 1 and 5 minutes, respectively, and adverse affects.

Pseudoangiomatous hyperplasia and response to tamoxifen therapy.

To the Editor: The recent article by Pruthi et al. (1) regarding tamoxifen and pseudoangiomatous stromal hyperplasia (PASH) was of particular interest to us in that we recently had a male patient with PASH who had a disappointing response to tamoxifen. PASH has previously been reported in patients with gynecomastia (2,3). Our patient, a 15-year-old white male with a complaint of enlarging tender breasts, was found to have clinical gynecomastia, with the right breast measuring 13 cm in diameter and the left measuring 3 cm in diameter. Laboratory testing and physical examination excluded causes of gynecomastia other than adolescence. A hormone panel including serum estradiol, human chorionic gonadotropin (HCG), testosterone, and thyroid function studies revealed no abnormalities. Physical examination of the chest, abdomen, and testicles was normal. Historically there was no steroid or marijuana use. He was athletically active, including hockey and weight lifting. He was treated with tamoxifen 10 mg twice a day for 3 months. One month after tamoxifen was initiated there was a softening of the right breast tissue without diminution of size and the left breast was no longer palpable; however, after 3 months the tamoxifen was no longer effective and bilateral subcutaneous mastectomies were performed. Microscopically the right breast showed that the stroma was the predominant element, with the typical appearance of pseudoangiomatous stromal hyperplasia. Immunostaining for estrogen and progesterone receptors was negative for the stromal cells and positive for the ductal epithelial cells. The left breast consisted predominantly of adipose tissue with a small amount of normal male breast tissue. The successful use of tamoxifen has been reported for reducing both pain and breast size in some patients with gynecomastia (4,5). Initially when we found that this patient had PASH and was not responsive in a satisfactory manner to tamoxifen, we thought perhaps the finding of PASH represented a subset of gynecomastia patients in whom tamoxifen would not be effective. This concept does not seem viable in light of the findings of Pruthi et al. (1), recognizing, however, that the gender difference of the patients may have some bearing. Additional future reported observations of both male and female patients with PASH who are treated with tamoxifen will prove interesting, as the clinical presentations of PASH can be frustrating for the treating physician.

Pediatric Spigelian hernia: A case report

Report of a Spigelian hernia in a 13 yr old girl. The condition may well be more common than generally believed, and the diagnosis should be considered in all children with intermittent abdominal pain, even in the absence of a palpable mass.

The Use of a Simplified Standardized Hyperalimentation Formula

The use of a standardized hyperalimentation solution that can be modified is discussed. A comparison of in-hospital addition of electrolytes with factor addition of electrolytes is presented, in which both solutions are acceptable to patients and in which the labor and cost to the pharmacy are decreased in the factory-mixed additives.

Benign-appearing mammographic abnormalities in women aged 40-49.

The ongoing debate was addressed concerning the appropriateness of mammographic screening for women aged 40–49 years, with particular emphasis on those patients with benign‐appearing mammographic abnormalities (BMA), and whether findings differed from those of successive age decades. A review was conducted of 2,482 patients presenting for surgical consultation with a mammographic abnormality as a chief complaint, with particular emphasis on the 1,632 patients with BMA and more specifically those aged 40–49 years. Surgical interventions and risk factors for breast cancer were evaluated. Although 16% of 393 patients with BMAs biopsied were proven to have breast cancer, only 2.7% of all patients with BMAs were found to have breast cancer as a result of biopsy or short‐term follow‐up. Women aged 40–49 years represented 48% of patients with BMAs, and only 1.5% of these patients had breast cancer. The finding of breast cancer in the BMA population was progressive by decade of age, as would be expected, and in a cut‐point analysis of those biopsied, age 60 best divided patients into high‐ and low‐risk groups. Women aged 40–49 years with BMAs should not be excluded from mammographic screening, as they represented part of a continuum when successive decades were compared. Efforts should be directed at minimizing patient and physician anxieties as well as diagnostic interventions related to a BMAs.