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Biomedical subjects

S Fussell

Publications and source records attributed to S Fussell.

9 recordsLinked to original sources
PubMed1996

Choline and choline esters in human and rat milk and in infant formulas.

Large amounts of choline are required in neonates for rapid organ growth and membrane biosynthesis. Human infants derive much of their choline from milk. In our study, mature human milk contained more phosphocholine and glycerophosphocholine than choline, phosphatidylcholine, or sphingomyelin (P < 0.01). Previous studies have not recognized that phosphocholine and glycerophosphocholine exist in human milk. Concentrations of choline compounds in mature milk of mothers giving birth to preterm or full-term infants were not significantly different. Infant formulas also contained choline and choline-containing compounds. In infant formulas derived from soy or bovine milk, unesterified choline, phosphocholine, glycerophosphocholine, phosphatidylcholine, and sphingomyelin concentrations varied greatly. All infant formulas contained significantly less phosphocholine than did human milk. Soy-derived formulas contained significantly less glycerophosphocholine (P < 0.01) and phosphocholine (P < 0.01) and more phosphatidylcholine (P < 0.01) than did human or bovine milk or bovine milk-derived infant formulas. Rat milk contained greater amounts of glycerophosphocholine (almost 75% of the total choline moiety in milk) and phosphocholine than did human milk. When dams were provided with either a control, choline-deficient, or choline-supplemented diet, milk composition reflected the choline content of the diet. Because there are competing demands for choline in neonates, it is important to ensure adequate availability through proper infant nutrition. Although the free choline moiety is adequately provided by infant formulas and bovine milk, reevaluation of the concentrations of other choline esters, in particular glycerophosphocholine and phosphocholine, may be warranted.

Adolescent↗
PubMed1991

Disseminated sarcoidosis: a case report.

Sarcoidosis is a systemic granulomatous disease of unknown etiology, most frequently involving the lungs, lymph nodes, spleen, liver, eyes and skin. Gastrointestinal sarcoidosis is uncommon, with rare histological documentation of noncaseating granulomas. Bone marrow sarcoidosis is also infrequent, and we are only aware of one case of documented gastric and bone marrow sarcoidosis in the same patient, which was diagnosed at autopsy. We herein report a case of endoscopic biopsy proven gastric sarcoidosis in a patient with systemic sarcoidosis with known hepatic and bone marrow involvement. To our knowledge this is the first description in a living patient of gastrointestinal and bone marrow involvement of systemic sarcoidosis.

Adult↗
PubMed1987

Comparison of two antibiotic regimens for neonatal necrotizing enterocolitis.

Treatment of neonatal necrotizing enterocolitis (NEC) regularly includes broad-spectrum antibiotics but there has been no comparative study of alternative regimens. We have studied 90 infants with definite NEC; 46 cases in 1982-3 were treated with ampicillin and gentamicin, while 44 cases in 1984-5 received cefotaxime and vancomycin. Groups were well matched and managed uniformly. Infants greater than or equal to 2200 g birthweight did well with either regimen. Smaller infants given cefotaxime and vancomycin had a lower risk of culture-positive peritonitis (P = 0.01), and as a result, were less likely to die (P = 0.048) or develop thrombocytopenia (P = 0.004). The better outcome might be explained by the greater suppression by cefotaxime and vancomycin of the gut flora of treated patients (P less than 0.001). Both regimens were well-tolerated. Our data suggest that carefully chosen antibiotic regimens can improve the outcome of NEC.

Ampicillin↗
PubMed1985

Spontaneous endotoxinemia in premature infants: correlations with oral feeding and bowel dysfunction.

Infants admitted to a tertiary care nursery were tested serially to determine the frequency and epidemiology of spontaneous endotoxinemia, a phenomenon suggested by previous studies. Plasma and stools were tested for endotoxin-like activity (ELA) using a Limulus amoebocyte lysate method and results were correlated with clinical data. We detected ELA in plasma of 28 of 47 infants (60%) tested throughout their hospital stay: only two of 58 separate episodes could be attributed to infection. Endotoxinemia was not consistently associated with classical signs of fever, shock, and jaundice. Prior to oral feeding, little or no ELA was detected in stools and endotoxinemia was ascertained in only six of 45 infants (13%). With feeding, fecal ELA concentrations rose sharply, and endotoxinemia was detected in 56% of remaining infants (p less than 0.001). Bowel disease predisposed to endotoxinemia: 16 of 20 infants (80%) with necrotizing entercolitis or difficult establishment on feeding were affected, compared to five of 17 infants (29%) without such problems (p less than 0.01). Fecal ELA concentrations were not abnormally elevated in those with bowel disease. We conclude that endotoxinemia occurs commonly in immature infants as their fecal flora develops with feeding but the amount of circulating endotoxin required for injury and the patterns this takes require further investigation.

Endotoxins↗
PubMed1984

Evaluation of skin antisepsis prior to blood culture in neonates.

In our Intensive Care Nursery, coagulase-negative staphylococcus is the most frequent blood culture isolate. As skin antisepsis is critical in preventing blood culture contamination, we examined the efficacy of the chlorhexidine tincture (CH) used in our nursery for this purpose. Staphylococcus epidermidis colonized the forearms of 88% of infants tested, in a mean density of 10(4) organisms/cm2. Following a 60-second application of CH (0.5% in 70% ethanol), bacterial growth from forearm skin remained abundant in 15/38 infants (39.4%). Cleansing with 70% isopropyl alcohol, followed by CH as above, left abundant residual growth in only 1/37 infants (2.7%) (P less than 0.001). All 136 S. epidermidis tested were susceptible to CH (MIC less than 5 micrograms/ml) and 14 of 15 exposed to CH 0.02% were rapidly killed (greater than or equal to 98% fall in viable counts within 90 sec). We conclude that two-phase antisepsis using isopropanol followed by CH is a more effective preparation for blood culture in neonates than is CH alone.

1-Propanol↗
PubMed1984

Bacterial endotoxins in umbilical cord blood of neonates.

We tested umbilical cord blood from 255 infants for evidence of bacterial endotoxins. Using a Limulus lysate gelation technique, endotoxin-like activity (ELA) was detected in 13 (9.1%) of 142 term infants and in 23 (20.3%) of 113 preterm infants (p less than 0.05), in concentrations ranging from 30 to 3,000 pg Escherichia coli equivalent activity per milliliter of plasma. No factors predisposing to endotoxemia could be detected in term pregnancies but among ELA+ premature infants, placental cultures more frequently revealed gram-negative species (p less than 0.05). Cord blood endotoxemia in the concentrations observed was without obvious consequence in mothers and term infants. Our data confirm the existence of natal endotoxemia, a potential mechanism of perinatal injury.

Endotoxins↗