An epidemiological study was conducted to estimate the proportion of infants on total parenteral nutrition (TPN) who developed cholestasis and to identify risk factors associated with the development of this disease. Data were abstracted from medical records of 624 infants less than or equal to 30 days of age who were treated with TPN. A case of TPN-related cholestasis was defined as an infant whose serum level of direct bilirubin was greater than or equal to 1.5 mg/dl subsequent to initiation of TPN. Risk factors were assessed using multiple logistic regression analysis. Forty-six of 624 infants in the cohort (7.4%) were classified as having TPN-related cholestasis. The multivariable analysis indicated that cholestasis was associated with intracranial hemorrhage, patent ductus arteriosus, sepsis and gastrointestinal conditions that require surgery. Two distinct processes appear to have occurred: in infants who experienced patent ductus arteriosus or intracranial hemorrhage (conditions associated with hypoxia) where TPN may be the necessary trigger for the development of cholestasis, and in infants with gastrointestinal conditions requiring surgery or sepsis, where cholestasis may develop with or without parenteral infusions.

Birth Weight↗

PubMedDate not supplied

Vancomycin-intermediate Staphylococcus aureus in a home health-care patient.

In June 2000, vancomycin-intermediate Staphylococcus aureus (VISA) was isolated from a 27-year-old home health-care patient following a complicated cholecystectomy. Two VISA strains were identified with identical MICs to all antimicrobials tested except oxacillin and with closely related pulsed-field gel electrophoresis types. The patient was treated successfully with antimicrobial therapy, biliary drainage, and reconstruction. Standard precautions in the home health setting appear successful in preventing transmission.

Adult↗

PubMedDate not supplied

A-78773: a selective, potent 5-lipoxygenase inhibitor.

The potency and selectivity of A-78773, a newly discovered 5-lipoxygenase inhibitor, were examined. The compound was significantly more potent than zileuton in inhibiting leukotriene formation in cell free lysates and in isolated human neutrophils. A-78773 inhibited a RBL cell lysate 5-lipoxygenase at concentrations 2 orders of magnitude lower than those required to inhibit rabbit reticulocyte 15-lipoxygenase or human platelet 12-lipoxygenase. The compound was also a potent, long lasting, orally active inhibitor of leukotriene formation ex vivo in dogs and in vivo in the rat. In experiments where leukotriene formation was completely inhibited, no increase in eicosanoids from other pathways was observed. A-78773 should prove to be a valuable clinical tool in treating leukotriene mediated diseases.

Administration, Oral↗