The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women.

In this double-blind study, the effects of ascorbic acid, vitamin B6, vitamin B12, and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied. Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos. Milk samples were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum. Fasting blood samples were taken from all mothers at the end of each milk collection period. Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum. There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups. Both the EGPT index and milk concentration of vitamin B6 were significantly different (p less than 0.01) between the unsupplemented and supplemented groups. The milk concentrations of vitamin B12 increased significantly (p less than 0.05) in the supplemented group, as did the milk concentrations of folate (p less than 0.01). Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women, either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens' breast milk.

Effects of a glandless cottonseed protein diet on fasting plasma amino acid levels in college women.

Plasma amino acids were determined and correlated to the level of dietary amino acids consumed over a 42-day period. Six college women, ages 19 to 23, were fed meals in which 99% of the dietary protein was supplied by glandless cottonseed flour. The protein content was decreased weekly from 14.6 to 9.9, 8.7, 7.5, 6.9, and 6.3 g nitrogen per day, until that amount was found that would not maintain nitrogen equilibrium. Fasting blood samples were obtained after subjects had consumed a specific protein level for 1 week. Significant (P less than 0.05) decreases in fasting plasma free amino acid levels occurred from day 0 to 7 of the study for threonine, proline, isoleucine, leucine, tyrosine, and lysine. There were no significant differences in these plasma amino acids thereafter. Of the essential amino acids, leucine, valine, histidine, and lysine appeared to have similar graphical trends between the plasma and dietary amino acid concentrations over the entire 6-week period. However, only leucine had a significant (P less than 0.05) correlation. Results indicated that fasting plasma free amino acid concentrations of young women on a cottonseed protein diet appear to drop initially, but rarely fall beyond the realms of normal values during nitrogen equilibrium.

The effects of vitamin C, vitamin B6, and vitamin B12 supplementation on the breast milk and maternal status of well-nourished women.

The effects of vitamin supplements and/or diet on the levels of vitamin C, vitamin B6, and vitamin B12 in milk and blood of lactating women were determined. At the end of gestation, subjects were divided into two lactation groups: supplemented (10 subjects) and nonsupplemented (seven subjects). Milk samples were collected from 5 to 7 days and 43 to 45 days postpartum. Fasting blood samples were drawn at 8 and 46 days postpartum for vitamin C, B6, and B12 status measurements. Dietary records of all foods consumed by the subject were kept for 4 days at 1 and 6 weeks postpartum. The vitamin B6 level in breast milk of the unsupplemented group of mothers was significantly lower (P less than 0.05) than the supplemented group of women at 5 to 7 days postpartum. Vitamin B12 concentration in milk of nonsupplemented mothers at 43 to 45 days postpartum was significantly lower (P less than 0.05) than the supplemented group of women at 43 to 45 days postpartum. None of the milk values or the maternal blood levels measured in the women was less than published norms for vitamin C, vitamin B6, and vitamin B12.

The effects of vitamin C, vitamin B6, vitamin B12, folic acid, riboflavin, and thiamin on the breast milk and maternal status of well-nourished women at 6 months postpartum.

The effects of vitamin supplements and/or diet on the vitamin levels in milk of women were determined at 6 months postpartum. Six subjects consumed a daily supplement (Natalins, Mead-Johnson) in addition to a well-balanced diet--supplemented group, and six subjects consumed only a well-balanced diet--nonsupplemented group. The subjects expressed milk for 3 days at 4-hr intervals, 0, 4, 8, and 12 hr after awakening or taking their vitamin supplement. A 4-day diet record, fasting blood sample, and 24-hr urine samples were collected on each subject at 6 months postpartum. Nutrient intake from diet alone did not differ significantly between the two groups except for riboflavin intake which was significantly higher in the supplemented group. The nutritional status of all women indicated excellent dietary intakes, which vitamin supplementation did not alter significantly. Milk concentration of vitamin B6, vitamin B12, folate, thiamin, riboflavin, and vitamin C, did not differ significntly between groups. Thiamin, vitamin B12, and vitamin B6 concentration in the milk did appear to plateau during the day. Vitamin supplementatin at 6 months postpartum did not affect the breast milk concentration or the nutritional status of well-nourished women.

Linkage of autosomal dominant radial drusen (malattia leventinese) to chromosome 2p16-21.

OBJECTIVE: To identify the chromosomal location of the gene involved in the pathogenesis of autosomal dominant radial drusen (malattia leventinese). PATIENTS: Eighty-six members of four families affected with radial drusen; one family of American origin and three families of Swiss origin. METHODS: Family members were clinically examined for the presence of radial drusen. Affected patients and potentially informative spouses were genotyped with short tandem repeat polymorphisms distributed across the autosomal genome. The clinical and genotypic data were subjected to linkage analysis. RESULTS: Fifty-six patients were found to be clinically affected. Significant linkage was observed between the disease phenotype and markers known to lie on the short arm of chromosome 2. The maximum two-point lod score (Zmax) observed for all four families combined was 10.5 and was obtained with marker D2S378. Multipoint analysis yielded a Zmax of 12, centered on marker D2S378. The lod-1 confidence interval was 8 cM, while the disease interval defined by observed recombinants was 14 cM. CONCLUSIONS: The gene responsible for autosomal dominant radial drusen has been mapped to the short arm of chromosome 2. This is an important step toward actually isolating the disease-causing gene. In addition, this information can be used to evaluate other familial drusen phenotypes such as Doyne's macular dystrophy for a possible allelic relationship.

Accuracy of clinical judgment in neonatal jaundice.

CONTEXT: Recommendations for management of jaundice in newborns presume thatjaundice is a reliable clinical finding and that the pattern and intensity of jaundice reflects the degree of elevation of the serum bilirubin level. OBJECTIVES: To determine whether experienced observers agree in describing the extent of jaundice and to evaluate the reliability of visual assessment as an indication for the measurement of serum bilirubin levels. DESIGN: Comparison of independent judgments of the extent of jaundice between examiners and with actual serum bilirubin measurements. SETTING: Well-newborn nursery in an urban public hospital. PARTICIPANTS: A convenience sample of 122 healthy term newborns whose bilirubin concentration was measured in the course of standard newborn care. Observers were experienced pediatric nurse practitioners, pediatric house staff, and pediatric attending physicians. RESULTS: Agreement was moderately good for whether an infant's skin was darkly pigmented (K = 0.56). However, agreement between observers regarding the presence of jaundice at each specific body site was poor (0%-23% agreement beyond chance); correlation between estimated bilirubin concentrations was similarly poor (Pearson correlation coefficient, 0.37). Correlation between estimated and actual bilirubin values was slightly better (Pearson correlation coefficient, 0.43-0.54). CONCLUSIONS: Clinical examination with visual assessment for jaundice in newborns is neither reliable nor accurate. The decision to perform serum bilirubin testing should be based on additional factors.

Fenestrated sheen macular dystrophy.

We examined a family with fenestrated sheen macular dystrophy. The red macular lesions were strikingly apparent in the propositus and more subtle in one affected cousin. Pronounced macular retinal pigment epithelial disruption or mottling was present in the father of the propositus, who also had markedly reduced electroretinogram rod and cone responses. The extent of electroretinogram amplitude reduction indicates abnormal function of the peripheral retina in addition to the clinically evident macular changes. Affected family members showed peripheral retinal pigment epithelial granularity. Central visual acuity remained normal despite the presence of macular lesions.

A technique for obtaining feedback from students using a computer program in a veterinary anesthesia course.

INTRODUCTION: The College of Veterinary Medicine at Michigan State University has been using computer-aided instructional programs in our pre-clinical veterinary anesthesia course. We describe an embedded feedback collection module (FCM) that facilitates the process of formative evaluation of the program. METHODS: The instructional program was divided into discrete sections. The FCM was accessed easily from all sections of the program. Instructions for use of the FCM were delivered orally to all users of the instructional program and were included in the introduction section of the program. RESULTS: Feedback was obtained from successive classes of veterinary students over four years, using our computer-aided instructional program. Students in each class were required to use the program either in class or for review and to leave at least one comment in the FCM. Of the 653 responses, 293 were positive and expressed appreciation for the program, 209 contained specific comments or suggestions, and 151 were questions relating to the subject material contained within the program. Written survey feedback was also obtained from some students in these classes. CONCLUSION: Our FCM was effective and easy to implement. It proved an easy way to obtain user feedback, which was used in the ongoing process of program design and content improvement.

Management of siderosis bulbi due to a retained iron-containing intraocular foreign body.

The authors report their experience in managing 14 cases of siderosis bulbi secondary to a retained iron-containing intraocular foreign body (IOFB). The IOFB was removed in 12 of the 14 eyes. The IOFB was removed with a sclerotomy and external magnet (5 eyes), a pars plana vitrectomy (PPV) and intraocular forceps (5 eyes), a PPV and intraocular magnet (1 eye), and a PPV with aspiration using the suction mode of the vitrectomy instrument (1 eye). A siderotic cataract developed in 11 eyes and cataract extraction resulted in postoperative visual acuity ranging from 20/15 to 20/40. The most recent siderotic cataracts have been managed with cataract extraction and posterior chamber intraocular lens (PC IOL) implantation. No patient in this series experienced visual deterioration after receiving medical attention. The current management of siderosis bulbi is discussed.

Early retinal adhesion from laser photocoagulation.

Histopathologic examination of eight cynomolgus monkey eyes and one human eye revealed that both argon and krypton laser photocoagulation cause adhesion between the neurosensory retina and the retinal pigment epithelium (RPE) within 24 hours of treatment. The neurosensory retina remained attached at the sites of laser burns despite surrounding retinal detachment in untreated areas. This early adhesion with the laser is useful for the treatment of eyes in which the retina has been recently reattached such as at the end of a vitrectomy for a retinal detachment with proliferative vitreoretinopathy (PVR) or after a pneumatic retinopexy. It is also useful for the treatment of retinal breaks without detachment.

Macular hole surgery with internal-limiting membrane peeling and intravitreous air.

OBJECTIVE: To examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients. DESIGN: A retrospective, interventional, noncomparative case series. PATIENTS: Fifty consecutive patients (58 eyes) with full-thickness macular holes. INTERVENTION: All eyes underwent a pars plana vitrectomy with internal-limiting membrane peeling and intravitreous air, and patients were asked to position face-down for only 4 days. MAIN OUTCOME MEASURES: Status of macular holes, visual acuity, and associated findings and complications. RESULTS: All patients had postsurgical follow-up of 6 months or greater. Eight eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with stage-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eyes (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91 %) of the 58 macular holes were closed with 1 operation, and 55 (95%) had closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months' duration, 44 (98%) had macular holes that were closed with 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months' duration or longer, 9 (69%) had macular holes that were closed with 1 operation and 4 (31 %) had a final visual acuity of 20/50 or better. Complications attributed to the operation included retinal tears, retinal detachments, postoperative macular puckers, and macular light toxicity. CONCLUSIONS: The anatomic and visual results in this series are good. The current technique is similar to that of conventional macular hole surgery except for the use of intravitreous air, internal-limiting membrane peeling in all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adjuvant for successful closure of macular holes.

Minimum nitrogen requirement from glandless cottonseed protein for nitrogen balance in college women.

Seven women, 18 to 23 years of age, were fed cooked cottonseed products for 42 days in order to determine the minimum nitrogen requirements for glandless cottonseen flour after baking. The women consumed from 81 to 213 mg N/kg body weight from cottonseed protein. Nitrogen intake from each experimental period was calculated from the average nitrogen content of the cottonseed products consumed each day of the experiment period. Nitrogen excretion was determined from the measurement of nitrogen in a total collection of urine and feces for each experimental period plus an obligatory loss of 5 mg/kg body weight. Fasting blood samples were taken prior to the study and at the end of each 7-day experimental period thereafter. The minimum requirement for cottonseed protein to maintain a positive nitrogen balance was 106 mg N/kg body weight. For the "reference woman," weighing 58 kg, at least 6.1 g of cottonseed flour nitrogen would be required to maintain nitrogen equilibrium. Plasma amino acid values of threonine, proline, valine, isoleucine, leucine, tyrosine, and lysine decreased significantly from day 0 to day 7 of the study. There were no significant differences in these plasma amino acids thereafter. Cottonseed flour incorporated into baked products maintained nitrogen balance in college women with no change in their nutritional status.

Choroidal detachment associated with malignant choroidal tumors.

The association of choroidal detachment with malignant choroidal tumors is not well recognized. The authors' experience with six cases suggests that choroidal detachment may be associated with both metastatic tumors and choroidal melanoma. In two of these cases, the choroidal or retinal detachment was so massive that echography was necessary to detect the underlying tumor. Three patients presented with painful visual loss, and three patients presented with painless visual loss or a visual field defect. In one patient, the correct diagnosis and appropriate treatment of the choroidal metastasis with external radiation relieved the patient's pain and improved visual acuity from 1/200 to 20/35. Metastatic and primary uveal malignant tumors should be added to the list of causes of choroidal detachment and can be excluded only after thorough clinical, and often echographic, examination.

Surgical management of late-onset retinal detachments associated with regressed retinopathy of prematurity.

The authors report their experience in managing 16 cases of late-onset retinal detachments (RDs) associated with regressed retinopathy of prematurity (ROP). Fourteen (88%) of the 16 eyes were successfully reattached. An initial scleral buckling procedure was successful in 6 of 12 eyes. A pars plana vitrectomy was necessary in a total of eight eyes that either initially presented with proliferative vitreoretinopathy (1 case), posterior retinal breaks (1 case), subretinal fibrosis (1 case), vitreoretinal traction bands (1 case), or had persistent vitreoretinal traction after failed scleral buckling procedures (4 cases). Visual acuity stabilized or improved in 13 of the 14 eyes with successful retinal reattachment. Because these cases often have significant vitreoretinal traction and/or posterior retinal breaks, pars plana vitrectomy in conjunction with scleral buckling may be necessary in order to achieve long-term retinal reattachment.