Effects of freezing and drying grass products prior to fatty acid extraction on grass fatty acid and lipid class composition--a technical note.

Grass and grass silage represent a rich and natural source of omega-3 polyunsaturated fatty acids, in particular linolenic acid, for ruminants. Recent research, focusing on improving the content of these beneficial fatty acids in grass, requires storage of the forage samples prior to analysis. In this study, we evaluated whether conservation of fresh grass and grass silage by freezing (1 and 4 weeks,--18 degrees C) and/or drying (24h, 50 degrees C) affected its fatty acid content and induced shifts between lipid classes. FA were extracted using chloroform/methanol (2/1, v/v) and triacylglycerols (TAG), free fatty acids (FFA) and polar lipids (PL) were separated by thin layer chromatography. Fatty methyl esters (FAME) were identified by gas chromatography. Loss of thawing liquor might provoke a dramatic decrease in extractable lipid after frozen storage of both grass and grass silage. Morever, after frozen storage, fatty acids in grass but not in grass silage seem subjected to a higher rate o f lipolysis and oxidation, as suggested by increased quantities of FFA (3.1, 7.6, 8.4 % of total FAME) and reduced proportions of poly-unsaturated fatty acids (79.5, 73.6 and 74.1 % of total FAME) when analysing fresh grass samples directly or after 1 and 4 weeks of frozen storage, respectively. Drying of fresh grass did not provoke changes in FA composition, but distribution of FA over lipid classes was significantly altered, with an increase in TAG (5.1 to 17.9 % of total FAME) and FFA (2.4 to 14.9 % of total FAME) and lower proportions of PL (90.7 to 55.7 % of total FAME).

Identifying elderly patients for early discharge after hospitalization for hip fracture.

BACKGROUND: Some elderly patients can be successfully treated in hospitals with lengths of stay (LOS) shorter than the norms developed by the diagnosis-related groups. This study was designed to test the hypothesis that elderly patients with short LOS after hip fracture have characteristics that can be identified shortly after hospital admission. METHODS: A retrospective chart review was performed of 216 patients over age 55 discharged alive from a university hospital after hip fracture. Demographic, medical, and functional data available within 48 hours of admission were used to develop an algorithm to identify patients eligible for early discharge. A prospective study of an additional 33 patients was undertaken to test this algorithm and to examine the predictive value of additional functional and psychosocial information not routinely recorded in the chart. RESULTS: Retrospective chart review identified 4 predictors of short LOS in multivariate analysis: age less than 75, admission from a nursing home, normality of admission laboratory results, and "no surgery or surgery by day three." These variables explain 25% of the total variation of LOS. In our prospective study the variable "day of surgery" had the greatest variance explanation (30.5%) in multivariate analysis. A model including day of surgery and the presence of dementia explained 42.5% of the variance of LOS. CONCLUSION: Short LOS can be predicted within 48 hours of admission utilizing data that measure severity of illness, functional status, and available support. The development of algorithms to identify patients eligible for early discharge would be beneficial to care managers.

Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin.

Recent reports have emphasized an increase in both infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in institutionalized older patients. We studied whether or not local treatment with mupirocin ointment could eliminate nasal colonization with S aureus. A total of 102 patients in a Veterans Administration nursing home were screened for S aureus nasal colonization. Thirty-nine patients (38.2%) were colonized, 18 with methicillin-sensitive Saureus (MSSA) and 21 with MRSA. Almost half of all colonized patients were in the most dependent functional category and there was a significant association of MRSA colonization, but not MSSA colonization, with poor functional status. Colonized patients were treated with mupirocin ointment applied to the anterior nares twice daily for seven days. After treatment, MSSA persisted in only two patients and MRSA in only one patient; thus, nasal colonization was eliminated in 91.4% of colonized patients. At one month and two months follow-up, 11 patients became transiently recolonized and three became persistently recolonized with S aureus. Mupirocin was well tolerated with no side effects noted. Mupirocin ointment may be useful in controlling nasal colonization with S aureus in the nursing home setting.

Effect of high-dose cyclophosphamide and total-body irradiation on left ventricular function in adult patients with leukemia undergoing allogeneic bone marrow transplantation.

Protocols used to prepare patients with leukemia for bone marrow transplantation have the potential for cardiac toxicity due to high-dose cyclophosphamide and total-body irradiation. We have reported one regimen, combining cytarabine (5 mg/kg), cyclophosphamide (90 mg/kg), and total-body irradiation (900 cGy), which is relatively effective in the treatment of leukemia. To assess cardiac effects of this treatment regimen, we performed serial echocardiography and radionuclide ventriculography in 28 patients with leukemia (age range, 18-48 years; mean, 31; 21 males) undergoing allogeneic bone marrow transplantation. No significant change in left ventricular fractional minor axis shortening or increase in left ventricular diastolic dimension was seen with weekly echocardiography. At an average of 77 days (range, 28-358) after transplant, repeat radionuclide ventriculography in 17 patients revealed no significant change in resting left ventricular ejection fraction compared to that on admission to the hospital (58% +/- 6.8% vs 56% +/- 8.0% SD; P = not significant). In seven of these 17 patients (41%), resting ejection fraction fell between baseline and discharge (from mean of 60% to 50%). Resting ejection fraction in four of these patients (23% of the entire group) fell into the abnormal range (from mean of 56% to 44%; lowest, 41%). Ten patients also had exercise radionuclide ventriculography and all had normal responses (greater than 5% increase with exercise) pre- and post-transplant. We conclude that this effective bone marrow transplantation regimen has little apparent short-term cardiac toxicity in the majority of patients; since a few patients do exhibit a deterioration in left ventricular function, continued cardiac surveillance is probably indicated in posttransplant patients.

Factitious hypoglycemia. Clues to identifying an elusive disorder.

Factitious hypoglycemia is similar in presentation to insulinoma and occurs most commonly in persons with ready access to insulin. Diagnosis previously was based on circumstantial evidence but now can be confirmed by demonstration of high insulin levels and low C-peptide levels in the presence of hypoglycemia. Treatment is primarily psychiatric, and success so far is limited.