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Objectives: The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR).Background: There is a wide discrepancy...

Objectives To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months. Background Radiation exposure to the public at large has increased dramatically over the past three decades, and the cardiac catheterization laboratory is a large contributor. Fluoroscopy pulse rate is one way to decrease radiation exposure. Methods Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (Ka, r), Air KERMA area product (PKA), procedural complications and major adverse cardiac events at 30 days and 6 months. Results In diagnostic catheterization median PKA (µGy·m2) and Ka,r (mGy) were significantly reduced (PKA – 5,613.3 vs. 4,400, P

A 57-year-old man with past medical history of asthma was transferred from an outside hospital for evaluation of cardiac mass where he was treated for extensive right lower extremity iliofemoral deep venous thrombosis with catheter-directed thrombolytic therapy and thrombectomy. Due to concern of

The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR).There is a wide discrepancy in the reported rate of RRT after TAVR (1.4% to 40%). The true incidence of RRT after TAVR is unknown.The STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) registry was linked to the Centers for MedicareMedicaid database to identify all patients that underwent TAVR from November 2011 through September 2015 and their outcomes. The authors compared rates of death, new RRT, and a composite of both as a function of pre-procedure glomerular filtration rate (GFR), both in stages of chronic kidney disease (CKD), as well as on a continuous scale.Pre-procedure GFR is associated with the risk of death and new RRT after TAVR when GFR is 60 ml/min/mIn both unadjusted and adjusted analysis, pre-procedural GFR was associated with the outcomes of death and new RRT. Increasing CKD stage leads to an increased risk of death and/or RRT. Continuous analysis showed significant differences in outcomes in all levels of CKD when GFR was 60 ml/min/m

Prosthetic valve paravalvular leak (PVL) is a known and relatively common complication of surgical valve replacement, which may lead to significant morbidity. Patients with significant mitral valve replacement (MVR) PVL typically present with symptoms of heart failure and elevated filling pressures or with hemolytic anemia. Percutaneous closure of these leaks has become the preferred therapy. Percutaneous closure of MVR PVL can be technically challenging, given the anatomy of the approach (trans-septal, trans-apical), the level of associated comorbidities and the geographic location of the paravalvular defect. Steerable catheters offer a unique ability to position themselves coaxial to the PVL. The Dexterity catheter (Spirus Medical LLC, Bridgewater, MA, USA) is a semi-rigid steerable catheter used in our lab with the ability to articulate at two separate points on the distal tip and flex greater than 360 degrees. We present cases of surgical valves that developed PVL which underwent successful repair with a Dexterity catheter.

To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months.Radiation exposure to the public at large has increased dramatically over the past three decades, and the cardiac catheterization laboratory is a large contributor. Fluoroscopy pulse rate is one way to decrease radiation exposure.Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (KIn diagnostic catheterization median PReducing fluoroscopy pulse rates to 7.5 from 10 is an effective way to reduce patient radiation exposure across meaningful dose indices. A pulse rate of 7.5 p/s is safe, with no difference in complications or outcomes. A fluoroscopy pulse rate of 7.5 p/s should be given strong consideration for a new standard. © 2016 Wiley Periodicals, Inc.

Aortic stenosis in combination with end-stage renal disease (ESRD) is a high-risk combination for surgical valve replacement and little data exists on the role of transcatheter aortic valve replacement (TAVR) Pooled retrospective data from eight experienced TAVR sites suggests that TAVR can be accomplished in ESRD patients with first generation percutaneous valve at a risk similar to surgical approaches. Even with TAVR, valve replacement in the ESRD patient remain high risk and future improvements in technology and approaches to this poorly studied group are needed.

Intravascular foreign bodies (IVFB) are a well-described complication of endovascular procedures with significant morbidity and mortality. Retrieval of the IVFB is indicated if at all possible. Retrieval of IVFBs can be complex based on the location and cumbersome nature of the embolized device.

Key points 5-Fr transradial sheathless guide technique using a 4-Fr mother–child technique can be accomplished with excellent clinical success An enhanced risk for local traumatic injury to the radial artery was observed that may stem from the imperfect transition and taper between catheters, or friction inherent in the catheter surface design, that technologic advances may be able to address in the future If larger sheath technology is not feasible, this sheathless approach presents an option whether the risk/benefits appear favorable despite the potential from radial artery trauma

Isolated congenital single coronary artery (SCA) is rare (incidence 0.024-0.066%). We present a case of a Lipton -1 subtype single coronary artery, incidentally discovered on coronary angiography prior to mitral valve surgery.

Background: Progression to renal replacement therapy (RRT) is a common concern for chronic kidney disease patients undergoing TAVR. Shared decision making requires accurate estimates on the need for RRT following TAVR; however, this information is unknown. We sought to quantify the need for RRT

Ionizing radiation makes invasive diagnostic imaging and therapeutic procedures possible but is also associated with deterministic and stochastic effects. Strategies to reduce radiation in the cardiac catheterization lab are well established and include appropriate collimation, reducing fluoroscopy

Objectives To evaluate safety and benefits of feeding preterm infants formulas containing docosahexaenoic acid (DHA) and arachidonic acid (ARA) until 92 weeks postmenstrual age (PMA), with follow-up to 118 weeks PMA. Study design This double-blinded study of 361 preterm infants randomized across three formula groups: (1) control, no supplementation; (2) algal-DHA (DHA from algal oil, ARA from fungal oil); and (3) fish-DHA (DHA from fish oil, ARA from fungal oil). Term infants breast-fed ≥4 months (n = 105) were a reference group. Outcomes included growth, tolerance, adverse events, and Bayley development scores. Results Weight of the algal-DHA group was significantly greater than the control group from 66 to 118 weeks PMA and the fish-DHA group at 118 weeks PMA but did not differ from term infants at 118 weeks PMA. The algal-DHA group was significantly longer than the control group at 48, 79, and 92 weeks PMA and the fish-DHA group at 57, 79, and 92 weeks PMA but did not differ from term infants from 79 to 118 weeks PMA. Supplemented groups had higher Bayley mental and psychomotor development scores at 118 weeks PMA than did the control group. Supplementation did not increase morbidity or adverse events. Conclusions Feeding formulas with DHA and ARA from algal and fungal oils resulted in enhanced growth. Both supplemented formulas provided better developmental outcomes than unsupplemented formulas.

Objective. Survival rates for preterm infants who weigh between 501 and 1500 g at birth have continued to improve over time. In response to this continuing decrease in birth weight of surviving preterm infants, Enfamil Human Milk Fortifier has recently been reformulated to meet the nutritional requirements of these smaller, more rapidly growing infants. It now provides an increased protein level of 1.1 g/58 kJ, a decreased carbohydrate level of 0.2 g/58 kJ, and a combined linoleic and α-linolenic fatty acid content of 157 mg/58 kJ. As these very small preterm infants have an increased requirement for dietary iron, the fortifier has been supplemented with 1.44 mg/58 kJ of iron, an amount of iron similar to that provided in a typical iron-fortified term infant formula. An iron-fortified product obviates the need for administration of an iron supplement, a hyperosmolar-inducing intervention. The purpose of this prospective, double-blind, randomized, controlled study was to evaluate growth, safety, and efficacy in a population of very low birth weight (VLBW) preterm infants who received human milk fortified with either the reformulated iron-fortified powdered human milk fortifier test product (HMF-T) or a powdered commercially available human milk fortifier control product (HMF-C). Methods. Infants who weighed ≤1500 g, had a gestational age ≤33 weeks postmenstrual age, and had an enteral intake of at least 100 mL/kg per day of unfortified human milk were stratified by gender and birth weight and randomized to receive HMF-T or HMF-C product from study day 1 to study day 28, hospital discharge, or the termination of human milk feedings, whichever came first. Unless medically indicated, investigators were not to administer iron supplements from study days 1 to 14. Infants were assessed serially for growth; enteral and parenteral intake; serum chemistry and hematologic values; clinical histories, including the administration of blood transfusions; feeding tolerance; respiratory outcomes; and morbidities, including adverse events. Results. Of the 181 participating infants in this study, 96 received HMF-T and 85 received HMF-C. At randomization, there were no significant differences in infant characteristics between the fortifier groups. The percentage of participants who remained in the study for 28 days was similar between fortifier groups (57% HMF-T, 46% HMF-C). For both fortifier groups, the most frequent reasons for discontinuing the study before study day 28 were unavailability of human milk and hospital discharge. Rate of weight gain was similar between the fortifier groups (17.5 ± 0.53 g/kg per day for HMF-T and 17.3 ± 0.59 g/kg per day for HMF-C). Mean achieved weight, length, and head circumference were comparable between groups across the 28-day study period. Total protein intake from enteral and parenteral nutrition was significantly greater for the HMF-T fortifier group; however, this difference did not result in any difference in growth between the 2 fortifier groups. An analysis of the growth and energy intake data of a subset of the intent-to-treat population who adhered more strictly to the study feeding protocol yielded results similar to those seen for the intent-to-treat population. There were no clinically significant differences in the results of laboratory studies between the groups at study days 0, 14, and 28. Anemia of prematurity was prevalent in both study groups; by study day 28, median hematocrit levels were 27.0% (interquartile range [IQR]: 24.0%–29.6%) for the HMF-T group and 26.0% (IQR: 24.0%–31.0%) for the HMF-C group. Median ferritin levels were 77.0 ng/mL (IQR: 37-155 ng/ml) for HMF-T and 92.0 ng/mL (IQR: 33-110 ng/mL) for HMF-C. There were no significant differences between the study fortifier groups in regard to the receipt of medically indicated iron supplements on or before study day 14 or in the administration of blood transfusions before study day 0 or from study days 0 through 14. However, from study day 15 to study day 28, fewer HMF-T infants (n = 12) required a blood transfusion than did HMF-C infants (n = 20). Although the higher levels of iron in the HMF-T fortifier (1.44 mg vs 0.35 mg for HMF-C per 4 packets of powdered fortifier) did not prevent anemia per se, it did reduce the frequency of one of the most serious outcomes of anemia: the need for a blood transfusion. There was no statistically significant difference between fortifier groups in regard to feeding tolerance. Rates of suspected sepsis (26% HMF-T vs 31% HMF-C) and confirmed sepsis (5% HMF-T, 7% HMF-C) were low as were the rates of suspected necrotizing enterocolitis (NEC; 6% HMF-T and 5% HMF-C) and confirmed Bell's stage 2 or more NEC (1% HMF-T and 1% HMF-C). There were no statistically significant differences between the study fortifier groups in regard to the incidence of confirmed and suspected sepsis and NEC. Conclusion. Both human milk fortifiers studied are safe, are well tolerated, and facilitate comparable good growth; however, using the iron-fortified product may reduce the need for blood transfusions in VLBW infants. The similar low rates of suspected and confirmed NEC and sepsis seen in both fortifier groups in this study refutes the premise that the inclusion of iron in fortifiers will increase the incidence of sepsis and NEC. Indeed, the incidence for NEC and sepsis for both groups in this study was lower than is reported for VLBW infants and similar to that seen for infants who are fed human milk.

Objective: To determine if docosahexaenoic acid (DHA) and arachidonic acid (ARA) supplementation influences growth or visual acuity of formula-fed premature infants. Study design: Double-blind, multi-center study of 194 premature infants given preterm formula with no DHA or ARA (control), 0.15% energy DHA, or 0.14% DHA + 0.27% ARA from single-cell triglycerides for at least 28 days and then fed term formula (no DHA or ARA) to 57 weeks postmenstrual age (PMA), with 90 breast-fed term infants as reference. Results: Infants fed DHA+ARA formula gained weight significantly faster (post-hoc analysis) during preterm formula feeding than control infants (34.7 vs. 30.7 g/d) and had weights and weight:length ratios not different from term breast-fed infants at 48 and 57 weeks PMA. Infants fed control or DHA formula had lower body weights than term infants. Red blood cell phosphatidylethanolamine ARA was significantly correlated to weight gain during preterm formula feeding and to weight and length at 40, 48, and 57 weeks PMA ( r = 0.19 to 0.24, P =.004-.02). Providing DHA or DHA+ARA during the preterm period had no effect on subsequent visual acuity or incidence of adverse events. Conclusions: Feeding DHA+ARA from single-cell triglycerides enhances weight gain in formula-fed premature infants with no evidence of adverse effects. (J Pediatr 2002;140:547-54)

To determine whether a low-lactose formula (LLF,5% lactose) would ameliorate feeding intolerance in premature infants.Prospective, randomized, controlled trial involving 306 infants36 weeks' gestation and weighing1800 g who received either lactose-containing formula (LCF) 24 kcal/oz or a specially prepared LLF, which was comparable to the LCF except for the functional replacement of lactose with maltose. We examined outcome variables of feeding intolerance and cases of necrotizing enterocolitis (NEC) and suspected NEC.One hundred forty-nine infants were assigned to receive LCF, of which 99 infants received LCF only. One hundred fifty infants were assigned to receive LLF, of which 102 infants received LLF only. The remaining infants received LCF or LLF plus some quantity of human milk or human milk alone. Infants receiving LLF had improved enteral caloric intake and weight gain, reached full feeds faster, had less gastric residual, spent less time without oral intake, and had fewer feedings stopped than the LCF group. The number of cases of NEC and suspected NEC was similar in both groups.Low-lactose premature infant formula improved feeding tolerance. There was no evidence that LLF altered the incidence of NEC, but the incidence of NEC in this study was too low to draw conclusions.

ICA and GAD65 autoantibody profiles and HLA-DR and DQ analysis were performed on 43 Black juvenile onset IDDM patients and 34 unrelated Black controls from Tennessee, USA. 75% of patients were positive for GAD65 autoantibodies but only 53% had ICA; 39% both ICA and GAD65 antibodies. The strongest HLA association was with the DR3 haplotype DRB1*03 DQA1*0501 DQB1*0201 (63% of patients v 12% of controls RR = 13.0, p0.00002). DRB1*04 DQA1*0301 DQB1*0302, associated with IDDM in Caucasians but rare in Negroids, occurred in 27% of patients and 6% of controls (RR = 5.9, p0.04). All patients carried DQB1*0302 or DQB1*0201. DQB1*0602 was significantly reduced in patients (2.4% v 41%, RR = 0.036, p0.008) and DRB1*1501 was absent in patients (0% v 35%). The frequency of GAD65 autoantibodies in Black American IDDM patients is comparable to that in Caucasians; however ICA positivity is reduced. GAD65 antibodies may therefore be a more sensitive serological test to identify individuals in the Black American general population for markers associated with increased risk of developing IDDM. Current screening methods for predicting preclinical IDDM in Caucasians relies on a combination of immune and HLA markers of IDDM; studies of these markers in the Black Americans will make it possible to extend these options to additional genetically diverse populations.

To assess the influence of protein intake on renal excretion of calcium and amino acids and on bone mineralization in preterm infants, we randomly selected within weight group strata 27 infants who weighed1500 gm at birth (nine per group) to be fed a high-mineral (calcium, 940 mg/L; phosphorus, 470 mg/L) premature formula with one of the following protein contents: formula A, 3.0 gm/100 kcal; formula B, 2.7 gm/100 kcal; and formula C, 2.2 gm/100 kcal. Mean (+/- SD) daily weight gain was greater in infants receiving the higher protein intakes for the first 30 days (formula A, 24.8 +/- 5.1 gm; formula B, 20.5 +/- 3.8 gm; formula C, 16.2 +/- 5.9 gm (analysis of variance: p0.01; CA, p0.05)). Bone mineral content did not differ at any time point, and all groups had a high prevalence of generalized aminoaciduria (4 weeks: formula A, 56%; formula B, 71%; formula C, 75%). Urinary calcium corrected for creatinine (in milligrams per milligram) increased as protein content decreased (2 weeks: formula A, 0.16 +/- 0.10; formula B, 0.20 +/- 013; formula C, 0.44 +/- 0.33 (CA, CB, p0.05); 4 weeks: formula A, 0.23 +/- 0.15; formula B,0.34 +/- 0.47; formula C, 0.49 +/- 0.22 (CA, p0.01). We conclude that the high mineral content and other components of premature formulas result in a higher growth rate and may increase protein requirements. Failure to meet protein requirements may result in underutilization of absorbed calcium and increased renal excretion of calcium. In preterm infants, higher protein intake probably supports rather than jeopardizes bone mineral accretion, and reduces rather then increases calciuria.

Growth and Development of Term Infants Fed Formulas with Docosahexaenoic Acid (DHA) from Algal Oil or Fish Oil and Arachidonic Acid (ARA) from Fungal Oil

We have examined the suppression of urinary pregnanetriol and 17-ketosteroids during treatment with cortisol, cortisone, prednisone, and dexamethasone in eight patients with congenital adrenal hyperplasia. A large individual variation in response to each agent was observed. In some individuals, cortisone is less effective than its generally accepted potency would indicate. At equivalent glucocorticoid dosage, dexamethasone was twice as effective as the other steroids in suppressing urinary 17-ketosteroids and pregnanetriol. The potency of dexamethasone in suppressing adrenal function was 80 times that of cortisol, about twice its generally accepted potency as a glucocorticoid or anti-inflammatory agent.

The dynamics of calcium metabolism in the human infant were determined using stable isotopes of calcium as tracers. Two isotopes, one given intravenously and the other orally were used. Tracer time-dependent dilutions were measured with high accuracy and precision using thermal ionization mass spectrometry. Similar studies were performed in infant rhesus monkeys using radio tracers. Analysis of the isotope dilutions using a compartmental model method showed quite similar results for the infants of both species. These similarities support the validity both of using stable isotopes in human studies, and the use of the rhesus monkey as a model for human calcium dynamics. It was found that the classical steady state compartmental model was inadequate for use in the rapidly growing infant, and the model was modified to account for the expansion of the body fluid calcium compartment during the time of the study. Comparison with adult human calcium metabolic parameters showed that urinary calcium flows are much higher in the adult than in the newborn, relative to other calcium metabolic parameters. Other parameters of infant calcium metabolism are all consistent with the growth and more rapid metabolism usually seen in the young.

Patterns of gonadotropin levels have been compared in specimens of serum, 24-h urine collections, and first morning urine voidings collected throughout a menstrual cycle from 8 sexually mature, young women. Quantities of gonadotropins in first morning voidings were found to provide a reliable estimate of 24-h excretion of these hormones and demonstrate the same patterns of change as do serum and 24-h urine specimens. Thus first morning voidings satisfactorily overcome logistical problems inherent is serial serum and 24-h urine sampling for studying gonadotropin excretion patterns.

We studied postnatal bone mineralization, as measured by photon absorptiometry, in 36 preterm infants (birth weight less than 1600 gm) who were fed (1) a commercial premature formula containing 117 mg calcium and 58.8 mg phosphorus per 100 kcal, (2) the same formula containing a higher concentration of phosphorus (82 mg/100 kcal), (3) the same formula with higher concentrations of calcium (140 mg/100 kcal) and phosphorus (82 mg/100 kcal), or (4) their mother's milk. Serum calcium, phosphorus, protein, albumin, bicarbonate, 25-hydroxyvitamin D, and alkaline phosphatase levels were measured at the start of the study and every 2 weeks until the infants achieved a weight of 1900 gm. Birth weights and gestational ages were similar in all four groups. The human milk group had lower serum phosphate and bone mineral values than those in the three formula groups. Bone mineral content was similar in the three formula groups. However, only the formulas of the first and third groups allowed approximation of the intrauterine bone mineralization curve. Bone mineral content in infants fed human milk was below the intrauterine rate.

We compared the growth, biochemical status, and mineral status of 30 very-low-birth-weight infants randomly assigned to receive preterm human milk (Group I, 10 infants) from their own mothers, fortified preterm human milk (Group II, 8 infants), or a high-caloric-density premature formula (Group III, 12 infants). Added to the infant's own mother's milk, a human milk fortifier at full strength provided additional protein (60:40 whey/casein, 0.7 g/dl), calories (4 kcal/oz), and minerals. Volume of intake, feeding tolerance, and complications were similar in the three groups. Infants receiving fortified preterm human milk showed growth, biochemical status, and mineral status similar to those receiving high-caloric-density formula, but infants receiving fortified preterm human milk grew faster (12.0 +/- 3.2 vs. 8.9 +/- 1.1 days/300 g, p less than 0.05), had higher serum protein (4.6 +/- 0.5 vs. 4.2 +/- 0.2 g/dl, p less than 0.05), and tended to have better mineral status (higher serum calcium, lower alkaline phosphatase, and higher serum phosphorus, none individually significant) than infants receiving preterm human milk alone. This study supports previous observations that fortified preterm human milk provides nutritional advantages for very-low-birth-weight infants.

With the use of prepared iodine-125-monoiodo-LH-RH, the disappearance rates of LH-RH (luteinizing hormone-releasing hormone) in man and in the rat were investigated, as well as the distribution of LH-RH in the rat. After 10 microcuries of iodine-125-LH-RH were injected as an iv bolus into 3 male volunteers, blood samples from the opposite arm were obtained through an indwelling venous catheter at 2, 5, 8, 11, 15, 20, 30, 45, and 60 minutes postinjection and at 6 and 24 hours postinjection. To describe the disappearance curve a 3-term exponential equation was necessary and sufficient. The ranges of the t1/2s for the first, second, and third components were 2-4 minutes, 30-55 minutes, and starting at more than 10 hours. The initial distribution space was 3-4.7 1 or 37-47 ml/kg body weight. Similar procedures in the rat (45) resulted in an equation with 2 exponentials, with the ranges of the t1/2s for the first and second components being 5-10 minutes and 150-600 minutes. In both man and rat the distribution volume approximated estimated plasma volume. Following the injection of iodine-125-LH-RH in the rat, pituitary radioactivity increased, as expected, reaching a maximum tissue/serum ratio of 1.5 at 90 minutes. 2 iodinated oligomers of LH-RH were found to have different disappearance rates and distributions in the rat than did iodine-125-LHrh. the disappearance rate of iodine-125-LH-RH in this study is consistent with values for other small peptide hormones.

• A unique case of dermal calcification occurred in a 14-month-old female infant. Results of all pertinent laboratory data obtained on this patient were within normal limits except for an elevation of the heat labile fraction of alkaline phosphatase. A skin biopsy specimen showed irregularly shaped deposits of calcified osteoid with osteoblasts. As yet, neither the cause nor the prognosis of this disease has been delineated. ( Arch Dermatol 1981;117:797-799)

Fetal lung insulin receptor numbers and affinities were studied in rat pregnancies from 15 to 22 days gestation. Insulin receptor binding capacities were found to increase six-fold from approximately 100 fmoles insulin bound/mg lung DNA at 15 days gestation to approximately 600 fmoles bound/mg DNA at 22 days gestation. However, the affinity constants of the receptors were unchanged during this same period (high affinity, 1.9 +/- 0.4 S.E. and low affinity, 0.03 +/- 0.01 S.E.). The results suggest that the lung may become increasingly more sensitive to insulin as development progresses.

The clomiphene and LRF induced gonadotropin responses of amenorrheic women were studied. The women were initially subdivided into two groups on the basis of their response to clomiphene. The amenorrheic women were tested with an intravenous bolus of 10 μg LRF and their responses compared with each other as well as with those of normally cycling women tested in the early and late follicular phases. A new subset of amenorrheic women was identified. Those women 1) failed to respond to clomiphene, 2) had significantly lower basal plasma hLH and hFSH levels than women sampled in the early or late follicular phase as well as amenorrheic women who responded to clomiphene and 3) displayed a strikingly different LRF response, characterized by a similar incremental change in plasma levels of FSH and LH. Their quantitative FSH response was greater than that observed in normally cycling women and amenorrheic women who responded to clomiphene. The LRF-induced gonadotropin response of the amenorrheic women who...

Summary: By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (< 1,600 g birth weight) fed either (a) a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, (b) the same formula containing higher phosphorus (82 mg/100 kcal), (c) the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or (d) their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25-hydroxy-vitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula-fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.

The relationships between plasma rennin activity (PRA) and plasma aldosterone were evaluated in rats maintained on altered dietary sodium or potassium intake for 6 weeks. A bivariate method of analysis was utilized to determine the correlations between these two dependent variables in the presence and absence of anesthesia for blood collection. Sodium restriction had a direct stimulatory effect on both renin and aldosterone, and a high sodium diet had the opposite effect. A significant positive correlation was observed between PRA and plasma aldosterone with variations in dietary sodium intake either in the presence (r = 0.79, P < 0.001) or absence (r = 0.67, P < 0.001) of anesthesia for blood collection. With variations in dietary sodium intake, linear changes in PRA were accompanied by logarithmic changes in plasma aldosterone. Varying potassium intake caused a negative correlation between PRA and aldosterone. High potassium intake was accompanied by significant suppression of PRA and marked stimulation...

Five patients with growth retardation due to Hand–Schuller–Christian disease were treated for a maximum of two years with human growth hormone, which was administered intramuscularly, three times per week, in doses of 2 IU. All patients experienced a significant increment in growth rate in comparison to the year before the therapy. During the first year of therapy the mean growth rate was 7.5 cm—an increase of 5.2 cm over the pretreatment year (p< 0.01). The growth rate during the second year of treatment was less, with a mean increase of 2.8 cm per year (P

The dynamics of calcium (Ca) metabolism in NB are poorly defined although disorders are often encountered. We studied Ca dynamics in NB to improve our understanding of calcium physiology and provide a rational basis for therapy. An injection of radioactive Ca-47 was given to two NB monkeys and Ca-45 administered with each feeding; specific activities were determined in plasma, feces, and urine. Risks of radioisotopes led us to the analogous use of stable Ca-46 and Ca-48 in two low birth weight infants; these were measured by mass spectrometry. Analysis by computer modeling gave the following results in mg/kg/hr. The observed similarities between NB monkeys and humans in their calcium metabolism suggests this laboratory animal is an appropriate model. The exchangeable calcium turnover rate in NB is 14 times the adult rate, and bone calcium dynamics are likewise accelerated. Endogenous fecal Ca loss is also markedly increased in NB despite similarities to the adult in % absorption and urinary excretion. These studies demonstrate the value, safety, and potential of stable isotopes in defining Ca metabolism and disclosing related abnormalities in human infants. We are currently analyzing similar data from infants with short-gut syndrome and isolated dermal ossification.

Preterm human milk (PHM) initially contains high levels of nutrients to help meet most premature infant needs. However, calcium and phosphorus and, after 2 to 4 weeks, some other nutrient levels in PHM are lower than required for optimal nutrition. A human milk fortifier (HMF) was designed to be added to PHM after 2 weeks post-partum to raise nutrient levels to approximate requirements. HMF increased protein (60:40 whey:casein) by 0.7 g/dl, calories by 4 kcal/oz, and minerals (mg/dl) as follows: Ca 60, P 33, Na 6.9, K 16, Cl 18, Mg 4, Cu 0.04, Zn 0.8. Ten preterm infants received PHM alone, 8 received PHM plus HMF (FPHM), and 12 received Enfamil Premature Formula (EPF). * p < .05 compared to the other groups. Serum values determined after 2 to 4 weeks on study. BMC = Bone mineral content of mid humerus at study conclusion. Cal effic = caloric efficiency. Those infants receiving HMF responded comparably to those receiving EPF, but grew faster and tended to have better mineral status (not statistically significant) than those receiving PHM alone. No clinically significant differences were observed in metabolic parameters, feeding tolerance, or complications. This data supports the use of HMF in human milk fed preterm infants.

Calcium (Ca) disorders and therapeutic effectiveness can be assessed by measurements of bone dynamics using stable tracer methods. A pulse of IV Ca-46 is followed by a 9-15 day continuous feeding of Ca-48. Ca isotopic abundances in serum, urine, and feces are determined by thermoionization mass spectrometry (0.5% precision). Kinetic parameters (mg/kg/d) are calculated by nonlinear, weighted least squares analysis and growth is compensated for by using expanding pool sizes. Two infants (Inf.) had Ca turnover rates 12 times that of a control adult (Ad); bone Ca deposition (vo+) and resorption (vo-) were determined with 2 to 5% precision. Two infants with osteogenesis imperfecta (OI) were studied before (B) and while taking ascorbic acid (C). Inf show excessive endogenous fecal (vf) to urinary (vu) Ca excretion as compared to adults, suggesting a major role for vf in regulating Ca balance in Inf. An Inf with OI had similar Ca dynamics except for a decrease in bone Ca fluxes. Ascorbic acid, as suggested for clinical use, had no effect on bone calcium balance.

Generalized aminoaciduria and high urinary calcium/urinary creatinine (Cr) seen in infants 200 mmol (>2SD) and 4 hypoproteinemic infants had both NAG

To improve bone mineralization, VLBW infants(