Di-(2-ethylhexyl)phthalate and deep venous thrombosis in children : a clinical and experimental analysis

BACKGROUND. Five children with catheter- related deep venous thrombosis were encountered in our PICU. Three types of polyvinyl chloride tubing for the administration of intravenous solutions were in use ( Terumo, Codan, and Perfusend). All were di-( 2- ethylhexyl) phthalate plasticized. We suspected problems with the Codan tubing. METHODS. Different types of tubing at different time intervals in vitro were investigated. Tubing segments were assessed on structural alterations by surface electron microscopy. High- performance liquid chromatography- diode array detection and liquid chromatography- mass spectrometry- diode array detection were performed to identify and to quantify di-( 2- ethylhexyl) phthalate. The hospital's minimal clinical data set ( coded with the International Classification of Diseases, Ninth Revision, Clinical Modification) was investigated on catheter- related deep venous thrombosis between 2000 and 2004. RESULTS. Surface electron microscopy demonstrated that the Codan tubing's inner surface was severely altered, showing large particles ( 34.5 +/- 6.1 mu m). Highperformance liquid chromatography documented that all Codan samples showed a peak at the di-( 2- ethylhexyl) phthalate retention time. The analysis of the minimal clinical data set for total catheter- related deep venous thrombosis showed an unusual high incidence in 2001 ( 52) compared with the expected 36 per year. CONCLUSIONS. Such occurrence of catheter- related deep venous thrombosis led to the assumption that disintegration of intravenous tubing resulted in intravenous administration of debris. Our data suggested that the particles derived from the tubing are of such size that they might induce catheter- related deep venous thrombosis. The absence of catheter- related deep venous thrombosis caused by the introduction of submicron inline filters outlines the important pathophysiological role of di-( 2- ethylhexyl) phthalate- plasticized particles in the onset of catheterrelated deep venous thrombosis. Our data indicate that a considerable number of patients might have been exposed to di-( 2- ethylhexyl) phthalate, and a major concern is whether this jeopardized the health of the patients at that time

A case of new onset cervical dystonia in pregnancy

Background: Though uncommon, primary movement disorders can occur in pregnancy, the most common being restless legs syndrome and chorea gravidarum [1]. New onset dystonia in pregnancy has been reported four times previously with a resolution of symptoms within six months of delivery [2345]. Exacerbation of pre-existing movement disorders and the onset of de novo movement disorders during pregnancy support the hypothesis that female sex hormones play an important role in the regulation of basal ganglia circuitry. Case report: Here we describe a case of new-onset cervical dystonia during pregnancy with persistence of symptoms after delivery. Discussion: The phenotypic overlap between this case and previously reported cases further establishes dystonia gravidarum as a distinct clinical entity.</p

Delivering best care and maintaining emotional wellbeing in the intensive care unit: the perspective of experienced nurses

Aim - This study explored the perspective of experienced intensive care nurses regarding maintenance of their emotional wellbeing. Background - Caring for critically ill patients has been identified as stressful. The demand for critical care nurses continues to grow in a climate of an ongoing nursing shortage and an aging workforce. This study sought to understand what environmental elements optimized the maintenance of emotional wellbeing. Methods - Grounded theory. Results - Fifteen experienced intensive care unit registered nurses from a metropolitan hospital in Western Australia, were interviewed. Five categories were identified: ‘achieving best care’, ‘caring for the patient's family’, ‘autonomy within the ICU environment’, ‘teamwork’, and ‘previous nursing and life experience’. Conclusions - The findings from this study increase our understanding of the environmental elements that can optimize the emotional wellbeing of intensive care nurses. These findings will assist in the development of strategies to retain nurses in the ICU area