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Biomedical subjects

A J Sim

Publications and source records attributed to A J Sim.

At least 37 records · Page 2Linked to original sources
PubMed1987

Comparison of the local and systemic effects of sepsis in predicting survival.

Progress in the study of sepsis has been hampered by the lack of a suitable system for grading its severity. Systems suggested for scoring sepsis have been based either on its systemic effects (APACHE II) or on a mixture of local and systemic variables (sepsis score). The APACHE II and sepsis scores were applied to patients with intra-abdominal sepsis of more than 3 days' duration, to determine if local or systemic factors were more important in predicting survival. Of 45 patients studied, 14 died. The sepsis score for non-survivors (median 21.5, range 11-32) was significantly higher than for survivors (median 14, range 10-26, P less than 0.05). There was overlap between the two groups, such that an individual score had no predictive value. The local component of the sepsis score was not significantly increased in non-survivors (P less than 0.05), but the systemic component was (P less than 0.05). The APACHE II score for non-survivors (median 24, range 15-38) was significantly higher than for survivors (median 12, range 3-21), and correctly identified 13 of the 14 fatalities. Both the systemic and non-systemic components (age and chronic disease) were significantly higher among the latter. The APACHE II was more effective than the sepsis score in predicting survival. We conclude that any system used for scoring sepsis should be based on systemic rather than local effects. At present the APACHE II score is preferred.

Abdomen↗
PubMed1987

Protein and energy metabolism with biosynthetic human growth hormone after gastrointestinal surgery.

The effect of biosynthetic human growth hormone (BSHGH) on postoperative protein and energy metabolism has been studied in patients who had major gastrointestinal surgery. Seven patients received placebo and seven patients received BSHGH, 0.1 mg/kg/24 h, for the first six postoperative days. Mean total nitrogen excretion was significantly lower with BSHGH (31.5 +/- 2.4 g N) (2287 +/- 160 mmol) than with placebo (42.7 +/- 3.1 g N) (3049 +/- 219 mmol) over the 6-day study period. The mean daily measured energy expenditure over days 3-6 was higher with BSHGH (31.3 +/- 1.8 kcal/kg LBM/24 h) (131 +/- 7 kJ/kg LBM/24 h) than with placebo (27.6 +/- 0.8 kcal/kg LBM/24 h) (114 +/- 2 kJ/kg LBM/24 h). Fat oxidation with BSHGH (2.05 +/- 0.26 mg/kg LBM/24 h) was greater than with placebo (1.5 +/- 0.17 mg/kg LBM/24 h) and protein oxidation was less with BSHGH (0.68 +/- 0.07 g/kg LBM/24 h) than with placebo (0.9 +/- 0.09 g/kg LBM/24 h) on days 1-6. Postoperative nitrogen turnover (BSHGH 943 +/- 174 mg N/kg LBM/24 h, placebo 557 +/- 50 mg N/kg LBM/24 h) (BSHGH 67 +/- 13 mmol/kg LBM/24 h, placebo 40 +/- 4 mmol/kg LBM/24 h), protein synthesis (BSHGH 5.31 +/- 1.09 g prot/kg LBM/24 h, placebo 2.54 +/- 0.33 g prot/kg LBM/24 h) and protein breakdown (BSHGH 5.90 +/- 1.09 g prot/kg LBM/24 h, placebo 3.48 +/- 0.31 g prot/kg LBM/24 h) were greater with BSHGH. On the first postoperative day serum insulin and blood glucose levels were higher with BSHGH than with placebo, and on days 4 and 7 serum somatomedin-C levels were significantly elevated. This study shows that BSHGH alters postoperative protein and energy metabolism by reducing protein oxidation and increasing fat oxidation with raised rates of whole body nitrogen turnover.

Adult↗
PubMed1986

Colonoscopy findings in symptomatic patients without X-ray evidence of colonic neoplasms.

Colonoscopy was carried out in 97 patients with persistent large-bowel symptoms in whom double-contrast barium enemas were either normal or showed diverticular disease alone. In 37 the X-ray was normal, but colonoscopy showed 9 polyps and 3 carcinomas. In 60 patients with barium enemas showing diverticular disease alone colonoscopy revealed 13 polyps and 1 carcinoma. Of the 4 carcinomas 1 was Dukes' A, 2 Dukes' B, and 1 Dukes' C. 23 of the 26 patients with a neoplastic lesion at colonoscopy had rectal bleeding, compared with only 40 of the 71 without a lesion. The frequency of neoplasia in those with a normal barium enema was 32%, compared with 23% in those whose X-ray showed diverticular disease. Colonoscopy, rather than double-contrast barium enema, should be the first line of investigation in patients with persistent large-bowel symptoms, especially rectal bleeding.

Adult↗
PubMed1986

Laparoscopy as an adjunct to decision making in the 'acute abdomen'.

When patients are admitted to hospital with acute abdominal pain, clinicians, irrespective of a specific diagnosis, intuitively select three diagnostic classes: operation definitely required (Group A); operation definitely not required (Group B); need for operation uncertain (Group C). The last is followed either by a precautionary laparotomy or a variable period of observation/investigation. We have studied prospectively the influence of laparoscopy on the distribution between these classes and particularly on outcome in group C. One hundred and twenty-five consecutive patients with abdominal pain severe enough for emergency admission have been classified by one of two admitting surgeons (SHO/registrar), who also expressed in group C a view on how they would proceed--operation or observation. Group C were then laparoscoped. The procedure confirmed a provisional view that laparotomy was needed in 11 of 15 patients. In the 'observation' sub-group the provisional decision was confirmed in 14 of 16 and early discharge followed in most. Six inappropriate decisions were thus avoided. Seven management decisions in group A and 4 in group B proved incorrect (11/94: 12 per cent). The majority were potentially recognizable by laparoscopy. Though relatively high rates of successful decision making are achieved with conventional clinical techniques, they can be further improved by laparoscopy. This procedure is particularly applicable in the management of patients with acute abdominal pain without a definite diagnosis, or when appendicitis is regarded as an established diagnosis.

Abdomen, Acute↗
PubMed1986

Changes in plasma fibronectin during acute nutritional deprivation in healthy human subjects.

1. Plasma fibronectin, a glycoprotein, is an opsonin of the reticuloendothelial system. 2. In ten healthy volunteers starved for 4.5 d, daily measurements showed a rapid reduction in plasma fibronectin, no alteration in either C3 or plasma transferrin and, at the end of the starvation period, an elevated serum albumin. 3. On refeeding, plasma fibronectin rapidly returned to its prestarvation level but plasma transferrin was significantly reduced and did not recover by the end of the study. 4. Changes in plasma fibronectin may be a sensitive index of nutritional status. The reduction of plasma fibronectin in short-term starvation may compromise host defence tolerance of injury and sepsis.

Adult↗
PubMed1985

Elevated rates of whole body protein metabolism in patients with disseminated malignancy in the immediate postoperative period.

Protein metabolism after surgery in the presence of disseminated malignancy has been investigated and compared with results obtained from patients undergoing similar surgical procedures for benign disease and localized malignancy. Whole body nitrogen turnover, measured by primed continuous infusion of 15N glycine, was highest with disseminated malignancy. Similarly rates of whole body protein synthesis and breakdown, calculated from turnover and nitrogen excretion (nitrogen intake being zero), were elevated in the presence of disseminated malignant disease. The increased rates of protein metabolism may represent adaptation to the demands of inevitably growing malignant tissue.

Aged↗
PubMed1985

Endocrine and protein response to elective surgery: effect of nursing at two different environmental temperatures.

Twenty male patients undergoing elective abdominal surgery were studied on one control day pre-operatively and for the first 4 days postoperatively at an environmental temperature of either 20 degrees C or 28 degrees C. Glucose, insulin, growth hormone and urinary catecholamine levels all rose significantly on the first postoperative day returning to within normal limits by day 4. Urine nitrogen excretion also increased significantly postoperatively in both groups. Environmental temperature did not influence these responses. Concentrations of C-reactive protein and a1-antichymotrypsin increased significantly on the first postoperative day and were returning to normal by day 4 while concentrations of haptoglobin, a1-antitrypsin and a1-acid glycoprotein, which also showed a significant increase, remained elevated at the end of the study. Concentrations of albumin, transferrin, a2-macroglobulin, prealbumin and retinol binding protein all decreased significantly following operation. Elevated environmental temperature did not affect the protein response to surgery. Urine cortisol and 17-hydroxycorticosteroid excretion rose significantly postoperatively and remained elevated throughout the study. Patients nursed at 28 degrees C showed significantly lower postoperative excretion of both hormones than patients nursed at 20 degrees C.

Journal Article↗
PubMed1984

Transient hypercalciuria after commencing total intravenous nutrition.

A study of 28 patients receiving a standard regimen of total intravenous nutrition (I.V.N.) for periods of > 14 days has shown the transient development of hypercalciuria in 14 patients (50%). The peak incidence of hypercalciuria occurred in 11 patients (39%) after 1 week of I.V.N. and hypercalciuria persisted for 1-4 weeks. In only one patient was hypercalciuria present at the end of the treatment period. Urine calcium (Ca) and nitrogen (N) excretion rates correlated significantly (r = 0.48 p < 0.001) and urine N excretion varied from week to week in parallel with urine Ca excretion in the hypercalciuric group of patients. There was no significant difference in urine Ca excretion between 12 patients who received 3.75 mmol Ca/day and 16 patients who received 8.75 mmol Ca/day. It is concluded that transient hypercalciuria may be related to increased protein catabolism and N excretion and that it probably does not indicate a major problem in mineral metabolism.

Journal Article↗
PubMed1983

The effect of isotonic amino acid infusions on serum proteins and muscle breakdown following surgery.

Twenty patients undergoing major surgical procedures received constant infusion (21/day) of either 3.5 per cent amino acid (AA) or 5 per cent dextrose (D5W) solutions in addition to other fluid requirements for 4 postoperative days. Ketosis was evident in AA patients as a mean daily beta-hydroxy butyrate excretion of 2.16 +/- 1.39 mmol and respiratory quotient of 0.708 +/- 0.013 compared with 0.28 +/- 0.45 mmol/day and 0.754 +/- 0.015 respectively in the D5W group. The serum total protein and albumin concentrations (but not those of transferrin and prealbumin) were significantly higher in the AA than the D5W group on day 4. However, the mean fluid balance for days 3 and 4 was significantly less positive in AA patients. The mean daily nitrogen balance of -6.6 +/- 7.7 gN/day in AA patients and -9.5 +/- 5.8 gN/day in D5W patients was not significantly different. Mean daily 3-methyl histidine excretion (38.2 +/- 12.3 mumol/mmol creatinine) in AA patients was significantly higher than in D5W patients (31.2 +/- 10.8 mumol/mmol creatinine). With no improvement in nitrogen balance, an increase in muscle protein breakdown and the possibility that decreased fluid retention explains the higher serum total protein and albumin levels, this study fails to demonstrate improved protein sparing by isotonic amino acid infusions following surgery.

Adult↗
PubMed1983

Dermoid cyst of the rectum.

Rectal cysts are uncommon, with a search of the medical literature revealing only 12 reported cases. This is in contrast with postanal and sacrococcygeal dermoids which, although still uncommon, appear to occur more frequently. This paper describes a case involving a dermoid cyst arising in the lateral wall of the rectum and reviews the recorded cases of rectal cysts.

Dermoid Cyst↗
PubMed1983

The relationship between delayed hypersensitivity response, nutritional status and clinical outcome in surgical patients referred for nutritional support.

Delayed hypersensitivity responses to recall antigens were measured in 125 surgical patients referred for nutritional assessment and support. On initial testing 57 patients were skin test positive and 68 were anergic each of these patient groups being closely matched in terms of surgical conditions. There was a mortality of 4 in the skin test positive group and 26 in the anergic group. The anergic patients were significantly older and in biochemical and anthropometric terms were in poorer nutritional status than the skin test positive group. Of 33 anergic patients who were repeat tested, 15 remained anergic and 18 converted to a positive response. Conversion from anergy to a positive response was not associated with changes in the measured indices of nutritional status and did not improve clinical outcome. The value of repeat skin testing is therefore in doubt.

Journal Article↗
PubMed1983

A comparison of tunnelled and nontunnelled subclavian vein catheters: a prospective study of complications during parenteral feeding.

Forty-four silastic catheters in 38 surgical patients, nursed in general surgical wards, were inserted under aseptic conditions by the infraclavicular subclavian route. The catheters were randomly allocated to non-tunnelled (NT) (n = 24) or tunnelled (T) (n = 20) groups. Catheters were removed on completion of intravenous feeding or clinical suspicion of catheter infection, and the catheter tip and blood samples taken through the catheter and from the peripheral vein were cultured. There was no significant difference between the two groups in terms of bacteriological infection (defined as two or more cultures of the same organism), clinical infection (defined by elevated temperature returning to normal after catheter removal) and combined infection (when both bacteriological and clinical infection co-existed). When the number of infected catheters was related to the duration of catheter insertion, the incidence of combined catheter related sepsis was reduced with tunnelling (NT: one infected catheter per 35 catheter days, T: one infected catheter per 89 catheter days). This study highlights the risks of subclavian vein catheterisation and emphasises the difficulties in defining catheter sepsis but suggests that its incidence may be reduced if skin tunnelling is employed.

Journal Article↗
PubMed1983

The effect of environmental temperature on resting metabolic rate and respiratory quotient following elective surgery.

Twenty male patients undergoing routine elective abdominal surgery of moderate severity nursed at either 20 or 28 degrees C had indirect calorimetry carried out on a control day pre-operatively and for the first four post-operative days. The mean resting metabolic rate over the four post-operative days was significantly elevated by 9% above control value. This increase was maximal on post-operative day 1 (13%). Respiratory quotient fell over four days of the post-operative period indicating that a greater proportion of energy was being derived from body fat stores. Nursing at different environmental temperatures did not affect these responses.

Journal Article↗
PubMed1983

Vitamin and mineral provision during enteral nutrition.

The adequacy of vitamin and mineral provision during enteral nutrition for a period of at least two weeks was studied in 20 patients. Significant increases were observed in plasma levels of vitamins C and E, and in B2, B6 and folate status. No significant changes were observed in vitamins A, B1, B12 or in plasma magnesium, zinc or copper. The requirements for vitamins and minerals during enteral nutrition are discussed.

Journal Article↗
PubMed1983

Three year follow-up study on the treatment of first and second degree hemorrhoids by sclerosant injection or rubber band ligation.

Two groups of 18 patients undergoing sclerosant injection or rubber band ligation for first or mild, second degree hemorrhoids have been followed-up at three years after the initial treatment. Following sclerosant injections, four of 18 patients initially presenting with bleeding per rectum did not have further episodes of bleeding within the three year follow-up period compared with 13 of 17 treated with rubber band ligation. The other symptoms of pain or discomfort, pruritus ani and soiling were not present with sufficient frequency to allow specific evaluation. Results of this study demonstrate that rubber band ligation produces better long term results than does sclerosant injection in treating bleeding, the principal symptom, of first and mild, second degree hemorrhoids.

Adult↗