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Biomedical subjects

G L Hill

Publications and source records attributed to G L Hill.

At least 19 recordsLinked to original sources
PubMed1979

A new appliance for collecting ileostomy and jejunostomy fluid in the postoperative period.

A new lightweight two-piece ileostomy appliance was tested in 11 patients with newly established ileostomies and jejunostomies. Seven of the patients presented difficult stoma care problems. The appliance was fitted in theatre on completion of the operation and the patient was followed until discharge from hospital. The appliance remained in place for an average of 4.8 +/- 1.2 days. In a total of 204 patient-days the pouch became dislodged from the flange on 10 occasions and there was leakage under the body flange on 7 occasions. All but one of the patients continued to use the appliance on discharge. No patient was allergic to the appliance nor complained of odour. It is concluded that this new appliance represents an important advance in postoperative stoma care.

Adult↗
PubMed1979

Fine needle catheter jejunostomy--an assessment of a new method of nutritional support after major gastrointestinal surgery.

The results of our experience with the technique of fine needle catheter jejunostomy and early postoperative feeding through the catheter over a 12-month period are presented. Of the 43 patiening with an elemental diet without complications, 3 (7 per cent) were not fed for different reasons and 13 (30 per cent) developed complications that led to temporary or permanent cessation of the feeding. One patient in this group died of inhalation pneumonia. The voluntary food intake of 12 of the patients who were fed by jejunostomy after major colorectal surgery was assessed daily for 2 weeks after operation and compared with that of 12 control patients who did not have nutritional support. No significant difference in voluntary food intake was found between the two groups. The changes in body composition and plasma proteins and the clinical outcome of 20 of the patients fed by jejunostomy after major colorectal surgery were also compared with those of 20 matched controls. Body weight and lean body mass (as assessed by total body potassium and arm muscle circumference) and plasma prealbumin fell significantly in the control patients but not in those fed by jejunostomy. However, plasma transferrin decreased in both groups and there was no significant difference in clinical outcome in terms of complication rate or duration of postoperative hospital stay. The study would suggest that this technique of jejunostomy feeding should be reserved for selected cases where it may prove to be of real value, rather than being used routinely.

Aged↗
PubMed1979

Multi-element analysis of the living body by neutron activation analysis-application to critically ill patients receiving intravenous nutrition.

Neutron activation analysis has been used to determine the total content in the body of N, K, Na, Cl, P and Ca in 25 critically ill surgical patients before and after a 14-day course of intravenous nutrition. Muscle elemental composition was also determined in these patients at the same time as the total body analysis. Over the 14-day period of intravenous feeding the total body contents of all the measured elements increased (2-9.7 per cent) but only the increase in K was statistically significant. Muscle chemistry suggested an intracellular K depletion which was corrected over the study period. The results of the total body multi-element analysis were interpreted to show a mean gain of 1.25 l of extracellular fluid and 0.51 l of intracellular fluid and direct measurement of total body water suggested that this interpretation was probably valid. The first application of the technique to patients with nutritional and metabolic problems has quantified the weight gained by two body compartments during a 2-week period of intravenous nutrition. Its further application should help to solve a number of nutritional and metabolic problems in clinical surgery.

Adult↗
PubMed1979

Plasma proteins in patients receiving intravenous amino acids or intravenous hyperalimentation after major surgery.

Eleven plasma proteins were compared for each of three groups of 10 closely matched patients before and 15 days after rectal excision who were receiving an addition to oral diets the following parenteral solutions by central venous catheter: 1) no hyperalimentation, 2) hypertonic glucose plus amino acids, or 3) amino acids alone. Plasma transferrin, prealbumin, and retinol-binding protein were normal before surgery in all but seven patients. Postoperatively, concentrations were decreased, but were restored to normal after full hyperalimentation whereas they were significantly less and lower than normal in controls and patients receiving amino acids. Acute phase proteins were higher than normal before surgery and also 15 days later. Lower values in patients receiving hyperalimentation were mainly due to hydration compared with higher values in the other groups caused by the higher incidence of sepsis. It is concluded that full hyperalimentation after major surgery restores "visceral" proteins more rapidly than by infusion of amino acids alone and is associated with fewer clinical complications.

Adult↗
PubMed1979

Assessment of protein nutrition in surgical patients--the value of anthropometrics.

In order to evaluate the reliability of anthropometry in assessing protein stores we have compared, in 10 normal adults and 82 surgical patients with varying degrees of weight loss, measurements of weight/height, arm circumference, arm muscle circumference, and arm muscle area with direct measurements of body nitrogen using in vivo neutron activation analysis. Anthropometry is reliable for the assessment of protein nutrition in groups of patients (for 100 patients 95% confidence limits are +/- 30 g nitrogen) but the magnitude of variance shown makes it inappropriate for assessing the individual as a single measurement (95% confidence limits are +/- 300 g nitrogen). Repeat measurements were made after 2 weeks on 35 patients and there was no correlation between changes in body nitrogen and changes in the anthropometric measurements. Anthropometry is not reliable in following changes in body nitrogen in individual patients over short periods of time.

Adult↗
PubMed1979

A review of the Zollinger-Ellison syndrome--with particular reference to a patient treated with cimetidine.

A case of the Zollinger-Ellison syndrome, presented with watery diarrhoea, malabsorption and multiple duodenal ulcers. Resection of a gastrinoma from the head of the pancreas was ineffective. Cimetidine, administered for more than 30 months produced an immediate and sustained relief of symptoms with a gain in weight of 19 kg and improvement of the biochemical features of malabsorption. Gastric acid secretion has been markedly inhibited and duodenal ulceration healed.

Aged↗
PubMed1979

Effect of an elemental diet on body composition. A comparison with intravenous nutrition.

Measurements of changes in body fat, protein, and water were carried out on two comparable groups of 14 ill surgical patients each over 2-wk period during which one group received an elemental diet (nonprotein energy source was 67% carbohydrate and 33% fat) and the other a course of intravenous nutrition (nonprotein energy source was 100% carbohydrate). The patients fed with the elemental diet had no significant changes in body weight, fat, protein, water, or plasma proteins over the study period, and although the patients fed intravenously also had no changes in body protein or plasma proteins, there was an average gain of 3.2 kg of body weight. This weight gain was mainly extracellular water. It is concluded that the administration of the elemental diet by continuous infusion was comparable to intravenous nutrition in maintaining body protein in these very ill patients and had the advantage of being cheaper and easier to manage. The problem of extracellular water accumulation seen in the patients fed intravenously was not present in the patients who received the elemental diet.

Adult↗
PubMed1978

Intravenous aminoacids and intravenous hyperalimentation as protein-sparing therapy after major surgery. A controlled clinical trial.

A solution of aminoacids without a calorie source was infused postoperatively in ten patients undergoing proctocolectomy or rectal excision and the results were compared with those in ten matched controls and ten patients who received intravenous hyperalimentation. Aminoacid infusion prevented the nitrogen and potassium loss that occurred in the untreated group but no clinical advantage could be seen. Nitrogen and potassium loss was also prevented in the patients treated with intravenous hyperalimentation but these patients had significantly fewer postoperative complications than either the controls or those given aminoacid infusion. It is suggested that aminoacid infusion is of very little benefit after major surgery. On the other hand the skilled administration of intravenous hyperalimentation to patients after major surgery can be of real benefit.

Adult↗
PubMed1978

Treatment of severe side effects after vagotomy and gastroenterostomy by closure of gastroenterostomy without pyloroplasty.

We describe nine patients who had severe, persistent abdominal pain, vomiting, dumping, or diarrhoea several years after truncal vagotomy and gastroenterostomy had been performed for duodenal ulceration. Each patient was judged to have a bad clinical result (Visick grade 4). There was no evidence of recurrent ulceration in any of the patients, and in each the patency of the pyloric canal was confirmed radiologically or endoscopically. Each patient was treated by simply dismantling the gastroenterostomy without addition for a pyloroplasty. In one patient the surgeon suspected that a vagal trunk might have been left intact, and a revagotomy was performed by the "highly selective" technique. Postoperatively, none of the patients developed gastric retention. Symptomatic improvement occurred in eight patients, and four of them achieved perfect results (Visick grade 1). Side effects are common after vagotomy and gastroenterostomy, and are largely attributable to the presence of the gastroenterostomy stoma. Our results show that the symptoms may be alleviated by closing the gastroenterostomy, without precipitating gastric retention.

Adult↗
PubMed1978

A prospective study of subclavian vein catheters used exclusively for the purpose of intravenous feeding.

One hundred and seventy-eight central venous catheters inserted via the subclavian vein for the purposes of intravenous feeding were studied in 77 patients. Insertion of the catheter was complicated by puncture of the subclavian artery on three occasions and by a pneumothorax on two. Catheters remained in situ for a mean period of 10 days. Ninety-two were removed because the requirement for nutrition no longer existed and 86 were removed because of suspected infection, venous thrombosis or mechanical problems. Infective organisms were grown from 17 catheters (9.5 per cent) but other unrelated causes of infection were frequently present in the population under study. Venous thrombosis of a major upper limb vein was seen in 8 patients.

Adolescent↗
PubMed1978

Vitamins in intravenous feeding: a study of water-soluble vitamins and folate in critically ill patients receiving intravenous nutrition.

Red cell B vitamins, folate and white cell vitamin C were measured in a group of critically ill surgical patients before and following a course of intravenous nutrition. Patients received a widely used vitamin supplementation regimen in the form of one ampoule of water-soluble vitamins daily and recommended doses of intramuscular folate, vitamin B12 and vitamin K weekly. This regimen was adequate to maintain tissue levels of the water-soluble vitamins and folate. Patients with initially low values had normal values at the end of the treatment period.

Ascorbic Acid↗