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Biomedical subjects

H Cleland

Publications and source records attributed to H Cleland.

10 recordsLinked to original sources
PubMed2006

Early versus delayed enteral nutrition support for burn injuries.

BACKGROUND: A burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, improving survival rates, and decreasing hospital length of stay. Enteral nutrition support is the best feeding method for patients who are unable to achieve an adequate oral intake to maintain gastrointestinal functioning, however, its timing (i.e. early versus late) needs to be established. OBJECTIVES: To assess the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2006), the Cochrane Injuries Group's Specialised Register, MEDLINE (1966 to May week 1, 2006), EMBASE (1980 to week 17, 2005) and CINAHL (1982 to May week 1, 2006). SELECTION CRITERIA: We included all randomised controlled trials comparing early enteral nutrition support (within 24 hours of injury) versus delayed enteral support (greater than 24 hours). DATA COLLECTION AND ANALYSIS: Two authors used standardised forms to independently extract the data. Each trial was assessed for internal validity with differences resolved by discussion. MAIN RESULTS: A total of three randomised controlled trials were eligible for inclusion in this review. Results of the studies indicate that evidence about the benefit of early enteral nutritional support on standardised clinical outcomes such as length of hospital stay and mortality, remains inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate as documented in part by our included studies, remains uncertain. AUTHORS' CONCLUSIONS: This systematic review has not found sufficient evidence to support or refute the effectiveness of early versus late enteral nutrition support in adults with burn injury. The trials showed some promising results that would suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but this is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilises valid and reliable outcome measures, is essential.

Adult↗
PubMed1995

Vascularised flexor tendon grafts.

In densely scarred digits, tendon reconstruction fails because of paucity of blood supply. This inevitably leads to adhesion formation and failure of gliding. Staged tendon grafting with silicone spaces can improve results but does not ameliorate the essential problem of reduced vascularity and may indeed worsen it. Tendon grafts can be implanted with their own living sheaths as free or pedicled vascularised transfers from the foot or forearm to either extensor or flexor sites in the hand. These mesenteric tendons with their fascial or synovial sheaths intact and vascularised by adjacent vascular pedicles include the extensor hallucis brevis and longus or the extensor digitorum communis on the dorsalis pedis system, the palmaris longus on the radial arterial system, the sublimus tendons of the ring and little fingers on the ulnar arterial system as well as the extensor indicis on the second metacarpal arterial system. These tendon grafts can be inserted into the intact or reconstructed tunnel systems of the digit and repaired proximally and distally to the tendon remnants. Gliding is enhanced although limitations still potentially occur at the proximal tendon junctions.

Amputation, Traumatic↗
PubMed1994

Free flaps in the aged and infirm.

Some of the most dramatic advances in reconstructive surgery have involved microvascular free-flap transfers. Although initial studies stressed the need for the procedures to be restricted to the healthy, with no evidence of vascular disease, it has become apparent that such restrictions need not apply if adequate patient care is available. Refinements of technique and development of new operations have made the free flap available to all. In particular, the procedure has been found to have unique benefits in the elderly and infirm population.

Age Distribution↗
PubMed1993

Oral and pharyngeal cancer, diet, smoking, alcohol, and serum vitamin A and beta-carotene levels: a case-control study in men.

A case-control study was conducted in Melbourne, Australia. Forty-one men with histologically confirmed squamous cell oral or pharyngeal cancer were compared with 398 male community controls. A statistically significant increase in risk was found for alcohol (ethanol) consumption and for smoking, and there was a synergistic effect for these two exposures. Statistically significant protection was noted with increasing intake of dietary vitamin C, dietary beta-carotene, fruit, vegetables, and dietary fiber. The mean serum levels of beta-carotene and vitamin A were statistically significantly lower when the cases were compared with another set of 88 male controls of a similar age who were hospitalized for minor surgical operations. This study confirms a causal effect of smoking and alcohol and a protective role for a high dietary intake of fruit, vegetables, cereals, and, particularly, beta-carotene- and vitamin C-containing foods.

Alcohol Drinking↗
PubMed1992

Diet, alcohol, smoking, serum beta-carotene, and vitamin A in male nonmelanocytic skin cancer patients and controls.

A case-control study was conducted in Melbourne, Australia of 88 consecutive males admitted for the surgical removal of a nonmelanocytic skin cancer (histologically confirmed basal cell carcinoma and squamous cell carcinoma) and of 88 male control patients admitted for small elective surgical procedures. In both cases and controls, previous diet, alcohol consumption, and smoking habit were investigated and serum beta-carotene and vitamin A levels were measured. A statistically significant inverse relationship was found between the risk of skin cancer and a high intake of fish (p = 0.05); vegetables in general (p < 0.001); beans, lentils, or peas (p < 0.001), carrots, silverbeet (Swiss chard), or pumpkin (p < 0.001); cruciferous vegetables (cabbage, brussel sprouts, or broccoli) (p < 0.001); and beta-carotene- and vitamin C-containing foods (p = 0.004). Cases had a lower mean serum level of beta-carotene (p < 0.001) and vitamin A (p = 0.02) than controls. The incidence of skin cancer in the study was inversely related to the level of serum beta-carotene (p < 0.0001). The correlation coefficient between dietary beta-carotene/vitamin C and serum beta-carotene was 0.22 (p = 0.04). Smoking and alcohol consumption showed no statistically significant association with the risk of nonmelanocytic skin cancer. The results were similar for both cell types. A high intake of vegetables including cruciferous vegetables, beta-carotene- and vitamin C-containing foods, and fish appears to be protective for nonmelanocytic skin cancer, and this deserves further study, as does the possible etiologic relevance of the low serum levels of beta-carotene and vitamin A.

Aged↗
PubMed1992

Review of Swanson trapezium implants.

Sixteen Swanson trapezium silicone prostheses are reviewed retrospectively an average of 3 years after insertion. Fifteen were performed for osteo-arthritis and one for rheumatoid arthritis. Despite a very high patient satisfaction, 14 thumbs had residual functional compromise and caused pain when performing certain tasks. Three implants were completely dislocated and another four were significantly subluxed. One patient required implant removal. Intra-osseous cysts or significant bony erosion around the implant were present in five thumbs. It is concluded that there are early significant problems associated with this procedure which make it unsuitable for use in the osteo-arthritic thumb.

Aged↗
PubMed1985

A simple rapid method of fixation of unstable zygomatic fractures.

A simple, effective and rapid method of fixation of unstable zygomatic fractures is described, in which a K-wire is inserted percutaneously through the prominence of the fractured malar and stabilized by further passage through both maxillae. The results of 11 cases are discussed. The method is compared with other commonly used methods of fixation, and with other techniques for internal fixation with K-wire previously described.

Fracture Fixation, Internal↗