Biomedical subjects

M A Stokes

Publications and source records attributed to M A Stokes.

41 records · Page 3Linked to original sources

PubMed1987

Transitional cell carcinoma in patients under forty years of age.

Transitional cell carcinoma of the urinary tract in patients under the age of 40 is often thought to be a milder form than in the older age groups. However, the literature provides little information on this and is contradictory. We report a series which shows that there is a significant recurrence rate, albeit less than in those aged over 40. The tumours were predominantly low grade and low stage and none could be described as aggressive.

Adolescent↗

PubMedDate not supplied

Mortality in patients on home parenteral nutrition.

Fifty out of 228 patients recorded on the U.K. Home Parenteral Nutrition Register have died. The earliest to die was at 10 days following the commencement of home parenteral nutrition (HPN), and the longest to die was after 5 1/2 years. Half of the patients who died, did so within 6 months of commencing HPN. Sixty % died of their underlying disease. Most patients with scleroderma or an underlying malignancy are dead within a year of commencing HPN. In contrast, patients with Crohn's disease or the short bowel syndrome due to volvulus do well. In only 14 patients was death attributable to the administration of HPN. In this group the main causes were septicemia, SVC thrombosis, and hepatic failure. Our study suggests that HPN should be used in patients with malignancy and scleroderma only in exceptional circumstances and that further work is necessary for the prevention of SVC thrombosis.

Adolescent↗

PubMedDate not supplied

A single, accurate measurement of resting metabolic expenditure.

Indirect calorimetry is widely used in estimating nutritional requirements for severely ill patients. However, because the accuracy of a single measurement is dependent on many factors, the authors have sought to find the optimal single measurement. It is shown here that a more accurate resting metabolic expenditure (RME) can be obtained by studying a fasted, rested patient in relaxing surroundings after acclimatizing him or her to the calorimetric hood. Using this altered protocol, a significantly lower RME (by a mean of 125 kcal/d, p less than 0.0001) is achieved. This RME compares well with most of the various predictive equations. A predictive equation, based on the normal patients in this study and relating the RME to TBK (a measure of the body cell mass), allows calculation of a predicted RME, and subsequently a Stress Index as a measure of metabolic stress, ie, Predicted RME = TBK X 0.34 + 4.94. Stress Index = Measured RME/Predicted RME.

Basal Metabolism↗

PubMedDate not supplied

Total energy expenditure in patients with Crohn's disease: measurement by the combined body scan technique.

A combined body scan technique for measuring total energy expenditure (TEE) from energy intake and changes in energy stores is presented. The TEE of 13 patients with Crohn's disease who required nutrition support over a 14-day period was measured. They had a mean TEE of 33 kcal/kg per day. The components of the TEE in these 13 patients were also measured. Seventy percent of the TEE was made up by resting metabolic expenditure, 10% by diet-induced thermogenesis, and the remaining 20% by activity energy expenditure. These patients had a mean activity energy expenditure of 369 kcal/day. The diet-induced thermogenesis was a mean 12.6% increase on the resting metabolic expenditure. Each percent increase was caused by a mean of 210 kcal of energy in either the intravenous nutrition or the enteral nutrition. There was no difference in diet-induced thermogenesis between those having enteral nutrition and those receiving intravenous nutrition. Decreased activity was significantly correlated with increased activity of the disease (r = .7, p < .01). This confirms the belief that patients with Crohn's disease require no more energy (ie, 33 kcal/kg per day) than other patients. If the resting metabolic expenditure is increased through illness, then the activity energy expenditure decreases. The combined in vivo neutron activation-dual energy x-ray absorptiometry technique has allowed for the first time measurements in ward patients with Crohn's disease. The measurements confirm that TEE is not raised and that 30 to 35 kcal/kg per day is sufficient to achieve energy balance in such patients.

Absorptiometry, Photon↗

PubMedDate not supplied

Peripheral parenteral nutrition: a preliminary report on its efficacy and safety.

In this preliminary study of peripheral parenteral nutrition, we compared our first nine patients fed by this method with 21 patients fed by total parenteral nutrition during the same period. We found that peripheral parenteral nutrition was as effective as total parenteral nutrition in improving physiologic function (both skeletal and respiratory muscle function). We also found that by using the protocol described here thrombophlebitis was not a significant problem. Additional study is required to ascertain the exact incidence of this and other complications. We would advocate the greater use of peripheral parenteral nutrition in suitable patients and the use of this protocol for its administration.

Adult↗