Biomedical subjects

M Butters

Publications and source records attributed to M Butters.

39 records · Page 3Linked to original sources

PubMed1984

[Gastrectomy in the aged].

Between 1969 and 1983 a total of 152 patients underwent total gastrectomy. 58 patients were older than 70 years. Surgical lethality was 14.47% with only minor differences between those patients younger than 70 and the older ones: 13.8 and 15.5%, respectively. Moreover, it did not make any major difference whether surgery was curative or merely palliative. Of 27 patients with the tumor stage TNM IV, only one patient died. Of the 66, who were operated upon during the recent 5 years period between 1979 and 1983, only one patient died. These results suggest that this remarkable decline of lethality is due to a precise standardisation of surgical technique, improvements in preoperative management of the patient and aftercare. 5 years survival rate was 17.3%; again there was no major difference between the group of patients older than 70 and those being younger than 70 years (16.5% and 19.4% respectively). It is of interest that the patients having additional splenectomy presented with an essentially worse prognosis as opposed to those without splenectomy although there were no differences between the TNM-stages. Even if the small numbers of patients can not yet be definitely conclusive, these preliminary results indicate that the indication for splenectomy in the course of total gastrectomy should be critically evaluated.

Age Factors↗

PubMed1984

[Blood glucose, ACTH, cortisol, T4, T3 and rT3 after cholecystectomy. Comparative studies of continuous peridural anesthesia and neuroleptanalgesia].

15 patients (12 women and 3 men) undergoing cholecystectomy were randomized into two groups. 8 patients were operated on under continuous thoracic epidural anaesthesia in combination with light general anaesthesia. Postoperatively they were kept painfree by continuous infusion of an 0.125% solution of bupivacaine via epidural catheter at a rate of 0.25-0.3 ml/kg X h over a period of four days. The 7 patients in the control group were operated on under neuroleptanalgesia. Piritramide was given for postoperative analgesia. All patients received 40 ml/kg X day of electrolyte solution during the period of investigation. Blood was collected at 8 am, 12 am, 4 pm, 8 pm, and 12 pm on the day of operation and on the third postoperative day, at 8 am on the first and second postoperative day, and at 8 am, 12 am, and 4 pm on the fourth postoperative day. Plasma glucose, ACTH, cortisol, T4, T3, and reverse T3 were measured. During the operation and for 12 h thereafter a mild hyperglycaemia was observed in the neuroleptanalgesia group but not in the epidural group. The differences were significant. A rise in ACTH was seen in both groups during and shortly after operation. The increase in cortisol concentration following this ACTH release was significant only in the neuroleptanalgesia, but not in the epidural group. From the first to the fourth postoperative day ACTH levels were low and cortisol concentrations within the normal range. On the third day it appeared that a diurnal variation in cortisol levels was again present. Cortisol suppression following the administration of 2 mg dexamethasone on the fourth postoperative day was detectable in both groups. Of the thyroid hormones, T4 remained unchanged and at a normal level during the investigation. T3 decreased and reverse T3 increased significantly, the maximum rise being observed on the second day. There were no differences between the groups. These changes are defined as low T3 syndrome, following caloric deprivation, injury, and stress. The metabolic and hormonal alterations caused by cholecystectomy are marked only during operation and shortly thereafter and only in this period are they influenced by epidural analgesia. From the first postoperative day onwards they are almost negligible so that a mitigation by using continuous epidural analgesia is not to be expected.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Home enteral nutrition via gastrostomy in advanced head and neck cancer patients.

We investigated whether home enteral feeding via a tube gastrostomy would enable patients with advanced malignant disease, who were unable to maintain themselves nutritionally via the oral route, to be independent of the hospital setting. Thirty-nine patients with advanced upper gastrointestinal and head and neck cancer had a tube gastrostomy placed. Before discharge, the patient was trained in the care and use of the gastrostomy feeding tube. Ten patients died of their disease before they could be discharged. During the 6-month period before gastrostomy insertion, the mean weight loss of the remaining 29 patients was 12.8%, and the mean body weight was less than 90% of ideal body weight. Prior to operation, the mean serum albumin and total lymphocyte count were 3.7 g/L and 1,087/mL, respectively. At discharge the mean caloric intake was 1.48 times resting energy expenditure. Home enteral nutrition was provided for a median of 94 days and resulted in stabilization of nutritional indices. During their median survival of 176 days, the 29 patients were admitted a total of 52 times. Twenty-eight percent of the patients were never re-admitted after gastrostomy and were adequately maintained at home, whereas 24% needed to be re-admitted once. Only 48% were re-admitted twice to assist in their nutritional management. Twenty patients received temporary home nursing services to aid in their transition. Four patients eventually resumed oral intake, and their feeding gastrostomies were removed.(ABSTRACT TRUNCATED AT 250 WORDS)

Energy Intake↗