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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
PubMed1991

Home parenteral nutrition at Auckland Hospital.

This paper reports the results of home parenteral nutrition (HPN) from Auckland Hospital. In the last two and a half years, six patients have gone home from hospital on HPN. Four are still on it, after periods of from one to 30 months. There has been one death and one patient who developed catheter sepsis. Quality of life on HPN has in general been very good. Body composition studies performed on these patients have shown that a normal body composition can be maintained while on HPN.

Adult↗
PubMed1991

Protein status and metabolic expenditure determine the response to intravenous nutrition--a new classification of surgical malnutrition.

To determine whether nutritional and metabolic factors affect the response to intravenous nutrition (IVN) 146 surgical patients were classified according to their protein and metabolic status using direct measurements of body protein and metabolic expenditure. The patients were grouped into four categories: category I, moderate to severe protein depletion without raised metabolic expenditure; category II, moderate to severe protein depletion with raised metabolic expenditure; category III, mild protein depletion without raised metabolic expenditure; and category IV, mild protein depletion with raised metabolic expenditure. After 2 weeks of IVN patients in category I gained a mean(s.e.m.) of 0.43(0.06) kg of body protein (P less than 0.001) and had significant rises in both plasma transferrin and prealbumin (P less than 0.05); patients in category II gained 0.30(0.11) kg of protein (P less than 0.005) and also had significant rises in transferrin and prealbumin (P less than 0.05). Patients in category III lost 0.24(0.11) kg protein (P less than 0.05) and had no changes in either transferrin or prealbumin and patients in category IV lost 0.51(0.13) kg of body protein (P less than 0.001) and although there was a significant rise in plasma prealbumin there was no significant change in plasma transferrin. When postoperative patients were examined separately, they did not differ significantly from preoperative patients except in category I, where their protein gain was only 0.19(0.10) kg, an amount not significantly different from that gained by patients in category II. In each of the four categories described, the changes in total body protein occurring with 2 weeks of IVN were determined by the relative effects of two competing processes; protein depletion and raised metabolic expenditure. With moderate to severe protein depletion (approximately 30 per cent depletion of body protein stores) there was a marked tendency to gain protein with IVN. When the patient had a raised metabolic expenditure or was postoperative this tendency of depleted patients to gain protein was still present but it was less. With only mild protein depletion (approximately 10 per cent depletion) increases in metabolic expenditure made it difficult, if not impossible, to prevent continuing protein loss in spite of aggressive nutritional support. The patient categories we have described determine the response to IVN and form the basis of a new clinical classification of surgical malnutrition.

Blood Proteins↗
PubMed1991

Ulcerative colitis in the anal canal of patients undergoing restorative proctocolectomy.

The development of stapling instruments has obviated the need to perform anal mucosectomy for ulcerative colitis, but the potential exists for continued inflammation and, perhaps, malignant change. We reviewed the pathology specimens of patients who had had restorative proctocolectomy, to determine the incidence and severity of inflammation in the anal mucosa.

Anal Canal↗
PubMed1991

Long-term changes in body composition after pancreatoduodenectomy.

Body protein and fat stores were measured in four long-term survivors both before Whipple's procedure for malignancy at the ampulla of Vater and at a mean of 40 months (range 20-64 months) later. The results were compared with predicted well values. At follow-up patients also underwent dietary assessment and measurement of faecal fat losses. A dietary intake of mean (s.d) of 2690 (733) kcal per day and 85 (21) g protein per day met the patients' requirements. There was notable steatorrhoea (faecal fat 28 (21) g per day) but faecal protein losses were normal. Before surgery, body-weight was significantly lower than well-weight (P less than 0.0005), three patients having body fat stores lower than predicted well values. After surgery, body-weight and protein stores did not change significantly but fat stores fell in each patient (P less than 0.04). A curative Whipple's procedure prevents further weight loss in ampullary malignancy but weight gain does not occur because of steatorrhoea, perhaps a result of the accompanying truncal vagotomy.

Adenoma, Islet Cell↗
PubMed1991

Postoperative fatigue: a prospective physiological study of patients undergoing major abdominal surgery.

We attempted to define the site of muscle action accounting for the apparent muscle weakness occurring with postoperative fatigue. A model of the normal pathway of muscle contraction is presented. A series of studies, designed to separate the elements of the pathway, was performed on 38 patients undergoing major abdominal surgery. Central fatigue was measured with Christensen's analogue, voluntary strength by grip strength, perceived effort by grading the difficulty of a set work load, involuntary muscle function by ulnar nerve stimulation, and muscle bulk represented by total body nitrogen, measured by in vivo neuron activation analysis. Fatigue increased for the first 2 weeks after operation, was back to pre-operative levels within 1 month, and improved further at 3 months. Grip strength fell after operation and returned to pre-operative levels within 3 months. Perceived effort rose after operation and returned to pre-operative levels by 3 months. Involuntary muscle function was unaffected by operation. Similarly, total body nitrogen fell in the first 2 weeks after operation but was improved on baseline levels at 3 months. However, there was no consistent correlation between the movement patterns of any of the muscle parameters and fatigue. The results suggest that fatigue after surgery is not accompanied by any muscular defect, and that the apparent muscular weakness is probably a secondary phenomenon to the central fatigue.

Abdomen↗
PubMed1990

Dietary management of the patient with massive enterectomy.

We present two cases who required massive enterectomy and who represent different points in the spectrum of this disease. We discuss their management from a nutritional stand-point and show details of energy uptake and expenditure for one of our patients. This describes our approach to this problem, and we hope it will be of use to others when dealing with patients following massive enterectomy.

Adaptation, Physiological↗
PubMed1990

Metabolism of body water and electrolytes after surgery for ulcerative colitis: conventional ileostomy versus J pouch.

Some authorities believe that patients with conventional ileostomies are chronically water and salt depleted but there are no data on the metabolism of body water and electrolytes after ileoanal J pouch. To clarify the situation we studied the body composition of 14 patients with well functioning ileostomies and 20 patients with well functioning J pouches. Both groups were compared with two closely matched control groups. Body weight, total body fat, fat-free mass, total body water and extracellular water were measured by neutron activation analysis, tritiated water and bromide dilution respectively; 24-h collections of urine and stool were analysed for volume and electrolyte content. The results show that the body content of water and extracellular fluid in ileostomy patients and J pouch patients is normal. The faecal volume and chemistry is similar in both groups resulting in a similar and significant degree of urinary sodium retention.

Adolescent↗
PubMed1990

Failure of nutritional recovery after total gastrectomy.

Malnutrition is reported to be an inevitable consequence of total gastrectomy, although there are few data to support this contention. Six patients of median age 63 years underwent total gastrectomy for malignancy. At follow-up (median 45 months, range 25-60 months) each patient was clinically tumour-free and underwent dietary assessment, faecal fat and nitrogen measurement and routine haematological testing. Protein and fat stores, measured by neutron activation analysis and the tritiated water dilution technique, were compared with the same measurements made before operation and with predicted values. Mean (s.d.) dietary intake (2224(381) kcal day-1 and 81(15)g protein day-1) met the patients' estimated requirements. Mean(s.d.) serum albumin and faecal nitrogen values were normal but there was notable steatorrhoea (21(17) g day-1). Body composition measurements revealed profound deficiencies of body-weight (P less than 0.02), protein (P less than 0.01) and fat (P less than 0.02) before operation which were not corrected by an apparently curative total gastrectomy (P less than 0.05), although further deterioration was prevented.

Adenocarcinoma↗
PubMed1990

Return to normal body composition after ileoanal J-pouch anastomosis for ulcerative colitis.

In 16 patients with ulcerative colitis, total body fat, total body protein, and total body water were measured before and two weeks, three months, and twelve months after the establishment of an ileoanal J-pouch anastomosis. The 16 patients underwent elective surgery for their inflammatory bowel disease but were significantly protein depleted before surgery when their body composition was first measured. Twelve months later, all patients were in good health, back to work, and had normally functioning pouches (average stool frequency 4.3 +/- 1.4 per day). As a group, their stores of body protein and hydration state had returned to normal limits although their body fat stores were increased. Over the postoperative period there were significant losses of weight, protein, fat, fat-free mass, and total body water. These levels had returned to preoperative values (but not to normal) three months later. It is concluded that protein depleted patients with ulcerative colitis presenting for major surgery continue to have distorted body composition for several months after surgery but after approximately 12 months, when they have returned to work and feel well, body composition has returned to normal.

Adult↗
PubMed1990

Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease.

The effect of IV nutrition on protein nutriture and physiological function in 19 patients who were clinically malnourished and had acute exacerbations of inflammatory bowel disease was studied. Total body protein, plasma proteins, respiratory muscle function, and skeletal muscle function were measured at the commencement of a 14-day course of IV nutrition and 7 and 14 days later. Final measurements were made after recovery approximately 200 days later. Compared with a group of matched controls, the patients had lost approximately 35% of their body protein stores with accompanying physiological impairments of 20%-40%. After 4 days of IV nutrition, there were improvements in all the physiological measurements (approximately 12%) but no significant change in total body protein. During convalescence, there were further improvements in physiological function, which were accompanied by an increase in body stores of protein. We conclude that there is an early and rapid improvement in physiological function with IV nutrition in patients hospitalised for exacerbations of inflammatory bowel disease even though this is not accompanied by significant protein gain. Later during anabolic recovery, physiological improvements occur in association with repletion of total body protein. Short courses of IV nutrition in these patients prevent protein loss and result in significant improvements in skeletal muscle function and respiratory muscle function.

Acute Disease↗
PubMed1990

In vivo measurement of total body carbon using 238Pu/Be neutron sources.

Total body carbon has been measured by in vivo neutron activation analysis (IVNAA) in 278 surgical gastroenterological patients and 29 normal volunteers. This is based on the inelastic scattering reaction [12C (n,n') 12C*] for neutrons with energy above 4.8 MeV, producing 4.43 MeV gamma rays. Since only part of the body is scanned, total body carbon is estimated as the ratio of the gamma ray emission from carbon to the emission from hydrogen, using hydrogen as the internal standard. The precision of the estimate is +/- 1.6 kg for a whole body dose of 0.3 mSv. There is a significant difference between the estimates of total body water from IVNAA measurements of carbon and nitrogen and measurements of body water in these subjects by tritium dilution (t = 3.1, p less than 0.005).

Adipose Tissue↗
PubMed1990

Results of 50 ileoanal J pouch operations.

Fifty ileo-anal J pouches were constructed in 26 males and 24 females for ulcerative colitis (n = 45) and familial adenomatous polyposis (n = 5). Two-thirds had proctocolectomy and pouch formation as a one-stage procedure. Thirty patients had a handsewn pouch and anastomosis and 20 were stapled. Forty-five patients had their defunctioning ileostomy closed for at least 2 months, of whom three have not been recently reviewed. One pouch was defunctioned for ischaemic stricture. The median time between pouch construction and ileostomy closure was 15 weeks and the time between closure and assessment ranged from 2 to 50 months (median 18 months). Median stool frequency was six per 24h in both the handsewn and stapled groups. Faecal incontinence occurred in 20% of patients with a handsewn anastomosis but in no patient with a stapled anastomosis (P less than 0.02). Soiling was also more common in the former group. Some 76% of patients noted an improvement in pouch function with time. In all, 67% of males and 78% of females reported unchanged or increased sexual activity since pouch surgery. Pouchitis has occurred in 20% of patients; 10% have had complications related to the pouch or anastomosis; 10% related to the ileostomy; and 6% have had small bowel obstruction. There have been no deaths. Overall, 88% of patients have had a good result, but none of the five patients with a poor result will revert to an ileostomy.

Adenomatous Polyposis Coli↗
PubMed1990

One hundred operations for Crohn's disease.

One hundred operations for Crohn's disease have been reviewed. The 100 procedures were performed on 54 patients. Thirty-four patients had had a single operation, and 20 patients had had the other 66 operations. The patients were classified into four categories: small intestinal disease (n = 17), jejuno-ileocolic (n = 7), colonic (n = 5) and classical ileocolic (n = 25). These categories had differing disease severity, symptomatology and re-operation rates. The distribution of the disease in Northern New Zealand seems similar to that elsewhere. Whereas a small number of patients may have a large number of complications and recurrences and a prolonged stay in hospital, the majority of patients can have safe and effective surgery for Crohn's disease. This is particularly true for patients with ileocolic disease and who have a limited ileocolic resection.

Adolescent↗