The selective management of penetrating wounds of the back.

Fifty patients with penetrating wounds of the back were prospectively evaluated and managed selectively on the basis of physical examination. Despite the theoretic problems of evaluating the retroperitoneum, physical examination was found to be a reliable method of determining the need for laparotomy. Every patient who had a significant injury had evidence for this on initial physical examination and no patient judged to have a normal examination required laparotomy.

Nutritional assessment by hand grip dynamometry.

Hand grip dynamometry was studied in 109 normally nourished and 26 malnourished patients. The grip strength was 37,5 +/- 9,9 kg/m2 in normal men, 30,5 +/- 14,4 kg/m2 in men with carcinoma of the oesophagus (starvation-adapted) and 22,0 +/- 9,2 kg/m2 in catabolic men (P less than 0,001). Normal women had a grip strength of 31,6 +/- 7,5 kg/m2 compared with 22,3 +/- 7,0 in catabolic women (P = 0,083).

Nutritional parameters in urban and rural Zulus.

Anthropometric, biochemical and haematological nutritional parameters were measured in 103 (65 men, 38 women) Durban Zulu adults (urban) and 109 (41 men, 68 women) Tugela Ferry Zulu adults (rural). Men conformed to an ideal weight for height whereas women were 18% overweight in Tugela Ferry and 30% so in Durban. Mean arm muscle circumference in men was between the 10th and 20th centiles.

Esophageal transection versus injection sclerotherapy in the management of bleeding esophageal varices in patients at high risk.

In a prospective randomized trial of 76 patients at high risk with bleeding esophageal varices, transection of the esophagus with the EEA stapling apparatus was compared with injection sclerotherapy in the management of patients with Child's class B and C liver status. Thirty-nine patients underwent transection and 37 patients, sclerotherapy with a total of 92 injection procedures (2.4 per patient).

Total parenteral nutrition by peripheral venous infusion in patients with oesophageal carcinoma.

The safety and efficacy of pre-operative intravenous feeding using a peripheral venous infusion technique was evaluated in 15 black patients with oesophageal carcinoma. Energy requirements were based on individual energy expenditure at rest calculated from oxygen consumption and the respiratory quotient. Patients received 7 600 non-protein kJ and 9,4 g nitrogen daily for 14 days.

Stapled anastomosis after colorectal resection for benign and malignant disease.

Low anastomosis using the EEA stapling device was performed in 60 patients after resection for benign and malignant colorectal disease. There were no procedure-related deaths. The anastomosis leaked in 11 patients (18%), and there was abscess formation in 7 patients (12%) in whom the anastomosis was performed 5-8 cm from the anus.

Fournier's gangrene.

Over a 5-year period 43 men with severe classic Fournier's gangrene of the scrotum and perineum and in some cases of the abdominal wall were treated at King Edward VIII Hospital, Durban. There were 8 deaths, an overall mortality rate of 18,6%. The mortality rate was high (33%) when associated with diabetes mellitus and lower (14,7%) among non-diabetic patients.

Air tamponade. A case report.

A 29-year-old man with post-traumatic cardiac tamponade resulting from the development of a tension pneumopericardium is described. To our knowledge this is the first such case reported in the literature.

Segmental artery occlusion for sequential renal injuries. A case report.

We report on a patient who experienced life-threatening haemorrhages in 1974 and 1980 after receiving stab wounds to the same kidney. Treatment by means of segmental artery occlusion was successful. Nephrectomy would have been necessary to control exsanguinating bleeding in both instances.

Retrosternal gastric bypass for the palliative treatment of unresectable oesophageal carcinoma. A simple technique.

A simple and effective technique of retrosternal gastric bypass of the excluded oesophagus for the palliative treatment of unresectable carcinoma of the upper thoracic oesophagus is described. It was used in 60 patients, of whom 5 (8,3%) died. Postoperative morbidity was considerable, complications including chest infection in 20 patients (33,3%), wound infection in 8 (13,3%) and anastomotic leakage in 5 (8,3%); the latter caused 2 deaths.

E-rosette inhibition and tumour recurrence in early breast cancer.

The relationship of serum blocking activity and susceptibility to tumour recurrence using E-rosette inhibition by normal allogenic lymphocytes was evaluated before and after operation in 20 patients with early breast cancer. Preoperative serum inhibition levels did not predict recurrent tumour. The mean postoperative inhibition in patient with recurrence was significantly greater than in those without recurrence.

Pulsion intubation v. restrosternal gastric bypass for palliation of unresectable carcinoma of the upper thoracic oesophagus.

The optimum method of restoring the ability to swallow in patients with oesophageal carcinoma remains controversial. This prospective randomized study evaluates the palliative potential of pulsion intubation v. retrosternal gastric bypass of the excluded oesophagus in 106 patients with unresectable carcinoma; 55 patients were intubated and 51 patients treated by gastric bypass.

Total parenteral nutrition--progress with the 3-litre bag.

Recently a disposable 3-litre plastic bag in which the 24-hour nutrient requirements for total parenteral nutrition can be mixed to provide a single solution was introduced to South Africa. We report our initial experience with the 3-litre bag (379 'catheter days'), comparing it with the conventional multiple-bottle system (267 days) in a series of 10 patients. The 3-litre bag system proved easier to administer and also reduced nursing supervision, improved metabolic control and reduced complications.

Nutritional support of the hospitalized patient. Part II. Clinical indications.

The first part of this review dealt with the background, methodology and techniques of nutritional support. As a significant proportion of hospitalized patients suffer from various forms of unrecognized and untreated malnutrition, nutritional support is essential for the maintenance of body mass and function until specific treatment is able to influence the course of disease. The following review highlights various medical and surgical conditions in which nutritional support, in particular total parenteral nutrition, has been advocated in adult patients.

Acid secretion and duodenal ulcer healing in patients on medical treatment.

The relationship between gastric acid secretion and ulcer healing was analysed in 168 patients with endoscopically proven duodenal ulceration. One hundred and three patients received active treatment with various therapeutic agents and 65 received placebo. The mean maximal acid output in patients with unhealed ulcers was significantly higher than that in patients with endoscopically confirmed ulcer healing in both the actively treated and the placebo groups (P less than 0,001).

Inhibition of mitogen-induced lymphocyte proliferation by autologous serum in oesophageal carcinoma.

The reactivity of lymphocytes from patients with oesophageal carcinoma in response to mitogenic stimulation with phytohaemagglutinin was assessed in four culture systems in an attempt to demonstrate an inhibitory effect of cancer serum on lymphocyte transformation. The metaphase index (number of cells at metaphase/1000 live cells) was used to determine lymphocyte reactivity of patients and controls in the presence of: (a) autologous plasma; (b) pooled AB serum; (c) pooled plasma from patients with oesophageal cancer, and (d) fetal calf serum. The division of lymphocytes from cancer patients was significantly depressed in the presence of autologous plasma (p<0,001) when compared with division of lymphocytes of control subjects.

Localized granulomatous mastitis--an unusual presentaton of typhoid: A case report.

A 32-year-old Black woman had a localized granulomatous mastitis. The lesion formed a discrete mass and had the clinical and radiological features of mammary carcinoma. Salmonella typhi was cultured from the lesion and also from the affected breast after excision.

Nutritional support in high-output fistulas of the alimentary tract.

A total of 63 patients with high-output alimentary tract fistules was treated during a 3-year period, using three different regimens of nutritional support. The fistula closed spontaneously in 46 patients (73%), and 7 patients (11%) were cured by direct surgical closure. Nine patients died, a mortality rate of 14.