The management of short-term intestinal failure in obese patients.

The prevalence of obesity in the general population is high and it is inevitable that artificial feeding will be needed from time to time in the obese patient, particularly in the critical care setting. Against a background of generous endogenous stores of energy as adipose tissue and the ability of obese individuals to survive starvation longer than non-obese individuals, emphasis is placed on preserving lean body mass and optimizing physiological function. Insulin resistance is typical of the obese individual and is exacerbated by stress; overfeeding is dangerous, particularly if it results in hyperglycaemia.

Caring for people with HIV in Zambia: are traditional healers and formal health workers willing to work together?

This study of traditional healers and formal health workers determined their knowledge and practices in the field of HIV/AIDS and examined their training needs and attitudes to collaboration, in preparation for planning joint training workshops. Several misconceptions concerning symptoms and transmission of HIV disease were found in both groups, particularly among traditional healers. Twenty healers (51%) and four formal health workers (15%) claimed a cure existed for AIDS.

Thyroid disease in pregnancy.

This review article provides a broad overview of thyroid disease and pregnancy.

Pseudoaneurysm of the radial artery complicating excision of a wrist ganglion.

A case of pseudoaneurysm of the radial artery complicating excision of a wrist ganglion is reported. Tourniquet release prior to wound closure would have allowed detection and immediate treatment of the vascular injury.

Cardiac output in asymptomatic primary hyperparathyroidism: a stigma of early cardiovascular dysfunction?

The resting cardiac output pre- and postoperatively in 10 patients with asymptomatic primary hyperparathyroidism has been studied. All patients had normal renal function and arterial blood pressure without a previous history of cardiovascular disease. Ten normotensive patients with a non-toxic goitre awaiting thyroidectomy were studied as controls.

Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London.

Objective: To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training, inner city general practices.

Design: Randomised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions.

Subjects: 24 inner city, non-training general practices.

Acetabular cup migration. Prediction of aseptic loosening.

We measured the proximal migration of 265 acetabular cups over seven years and correlated the findings with clinical outcome and acetabular revision for aseptic loosening. Cups which eventually became aseptically loose were shown to migrate more rapidly than successful cups. The average proximal migration at two years postoperatively for four groups of cups showed a monotonic relationship to the acetabular revision rate for aseptic loosening at 6.

Total anorectal reconstruction.

Abdominal stomas carry a considerable physical and psychological morbidity. Several authors have attempted total anorectal reconstruction (TAR) to avoid a permanent stoma for patients undergoing abdominoperineal excision of the rectum (APER). The published series of TAR are reviewed.

Mathematical modelling of the enteric nervous network. 4. Analysis of adrenergic transmission.

Based on the model of the adrenergic neurone proposed earlier, the dynamics of nerve-pulse transmission after treatment with inhibitors of neuronal uptake and catechol-O-methyltransferase, alpha 1-adrenoceptor antagonists, changes in the concentration of Ca2+ ions in the external medium, the action of tetrodotoxin (TTX) and repetitive stimulation, are analysed. The results of numerical simulation show that: the addition of drugs that inhibit neuronal uptake and catechol-O-methyltransferase cause the augmentation of noradrenaline action on post-synaptic structures and an increase in the amplitude of the generated inhibitory post-synaptic potential (IPSP); treatment with adrenergic antagonists reduces the amplitude of IPSP; decrease in the concentration of extracellular Ca2+ ions and application of TTX abolish the post-synaptic response. All these effects are shown to be dose-dependent.

Mathematic modelling of the enteric nervous network. 5. Excitation propagation in a planar neural network.

A mathematical model of the enteric nervous system (Auerbach's plexus) as a planar neural network has been developed, based on the actual morphological data of its organization. The network is composed of excitatory (cholinergic) and inhibitory (adrenergic) neurones interconnected by polysynaptic channels, formed of the geometrically non-uniform unmyelinated nerve axons. The synaptic zones are modelled as a three-compartment open pharmacokinetics system, i.

Intermittent endocrine therapy and its potential for chemoprevention of prostate cancer.

This chapter has reviewed the limitations of the use of chemotherapy in patients with hormone resistant prostate cancer. Although demonstrating that there is a small number of patients with very chemosensitive tumours, the age profile and intolerance to chemotherapy make it highly unlikely that this modality of treatment will be used more routinely despite the increasing evidence that the slow decline of prostate specific antigen with endocrine treatment can be used early to select patients who might respond to chemotherapy. Equally certain is that it will not be of use for chemoprevention of the early stages of this disease.

S100 protein in oral biology and pathology.

The demonstration of S100 protein is used extensively for both research and diagnostic purposes in oral biology and pathology. This article reviews the structure and putative function of S100, technicalities of S100 immunohistochemistry, the cells of the oral and perioral tissues which express S100 and the possible significance of S100 expression in disease.

Modelling of the enteric nervous network: 3. Adrenergic neuron.

A mathematical model is developed to investigate the coupled electrochemical processes of nerve-pulse transmission via adrenergic synapse. Based on pharmacological and morphophysiological data, the model describes the dynamics of the propagation of the electric signal along the unmyelinated geometrically non-uniform axon of the neuron and the chemical mechanisms of the transformation of the electrical signal in the synaptic zone into the post-synaptic output. The combined nonlinear system of partial and ordinary differential equations has been obtained and solved numerically.

Wear induced by motion between bone and titanium or cobalt-chrome alloys.

We studied the wear generated by motion between polished and shot-blasted titanium-alloy (Ti-6Al-4V) or cobalt-chrome alloy (Co-Cr) surfaces and cortical bone in vitro. Semicircular sections of human proximal femoral cortex were reamed to fit metal cylinders of each alloy. The cylinders were then fitted in the bone, loaded and rotated in physiological saline.

Cuffed polyurethane catheter for ambulatory infusional chemotherapy.

This article describes the technique for inserting cuffed polyurethane catheters under local anaesthesia. A very low complication rate is seen with these catheters and patients tolerate the catheters and Cadd infusional pumps for continuous chemotherapy very well.

Intra-articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy.

Objective: To determine the safety and efficacy of intra-articular injections of hyaluronan in the treatment of osteoarthritis of the knee.

Methods: A randomised double-blind placebo-controlled trial was carried out on 91 patients with radiologically confirmed osteoarthritis of the knee who were recruited from the outpatient clinics.

Results: It was found that weekly intraarticular injections of 20 mg of hyaluronan of M(r) = 750,000 (Hyalgan) in 2 ml of buffered saline performed no better than the inert vehicle alone over a five week period.

Numerical simulation of the peristaltic reflex of the small bowel.

A mathematical model and results of numerical simulation of the peristaltic reflex development of the small bowel are presented. The organ is modeled as a soft orthotropic cylindrical biological shell, reinforced by the smooth muscle elements. Their mechanical activity is under the control of a simple reflex arc represented by a single cholinergic neurone.

Early migration and late aseptic failure of proximal femoral prostheses.

The vertical migration of four configurations of a proximal femoral prosthesis, followed for up to nine years, was measured on standard radiographs. The same implant was used without cement (group 1) and with cement (group 2). The migration of both groups was linear from six months onwards.

Effect of three animal models of inflammation on nerve fibres in the synovium.

Objectives: Both sensory and sympathetic nerve fibres are depleted in the synovium in rheumatoid arthritis (RA). The hypothesis that the induction of an inflammatory response in the synovium is capable of causing depletion of nerve fibres was tested.

Methods: To investigate this phenomenon experimental arthritis in the rat was induced by three different methods and the synovium was examined for evidence of nerve depletion by immunocytochemistry.

The observation of angiogenin and basic fibroblast growth factor gene expression in human colonic adenocarcinomas, gastric adenocarcinomas, and hepatocellular carcinomas.

Using digoxigenin-labelled, synthetic oligonucleotide probe cocktails of angiogenin and bFGF genes, the expression of the two genes was observed by in situ hybridization in ten colonic adenocarcinomas, seven gastric adenocarcinomas, and four hepatocellular carcinomas. The angiogenin gene was expressed in eight of the ten cases of colonic adenocarcinoma and in all of the four cases where dysplastic glands were found. Angiogenin expression was evident in four of the seven cases of gastric adenocarcinoma.

Mathematical modelling of the enteric nervous network. 1: Cholinergic neuron.

A mathematical model is proposed to describe the coupled electrochemical mechanisms of nerve-pulse transmission via cholinergic synapse. Based on pharmacological and morphophysiological data, the model describes the dynamics of the propagation of the electric signal along the unmyelinated geometrically non-uniform axon of the neuron and the chemical mechanisms of the transformation of the electrical signal in the synaptic zone into the postsynaptic output. The combined nonlinear system of partial and ordinary differential equations has been obtained and solved numerically.

Lipid fuel metabolism after abdominal surgery.

The work investigated fuel interrelationships in surgical patients infused with saline (Group I) or glucose (Group II) (13 patients in each group) on the day of surgery and subsequently maintained solely on saline until the fifth postoperative day. Blood concentrations of non-esterified fatty acids (NEFA) and ketone bodies were markedly increased in response to surgical stress on the day of surgery only in patients who were not administered carbohydrate. Increased concentrations of lactate and glucose were observed on the day of surgery in patients infused with either saline or glucose.

Micronutrients in gastrointestinal cancer.

The monitoring of micronutrients and the relationship between dietary intake and micronutrient status prior to and after surgery in patients with histologically proven gastrointestinal adenocarcinoma, both weight-stable and weight-losing (> 7.5% of their pre-illness weight) has been studied and the results compared to controls. Plasma vitamin C and red blood cell thiamine levels were significantly lower in weight-losing cancer patients when compared to their weight-stable counterparts (P < 0.