Utilizing Solanum glaucophyllum alone or with phytase to improve phosphorus utilization in broilers.

Experiments were conducted to determine if Solanum glaucophyllum (SG), a plant containing a glycoside of 1,25-dihydroxyvitamin D, could be used as a feed additive to improve P utilization of broilers. SG leaves (1, 2.5, or 5 g/kg), 1,25-dihydroxyvitamin D (15 microg/kg), or Ca and P (to achieve a 0.92% Ca:0.65% P:0.41% nonphytate P control diet) were added to a 0.56% Ca/0.45% P/0.28% nonphytate P basal diet and fed to broilers from 7 to 28 d of age. Birds fed basal ration alone exhibited reduced weight gain, bone density, and bone mineral content when compared with birds fed the 0.92% Ca:0.65% P diet. Adding 5 g SG leaves or 15 microg of 1,25-dihydroxyvitamin D/kg to the basal diet increased body weight gain, plasma Ca and P, bone ash, and bone density above basal diet levels. Plasma P and weight gain of birds fed 5 g SG or 15 microg of 1,25-dihydroxyvitamin D/kg basal diet were equivalent to those observed in birds fed the 0.92% Ca:0.65% P diet. In experiment 2, the effect of higher doses of SG, as well as the additive effect of SG with 1,200 phytase units/kg diet, were examined in chicks fed a 0.59% Ca and 0.42% P basal diet. Two levels of SG leaves (7.5 g and 10 g), phytase, or both SG (7.5 g) and phytase were added per kilogram of basal diet. Adding SG or phytase to the basal diet increased weight gain, plasma Ca, plasma P, and bone mineral content over that observed in birds fed basal diet alone. Combining SG with phytase provided no significant gains in growth or bone parameters over treatment with phytase alone.

Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy.

PURPOSE: The object of this study was to evaluate technique using the ultrasonically activated scalpel as an alternative to closed hemorrhoidectomy in an unbiased evaluation of this new technology. METHODS: Thirty patients with Grade 2 or 3 symptomatic hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by electrocautery or hemorrhoidectomy with the ultrasonically activated scalpel, i.e., the Harmonic Scalpel. We evaluated the difference between techniques in operative time, postoperative pain, incontinence, and quality of life (using the Short Form-36 survey), as well as complications. RESULTS: Mean operative time for closed hemorrhoidectomy with electrocautery was 35.7 +/- 3 minutes; for Harmonic Scalpel patients, it was 31.7 +/- 2 minutes (P < 0.37). There was no statistical difference in operative time for two- or three-column hemorrhoidectomy. There was no significant difference in pain measurements reported on Day 1 (5.8 +/- 0.4 for electrocautery and 5.6 +/- 0.6 for Harmonic Scalpel, P < 0.82). On postoperative Day 7, the difference in pain between groups approached significance, with pain reported as 3.7 +/- 0.3 for electrocautery and 5.1 +/- 0.7 for Harmonic Scalpel(R) (P < 0.06). At six weeks, both groups were pain free. There was a significant decrease in pain between postoperative Days 1 and 7 in the electrocautery patients that was not seen in the Harmonic Scalpel patients. Incontinence measured preoperatively, at postoperative Day 7, and at postoperative Week 6 was similar for both groups and reflected occasional incontinence of gas. When the various items of the Short Form-36 survey were compared, there was no significant difference between posttreatment and preoperative values. There was no difference in the number of complications between patient groups. CONCLUSION: Although the Harmonic Scalpel is an effective tool in the treatment of hemorrhoidal disease, we found no specific advantage in postoperative pain, fecal incontinence, operative time, quality of life, or complications compared with traditional closed hemorrhoidectomy.

Acute colonic perforation associated with colorectal cancer.

Our purpose was to evaluate long-term outcome in patients presenting with acute colonic perforation in the setting of colorectal cancer. We conducted a retrospective review of 48 consecutive patients presenting with acute colonic perforation associated with colorectal cancer at a single institution. Patients presented either with free air or acute peritonitis. No patients with colonic obstruction were included. Forty-eight patients presented with colon perforation. Thirty-six had perforation at the tumor, 11 proximal to the tumor, and one distal to the primary tumor. Patients who perforated proximal to the tumor were older (74.5 +/- 2 vs 64.7 +/- 3; P < 0.04) and had a longer length of stay (46.8 +/- 17 vs 11.6 +/- 1 P < 0.001). Fourteen patients had stage II disease, 19 stage III, and 15 stage IV. Thirty-day mortality was 14 per cent (n = 7) with nine in-hospital deaths. Of 30-day survivors 29 (60%) had curative resection (21 with local perforation and nine with proximal perforation). Of these 14 received adjuvant chemotherapy. Eleven patients (33%) had either unresectable or metastatic disease on exploration. Mean follow-up was 21.5 months. Ten patients developed metastatic disease after potentially curative resections. Of these nine patients had perforations of the primary tumor. Three patients developed local recurrence and all had local tumor perforations. One-year survival was 55 per cent (n = 16). Five-year disease-free survival was 14 per cent (n = 4). There were no long-term survivors after perforation proximal to the tumor, although disease stage was comparable in both groups. We conclude that perforation proximal to a cancer is associated with a higher perioperative mortality and worse long-term outcome when compared with acute perforations at the site of the tumor. Long-term survival requires both aggressive management of the concomitant sepsis and definitive oncologic surgery.