Gastrointestinal investigations for anaemia in the elderly: a prospective study.

Of 60 patients referred for geriatric assessment with clinically significant hypochromic anaemia, in the absence of frank bleeding, 44 underwent upper gastrointestinal and 27 lower gastrointestinal investigations. The probability of identifying a potential cause at upper gastrointestinal endoscopy was three times that at barium enema, and five times that at sigmoidoscopy, and the lesions identified at endoscopy were more likely to need treatment. Of 41 who completed investigation, a cause was found in 36, upper gastrointestinal in 29, colonic in six and ileal in one. Six upper gastrointestinal and three colonic lesions were found in the 11 of these without gastrointestinal symptoms. Upper gastrointestinal endoscopy in elderly patients with unexplained hypochromic anaemia will identify a treatable cause in a high proportion of cases.

A new prognostic index in surgery and parenteral feeding: the ratio of triiodothyronine to reverse triiodothyronine in serum (T3/rT3 ratio).

Serum concentrations of albumin, triiodothyronine (T3), and reverse triiodothyronine (rT3) were measured in 46 patients on the first day after routine gastrointestinal surgery, and the molar ratio T3/rT3 was calculated. The median value of this ratio, but not of albumin, was significantly lower in 11 who subsequently suffered major septic complications than in the remainder. Measurement of the ratio correctly predicted the outcome of 80% of individuals. The T3/rT3 ratio, midarm muscle circumference (MAMC), triceps skin fold (TSF) and serum concentrations of albumin and transferrin were measured in 23 patients at referral for parenteral feeding. Median values of T3/rT3 ratio, MAMC and transferrin, but not of the other parameters, were significantly lower in nine who died than in survivors. Measurements of the ratio, MAMC and transferrin correctly predicted the outcome of 87%, 78% and 74% of individuals, respectively.

Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis.

Sixty-four patients admitted with acute alcoholic hepatitis, with or without underlying cirrhosis, were randomized regardless of encephalopathy to receive a controlled diet either alone, or supplemented orally, nasogastrically, or intravenously as necessary, with 2000 kCal and 10 g nitrogen daily. Whether this came from a conventional protein source or a branched chain amino acid enriched formulation was also randomly determined. In the absence of renal failure, nitrogen intakes of 10 g or more daily were invariably associated with positive nitrogen balance, but complications of liver dysfunction prevented the attainment of significantly more positive balance in the supplemented groups than in controls. Neither in the series as a whole, nor in any identifiable subgroup of patients, was mortality affected by treatment. Changes in prothrombin time and in measured nutritional parameters during the study did not differ between supplemented and control groups, and the observed changes in midarm muscle circumference appeared to reflect changes in degree of fluid retention. Neither enteral nor parenteral branched chain amino acids showed any consistent effect upon encephalopathy.

Prospective study of nasogastric feeding via East Grinstead or Viomedex tubes compared with oral dietary supplementation in patients with cirrhosis.

Forty-seven patients with alcoholic hepatitis and/or cirrhosis were randomised to receive nutritional supplementation by oral sip feeding or by nasogastric infusion administered via either an East Grinstead or a Viomedex nasoenteric tube. The three groups were well matched for severity and complications of liver disease. Patients fed by the nasogastric route attained their daily target dietary intake significantly more often than did those supplemented orally, but the consequent improvement in their nitrogen balance was not significant. There were no significant differences between nasogastric and sip feeding, or between the types of tube studied, in the frequency with which vomiting, diarrhoea or variceal bleeding occurred, but Viomedex tubes required reinsertion significantly less frequently than did the East Grinstead type.

Estimation of urinary nitrogen losses from urea excretion in patients with intestinal diseases requiring parenteral nutrition, and in those with hepatic decompensation.

A comparison of daily urinary nitrogen excretion measured directly, with values derived from urea excretion, was carried out on 110 occasions in patients with either gastrointestinal disease requiring total parenteral nutrition or with alcoholic liver disease. The values were found to correlate well in both patient groups (r = 0.88 and 0.9 respectively). Values of urinary nitrogen loss calculated from urea excretion may safely be used when performing nitrogen balance studies in such cases.

Polyneuropathy: an unreported non-metastatic complication of primary hepatocellular carcinoma.

A patient with hepatic cirrhosis is described, who presented with a sensorimotor polyneuritis at the time of the development of a primary hepatocellular carcinoma. Typical clinical and electrodiagnostic features of a paraneoplastic peripheral neuropathy, not previously reported in hepatocellular carcinoma, were found on investigation.

Hepatocellular carcinoma complicating chronic granulomatous hepatitis.

The development of hepatocellular carcinoma, is reported in a patient with chronic granulomatous hepatitis after a seven year interval in which clinical and biochemical improvement had occurred on corticosteroid therapy and in whom, the development of cirrhosis was excluded by liver biopsy.