Postgraduate medical journal
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Pre-operative intravenous feeding--a controlled trial.
Seventy-four patients with a pre-operative diagnosis of stomach or oesophageal cancer were entered into a randomized, controlled clinical trial to assess the value of a short course of pre-operative intravenous nutrition. The effectiveness of this treatment was assessed by the clinical course and monitored by means of immune and biochemical profiles. ⋯ Clinical benefit was confined to those patients who had a low serum albumin on admission to hospital. It is doubtful whether this limited benefit justifies the routine use of intravenous feeding, with its attendant hazards, in the pre-operative preparation of patients with upper gastrointestinal cancer.
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Comparative Study
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part II. Self assessments of effects of the service on surviving spouses.
Self-assessments of 34 spouses of patients who had died from cancer at St Christopher's Hospice were compared with self-assessments of a matched group of spouses of patients who had died in other hospitals in the vicinity. The spouses of St Christopher's patients differed significantly from the comparison group in spending more time at the hospital, talking to more members of staff, other patients and visitors, reporting less anxiety and psychosomatic accompaniments of anxiety before (but not after) the patient's death and being less worried about pain, others hurting or harming the patient or about revealing their own fears to the patient. The institutional ideals of the Hospice were characterized as: 'The hospital is like a family', 'Nothing is too much trouble' and 'Don't worry'.
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Historical Article
Introductory address: lessons to be learned from high altitude.
A historical account of the important landmarks in man's experience with the high altitude environment is followed by comments on the important stages in the understanding of its physiological effects. The work of The Mount Logan High Altitude Physiology Study on acute mountain sickness is reviewed from its inception in 1967 until the present.
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Malabsorption of prednisolone administered as enteric coated tablets was suspected following therapeutic failure in an asthmatic. This was investigated by cortisol estimation and a Synacthen test and substantiated by the demonstration of abnormally low absorption of prednisolone from these tablets which nevertheless were normally absorbed by a volunteer. The absorption of prednisolone from conventional tablets in this patient was normal.
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Coagulation problems in pregnancy are primarily associated with overactivity of the intrinsic clotting system. This accounts for the increased incidence of thrombo-embolism during pregnancy. ⋯ Therefore the role of anticoagulant treatment in the management of pre-eclampsia remains questionable. A new test for estimating factor VIII consumption is proving to be a sensitive index of early activation of the clotting system and can be used for the diagnosis of early pre-eclampsia.