Journal of the Royal College of Surgeons of Edinburgh
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J R Coll Surg Edinb · Oct 1993
Comparative StudyPyloromyotomy: why make an easy operation difficult?
Recently Ohri et al. advocated a modification to the standard pyloromyotomy for pyloric stenosis which they believed reduced postoperative vomiting. Their study had no control group to support their contention. ⋯ Data were recorded prospectively and the postoperative vomiting was assessed using the same scale as in the previous report. The incidence of vomiting was significantly less in the children undergoing the conventional operation (P = 0.03), suggesting that there is no justification for performing a double V-shaped pyloric incision in pyloric stenosis.
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The metabolic response to critical illness is an integrated process producing profound changes to multiple systems. The altered metabolism of carbohydrates, lipids, and proteins in critically injured patients, and the crucial role of cytokine mediators such as tumour necrosis factor, interleukins, and interferons are described in detail. ⋯ The research on specifically enriched amino acid formulations with glutamine, branched-chain amino acids, and arginine solutions is reviewed with emphasis on both theoretical and clinical issues. The role of dietary lipids in the production of specific modulators of immunoresponsiveness and investigations focusing on metabolic modulation relating to nutritional support are summarized.