Nutritional support in a general urological service

A nutritional support team was used in the assessment and management of patients on a general urological service. Indications for nutritional evaluation included history of weight loss, anorexia, significant infection, chronic neoplastic disease, trauma or major surgery. The fat and protein status of the patient was assessed by anthropomorphic and laboratory determinations. The patient then was categorized as having mild, moderate or severe degrees of nutritional depletion. Deficiencies in vitamins, trace elements or essential fatty acids were not noted. Caloric and protein needs were calculated by multiplication of the basal energy expenditure by a metabolic activity factor, which was derived from the degree of illness or stress. Nutritional support was provided by enteral feedings via oral, nasogastric or jejunal feeding tubes and/or intravenous hyperalimentation via peripheral or central venous nutrient lines. During a 6-month interval nutritional consultation was requested for 50 patients, who represented 7 per cent of the urological admissions. Nutritional support was provided for patients who had obstructive uropathy with or without neoplasms, radiation cystitis, sepsis, urinary fistulas, mental depression, end stage renal disease or neurological dysfunction. In patients in whom urological treatment controlled the disease nutritional support maintained the weight, and stabilized serum albumin and lymphocyte counts. We concluded that a nutritional support program has a significant and, often, unappreciated role in the management of urological patients.     

An analysis of the post-mortem findings in the 21 victims of the Birmingham pub bombings.

On the evening of 21 November, 1974 explosions occurred almost simultaneously in two crowded public houses in the centre of Birmingham. Of the 21 people who died, 18 were killed outright and 3 died later in hospital. All 21 cases showed the terrible multiple injuries associated with close proximity to a powerful explosion within a confined space. Although all the victims suffered one or more injuries which alone would have been fatal, certain patterns of injury were noted which, if appreciated early in any future similar incident, may help to save the lives of those who are futher removed from the centre of the explosion or exposed to one of lesser force.