Determination of the fiber content of enteral feedings.

The importance of dietary fiber in maintaining optimum bowel function has been shown in feeding studies, and many enteral formulas now contain dietary fiber, usually as soy polysaccharide (SP). Generally only total dietary fiber (TDF) values are given on the label or in product literature, with no indication of insoluble dietary fiber (IDF) and soluble dietary fiber (SDF) content. Often product literature highlights the amount of SP contained in the formula, not the TDF. The method used to determine TDF content usually is not specified, making it impossible to compare products on a TDF basis. We compared the dietary fiber content of commercially available enteral formulas objectively to help clinicians make informed choices when selecting fiber-containing formulas. Fiber-containing formulas by suppliers were freeze-dried and total, water-soluble, and water-insoluble dietary fiber measured by the Association of Official Analytical Chemists (AOAC) approved method. TDF per 1000 mL ranged from 4.0 to 9.9 g for blenderized formulas and from 7.2 to 20.3 g in formulas containing SP. IDF values per 1000 mL ranged from 2.0 to 5.4 g for blenderized product, and the soy formulas ranged from 5.5 to 16.9 g. SDF values per 1000 mL ranged from 2.0 to 4.5 g in blenderized products, and in soy formulas SDF ranged from 1.7 to 3.8 g. Differences in physiological effects of fiber-containing enteral formulas may be because of differences in fiber composition.     

Hematologic effects of nitrous oxide in surgical patients

Nitrous oxide can cause hematologic abnormalities, including death, if it is administered for several days. However, the adverse hematologic effects of its use for surgical anesthesia are unclear. Accordingly, we have studied the hematologic responses of patients undergoing procedures involving hematologic stress or prolonged anesthesia with and without nitrous oxide. We measured red cell count, hemoglobin concentration, mean red cell volume, reticulocyte count, platelet count, mean platelet volume, blood leukocyte level, and leukocyte differential in patients undergoing total hip arthroplasty or removal of an acoustic neuroma. Nitrous oxide did not affect the production of red blood cells or platelets. Nitrous oxide treatment was associated with an increase in postoperative leukocyte levels that was modestly but significantly smaller than that found in patients not given nitrous oxide. There was no evidence that this small decrease in maximal leukocytosis adversely affected clinical outcome.     

Postoperative hypoxemia after nonabdominal surgery: a frequent event not caused by nitrous oxide

We tested whether anesthesia that includes nitrous oxide (N2O) results in the development of intraoperative and postoperative pulmonary complications, including hypoxemia. We also tested whether aging contributes to the development of such complications, particularly when anesthesia includes N2O. We randomly allocated patients having total hip replacements, carotid endarterectomies, or transsphenoidal hypophysectomies (total n = 270) to an anesthetic regimen with and without N2O (stratified within surgical group). A heat-and-moisture exchanger was included in the anesthetic circuit of all patients. Patients were monitored perioperatively and for 1 wk after surgery using intermittent and continuous pulse oximetry to determine oxyhemoglobin saturation. Intraoperatively, mean oxygen (O2) saturations were lower in patients given N2O, particularly older patients. Hypoxemia (O2 saturation less than 86%) developed in five patients receiving N2O and in one receiving O2. This difference was not significant. Administration of N2O did not decrease postoperative O2 saturation, nor did it alter the incidence of postoperative hypoxemia, cough, or sputum production.     

Early detection of colorectal cancers by detection of occult blood in feces using Krypto-Haem SSW

Screening for cancer of the bowels with tests for occult blood in the stools obtained an increasing interest during the last 15 years. In the GDR Krypto-Haem SSW is at the disposal for this purpose. Up to now two larger investigations were performed with this preparation. The results of the studies with Krypto-Haem and Haemoccult were compared as well as questions of the test performance, the secondary diagnostics, the sensitivity of the tests, the compliance and organisation of a screening are treated. From this derived that Krypto-Haem SSW can be recommended as diagnostic test for colorectal tumours within the basic medical care.     

Serum lipid and fecal bile acid changes with cereal, vegetable, and sugar-beet fiber feeding.

Thirty-four subjects consumed six controlled formula diets for 3 wk each, supplemented with 0 g added fiber, 10 and 30 g dietary fiber as wheat bran (WB), 10 and 30 g dietary fiber as mixed vegetable fiber (VF), and 30 g dietary fiber as sugar-beet fiber (SBF). Serum cholesterol changes for fiber free, 10 g WB, 30 g WB, 10 g VF, 30 g VF, and 30 g SBF (-0.13, -0.18, -0.05, -0.17, -0.24, and -0.70 mmol/L, respectively) were significant for 30 g VF and 30 g SBF. Reduction in total cholesterol with SBF was largely due to significant lowering of low-density-lipoprotein cholesterol. Total fecal bile acid concentrations were significantly higher with the fiber-free diet than with 30 g WB, VF, and SBF (P less than 0.001) and were also higher with 30 g SBF than with 30 g WB and 30 g VF (P less than 0.005). Daily fecal bile acid excretion was not different on 30 g SBF compared with 30 g WB and 30 g VF. Differences in cholesterol reduction across the diets could not be explained by differences in fecal bile acid excretion.     

Frey's syndrome and parotidectomy flaps: A retrospective cohort study.

Gustatory sweating, also known as Frey's syndrome, is a recognized phenomenon after parotidectomy. The incidence of clinically significant gustatory sweating may be dependent on the thickness of the skin flap that is elevated at the time of surgery. Dissection in the subcutaneous level or the deeper sub-superficial musculoaponeurotic system level are 2 commonly used techniques in the operation. Twenty-eight patients were prospectively evaluated for Frey's syndrome after superficial parotidectomy. Thirteen patients underwent subcutaneous and 15 patients sub-superficial musculoaponeurotic system flap elevation. The overall incidence of gustatory sweating was determined, and a comparison of the two surgical techniques was assessed subjectively by patient interview-questionnaire and objectively evaluated with starch-iodine testing.     

Flow cytometry: DNA analysis of squamous cell carcinoma of the upper aerodigestive tract

The flow cytometer is capable of analyzing a large number of cells or cell nuclei. The flow cytometer has been used to analyze the DNA content of tumor cells from squamous cell carcinomas of the upper aerodigestive tract using a modification of the Vindelov staining procedure. The main difficulty in analyzing solid tumors using flow cytometry technology is the disaggregation of the cells and the quantification of the diploid point (2N point). A set of internal standards was developed for establishing the 2N point, as well as a technique for disaggregation, which is described. A histogram characteristic of a more aggressive squamous cell carcinoma which tends to recur more quickly and more frequently than the other squamous cell carcinoma histogram types was identified. The flow cytometer proved to be a practical method of analysis allowing for quantitative measurement of DNA content from a large number of cells originating from a squamous cell carcinoma. The trend between recurrence and histogram type will require further study.