1. Indirect calorimetry has been used to measure resting energy expenditure (REE) and the thermogenic response to a test meal (diet-induced thermogenesis) in groups of weight-stable and weight-losing patients with gastrointestinal adenocarcinoma. Average daily intakes of energy and protein were computed from dietary assessment for the week before hospitalization. Results were compared with a control group of patients with benign gastrointestinal disease. 2. Weight-losing cancer patients had a significantly reduced mean total energy and protein intake. 3. There was no significant difference in REE between the groups when results were normalized in terms of metabolic body size (kJ/kg 0.75 ) and lean body mass (kJ/kg). 4. Diet-induced thermogenesis was reduced in weight-losing cancer patients. 5. It is suggested that the reduction of diet-induced thermogenesis in weight-losing cancer patients is another element of starvation adaptation, subsequent to their weight loss, and that altered thermogenesis does not contribute to the weight loss seen in cancer cachexia.
1. Topical irrigation with normal saline is known to produce rapid healing in chronic leg ulcers. This study was designed to determine if the rate of healing could be improved by the addition of topical nutrition to the irrigating solution. 2. Forty-eight patients with chronic leg ulcers were admitted to hospital for a minimum of 6 weeks bed-rest. During this time the ulcers were continuously irrigated by one of four test solutions. The solutions were: normal saline; a dilute amino acid solution isotonic with the normal saline; a hyperosmolar saline solution; a hyperosmolar amino acid solution. There were 12 ulcers in each group. 3. The amino acid solutions produced significantly faster healing than the saline solutions ( P < 0.01). Concentration had no significant effect on healing ( P > 0.15). 4. The application of amino acids does appear to enhance healing in this model of delayed wound healing. This effect does not depend only on the osmolarity of the solution used.
1. Fractional fat clearance rate ( K 2 ) in 21 patients with colorectal cancer was studied using the intravenous fat tolerance test. 2. K 2 showed a negative correlation with weight change( r = −0.736, P < 0.001) with the tumour in situ. 3. Fourteen patients were retested 12 weeks after curative resection of their tumours. Eight of the fourteen patients had raised K 2 values pre-operatively; in all these the K 2 values were reduced post-operatively (pre-operative median 3.94%/min, range 2.63–7.20%/min, postoperative median 2.31%/min, range 1.57–5.36%/min, P < 0.01 by Wilcoxon's signed rank test). A high preoperative K 2 value was associated with a large reduction in K 2 post-operatively ( r = − 0.844, P < 0.001). 4. Seven patients with relatively high K 2 values received a pre-operative course of intravenous nutrition after which K 2 values were significantly reduced (pre-feeding median 7.20%/min, range 4.72–12.12%/min, post-feeding median 4.44%/min, range 2.17–6.83%/min, P < 0.05).
1. A portable stereocamera linked to a computer has been developed capable of taking photographs in the clinical situation. 2. The accuracy and precision of this system has been measured and compared with direct tracing and simple photography, the two systems currently in use for this type of work. It was found to have a precision of better than 2% and to be accurate to within 1% for edge length and area in models of chronic leg ulcers whose dimensions were known exactly. These results are between five and ten times better than direct tracing and simple photography measured under similar circumstances. 3. When used on patients' ulcers, stereophotogrammetry was found to have a precision of 2% for edge length and 3.4% for area, again between five and ten times more accurate than the other two systems. 4. The accuracy with which an epithelial edge can be identified with the naked eye, a possible limiting factor in any visual measuring system, was measured on fixed preparations of healing wounds on pigs. The mean error was found to be 240 μm with a confidence limit of 440 μm. 5. Finally, the rate of healing of chronic leg ulcers was measured in a clinical trial on patients. Only stereophotogrammetry had errors consistently smaller than the changes being measured in the clinical trial, making it the only system which can validly be used to study rates of healing in this model. It is also able to measure volume to within 5% and is unique in being able to do this non-invasively.