Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation.

BACKGROUND: Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown. AIM: To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial. METHODS: Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL). RESULTS: Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences. CONCLUSIONS: Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated.

Central line-related sepsis in acute burn patients.

A retrospective review of all 443 burn patients admitted during a 13-month period from October 1, 1992 to October 31, 1993, was completed. Of these, 8 were transferred and eliminated from the study. Twenty-two patients who were felt to be terminal on admission and did not have blood cultures were included in the demographic data but were excluded from subsequent statistical analysis. One hundred ten patients had central venous lines (CVLs). Three patients with CVLs were transferred, thus leaving 107 patients with CVLs for statistical analysis. Additionally, 17 of the aforementioned terminal patients who had CVLs and 1 patient with a CVL who had documented sepsis before CVL insertion were excluded, leaving 89 patients with CVLs used in statistical analysis. Mean burn surface for those with central lines was 35.8 per cent, and for those without, 10.9 per cent. Sixty-four patients (59.8%) with a central line had inhalation injuries, as did 18 patients (5.5%) without. The number of lines per patient varied from 1 to 7. Sixty-one patients had one line, 46 had more than one. The total number of central line days for the entire group was 1749. The mean number of central line days per patient was 16.3. The mean number of line days per catheter was 8.48. The mortality rate for the 107 patients with a central line was 34 (32.7%). Mortality for all patients was 41 (9.4%). The incidence of sepsis increased with increasing number of central line days and increasing number of central line changes, but the effect of these two factors on the incidence of sepsis could not be studied separately, as they are highly correlated with each other. The most commonly recovered organisms were various types of Staphylococcus. Polymicrobial infections were common. There were 51 subclavian, 17 internal jugular, and 135 femoral catheters inserted. By logistic regression analysis, there was no statistically significant difference in the incidence of sepsis between upper- and lower-body CVL sites. Twenty-four patients (22.4%) with a CVL and one or more positive blood cultures were felt to have demonstrated sepsis. Some had more than one septic episode while lines were in place, reported as separate patients but not as separate septic episodes.

A program to decrease hospital stay in acute burn patients.

A program of early excision, increased outpatient care, and aggressive discharge planning was introduced gradually over a 5 yr period from 1991 to 1995 with the goal of decreasing the length of stay for burn patients. Results from 1 January 1991, to 30 June 1993, were compared with results from 1 July 1993 to 31 December 1995. Burns under and over 25 percent were considered separately. There was a significant reduction in LOS of 51.4 percent for burns under 25 percent. There was also a significant reduction in LOS of 23.7 percent for burns over 25% TSA. There was no significant difference in age, burn size or mortality between the early and late groups.

A regional medical center's experience with burns of the elderly.

For a 10-year period, the cases of 236 patients aged 60 years old or older were evaluated with regard to mortality and length of hospital stay. Multiple variables were evaluated. Total mortality for the entire group was 41.9%. Mortality was adversely affected by increased age and the development of complications after admission. Larger burn size increased mortality when it was considered in association with the presence of inhalation problems sufficiently severe to require a ventilator. Mean length of stay for survivors was 34.04 days. Length of stay (LOS) was increased in association with larger burn size, preexisting medical problems, and the development of complications after admission. The increase in the number of elderly patients as part of the in-hospital burn population mandates evaluation of this growing group.

Intimal thickness and layering, and smooth muscle cell phenotypes in aorta of youth.

Proneness to the lesions of atherosclerosis varies along the length and circumferential topography of the aorta. Smooth muscle cells, in particular those of the 'modulated' synthetic phenotype which are able to proliferate and synthesize matrix proteins, are considered to play an important role in lesion progression. We report on a study of the aortic intima at a lesion-prone site from abdominal aorta and a lesion-resistant site from thoracic aorta in young humans to determine (1) whether the histologic structure and the smooth muscle cell composition show quantitative differences between lesion-prone and lesion-resistant aortic sites; (2) whether there are gender differences, and (3) whether any differences increase in degree with increasing age in this young population. Material for this study was obtained as part of the NIH-funded multicenter study on Pathobiological Determinants of Atherosclerosis in Youth (PDAY) from autopsies of male and female subjects between the ages of 15 and 34, victims of unexpected sudden death, usually from trauma. The samples consisted of strips of abdominal and thoracic aorta, all derived from the same anatomical sites standardized in the PDAY studies. The thickness of total intima (TI) and its elastic hyperplastic (EH) layer was measured. Smooth muscle cells of all types (SMC) and separately those of the synthetic phenotype (SynSMC) were quantified in each site using immunohistochemical procedures in replicate sections of uniform thickness. The intima of the atherosclerotic lesion-prone dorsal half of the abdominal aorta (AD) shows significant differences from the lesion-resistant ventral half of thoracic aorta (TV) in that (1) its EH layer is significantly thicker; (2) its EH layer has a comparatively higher number of both total SMC and SynSMC, even when adjusted for intimal thickness, and (3) the age-related increase in thickness of both TI and EH layer of AD is much greater than that of TV.