Impact of STIMUlant and osmotic LAXatives (STIMULAX trial) on gastrointestinal recovery after colorectal surgery: randomized clinical trial.

BACKGROUND: Recovery of gastrointestinal (GI) function is often delayed after colorectal surgery. Enhanced recovery protocols (ERPs) recommend routine laxative use, but evidence of benefit is unclear. This study aimed to investigate whether the addition of multimodal laxatives to an ERP improves return of GI function in patients undergoing colorectal surgery. METHODS: This was a single-centre, parallel, open-label RCT. All adult patients undergoing elective colorectal resection or having stoma formation or reversal at the Royal Adelaide Hospital between August 2018 and May 2020 were recruited into the study. The STIMULAX group received oral Coloxyl® with senna and macrogol, with a sodium phosphate enema in addition for right-sided operations. The control group received standard ERP postoperative care. The primary outcome was GI-2, a validated composite measure defined as the interval from surgery until first passage of stool and tolerance of solid intake for 24 h in the absence of vomiting. Secondary outcomes were the incidence of prolonged postoperative ileus (POI), duration of hospital stay, and postoperative complications. The analysis was performed on an intention-to-treat basis. RESULTS: Of a total of 170 participants, 85 were randomized to each group. Median GI-2 was 1 day shorter in the STIMULAX compared with the control group (median 2 (i.q.r. 1.5-4) versus 3 (2-5.5) days; 95 per cent c.i. -1 to 0 days; P = 0.029). The incidence of prolonged POI was lower in the STIMULAX group (22 versus 38 per cent; relative risk reduction 42 per cent; P = 0.030). There was no difference in duration of hospital day or 30-day postoperative complications (including anastomotic leak) between the STIMULAX and control groups. CONCLUSION: Routine postoperative use of multimodal laxatives after elective colorectal surgery results in earlier recovery of gastrointestinal function and reduces the incidence of prolonged POI. Registration number: ACTRN12618001261202 (www.anzctr.org.au).

Reduction of energy requirements of steers fed on low-quality-roughage diets using trenbolone acetate.

1. Six steers implanted with 300 mg trenbolone acetate and six steers not implanted were fed on low protein, low-quality-roughage diets ad lib. in two experiments. The steers were Hereford (Bos taurus) x Brahman (Bos indicus) crossbreds (50:50), initially of about 400 kg mean live weight (LW). In the first experiment of 8 weeks duration roughage was given alone. In the second experiment of 6 weeks duration the diet was supplemented with 100 g urea and 4.6 g sulphur daily. The same steers were implanted in each experiment. At the conclusion of each experiment metabolic rate was measured after a 72 h fast. 2. In the first experiment control and implanted steers had similar rates of LW loss (0.57 and 0.59 kg/d respectively). Implanted steers had significantly (P less than 0.01) lower feed intakes (12.8 v. 10.9 g dry matter (DM)/kg LW), significantly (P less than 0.01) lower fasting metabolic rates even after adjustment for intake (83.3 v. 74.5 kJ/kg per d) and significantly (P less than 0.01) lower plasma insulin concentrations (24 v. 19 mu units/ml). Differences in plasma concentrations of free 3,5,3'-triiodothyronine (T3), non-esterified fatty acids and urea-nitrogen were not significant. 3. In the second experiment intake of the supplemented diet was similar in both control and trenbolone acetate-treated steers (19.5 and 20.0 g DM/kg LW respectively). LW gains were 0.23 and 0.41 kg/d for control and implanted steers respectively, the difference being significant (P less than 0.05). Fasting metabolic rate (76.9 v. 70.7 kJ/kg per d) was significantly (P less than 0.05) lower in implanted steers.

Treatment of advanced ovarian cancer with sequential combination chemotherapy.

Fifty previously untreated patients with advanced or recurrent ovarian cancer (FIGO Stages III and IV) were treated with alternating combination chemotherapy. This consisted of high-dose doxorubicin (70 mg/m2) and cisplatin (100 mg/m2) alternated with CHF (cyclophosphamide, hexamethylmelamine, and 5-fluorouracil). Toxicity (myelosuppression, nephropathy, and neuropathy) was infrequent and mild. Clinical response rates were high (94% response, 62% complete clinical response), but the majority of patients had residual intraabdominal disease at second-look surgery (75%). Thirteen patients (26%) are alive after 4 years of observation (minimum follow-up). Survival was adversely influenced in patients who were older than 70, had Stage IV disease, residual tumor bulk greater than 2 cm, and who failed to achieve complete clinical remission. The median duration of survival (28 months) and percentage of long-term survivors appear similar to that in other platinum-based chemotherapy studies. Although the role of alternating combination chemotherapy in epithelial ovarian cancer remains undefined, it is likely that an alternate approach will be necessary to markedly improve survival rates for patients with this disease.

Utilization of low-quality roughage by Bos taurus and Bos indicus cattle. 1. Rumen digestion.

Six Hereford and six Brahman steers were fed ad lib. Pangola grass (Digitaria decumbens) and Spear grass (Heteropogon contortus) hay alone and supplemented with rumen-degradable nitrogen and sulphur and minerals. The rumen digestion of the two feeds was determined by reference to the disappearance of substrate from nylon bags suspended in the rumen and withdrawn after intervals ranging from 8 to 120 h. The digestion of the unsupplemented Pangola grass diet occurred more rapidly in Brahmans than in Herefords and was associated with higher rumen ammonia concentrations in Brahmans (40 v. 16 mg/l). The rumen NH3 concentrations were increased to over 100 mg/l by supplementation. The digestion rate increased in both breeds after supplementation and the breed difference disappeared. Increases in digestion rate were not achieved above NH3 concentrations of 60-80 mg/l. Spear grass, especially the cell-wall-constituent fraction, was more resistant to digestion than Pangola grass. Digestion of the unsupplemented Spear grass diet proceeded more rapidly in Brahmans than in Herefords. The digestion rate in Brahmans were similar irrespective of whether the diet was supplemented or not. Supplementation increased digestion rate in Herefords.

Utilization of low-quality roughage by Bos taurus and Bos indicus cattle. 2. The effect of rumen-degradable nitrogen and sulphur on voluntary food intake and rumen characteristics.

In a number of experiments voluntary food intake of three low-quality roughages, either alone or supplemented with rumen-degradable nitrogen and sulphur and minerals, was measured in Brahman (Bos indicus) and Hereford (Bos taurus) steers. The chaffed hays were Spear grass (Heteropogon contortus) (6.2 g N/kg organic matter (OM)), Pangola grass (Digitaria decumbens) (7.9 g N/kg OM), and Pangola grass (12.0 g N/kg OM). Rumen characteristics relating to rate of fluid outflow from the rumen were also determined. There was no significant difference between breeds in the dry-matter intakes of the unsupplemented diets which ranged from 11.3 to 17.8 g/kg body-weight (BW) by Herefords and from 11.8 to 16.1 g/kg BW by Brahmans. Supplementation of Spear grass with N and S significantly (P less than 0.05) increased intake by Herefords (24%) but not by Brahmans. When the lower-N Pangola grass was supplemented there was a significant increase in intake by both breeds with the magnitude of the response in Herefords (42%) (P less than 0.001) being greater than that in Brahmans (15%) (P less than 0.05). The intakes of both the supplemented Spear grass and the lower-N Pangola diets were significantly (P less than 0.05) greater by Herefords than Brahmans. There was no breed difference in intake when the higher-N Pangola grass was supplemented. Both breeds recorded an 8% intake response to supplementation, although the increase was only significant (P less than 0.05) in Herefords. The mean retention time of fluid in the rumen on the unsupplemented Pangola grass diet of lower N content was 12.7 h in Brahmans compared with 17.5 h in Herefords (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)