Extent of methionine limitation in peak-, early-, and mid-lactation dairy cows.

Five multiparous, ruminally and duodenally cannulated Holstein cows were assigned to 5 x 5 Latin squares at wk 2 (experiment 1), wk 11 to 13 (experiment 2), and wk 17 to 19 postpartum (experiment 3) to determine extent of Met limitation. Treatments were duodenally infused and consisted of 10 g/d of l-Lys plus 0, 3.5, 7.0, 10.5, or 16.0 g/d of dl-Met in experiments 1 and 2 and 8 g/d of l-Lys plus 0, 5, 10, 15, or 20 g/d of dl-Met in experiment 3. Calculated Lys contributions to total AA (TAA) in duodenal digesta for control treatments were 8.6, 7.5, and 9.0% for experiments 1, 2, and 3, respectively. Methionine contributions to TAA for the 5 infusion treatments were 1.9, 2.1, 2.2, 2.4, and 2.7% for experiment 1; 2.1, 2.3, 2.4, 2.5, and 2.7% for experiment 2; and 1.8, 2.0, 2.2, 2.4, and 2.5% for experiment 3, respectively. Milk protein yield increased linearly in experiments 1 and 2, indicating that Met contribution to TAA in duodenal digesta for maximal milk protein synthesis exceeded 2.7 for early-lactation cows. In experiment 2, a quadratic relationship was found between level of infused Met and milk protein content, with the response reaching a plateau when 12.2 g of Met was infused, corresponding with a Met contribution to TAA in duodenal digesta of 2.4%. In experiment 3, milk protein content increased quadratically, but milk yield declined linearly with increasing levels of infused Met; hence, milk protein yield was unaffected by treatment. The calculated plateau point of the milk protein content response curve was determined to be 12.4 g of infused Met, which corresponds to a Met contribution to TAA in duodenal digesta of 2.3%. Experiment 3 results indicate that the required level of Met in duodenal digesta for maximizing milk protein yield is lower than that required for maximizing milk protein content.

Improving intestinal amino acid supply of pre- and postpartum dairy cows with rumen-protected methionine and lysine.

Eighty-four Holstein cows were assigned to a randomized block experiment to determine effects of supplementing pre- and postpartum diets containing highLys protein supplements with rumen-protected Met and Lys. Before parturition, cows received a basal diet with 1) no rumen-protected amino acids (AA), 2) 10.5 g/d of Met from rumen-protected Met, or 3) 10.2 g/d of Met and 16.0 g/d of Lys from rumen-protected Met plus Lys. After parturition, cows continued to receive AA treatments but switched to diets balanced for 16.0 or 18.5% crude protein (CP). Diets were corn-based; supplemental protein was provided by soybean products and blood meal. Cows received treatments through d 105 of lactation. Compared with basal and Met-supplemented diets, Met + Lys supplementation increased yield of energy-corrected milk, fat, and protein, and tended to increase production of 3.5% fat-corrected milk. Significant CP x AA interactions were observed only for milk protein and fat content. Supplementation of the 16% CP diet with Met and Met + Lys had no effect on milk true protein and fat content. However, Met and Met + Lys supplementation of the 18.5% CP diet increased milk protein content by 0.21 and 0.14 percentage units, respectively, and Met supplementation increased fat content by 0.26 percentage units. Results of this study indicate that early-lactation cows fed corn-based diets are responsive to increased intestinal supplies of Lys and Met and that the responses depend on dietary CP concentration, supply of metabolizable protein, and intestinal digestibility of the rumen-undegradable fraction of supplemental proteins.

Pediatric reference values for respiratory resistance measured by forced oscillation.

OBJECTIVES: To determine, in North American children, reference values for respiratory resistance measurements by the forced oscillation (Rfo) technique and to examine whether sitting height, as index of truncal length, is a better determinant of resistance, less influenced by race and gender, than standing height. DESIGN/SETTING: A prospective cross-sectional study of healthy nonobese children, carefully selected for absence of atopy, exposure to tobacco smoke, and recent upper respiratory tract infection. MEASUREMENTS: Three measurements of respiratory resistance by forced oscillation were obtained at the fixed frequencies of 8 Hz (Rfo8), 12 Hz (Rfo12), and at 16 Hz (Rfo16) using the Custo Vit R (Custo Med GMBH; Munich, Germany). In cooperative children, routine spirometry (FEV1, FVC, and peak expiratory flow rate [PEFR]) was also performed. RESULTS: We recruited 217 healthy children aged 3 to 17 years. Reproducible measurements of Rfo8 were obtained for 206 children, Rfo12 for 197 children, and Rfo16 for 209 children. Normal FEV1, FVC, and PEFR values were documented in all 69 subjects who were able to reproducibly cooperate with spirometry. Multiple linear regression identified measurements of either sitting or standing height as the best, and equally strong, determinants of respiratory resistance at all three frequencies. Gender and race were not important factors once either sitting or standing height measurement was considered. Our regression equations at 8 Hz are comparable to published reference values obtained at fixed frequencies of 6, 8, and 10 Hz using other instruments. However, in comparison to our results, prior values tended to underestimate resistance in the shortest children or to overestimate it in the tallest ones. Our regression equation for Rfo12 is similar to the only previously published one, while no reference values at 16 Hz were available for comparison. CONCLUSIONS: Height is the best predictor for total respiratory resistance at 8, 12, and 16 Hz in children aged > or = 3 years. Use of sitting height does not appear to be a stronger determinant of resistance than standing height.

Response of lactating cows to methionine or methionine plus lysine added to high protein diets based on alfalfa and heated soybeans.

Lactation diets based on wilted alfalfa silage and heated whole soybeans are common in the midwestern US. We examined the milk production response of multiparous Holstein cows to the addition of ruminally protected methionine at two percentages to a basal total mixed ration. An additional total mixed ration included both methionine and lysine supplementation. Sixteen Holstein cows in early lactation were used in a replicated 4 x 4 Latin square design with 21-d periods. Milk production, milk composition, and dry matter intake were determined for the last 5 d of each period. Milk production (41.5 kg/d), dry matter intake (25.9 kg/d), and milk fat concentration (3.26%) were unaffected by the supplementation of amino acids. The addition of methionine increased milk protein concentration and yield linearly. Each gram of methionine increased milk protein yield by 4 g, and milk protein concentration increased from 2.89 to 2.99% with the addition of 10.5 g/d of methionine. The proportion of casein N in total milk N was unaffected by treatment. The addition of lysine did not elicit a response. Total mixed rations based on alfalfa haylage, heated soybeans, and animal proteins were clearly limited by their methionine content but were adequate in their lysine content.

Reference values obtained by kernel-based estimation of quantile regressions.

In this paper, we study the problem of estimating non-parametrically a quantile regression curve as it applies to computing reference values. We propose an automatic procedure that uses a symmetrized nearest-neighbor kernel estimator of conditional distributions. We also discuss ways of measuring the dispersion of quantile regression estimator. One is based on the asymptotic distribution of such quantiles, while the other relies on the bootstrap method. The results of a small simulation study show that the methods of the paper perform rather well even in a situation where a good parametric solution is available. As an example, we analyze a small part of a data set that was collected to establish reference values for blood velocity in different parts of the umbilical cord of human fetuse as they grow toward birth.

Lactation response to ruminally protected methionine and lysine at two amounts of ruminally available nitrogen.

Sixty multiparous Holsteins were used in a 200-d continuous lactation trial designed to measure the response to a mixture of ruminally protected Met and Lys. Response to AA was determined at two dietary concentrations of degraded protein designed to provide 85 and 100% of NRC recommended amounts. This difference in degraded protein content was achieved by addition of urea. Diets without urea supported lactation as well as diets with added urea in early lactation. In midlactation, urea addition was detrimental to yields of milk and milk protein; addition of AA prevented this negative effect. In early lactation, AA addition raised milk protein concentration and yield by 1 g/kg of milk of 37 g/d and did not interact with urea. Increases in protein concentration in response to AA addition were similar in early and late lactation and corresponded to changes in the casein fraction of milk. These results support previous work showing the importance of adequate absorbable Lys and Met to maximize the protein content of milk. The results suggest that interactions may occur between ruminal ammonia production and AA supply.

Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life.

OBJECTIVES: To establish the rate of spontaneous closure of atrial septal defects diagnosed before age 3 months, 101 infants (mean age 26 days) with an interatrial shunt confirmed by Doppler echocardiography were followed up for an average of 265 +/- 190 days. BACKGROUND: Even if interatrial shunts in the newborn are frequently encountered, little is known about their natural history. METHODS: Defect diameter on two-dimensional echocardiography and width of color flow jet were measured in the subcostal view. Right and left ventricular diameters and atrial septal curvature were also studied. Kaplan-Meier curves were obtained to predict age of spontaneous closure in relation to initial defect diameter. RESULTS: There was no significant correlation between the diameter of the atrial septal defect and right ventricular/left ventricular ratio or type of septal curvature (vertical or concave toward the left atrium). The classic predominance of girls over boys was observed only for defects > 5 mm. An overall rate of spontaneous closure of 87% was observed. Frequency and timing of closure were inversely correlated to atrial septal defect diameter: closure occurred in 100% (32 of 32) of defects in group 1 (diameter < 3 mm), 87% of defects (39 of 45) in group 2 (diameter 3 to 5 mm), 80% of defects (16 of 20) in group 3 (diameter 5 to 8 mm). Spontaneous closure did not occur in four patients of group 4 (defect > or = 8 mm) during an average follow-up interval of 417 days (range 294 to 597 days). CONCLUSIONS: These results suggest that infants with an atrial septal defect < 3 mm need not be followed up as 100% of these defects will be closed by age 18 months; those with a defect 3 to 5 or 5 to 8 mm should be evaluated by the end of the 12th and the 15th month, respectively, when > 80% of these defects will be closed. An atrial septal defect with a diameter > or = 8 mm may have little chance of closing spontaneously and the possibility of surgical correction should be considered. Defects < 3 mm probably do not constitute a cardiac malformation in light of their natural evolution and gender distribution.

Reference values for Doppler velocimetric indices from the fetal and placental ends of the umbilical artery during normal pregnancy.

A range-gated Doppler ultrasound system combined with a real-time imaging system was used to determine arterial blood velocity values from the fetal and placental ends of the umbilical cord in 269 normal pregnancies between 17 and 40 weeks, menstrual age. The systolic-diastolic ratio (S/D), pulsatility index (PI), and resistance index (RI) were higher at the fetal end compared to the placental end of the cord. The individual differences in these Doppler indices, obtained between the fetal and placental recording sites, were inversely related to menstrual age: S/D: r = -0.38, p < 0.001; PI: r = -0.25, p < 0.001; and RI: r = -0.15, p < 0.01. After normalization for the angle of insonation, the peak systolic velocity was higher and the end-diastolic velocity was lower at the fetal than at the placental end of the cord. It is concluded that routine recordings for Doppler velocimetric indices should take into account the recording site on the umbilical cord in order to reduce methodological sources of variance, especially during midgestation. Furthermore, the data presented here in the form of the median and percentile values are proposed as normal reference values to facilitate this procedure.

Electrophysiologic effects of sotalol on the immature mammalian heart.

Sotalol is a beta-blocker with class III antiarrhythmic properties that has recently been used in children for the treatment of supraventricular and ventricular arrhythmias. However, little is known about its electrophysiologic effects on the immature heart. Using intracardiac electrocardiographic recordings and stimulation techniques, 15 canine neonates (8-15 days) and 15 adult mongrel dogs were studied with cumulative doses of sotalol (0.5, 1, 2, and 4 mg/kg plus an additional dose of 8 mg/kg for neonates). Heart rate decreased significantly in the two groups, but more in adult dogs (-43% in adult dogs versus -25% in neonates, p less than 0.05). There was no significant change for QRS duration and His-Purkinje system conduction time interval. QT and atrioventricular nodal conduction time intervals increased in adult dogs and neonates. Sinus node recovery time increased significantly in the two groups, but more in adult dogs. Refractory periods of the atrioventricular (AV) node increased significantly in neonates. Atrial flutter was no longer inducible in 12 of 15 neonates after the 2 mg/kg dose. Atrial effective refractory period increased significantly more in neonates (96%, p less than 0.001) than in adult dogs (58%, p less than 0.001). Ventricular effective refractory periods increased significantly both in neonates (46%) and adult dogs (50%), in a similar way. In conclusion, sotalol has greater electrophysiologic effects on the immature heart at the atrial level when compared to the adult, and similar effects on the refractory period of AV node and ventricle.

A four-parameter generalization of the Gompertz curve suitable for somatic growth.

A four-parameter generalization of the Gompertz curve is proposed which passes through the origin with respect to total age and is often more suitable for somatic growth than the three-parameter Gompertz curve. Applied to published cross-sectional data on 44 male white rats, the new curve differs from another four-parameter curve proposed earlier by Jolicoeur and Pirlot (1988) in that it does not involve initial growth delays and it avoids an arbitrary assumption concerning the initial curvature, but it nevertheless yields approximately similar descriptions of chronological growth and complex allometry. The new four-parameter version of the Gompertz curve may be useful in cases where other growth curves do not provide a satisfactory fit.

Frequency and prognosis of arrhythmias after operative "correction" of tetralogy of Fallot.

Two hundred twenty-four consecutive patients operated on for tetralogy of Fallot were followed from 1 to 28 years (mean 11). Mean age at surgery was 5.3 years (range 1 to 14). Postoperative right ventricular systolic pressure was 60 mm Hg in 19 of 213 patients (9%). Fourteen patients (6%) had ventricular premature complexes on surface electrocardiograms. Seventy-nine patients underwent treadmill exercise tests, and ventricular premature complexes were induced in 17 (22%). Twenty-four-hour ambulatory monitoring in 92 patients demonstrated significant ventricular arrhythmias (greater than or equal to grade 2 of the Lown classification) in 41 (45%). The frequency of ventricular arrhythmias correlated with length of follow-up and duration of cardiopulmonary bypass. No correlation was found with age at surgery, postoperative right ventricular systolic pressure and importance of conduction defects on electrocardiogram. There were no sudden or unexpected deaths during follow-up.

A computer-derived protocol using recursive partitioning to aid in estimating prognosis of horses with abdominal pain in referral hospitals.

In order to determine which variables are useful and accurate in estimating prognosis in horses with abdominal pain, data were analyzed from 231 horses presented at a veterinary teaching hospital. Using multiple stepwise discriminant analysis in a recursive partition model, we obtained a decision protocol that identified survivors and nonsurvivors. The prevalence of survivors was 61% in this population. The sensitivity, specificity, and positive and negative predictive values of this model were 71, 83, 87 and 65%, respectively. This decision protocol was validated by Jackknife classification and also by evaluation with a referral population of 100 horses in which the prevalence of survivors was 83%. This led to sensitivity, specificity, and positive and negative predictive values of 83, 78, 94 and 50%, respectively.

A computer-derived protocol to aid in selecting medical versus surgical treatment of horses with abdominal pain.

In order to determine which variables are useful in identifying horses with abdominal pain requiring surgery, data were analysed from 219 horses presented at one veterinary teaching hospital. Using multiple stepwise discriminant analysis with a recursive partitioning algorithm, we obtained a decision tree that identifies surgical and non-surgical patients. The prevalence of surgical patients was 79 per cent in this population. The sensitivity, specificity, and positive and negative predictive values of this decision tree were 99 per cent, 55 per cent, 90 per cent and 99 per cent respectively. Compared to the clinical decision, this decision tree yielded more false positives (11 per cent) but almost eliminated false negatives (1 per cent). This decision tree was validated by the jack-knife method and also by evaluation using a new sample in a second veterinary teaching hospital in which the prevalence of surgical patients was 55 per cent. This led to sensitivity, specificity and positive and negative predictive values of 93 per cent, 73 per cent, 81 per cent and 89 per cent respectively.

Cardiac rejection following transplantation in dogs: transmural myocardial blood flow changes.

In cardiac allografts acute rejection produces deleterious effects on blood flow adjustments. In order to differentiate the role of rejection over that of denervation cardiac denervated and cardiac transplanted dogs were compared. A canine model of orthotopic cardiac transplantation was utilized. Electronic devices were implanted for chronic hemodynamic studies. Regional myocardial blood flow distribution was assessed by radioactive microspheres (15 micron in diameter). Studies were carried out when animals had fully recovered (two to three days postoperatively), then in the 'early rejection' stage (five to six days post transplant) and in the 'severe rejection' stage (24 h before death). No significant difference in hemodynamic data or blood flow values were observed between groups in the recovery stage. In the denervated group, adequate cardiac function and myocardial blood perfusion was maintained throughout the study. In the transplanted group, significant loss of function was observed at the severe rejection stage. This was combined with significant decrement in blood flow to all areas of the myocardium. No selective area of underperfusion nor an early reduction in total blood flow could be observed. This study indicates that within cardiac rejection there is a parallel impairment in function and transmural myocardial blood flow which is unrelated to denervation or interruption of lymphatics.

Left ventricular diastolic function during the first month of life.

UNLABELLED: In order to assess possible changes in myocardial relaxation occurring during the neonatal period, M-mode echocardiograms were recorded serially in 9 normal term infants and in another group of 10 one-month-old infants. The tracings were studied with an M-mode calculator. Although individual variations were greater in the data collected during the first 24 h, no significant difference was found in the indices of diastolic function of the left ventricle during the first 4 days of age. The following changes were observed between data recorded at 4 days and 1 month, respectively: normalized peak rate of left ventricle filling, 4.03 vs. 4.71 cm/s; diastolic peak velocity of early posterior motion of aortic root, 1.89 vs. 5.15 cm/s; peak velocity of left ventricle posterior wall motion in diastole, 3.31 vs. 3.50 cm/s; mitral valve EF slope, 59.05 vs. 84.92 mm/s; left ventricle isometric relaxation time, 43.88 vs. 28.50 ms. IN CONCLUSION: (1) greater individual variations are observed in indices of left ventricle diastolic function during the first day of life, and (2) significant increase in left ventricle compliance occurs during the first month of life. These changes should play a critical role in the clinical course of newborn with cardiopulmonary disease.

Value of respiratory variations of right ventricular dimension in the identification of small atrial septal defects (secundum type) not requiring surgery: an echocardiographic study.

In search of reliable criteria that could help differentiate insignificant atrial septal defects (ASDs) from those with a large shunt, M-mode echocardiograms of three groups of patients were studied retrospectively: group I = 10 normal children (mean age 5.7 years); group II = 10 patients (mean age 7 years) with small ASD in whom the decision was taken not to proceed to surgical closure, based on hemodynamic and angiographic criteria; and group III = 15 patients (mean age 7 years) with an "operable" shunt, who underwent corrective surgery. The results showed that right ventricular end-diastolic dimensions during expiration (RVDDE) were increased in all patients in group III but were normal in only 3 of the 10 patients in group II. A normal septal movement was found in all patients in groups I and II but also in five patients in group III. The variation in right ventricular diastolic dimension with respiration (RVDVR) was always normal in group II. However, in group III all patients but one had a small RVDVR (less than 6%). It was concluded that a normal RVDDE is very specific (100%) but not sensitive (30%), a normal septal movement is very sensitive (100%) and moderately specific (70.6%), and a normal RVDVR is both very sensitive (100%) and specific (94.4%) as a criterion for identification of small ASDs not requiring surgery.

Myocardial function and hemoglobin oxygen affinity during hyperglycemia in the fetal lamb.

To determine the effects of maternal hyperglycemia on fetal hemodynamic and cardiac function, a study was carried out on nine chronically catheterized fetal sheep. In six fetuses, glucose was infused intravenously with an initial dose of 5 mg/kg per min. Data were compared with controls. This dose was gradually increased to 16 mg/kg per min by the fifth day. The initial blood glucose was 14.7 +/- 3.0 mg/dl and increased to 54.6 +/- 16.4 mg/dl by the last day of the infusion period (P less than 0.001). The PO2 decreased from a baseline of 20.25 +/- 3.40 to 15.88 +/- 5.24 mmHg (P less than 0.01). Similarly significant decreases were also observed for the blood O2 content and O2 hemoglobin saturation: 8.5 +/- 1.7 to 6.4 +/- 2.2 ml/dl and 62.3 +/- 13.6 to 46.1 +/- 17.6%, respectively, during hyperglycemia (P less than 0.01). The duration of the preejection period (PEP) before the start of the experiment was 45 +/- 4 ms; a final value of 57 +/- 10 ms was obtained (P less than 0.01). However, the electromechanical delay and ejection time (ET) showed no significant variation. The ratio of the PEP/ET increased from 0.31 +/- 0.04 to 0.38 +/- 0.07 (P less than 0.01) during hyperglycemia. The reticulocytes increased from 1.4 +/- 1.8 to 3.1 +/- 2.9% (P less than 0.05) and the 2,3-diphosphoglycerate decreased from 4.4 +/- 1.1 to 2.8 +/- 1.2 mumol/g hemoglobin (P less than 0.005). This study demonstrated that fetal hyperglycemia depresses myocardial function in the fetal lamb. The changes in cardiac function could not be explained by the small drop in O2 saturation.

Wall thickness, cavity dimensions, and myocardial contractility of the left ventricle in patients with simple transposition of the great arteries. A multicenter study of patients from 10 to 20 years of age.

Fifty-one patients with uncomplicated transposition of the great arteries (TGA) and normal pulmonary pressure who were 10 to 20 years old and 69 normal subjects matched for age were studied by M mode echocardiography. Left ventricular internal dimensions and posterior wall thickness showed positive correlation with the body surface area in the TGA as well as in the control groups. Values for these parameters in the TGA group were generally smaller than those in the normal population. Septal thickness of patients with TGA (5.9 +/- 1 mm) was also smaller than that in the control group (6.6 +/- 1 mm) (p less than .01). Septal motion was normal in 11 patients with TGA and paradoxical in 19 patients in this group. In the other 21 patients the septum was flat. The following systolic time intervals of the left ventricle were found for patients with TGA: preejection period (PEP) 64 +/- 11 msec, ejection time (ET) 310 +/- 37 msec, and PEP/ET 0.21 +/- 0.04. These values were significantly different from those of the right ventricle for the normal population: PEP 77 +/- 12 (p less than .01), ET 327 +/- 25 (p less than .05), and PEP/ET 0.24 +/- 0.03 (p less than .01). Shortening fraction and mean velocity of circumferential fiber shortening (49 +/- 7% and 1.6 +/- 0.3 circ/sec, respectively) were also significantly higher (p less than .01) in patients with TGA than in the control group (33 +/- 4% and 1.1 +/- 0.2 circ/sec). These data should help achieve reliable quantitative and qualitative interpretations of echocardiograms of patients with TGA.

Psychomaintenance of childhood asthma: a study of 34 children.

Following the study on psychomaintenance of asthma by Kinsman, Dirks, and Jones (1977), we adapted the Battery for Asthma Illness Behavior (BAIB) to children. Thirty-four children aged 9.3 to 15.4 years were tested with this modified BAIB. They were scored simultaneously on a semistructured psychological interview. Three groups emerged out of these data: low-, medium-, and high-panic-fear personalities. Patients were also rated with regard to their pulmonary function and clinical status, including medication prescribed. The high-panic-fear personality was significantly associated with a higher intensity of prescribed medication, in particular corticosteroids. These results were independent of spirometric pulmonary measurements. We conclude that doctors may overreact to the exaggerated distress of high-panic-fear patients. Psychotherapy could be of help for this group.

[Treatment of acute perforated appendicitis with intraperitoneal cefazolin]. / Le traitement de l'appendicite aiguë perforée avec la céfazoline intrapéritonéale.

Until recently intra-abdominal sepsis following surgery for perforated appendicitis has remained a frequent occurrence. In 1975 Fowler reported an incidence of one intra-abdominal abscess in 36 perforated appendicitis treated with a protocol consisting of saline irrigation at surgery, followed by intraperitoneal administration of cephaloridine q. 6 hours for 48 hours. The same antibiotic was then given i.v. for 72 hours. He concluded that this method was an effective way to minimize post-op intra-abdominal abscess, and that the intraperitoneal route was more effective, for this purpose, than systemic administration. More recently, with better knowledge of the role of anaerobes, improved results have also been obtained by adding clindamycin or metronidazole to the antibiotic regimen. A prospective study based on two groups of patients randomly assigned to two protocols was undertaken. The study group consisted of 45 children operated for perforated appendicitis with abscess or generalized peritonitis. These patients were treated with Fowler's protocol. Because it is less nephrotoxic and is active against the same organisms, cefazolin was used instead of cephaloridine. The control group consisted of 43 patients, also operated for perforated appendicitis, treated with saline irrigation at surgery, with either i.v. gentamycin or tobramycin and clindamycin or metronidazole for an average of 7.8 +/- 3.1 days. Both groups were fairly well matched in terms of age, sex, severity of disease, and bacterial flora. They showed an identical 6% post-op intra-abdominal sepsis rate. Days before afebrile, days under gastric suction, complications and average hospital stay were comparable in both groups. The wound infection rate was 20% in the study group and 9% in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)