Search

The contribution of free fatty acid oxidation to the elevation in energy expenditure after trauma has not been well characterized. Six control subjects and six traumatized patients were fasted for 48 hours and given a primed continuous infusion of (1-14C)palmitate to measure plasma palmitate and total free fatty acid kinetics. Traumatized patients had greater urinary nitrogen losses (20.8 vs. 9.3 g N per day) and a significantly greater ratio of measured to predicted resting energy expenditure (+36% vs. -6%) compared with controls. Individual and total plasma free fatty acid concentrations were similar for the two groups. The turnover and oxidation of plasma palmitate and total free fatty acids were not changed by multiple trauma. These results demonstrated that plasma free fatty acids and palmitate do not contribute to increased energy expenditure following trauma.

Primary perineal hernia is rare and may be mistaken for other diseases of the perineum and adjacent organs. It most often presents as a mass at the inferior margin of the gluteus maximus muscle. Reduction into the pelvis identifies the defect in the levator ani or coccygeus muscles. Discomfort with sitting is a common complaint. Most authors have preferred to repair primary perineal hernias through an abdominal incision.

A patient in whom a large radiation-induced rectovaginal fistula was successfully repaired by a pull-through operation is described. Normal bowel and vaginal function were restored. If repair of a rectovaginal fistula is indicated, and the fistula is large and located in the proximal vagina, the abdominal endorectal operation should be considered.