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Thirty-eight patients with external gastrointestinal fistulas arising from different levels of the gastrointestinal tract, observed and treated at the Massachusetts General Hospital, from December 1970 to April 1973, are analyzed. Surgical complications were the causes of fistulization in 77% of the cases. The treatment program included parenteral nutrition through a subclavian line in all cases. The 38 patients were fed parenterally for a total of 2311 days. Spontaneous fistula closure occurred in only 11 of the 38 patients. Surgical procedures were necessary in 71.05% of the cases to control fistula complications or persistent fistula drainage. Operative success rate was 70.4%. Parenteral nutrition effects on metabolic parameters, fistula secretion, nutritional status, morbidity and mortality of fistulas are discussed. Parenteral nutrition hazards are also presented. Overall mortality in this series was 21%. Roles of parenteral nutrition and surgery in the total management of external gastrointestinal fistulas are suggested.

Complete mixed diets containing 0, 10, 15, or 20% whole cottonseed were fed to 12 cows in a 4 X 4 Latin square design. Cows were assigned to the Latin square by production status resulting in one square each for cows in early first lactation and older cows either in early or late lactation. Diets were fed for ad libitum intake, and periods were 21 days. Percentages of milk fat and total solids increased, and protein percentage decreased with cottonseed feeding. Milk casein nitrogen decreased from .387 to .375% with cottonseed feeding. Nitrogen in whey remained unchanged, and nonprotein nitrogen increased. Proportion of total nitrogen in casein and whey fractions was not altered, but proportion of nonprotein nitrogen increased. Cottonseed decreased proportions of short-chain fatty acids (carbon-6 to carbon-16) in milk and increased stearic and oleic acids. Actual yield of milk was not affected by cottonseed feeding, but yields of fat-corrected milk and milk fat were increased. Production status affected milk composition with older cows in early lactation producing milk of lower fat, total solids, and protein content compared with cows in other groups. Casein nitrogen was highest for first-lactation and lowest for older, high-producing cows. Whey nitrogen was highest for older, low-producing cows. First-lactation cows had the highest proportion of nitrogen in the casein fraction, and older, low-producing cows had the lowest. Milk fatty acid composition changed little with status.

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