Forty six patients with less than 200 cm of normal jejunum and no functioning colon were compared with 38 patients with similar jejunal lengths in continuity with a functioning colon. Women predominated (67%), and the most common diagnosis in each group was Crohn's disease (33 of 46 no colon, 16 of 38 with colon).

SUMMARY In a prospective, randomised clinical trial, 47 patients with severe, acute, noninfective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.Severe attacks of colitis are uncommon but potentially dangerous, particularly if urgent surgical treatment is needed.' 2 Medical treatment of severe colitis relies upon intravenous corticosteroids and nutritional replacement. There has been considerable interest in the use of parenteral nutrition as a possible treatment to reduce mucosal inflammation. The concept of 'bowel rest' is theoretically attractive and one might expect that inflamed intestine would heal more quickly if relieved of mechanical trauma, intestinal secretions, and the antigenic challenge of food. The only controlled trial so far published was not encouraging3 and the present trial was designed to study further the effect of 'bowel rest' in patients with severe attacks of non-infective colitis. Methods PATIENTSA diagnosis of non-specific colitis was established by endoscopy and/or barium enema, in the absence of specific infection or possibility of antibiotic associated colitis.Patients were admitted to the trial if they presented with an attack of colitis severe enough to necessitate admission to hospital and to require treatment with intravenous prednisolone. They were excluded from entry if, at the time of presentation, they exhibited Addrcss for corrcspondcncc: Professor J E Lennard-Jones. St Mark's Hospital, London ECI V 2PS.

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Background We evaluated the clinical outcomes, functional burden, and complications one month after COVID-19 infection in a prospective United States Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at nine sites across the United States with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and ICD-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1,202 participants were enrolled. There were 1,070 laboratory confirmed SARS-CoV-2 cases and 132 SARS-CoV-2 negative participants. In the first month post-symptom onset among the SARS-CoV-2 positive cases, there were 214 hospitalizations, 79% requiring oxygen, 22 ICU admissions, and 9 deaths. Risk factors for COVID-19 associated hospitalization included race (increased for Asian, Black, and Hispanic compared to non-Hispanic White), age (age 45-64 and 65+ compared to <45), and obesity (BMI>=30 compared to BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen and 31% had not returned to normal daily activities at one-month post-symptom onset. Conclusions Older age, reporting Asian, Black or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by one month.

(Gut 1998;43:759-762)

Central venous access for feeding catheters may prove difficult in patients who have had numerous previous central line insertions or complications. Duplex Doppler ultrasound was used to identify the anatomy and patency of major central veins in 11 patients in whom attempts at obtaining central venous access by an experienced operator had failed at least once and in 40 control subjects. Doppler ultrasound demonstrated the subclavian veins (diameter 12.5 +/- 3.5 mm, mean +/- SE) and internal jugular veins (11 +/- 3.5 mm) in all the control subjects. In the patients, 18 of 44 veins were patent, 11 were small or had low blood flow, and 15 were thrombosed. In 7 patients who required central feeding catheter insertion, a suitable vein was identified and the catheter suitably placed, even in 3 subjects where no central vein was considered normal. Duplex Doppler ultrasonography is a useful technique for identifying veins suitable for the insertion of central venous lines when access has previously proved difficult.

The number of potential candidates for small bowel transplantation in the UK is unknown. Potential recipients are those with irreversible small intestinal failure, including those treated with permanent parenteral nutrition. This study of one of the largest groups of patients receiving such nutrition identified ten of 25 adult patients as possible recipients. The remaining 15 were considered unsuitable, mainly because of multiple previous abdominal operations or abscesses. Extrapolation of these data to national figures on the incidence of irreversible small intestinal failure suggests that each year up to 20 new adult patients in the UK might benefit from small bowel transplantation.

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