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Oral Intake (oral + intake)
Selected AbstractsDevelopment of swallowing and feeding: Prenatal through first year of lifeDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2008Amy L. Delaney Abstract The development of feeding and swallowing involves a highly complex set of interactions that begin in embryologic and fetal periods and continue through infancy and early childhood. This article will focus on swallowing and feeding development in infants who are developing normally with a review of some aspects of prenatal development that provide a basis for in utero sucking and swallowing. Non-nutritive sucking in healthy preterm infants, nipple feeding in preterm and term infants, and selected processes of continued development of oral skills for feeding throughout the first year of life will be discussed. Advances in research have provided new information in our understanding of the neurophysiology related to swallowing, premature infants' sucking and swallowing patterns, and changes in patterns from preterm to near term to term infants. Oral skill development as texture changes are made throughout the second half of the first year of life is an under studied phenomenon. Knowledge of normal developmental progression is essential for professionals to appreciate differences from normal in infants and children with feeding and swallowing disorders. Additional research of infants and children who demonstrate overall typical development in oral skills for feeding is encouraged and will provide helpful reference points in increasing understanding of children who exhibit differences from typical development. It is hoped that new technology will provide noninvasive means of delineating all phases of sucking and swallowing from prenatal through infancy. Further related topics in other articles of this issue provide a comprehensive review of factors influencing oral intake, growth, nutrition, and neurodevelopmental status of children. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:105,117. [source] Transcranial magnetic stimulation in child psychiatry: disturbed motor system excitability in hypermotoric syndromesDEVELOPMENTAL SCIENCE, Issue 3 2002Gunther H. Moll Normal development and dysfunctions of motor system excitability can be investigated in vivo by means of single- and paired-pulse transcranial magnetic stimulation (TMS). While different TMS-parameters show different developmental time courses between 8 and 16 years of age, distinct dysfunctional patterns of motor system excitability can be demonstrated in child psychiatric disorders with hypermotoric behavior: in tic disorder, a shortened cortical silent period can be stated providing evidence for deficient inhibitory mechanisms within the sensorimotor loop, probably primarily at the level of the basal ganglia. In attention deficit hyperactivity disorder (ADHD), a decreased intracortical inhibition indicates deficient inhibitory mechanisms within the motor cortex (but enhancement of intracortical inhibition after oral intake of 10 mg methylphenidate). In children with comorbid ADHD and tic disorder, the findings of a reduced intracortical inhibition as well as a shortened cortical silent period provide evidence for additive effects at the level of motor system excitability. Thus, TMS allows us to obtain substantial insight into both the normal development and the neurobiological basis of hypermotoric syndromes in child psychiatry. [source] REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENTDIGESTIVE ENDOSCOPY, Issue 4 2005Iruru Maetani Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective means of enteral nutrition where oral intake is not possible. PEG placement is safe and has now replaced the nasogastric tube in patients who need long-term feeding. Although it is relatively safe with a very low associated mortality, minor complications, especially local and systemic infection, remain a problem. Of these, peristomal wound infections are the most common complication of PEG. In patients indicated for this procedure who are aged and/or frail, this complication may pose a critical problem. In the commonly used pull or push methods for PEG placement, the PEG tube is readily colonized by oropharyngeal bacteria. Infection of the PEG site is considered to be associated with contamination of the PEG catheter. There are important measures that should be taken to prevent peristomal infection. A number of rigorous studies have shown that prophylactic antibiotics are effective in reducing the risk of peristomal infection. As methicillin-resistant Staphylococcus aureus (MRSA) or other resistant organisms are emerging as a major pathogen in peristomal infection, however, currently recommended antibiotic prophylaxis regimens might be inappropriate. Alternative regimens and other approaches to prevent contamination of the PEG tube during the procedure are required. [source] Colonic perforation after endoscopic biopsy of a submucosal tumor: successful conservative treatmentDIGESTIVE ENDOSCOPY, Issue 4 2002Kuang-I. Colonoscopy is a powerful diagnostic and therapeutic procedure with a recognized risk of complications ranging from perforation to hemorrhage and septicemia. Perhaps the most dangerous complication associated with this procedure is bowel perforation. Although some colonic perforations can be treated medically, prompt surgery is generally preferred to minimize morbidity and mortality. We present a case of colonic perforation resulting from bite biopsy followed by mucosal resection of a submucosal tumor. Perforation occurred in a delayed manner despite prophylactic closure of the mucosal defect by the replacement of endoclips. The patient recovered spontaneously after antibiotic treatment and reduction of oral intake. We carried out successful conservative medical treatment of a minor iatrogenically induced bowel perforation without operation. [source] A Gene Therapy Technology-Based Biomaterial for the Trigger-Inducible Release of Biopharmaceuticals in MiceADVANCED FUNCTIONAL MATERIALS, Issue 15 2010Michael M. Kämpf Abstract Gene therapy scientists have developed expression systems for therapeutic transgenes within patients, which must be seamlessly integrated into the patient's physiology by developing sophisticated control mechanisms to titrate expression levels of the transgenes into the therapeutic window. However, despite these efforts, gene-based medicine still faces security concerns related to the administration of the therapeutic transgene vector. Here, molecular tools developed for therapeutic transgene expression can readily be transferred to materials science to design a humanized drug depot that can be implanted into mice and enables the trigger-inducible release of a therapeutic protein in response to a small-molecule inducer. The drug depot is constructed by embedding the vascular endothelial growth factor (VEGF121) as model therapeutic protein into a hydrogel consisting of linear polyacrylamide crosslinked with a homodimeric variant of the human FK-binding protein 12 (FM), originally developed for gene therapeutic applications, as well as with dimethylsuberimidate. Administrating increasing concentrations of the inducer molecule FK506 triggers the dissociation of FM thereby loosening the hydrogel structure and releasing the VEGF121 payload in a dose-adjustable manner. Subcutaneous implantation of the drug depot into mice and subsequent administration of the inducer by injection or by oral intake triggers the release of VEGF121 as monitored in the mouse serum. This study is the first demonstration of a stimuli-responsive hydrogel that can be used in mammals to release a therapeutic protein on demand by the application of a small-molecule stimulus. This trigger-inducible release is a starting point for the further development of externally controlled drug depots for patient-compliant administration of biopharmaceuticals. [source] Prevention of wound complications following salvage laryngectomy using free vascularized tissueHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007FRCS(C), Kevin Fung MD Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynxHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004Manuel Bernal-Sprekelsen MD Abstract Background. CO2 -laser surgery is a relatively new treatment for selected carcinomas of the upper aerodigestive tract. The purpose of our study was to evaluate prospectively the functional results for swallowing after C02 -laser resections. Methods. The sample was composed of 210 consecutive patients with malignancies of the larynx and hypopharynx treated with CO2 laser between February 1998 and January 2002. Endoscopic resections included all T1 and T2 tumors and selected T3 and T4 tumors. T1 glottic tumors were not included in the analysis. We assessed the need for a feeding tube and the period the tube remained in place, aspiration pneumonia, tracheotomy secondary to aspiration, the need for a permanent or temporary gastrostomy, and total laryngectomy secondary to aspiration. Results. The nasogastric feeding tube was used in 23.2% of small tumors (2.5 ± 8.04 days) and in 63% of locally advanced tumors (13.95 ± 22.55 days). Frequency and period of storage of the feeding tube were higher in locally advanced tumors (p = .0001). Twelve patients (5.7%) had postoperative pneumonia and 59 (28.1%) had temporary postoperative cough during oral intake. Aspiration symptoms correlated with location (p = .001) and locally advanced tumors (p = .016). Eight patients (3.8%) needed a postoperative tracheotomy for severe swallowing difficulties; six (2.9%) of them were definitive and two (0.95%) temporary. Thirteen gastrostomies (6.2%) were performed to avoid severe aspirations; five of them were definitive. The need for gastrostomy correlated significantly with location (p = .002), pT3 and pT4 tumors (p = .002), age (p = .02), and postoperative radiotherapy (p = .04). No correlation was found with the period of feeding tube (p = .38), or aspiration pneumonia (p = .24). Conclusions. Endoscopic resection of laryngeal and hypopharyngeal tumors is associated with good recovery of deglutition. Many tracheotomies are avoided, the need for a feeding tube is usually reduced, and organ preservation is often feasible even in locally advanced tumors. © 2003 Wiley Periodicals, Inc. Head Neck26: 103,110, 2004 [source] Xerostomia: 12-Month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiationHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2003Jeri A. Logemann PhD Abstract Background. Previous investigators have found permanent changes in saliva production after chemoradiation but have not examined these in relation to swallowing measures, diet changes, and patient comfort over time. Methods. Thirty patients with advanced stage cancer of the oropharynx treated with chemoradiation were followed with videofluoroscopic swallow studies, a measure of stimulated total saliva production, a questionnaire of their perception of dry mouth, and a questionnaire on the nature of their oral intake at pretreatment until 12 months after treatment. Results. Saliva declined significantly from pretreatment to 12 months. Swallowing-related complaints increased significantly over the 12 months, especially in patients with lower saliva weights. Diet choices increased over time after treatment, except crunchy foods. Swallow measures did not relate to saliva weight. Conclusions. Reduced saliva weight does not correlate with slowed or inefficient swallow. Instead, reduced saliva weight seems to change patients' perceptions of their swallowing ability and, on that basis, their diet choices. © 2003 Wiley Periodicals, Inc. Head Neck 25: 432,437, 2003 [source] Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency with inadvertent caries in infantsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2007FELIX BLAKE Background., Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is a rare systemic disease that is associated with early tooth decay. Case report., This report describes the case of a 3-year-old boy suffering from LCHADD. At the time of referral, extensive carious lesions of the subject's maxillary dentition necessitated the surgical removal of eight teeth. Preventive treatment for LCHADD involves a regular oral intake of glucose that is vital for the survival of the affected individual. In young infants, the glucose solution needs to be administered as often as every 3 h in order to prevent hypoglycaemia, leading to a local environment similar to that experienced in nursing bottle syndrome. While nursing bottle syndrome can be resolved by eliminating the sugar substrate and curtailing the feeding sessions, these alternatives are not available in cases of LCHADD. Conclusion., This report highlights this rare disease and emphasizes its dire consequences for the dentition. Prophylactic recommendations for high-risk children are reviewed. Familiarity with LCHADD allows this high-risk group of patients to be identified, and thus, ensures diligent prophylactic action. [source] The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbiditiesINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2007Yukio Naya Objectives: Laparoscopic surgery for kidney treatment is a common procedure. However, the efficacy of this procedure in patients with several comorbidities has not been well investigated. We conducted a retrospective comparison of results of laparoscopic surgery between patients with several comorbidities and patients with no comorbidity to access the efficacy and safety of this procedure. Methods: The subjects were 20 patients with three or more comorbidities (group A) and 46 patients with less than three comorbidities (group B). These 66 patients were 48 men and 18 women with a mean age of 62.3 years (age range, 24,83 years). The data from these two groups were compared for American Society of Anesthesiology (ASA) physical status score, previous surgical history, duration of surgery, estimated blood loss, tumor size, complications during and after surgery, conversion rates, time to oral intake, and length of hospital stay. Results: The initial ASA score and age were significantly higher for the patients with comorbidities (P < 0.0001, P = 0.0008, respectively). All other variables before, during, and after surgery were similar for both laparoscopic groups. However, the incidence of atelectasis of laparoscopy was higher than that of open surgery. Conclusions: Laparoscopic nephrectomy for patients with comorbidities is safe and minimally invasive. Further investigation to prevent atelectasis is necessary. [source] Hand-assisted laparoscopic and open living donor nephrectomy in KoreaINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2005JA HYEON KU Abstract Background: We compared the results of hand-assisted laparoscopic living donor nephrectomy (LLDN) and conventional open living donor nephrectomy (OLDN). Methods: The clinical data on 49 hand-assisted LLDN and 21 OLDN on the left side performed at two institutions in Korea from January 2001 to February 2003 were reviewed. Demographic data of donors and recipients were similar in the two groups. Results: There was one conversion to an open procedure due to bleeding in the LLDN group. The median operation times (180 min in LLDN versus 170 min in OLDN) and warm ischemic times (2.5 min in LLDN versus 2.0 min in OLDN) in the two groups were similar. The estimated mean blood loss, duration of hospital stay and complication rate was also similar in the two groups. The LLDN group reported less pain (visual analog scale) postoperatively (4.1 versus 5.3), but this was not significant (P = 0.058). The time to oral intake in the LLDN group was significantly longer by an average of 1 day (P = 0.001). Return to work was sooner in the LLDN group (4.0 weeks versus 6.0 weeks; P = 0.026). The recipient graft function was equivalent between the two groups. Hand-assisted LLDN appears to be a safe and effective alternative to OLDN. Conclusion: Our findings suggest that this technique may give the ability provide grafts of similar quality to OLDN, while extending to the donors the advantages of a traditional LLDN procedure. [source] Hand-assisted retroperitoneoscopic radical nephrectomy: Initial experienceINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2002AKIHIRO KAWAUCHI Abstract Objectives: To report our initial experience of hand-assisted retroperitoneoscopic radical nephrectomy for stage T1 renal tumors. Methods: The clinical data on 22 consecutive patients who had undergone hand-assisted retroperitoneoscopic radical nephrectomy and 22 who had undergone open radical nephrectomy were reviewed. The operation was performed with a hand placed retroperitoneally through a pararectal longitudal 7,7.5 cm incision using a LAP DISC. Results: The total operating time was between 2.3 and 5.8 h (mean: 3.4 h). The estimated blood loss was between 15 and 650 mL (mean: 170 mL). The complication rate was 9% (2/22). No conversions to open procedure occurred. In comparison to open radical nephrectomy, the operating time was similar (3.4 vs 3.9 h) whereas the estimated blood loss was significantly less in this procedure (170 vs 495 mL). During the convalescence period the patients revealed significantly less postoperative pain, shorter intervals to resuming oral intake and more rapid return to normal activities compared to the open radical nephrectomy patients. Conclusion: Hand-assisted retroperitoneoscopic radical nephrectomy is an effective and safe procedure for T1 renal tumors. [source] Is ,-lipoic acid a scavenger of reactive oxygen species in vivo?IUBMB LIFE, Issue 6 2008Evidence for its initiation of stress signaling pathways that promote endogenous antioxidant capacity Abstract The chemical reduction and oxidation (redox) properties of ,-lipoic acid (LA) suggest that it may have potent antioxidant potential. A significant number of studies now show that LA and its reduced form, dihydrolipoic acid (DHLA), directly scavenge reactive oxygen species (ROS) and reactive nitrogen species (RNS) species and protect cells against a host of insults where oxidative stress is part of the underlying etiology. However, owing to its limited and transient accumulation in tissues following oral intake, the efficacy of nonprotein-bound LA to function as a physiological antioxidant has been questioned. Herein, we review the evidence that the micronutrient functions of LA may be more as an effector of important cellular stress response pathways that ultimately influence endogenous cellular antioxidant levels and reduce proinflammatory mechanisms. This would promote a sustained improvement in cellular resistance to pathologies where oxidative stress is involved, which would not be forthcoming if LA solely acted as a transient ROS scavenger. © 2008 IUBMB IUBMB Life, 60(6): 362,367, 2008 [source] Barriers to Caregiver Compliance with Eating and Drinking Recommendations for Adults with Intellectual Disabilities and DysphagiaJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 2 2006Darren D. Chadwick Background, There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists' (SLTs) dysphagia management strategies more difficult. Method, Semi-structured open-ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia. Results, Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers. Conclusions, Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies. [source] Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatmentJOURNAL OF DIGESTIVE DISEASES, Issue 2 2006Ke DONG Postsurgical gastroparesis syndrome (PGS) is a complex disorder characterized by post-prandial nausea and vomiting, and gastric atony in the absence of mechanical gastric outlet obstruction, and is often caused by operation at the upper abdomen, especially by gastric or pancreatic resection, and sometimes also by operation at the lower abdomen, such as gynecological or obstetrical procedures. PGS occurs easily with oral intake of food or change in the form of food after operation. These symptoms can be disabling and often fail to be alleviated by drug therapy, and gastric reoperations usually prove unsuccessful. The cause of PGS has not been identified, nor has its mechanism quite been clarified. PGS after gastrectomy has been reported in many previous studies, with an incidence of approximately 0.4,5.0%. PGS is also a frequent complication of pylorus-preserving pancreatoduodenectomy (PPPD), and the complication occurs in the early postoperative period in 20,50% of patients. PGS caused by pancreatic cancer cryoablation (PCC) has been reported about in 50,70% of patients. Therefore, PGS has a complex etiology and might be caused by multiple factors and mechanisms. The frequency of this complication varies directly with the type and number of gastric operations performed. The loss of gastric parasympathetic control resulting from vagotomy contributes to PGS via several mechanisms. It has been reported that the interstitial cells of Cajal (ICC) may play a role in the pathogenesis of PGS. Recent studies in animal models of diabetes suggest specific molecular changes in the enteric nervous system may result in delayed gastric emptying. The absence of the duodenum, and hence gastric phase III, may be a cause of gastric stasis. It was thought that PGS after PPPD might be attributable, at least in part, to delayed recovery of gastric phase III, due to lowered concentrations of plasma motilin after resection of the duodenum. The damage to ICC might play a role in the pathogenesis of PGS after PCC, for which multiple factors are possibly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the pancreatoduodenal regions or reduction of circulating levels of motilin. As the treatment of gastroparesis is far from ideal, non-conventional approaches and non-standard medications might be of use. Multiple treatments are better than single treatment. This article reviews almost all the papers related to PGS from various journals published in English and Chinese in recent years in order to facilitate a better understanding of PGS. [source] Resumption of oral intake following percutaneous endoscopic gastrostomyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2009Sudarshan Paramsothy Abstract Background and Aims:, Percutaneous endoscopic gastrostomy (PEG) provides enteral nutrition to patients who cannot swallow. Few studies have prospectively evaluated its long-term outcomes or eventual resumption of oral intake. Methods:, Consecutive PEG patients were prospectively recruited from a tertiary hospital over 12 months and followed until all had met the primary endpoints of death or resumption of oral diet with PEG extubation. Data was collected by standardised periodic phone interview. Results:, Forty patients (24 males, median age 74 years) were followed for up to 8.4 years (median 5.3 months, interquartile range [IQR] 13.6 months). The end-of-study mortality rate was 70% (median 6.8 months, IQR 19.9 months) and the only predictor of mortality was head injury as the indication for PEG (Cox regression HR 5.90, 95% CI: 1.2,28.4). At two years following PEG, 30% of patients had resumed oral intake (median 2.9 months, IQR 7.2 months) and 19% remained on PEG-feeding. Predictors of resumption of oral intake were the ability to tolerate some oral intake at 3 months (HR: 248.5, 95% CI: 8.7,7065.3) and 6 months (HR: 6.3, 95% CI: 1.03,38.9) but not at 12 months. Cumulative survival was highest for ear nose and throat (ENT) tumour and worst for acute head injury (log rank P = 0.048). Conclusions:, Half of all PEG patients remained alive at 2 years using PEG or have resumed full oral intake. A supervised trial of oral intake at 3 or 6 months may help predict eventual resumption of per oral diet. [source] Early versus late enteral nutritional support in adults with burn injury: a systematic reviewJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 2 2007J. Wasiak Abstract Background Burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, and improving survival rates. Enteral nutrition support is the best feeding method in a patient who is unable to achieve an adequate oral intake, but optimal timing of its introduction after burn injury (i.e. early versus late) needs to be established. The purpose of this review is to examine evidence for the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. Methods An examination of randomized and controlled clinical trials using various medical databases such as The Cochrane Library (Issue 3, 2006), MEDLINE (from 1950), CINHAL (from 1982) and EMBASE (from 1980). Results The trial evidence about the benefit of early enteral nutritional support on standardized clinical outcomes such as length of hospital stay and mortality remained inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate, reduced septic and other complications remained uncertain. Conclusions Promising results suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but it is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilizes valid and reliable outcome measures is essential. [source] An audit designed to assess the need for planned pretreatment PEG placement in patients with stage III & stage IV oral cancerJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2004F.R. Dawson Background:, Nutritional support is a crucial and challenging part of treatment for patients with oral cancer. The aim of this audit was to assess the need for planned pretreatment percutaneous endoscopic gastrostomy (PEG) placement in this group of patients and to assess diet consistency as a predictor of poor outcomes. Method:, This was a retrospective study of 77 consecutive patients with stage III and IV squamous cell carcinoma of the oral cavity treated by radical surgery and post-operative radiotherapy between January 1999 and December 2001. Information was taken from dietitians' records. Patients were divided into two groups according to survival: group 1 (40 patients) comprised nonsurvivors and group 2 (37 patients), survivors. All patients were enterally fed post-operatively. After approximately 10 days, swallowing was assessed and, if deemed competent, patients progressed to a fluid diet. Tube feeding was gradually reduced and then stopped when oral nutrition was sufficient to maintain weight. Patients progressed to soft diet as they were able. During radiotherapy, liquid diet or tube feeding was instigated as required. Results:, In group 1, 65% required tube feeding for less than 30 days (mean 17 days), 20% for 31,100 days (mean 51 days) and 15% for over 100 days (mean 231 days). The overall mean length of tube feeding was 97 days. Thirty-eight per cent of nonsurvivors developed recurrence and went on to subsequent operations necessitating further tube feeding for an average of 129 days. In group 2, 70% were tube fed for less than 30 days (mean 11 days), 14% for between 31,100 days (mean 43 days), and 17% for more than 100 days. The overall mean length of tube feeding was 72 days. The dietary consistency of nonsurvivors was worse than survivors throughout treatment. At first presentation, only 37% of nonsurvivors managed a normal diet, 8% managed a near normal diet and 3% required tube feeding, whereas 48% of survivors managed a normal diet and 16% a near normal diet. At 1 year, there was a significant difference between the two groups' diets. No patients in group 1 managed a normal or near normal diet, whilst 62% required tube feeding. In group 2, 12 and 32% managed a normal and near normal diet, respectively and only 9% required or wished to remain on tube feeding to supplement their diet. Five per cent of patients in this group remained nil by mouth due to fistula. Conclusion:, Deciding whether a patient has a naso-gastric tube, PEG or radiologically inserted gastrostomy tube placed can be a difficult decision. However, a gastrostomy should be considered prior to treatment in patients whose diet is of poor consistency at presentation or who have an inadequate oral intake to maintain or increase weight and in those with a fistula, expected slow recovery of swallowing function, for example, pharyngeal tumour or undergoing brachytherapy or chemoradiotherapy. [source] Crushed Clopidogrel Administered via Nasogastric Tube Has Faster and Greater Absorption than Oral Whole TabletsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2009M. UROOJ ZAFAR M.B.B.S. Objectives: To compare the absorption of 300 mg clopidogrel administered crushed via nasogastric (NG) tube versus whole tablets taken orally in healthy volunteers. Background: Earlier antiplatelet therapy has proven benefits in treatment of myocardial infarction and in patients undergoing PCI. Aspirin can be delivered early in crushed form via NG tube after CABG surgery to prevent graft occlusion. If clopidogrel given crushed via NG tube provides faster absorption, it could allow earlier clopidogrel loading. Methods: Nine healthy human subjects (34.7 ± 11.1 years, 5 males) were given 300 mg clopidogrel in crushed form via NG tube with 30 mL water after 8 hours of fasting. Plasma levels of the primary circulating inactive clopidogrel metabolite SR26334 were measured after 20 minutes, 40 minutes, 1, 2, 4, 8, 12, and 24 hours of dosing. Following ,2 week washout, same subjects swallowed 300 mg clopidogrel (four 75 mg tablets) after an 8-hour fasting and SR26334 levels were measured at the same time points. Results: Plasma SR26334 concentrations peaked earlier after crushed delivery than after oral intake (44 vs. 70 minutes, P = 0.023) and the median peak was 80% higher (13,083 vs. 7,255 ng/mL, respectively, P = 0.021). At 40 minutes, area under the curve was almost twofold greater with NG administration than oral administration (geometric means ratio = 0.5299, 95% CI = 0.28,0.99, P = 0.048), but was similar over the 24-hour period with both administration methods (geometric means ratio = 1.05, 95% CI = 0.84,1.32, P = 0.646). Conclusions: A 300 mg loading dose of crushed clopidogrel administered via NG tube provides faster and greater bioavailability than an equal dose taken orally as whole tablets. The clinical benefits of this strategy need to be investigated. [source] Studies on the metabolism of the ,9-tetrahydrocannabinol precursor ,9-tetrahydrocannabinolic acid A (,9-THCA-A) in rat using LC-MS/MS, LC-QTOF MS and GC-MS techniquesJOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 10 2009Julia Jung Abstract In Cannabis sativa, ,9-Tetrahydrocannabinolic acid-A (,9-THCA-A) is the non-psychoactive precursor of ,9-tetrahydrocannabinol (,9-THC). In fresh plant material, about 90% of the total ,9-THC is available as ,9-THCA-A. When heated (smoked or baked), ,9-THCA-A is only partially converted to ,9-THC and therefore, ,9-THCA-A can be detected in serum and urine of cannabis consumers. The aim of the presented study was to identify the metabolites of ,9-THCA-A and to examine particularly whether oral intake of ,9-THCA-A leads to in vivo formation of ,9-THC in a rat model. After oral application of pure ,9-THCA-A to rats (15 mg/kg body mass), urine samples were collected and metabolites were isolated and identified by liquid chromatography-mass spectrometry (LC-MS), liquid chromatography-tandem mass spectrometry (LC-MS/MS) and high resolution LC-MS using time of flight-mass spectrometry (TOF-MS) for accurate mass measurement. For detection of ,9-THC and its metabolites, urine extracts were analyzed by gas chromatography-mass spectrometry (GC-MS). The identified metabolites show that ,9-THCA-A undergoes a hydroxylation in position 11 to 11-hydroxy-,9-tetrahydrocannabinolic acid-A (11-OH-,9-THCA-A), which is further oxidized via the intermediate aldehyde 11-oxo-,9-THCA-A to 11-nor-9-carboxy-,9-tetrahydrocannabinolic acid-A (,9-THCA-A-COOH). Glucuronides of the parent compound and both main metabolites were identified in the rat urine as well. Furthermore, ,9-THCA-A undergoes hydroxylation in position 8 to 8-alpha- and 8-beta-hydroxy-,9-tetrahydrocannabinolic acid-A, respectively, (8,-Hydroxy-,9-THCA-A and 8,-Hydroxy-,9-THCA-A, respectively) followed by dehydration. Both monohydroxylated metabolites were further oxidized to their bishydroxylated forms. Several glucuronidation conjugates of these metabolites were identified. In vivo conversion of ,9-THCA-A to ,9-THC was not observed. Copyright © 2009 John Wiley & Sons, Ltd. [source] Effect of maternal fasting on uterine arterial blood flowJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2007Hisham M. Mirghani Abstract Aim:, To determine the effect maternal diet pattern on the uterine artery Doppler flow velocimetry. Methods:, This is a cross-sectional observational study. The uterine artery Doppler flow velocimetry was measured between 20 and 24 weeks' gestation in healthy pregnant women observing Ramadan. For each fasting mother, a non-fasting healthy pregnant woman was recruited as a control. Maternal blood glucose level was measured. Results:, A total of 106 pregnant women were studied. The mean hours since last oral intake were significantly longer, and the maternal glucose level was significantly lower in the study group than in the control group. The Mean (95% CI) of the uterine artery pulsatility index, resistance index, peak systolic velocity, end diastolic velocity and systolic/diastolic ratio was similar in both groups. Conclusion:, Maternal fasting is not associated with significant changes in the uterine artery Doppler flow velocimetry. [source] Ethanol Attenuates Spatial Memory Deficits and Increases mGlu1a Receptor Expression in the Hippocampus of Rats Exposed to Prenatal StressALCOHOLISM, Issue 8 2009Vincent Van Waes Background:, Although it is generally believed that chronic ethanol consumption impairs learning and memory, results obtained in experimental animals are not univocal, and there are conditions in which ethanol paradoxically improves cognitive functions. In the present work, we investigated the effects of prenatal stress and of chronic ethanol exposure during adulthood on spatial memory in rats. Methods:, Rats were subjected to a prenatal stress delivered as 3 daily 45-minute sections of restraint stress to the mothers during the last 10 days of pregnancy (PRS rats). After 7 months of ethanol exposure (ethanol 10%, oral intake), memory performances were evaluated in a spatial discrimination test in control and PRS male rats. Then, the oxidative damages and the expression of metabotropic glutamate (mGlu) receptors were assessed in their hippocampus. Results:, Chronic ethanol exposure resulted in a reduced performance in a spatial recognition task in control animals. Unexpectedly, however, the same treatment attenuated spatial memory deficits in rats that had been subjected to prenatal stress. This paradigm of ethanol administration did not produce detectable signs of oxidative damage in the hippocampus in either unstressed or PRS rats. Interestingly, ethanol intake resulted in differential effects in the expression of mGlu receptor subtypes implicated in mechanisms of learning and memory. In control rats, ethanol intake reduced mGlu2/3 and mGlu5 receptor levels in the hippocampus; in PRS rats, which exhibited a constitutive reduction in the levels of these mGlu receptor subtypes, ethanol increased the expression of mGlu1a receptors but did not change the expression of mGlu2/3 or mGlu5 receptors. Conclusion:, Our findings support the idea that stress-related events occurring before birth have long-lasting effects on brain function and behavior, and suggest that the impact of ethanol on cognition is not only dose- and duration-dependent, but also critically influenced by early life experiences. [source] Braun enteroenterostomy is associated with reduced delayed gastric emptying and early resumption of oral feeding following pancreaticoduodenectomyJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Steven N. Hochwald MD Abstract Background and Objectives Morbidity rates following pancreaticoduodenectomy (PD) remain high with delayed gastric emptying (DGE) and slow resumption of oral diet contributing to increased postoperative length of stay. A Braun enteroenterostomy has been shown to decrease bile reflux following gastric resection. We hypothesize that addition of Braun enteroenterostomy during PD would reduce the sequelae of DGE. Methods From our PD database, patients were identified that underwent classic PD with partial gastrectomy from 2001 to 2006. All patients with reconstruction utilizing a single loop of jejunum at the University of Florida Shands Hospital were reviewed. Demographics, presenting signs and symptoms, pathologic diagnoses, and postoperative morbidity were compared in those patients undergoing reconstruction with an additional Braun enteroenterostomy (n,=,70) to those not undergoing a Braun enteroenterostomy (n,=,35). Results Patients undergoing a Braun had NG tubes removed earlier (Braun: 2 days, no Braun: 3 days, P,=,0.002) and no significant change in postoperative vomiting (Braun: 27%, no Braun: 37%, P,=,0.37) or NG tube reinsertion rates (Braun: 17%, no Braun: 29%, P,=,0.21). Median postoperative day with tolerance of oral liquids (Braun: 5, no Braun: 6, P,=,0.01) and solid diets (Braun: 7, no Braun: 9, P,=,0.01) were significantly sooner in the Braun group. DGE defined by two criteria including the inability to have oral intake by postoperative day 10 (Braun: 10%, no Braun: 26%, P,<,0.05) and the international grading criteria (grades B and C, Braun: 7% vs. no Braun: 31%, P,=,0.003) were significantly reduced in those undergoing the Braun procedure. In addition, the median length of stay (Braun: 10 days, no Braun: 12 days, P,<,0.05) was significantly reduced in those undergoing the Braun procedure. The rate of pancreatic anastomotic failure was similar in the two groups (Braun: 17% vs. no Braun: 14%, P,=,0.79). Median bile reflux was 0% in those undergoing a Braun. Conclusions The present study suggests that Braun enteroenterostomy can be safely performed in patients undergoing PD and may reduce the indicence of DGE and its sequelae. Further studies of Braun enteroenterostomy in larger randomized trials of patients undergoing PD are warranted. J. Surg. Oncol. 2010; 101:351,355. © 2010 Wiley-Liss, Inc. [source] Effects of Intravenously Administrated Omeprazole on Gastric Juice pH and Gastric Ulcer Scores in Adult HorsesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2006Frank M. Andrews The study was performed to evaluate the efficacy of omeprazole powder in sterile water, administered intravenously, on gastric juice pH in adult horses with naturally occurring gastric ulcers. Omeprazole (0.5 mg/kg, IV) was administered once daily for 5 days to adult horses with gastric ulcers. Gastric juice was aspirated through the biopsy channel of an endoscope and pH was measured before and 1 hour after administration of omeprazole on day 1, and then before and after administration of omeprazole on day 5. Gastric ulcer scores were recorded on day 1 before administration of omeprazole and on day 5, 23 hours after the 4th daily dose. Gastric juice pH and ulcer scores were compared between the times. When compared with the pre-injection value (2.01 ± 0.42), mean ± SD gastric juice pH was significantly higher when measured 1 hour after administration of the initial dose (4.35 ± 2.31), and before (5.27 ± 1.74) and 1 hour after (7.00 ± 0.25) administration of omeprazole on day 5. Nonglandular gastric ulcer number score significantly decreased from a mean ± SD of 3.2 ± 0.80 to 2.0 ± 1.1, but nonglandular gastric ulcer severity score remained the same. Few glandular ulcers were seen in the study, and scores did not change. Because of its potent and long duration of action on gastric juice pH, this intravenous formulation of omeprazole may show promise for treatment of equine gastric ulcer syndrome (EGUS) in horses with dysphagia, gastric reflux, or other conditions that restrict oral intake of omeprazole paste.a Aspiration of gastric juice and measurement of pH can be of use to determine whether the desired pH > 4.0 has been reached after omeprazole treatment. [source] Omega-3 fatty acids inhibit an increase of proinflammatory cytokines in patients with active Crohn's disease compared with omega-6 fatty acidsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2005A. A. NIELSEN Summary Background :,Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract. Polyunsaturated omega-3 fatty acids given orally may reduce the secretion of proinflammatory cytokines and hereby downregulate the inflammatory process. Aim :,To assess the effects of enteral fatty acids, in the form of Impact Powder (Novartis, Switzerland), as adjuvant therapy to corticosteroid treatment on the proinflammatory and anti-inflammatory cytokine profiles in patients with active Crohn's disease. Methods :,The proinflammatory and anti-inflammatory cytokines were measured in plasma from 31 patients with active Crohn's disease. Patients were randomized for oral intake of omega-3 fatty acid (3-Impact Powder) or omega-6 fatty acids (6-Impact Powder). Clinical and biochemical markers of inflammation were studied at baseline and after 5 and 9 weeks. Results :,Within the 3-Impact Powder group, no significant changes in concentrations of interleukin-6, interferon- ,, monocyte chemoattractant protein-1, interleukin-2, interleukin-5 and interleukin-10, whereas a significant differences in concentration of interleukin-1, and interleukin-4 were observed during therapy. Within the 6-Impact Powder group a significant changes in concentrations of interleukin-1,, interleukin-6, interferon- ,, monocyte chemoattractant protein-1, interleukin-2, interleukin-4, interleukin-5 and interleukin-10 were observed. Conclusions :,The 3-Impact Powder showed immunomodulatory properties and might inhibit an increase of proinflammatory cytokines in contrast to the 6-Impact Powder. [source] Acetylcholine-Induced Vasodilation and Reactive Hyperemia Are Not Affected by Acute Cyclo-Oxygenase Inhibition in Human SkinMICROCIRCULATION, Issue 4 2004Anne Dalle-Ave Objective: To examine whether prostaglandins are involved in endothelium-dependent vasodilatory responses of the skin microcirculation. Methods: Twenty-three young male volunteers were studied on 2 different days 1,3 weeks apart. On each experimental day the forearm skin blood flow response to iontophoretically applied acetylcholine (Ach, an endothelium-dependent vasodilator) was determined with laser Doppler imaging following the intravenous administration of either the cyclo-oxygenase inhibitor lysine acetylsalicylate (L-AS), 900 mg, or the oral intake of indomethacin, 75 mg. Acetylcholine was iontophoresed both in presence and in absence of surface anesthesia. In some subjects, the effects of L-AS on skin reactive hyperemia were also assessed. Results: Acute cyclo-oxygenase inhibition with either drug influenced neither the skin blood flow response to 4 different doses of Ach (0.28, 1.4, 7, and 14 mC/cm2) nor reactive hyperemia. The peak vasodilatory response to Ach was significantly increased by skin anesthesia, regardless of whether the subjects received the cyclo-oxygenase inhibitor or not. For example, the mean response (± SD) to the largest dose of Ach (tested in 6 subjects, expressed in perfusion units) were as follows: in absence of anesthesia: L-AS 339 ± 105, placebo 344 ± 68; with anesthesia: L-AS 453 ± 76, placebo 452 ± 65 (p < .01 for effect of anesthesia). Conclusions: These data give no support for a contribution of prostaglandins to acetylcholine-induced vasodilation or to reactive hyperemia in the skin microcirculation. In this vascular bed, local anesthesia seems to amplify acetylcholine-induced vasodilation via a prostaglandin-independent mechanism. [source] The estimated benefits of vitamin D for GermanyMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 8 2010A. Zittermann Abstract This article gives an overview of the vitamin D status in Germany, provides evidence for an independent association of vitamin D deficiency with various chronic diseases, and discusses preventive measures for improving vitamin D status in Germany. The prevalence of vitamin D insufficiency is 40,45% in the general German population. An additional 15,30% are vitamin D deficient. Vitamin D can prevent falls and osteoporotic fractures in older people. There is also accumulating evidence that vitamin D may prevent excess mortality and may probably prevent some chronic diseases that occur in early life such as type 1 diabetes and multiple sclerosis. Adherence to present sun safety policy (avoidance of the sun between 11 am and 3 pm) and dietary recommendations (5,10,,g daily for adults) would, however, definitively lead to vitamin D deficiency. The estimated cost saving effect of improving vitamin D status in Germany might be up to 37.5 billion , annually. It should be the goal of nutrition and medical societies to erase vitamin D deficiency in Germany within the next 5,10 years. To achieve this goal, the daily production of at least 25,,g of vitamin D in the skin or an equivalent oral intake should be guaranteed. [source] Quantitative 19F MR spectroscopy at 3 T to detect heterogeneous capecitabine metabolism in human liverNMR IN BIOMEDICINE, Issue 5 2007Dennis Klomp Abstract Chemotherapy in non-responding cancer patients leads to unnecessary toxicity. A marker is therefore required that can predict the sensitivity of a specific tumour to chemotherapy, which would enable individualisation of therapy. 19F MR spectroscopy (19F MRS) can be used to monitor the metabolism of fluorinated drugs. The aim of this study was to develop a method for quantified localised detection of fluorinated compounds in human liver. For this purpose, sensitivity-optimised localised 19F MRS methods at 3 T were used to detect MR signals from capecitabine, 5,DFUR, 5,DFCR and FBAL after oral intake of capecitabine. As the radio-frequency (rf) coil is made tuneable to 19F and 1H, the same localisation method is applied to obtain 1H MR signals of water and of the 19F metabolites. In addition, T1 measurements have been performed to correct for measurement-induced saturation effects. Finally, absolute tissue concentrations of capecitabine metabolites were obtained in vivo, which revealed a substantial spatial heterogeneity of these metabolites in human liver after chemotherapy. Copyright © 2006 John Wiley & Sons, Ltd. [source] Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgeryPEDIATRIC ANESTHESIA, Issue 6 2009CHRISTOPHER F. TIROTTA MD MBA Summary Aim:, To determine the efficacy and safety of a continuous subcutaneous local anesthetic (LA) infusion in pediatric patients following open heart surgery. Background:, The use of a continuous LA infusion has been shown to be beneficial following adult cardiac surgery. To date there are no studies in the pediatric population. Methods/Materials:, Using a prospective, randomized, and double blind design, we compared LA, either 0.25% levobupivacaine or bupivacaine (Treatment Group) to saline (Placebo Group) delivered subcutaneously via a continuous infusion for 72 h after open heart surgery in 72 patients. Requirements for postoperative analgesics and pain scores were recorded for 72 h and plasma levels of local anesthetic were measured. Secondary outcomes measures included time to first oral intake, time to first bowel movement, time to urinary catheter removal, length of stay, requirements for antiemetics and additional sedation. Results:, Total morphine requirements over the first 24 h were less in the Treatment Group than the Placebo Group (0.05 mg·kg,1 vs 0.2 mg·kg,1, P = 0.007); this was true for all patient groups except those patients weighing less than 6.3 kg. The number of patients requiring no morphine was greater in the Treatment Group (7/35 vs 1/37, P = 0.02). The Treatment Group also received less midazolam, lorazepam, and ketorolac than the Placebo Group over 72 h due to the reduced clinical need for these agents in patients weighing less than 31 kg. There were no differences in secondary outcomes. Conclusions:, A continuous incisional infusion of LA reduced postoperative analgesic requirement and sedative use in pediatric patients undergoing a median sternotomy incision. Dosed at a maximum rate of 0.4 mg·kg,1·h,1, a continuous incisional infusion of LA is effective and safe for up to 72 h, with plasma levels of local anesthetic well below the toxic threshold. [source] Incidence of postoperative nausea and vomitingin paediatric ambulatory surgeryPEDIATRIC ANESTHESIA, Issue 8 2002I. Villeret SummaryBackground: We performed a prospective descriptive study over a 5-month period to determine the incidence of postoperative nausea and vomiting (PONV) during the first 24 h following elective ambulatory paediatric surgery, excluding head and neck procedures. Methods: Four hundred and seven patients, aged 15 days to 16 years, were analysed prospectively. Results: The incidence of PONV was 9.4%, occurring most frequently during the first 3 h after anaesthesia and in hospital but rarely during the journey home. It was associated with age, previous history of PONV, tracheal intubation or use of the laryngeal mask airway (LMAÔ), controlled or manual ventilation, opioids and absence of oral intake of liquids or solids. Conversely, type of surgery, premedication, induction mode, association of regional anaesthesia, inhaled nitrous oxide, duration of anaesthesia, stay in the postanaesthesia care unit and duration of journey after discharge were not significantly associated with PONV. Conclusions: PONV never induced complications or delayed patient discharge and curative treatment was rapidly effective. [source] | ||||||||||||||||||||||||||||||||||