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Total Parenteral Nutrition (total + parenteral_nutrition)
Selected AbstractsSimultaneous onset of acute inflammatory response, sepsis-like symptoms and intestinal mucosal injury after cancer chemotherapyINTERNATIONAL JOURNAL OF CANCER, Issue 2 2003Eiichi Tsuji Abstract Chemotherapy is 1 method for the treatment of cancer, but serious side effects can sometimes limit the dosage given. Mild fever and diarrhea are common side effects of cancer chemotherapy. Gastrointestinal injury induced by chemotherapeutic agents may result in bacterial/endotoxin translocation from the gut into the systemic circulation. An experimental study was therefore conducted to clarify the effect of systemic chemotherapeutic agents on gastrointestinal barrier function. Male Wistar rats were divided into a 5-fluorouracil (5-FU) group (100 mg/kg/day for 4 days; n = 27) and a control group (n = 5). All rats were fasted and central venous catheterization was performed for total parenteral nutrition and blood sampling. Intestinal tissue was also sampled for pathological examination. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor , (TNF,) were determined by ELISA, bacterial translocation was quantified by lymph node culture and plasma endotoxin content of portal blood was measured by the Limulus -amebocyte-lysate test. In the 5-FU group on day 4, a proportion of rats exhibited severe watery diarrhea (73.9%) and occasional vomiting (86.2%). The levels of plasma TNF, and IL-6 were seen to increase, peaking at day 6 (IL-6, 350.0 ± 67.8 pg/ml; TNF,, 26.1 ± 3.2 pg/ml). The pathological findings also changed on day 4. On day 6, 90% of the rats in the 5-FU group showed dramatic sepsis-like manifestations, whereas the control group did not. Within the 5-FU group, only at day 6 was bacterial translocation in the rat mesenteric lymph nodes or significantly elevated levels of endotoxin evident. These results suggest that bacterial/endotoxin translocation might cause sepsis-like manifestations after systemic chemotherapy. © 2003 Wiley-Liss, Inc. [source] Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switchJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008Theodossis S Papavramidis Abstract Background and Aim:, Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5,3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Methods:, Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. Results:, All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. Conclusion:, The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery. [source] Ward reduction of gastroschisis in a single stage without general anaesthesia may increase the risk of short-term morbidities: Results of a retrospective auditJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2009Shripada C Rao Background: Ward reduction of gastroschisis in a single stage without the need for general inhalational anaesthesia (ward reduction) has been reported by some authors to be effective and safe. We introduced this practice to our neonatal unit 2 years ago. Aim: To compare the short-term outcomes of this new practice with the standard procedure of reduction under general anaesthesia (GA). Methods: Retrospective case series of all infants with gastroschisis between January 2004 and January 2008. Results: Twenty-seven infants were managed with the traditional approach and 11 infants underwent ward reduction without GA. Infants in the ward reduction group had an increased frequency for all the three major adverse events (ischemic necrosis of bowel: 27.3% vs. 3.7%, odds ratio (OR) 10.72, 95% confidence interval (CI): 0.72, 159.6; need for total parenteral nutrition (TPN) more than 60 days: 18% vs. 3.7%, OR 4.13, 95% CI: 0.28, 61.55; and unplanned return to theatre: 27.3% vs. 7.4%, OR 3.88, 95% CI: 0.44, 34.08), although none of these events reached statistical significance. There were no significant differences between the groups for the outcomes of time to reach full feeds, duration of hospital stay and number of days on antibiotics. Conclusions: These results raise concerns over the role of ward reduction of gastroschisis in a single sitting without the use of GA. Randomised trials with appropriate design and sample size are needed before embracing this method as a standard practice. [source] Predictors of corticosteroid-dependent and corticosteroid-refractory inflammatory bowel disease: analysis of a Chinese cohort studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009D. K. L. CHOW Summary Background, Patients with inflammatory bowel disease (IBD) who are corticosteroid-dependent or -refractory are at higher risk of developing disease- and treatment-related complications. Aims, To identify retrospectively clinical factors present at diagnosis that predict the occurrence of corticosteroid dependency and refractoriness in Crohn's disease (CD) and ulcerative colitis (UC) patients. Methods, A total of 310 IBD patients (134 CD, 176 UC) were observed for 2140 person years and their use of systemic corticosteroids was determined. Outcomes of corticosteroid dependency and refractoriness were recorded. Univariate and multivariate analyses were performed to determine the clinical factors associated with outcomes. Results, Seventy-seven (57.5%) CD and 95 (54.0%) UC patients had received corticosteroids during study period. In CD, thrombocytosis [Hazard ratio (HR):3.0] predicted, whereas colonic CD (HR:0.3) negatively predicted corticosteroid dependency. Stricturing phenotype (HR:4.5) predicted corticosteroid-refractory CD. For UC, thrombocytosis (HR:3.9) and extensive colitis (HR:1.7) predicted corticosteroid dependency. Presence of anaemia (HR:10.8) at diagnosis and initial requirement of total parenteral nutrition (TPN) (HR:18.8) predicted corticosteroid-refractory UC. The cumulative risks of surgery were 17.8% and 5.4% for CD and UC patients respectively at 1 year after starting corticosteroids. Conclusions, Thrombocytosis at diagnosis predicted corticosteroid-dependency in IBD. Stricturing phenotype of CD and the presence of anaemia in UC predicted subsequent course of corticosteroid refractoriness. [source] Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imagingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005M. Nolli We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke,Korsakoff syndrome with ataxia and memory and cognitive defects. Thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition. [source] Oral tacrolimus long-term therapy in patients with Crohn's disease and steroid resistanceALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2001E. Ierardi To report the results of a prospective, open-label, uncontrolled study in 13 patients affected by Crohn's disease with resistance to steroids. Methods: The patients were treated long-term with oral tacrolimus, aiming to both resolve acute attacks and maintain remission. Tacrolimus was administered at the dose of 0.1,0.2 mg.day/kg and adjusted in order to achieve levels of 5,10 ng/mL; only mesalazine was continued concomitantly. Steroids and total parenteral nutrition were tapered when appropriate. Results: Median treatment was 27.3 months. Only one patient dropped out due to adverse events. Crohn's disease activity index score significantly decreased after 6 months in 11 patients; for 1 year in nine of them, and 7 years in two of them. The inflammatory bowel disease life-quality questionnaire score significantly increased over the same periods. A marked drop in hospitalizations was recorded. In three out of six patients complete closure of fistulas occurred. Tacrolimus allowed total parenteral nutrition to be withdrawn in three out of five patients. Supplementation with low-dose steroids was required in five patients. Two patients underwent surgery. Conclusions: Tacrolimus therapy appears to be associated with both short- and long-term benefits, and may represent a therapeutic option in Crohn's disease when conventional therapies fail. This study encourages its use in controlled trials. [source] Nosocomial bloodstream infections associated with Candida species in a Turkish University HospitalMYCOSES, Issue 2 2006Nur Yapar Summary In recent years, a progressive increase in the frequency of nosocomial candidaemia has been observed, especially among the critically ill or immunocompromised patients. The aim of this study was to evaluate the trend in incidence of candidaemia together with potential risk factors in an 850-bed Turkish Tertiary Care Hospital in a 4-year period. A total of 104 candidaemia episodes were identified in 104 patients. The overall incidence was 0.56 per 1000 hospital admissions and the increase in incidence of candidaemia from 2000 to 2003 was found to be statistically significant (P = 0.010). Candida albicans was the most common species (57.7%) and non- albicans species accounted for 42.3% of all episodes. The most common non- albicans Candida sp. isolated was C. tropicalis (20.2%) followed by C. parapsilosis (12.5%). The most frequent risk factors possibly associated with the candidaemia were previous antibiotic treatment (76.9%), presence of central venous catheter (71.2%) and total parenteral nutrition (55.8%). Our results show the fact that the incidence of candidaemia caused by non- albicans species is frequent and increasing significantly, although the most common isolated Candida species were C. albicans and further investigations are necessary to evaluate the mechanisms of increasing incidence of candidaemia caused by non- albicans species. [source] Postinfectious gastroparesis related to autonomic failure: a case reportNEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2006A. Lobrano Abstract, Background and aim:, Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. Hospital course:, This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. Conclusion:, A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings. [source] Chylous Ascites Requiring Surgical Intervention after Donor Nephrectomy: Case Series and Single Center ExperienceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010J. Aerts Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN. [source] Prevention and treatment of lymphorrhoea following surgery for gastric cancerANZ JOURNAL OF SURGERY, Issue 7-8 2010Sheng-Zhang Lin Abstract Background:, Lymphorrhoea is a rare complication of abdominal surgery. However, there have been a few reports of lymphorrhoea following radical gastrectomy. Here, we retrospectively review the clinical analysis and treatment of lymphorrhoea based on our experiences. Methods:, We retrospectively reviewed a total of 1596 patients who underwent surgery for gastric cancer between January 1995 and January 2007. D1 and D2 lymphadenectomies were performed in 1104 patients, and D3 and D4 lymphadenectomies were performed in the other 492 patients. Disrupted lymph vessels were ligated in 545 patients, and electrically cauterized in 559 patients. Before December 31 2000, total parenteral nutrition (TPN) was administered to all the patients, and after 1 January 2001, TPN was supplemented with octreotide in all the post-operative patients. Results:, The incidence of lymphorrhoea in patients with D3 and D4 lymphadenectomy was much higher than that in D1 and D2 lymphadenectomy patients (P < 0.05). In addition, the incidence of lymphorrhoea in patients in whom the electrotome cautery was significantly higher than that in patients who received ligation. The addition of octreotide to TPN can reduce the quantity and duration of lymphorrhoea (P < 0.05). Conclusion:, Ligating rather than cauterizing the disrupted lymph vessels can be done to minimize the incidence of lymphorrhoea. The combination of Octreotide and TPN appears to be an effective therapeutic modality for lymphorrhoea. [source] Enterocutaneous fistula: a single-centre experienceANZ JOURNAL OF SURGERY, Issue 3 2010D. E. Gyorki Abstract Background:, Enterocutaneous fistulae (ECFs) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients. Methods:, A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006 was performed. Demographic, management and outcome data including ECF closure, morbidity and mortality were recorded. Results:, A total of 33 patients (17 male) were identified with ECF (median age: 63 years, range: 27,84). The primary aetiology was Crohn's (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4,72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 h (standard deviation = 1.8). The median hospital stay for the operative group was 19 days (7,85). Four patients required post-operative TPN with one patient requiring home TPN. Fistula closure rate was 97% (operative group: 21 out of 21; non-operative group: 11 out of 12). Mean follow-up was 37.3 months (0.5,217). Six (19%) operative patients developed fistula recurrence. There were two deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis, respectively). Conclusion:, Patients with ECF can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. We believe that patients with ECF should be referred to specialist units for management. [source] CR12 ENTEROCUTANEOUS FISTULAE , ARE WE GETTING IT RIGHT?ANZ JOURNAL OF SURGERY, Issue 2007D. E. Gyorki Purpose Enterocutaneous fistulae (ECF) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients. Methodology A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006. Demographic, management and outcome data was recorded. Factors influencing ECF closure and outcome were assessed with Cox regression analysis. Results Thirty-three patients (17 male) were identified with ECF (median age 63, range 27,84). The primary aetiology was Crohn's (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4,72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 hours (SD = 1.8). The median hospital stay for the operative group was 19 days (7,85). Four patients required post-operative TPN. Fistula closure rate was 97% (operative group 21/21, non-operative group 11/12). Mean follow up was 37.3 months (0.5,217). Six operative patients (19%) developed fistula recurrence. There were 2 deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis respectively). No factor was predictive of fistula recurrence. Conclusion Patients with enterocutaneous fistula can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. Patients with ECF should be referred to specialist units for management. [source] Bacterial translocation studied in 927 patients over 13 yearsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2006J. MacFie Background: Bacterial translocation (BT) describes the passage of bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes (MLNs) and other internal organs. The clinical and pathophysiological significance of BT remains controversial. This report describes results obtained over a 13-year period of study. Methods: MLNs were obtained from 927 patients undergoing laparotomy. Nasogastric aspirates were obtained from 458 (49·4 per cent) of 927 patients for culture; pH was measured in 172 (37·6 per cent) of 458. Preoperative clinical variables were evaluated and factors that influenced BT were included in a multivariate logistic regression analysis. Results: BT was identified in 130 (14·0 per cent) of 927 patients. Postoperative sepsis was more common in patients with BT (42·3 versus 19·9 per cent; P < 0·001). Independent preoperative variables associated with BT were emergency surgery (P = 0·001) and total parenteral nutrition (TPN) (P = 0·015). Gastric colonization was confirmed in 248 (54·1 per cent) of 458 patients, and was associated with both BT (P = 0·015) and postoperative sepsis (P = 0·029). A gastric pH of less than 4 was associated with a significant reduction in gastric colonization (53 versus 80 per cent; P < 0·001) and postoperative sepsis (46 versus 70·3 per cent; P = 0·018) but not BT. Conclusion: BT is associated with postoperative sepsis. Emergency surgery and TPN are independently associated with an increased prevalence of BT. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Therapeutic management of neonatal chylous ascites: report of a case and review of the literatureACTA PAEDIATRICA, Issue 9 2010Belma Saygili Karagol Abstract Congenital chylous ascites is a rare condition seen in the neonatal period and the data on pathogenesis and treatment modalities are limited. In this article, we report a case of neonate with chylous ascites and review the therapeutic management procedures on chylous ascites in childhood. We present our experience in the diagnosis and treatment of this condition. Conclusion:, Medium-chain triglycerides (MCT)-based diet can be tried as a first option in chylous ascites treatment. In resistant or unresponsive cases, somatostatin along with TPN can have use in closing the lymphatic leakage or relieving the symptoms effectively and rapidly. Conventional regimens including enteral feeding with MCT-based formula can then be re-administered as a maintenance treatment after reduction of lymph flow with the use of total parenteral nutrition (TPN) and somatostatin infusion combination. Patient-specific approach should be attempted for chylous ascites caused by various disorders and started as soon as possible. [source] Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newbornsACTA PAEDIATRICA, Issue 1 2009Gianluca Terrin Abstract Aims: To evaluate the efficacy and safety of minimal enteral feeding (MEF) nutritional practice in feed-intolerant very low birth weight (VLBW) infants. Methods: A retrospective design using data reported in the clinical charts of VLBW newborns consecutively observed in neonatal intensive care units (NICU) that presents feed intolerance. During the study period, two feeding strategies were adopted: total parenteral nutrition (PN) (group 1) or PN plus MEF (group 2), for at least 24 h. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of hospitalization, the occurrence of necrotizing enterocolitis (NEC) Bell stage >II and death. Results: In total, 102 newborns were evaluated: 51 in group 1, and 51 in group 2. Neonates in group 2 achieved full enteral nutrition earlier (8 days, interquartile range [IQR] 5) compared with subjects receiving total PN (11 days, IQR 5, p < 0.001). A reduction of sepsis episodes was observed in group 2 (15.7%) compared with group 1 (33.3%, p = 0.038). Additionally, subjects in group 2 regained their birth weight and were discharged earlier. The occurrence of NEC and death were similar in the two groups. Conclusion: Minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death. [source] Metabolic effects in neonates receiving intravenous medium-chain triglyceridesACTA PAEDIATRICA, Issue 2 2002G Angsten The effects of two lipid emulsions, one with 50% each of medium-chain and long-chain triglycerides, and a long-chain triglycerides lipid emulsion as a control, were evaluated for lipid and carnitine metabolism and respiratory quotient when given to neonates after major surgery during a short period of total parenteral nutrition. Each group included 10 neonates, and all tolerated the total parenteral nutrition well. The relative contents of linoleic acid and ,-linolenic acid increased in all lipid esters in plasma and adipose tissue in both groups, indicating that the content of these fatty acids is sufficient even in the medium-chain triglycerides emulsion. The serum concentration of ketones was within normal limits. Free fatty acids in plasma did not increase in either group. The total plasma carnitine concentration decreased in both groups but the distribution of free carnitine and acylcarnitine did not change. The total muscle carnitine did not change significantly but the ratio of acylcarnitine to free carnitine tended to increase in muscle in the treatment group, probably an effect of the medium-chain triglyceride supplementation. Conclusions: The two groups displayed the same fatty acid pattern in plasma and adipose tissue and the same respiratory quotient during the treatment period. Regarding carnitine status, essentially the same changes were seen in the two groups. However, discrete changes were seen in muscle tissue in the treatment group. [source] Selenium status, kwashiorkor and congestive heart failureACTA PAEDIATRICA, Issue 8 2001MJ Manary Selenium deficiency is associated with congestive heart failure (CHF) in geographic areas where dietary selenium intake is low and in individuals receiving total parenteral nutrition. Among 66 children with kwashiorkor (including marasmic-kwashiorkor), those who developed CHF had lower serum selenium concentrations than those who did not (32.9 ±8.3 vs 41.1 ± 11.9 Lig/L, meaniSD, p= 0.03). This association was independent of serum albumin and selenium status was not associated with severity of symptoms, anthropometric indices or HIV infection. Conclusion: This association raises the possibility that selenium may contribute to CHF in kwashiorkor. [source] | |||||||||||||||||||||||||