Gastrointestinal Insufficiency Research Articles

Controlled mechanical hypoventilation in a paediatric burn patient as treatment of acute respiratory distress syndrome

The paediatric patient we are describing suffered a scald injury covering 83 per cent of the total body surface area (TBSA). This injury was complicated by Klebsiella pneumoniae septicaemia resulting in multiorgan failure (MOF). Acute respiratory distress syndrome (ARDS), gastrointestinal insufficiency, hepathopathy and wound conversion to full thickness posed the main problems. The boy was ventilated with pressure-controlled mechanical ventilation. The concept of permissive hypercapnia (PHC) resulted in a complete resolution of ARDS within 4 weeks. From our experience, further lung injury among infants and children suffering from severe ARDS can be avoided by using controlled mechanical hypoventilation. It is a simple and safe technique that allows adequate oxygenation.

Granulocyte Colony-Stimulating Factor for Gastrointestinal Perforation in Patients with Leukopenia

Leukopenia in the setting of widespread infection may predispose to sepsis, which is associated with a poor prognosis. Granulocyte colony-stimulating factor (G-CSF), which restores polymorphonuclear leukocyte function and count, has been shown to have protective effects in animal models of sepsis and burns. The aim of this retrospective study was to determine whether G-CSF can reduce the morbidity and mortality gastrointestinal perforation with leukopenia. The studied subjects were 31 patients who had reduced leukocyte and neutrophil counts before undergoing surgery for gastrointestinal perforation, including six gastroduodenal, nine small intestinal, and 16 colonic perforations from 1986 to 1994. The patients were divided into two groups: a G-CSF(+) group (n = 8) that received G-CSF subcutaneously (150 microgram/day) during the perioperative period, and a G-CSF(-) group which did not. No significant difference was found in the preoperative and operative factors of the two groups. The postoperative increase in the leukocyte and polymorphonuclear cell counts of the G-CSF(+) group was significantly higher than that of the G-CSF(-) group (p <0.01). Renal, hepatic, and gastrointestinal insufficiency was significantly less common in the G-CSF(+) group than in the G-CSF(-) group. The mean number of organs that failed was reduced from 4.00 +/- 2.50 in the G-CSF(-) group to 1.88 +/- 2.03 in the G-CSF(+) group. One of the eight patients who received G-CSF died of sepsis because of panperitonitis. In contrast, in the G-CSF(-) group, 15 of 23 patients died of sepsis because of panperitonitis. The cause-specific survival rate of the G-CSF(+) group was better than that of the G-CSF(-) group (p <0.05). These results suggested that G-CSF reduced the morbidity and mortality of gastrointestinal perforation in patients with leukopenia and encouraged a prospective randomized study in future.

NUTRITION THERAPY FOR THE CANCER PATIENT

Malnutrition commonly occurs in cancer and adversely affects the quality of life and survival of patients. It is caused by a variety of factors, including decreased food intake, adverse effects from anticancer treatment, and wasteful metabolic processes. Over the past 2 decades, there have been major advances in methods and techniques of feeding patients with cancer and other disease. Special diets can be helpful in the treatment of a variety of conditions, some of which are outlined in Table 1. Enteral feeding is developing rapidly because endoscopic techniques have made it simpler to place feeding tubes, and a variety of enteral feeding solutions are commercially available. Enteral feeding is an effective way to deliver nutrients when patients are unable to ingest food because of neurologic disorders or structural abnormalities in the upper gastrointestinal tract, including the oropharynx, esophagus, and stomach. The role of enteral feeding as an adjuvant to anticancer therapy has not been fully evaluated. Parenteral nutrition is an effective method of delivering nutrients into the blood stream. It has proved to be life-saving for patients with chronic severe gastrointestinal insufficiency (such as short bowel or radiation enteritis), whose cancer is cured or nonprogressive. Numerous studies have assessed the role of TPN as an adjuvant therapy. To date, a clear benefit from its routine use has been demonstrated only in very limited, specific situations. As an adjuvant to chemotherapy, TPN does not seem to be useful, unless there are prolonged periods of gastrointestinal toxicity (as in the case with bone marrow transplantation) that severely limit oral intake and absorption. Malnourished surgical patients undergoing specific major operations for cancer may benefit from perioperative TPN. TPN as an adjunct therapy in the treatment of the cancer patient has to be individually evaluated and appropriately applied in situations in which it has proven beneficial in randomized studies.

Laboratory Diagnosis of Gastrointestinal Disease and Pancreatic Insufficiency

Laboratory Diagnosis of Gastrointestinal Disease and Pancreatic Insufficiency

High caloric glucose-nitrogen infusions. Postoperative management of neonatal infants.

Prolonged infusions of concentrated glucose-nitrogen solutions through central venous catheters have been shown by Dudrick and Wilmore to promote and maintain positive nitrogen balance. 1-4 These solutions may offer an important adjuvant to the postoperative management of surgical patients. The nutritional requirement of small infants is so critical that the use of this technique during even relatively short periods of gastrointestinal insufficiency may be justified. In many cases, it is difficult to predict at the onset how long such parenteral therapy will be required. This mode of therapy is potentially hazardous, if not carefully monitored, in neonatal infants because of the hypertonic nature of the solutions. 5,6 This paper reports the use of this technique in seven neonatal infants receiving relatively short-term high caloric parenteral therapy. Clinical Series Seven neonatal infants weighing between 1,100 and 2,770 gm (2.42 and 5.95 lb), average weight of 2,260 gm (4.98 lb), received high

Metabolic effects of small bowel reversal in treatment of the short bowel syndrome.

MASSIVE bowel resection remains a clinical catastrophe. 1 While patients who survive removal of 50% of the small bowel can live relatively normal lives, serious problems occur when less than 8 feet of bowel remains. Severe diarrhea, dehydration, hypovolemia, acidosis, electrolyte imbalance, renal failure, steatorrhea, hypoproteinemia, weight loss, and cachexia characterize the gastrointestinal insufficiency of the short-bowel syndrome. Small-bowel reversal is a method of increasing intestinal absorption after massive bowel resection. 2-4 The short antiperistaltic segment, anastomosed terminally to the remaining small bowel, maintains its functional polarity and acts as an incomplete small-bowel obstruction. 5 Gastrointestinal transit is delayed, and contact time between nutrients and intestinal mucosa is increased, allowing more effective absorption of foodstuffs from the bowel lumen. Hammer et al, 2 utilizing these facts, evaluated reversed segments in dogs after 80% bowel resection. Control animals with comparable amounts of gastrointestinal absorptive surface died from dehydration, electrolyte imbalance,

Gastrointestinal insufficiency after partial gastrectomy.

Acta Medica ScandinavicaVolume 158, Issue 2 p. 151-155 Gastrointestinal Insufficiency after Partial Gastrectomy JAN W. MURI, JAN W. MURI Aker Sykehus, Medical Department A, Oslo. (Chief: Prof. Roald Opsahl, M. D.)Search for more papers by this author JAN W. MURI, JAN W. MURI Aker Sykehus, Medical Department A, Oslo. (Chief: Prof. Roald Opsahl, M. D.)Search for more papers by this author First published: January/December 1957 https://doi.org/10.1111/j.0954-6820.1957.tb15757.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume158, Issue2January/December 1957Pages 151-155 RelatedInformation