Peritoneovenous shunt for hydrothorax associated with ascites.

Two patients with massive hydrothorax associated with ascites resistant to intensive long-term medical management were treated by insertion of a peritoneovenous (LeVeen) shunt. In each case the effusion was resolved within one month after insertion. With one revision each, the two shunts have remained clear for nine and 18 months.

Serum protein response to surgery and starvation.

To investigate the effect of stress on the dynamics of serum protein response during starvation, serum albumin, prealbumin, and transferrin changes were studied in six chair-adapted macaques during two separate 7-day test periods: (1) Starvation--NPO + IV D5/W (100 cc/kg/day), and (2) Surgery/starvation--laparotomy and gastrostomy + NPO + IV D5/W (100 cc/kg/day). During the starvation period, transferrin was the only protein that decreased from baseline values and did so at day 7 of the study period. In contrast, during the period of starvation following surgery, both prealbumin and transferrin were significantly decreased at both day 4 and day 7 of the study period, whereas albumin was only decreased at day 7 of this period.

Evaluation of 5'-nucleotide phosphodiesterase isozyme-V as a predictor for liver metastasis in breast cancer patients.

5'-nucleotide phosphodiesterase isozyme-V (5'-NPD-V) was evaluated in 85 biopsy proven breast cancer patients as a potential marker for early liver metastasis. It correctly predicts liver metastasis in 6/7 (85.7%) patients with abnormal radiologic liver scan and 2/2 other patients with palpable liver.

Radiographic findings in the esophagus following the Sugiura procedure.

Sixteen patients underwent a modification of the Sugiura procedure for bleeding esophageal varices, involving (a) esophageal transection, (b) splenectomy, (c) selective vagotomy, and (d) pyloroplasty. Five patients died, and the remaining 11 had barium studies of the esophagus and stomach which were compared with the preoperative appearance. Esophageal varices disappeared in 7 patients and persisted in 1.

Intestinal fatty acid esterification activity in jejunoileal bypass patients.

In four patients undergoing reversal of jejunoileal bypass we compared functional (in continuity) with bypassed intestine in order to determined the effects of luminal contents. Total mucosal thickness, villus height, and crypt depth, as well as in vitro fatty acid esterification activity were determined. Morphological studies in segments exposed to luminal contents revealed that the ileum had a greater mucosal thickness than the jejunum (p less than 0.

Effect of parenteral nutrition on protein synthesis in adult cancer patients.

The rate of whole body protein synthesis was measured with 15N glycine in three groups of subjects: 1) normal healthy adult controls, 2) semistarved adult patients with upper gastrointestinal tract malignancies and, 3) a group of patients similar to 2) except they were maintained parenterally on a regimen adequate in amino acids and glucose. By comparing the patient results with data obtained from rat studies with 15N glycine were concluded that the patients were protein rather than energy depleted.

The efficacy of nutritional assessment and support in cancer surgery.

Malnutrition is common in cancer patients and may be an important determinant of operative morbidity and mortality. To determine whether preoperative nutritional assessment can be used to identify a group of high-risk patients, and whether preoperative TPN decreases morbidity and mortality in this group, retrospective, nonrandomized review of 159 patients who were subjected to major cancer surgery was performed. All patients underwent preoperative multiparameter assessment.

Successful long-term percutaneous decompression of the biliary tract.

The efficacy of percutaneous transhepatic biliary drainage for long-term (greater than 3 months) decompression of biliary obstruction was evaluated in 35 patients with benign (10) and malignant (25) obstructing lesions. The results indicate that such drainage is a safe and effective means for long-term decompression of the biliary tract in selected patients, especially patients who are poor operative risks and those with metastatic or nonresectable malignancy. In addition, the procedure provides access to the biliary tract for percutaneous dilatation of selected common duct or anastomotic strictures.

Dilatation of severe esophageal strictures by an inflatable balloon catheter.

Most benign strictures of the esophagus can be successfully dilated with conventional bougienage techniques. Occasionally strictures are so severe, lengthy, or irregular that these techniques fail, and surgery is required. We describe 2 patients with such severe esophageal strictures that conventional techniques were initially unsuccessful.

Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support.

A previously developed and validated predictive nutritional assessment model (Prognostic Nutritional Index) was applied to a heterogenous surgical population. Without knowledge of the then undeveloped PNI, adequate preoperative nutritional repletion (TPN) was provided on clinical indications alone to 50 of 145 patients with the remaining 95 patients receiving no preoperative total parenteral nutrition. Analysis of the two groups found no baseline differences in nutritional status, type and severity of disease and/or operative therapy, and other potentially important variables.

Cronkhite-Canada syndrome: report of an unusual case.

This report describes the findings in a 58-yr-old woman with multiple gastrointestinal polyps, associated with diarrhea, abdominal discomfort, hypoalbuminemia, alopecia, nail atrophy, and pigmentary changes. The patient met the criteria of the Cronkhite-Canada syndrome. Pathological evaluation of her polyps revealed regenerative (inflammatory) pseudopolyps, rather than true adenomatous polyps recorded in some earlier descriptions of patients with this syndrome.

Hyperalimentation in primates. A nutritional model.

To establish the subhuman primate as an effective laboratory animal in parenteral nutrition research, 18 male macaque monkeys were adapted to chronic chair restraint and maintained on intravenous nutrition for 1- and 2-week periods. The animals remained in the restraint chairs for 11.6 +/- (2.

Host-tumor interaction and nutrient supply.

Adequate parenteral nutritional support improves nutritional status in cancer patients, but its effect on tumor growth remains controversial. Using a transplantable mammary adenocarcinoma in a rat-TPN model, the relative effect of different exogenous intravenous nutrients on tumor growth and host maintenance was studied. Relative to chow controls, starvation increased host depletion without reducing tumor growth.

Protein synthesis dynamics in human gastrointestinal malignancies.

The malnourishing effects of cancer and its treatments haveprovided a strong clinical incentive for the nutritional support of cancer patients with intravenous hyperalimentation (IVH), but potential enhancement of tumor growth by additional substrate provision has generated concern. Twenty-five patients undergoing surgical treatment for gastrointestinal cancer were studied on one of two preoperative dietary regimens: ad libitum oral diet or intravenous hyperalimentation. Using a stable isotope tracer, N-glycine, in vivo tissue fractional protein synthesis rates were determined from operative specimens of tumor and normal gastrointestinal tissue.

Prognostic nutritional index in gastrointestinal surgery.

Based on assessment of 161 nonemergency general surgical patients, a multiparameter index of nutritional status was defined relating the risk of postoperative complications to baseline nutritional status. When applied prospectively to 100 gastrointestinal surgical patients, this index provided an accurate, quantitative estimate of operative risk, permitting rational selection of patients to receive preoperative nutritional support.

Delayed esophageal perforation after pneumatic dilatation for the treatment of achalasia.

Two cases of delayed esophageal perforation following a pneumatic dilatation for the treatment of achalasia are presented. Esophagrams obtained immediately after pneumatic dilatation failed to reveal a perforation. Increasing symptoms prompted repeat contrast studies, at which time an esophageal perforation was demonstrated.

Percutaneous decompression of benign and malignant biliary obstruction.

Percutaneous transhepatic catheterization of the biliary tree was performed in 41 patients with obstructive jaundice. In 39 patients, the catheter was successfully advanced past the obstructing lesion into the distal common duct and duodenum to establish internal biliary drainage. The remaining two patients had the obstructed biliary tract drained externally.

Implications of malnutrition in the surgical patient.

The substantial prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative nutritional and immunological assessment was performed prospectively on admission in 64 consecutive surgical patients. Factors measured included weight loss, triceps skinfold, midarm muscle circumference, creatinine-height index, serum albumin level, serum transferrin level, total lymphocyte count, serum complement level, serum immunoelectrophoresis, lymphocyte T rosettes formation, neutrophil migration, and delayed hypersensitivity.

Assessment of peritoneojugular shunts by direct roentgenographic examination.

The silicone rubber tubing of the LeVeen peritoneojugular shunt can be safely punctured with a 23 gauge needle. Radiopaque contrast material can be injected through the needle to delineate the cause of any obstruction to the venous tubing.