Preoperative total parenteral nutrition (TPN) in severe Crohn's disease.

This study was performed to evaluate the effect of preoperative total parenteral nutrition (TPN) on the results after surgical treatment of patients with severe Crohn's disease. Of 67 patients admitted with complications of Crohn's disease, 51 had severe active disease and abdominal masses, fistulas and/or obstruction (mean Crohn's disease activity index score, 301). Forty-four patients received preoperative TPN for a mean period of 33 days.

A simple procedure for relieving obstruction of sump catheters.

A simple technique for the desobstruction of sump drains is described. The technique consists of disassembling the obstructed catheter, leaving the outer part in situ and cleaning the disengaged inner and outer parts. Proper function is regained after reassembly of the catheter.

gamma-Aminobutyric acid production in small and large intestine of normal and germ-free Wistar rats. Influence of food intake and intestinal flora.

In recent hypotheses concerning the pathogenesis of hepatic encephalopathy, gamma-aminobutyric acid (GABA) is claimed to be produced by the colonic flora, although enzymes necessary to generate GABA have been reported to be present in intestinal mucosa. In this study, using normal and germ-free Wistar rats, we determined GABA levels and amino-grams of arterial blood and of venous effluent from small and large bowel. The data indicate that large and small intestinal mucosa significantly contribute to GABA production.

Progression of a benign epithelial ampullary tumor to adenocarcinoma.

Benign tumors of the extrahepatic biliary ducts are rare. The high recurrence rate following local resection of these benign tumors is well known, but the development of one into a malignant tumor has received little attention. The recurrence 4 years after local excision of a benign periampullary tumor that developed into a well-differentiated papillar adenocarcinoma is described in this case report.

The value of computed tomography to the staging of non-small-cell primary bronchogenic carcinoma: a prospective study.

The value of computed tomography (CT) for the diagnosis of non-small-cell primary bronchogenic carcinoma with regard to T and N classifications was prospectively evaluated in a series of 29 patients. The sensitivity of CT in evaluating the extension of tumor to pleura or mediastinum was 100%, with only a 76% specificity. Computed tomography demonstrated 73 lymph nodes greater than or equal to 10 mm and 55 lymph nodes less than 10 mm in 27 patients.

[Ammonia and glutamine metabolism of the intestine. The effect of lactulose and neomycin].

The present work is directed to distinguish between ammonia production by the mucosa and by the intestinal flora, as well as to evaluate the influence of neomycin and lactulose. In vitro studies using rat intestine show that mucosa cells produce ammonia alanine and glutamic acid when incubated with glutamine, whose process can be impaired by neomycin or lactulose. Since the release of the above solutes is virtually the same in germ-free rats, the influence of the bacterial flora might be negligible under the experimental conditions used.

Fibronectin levels in stressed and septic patients fed with total parenteral nutrition.

Plasma fibronectin concentrations were measured in healthy persons as well as in septic and stressed patients. A decrease in plasma fibronectin concentration was shown in volunteers receiving a low energy (600 kcal), amino acids- and lipid-deficient diet. Increased fibronectin levels were measured in stressed and septic patients, not receiving enteral nutrition, after adequate total parenteral nutrition (TPN during 1 week).

Sequential metabolic characteristics following portacaval shunt in rats.

A portacaval shunt (PCS) model is frequently employed to study phenomena inherent in portal-systemic shunting of splanchnic blood. In many species, a PCS induces hepatic insufficiency, accompanied by encephalopathy. Rats operated on with a 'nonsuture' technique tolerate a PCS better and exhibit no or only slight encephalopathy.

Morphological effects of high dose neomycin sulphate on the small and large intestine.

The morphology of the intestinal wall and the activity of certain mucosal enzyme systems in the course of neomycin treatment were evaluated. Conventional and, to study the role of the bacterial flora, germ-free rats received 500 mg neomycin daily by stomach tube. Rats were sacrificed after seven days and small intestine (proximal and distal part) together with segments of the colon were removed and prepared for histochemistry.

The value of objective measurements to select patients who are malnourished.

Several studies have attempted to define nutritional parameters that can be used to select malnourished hospitalised patients for nutritional support. A combination of objective nutritional parameters was evaluated in a group of 50 patients selected for total parenteral nutrition on clinical grounds only and compared with a control group. This control group consisted of 38 patients who were admitted for elective minor surgical procedures such as varicectomy and hernia repair.

Gastro-intestinal fistulas: the role of nutritional support.

Over the decades the advent of advanced surgical techniques, antibiotics, management of acid-base and electrolyte disorders, monitoring and support of cardiorespiratory function, have greatly implemented the treatment of patients with gastro-intestinal fistulas, resulting in most series in a mortality of approximately 20%. The apparent clinical benefit of sophisticated parenteral nutrition has not further reduced mortality because in the seventies patients in most series were older, sicker, had more advanced cancer, underwent bigger operations and were more at risk in almost every respect. In recent series mortality is almost exclusively determined by uncontrolled sepsis.

Liver damage as a potential source of error in the estimation of myocardial infarct size from plasma creatine kinase activity.

The occurrence of liver damage was investigated in patients with uncomplicated acute myocardial infarction (AMI). Cumulative plasma release of creatine kinase (CK) and alpha-hydroxybutyrate dehydrogenase (HBD) was compared with release of alanine aminotransferase (ALT). Up to 48 h after AMI, the appearance of ALT could be fully explained by myocardial ALT release.

Complications of central venous catheterization of the subclavian vein: the influence of a parenteral nutrition team.

Early and late complications of central venous catheterization were investigated in 488 consecutive catheters, 389 introduced in the subclavian vein by a percutaneous puncture technique, 84 by a cut down technique of the cephalic vein, and 15 by a peel away technique. Care and introduction of the catheters was controlled by the parenteral nutrition team in 239 cases. Immediate and late complications were found using both the puncture and venous cut down techniques, but immediate complications differed in the two groups due to the different methods of insertion.

Prospective study on the incidence of complications of right heart catheterization.

Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction.

A palliative percutaneous drainage procedure for proximal bile duct carcinoma.

Proximal bile duct carcinoma is surgically irresectable in most patients and some form of palliative drainage is necessary. Percutaneous transhepatic drainage for this condition has been performed in eight patients through internal and external drainage. Five patients had an adequate drainage with a mean palliative drainage period of 11 months, the longest period being 21 months.

Percutaneous transhepatic drainage and insertion of an endoprosthesis for obstructive jaundice.

As a consequence of the good results with percutaneous transhepatic cholangiography using the Chiba needle, a similar technique was employed for percutaneous transhepatic drainage and insertion of a percutaneous transhepatic endoprostheses. Herein we have described the technique and results of percutaneous transhepatic cholangiography with the Chiba needle in 45 patients and of combined percutaneous transhepatic drainage and insertion of an endoprosthesis in a consecutive group of 69 patients with obstructive jaundice. In the latter group, 50 patients had a malignant lesion.

Ruptured abdominal aortic aneurysms presenting as radicular compression syndromes.

Two patients are described: one with an aneurysm of the infrarenal aorta and common iliac artery that ruptured posteriorly into the iliac vein, the other with an aneurysm of the distal abdominal aorta that ruptured posteriorly into the iliopsoas muscle. Both patients had symptoms compatible with a radicular compression syndrome. Ruptured aneurysm of one of the major abdominal arteries should be considered in the differential diagnosis of affections of the lumbosacral neural outflow, because immediate operation can be life-saving.

[Total parenteral nutrition (TPN) in oncology (author's transl)].

The role of TPN in oncology is, in spite of favourable reports, not yet settled. Selected undernourished cancer patients are certainly helped by parenteral nutrition during their course of therapy. Their nutritional status becomes better, their endurance to antineoplastic therapy is enhanced with less complications and more important, their "quality of life" is improved.