A comparison of the effect of elemental and immune-enhancing polymeric jejunal feeding on exocrine pancreatic function

BACKGROUND

There are few studies examining the effect of jejunal feeding on pancreatic exocrine output. The purpose of this study was to compare the effects of jejunal feeding with an elemental formula (EF) and with a polymeric immune-enhancing formula (PIEF) on pancreatic exocrine function.

METHODS

Patients undergoing a partial pancreatectomy had a jejunal feeding tube inserted and a pancreatic stent exteriorized, facilitating collection of pancreatic secretions. Postoperatively, patients underwent a secretin-stimulation test to document adequate pancreatic reserve. Patients were then randomized to receive jejunal feeding with EF or with PIEF for a 24-hour period, followed by a washout period of feeding with dextrose, and subsequent jejunal feeding with EF or PIEF.

RESULTS

The secretin-stimulation test demonstrated significant pancreatic reserve in all patients. There was a mild increase in pancreatic exocrine secretion with jejunal feeding with EF and PIEF compared with baseline and with dextrose. There was increased bicarbonate secretion with EF compared with PIEF, but there were no other significant differences in pancreatic exocrine function.

CONCLUSIONS

In this model of partial pancreatectomy, there was no significant difference in pancreatic exocrine output when use of an EF was compared with use of a PIEF for jejunal feeding. Further clinical studies are needed to determine the potential role of PIEF in pancreatic disease.

Does jejunal feeding with a polymeric immune-enhancing formula increase pancreatic exocrine output as compared with TPN? A case report

This case report compares the pancreatic output with different feeding regimes in a patient who underwent a partial pancreatectomy for carcinoma of the ampulla of Vater. A postoperative secretin stimulation test demonstrated significant pancreatic reserve. There was no difference in pancreatic exocrine secretion when the patient was fed jejunally with a polymeric immune-enhancing formula or supported with two different formulations of total parenteral nutrition. This result suggests that jejunal infusion of a polymeric immune-enhancing formula may be safe to administer in patients with acute pancreatitis.

Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters

BACKGROUND

Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use peripherally inserted central catheters (PICCs). This development has occurred without controlled clinical trials.

METHODS

Over a 10-year period, the nutrition support service at a single institution has prospectively collected data on CVADs used for providing PN. The types of CVAD used for providing PN were analyzed, and the major complications associated with CVADs, thrombosis and line sepsis, were compared over three different time periods: 1988-1989; 1992-1993; 1996-1997. In addition, complications associated with PICCs were compared with other CVADs.

RESULTS

The following were the dominant CVADs over each of the three time periods: 1988-1989: tunneled catheters, 80%; 1992-1993: nontunneled catheters, 46%; and 1996-1997: PICCs, 48%. There was a decreased incidence of sepsis and pneumothorax in 1996-1997 and an increase in severed or leaking catheters and phlebitis. In a comparison of PICC and non-PICC catheters over the past 3 years, there was a trend toward decreasing sepsis with PICC catheters but an increase in malposition, inadvertent removal, and severed or leaking catheters.

CONCLUSIONS

PICCs have replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition.

Diagnostic laparoscopy in primary and secondary infertility

PURPOSE

Our purpose was to compare the diagnostic efficacy of laparoscopy between primary and secondary infertility and to define a subgroup in which the positive findings are low.

METHODS

A retrospective review of the cases of 206 infertile women who underwent laparoscopy was conducted.

RESULTS

Eighty-two (39.8%) patients were found to have evidence of pelvic disease--20 (22.2%) with primary infertility and 62 (54.3%) with secondary infertility. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. In only 3 of the 20 patients with primary infertility was there no history of an abdominal operation, pelvic inflammatory disease, or an abnormal hysterosalpingography. Of the 62 women who suffered secondary infertility and had positive findings in laparoscopy, 15 had no history of suspect findings.

CONCLUSIONS

The diagnostic yield of laparoscopy for primary infertility in the absence of indications of mechanical factors is low. Therefore the need for diagnostic laparoscopy in these cases should be reconsidered.

Body composition in quadriplegic patients

The nutritional state of 12 patients with quadriplegia, secondary to spinal cord injury, was assessed by determining body composition with a multiple isotope dilution technique. For comparative purposes, similar measurements were obtained in 25 normal volunteers. The mean duration of quadriplegia was 14.8 +/- 8.5 months. All the patients were hospitalized, receiving a regular hospital diet and all were on a similar rehabilitation program. Because skeletal muscle atrophy is extensive in quadriplegics, we had expected a reduced body size, which was otherwise normal in composition, with a comparable decrease in both the body cell mass (BCM) and the extracellular mass (ECM). Instead, a body composition characteristic of malnutrition was observed in an unexpectedly large percentage (58%) of patients. In the normally nourished individual, the BCM and ECM are approximately equal in size. However, in seven of the 12 quadriplegic patients, the body composition was characteristic of malnutrition, with a BCM (13.5 +/- 1.6 kg) which was reduced relative to the ECM (28.7 +/- 1.9 kg). Their body composition was significantly (p less than 0.05) different from the body composition of both the healthy volunteers and the other five quadriplegic patients, whose body composition was normal (BCM = 22.9 +/- 1.5 kg, ECM = 28.5 +/- 1.6 kg). The nutritional state of the quadriplegic patients correlated significantly with the level of spinal cord injury and not with the duration of quadriplegia.

The inlet patch: heterotopic gastric mucosa in the upper esophagus

Careful endoscopic survey of the upper esophagus indicates that a visually recognizable patch of gastric mucosa is grossly visible much more commonly than is generally recognized. Sixteen instances were found in 420 sequential endoscopies, an incidence of 3.8%. The gastric mucosal rest presented as a velvety red patch with a distinct border, varying from a few millimeters in diameter to complete encirclement of the esophagus, was occasionally paired, and was found either at or just below the upper esophageal sphincter. In all instances except one the patch consisted of gastric-type mucosa containing both parietal and chief cells; in the single exception, it consisted of gastric-type mucous glands without parietal cells. Although larger patches can be shown to function under stimulation (they produce a local drop in pH with pentagastrin stimulation), there are usually no apparent associated clinical symptoms.

Randomized, double-blind comparison of cefotaxime, cefoxitin, cefazolin or placebo as prophylaxis during gastric, small bowel or complicated biliary surgery

In a double-blinded trial, 142 patients were randomized to receive placebo, cefazolin, cefoxitin or cefotaxime during high-risk gastroduodenal, biliary tract or small bowel surgery. Of the 125 evaluable patient trials, postoperative wound infection or intra-abdominal sepsis developed in 14/29 (48%) of placebo controls, 8/24 (33%) cefazolin, 7/37 (19%) cefoxitin, and in 2/35 (6%) of cefotaxime recipients. When patients undergoing vagotomy and pyloroplasty with prior cimetidine therapy were excluded, cefotaxime was superior to cefoxitin prophylaxis (2/26 versus 7/28, P = 0.014). Cefotaxime may be useful as a prophylactic agent in high-risk upper gastrointestinal surgery.

Testicular function in patients with familial Mediterranean fever on long-term colchicine treatment

Sperm counts and hormonal studies were carried out in six patients with familial Mediterranean fever who were receiving long-term colchicine therapy. The duration of therapy ranged between 7 and 31 months. In all subjects, spermograms, testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels were within normal limits.