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Gliwska E, Głąbska D, Zaczek Z, Sobocki J, Guzek D. Influence of Enteral Nutrition on Quality of Life in Head and Neck Cancer and Upper Gastrointestinal Tract Cancer Patients within a Pair-Matched Sample. Nutrients 2023; 15:4698. [PMID: 37960351 PMCID: PMC10647548 DOI: 10.3390/nu15214698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Patients with cancers of the head and neck and upper gastrointestinal tract are particularly susceptible to malnutrition, which worsens both their prognosis and quality of life and may result in the need for enteral or parenteral nutrition. The aim of this study was to investigate the impact of enteral nutrition on the quality of life in a paired sample. This study included 50 patients with cancer in two paired subgroups: with enteral nutrition (studied group) and without enteral nutrition (matched group). This study was based on self-reports collected with the EORTC QLQ C30 questionnaire and retrospective analysis of medical records. The analysis revealed that weight loss, group type, and age were the primary factors influencing patients' quality of life. Compared with all cancer patients and the general Polish population, the scores of patients in both groups were below reference values for functional scales and exceeded reference values or were similar for fatigue and vomiting/nausea. Patients who received enteral nutrition more frequently scored lower on the functional scales and higher on the symptomatic scales than the control group. These findings emphasize the complex relationship between cancer, nutritional status, and quality of life.
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Affiliation(s)
- Elwira Gliwska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland; (Z.Z.); (J.S.)
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 27 Erazma Ciolka Street, 01-445 Warsaw, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland; (Z.Z.); (J.S.)
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Banasiewicz T, Machała W, Borejsza Wysocki M, Lesiak M, Krych S, Lange M, Hogendorf P, Durczyński A, Cwaliński J, Bartkowiak T, Dziki A, Kielan W, Kłęk S, Krokowicz Ł, Kusza K, Myśliwiec P, Pędziwiatr M, Richter P, Sobocki J, Szczepkowski M, Tarnowski W, Zegarski W, Zembala M, Zieniewicz K, Wallner G. Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects. Pol Przegl Chir 2023; 95:14-39. [PMID: 38084044 DOI: 10.5604/01.3001.0053.8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Waldemar Machała
- Klinika Anestezjologii i Intensywnej Terapii - Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej - Centralny Szpital Weteranów, Łódź
| | - Maciej Borejsza Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Maciej Lesiak
- Katedra i Klinika Kardiologii Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Sebastian Krych
- Katedra i Klinika Kardiochirurgii, Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM. Studenckie Koło Naukowe Kardiochirurgii Dorosłych. Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Lange
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Hogendorf
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Adam Durczyński
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Tomasz Bartkowiak
- Oddział Kliniczny Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej Uniwersytetu Medycznego w Łodzi
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej, Uniwersytet Medyczny we Wrocławiu
| | - Stanisław Kłęk
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii - Państwowy Instytut Badawczy im. Marii Skłodowskiej-Curie, Oddział w Krakowie, Kraków
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Krzysztof Kusza
- Katedra i Klinika Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Michał Pędziwiatr
- Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński - Collegium Medicum, Kraków
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawski Uniwersytet Medyczny, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Onkologicznej i Bariatrycznej CMKP, Szpital im. Prof. W. Orłowskiego, Warszawa
| | | | - Michał Zembala
- Wydział Medyczny, Katolicki Uniwersytet Lubelski Jana Pawła II w Lublinie
| | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby, Warszawski Uniwersytet Medyczny, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer. Cancers (Basel) 2023; 15:3816. [PMID: 37568634 PMCID: PMC10417457 DOI: 10.3390/cancers15153816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with pancreatic cancer who develop irreversible cancer cachexia have a life expectancy of less than 3 months. Therefore, it is extremely important to evaluate the patient's nutritional status as early as possible and to implement an appropriate nutritional intervention in order to reduce the risk of further weight loss and/or muscle loss, which affect the outcomes of cancer treatment and the correct nutritional treatment in patients with pancreatic cancer. A literature review was performed by using the PubMed and Cochrane quick search methodology. The main purpose of this review was to present the current approach to nutritional treatment in pancreatic cancer. The review included publications, most of which concerned clinical nutrition as part of the phase of treatment of patients with pancreatic cancer, nutritional and metabolic disorders in pancreatic cancer, and the period after pancreatic resection. Some of the publications concerned various nutritional interventions in patients with pancreatic cancer undergoing chemotherapy or surgical treatment (nutritional support before surgery, after surgery, or during palliative treatment). There is an unmet need for integrated nutritional therapy as a key part of the comprehensive care process for PC patients. Nutritional counseling is the first line of nutritional treatment for malnourished cancer patients, but pancreatic enzyme replacement therapy also constitutes the cornerstone of nutritional treatment for relieving symptoms of indigestion and maintaining or improving nutritional status.
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Affiliation(s)
- Dominika Mękal
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Anna Badowska-Kozakiewicz
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland;
| | - Elżbieta Cipora
- Medical Institute, Jan Grodek State University, 38-500 Sanok, Poland;
| | - Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland;
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, 01-445 Warsaw, Poland;
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
| | - Andrzej Deptała
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M, Banasiewicz T, Budzyński A, Dziki A, Grąt M, Jackowski M, Kielan W, Matyja A, Paśnik K, Richter P, Szczepanik A, Szura M, Tarnowski W, Zieniewicz K. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part I. Wideochir Inne Tech Maloinwazyjne 2023; 18:187-212. [PMID: 37680734 PMCID: PMC10481450 DOI: 10.5114/wiitm.2023.127877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Dąbrowska K, Zaczek Z, Panczyk M, Osowska S, Kowalczyk P, Kramkowski K, Sobocki J. Molecular Oxygen Levels and Percentages of DNA Damage in TPN Patients. Nutrients 2023; 15:2206. [PMID: 37432338 DOI: 10.3390/nu15092206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
Total parenteral nutrition (TPN) is a life-saving therapy for patients with intestinal failure, but it carries the risk of complications, including an increase in liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) after long-term use. Patients receiving chronic TPN are also exposed to metabolic stress from both the underlying disease and parenteral nutrition. The aim of this study was to compare the concentration of liver transaminases AST and ALT in relation to the rate of oxygen consumption in platelet mitochondria in patients receiving long-term TPN with the degree of oxidative stress induced by lipid emulsions, and to explain their role in cellular energy metabolism and changes in the liver based on the percentage of genomic DNA damage. The study group consisted of 86 TPN patients, while the control group consisted of 86 healthy volunteers who were fed only orally. The results of the study showed that the percentage of molecular oxygen depended on the type of lipid emulsion supplied. Analyzing time on TPN as a factor, we observed a decrease in percentage genomic DNA damage and an increase in percentage molecular oxygen in cells. It remains unclear whether TPN has a direct effect on genomic DNA damage and the level of molecular oxygen in cells during the course of treatment. In conclusion, this study provides important insights into the potential effects of TPN on liver enzymes and cellular metabolism. Further research is needed to better understand the underlying mechanisms and to develop strategies to minimize the risk of complications associated with TPN.
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Affiliation(s)
- Karolina Dąbrowska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Erazma Ciołka 27, 01-445 Warsaw, Poland
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Erazma Ciołka 27, 01-445 Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Litewska 14/16, 00-581 Warsaw, Poland
| | - Sylwia Osowska
- Department of Applied Pharmacy, Warsaw Medical University, Banacha 1, 02-097 Warszawa, Poland
| | - Paweł Kowalczyk
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-110 Jablonna, Poland
| | - Karol Kramkowski
- Department of Physical Chemistry, Medical University of Bialystok, Kilińskiego 1, 15-089 Bialystok, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
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Klek S, Rymarowicz J, Sobocki J, Banasiewicz T, Pędziwiatr M, Dziki A, Jackowski M, Jankowski M, Kawecki D, Kielan W, Konturek A, Mitura K, Murawa D, Lorenc Z, Matras P, Myśliwiec P, Richter P, Słodkowski M, Strzelczyk J, Szczepanik A, Szczepkowski M, Szura M, Tarnowski W, Śmietański M, Zieniewicz K, Wallner G. Recommendations for modern perioperative care for elective surgery: consensus of panel of exerts. Pol Przegl Chir 2023; 95:1-5. [PMID: 36808061 DOI: 10.5604/01.3001.0016.2732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Correct surgical technique and perioperative care are two factors that can reduce the number of complications, improve treatment outcomes and shorten the length of hospital stay. The introduction of enhanced recovery protocols has changed the approach to patient care in some centers. However, there are significant differences among centers, and in some the standard of care has remained unchanged. AIM the goal of the panel was to develop recommendations for modern perioperative care in accordance with current medical knowledge in order to reduce the number of complications associated with surgical treatment. An additional goal was to optimize and standardize perioperative care among Polish centers. MATERIALS AND METHODS the development of these recommendations was based on a review of the available literature from the PubMed, Medline and Cochrane Library databases from January 1, 1985 to March 31, 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and were assessed using the Delphi method. RESULTS AND CONCLUSIONS 34 recommendations for perioperative care were presented. They cover aspects of pre-, intra- and post-operative care. Implementation of the presented rules allows to improve the results of surgical treatment.
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Affiliation(s)
- Stanislaw Klek
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii-Państwowy Instytut Badawczy, Oddział w Krakowie
| | - Justyna Rymarowicz
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej, Metabolicznej i Stanów Nagłych, II Katedra Chirurgii CMUJ, Kraków
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
| | - Tomasz Banasiewicz
- Katedra i Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej Uniwersytetu Medycznego im K. Marcinkowskiego w Poznaniu
| | - Michał Pędziwiatr
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej, Metabolicznej i Stanów Nagłych, II Katedra Chirurgii CMUJ, Kraków
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Marek Jackowski
- Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej Collegium Medicum w Bydgoszczy UMK, Toruń
| | - Michał Jankowski
- Katedra Chirurgii Onkologicznej Collegium Medicum Uniwersytetu Mikołaja Kopernika, Oddział Chirurgii Onkologicznej Centrum Onkologii im. Łukaszczyka w Bydgoszczy
| | - Dariusz Kawecki
- Katedra i Zakład Mikrobiologii Lekarskiej, Warszawski Uniwersytet Medyczny, Warszawa
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej Uniwersytetu Medycznego we Wrocławiu
| | - Aleksander Konturek
- Oddział Kliniczny Chirurgii Ogólnej Szpital Uniwersytecki, Klinika Chirurgii Endokrynologicznej III Katedry Chirurgii Ogólnej UJ CM w Krakowie
| | - Kryspin Mitura
- Wydział Nauk Medycznych i Nauk o Zdrowiu, Uniwersytet Przyrodniczo-Humanistyczny w Siedlcach, Oddział Chirurgii Ogólnej Szpital Miejski SP ZOZ w Siedlcach
| | - Dawid Murawa
- Katedra Chirurgii i Onkologii Collegium Medicum Uniwersytetu Zielonogórskiego. Klinika Chirurgii Ogólnej i Onkologicznej Szpitala Uniwersyteckiego w Zielonej Górze
| | - Zbigniew Lorenc
- Kliniczny Oddział Chirurgii Ogólnej, Kolorektalnej i Urazów Wielonarządowych, Szpital Wojewódzki nr 5 im. Św. Barbary, Sosnowiec
| | - Przemysław Matras
- Oddział Chirurgii Ogólnej i Leczenia Żywieniowego SPSK 4 w Lublinie, Zakład Żywienia Klinicznego Uniwersytet Medyczny w Lublinie
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Maciej Słodkowski
- Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej WUM, Warszawa
| | - Janusz Strzelczyk
- Kliniki Chirurgii Ogólnej i Transplantacyjnej Uniwersytet Medyczny w Łodzi
| | - Antoni Szczepanik
- Oddział Kliniczny Chirurgii Ogólnej Szpital Uniwersytecki, Klinika Chirurgii Endokrynologicznej III Katedry Chirurgii Ogólnej UJ CM w Krakowie
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Mirosław Szura
- Klinika Chirurgii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum, Kraków
| | - Wiesław Tarnowski
- Klinika Chirurgii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum, Kraków
| | | | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby Warszawskiego Uniwersytetu Medycznego, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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8
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Osowska S, Kunecki M, Sobocki J, Tokarczyk J, Majewska K, Burkacka M, Radkowski M, Makarewicz-Wujec M, Fisk HL, Mashnafi S, Baumgartner S, Plat J, Calder PC. Potential for Omega-3 Fatty Acids to Protect against the Adverse Effect of Phytosterols: Comparing Laboratory Outcomes in Adult Patients on Home Parenteral Nutrition Including Different Lipid Emulsions. Biology (Basel) 2022; 11:biology11121699. [PMID: 36552209 PMCID: PMC9774711 DOI: 10.3390/biology11121699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND the effect on liver function markers and inflammation of the different content of phytosterols in lipid emulsions (LEs) used in the parenteral nutrition (PN) regimen of adult home PN (HPN) patients is not clear. METHODS plasma phytosterol and cytokine concentrations, fatty acid composition, liver function markers, and triglycerides were measured in 58 adult HPN patients receiving one of three different LEs (soybean oil-based: Intralipid; olive oil-based: ClinOleic; containing fish oil: SMOFLipid). RESULTS patients receiving Intralipid had higher plasma campesterol and stigmasterol concentrations than those receiving ClinOleic or SMOFLipid. Plasma sterol concentrations were not different between patients receiving ClinOleic and SMOFLipid. Differences in plasma fatty acids reflected the fatty acid composition of the LEs. Markers of liver function did not differ among the three groups. Blood triglycerides were higher with ClinOleic than with Intralipid or SMOFLipid. Total bilirubin correlated positively with the plasma concentrations of two of the phytosterols, ALT correlated positively with one, AST with one, and GGT with three. CONCLUSIONS liver function markers correlate with plasma plant sterol concentrations in adult HPN patients. Adult HPN patients receiving SMOFLipid are more likely to have liver function markers and triglycerides within the normal range than those receiving ClinOleic or Intralipid. The omega-3 fatty acids in SMOFLipid may act to mitigate the adverse effects of plant sterols on liver function.
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Affiliation(s)
- Sylwia Osowska
- Applied Pharmacy Department, Warsaw Medical University, 02-097 Warsaw, Poland
- Centre of Clinical Nutrition, Pirogow Hospital, 90-531 Lodz, Poland
- Correspondence:
| | - Marek Kunecki
- Centre of Clinical Nutrition, Pirogow Hospital, 90-531 Lodz, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, 00-416 Warsaw, Poland
| | - Joanna Tokarczyk
- Centre of Clinical Nutrition, Pirogow Hospital, 90-531 Lodz, Poland
| | - Krystyna Majewska
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, 00-416 Warsaw, Poland
| | | | - Marek Radkowski
- Department of Immunopathology, Warsaw Medical University, 02-097 Warsaw, Poland
| | | | - Helena L. Fisk
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Sultan Mashnafi
- Department of Nutrition and Movement Sciences, NUTRIM School of Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Sabine Baumgartner
- Department of Nutrition and Movement Sciences, NUTRIM School of Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, NUTRIM School of Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Philip C. Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
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9
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Madariaga A, Lau J, Dzierżanowski T, Ghoshal A, Larkin P, Sobocki J, Dickman A, Furness K, Fazelzad R, Crawford GB, Lheureux S. Response to Cleary et al. re MASCC evidence-based recommendations for the management of malignant bowel obstruction. Support Care Cancer 2022; 30:7825-7826. [PMID: 35902407 DOI: 10.1007/s00520-022-07304-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ainhoa Madariaga
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
- Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical Oncology, 12 Octubre University Hospital, Madrid, Spain
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Tomasz Dzierżanowski
- Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Arunangshu Ghoshal
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Andrew Dickman
- Academic Palliative and End of Life Care Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England, UK
| | - Kate Furness
- Department of Dietetics, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rouhi Fazelzad
- Library and Information Services, University of Health Network, Toronto, Canada
| | - Gregory B Crawford
- Northern Adelaide Palliative Service, Northern Adelaide Local Health Network, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephanie Lheureux
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada.
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10
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Madariaga A, Lau J, Ghoshal A, Dzierżanowski T, Larkin P, Sobocki J, Dickman A, Furness K, Fazelzad R, Crawford GB, Lheureux S. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer 2022; 30:4711-4728. [PMID: 35274188 PMCID: PMC9046338 DOI: 10.1007/s00520-022-06889-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. METHODS The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions. RESULTS The systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided. CONCLUSION This MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.
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Affiliation(s)
- Ainhoa Madariaga
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Autonomous University of Barcelona, Barcelona, Spain.,12 Octubre University Hospital, Madrid, Spain
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Arunangshu Ghoshal
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Tomasz Dzierżanowski
- Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Andrew Dickman
- Academic Palliative and End of Life Care Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England, UK
| | - Kate Furness
- Department of Dietetics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Rouhi Fazelzad
- Library and information services, University of Health Network, Toronto, Canada
| | - Gregory B Crawford
- Northern Adelaide Palliative Service, Northern Adelaide Local Health Network, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephanie Lheureux
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
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11
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Zaczek Z, Jurczak-Kobus P, Panczyk M, Braszczyńska-Sochacka J, Majewska K, Kunecki M, Dąbrowska K, Sobocki J. Changes in Parenteral Nutrition Requirements and BMI in Patients with Parenteral Nutrition-Dependent Short Bowel Syndrome after Stopping Teduglutide-9 Years of Follow-Up. Nutrients 2022; 14:nu14081634. [PMID: 35458196 PMCID: PMC9024979 DOI: 10.3390/nu14081634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
Teduglutide (TED) is widely used in patients with short-bowel-syndrome-associated intestinal failure (SBS-IF) to enhance intestinal adaptation and reduce the need for parenteral support (PS). There are limited data on the effects of discontinuing TED. In this study, we describe the changes in parenteral nutrition (PN) requirements and body mass index (BMI) in a 9-year follow-up of patients receiving home parenteral nutrition after discontinuation of the TED treatment. We performed a retrospective analysis of changes in weekly PN orders and BMI in all patients with PN-dependent SBS from two Polish home parenteral nutrition (HPN) centers who received teduglutide between 2009 and 2013 and still required HPN 9 years after discontinuation of the TED treatment. Data included in the analysis were collected prospectively at mandatory visits to the HPN centers at 12, 24, 60, 84, and 108 months after drug discontinuation and compared with values before and after TED treatment. Weekly PN volume values varied significantly between all of the above time points from baseline to 9 years after TED discontinuation (χ2 = 34.860, p < 0.001). After an initial increase within the first year after treatment discontinuation (not statistically significant), the PN volume requirements remained stable for 4 years and increased 5−9 years after treatment discontinuation. The rate of patients requiring an increase in PN volume was 84.62% at 60 and 84 months and 92.30% at 108 months. At 9 years after cessation of the TED treatment, 53.85% of the study group required a 21.21% increase in PN volume compared with values before treatment. The need for PN volume in patients with PN-dependent SBS who discontinued the TED treatment increased within the first year and 4−5 years after treatment cessation, and in some cases might even exceed pretreatment values after 9 years.
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Affiliation(s)
- Zuzanna Zaczek
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Erazma Ciołka 27, 01-445 Warsaw, Poland
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Czerniakowska 231, 00-416 Warsaw, Poland; (P.J.-K.); (K.M.); (K.D.); (J.S.)
- Correspondence: ; Tel.: +48-(22)-584-13-20
| | - Paulina Jurczak-Kobus
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Czerniakowska 231, 00-416 Warsaw, Poland; (P.J.-K.); (K.M.); (K.D.); (J.S.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Litewska 14/16, 00-581 Warsaw, Poland;
| | | | - Krystyna Majewska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Czerniakowska 231, 00-416 Warsaw, Poland; (P.J.-K.); (K.M.); (K.D.); (J.S.)
| | - Marek Kunecki
- Clinical Nutrition Department, M. Pirogov Hospital, Wólczańska 191/195, 90-531 Lodz, Poland; (J.B.-S.); (M.K.)
| | - Karolina Dąbrowska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Czerniakowska 231, 00-416 Warsaw, Poland; (P.J.-K.); (K.M.); (K.D.); (J.S.)
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Czerniakowska 231, 00-416 Warsaw, Poland; (P.J.-K.); (K.M.); (K.D.); (J.S.)
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12
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Przekop Z, Szostak-Węgierek D, Milewska M, Panczyk M, Zaczek Z, Sobocki J. Efficacy of the Nutritional Risk Index, Geriatric Nutritional Risk Index, BMI, and GLIM-Defined Malnutrition in Predicting Survival of Patients with Head and Neck Cancer Patients Qualified for Home Enteral Nutrition. Nutrients 2022; 14:nu14061268. [PMID: 35334925 PMCID: PMC8949001 DOI: 10.3390/nu14061268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Malnutrition is a poor prognostic factor in cancer disease. In case of head and neck cancer, there are multiple disease symptoms and side effects of treatment that increase the risk of malnutrition. The aim of the study is to assess the association between nutritional status at the time of qualification for home enteral nutrition (HEN) and overall survival of patients with head and neck cancer (HNC), and assessment usefulness of selected nutritional indices as prognostic factors. The retrospective survival analysis involved 157 patients with HNC referred to HEN between January 2018 and October 2021. The nutritional status assessment was performed at the qualification for HEN visit. We have analyzed results of body mass index (BMI), Nutritional Risk Index (NRI) for patients <65 years, Geriatric Nutritional Risk Index (GNRI) for patients ≥65 years and malnutrition defined by Global Leadership Initiative on Malnutrition (GLIM). The mean patient survival was 44.7 weeks and the median was 23.9 weeks. Patients with low NRI and GNRI score had a higher risk of death (NRI: p = 0.0229; GNRI: p = 0.371). NRI, GNRI, and malnutrition defined by GLIM were superior to BMI as prognostic markers for survival. Results suggest that the use of NRI, GNRI, and GLIM criteria could provide useful prognostic information. The longer survival since the qualifying visit for home enteral nutrition suggests that nutritional management could be initiated earlier.
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Affiliation(s)
- Zuzanna Przekop
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (D.S.-W.); (M.M.)
- Correspondence: ; Tel.: +48-22-57-20-931
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (D.S.-W.); (M.M.)
| | - Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (D.S.-W.); (M.M.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 00-581 Warsaw, Poland;
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 00-401 Warsaw, Poland; (Z.Z.); (J.S.)
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 00-401 Warsaw, Poland; (Z.Z.); (J.S.)
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13
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Zaczek Z, Dąbrowska K, Omidi M, Panczyk M, Sobocki J. Effect of Thickening Powder on Gastrointestinal Losses in Patients With High-output End Jejunostomy Syndrome - Preliminary Results. In Vivo 2022; 36:884-889. [PMID: 35241546 DOI: 10.21873/invivo.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM End jejunostomy syndrome is a type of short bowel syndrome (SBS) in which the jejunum forms the end of the bowel, as a result of resection or exclusion of the ileum and colon. It is associated with a high risk of dehydration, electrolyte imbalance, and malnutrition due to excessive stomal losses. PATIENTS AND METHODS In this retrospective study, we analyzed the medical records of sixteen adult patients with SBS and high-output end jejunostomy syndrome who received thickened fluids during their hospitalization in the home parenteral nutrition unit. The main parameter considered was daily stoma excretion volume, measured by 24-h collection. Values were compared between days when patients drank the daily amount of 600 ml of water, and days when patients ingested the same amount of water but mixed with thickening powder to achieve a mildly thick consistency. RESULTS Median volumes of end jejunostomy output were significantly lower when patients consumed the mixture of water and thickening powder, compared with drinking water without additives (550.0 ml/d vs. 811.9 ml/d, p=0.002). CONCLUSION These preliminary results demonstrate a potential benefit of thickening powder for the nutritional management of patients with SBS type I, and point to the need for further randomized clinical studies with larger patient groups.
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Affiliation(s)
- Zuzanna Zaczek
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland; .,Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Dąbrowska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mohammad Omidi
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
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14
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Suszko M, Sobocki J, Imieliński C. Mortality in extremely low BMI anorexia nervosa patients - implications of gastrointestinal and endocrine system dysfunction. Psychiatr Pol 2022; 56:89-100. [DOI: 10.12740/pp/126233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Leńska-Mieciek M, Jurczak-Kobus P, Kuls-Oszmaniec A, Fiszer U, Sobocki J. Different cardiovascular risk scores in adults receiving long-term home parenteral nutrition. Pol Arch Intern Med 2022; 132. [DOI: 10.20452/pamw.16207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Przekop Z, Milewska M, Szostak-Węgierek D, Panczyk M, Sobocki J. GLIM-Defined Malnutrition in Patients with Head and Neck Cancer during the Qualification Visit for Home Enteral Nutrition. Nutrients 2022; 14:nu14030502. [PMID: 35276861 PMCID: PMC8840501 DOI: 10.3390/nu14030502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with head and neck cancer (HNC) present multiple symptoms that increase the risk of malnutrition. Nutritional care, including enteral nutrition (EN), plays a crucial role in the management of this group of patients. The aim of the study was to determine the Global Leadership Initiative on Malnutrition (GLIM)-based stages of malnutrition and the relationship with selected biochemical parameters during the home enteral nutrition (HEN) qualification visit of patients with HNC. The retrospective analysis involved 224 patients with HNC referred for HEN. The following parameters were evaluated: body mass index (BMI), percent weight loss, and laboratory tests (serum albumin, total serum protein, C-reactive protein (CRP), and total lymphocyte count (TLC)). Malnutrition was defined using GLIM-based criteria. The prevalence of malnutrition based on GLIM criteria was 93.75% (15.18% moderately malnourished, 78.57% severely malnourished). There was a positive correlation between malnutrition based on GLIM criteria, serum albumin, and CRP. In the model assessing the odds of severe malnutrition according to the criteria of GLIM, TLC and CRP had a statistically significant effect on the chance in the probability of qualifying a patient to the severe malnutrition group, but the strength of the results was weak. The prevalence of malnutrition in HNC patients enrolled to HEN is high and most of them are severely malnourished. This suggests that it is important to identify more efficiently patients with risk of malnutrition at an earlier stage. GLIM criteria for malnutrition can be easily applied in this group of patients, but the definition of inflammation criteria should be clarified.
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Affiliation(s)
- Zuzanna Przekop
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (M.M.); (D.S.-W.)
- Correspondence: ; Tel.: +48-22-57-20-931
| | - Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (M.M.); (D.S.-W.)
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (M.M.); (D.S.-W.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 00-681 Warsaw, Poland;
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 00-401 Warsaw, Poland;
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Gliwska E, Guzek D, Przekop Z, Sobocki J, Głąbska D. Quality of Life of Cancer Patients Receiving Enteral Nutrition: A Systematic Review of Randomized Controlled Trials. Nutrients 2021; 13:nu13124551. [PMID: 34960103 PMCID: PMC8705712 DOI: 10.3390/nu13124551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022] Open
Abstract
Most studies confirm the beneficial effects of enteral nutrition on the quality of life, but some studies indicate an inverse association and its detrimental impacts. However, there are insufficient data on the effects of enteral nutrition on the quality of life of cancer patients. This systematic review aimed to describe the influence of applied enteral nutrition on the quality of life of cancer patients, based on the results of randomized controlled trials. It was registered in the PROSPERO database (CRD42021261226) and conducted based on the PRISMA guidelines. The searching procedure was conducted using the PubMed and Web of Science databases, as well as Cochrane Library, and it included studies published until June 2021. It was conducted to select randomized controlled trials assessing the influence of enteral nutrition (compared with the other model of nutrition) on the quality of life of cancer patients. A general number of 761 records were screened and a final number of 16 studies were included in the systematic review. The studies were included and assessed by two independent researchers, while the risk of bias was analyzed using the Newcastle–Ottawa Scale (NOS). Studies compared patients treated with and without enteral nutrition, patients treated with various methods of enteral nutrition or with enteral diets of various content, as well as patients treated with enteral and parenteral nutrition. Within the included studies, the majority were conducted in patients with cancers located in various parts of the body, or diverse areas within the gastrointestinal system, while some studies were conducted in specific populations of patients with a defined cancer location—esophagus, stomach, or ovary. The duration of applied enteral nutrition within the included studies was diversified—from two weeks or less to half a year or even more. The vast majority of studies used well-known and validated tools to assess the quality of life, either developed for a specific group of head/neck, esophagus/stomach, and ovary cancer patients or developed for more general patient populations. Most studies concerning patients treated with and without enteral nutrition supported applying enteral nutrition, which was concluded in seven studies out of ten (including four studies with a low risk of bias). The other important observations to be emphasized—formulated based on the studies with a low risk of bias—presented the role of oral supportive nutrition guided by a dietitian, as well as the beneficial role of enteral and parenteral nutrition, combined. In spite of a relatively low number of randomized controlled trials assessing the influence of enteral nutrition on the quality of life of cancer patients, which should be considered as a limitation, the results were promising. Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.
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Affiliation(s)
- Elwira Gliwska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Cancer Epidemiology and Primary Prevention Department, The Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-225-937-134
| | - Zuzanna Przekop
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 27 Ciołka Street, 01-445 Warsaw, Poland;
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland;
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Gliwska E, Zaczek Z, Milewska M, Sobocki J. The influence of enteral nutrition on language abilities in malnourished cancer patients. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kowalczyk P, Zaczek Z, Osowska S, Sobocki J. Analysis of mitochondrial and genomic DNA damage induced by lipid peroxidation in parenteral nutrition. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kowalczyk P, Zaczek Z, Osowska S, Sobocki J. Fatty acids - friend or enemy in oxidative stress? Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sobocki J, Jackowski M, Dziki A, Tarnowski W, Banasiewicz T, Kunecki M, Słodkowski M, Stanisławski M, Zaczek Z, Richer P, Matyja A, Frączek M, Wallner G. Clinical guidelines for the management of gastrointestinal fistula - developed by experts of the Polish Surgical Society. Pol Przegl Chir 2021; 93:57-69. [PMID: 34515646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. AIM This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. MATERIAL AND METHODS The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. RESULTS AND CONCLUSIONS Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).
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Affiliation(s)
- Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
| | - Marek Jackowski
- Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
| | - Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny w Poznaniu
| | - Marek Kunecki
- Oddział Chirurgii Ogólnej i Naczyniowej, Centrum Leczenia Żywieniowego, Wojewódzki Szpital Specjalistyczny im. M. Pirogowa, Łódź
| | - Maciej Słodkowski
- Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej, Warszawski Uniwersytet Medyczny
| | - Michał Stanisławski
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
| | - Zuzanna Zaczek
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
| | - Piotr Richer
- Katedra i Oddział Kliniczny Chirurgii Ogólnej Gastroenterologicznej i Transplantologii, Uniwersytet Jagielloński Collegium Medicum, Kraków
| | - Andrzej Matyja
- II Katedra Chirurgii, Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej, Metabolicznej i Stanów Nagłych, Uniwersytet Jagielloński Collegium Medicum, Kraków
| | - Mariusz Frączek
- II Katedra i Klinika Chirurgii Ogólnej, Naczyniowej i Onkologicznej Warszawskiego Uniwersytetu Medycznego
| | - Grzegorz Wallner
- I Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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Sobocki J, Jackowski M, Dziki A, Tarnowski W, Banasiewicz T, Kunecki M, Słodkowski M, Stanisławski M, Zaczek Z, Richer P, Matyja A, Frączek M, Wallner G. Clinical guidelines for the management of gastrointestinal fistula
– developed by experts of the Polish Surgical Society. Pol Przegl Chir 2021. [DOI: 10.5604/01.3001.0015.0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. </br>Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. </br>Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. </br>Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).
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Affiliation(s)
- Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Marek Jackowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Collegium Mediucm at the Nicolaus Copernicus University in Torun, Poland; Head: prof. Marek Jackowski MD PhD
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland; Head: prof. Adam Dziki MD PhD
| | - Wiesław Tarnowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Postgraduate Medical Education Center, Warsaw, Poland; Head: prof. Wiesław Tarnowski MD PhD
| | - Tomasz Banasiewicz
- Department of General Surgery, Endocrine Surgery and Gastrointestinal Oncology, Institute of Surgery, Poznan University of Medical Sciences, Poland; Head: prof. Tomasz Banasiewicz MD PhD
| | - Marek Kunecki
- General and Vascular Surgery Unit, Center for Nutritional Therapy, M. Pirogow Regional Specialist Hospital, Lodz, Poland; Head: Marek Kunecki MD PhD
| | - Maciej Słodkowski
- Department of General Surgery, Gastrointestinal Surgery and Surgical Oncology, Medical University of Warsaw, Poland; Head: Maciej Słodkowski MD PhD
| | - Michał Stanisławski
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Zuzanna Zaczek
- Department of General Surgery and Clinical Nutrition, Postgraduate Medical Education Center, Warsaw, Poland; Head: Jacek Sobocki MD PhD, CMPK Professor
| | - Piotr Richer
- Department and Clinical Unit of General Surgery, Gastrointestinal Surgery and Transplantology, Jagiellonian University Medical College, Cracow, Poland; Head: prof. Piotr Richter MD PhD
| | - Andrzej Matyja
- II Department of Surgery, Clinical Unit of General Surgery, Surgical Oncology, Metabolic Surgery and Emergency Surgery, Jagiellonian University Medical College, Cracow, Poland; Head: prof. Andrzej Matyja, MD PhD
| | - Mariusz Frączek
- II Department and Clinic of General Surgery, Vascular Surgery and Surgical Oncology at the Medical University of Warsaw, Poland; Head: prof. Mariusz Frączek MD PhD
| | - Grzegorz Wallner
- II Department and Clinic of General Surgery, Gastrointestinal Surgery and Gastrointestinal Neoplasia, Medical University of Lublin, Poland; Head: prof. Grzegorz Wallner MD PhD
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Matysiak K, Szewczuk M, Sobocki J, Zdziarska M, Siatkowski I. Complications of tunneled peripherally inserted and tunneled-cuffed central catheters in home parenteral nutrition. Nutrition 2021; 91-92:111354. [PMID: 34246088 DOI: 10.1016/j.nut.2021.111354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to compare complications associated with tunneled peripherally inserted central catheters (tPICCs) and tunneled-cuffed centrally inserted central catheters (tCICCs) in adult home parenteral nutrition (HPN). METHODS The study (2017-2019) identified 257 people with type III chronic intestinal failure requiring HPN. The data were analyzed for tPICC- and tCICC-related complications. The rate of catheter-related complications was recorded as the number of complications analyzed per 1000 d of catheter use, and rates were compared using the Mann-Whitney Wilcoxon test. RESULTS A total of 273 venous access devices were included to the analyses: 150 (55%) non-cuffed tPICCs and 123 (45%) tCICCs. In-dwelling time for tPICCs and tCICCs were 23 045 and 43 789 catheter d, respectively. Median (interquartile range) catheter days and duration of HPN, for tPICCs and tCICCs, were respectively 119 (166) and 324 (314) d and 108 (159) and 324 (322) d. The overall complication rates per 1000 catheter d for tPICCs and tCICCs were 1.52 and 0.8, respectively (P = 0.565). On analysis, there was no statistical difference between complication rates per 1000 catheter d. The removal rate and conversion ratio due to complications were similar for tPICCs and tCICCs. CONCLUSIONS Both tPICCs and tCICCs have similar complication rates per 1000 d. This study highlights that tCICCs, the preferred and currently used venous access devices in HPN, can be effectively and safely replaced by tPICCs, depending on the indications.
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Affiliation(s)
- Konrad Matysiak
- Centre for Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland.
| | - Magdalena Szewczuk
- Department of Gastroenterology, Heliodor Swiecicki University Hospital, Poznan, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Zdziarska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Idzi Siatkowski
- Department of Mathematical and Statistical Methods, Poznan University of Life Science, Poznan, Poland
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Rogulska J, Osowska S, Kunecki M, Sobocki J, Ładyżyński P, Giebułtowicz J. Antioxidant balance in plasma of patients on home parenteral nutrition: A pilot study comparing three different lipid emulsions. Clin Nutr 2021; 40:3950-3958. [PMID: 34139468 DOI: 10.1016/j.clnu.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Parenteral nutrition (PN) can supply all essential nutrients to a patient with gastrointestinal insufficiency. However, the sensitivity to lipid peroxidation might increase in those receiving PN, especially home parenteral nutrition (HPN). This study aimed to investigate whether PN affects the antioxidant balance of plasma of HPN patients without comorbidities and whether this balance is influenced by comorbidities and according to the type of lipid emulsion included in the PN. METHODS Adult patients on HPN (n = 86) received one of three types of lipid emulsion (based on 1) soyabean oil, 2) olive and soyabean oil or 3) soyabean, coconut, olive and fish oil) in all-in-one mixtures; in addition healthy controls (n = 66) were studied as comparators. HPN patients were classified to the following subgroups: 1) patients without (n = 58) or with (n = 28) comorbidities 2) patients on Intralipid (GINTRA, n = 53), ClinOleic (GCLIN, n = 17) or SMOFlipid (GSMOFn = 16). The activities of total glutathione peroxidase (GSH-Px), selenium dependent glutathione peroxidase (Se-GSHPx) and glutathione S-transferase (GST) in plasma were determined spectrophotometrically. The antioxidant potential of plasma was determined using oxygen radical absorbance capacity (ORAC). The lipid peroxidation marker malondialdehyde (MDA) was analyzed with high performance liquid chromatography. RESULTS MDA concentration was the highest in GINTRA and the lowest in GSMOF (p < 0.05). GSMOF also had the highest activity of GSH-Px. No differences in Se-GSHPx, GST and ORAC were observed among GINTRA, GCLIN and GSMOF. Comparing with healthy controls, significantly lower GST (p = 0.0293) and ORAC (p < 0.0001) were observed in the HPN patients. Among all measured parameters only the concentration of MDA was significantly higher in patients with comorbidities compared to those without them. Comorbidities did not influence MDA level in GINTRA and GSMOF being still the lowest in GSMOF (p = 0.0033). In contrast, significantly higher MDA level was observed for GCLIN in those with vs. without comorbidities (p = 0.0262). CONCLUSIONS Patients on HPN have lower antioxidant defenses than healthy controls. The type of lipid emulsion used in HPN affects lipid peroxidation (even after taking into account comorbidities which often involve oxidative stress) being the highest in GINTRA and the lowest in GSMOF. Thus, to minimize the risk of oxidative stress, SMOFlipid can be considered in patients in HPN especially for those with comorbidities. ClinOleic can be considered in HPN patients without comorbidities. The observation should be confirmed in larger studies.
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Affiliation(s)
- Joanna Rogulska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Sylwia Osowska
- Department of Clinical Pharmacy, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Marek Kunecki
- Clinical Nutrition Center, Pirogov Hospital, 191/195 Wólczańska Street, 90-001 Łódź, Poland.
| | - Jacek Sobocki
- Department of Clinical Nutrition and Surgery, Medical Center of Postgraduate Medical Education, Prof. Orłowski Hospital, 231 Czerniakowska Street, 00-416 Warsaw, Poland.
| | - Paweł Ładyżyński
- Interdisciplinary PhD Studies, Polish Academy of Sciences, 5 Jana Kazimierza Street, 01-248 Warsaw, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
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Folwarski M, Kłęk S, Matras P, Bartoszewska L, Bednarz S, Jakubczyk M, Kamocki Z, Krasowski G, Kunecki M, Kwella B, Matysiak-Luśnia K, Matysiak K, Pierzynowska G, Szafrański W, Szopiński J, Urbanowicz K, Sobocki J. Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study. Nutrition 2021; 86:111202. [PMID: 33735654 PMCID: PMC7881293 DOI: 10.1016/j.nut.2021.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The pandemic requires adaptation of the health care standards, including epidemiologic surveillance, logistics of home supply, and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of this study was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first 3 mo of the pandemic (March through May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for home artificial nutrition (HAN) was estimated. Fourteen of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75/1 million citizens. Of HCWs, 344 were involved in patient care in Polish HPN units; 18.9% were physicians (49% surgeons, 18.46% internal medicine specialists, 15.38% anesthesiologists, 7.69% pediatricians, 1.54% palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN patient-to-HCW ratios for physicians, nurses, pharmacists, dietitians were 49.5, 29.15, 111.6, and 181.6, respectively. Medium ages of physicians and nurses were 45.6 and 44.15 y, respectively. Slightly less than half (53.8%) of physicians and 31.53% of nurses worked parallelly in hospital wards. Thirty-one pharmacists overall were working in all HPN units (2.21 per unit) as were 18 dietitians (1.3 per unit). Nine patients had a confirmed COVID-19 infection (four HPN, five home enteral nutrition). All the units introduced telemedicine solutions in the first months of the pandemic. The number of new qualifications for HPN and home enteral nutrition in the units did not significantly decline from March through May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health systems may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental effect on HPN including serious issues with access to professional HCWs.
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Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Gdansk, Poland; Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, Gdansk, Poland.
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland
| | - Przemysław Matras
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Lidia Bartoszewska
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Sławomir Bednarz
- General Surgery Clinic, St.Queen Jadwiga's Clinical Regional Hospital No. 2, Rzeszów, Poland
| | - Marlena Jakubczyk
- Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Zbigniew Kamocki
- 2nd Department of General and Gastroenterological Surgery Medical University of Bialystok, Poland
| | | | - Marek Kunecki
- Center of Clinical Nutrition, M. Pirogow Provincial Hospital, Lodz, Poland
| | - Bogna Kwella
- Provincial Specialist Hospital, Department of Clinical Nutrition, Olsztyn, Poland
| | - Katarzyna Matysiak-Luśnia
- Medical University of Wroclaw, Poland; Department and Clinic of Anaesthesiology and Intensive Therapy, Enteral and Parenteral Nutrition Outpatient Clinic, Voyevodin Hospital, Jelenia Gora, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Waldemar Szafrański
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, Gdansk, Poland
| | - Jacek Szopiński
- Department of General Hepatobiliary and Transplant Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Krystyna Urbanowicz
- Provincial Specialist Hospital, Department of Clinical Nutrition, Olsztyn, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
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Leńska-Mieciek M, Jurczak-Kobus P, Kuls-Oszmaniec A, Fiszer U, Sobocki J. Carotid artery intima-media thickness in adults receiving long-term home parenteral nutrition. Nutr Metab Cardiovasc Dis 2021; 31:489-497. [PMID: 33127253 DOI: 10.1016/j.numecd.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Nutrition regimen in parenteral nutrition (PN) patients allows for a control of diet components. This may affect the process of lipid deposition in the vascular wall and change the risk of atherosclerosis. This study aims to examine the effect of long-term PN in adults on carotid intima-media thickness. METHODS AND RESULTS Thirty long-term PN patients (15 men and 15 women, mean age 64.7 ± 8.5 years) and thirty healthy volunteers (HV) (15 men and 15 women, mean age 64.9 ± 8.77 years) entered the study. Total amino acid and lipid formulation intake as well as duration of PN were calculated for PN patients. The common carotid artery intima-media thickness (CCA IMT) was examined in both groups. A lower CCA IMT (right/left mean: PN - 776 ± 121 vs HV - 848 ± 121 μm, p < 0.05; right/left maximum CCA IMT: PN - 935 ± 139 vs HV - 1024 ± 135 μm, p < 0.05) in PN patients was observed. A lower serum level of total (PN - 131.43 ± 43.12 vs HV - 209.2 ± 48.01 mg/dl, p < 0.05) and HDL (PN- 44.16 ± 12.45 vs HV - 72.57 ± 25.04 mg/dl, p < 0.05) cholesterol was reported in the PN patients. A correlation between patients' age and CCA IMT was observed in the control group, but not in the PN patients (right/left mean CCA IMT - PN: r = 0.48, p-0.007 vs HV: p-0.073; right/left maximum CCA IMT - PN: r = 0.48, p-0.008, vs HV: p-0.073). CONCLUSIONS Long term PN in adults is associated with lower CCA IMT. Long-term PN patients are a unique group in which carotid intima-media thickness does not correlate with the age.
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Affiliation(s)
- Marta Leńska-Mieciek
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Paulina Jurczak-Kobus
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Aleksandra Kuls-Oszmaniec
- Department of Neurology and Epileptology Professor Orlowski's Hospital, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
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Mitura K, Myśliwiec P, Rogula W, Solecki M, Furtak JP, Kazanowski M, Kłęk S, Nowakowski M, Pędziwiatr M, Zawadzki M, Wallner G, Sobocki J. In pursuit of COVID-19 surgical risk stratification to manage a limited workforce and supplies in minimally invasive surgery. Wideochir Inne Tech Maloinwazyjne 2020; 15:416-423. [PMID: 32904725 PMCID: PMC7457190 DOI: 10.5114/wiitm.2020.95073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022] Open
Abstract
The protective barriers used so far in surgery do not provide adequate protection against SARS-CoV-2 virus, and reinforced protective equipment is needed. The rapid increase in the number of patients and the worldwide panic associated with the increasingly low availability of protective equipment has resulted in a shortage of protective equipment in many hospitals. Appropriatepersonal protective equipment must be provided so that the surgical team proceeding to surgery is not excluded from the further struggle for patients' health, especially in MIS. Reckless and excessive use of maximum protective equipment may result in a severe shortage of these products when the number of infected persons requiring surgery increases. The use of a structured infection risk scheme for medical staff, depending on the results of reverse transcription polymerase chain reaction assays and COVID-19 symptoms, combined with the division of protection equipment into three groups, allows easy selection of an appropriate clothing scheme for the clinical setting.
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Affiliation(s)
- Kryspin Mitura
- Faculty of Medical and Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Rogula
- Department of Paediatric Surgery, University Paediatric Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Solecki
- 2 Department of General, Gastrointestinal, and Surgical Oncology, Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | | | | | - Stanisław Kłęk
- Department of General Surgery, Stanley Dudrick Memorial Hospital, Krakow, Poland
| | - Michał Nowakowski
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Zawadzki
- Regional Specialist Hospital, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Wallner
- 2 Department of General, Gastrointestinal, and Surgical Oncology, Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Medical Centre of Postgraduate Education, Warsaw, Poland
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Matras P, Klek S, Folwarski M, Zmarzly A, Bartoszewska L, Cebulski W, Jakubczyk M, Kamocki Z, Klepczyk K, Kunecki M, Lawiński M, Majewska K, Matczuk M, Matysiak-Lusnia K, Sadowski M, Sobocki J, Sumlet M, Szafranski W, Szczepanek K, Urbanowicz K, Zoubek-Wojcik A. Home medical nutrition during SARS-CoV-2 pandemic - A position paper. Clin Nutr ESPEN 2020; 38:196-200. [PMID: 32690158 PMCID: PMC7211693 DOI: 10.1016/j.clnesp.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. METHODS The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. CONCLUSIONS the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.
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Affiliation(s)
- Przemyslaw Matras
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin. Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland.
| | - Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, Copernicus Hospital, Home Enteral and Parental Nutrition Unit, Gdansk, Poland
| | - Anna Zmarzly
- Regional Gromowski's Hospital, Center for Nutritional Therapy, 2nd Department for Infectious Diseases, Wroclaw, Poland
| | - Lidia Bartoszewska
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin. Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Wlodzimierz Cebulski
- Department of General, Gastroenterological and Cancer Surgery, Warsaw Medical School, Warsaw, Poland
| | - Marlena Jakubczyk
- Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz. Nicolaus Copernicus University in Toruń, Poland; Nutritional Team, Home Enteral and Parenteral Nutrition Clinic University Hospital No. 1 in Bydgoszcz, Poland
| | - Zbigniew Kamocki
- 2nd Department for General and Gastroenterology Surgery, Bialystok, Poland
| | - Katarzyna Klepczyk
- Regional Gromowski's Hospital, Center for Nutritional Therapy, 2nd Department for Infectious Diseases, Wroclaw, Poland
| | - Marek Kunecki
- Center for Clinical Nutrition, M Pirogow's Hospital, Lodz, Poland
| | - Michal Lawiński
- Department of General, Gastroenterological and Cancer Surgery, Warsaw Medical School, Warsaw, Poland
| | - Krystyna Majewska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Matczuk
- Regional Paediatric Hospital, Center for Clinical and Home Nutrition, Gizinscy Medical Center, Bydgoszcz, Poland
| | - Katarzyna Matysiak-Lusnia
- Medical University of Wroclaw, Poland; Department and Clinic of Anaesthesiology and Intensive Therapy, Enteral and Parenteral Nutrition Outpatient Clinic, Voyevodin Hospital, Jelenia Gora, Poland; Home Hospice and Palliative Care Ward, Voyevodin Hospital, Jelenia Gora, Poland
| | - Maciej Sadowski
- Regional Hospital of the Province Olsztyn, Enteral and Parenteral Nutrition Unit, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Sumlet
- Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland
| | - Waldemar Szafranski
- Copernicus Hospital, Home Enteral and Parental Nutrtion Unit, General Surgery Unit, Gdansk, Poland
| | - Kinga Szczepanek
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin. Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | - Krystyna Urbanowicz
- Regional Hospital of the Province Olsztyn, Enteral and Parenteral Nutrition Unit, Poland
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Mitura K, Myśliwiec P, Rogula W, Solecki M, Furtak JP, Kazanowski M, Kłęk S, Nowakowski M, Pędziwiatr M, Zawadzki M, Wallner G, Sobocki J. Guidelines for the management of surgical departments in non-uniform hospitals during the COVID-19 pandemic. Pol Przegl Chir 2020; 92:48-59. [PMID: 32312919 DOI: 10.5604/01.3001.0014.1039] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.
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Affiliation(s)
- Kryspin Mitura
- Wydział Nauk Medycznych i Nauk o Zdrowiu, Uniwersytet Przyrodniczo-Humanistyczny w Siedlcach
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Wojciech Rogula
- Oddział Kliniczny Chirurgii Dziecięcej, Uniwersytecki Szpital Dziecięcy w Krakowie, Uniwersytet Jagielloński, Kraków
| | - Michał Solecki
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie, SPSK Nr 1 w Lublinie
| | - Jarosław Piotr Furtak
- Oddział Chirurgiczny, Samodzielny Publiczny Zakład Opieki Zdrowotnej w Puławach - szpital jednoimienny zakaźny
| | - Michał Kazanowski
- Oddział Chirurgii Nowotworów Przewodu Pokarmowego, Dolnośląskie Centrum Onkologii, Wrocław
| | - Stanisław Kłęk
- Oddział Chirurgii Ogólnej i Leczenia Niewydolności Przewodu Pokarmowego, Szpital Wielospecjalistyczny im. Stanley Dudricka
| | - Michał Nowakowski
- II Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński Collegium Medicum, Szpital Uniwersytecki w Krakowie - szpital jednoimienny COVID19
| | - Michał Pędziwiatr
- II Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński Collegium Medicum, Szpital Uniwersytecki w Krakowie - szpital jednoimienny COVID19
| | - Marek Zawadzki
- Wojewódzki Szpital Specjalistyczny we Wrocławiu, Oddział Chirurgii Onkologicznej, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie, SPSK Nr 1 w Lublinie
| | - Jacek Sobocki
- Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego w Warszawie
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Klek S, Chambrier C, Cooper SC, Gabe S, Kunecki M, Pironi L, Rahman F, Sobocki J, Szczepanek K, Wanten G, Lincke N, Glotzbach B, Forbes A. Home parenteral nutrition with an omega-3-fatty-acid-enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study): study protocol for a randomized, controlled, multicenter, international clinical trial. Trials 2019; 20:808. [PMID: 31888740 PMCID: PMC6938010 DOI: 10.1186/s13063-019-3994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017.
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Affiliation(s)
- Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, 15 Tyniecka Street, 32-050, Skawina, Poland.
| | - Cécile Chambrier
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Sheldon C Cooper
- GI Medicine - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Simon Gabe
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, HA1 3UJ, UK
| | - Marek Kunecki
- Wojewódzki Specjalistyczny Szpital im. M. Pirogowa w Łodzi, Oddział Chirurgii Ogólnej i Naczyniowej, ul. Wólczańska 191/195, 90-531, Łódź, Poland
| | - Loris Pironi
- Department of Medical and Surgical Science, University of Bologna, St. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Farooq Rahman
- University College Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Jacek Sobocki
- Samodzielny Publiczny Szpital Kliniczny im. Prof. dr W. Orlowskiego, Oddzial Kliniczny Zywienia i Chirurgii, ul. Czerniakowska 231, 00-416, Warszawa, Poland
| | - Kinga Szczepanek
- Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, 15 Tyniecka Street, 32-050, Skawina, Poland
| | - Geert Wanten
- Radboud Universitair Medisch Centrum, Afdeling Maag-, Darm- en Leverziekten, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicole Lincke
- Medical Scientific Affairs, B. Braun Melsungen AG, Carl-Braun-Str. 1, 34212, Melsungen, Germany
| | - Bernhard Glotzbach
- Medical Scientific Affairs, B. Braun Melsungen AG, Carl-Braun-Str. 1, 34212, Melsungen, Germany
| | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
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Lenska-Mieciek M, Jurczak-Kobus P, Kuls-Oszmaniec A, Fiszer U, Sobocki J. MON-PO431: Cardiovascular Risk in Home Parenteral Nutrition Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sobocki J, Groszek P, Kaczanowska J, Omidi M, Lachowicz K, Majewska K. Fluconazole withdrawal from routine empiric treatment of CRBSI in hpn patients – safety, cost effectiveness and effect on MDR fungal infection. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lachowicz K, Kasprzak A, Majewska K, Sobocki J. Home-based parenteral nutrition complications in geriatric patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sobocki J, Lachowicz K, Kaczanowska J, Omidi M, Majewska K, Osowska S, Kunecki M. Racecadotryl reduces stoma output in end jejunostomy syndrome patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lachowicz K, Majewska K, Sobocki J. Sip feeds vs granulate supplements – comparison of two nutritional supplementation strategies for treatment malnourished hospitalized patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Turkot M, Sobocki J. Results of home parenteral nutrition in patients with severe inflammatory bowel disease - an alternative for surgery of malnourished patients. Pol Przegl Chir 2017; 89:23-28. [PMID: 29154237 DOI: 10.5604/01.3001.0010.5408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. AIM The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. MATERIALS AND METHODS A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn's disease or ulcerative colitis. RESULTS Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. CONCLUSIONS Home parenteral nutrition positively affects patient's general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate.
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Affiliation(s)
- Maryla Turkot
- Department of General Surgery and Clinical Nutrition, Warsaw Medical University; Head: dr hab. n. med. Jacek Sobocki
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Warsaw Medical University; Head: dr hab. n. med. Jacek Sobocki
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Sobocki J, Lachowicz K, Omidi M, Majewska K. SUN-P141: Is There a Need for Routine Broviac Catheter Replacement in HPN Patients After 10 Years? Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sobocki J. MON-P001: Indirect Calorimetry vs Metabolic Limits Tracing for Effective Parenteral Nutrition in ICU Patient. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sobocki J, Jurczak P, Lachowicz K, Majewska K. OR52: Restricted vs Unrestricted Oral Intake in High Output End Jejunostomy Syndrome Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zakrzewska E, Majewska K, Sobocki J. SUN-P102: Complications of Nutritional Therapy in Home Enterally Fed Patients with Cancer. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sobocki J, Lachowicz K, Jurczak P, Groszek P, Majewska K. SUN-P140: Thickening Powder Reduces Ostomy Output and Thirst in Patients with End Jejunostomy Syndrome – Preliminary Study. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kołodziejczak M, Santoro GA, Sobocki J, Szopiński T, Wiączek A, Sudoł-Szopińska I. Anorectal malformation as a cause of recurring perineal abscesses - value of anorectal endosonography and magnetic resonance imaging: a case report. Med Ultrason 2017; 19:228-231. [PMID: 28440360 DOI: 10.11152/mu-928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Malformations of the rectum and urinary tract frequently coexist, and the prevalence of urogenital defects in patients with a rectal defect ranges from 20 to 54%. In most patients, anorectal malformations are diagnosed and treated surgically in early childhood. In this report, we present a case of a 52-year-old male with a history of urological operations in infancy due to a congenital urethral malformation and multiple recurrent episodes of perineal abscesses with urinary retention. Anorectal endosonography and magnetic resonance imaging revealed the presence of a large cystic lesion adjacent to the rectal wall which became smaller at the level of the puborectalis. The walls of the lesion had a layered structure identical to the wall of the rectum. In addition, the examinations showed hypotrophy of the left lobe of the prostate and lack of left semnal vesicles. Thus, the lesion was diagnosed as duplication of the rectum or rectal diverticulum. Surgery was performed by an interdisciplinary team of colorectal surgeons and urologist. The lesion was removed laparoscopically. The pathological report revealed that the cystic wall was typical of the intestinal wall, consistent with a diagnosis of rectal duplication.
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Affiliation(s)
| | - Giulio A Santoro
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jacek Sobocki
- Clinic of Nutrition and Surgery, Orłowski Hospital in Warsaw, Poland
| | - Tomasz Szopiński
- Department of Urology of the Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Anna Wiączek
- Warsaw Proctology Centre, Saint Elisabeth Hospital, Warsaw, Poland, General Surgical Unit, Solec Hospital in Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Radiology Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland Imaging Department of the Second Faculty of Medicine, Warsaw Medical University, Warsaw, Poland.
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Rogulska J, Osowska S, Giebułtowicz J, Zawada K, Forbes A, Majewska K, Sobocki J, Wroczyński P. MON-P178: The Oxidative Stability Estimation of All-In-One Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions after 24. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rogulska J, Osowska S, Giebuttowicz J, Forbes A, Sobocki J, Wroczyński P. MON-P176: Estimation of the Oxidative Stability of All-In-One (AIO) Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions After Three Days of Storage in the Fridge. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sobocki J, Majewska K, Jurczak P, Omidi M. SUN-P061: Clinical Status of Patients with Parenteral Nutrition-Dependent Short Bowel Syndrome 4 Years after Teduglutide Treatment. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sobocki J, Nowakowski M, Herman RM, Wałęga P, Frączek M, Tuz R, Schwartz T, Murawski M. Laparoscopically Implanted System for Stimulation of the Hypogastric Plexus Induces Colonic Motility, Defecation, and Micturition. Surg Innov 2014; 22:70-6. [DOI: 10.1177/1553350614530190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Modulation of the enteric nervous system seems to be promising in several functional colorectal disorders for which targeted, causal treatment methods do not exist. However, sacral nerve stimulation can induce undesirable muscle contraction or paresthesia. Therefore, we have developed a laparoscopic technique for implanting a neural electrode, placed directly over the pelvic autonomic nerve plexus. The aim of this experimental study was to evaluate the effect of stimulating the hypogastric plexus and pelvic nerves on inducing distal colon contraction, defecation, and micturition. Method. A total of 10 white, male healthy pigs (25-30 kg) were subjected to the laparoscopic implantation of the electrode and the stimulator. In the third and fourth weeks postimplantation, the efficacy of the acute and chronic stimulation to induce defecation was evaluated. Results. The average operative time was 105 minutes (85-150 minutes). In all pigs, acute stimulation activated induced defecation, every second day, every time on demand, with an average delay of 139.7 s. Micturition was induced incidentally. Acute or chronic stimulation did not cause any harm, pain, or suffering to the animals. No adverse effects of the stimulation were observed, and no septic complications or macroscopic fibrosis around the electrodes were found on autopsy. Conclusion. Hypogastric plexus stimulation can be a useful and safe option of distal colon contraction, defecation, and micturition. However, the efficacy of the stimulation was observed for a relatively short period of time, and it is not known if it will be sustained for a longer duration.
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Sobocki J, Herman RM, Fraczek M. Occipital C1–C2 Neuromodulation Decreases Body Mass and Fat Stores and Modifies Activity of the Autonomic Nervous System in Morbidly Obese Patients—a Pilot Study. Obes Surg 2013; 23:693-7. [DOI: 10.1007/s11695-012-0857-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wałega P, Scheyer M, Arnold S, Kenig J, Nowakowski M, Sobocki J, Herman RM. [Selective Doppler-guided hemorrhoidal artery ligation as a minimaly invasive method of treatment of hemorrhoidal disease]. Przegl Lek 2009; 66:122-125. [PMID: 19689035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study was to present the experience of two centres concerning minimal invasive technique for treating hemorrhoids--Doppler Guided Hemorrhoidal Artery Ligation (DGHAL). From our own experience and based on the literature--we can say that DGHAL is a minimally invasive, safe and effective method in grade II and III hemorrhoids. It can also be recommended in selected grade IV cases combined with anodermal folds resection. A properly carried out operation should involve no intra- and postoperative complications. However, this procedure requires more controlled trials on a larger group of patients and long term follow-up (longer than 3 years postoperatively).
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Affiliation(s)
- Piotr Wałega
- III Katedra i Klinika Chirurgii Ogólnej Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków.
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Sobocki J, Fourtanier G, Estany J, Otal P. Does vagal nerve stimulation affect body composition and metabolism? Experimental study of a new potential technique in bariatric surgery. Surgery 2006; 139:209-16. [PMID: 16455330 DOI: 10.1016/j.surg.2005.06.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 06/08/2005] [Accepted: 06/12/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been shown that vagal nerve stimulation (VNS) can affect body mass. The aim of this study was to evaluate effect of VNS on body mass, body composition, metabolic rate, and plasma leptin and IGF-I levels. METHODS Eight female pigs were included in the study. Under general anesthesia, a bipolar electrode was implanted on the anterior vagal nerve by laparoscopy. Group A was treated by VNS, and group B was the control. After 4 weeks, stimulation was discontinued in group A and started in group B. The following parameters were evaluated: body mass, body composition, metabolic rate, plasma leptin and IGF-1 levels and intramuscular fat content (IMF). RESULTS VNS attenuated body weight gain (2.28 +/- 3.47 kg vs 14.04 +/- 6.75 kg; P = .0112, for stimulation and nonstimulation periods, respectively), backfat gain (0.04 +/- 0.26 mm vs 2.31 +/- 1.12 mm) and IMF gain (-3.76 +/- 6.06 mg/g MS vs 7.24 +/- 12.90 mg/g MS; P = .0281). VNS resulted in lower backfat depth/loin muscle area ratio (0.33 +/- 0.017 vs 0.38 +/- 0.35; P = .0476). Lower plasma IGF-I concentration was found after VNS (-3.67 +/- -11.55 ng/mL vs 9.86 +/- 10.74 ng/mL; P = .0312). No significant changes in other parameters were observed. CONCLUSIONS VNS affects body weight mainly at the expense of body fat resources; however, metabolic rate is not affected.
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Affiliation(s)
- Jacek Sobocki
- Department of Digestive Surgery, CHU Rangueil, University Paul Sabatier, Toulouse, France.
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