57 research outputs found
Twenty-four-hour pH measurements in morbid obesity: effects of massive overweight, weight loss and gastric distension
No full textTo investigate the influence of untreated (super)morbid obesity and the effects of massive weight loss and chronic gastric distension on gastro-oesophageal reflux. Seventeen young morbidly obese patients (32 years old; body weight 166.5 kg; body mass index 55 kg/m2) underwent 24-h ambulatory oesophageal pH monitoring before weight reduction and 4 months after treatment with energy-restricted diet, physical exercise and intragastric balloon or sham placement in a randomized, double-blind design. To minimize bias, both 24-h pH measurements were performed under similar conditions and dietary intake, and patients were matched for age, sex, body weight and body mass index. At the start, group median data for the fraction of total time, time upright and time supine with pH less than 4 were within normal limits. After a major median weight loss of 38.8 kg in 4 months these parameters did not change. On an individual basis, five out of 17 patients had pathological acid reflux prior to weight loss. This reversed to normal in three subjects, but remained abnormal in two and became abnormal in one patient. The weight loss (58.4 kg) of those remaining or becoming acid refluxers was significantly different (P < 0.01) from those with normal or normalizing pH measurements (36.9 kg). A 4-month period of gastric distension by a 500 ml balloon did not influence acid reflux parameters. The influence of untreated (super)morbid obesity on acid reflux was less pronounced than expected. There was also no major adverse effect of chronic gastric distension. Only excessive weight loss (i.e. 58 kg) appeared to have an untoward effect on acid reflu
Safety, patient's tolerance, and efficacy of a 2-liter vitamin C-enriched macrogol bowel preparation: a randomized, endoscopist-blinded prospective comparison with a 4-liter macrogol solution
No full textOptimal bowel preparation is associated with lower polyp miss rates, but patients have difficulties in complying with the usual 4-L bowel preparation. This study aimed to compare the safety, acceptance, and efficacy of 2-L polyethylene glycol electrolyte solution enriched in vitamin C with 4-L polyethylene glycol electrolyte solution. This study is an endoscopist-blinded randomized controlled trial. The study was conducted at a tertiary referral hospital. Consecutive outpatients were randomly assigned to receive 4-L polyethylene glycol electrolyte solution or 2-L polyethylene glycol electrolyte solution enriched in vitamin C with 2 L of clear fluids in a single-dose or a split-dose regime. Safety was assessed by blood sampling before and after the preparation and by a 30-day postcolonoscopy chart and complication database review. Acceptance was investigated by questionnaires, and the adequacy of bowel preparation was assessed by the Aronchick and Ottawa scales. One hundred eighty-eight patients, 98 in the polyethylene glycol electrolyte solution enriched in vitamin C group and 90 in the polyethylene glycol electrolyte solution group, participated. Although changes in bicarbonate blood concentrations with polyethylene glycol electrolyte solution enriched in vitamin C were seen to such an extent that the blinded investigator correctly guessed the preparation in 75.6%, no unsafe values were observed. A 30-day chart and complication database review revealed 1 severe adverse event of a myocardial infarction in the polyethylene glycol electrolyte solution enriched in vitamin C group. Patient acceptance and compliance were significantly higher with the polyethylene glycol electrolyte solution enriched in vitamin C group. The impact on sleep, daily activities, and physical complaints were similar in both groups. Polyethylene glycol electrolyte solution enriched in vitamin C was noninferior to polyethylene glycol electrolyte solution in cleansing efficacy, but the segmental rating of excellent and good preparation in right and transverse colon was significantly better for polyethylene glycol electrolyte solution, especially when taken as a split dose. The results cannot be extrapolated to immobile inpatients with comorbidities. Another limitation of our study was the inability to determine plasma vitamin C concentrations and to assess the quality of colonoscopy performance. Two-liter polyethylene glycol electrolyte solution enriched in vitamin C is a safe and patient-friendly alternative to the 4-L polyethylene glycol electrolyte solution. Endoscopists slightly preferred the 4-L polyethylene glycol electrolyte solutio
Vitamin and micronutrient supplement advice given to post-bariatric surgery patients by UK dietitians
No full textThis study was to determine the vitamin and micro-nutrient supplementation recommendations made by UK registered dietitians to patients following bariatric surgery. There is a well recognised risk of nutritional deficit following bariatric surgery. Twenty one members (10.5%) of “Dietitians in Obesity Management UK” responded to an anonymous on-line survey about their bariatric activity and nutritional recommendations to patients following “food limiting” and “nutrient absorption limiting” surgery. Nine respondents had each consulted with over 100 patients last year, with 85% of dietitians’ caseloads being within the NHS. Compared against the 2007 Inter-disciplinary European Guidelines on Surgery of Severe Obesity, 90% of dietitians were meeting the recommended nutritional supplement guidelines for food limiting procedures. Only one respondent (5%) was meeting the supplementation guidelines for nutrient absorption limiting procedures. Two dietitians were recommending additional vitamin or micro-nutrients to their patients’ general vitamin and micro-nutrient supplement following food limiting procedures. Four out of twenty dietitians, with smaller caseloads, were only recommending a general vitamin and micro-nutrient supplement to patients following nutrient absorption limiting procedures. The range of nutritional composition of products named by the dietitians was substantial, with iron, vitamin B12, calcium and vitamin D levels below those known to prevent common nutritional deficiencies following bariatric surgery. Only five respondents (25%) stated that the results of laboratory tests influenced their recommendations. Increasing the awareness of the nutritional needs to this group of patients to all healthcare practitioners and exploration of the use of bariatric surgery specific nutritional supplements may reduce to risk of patients’ nutritional deficit
Current Literature: Bacterial Contamination of Ready‐to‐use 1‐L Feeding Bottles and Administration Sets in Severely Compromised Intensive Care Patients
No full textSondevoeding op de intensive care-afdeling
No full textDe belangrijkste aspecten van de afwijkingen in de stofwisseling en het belang van voeden voor de IC-patiënt komen aan bo
Split-dose bowel cleansing with picosulphate is safe and better tolerated than 2-l polyethylene glycol solution
No full textBackground In physically less fit patients and patients requiring repeated exams, adequate bowel preparation for colonoscopy remains problematic, particularly because patients need to drink large volumes of unpleasant-tasting fluids. A further concern is potential unwarranted fluid shifts. Aims This study aimed to compare the safety and burden of a small-volume sodium picosulphate/magnesium citrate preparation (SPS-MC) with a 2-l ascorbic-acid-enriched polyethylene glycol solution plus bisacodyl pretreatment (PEG-Asc+B). Patients and methods Patients referred for colonoscopy were randomized to SPS-MC or PEG-Asc+B administered as a split-dose regimen. Patients received advice on the recommended 4-l SPS-MC and 2-l PEG-Asc+B fluid intake. Safety was assessed by blood sampling before and after the preparation and during a 30-day follow-up period. A questionnaire assessed tolerability and perceived burden of the preparation. Results A total of 341 patients underwent colonoscopy. Blood sampling showed a slight but significant decrease in sodium, chloride and osmolality and increase in magnesium in the SPS-MC group and a decrease in bicarbonate in the PEG-Asc+B group. Hyponatraemia and hypermagnesaemia without clinical signs were observed in 16 (14 SPS-MC) and 13 SPS-MC patients, respectively. Patients reported significantly fewer physical complaints and a significantly higher completion rate with SPS-MC. Patients receiving SPS-MC rated the intake as being easier and better tasting. In the event of a repeat colonoscopy, 59.7% of patients in the PEG-Asc+B and 93.6% of patients in the SPS-MC group would opt for the same preparation again. Conclusion Despite electrolyte shifts, both SPS-MC and PEG-Asc+B appeared clinically safe. From a patient's perspective, a small-volume preparation formula such as SPS-MC is preferred, resulting in fewer physical complaints and greater ease of intake
Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis and impaired pulmonary function
No full textAmyotrophic lateral sclerosis is a rapidly progressive disease of unknown etiology resulting in tetraparalysis, dysarthria, dysphagia, and ultimately death from respiratory insufficiency. In the course of the disease, recurrent episodes of aspiration, pneumonia, dehydration, and malnutrition may necessitate nasoenteral tube placement, an inconvenient and unattractive arrangement in patients with dribbling and impaired swallowing. A percutaneous endoscopic gastrostomy seemed a better, though potentially hazardous, alternative in view of the often severely restricted pulmonary function of these patients. Therefore, we prospectively investigated the use of percutaneous endoscopic gastrostomy in 68 consecutive patients with amyotrophic lateral sclerosis. Minimum required pulmonary function was defined as forced vital capacity (FVC) of 1 L or more and CO2 gas exchange capability as pCO2 of 45 mm Hg or less. The methodology of insertion was adapted to facilitate the early removal of gastric air. Fifty-five patients (median FVC, 1.7 L; pCO2, 40 mm Hg) were eligible for the gastrostomy procedure, and 13 patients (median FVC, 0.8 L; pCO2, 47 mm Hg) were not. Despite the fact that modification of the method of insertion rendered the procedure more difficult, the success rate was 89% (49/55); it was 96% (49/51) when failures related to distorted anatomy were excluded. The procedure-related mortality rate was 1.8% and the 24-hour in-hospital mortality rate was 3.6%, mainly related to respiratory insufficiency. The 30-day out-of-hospital mortality rate was 11.5%. Major complications (3.6%) consisted of a spontaneously draining cutaneous abscess in 2 cases. Peristomal redness was present in 6 cases, and 5 patients required analgesics for wound pain.(ABSTRACT TRUNCATED AT 250 WORDS
Gastrotomia percutânea endoscópica em crianças: complicações associadas
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Pediatria
Do proton pump inhibitors reduce the incidence of pharyngocutaneous fistulae following total laryngectomy?
No full textIncludes abstract.Includes bibliographical references.Pharyngocutaneous fistula is a common complication of total laryngectomy. We hypothesised that perioperative proton pump inhibitor (PPI) treatment could reduce the incidence of pharyngocutaneous fistulae. This prospective placebo-controlled double-blind randomised controlled trial compared PPI treatment (14 days enteral omeprazole) with a placebo in patients undergoing primary total laryngectomy. The incidence of pharyngocutaneous fistula was recorded
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