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Biomedical subjects

A Palmo

Publications and source records attributed to A Palmo.

At least 19 recordsLinked to original sources
PubMed2006

Total parenteral nutrition-related gastroenterological complications.

Total parenteral nutrition is a life saving therapy for patients with chronic gastrointestinal failure, being an effective method for supplying energy and nutrients when oral or enteral feeding is impossible or contraindicated. Clinical epidemiological data indicate that total parenteral nutrition may be associated with a variety of problems. Herein we reviewed data on the gastroenterological tract regarding: (i) total parenteral nutrition-related hepatobiliary complications; and (ii) total parenteral nutrition-related intestinal complications. In the first group, complications may vary from mildly elevated liver enzyme values to steatosis, steatohepatitis, cholestasis, fibrosis and cirrhosis. In particular, total parenteral nutrition is considered to be an absolute risk factor for the development of biliary sludge and gallstones and is often associated with hepatic steatosis and intrahepatic cholestasis. In general, the incidence of total parenteral nutrition-related hepatobiliary complications has been reported to be very high, ranging from 20 to 75% in adults. All these hepatobiliary complications are more likely to occur after long-term total parenteral nutrition, but they seem to be less frequent, and/or less severe in patients who are also receiving oral feeding. In addition, end-stage liver disease has been described in approximately 15-20% of patients receiving prolonged total parenteral nutrition. Total parenteral nutrition-related intestinal complications have not yet been adequately defined and described. Epidemiological studies intended to define the incidence of these complications, are still ongoing. Recent papers confirm that in both animals and humans, total parenteral nutrition-related intestinal complications are induced by the lack of enteral stimulation and are characterised by changes in the structure and function of the gut. Preventive suggestions and therapies for both these gastroenterological complications are reviewed and reported in the present review.

Animals↗
PubMed2006

Chronic anorexia nervosa: enteral nutrition via percutaneous endoscopic gastrostomy and liaison psychiatry.

Anorexia nervosa is a complex mental disorder characterized by altered eating behaviour often resulting in life-threatening weight loss (<85% of expected body weight) associated with amenorrhea and a disturbance of body image. Although classified as mental health disorders, they may lead to serious medical consequences and have the highest rate of premature death of any mental health diagnosis. We report our experience with the use of enteral feeding via percutaneous endoscopic gastrostomy in a 39-year-old woman with chronic restricter anorexia nervosa treated in liaison psychiatry and psychotherapy. On admission to psychiatry unit, the patient presented seriously deteriorated general condition and a body mass index (BMI) of 10 (BMI = weight kg/height m(2)). She refused oral feeding, but eventually accepted nasogastric feeding. In preparation for her continuing long-term (>1 month) enteral feeding at home, a percutaneous endoscopic gastrostomy was performed and a home nutrition support regimen that met her energy-protein intake requirements was prescribed. During the follow-up period, an overall improvement in nutritional status, general condition, mood and cognitive functioning was observed. Patient compliance with refeeding is notoriously problematic; however, enteral feeding interventions may be feasible in the long-term treatment of selected anorexia nervosa patients when closely followed-up by a multidisciplinary medical team.

Adult↗
PubMed2004

The use of the anti-tumour necrosis factor monoclonal antibody--infliximab--to treat ulcerative colitis: implications and trends beyond the available data.

The monoclonal antibody to the tumour necrosis factor--infliximab--has recently been added to the list of off-label therapeutic means for ulcerative colitis. We conducted a descriptive analysis of the results from studies on the use of the drug published so far. A total of 187 patients qualified for analysis. They were divided into four main categories, including steroid-refractory and responsive adults and children. The median frequencies of an early and a sustained response were 77 and 44.5%. These data suggest that adult non-steroid-refractory, and paediatric patients may respond with the highest frequency. While it is obligatory to wait for the yield of the ongoing controlled trials before any conclusion on these indications is drawn, the data provide seminal ideas to further investigations, including the hypothesis to inaugurate with infliximab a top-down strategy for the treatment of inflammatory bowel disease.

Antibodies, Monoclonal↗
PubMed2004

Long-term efficacy of oral microemulsion cyclosporin for refractory ulcerative colitis.

AIM: The 60% bioavailable oral microemulsion formulation of cyclosporin (NEORAL ), has replaced the intravenous route to treat both organ transplant and immune-based disease. Its use for steroid-refractory ulcerative colitis (a recognized indication for intravenous cyclosporin) has been scanty. METHODS: Twenty-three consecutive patients (14 male/9 female, universal colitis 14/23) entered a 3-month course of NEORAL (initially dosed at 5 mg/kg/day) because of steroid-refractoriness (14 cases) and steroid-dependence (9 cases). Responders (at least showing a 50% reduction of a clinical activity score) were continued on azathioprine. The initial steroid dose was tapered on commencing NEORAL; patients requiring steroid resumption or increase in the follow-up were defined as relapsers. RESULTS: The target trough concentration of 200 ng/ml of whole blood was achieved without major titration in all but 1 patient. There were 7 non-responders (30%). Of the 16 responders (70%), 2 have not relapsed; the remaining 14 relapsed at the median time of 9.5 months (1.5-60) with 10 (71%) showing only 1 relapse. Five patients were colectomized 12 months after NEORAL (1.5-24), leaving 11 of the initial 23 (47%) with their colon. Of the 16, all but 1 had azathioprine; the median daily steroid needs fell from 32 to 5 mg. CONCLUSION: The rates of acute and chronic response of 70% and 47% achieved by NEORAL in this indication duplicate the figures achieved by the traditional schedules of cyclosporin administration.

Administration, Oral↗
PubMed2004

[Need for hospital admission in patients with ulcerative colitis during maintenance with azathioprine].

AIM: The aim of this study is to analyse the clinical course of ulcerative colitis during maintenance therapy with azathioprine, a drug which is still not proved to be able to modify the natural history of the disease. METHODS: A retrospective study is made of data regarding the frequency of hospital admission for patients with ulcerative colitis referring to a gastroenterological Day-Hospital between 1991 and 2000. The disease history of these patients has been divided into 2 sections: one preceding and the other following an index-event, identified as the beginning of a maintenance regimen with azathioprine; this allowed to find possible differences in the clinical course after the index-event. Patients were controls of themselves. RESULTS: Seventeen patients qualified for analysis. Remission from an acute severe attack of ulcerative colitis was reached by intravenous or oral cyclosporine for 14 of them and by prednisone for 3 of them. The maintenance treatment with azathioprine, which started in all but 1 patient (intention-to-treat), showed a reduction in the number of hospital admissions, decreasing from a mean of 2.12+/-0.69 in the preceding 4.2+/-4.3 years to a mean of 0.12+/-0.33 in the following 5.8+/-2.5 years (p=0.000). CONCLUSIONS: Patients undergoing maintenance therapy with azathioprine showed face fewer relapses needing hospitalisation than those without azathioprine.

Adolescent↗
PubMed2004

[The efficacy of dietetic intervention in multiple sclerosis].

The involvement of nutritional factors in the etiopathogenesis of multiple sclerosis is currently being investigated. Notwithstanding the huge amount of data present in the literature, the possible etiological or protective role of nutrients with regard to the disease remain debatable. The epidemiological data suggest an association between multiple sclerosis and nutrition; the populations that take in a higher quantity of foods of animal origin (meat p<0.0001 and dairy products p<0.01) seem to be the most affected. A role of saturated fatty acids in the etiopathogenesis of myelinic damage has been hypothesised. Case control studies have identified certain foods that act as risk factors and others as protection in the onset of the disease. Some case control studies point to a time-cause relationship between the intake of total calories (O.R. 2.03) and saturated fats (O.R. 1.88) and the incidence of multiple sclerosis; other prospective studies failed to confirm this hypothesis, negating the protective effect of a diet rich in anti-oxidant vitamins and polyunsaturated fatty acids. Intervention studies are discordant with respect to the effects of polyunsaturated fatty acid supplements on the course of the disease. In patients with a progressive chronic form of the disease, polyunsaturated fatty acids did not demonstrate any effect on the progression of the invalidating lesions. Interventions on patients suffering from an acute and remittent form have pointed to the significant effect of treatment with polyunsaturated fatty acids in slowing down the progression of lesions only in cases with a slight initial degree of disability or no disability (p=0.001) at all. They do, however, seem to confirm the hypothesis of an association between the gravity of the disease and consumption of saturated fats (p<0.05) and show an improvement trend in patients treated with polyunsaturated fatty acids, although the data are not statistically significant.

Humans↗
PubMed2004

[Nutrition in acute pancreatitis].

Nutritional management during acute pancreatitis has the purpose to avoid a negative influence on the outcome and to preserve the morphofunctional integrity of the gut, preventing bacterial translocation. When the patient would start again normal nutrition after a period shorter than a week, thanks to the resolution of the clinical picture, and when the initial nutritional state of the patient is satisfactory, a particular nutritional support is not necessary. When the course of the disease is longer and the severity is higher, an early artificial nutritional support is advisable. Caloric needs thought to be useful are 25-30 kcal/kg/die; 40-60% of nutrient mixture should consist of carbohydrates and 20-30% of lipids. Proteins should be approximately 1.0-1.5 g/kg/die. On the basis of recent randomised, prospective clinical trials, enteral jejunal feeding is indicated as a first choice nutritional way, because of its ability to maintain the integrity of the intestinal barrier and its minimal effect on pancreatic secretion, acting significantly on inflammatory parameters and on prognostic markers. This procedure is not indicated when ileum is present and when it causes nausea, vomiting, abdominal pain and an increase of hepatic enzymes. In this case, parenteral feeding is an alternative. Hydroly-sated formulas, containing short peptides and a low percentage of long chain fat acids, are recommended.

Acute Disease↗
PubMed1993

[Trace nutrients in total enteral nutrition: the basal status and longitudinal course].

INTRODUCTION: Previous studies demonstrated deficiencies of selenium and other micronutrients in patients receiving total enteral nutrition (TEN). The content and bioavailability of trace elements in enteral formulas can be suboptimal. MATERIAL AND METHODS: Basal blood levels of some trace elements (copper, iron, selenium, zinc) and vitamins (B12, folic acid) were determined in twenty patients at the beginning of TEN. Vitamin E was measured in 7 patients. Primary diagnosis was cancer (no. = 13) and organic brain syndromes (no. = 7). Commercially available polymeric and oligomeric enteral formulas were used, containing respectively, as a percent of RDA in 1500 kcal, 65-39% of copper, 180-135% of iron, 80-100% of zinc. Selenium was not indicated; determinations in our laboratory gave a content of 78-63% of the minimum recommended intake. Blood levels of copper and zinc (no. = 6), selenium (no. = 5), iron, transferrin and ferritin (no. = 13) were measured after two months of TEN (mean intake of 30 +/- 3 kcal/kg/day). Copper, selenium and zinc were measured with atomic absorption; iron with the complessometric method: vitamin B12 and folic acid with RIA; vitamin E with HPLC. RESULTS: Mean values, expressed as mean +/- SD (range) were: copper: 129 +/- 23 (82-300) micrograms/dl; iron: 37 +/- 18 (16-89) mg/dl; selenium: 53 +/- 20 (22-93) micrograms/dl; zinc: 85 +/- 34 (44-185) micrograms/dl; vitamin B12: 632 +/- 450 (140-1575) pg/ml); vitamin E: 5.4 +/- 1.5 (3.3-7.8) mg/dl; folic acid: 11 +/- 8 (2-20) ng/ml. Values below the lower normal limit were found in 100% (vitamin E), 89% (selenium), 60% (iron), 35% (zinc), 24% (vitamin B12) and 14% (folic acid) of the patients studied. Copper was higher than the upper normal limit in 31% of cases; no data below normal range was found. Mean blood levels of depleted subjects were at the 28%, 43%, 54% and 63% of the mean normal value respectively for iron, selenium, vitamin E and zinc. Blood iron (p < 0.05) and selenium (p < 0.001) were significantly lower in more malnourished patients (weight loss > 20% vs < 20% on usual body weight). After two months of TEN, a reduction of 33% of mean blood selenium was observed in 4 of 5 patients studied. Blood copper and zinc remained stable in 6 subjects with initial normal or higher than normal values. Blood iron increased nonsignificantly, ferritin remained stable, transferrin increased significantly (p < 0.05). No clinical deficiency syndromes were observed. CONCLUSIONS: A careful monitoring of micronutrients during TEN is recommended. Selenium content of enteral formulas, unless supplemented by the producers, seems to be insufficient to maintain the initial blood level in two months of TEN.

Aged↗
PubMed1989

Proposal of a new formula to calculate total urinary nitrogen from urea urinary nitrogen.

Urea urinary nitrogen (UUN) and total urinary nitrogen (TUN) were determined in 15 patients to study their relationship mainly in highly catabolic patients. The subjects were: 7 multiple trauma, 3 autologous bone-marrow transplant, 1 tetanus, 4 postcholecystectomy patients; 180 determination were made, 111 of which in highly catabolic phase (TUN > 15 g/day). TUN and UUN are well correlated (r = 0.9742; p < 0.001) in the range 3 to 52 g/ day of TUN. Urea represents the 83.2 +/- 9.4% (M +/- SD). A double-linear formula to calculate TUN from UUN is proposed (for UUN 15 g/ day: TUN = UUN x 1.17 + 0.7; for UUN > 15 g/ day: TUN = UUN + 4). The least square procedure was used to compare the differences between measured and calculated TUN, and the results obtained with the proposed double-linear formula were compared with that obtained employing pre-existing formulas (Lee's and Mackenzie's). Considering all ranges of values studied (3-52 g of TUN) the results obtained were significantly different (p < 0.005); dividing the levels of TUN in 15 g; 16-29 g and 30 g, the results were always better, but the statistical significancy was not always reached.

Journal Article↗
PubMed1982

[Organization of the hospital food service in a provincial general hospital. Criteria and initial evaluation].

The results of restructuring the meals service in Ivrea Hospital are reported. 7 diet-sheets with food prepared by the central kitchen composed: 2 of normal nutritional content (the first cooked with normal ingredients; the second using special recipes for the bed-ridden); one hypoprotein (50 g/24 hrs of protein), one hypoglycidic (145-170-210 g/24 hrs of glycides), 1 hyposodic (0.6-1.4 g of N/24 hrs), one semiliquid and one divided into 6 small meals. Special diets were needed for 0.5-6-12-2-0.1% of the patients. The amount of uneaten food fell (from 30% to 10%) and there was a real increase in calories (1390 leads into 1870 cals/24 hrs) and protein consumption (70-95 g/24 hrs). The cost remained the same (2079-2176 lire/per day/per capita).

Diet, Diabetic↗
PubMed1979

["Resistent" obesity. Clinical and metabolic aspects, cellularity of the adipose tissue and personality factors].

A study was made of 20 patients with "resistant" obesity selected from a series of about 4000 observed between 1970 and 1976 in an assessment of the possible existence of features distinguishing such patients from those who respond to treatment and display a satisfactory decrease in weight. The group was marked by a higher incidence of familial obesity, earlier onset of overweight, and certain personality features (evaluated by psychometric tests). Their blood sugar and insulin curves, blood cholesterol and uric acid, adipose tissue cellularity, and blood pressure (LHAP) were similar to those in the general series. Whereas their blood triglyceride values were normal, however, those in the general series were up by 21%. It is therefore felt that the clinical tests used at present do not enable the "resistant" obese subject to be distinguished. "Resistant" obesity may well constitute a distinct nosological entity, but one that is only identifiable via the patient's response to treatment.

Adipose Tissue↗
PubMed1978

[Preoperative renutrition in patients with esophageal stenosis].

UNLABELLED: 50 patients suffering from dysphagia and oesophageal stenosis were treated in the period 1975-77. Of these 31 had renutrition of longer than two weeks and are the subject of the present study. Three nutrition systems were employed: 1) total parenteral feeding (7 patients), 2) feeding by naso-gastric tube or gastric fistula (15 patients), 3) feeding per os with semiliquid foods (9 patients). The patients were suffering from benign cicatricial stenosis (5), tumours of the cardia (7), tumours of the oesophagus (19). Short-term survival, weight behaviour and the course of certain blood parameters (Hb, GR, cholesterol, albumin, total proteins) are reported. CONCLUSIONS: --in benign cicatricial stenosis and tumours of the cardia, a normal protein-caloric amount (2000-3500 KCal., 80-120 g/24 h of proteins) is sufficient to obtain weight increase and stabilization of blood examinations. The administration route is unimportant; --in malignant stenosis, 4000-6000 KCal. and 100-130 g of protein/24 h must be provided to obtain the same result. In patients treated with total parenteral nutrition the weight loss persists. The reason for this behaviour is not known; it is likely that enzymatic blocks exist in substrate utilization; --further study is needed to improve results obtained and to clarify the reasons for such behaviour.

Adult↗