Two patients with obliterative peritonitis complicating enterocutaneous fistulae received total parenteral nutrition prior to surgical closure. One patient managed on home parenteral nutrition for 8 mo experienced psychosocial and nutritional rehabilitation at a daily cost of $37. Experience with the other patient confirmed that a significant resolution of obliterative inflammatory changes can occur during a 4-mon period of bowel rest when septic foci have been drained adequately. In-hospital management was required by this patient, and daily charges greatly exceeded those accrued by the other patient who could be managed at home. A home parenteral nutrition program is a cost-effective means of providing time for resolution of obliterative peritonitis.

Adult↗

PubMedDate not supplied

Suboptimal selenium status in home parenteral nutrition patients with small bowel resections.

The selenium status of 13 adult home parenteral nutrition (HPN) patients was evaluated using 12 healthy adult volunteers as controls. Patients had been maintained on HPN for a mean of 36 months and averaged 121 cm of residual small bowel. Prospective diet surveys in patients indicated a mean oral caloric intake of 902 kcal/day. The mean plasma selenium concentrations (microgram/g) were 0.044 in patients and 0.117 in controls (p less than 0.01). The erythrocyte glutathione peroxidase activities, as mumol of NADPH oxidized/g hemoglobin/min, averaged 11.01 in patients and 31.76 in controls (p less than 0.01). Four patients exhibited myalgic symptomatology suggestive of clinical selenium deficiency. No correlations could be ascertained between plasma selenium levels and glutathione peroxidase activities in either patients or controls. Additionally, in the patient group, no significant correlations could be ascertained between selenium status and oral caloric intake, residual small bowel length, symptomatology suggestive of deficiency or HPN duration. However, since sample size was not large, lack of correlations might best be considered suggestive not conclusive. The data indicate that HPN patients with small bowel resections exhibit suboptimal selenium status and may be at risk of developing clinically evident selenium deficiency. HPN patients should be prophylactically supplemented with selenium regardless of oral intake, duration of HPN, or residual length of resected small bowel.

Adult↗

PubMedDate not supplied

Periodic reassessment for improved, cost-effective care in home total parenteral nutrition: a case report.

Home parenteral nutrition (HPN) patients need periodic reassessment for compliance, appropriateness of parenteral formulation, infusion regimen, bowel adaptation, and effective oral nutrient intake. Additionally, new technological advances need to be considered for potential use in the home parenteral nutrition population. Since costs for home parenteral nutrition therapy are substantial, cost-effective options should be exercised whenever reasonable. The following case illustrates our approach to the reassessment process, subsequent modifications, and resultant impact on the lifestyle, adequacy, and cost of home parenteral nutrition therapy.

Adult↗

PubMedDate not supplied

Chemical oxygen demand analysis of wastewater using trivalent manganese oxidant with chloride removal by sodium bismuthate pretreatment.

Current chemical oxygen demand (COD) analyses generate wastes containing hexavalent and trivalent chromium, mercury, and silver. Waste disposal is difficult, expensive, and poses environmental hazards. A new COD test is proposed that eliminates these metals and shortens analysis time, where trivalent manganese oxidant replaces hexavalent chromium (dichromate). A silver catalyst is not required. Optional pretreatment removes chloride via oxidation to chlorine using sodium bismuthate, eliminating the need for mercury. Sample aqueous and solid components are separated for chloride removal, then recombined for total COD measurement. Soluble and nonsoluble COD can be determined separately. Digestion at 150 degrees C is complete in 1 hour. Results are determined by titration or by spectrophotometric reading. Test wastes contain none of the metals regulated for disposal under the Resource Conservation and Recovery Act. Results are shown for selected organic compounds and various wastewaters. Statistical comparisons are made with dichromate COD and biochemical oxygen demand (BOD5) test values.

Bismuth↗

PubMedDate not supplied

Psychosocial crisis in diabetic renal failure.

Twenty-nine diabetic renal failure patients suffered a psychosocial crisis at the time when chronic dialysis or renal transplantation was required. These patients could be classified into groups as to the impact of the crisis in terms of participation in life-support therapy. Group 1 consisted of potentially lethal mechanism (9 patients): discontinued dialysis (5); refused to start dialysis (3); overt act to cause personal harm (1). Group 2 contained probably nonlethal mechanism (11 patients): threatened to discontinue dialysis or to never start dialysis if not given a chance for a transplant (5); threatened to discontinue dialysis or to never start dialysis (5); threatened to cause personal harm (1). Group 3 consisted of a combination of mechanisms (9 patients): with drug abuse (4); without drug abuse (5). Important similarities between the groups were easier to document than were subtle differences in the kinds of options in family and employment relationships; in the degree of objective and subjective handicap due to impaired vision; in the level of expectation and/or disappointment following renal transplantation; and in the capacity to cope with changing personal relationships produced by the complications of diabetes.

Adult↗