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Biomedical subjects

E Lerebours

Publications and source records attributed to E Lerebours.

At least 127 records · Page 7Linked to original sources
PubMed1980

[Effect of protein and energy intake on nitrogen metabolism of undernourished patients on continuous enteral nutrition].

Nitrogen balance, energy balance and respiratory quotient were measured in 18 undernourished patients fed with continuous enteral nutrition in order to assess the effects of: a) various levels of protein and energy intakes with a fixed diet composition; b) energy/nitrogen ratio; c) proportions of carbohydrates in energy intake. The results were the following: 1) With energy intakes from 4,880 to 8,360 kJ/m2/day (protein: 18 p. 100) nitrogen balance and net protein absorption were significantly correlated with nitrogen intake (respectively P less than 0.01 and P less than 0.001). 2) Nitrogen balance was not significantly different whether the patient received normo (energy/nitrogen = 476 kJ/g) or hypernutrition ( energy /nitrogen = 1,056 kJ/g). 3) Nitrogen balance was not different in 6 patients receiving the same energy and nitrogen intakes but 80 or 55 p. 100 carbohydrates; high carbohydrates diet induced lipid synthesis. These results confirm the value of continuous enteral nutrition to positive nitrogen balance in undernourished patients. Except when energy expenditure level is very high they do not support a policy of routinely use hypernutrition with high carbohydrates diet.

Adult↗
PubMed1978

[Zinc in digestive diseases (author's transl)].

The present review is concerned by the main features of zinc metabolism (requirements, intestinal absorption, tissue distribution, excretion). The relationships between zinc variations and gut pathology are discussed with respect to the following points: criteria for the diagnostic of zinc deficiency, pathophysiological mechanisms, clinical consequences, therapeutic implications. Evidence for zinc malabsorption is present in Acrodermatitis enteropathica and in chronic zinc deficiency observed in Middle-East. During last decade zinc deficiency has been frequently reported in total parenteral feeding. Alterations in plasma zinc concentrations have been described in coeliac disease and inflammatory bowel disease but a true deficiency remains to be established in this pathological states.

Acrodermatitis↗
PubMedDate not supplied

Efficacy of antibiotic-lock technique with teicoplanin in staphylococcus epidermidis catheter-related sepsis during long-term parenteral nutrition.

BACKGROUND: The antibiotic-lock technique has been suggested to treat catheter-related sepsis in parenteral nutrition and to avoid catheter removal. METHODS: To determine the incidence of catheter-related sepsis, the bacteria involved, and the efficacy of the antibiotic-lock technique with teicoplanin, all patients (n = 263) undergoing parenteral nutrition from January 1997 to December 1999 in one center, with patients at the hospital (n = 209) and at home (54) were retrospectively studied. The antibiotic-lock technique with teicoplanin was systematically used in all suspected infections and maintained in staphylococcus epidermidis (SE) infections. RESULTS: A total of 21 of 263 patients had 34 infections (0.11/patient per year): 12 of 209 hospitalized and 9 of 54 home patients. A total of 10 of 34 infections were due to non-SE, and the catheter was immediately removed. The other 24 of 34 infections were due to SE; in 5 of 24, the catheter was removed after 48 hours of the antibiotic-lock technique because of persistent fever or thrombosis. A total of 5 of 12 patients had 2 or more infections on the same catheter. The antibiotic-lock technique prevented short-term catheter removal in these cases, but a second infection occurred within a median of 50 days. In 4 of 5 cases, a third infection occurred in a mean delay of 90 days so that the catheter was removed. In 3 of 5 patients, bacteria was analyzed with pulsed field gel electrophoresis, which showed that recurrent infections were due to the same strain in all cases. CONCLUSIONS: In this study, the incidence of catheter-related sepsis was low and mostly related to SE. Our results do not support the use of the teicoplanin antibiotic-lock technique in SE infections.

Anti-Bacterial Agents↗
PubMedDate not supplied

An evaluation of total parenteral nutrition in the management of steroid-dependent and steroid-resistant patients with Crohn's disease.

This study is an evaluation of short- and long-term benefits of total parenteral nutrition (TPN) in 20 patients with active Crohn's disease but without fistulae. TPN was done during 42 (14-80) days (median-range) after failure of medical therapy including patients with steroid-resistant (11 SR) or steroid-dependent (9 SD) active Crohn's disease. Efficacy of short-term TPN was demonstrated by nutritional repair and achievement of clinical remission in all but one patients. Follow-up was 28 (8-78) months in the 19 patients (10 SR, 9 SD) discharged improved after the end of TPN. At 1 yr, the cumulative recurrence rate was 26% (5/19). During the follow-up, three patients (2 SR, 1 SD) remained symptom-free, 13 (6 SR, 7 SD) had a partial remission defined as relapse controlled by medication, and only three patients (2 SR, 1 SD) had a relapse uncontrolled by medical therapy leading to surgery. Therefore in our selected population without fistula or abscess, after failure of medical therapy TPN was obviously an effective therapy which avoided surgery. Furthermore follow-up indicated that SD and SR were only transient events in the course of Crohn's disease patients.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Comparison of the effects of continuous and cyclic nocturnal parenteral nutrition on energy expenditure and protein metabolism.

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7-day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 +/- 41 kcal/day-1) and cyclic total parenteral nutrition (1428 +/- 46 kcal/day-1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24-hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions.

Adult↗
PubMedDate not supplied

Duodenojejunal motility after oral and enteral nutrition in humans: a comparative study.

BACKGROUND: Small bowel motility during enteral nutrition (EN) remains poorly known. Our aim was to compare, in six healthy volunteers, the duodenojejunal motor patterns after a 750-kcal meal either ingested or infused intraduodenally at two different infusion rates: 2 kcal/min for 6 hours (6-hour EN) or 1 kcal/min for 12 hours (12-hour EN). METHODS: In each volunteer, the three manometric studies were carried out in a random order with an interval of > or = 1 week between each recording. Number of phase III (PIIIs), their characteristics, number of waves (NW), and area under the curve (AUC) were determined. RESULTS: PIIIs were interrupted by each type of nutrition in every volunteer. In five of six during 6-hour EN and in six of six during 12-hour EN, the first PIII returned before the end of EN. The mean duration of the fed pattern was similar in the three studies. During the interruption of PIIIs after oral meal, duodenojejunal motility was characterized by uninterrupted random contractions. By contrast, in four of six during the 6-hour EN and in five of six during 12-hour EN, it was organized as regular short bursts of contractions separated by motor quiescence. In all studies during the disruption of PIIIs, NW and AUC values decreased progressively with time and were higher at the jejunum level than in the duodenum (p < .001). However, at each level of recording, NW and AUC values were similar in the three types of feeding. After the return of PIIIs, the number, duration, and propagation velocity of PIIIs, NW, and AUC values were similar in the three studies. CONCLUSIONS: EN interrupts PIIIs, but, in most cases, PIIIs reappear before the end of EN. During the interruption of PIIIs, the organization of the contractions is qualitatively different from the fed pattern observed after oral feeding. For the same caloric value of the meal, the quantitative duodenojejunal motor response is not affected by the infusion rate, and the more important jejunal, rather than duodenal motor response found after an oral meal, is observed during EN. During EN, after the return of PIIIs, despite the persistence of a nutrient infusion into the duodenum, the small bowel motor patterns are not qualitatively or quantitatively different from those recorded in fasting subjects.

Adult↗
PubMedDate not supplied

Neurologic disorders due to brain manganese deposition in a jaundiced patient receiving long-term parenteral nutrition.

BACKGROUND: Neurologic and radiologic disorders have been reported in patients receiving long-term parenteral nutrition (PN). On the basis of elevated serum manganese levels, some of these abnormalities have been attributed to manganese intoxication. Alterations of the basal ganglia signal intensity on T1-weighted magnetic resonance images (MRIs) have been previously reported, but the precise nature of these alterations remains controversial although the deposition of manganese has been suggested in patients with chronic hepatic encephalopathy due to liver failure. METHODS: We report the case of a patient who was receiving PN and exhibited a chronic cholestasis. Neurologic disorders appeared after several months of PN, when a hypersignal in the basal ganglia and white matter was found on T1-weighted MRIs of the brain in association with elevated serum and manganese levels. RESULTS: Elevated autopsic concentrations of manganese were found in the radiologic abnormal cerebral areas. CONCLUSIONS: Our observation is the first demonstration of a relationship between high intracerebral manganese levels, radiologic abnormalities, and neurologic disorders during long-term PN. Moreover, serum manganese levels are not a good indicator of cerebral levels. In fact, in our patient, serum manganese levels returned to normal, whereas those of cerebral manganese remained increased.

Brain↗
PubMedDate not supplied

[Hepatitis due to pirprofen; 3 cases, 1 fatality].

We report three cases of jaundice in women taking 800 mg pirprofen.day-1 during 6 weeks to 4 months and a half. Two of them presented cutaneous side effects: one case was rapidly better with corticosteroids. Fatal case possibility incite to transaminase surveillance.

Aged↗
PubMedDate not supplied

[Conditions for functioning of an effective peritoneo-jugular shunt. Doppler infrared thermographic study].

A peritoneo-jugular shunt clinically effective in a 48 years old male patient with cirrhosis, is explored concomitantly with Doppler and infrared thermography. In this patient, without clinical signs of ascites, these two non invasive methods associated to sensitization techniques (decubitus, deep breathing, abdominal binding) specify the functioning conditions of the valve and permit to consider a close monitoring of these patients for screening and prevention of the frequent, asymptomatic obstruction of their shunt.

Humans↗