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Biomedical subjects

J L Rombeau

Publications and source records attributed to J L Rombeau.

14 recordsLinked to original sources
PubMed1992

Increased in vitro release of soluble interleukin 2 receptor by colonic lamina propria mononuclear cells in inflammatory bowel disease.

Increased concentrations of the soluble form of the interleukin 2 receptor have been observed in the sera of Crohn's disease and ulcerative colitis patients. In this study we have observed the spontaneous release of soluble interleukin 2 receptor by unstimulated, isolated normal and inflammatory bowel disease colonic lamina propria mononuclear cells. Lamina propria mononuclear cells from Crohn's disease patients (median = 204 U/ml (interquartile range 126-396, n 17) secreted significantly (p less than 0.01) more soluble interleukin 2 receptor than normal controls (median = 124.5 U/ml (108-131), n 12). No statistically significant differences were seen between ulcerative colitis (median = 135 U/ml (92-196), n 20) and normal controls. Moreover, significantly (p less than 0.01) increased amounts of soluble interleukin 2 receptor were secreted by colonic diverticulitis lamina propria mononuclear cells (median = 259 U/ml (149-282), n 15) which were used as disease specificity controls. Time course experiments showed that the majority of soluble interleukin 2 receptor was released by isolated lamina propria mononuclear cells in the first six days of culture. Upon stimulation with pokeweed mitogen, Crohn's disease (median = 2258 U/ml (1435-3584), n 14), normal control (median = 2622 U/ml (2030-3180), n 14) and diverticulitis lamina propria mononuclear cells (median = 2745 U/ml (1733-3192), n 10) reached similar maximal soluble interleukin 2 receptor secretion levels, while ulcerative colitis lamina propria mononuclear cells secreted significantly (p less than 0.005) less soluble interleukin 2 receptor (median = 912 U/ml (494-1259), n 17). These results suggest that enhanced shedding/secretion of soluble interleukin 2 receptor by intestinal lymphocytes may account in part for increased serum soluble interleukin 2 receptor concentrations during chronic intestinal inflammatory reactions.

Cells, Cultured↗
PubMed1992

Recombinant human growth hormone enhances the metabolic efficacy of parenteral nutrition: a double-blind, randomized controlled study.

This multicenter, randomized, double-blind study was performed to investigate whether recombinant GH improves the efficacy of total parenteral nutrition (TPN). Fifteen stable patients requiring parenteral feeding due to gastrointestinal/pancreatic disease were studied. Constant maintenance TPN providing approximately 30 kcal/kg day and approximately 1.6 g protein/kg.day was administered during an initial 7-day baseline period. After randomization, daily sc injections of saline (control, n = 9) or GH (10 mg/day, n = 6) were administered a 14-day treatment period as nutrient intake remained constant. Elemental balances for nitrogen (N), potassium (K), phosphorus (P), and sodium (Na) were determined daily and serial blood indices, vital signs, and other clinical parameters were monitored. Nutrient balances approached equilibrium during the baseline week in both groups. With GH administration, a significant increase in N, K, and P balance occurred; in contrast, nutrient balances did not change significantly from baseline values in control patients. The cumulative change (delta) in nutrient balances from the baseline week was also significantly greater in the GH-treated patients (delta N: control+2 +/- 7 g vs. GH+36 +/- 6. g, P less than 0.005; delta K:+57 +/- 45 mmol vs.+199 +/- 19 mmol, P less than 0.03; delta P: -27 +/- 30 mmol vs. +91 +/- 69 mmol, P less than 0.02). Plasma insulin-like growth factor-I concentrations rose 5-fold and serum cholesterol rose slightly with GH; no other significant change in group mean blood values occurred. One patient receiving GH and chronic prednisone therapy developed moderate hyperglycemia and mild peripheral edema; no other deleterious effects attributable to GH were observed. GH was well tolerated and significantly enhanced nutrient retention compared to standard parenteral feeding alone. GH improves the efficacy of parenteral nutrient utilization in patients requiring TPN.

Adolescent↗
PubMed1991

Experimental short-bowel syndrome: effect of an elemental diet supplemented with short-chain triglycerides.

To determine whether short-chain triglycerides (SCTs, 1:1 triacetin:tributyrin, wt:wt) enhance intestinal adaptation in short-bowel syndrome (SBS), male Sprague-Dawley rats underwent 60% distal small-bowel resection with cecectomy and received either a chemically defined diet (CD) or a CD containing 40% of nonprotein energy as either medium-chain triglycerides (MCTs) or SCTs. After 12 d the SCT group had significantly increased jejunal mucosal weight compared with the MCT and CD groups and had significantly increased segment weight and mucosal protein compared with the CD group. In the colon the SCT group had significantly increased segment and mucosal weights and mucosal protein and DNA compared with both the MCT and CD groups. Body-weight change and measurements of serum ketones, albumin, glucose, and triglycerides revealed no significant differences among groups. SCTs improved jejunal and colonic adaptive growth and maintained comparable nutritional status in SBS when compared with CD alone or CD with MCTs.

3-Hydroxybutyric Acid↗
PubMed1990

Parenteral nutrition supplemented with short-chain fatty acids: effect on the small-bowel mucosa in normal rats.

When enteral nutrition is excluded from animals maintained solely with total parenteral nutrition (TPN), atrophy of the intestinal mucosa is observed. Short-chain fatty acids (SCFAs) are produced in the colon by the fermentation of dietary carbohydrates and fiber polysaccharides and have been shown to stimulate mucosal-cell mitotic activity in the intestine. This study compared the effects of an intravenous and an intracecal infusion of SCFAs on the small-bowel mucosa. Rats received standard TPN, TPN with SCFAs (sodium acetate, propionate, and butyrate), TPN with an intracecal infusion of SCFAs, or rat food. After 7 d jejunal and ileal mucosal weights, DNA, RNA, and protein were determined. Standard TPN produced significant atrophy of the jejunal and ileal mucosa. Both the intracecal and intravenous infusion of SCFAs significantly reduced the mucosal atrophy associated with TPN. The intravenous and intracolonic infusion of SCFAs were equally effective in inhibiting small-bowel mucosal atrophy.

Animals↗
PubMed1979

Late development of colorectal cancer subsequent to pelvic irradiation.

Two cases of irradiation-associated carcinoma of the colon are reported and the literature reviewed. The clinical courses and operative difficulties in treating these patients are emphasized. The necessity for life-long follow-up examinations with proctoscopic and barium-enema evaluations in high-risk patients is stressed. Irradiation-associated carcinoma of the colon occurs almost exclusively in women, but should be investigated in patients of either sex who live for long periods after pelvic irradiation.

Adenocarcinoma↗
PubMed1978

Left-sided colectomy with retroileal colorectal anastomosis.

Following resection of the sigmoid and descending colon for cancer or extensive diverticular disease, it may be impossible to make a colorectal anastomosis due to inadequate length of the residual transverse colon. To correct this problem, the remaining transverse colon may be pulled into the pelvis by making a "window" in the terminal part of the ileal mesentery. From January 1966 to January 1975, 302 resections of the descending colon with colorectal anastomoses were performed by one of the authors (R.B.T.) for upper sigmoid cancer and extensive diverticulitis at the Cleveland Clinic. Eleven patients (4%) had retroileal colorectal anastomoses. The retroileal apprach is a technical aid when performing an extensive left-sided colectomy and/or when there is insufficient length of residual transverse colon to make a tension-free colorectal anastomosis.

Adult↗
PubMed1978

Hidden-loop colostomy.

Records of 15 patients having hidden-loop colostomies were reviewed. All patients had metastatic colonic cancers with impending obstructions. Six colostomies were subsequently opened because of obstructions due to cancer. All colostomy openings were done using local anesthesia in the emergency room. This technique prevented six major celiotomies and provided additional time of living without a stoma. There were two postoperative stomal prolapses, one of which necessitated reoperation. A hidden-loop colostomy is easily constructed and readily opened. It should be considered at celiotomy for selected patients who have metastatic colonic cancer with impending obstruction.

Abdomen↗
PubMed1978

Transperitoneal relocation of the ileal stoma without formal laparotomy.

A method of transperitoneal ileal stoma relocation without formal laparotomy is described. Twenty of these procedures were performed during a ten year period. There was one postoperative failure. The barium stomal injection is a valuable aid in the peroperative diagnosis of possible underlying Crohn's disease. Transperitoneal relocation of an ileal stoma without formal laparotomy is a safe and useful method in selected patients.

Adolescent↗
PubMedDate not supplied

Protein-calorie malnutrition in patients with colorectal cancer.

Protein-calorie malnutrition, as determined by anthropometric measures and laboratory tests, was assessed in 17 preoperative patients with colorectal cancer and 47 control patients. The cancer patients had significant deficits in visceral protein and skeletal muscle and no deficit in fat stores. Greater attention should be given to preoperative nutritional assessment and to the correction of protein deficits.

Anthropometry↗
PubMedDate not supplied

[Nutrition team. Units of nutritional support].

During the VIII National Congress of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) held in Santander on 5th, 6th and 7th of June last, a subject was raised among several others, which for us was of great current interest and not often found in scientific affairs, related to the organizational affairs of the discipline of Artificial Nutrition, namely the Nutritional Teams or Nutritional Support Units. The aim was to respond to the many problems raised by this discipline: What does it consist of? Is it necessary? What is its purpose? Who is involved in it? What qualifications must these people have? Does it enter into competition with Nutritional, Clinical and Dietetic Services? To reply to these and many other questions, we invited a number of professionals with wide experience in nutritional and other fields, in an attempt to form a group of experts in different specialties with interests in the subject. We were also lucky enough to be able to invite Doctor Rombeau, an internationally-recognized expert, in whose country there exists great experience in the organization of these units. This summary of our Round Table was prepared by the organizer, Doctor Ordóñez, and an attempt was made to respect the spirit of each author's contribution.

Enteral Nutrition↗