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Biomedical subjects

J M Nightingale

Publications and source records attributed to J M Nightingale.

34 records · Page 2Linked to original sources
PubMed1992

Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gall stones in patients with a short bowel.

Forty six patients with less than 200 cm of normal jejunum and no functioning colon were compared with 38 patients with similar jejunal lengths in continuity with a functioning colon. Women predominated (67%), and the most common diagnosis in each group was Crohn's disease (33 of 46 no colon, 16 of 38 with colon). All patients without a colon and less than 85 cm of jejunum and all those with a colon and less than 45 cm jejunum needed long term parenteral nutrition. Six months after the last resection 12 of 17 patients with less than 100 cm jejunum and no colon needed intravenous supplements compared with 7 of 21 with a colon. Between 6 months and 2 years, little change occurred in the nutritional/fluid requirements in either group, though there was weight gain. Of 71 patients assessed clinically at a median of 5 years, none with more than 50 cm of jejunum and a colon needed parenteral supplements. Most (25 of 27) of those without a colon who did not need parenteral supplements required oral electrolyte replacement compared with few (4 of 27) with a colon. None of the patients without a colon developed symptomatic renal stones compared with 9 of 38 (24%) with a colon (p < 0.001). Stone analysis in three patients showed calcium oxalate. Gall stone prevalence was high but equal in the two groups--43% of those without and 44% of those with a colon.

Calcium Oxalate↗
PubMed1992

Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution.

Six patients with jejunostomies and residual jejunal lengths of 105 to 250 cm took the same food and water each day for eight study days. In random order, three methods of salt replacement were tested, each over 48 hours, against a period without added salt. During the three test periods the patients took 120 mmol of sodium chloride daily, as salt in gelatine capsules, as an isotonic glucose electrolyte (280 mOsmol/kg; 30 kcal) solution, and as a glucose polymer (Maxijul) solution (280 mOsmol/kg; 200 kcal). The daily stomal output remained constant for each patient during the four test periods but varied between patients from 0.60 to 2.84 kg (daily intestinal fluid balance 0.74-2.61 kg). Without a salt supplement, three patients lost more sodium from the stoma than they took in by mouth (-25, -94, and -101 mmol/day) and the mean sodium balance for all six subjects was -16 mmol (range -101 to 79) daily. Extra salt was absorbed with each form of supplement (p less than 0.05); no patient with the glucose electrolyte solution (mean 96, range 0 to 226 mmol), but one patient with the glucose-polymer solution (mean 96, range -25 to 164 mmol) and two with the salt capsules (mean 66, range -8 to 145 mmol) were in negative balance. Two patients vomited with the salt capsules. There was only a small increase in energy absorption (mean 115 kcal) with the glucose polymer solution compared with the glucose electrolyte solution. A sipped glucose electrolyte solution seems to be the optimal mode of sodium replacement in patients with a high output jejunostomy.

Adult↗
PubMed1991

Length of residual small bowel after partial resection: correlation between radiographic and surgical measurements.

The capacity for absorption after a small bowel resection depends upon the remaining length of intestine. This is important in planning nutritional therapy and affects surgical policy should further resection appear necessary. In 18 patients, the remaining small bowel length from the duodenojejunal flexure had been measured at operation and found to be less than 200 cm; this was compared with a measurement obtained by one observer using an opisometer on a subsequent barium follow-through (BaFT) examination. A significant correlation (p less than 0.001) of 0.72 was found. Radiographic measurement was easiest when the bowel was short (less than 150 cm) and all seen on one film with no overlapping loops. A residual small intestinal length of less than 200 cm measured from a BaFT radiograph is sufficiently accurate to formulate management decisions.

Barium Sulfate↗
PubMed1991

Effect of omeprazole on intestinal output in the short bowel syndrome.

Ten patients with an end jejunostomy and one with a jejuno-rectal anastomosis (jejunal length 30-140 cm) ate a constant chosen diet for 2 control days, and 2 test days when 40 mg omeprazole orally was taken each morning. In the 7 patients with a net secretory output of fluid, there was a mean reduction in wet weight of 0.66 kg/24 h (range -0.16 to 1.45 kg/24 h; P less than 0.05) and sodium 46 mmol/24 h (-51 to 135 mmol/24 h; N.S.); the four patients with net absorption of fluid showed no reduction in intestinal output. One patient with 30 cm jejunum responded little to oral but did so to intravenous 40 mg omeprazole twice a day with a reduction in wet weight of 3.00 kg/24 h and sodium 157 mmol/24 h. In one patient oral 40 mg omeprazole daily gave equivalent results to oral 300 mg ranitidine twice daily; in 2 others it was equivalent to intravenous 50 micrograms octreotide twice daily. Omeprazole reduces the intestinal output in patients with the short bowel syndrome and a net secretory output, but not enough to prevent the need for parenteral fluid and electrolyte replacement.

Anastomosis, Surgical↗
PubMed1990

Jejunal efflux in short bowel syndrome.

24 h oral intake and intestinal output were studied in 15 patients with a short residual length of jejunum and no colon. 8 patients showed a net secretory, and 7 a net absorptive response to food. In secretors, daily intestinal output exceeded oral intake (mean 2.3 kg wet weight, and 233 mmol sodium). Long-term parenteral fluid and electrolyte replacements were needed only in those with a secretory response. Jejunal length inversely correlated with net intestinal output of fluid, sodium, potassium, and with percentage energy absorption. A secretory response was observed if jejunal length was less than 100 cm and was reduced by gastric antisecretory drugs and octreotide.

Administration, Oral↗
PubMed1990

Short bowel syndrome.

Nine patients with short bowel syndrome and high intestinal output received octreotide either intravenously (50-100 micrograms t.i.d.) or subcutaneously (100 micrograms b.i.d.) on 2 test days. In the 6 patients with net secretory output, there was a reduction in mean daily intestinal output of 0.5-5.0 kg; total daily intestinal output of sodium and potassium was also reduced significantly. Of the 3 patients with a net absorptive state, there was a worsening of output in 2 and no improvement occurred in the other. Two patients with net secretory output received long-term octreotide therapy, allowing a reduction in daily intravenous fluid intake of 1.0-1.5 litres.

Administration, Oral↗
PubMed1989

Octreotide (a somatostatin analogue) improves the quality of life in some patients with a short intestine.

Six patients with short intestine (jejunal length 25-70 cm) on long-term parenteral nutrition, needing 4-5 L of intravenous fluid daily, were given octreotide (a somatostatin analogue, SMS 201-995) to investigate whether it would reduce beneficially their secretory diarrhoea (3.6-6.9 kg/day). They consumed the same diet for 2 control days, followed by 2 test days. Octreotide was given intravenously, initially in a dose of 50 micrograms b.d. through the central feeding line. There was a significant reduction of daily stomal output (0.5-5.0 kg) and daily sodium and potassium output; however there was no significant change in energy absorption. The response to octreotide was greatest in those patients who absorbed least nutrients. A dose increase to 100 micrograms t.d.s. gave no further measurable benefit though the patients found it smoothed-out the post-prandial rise in stomal output. Two patients were continued on long-term octreotide therapy, which allowed for a daily reduction in intravenous fluid of 1 and 1.5 L. Octreotide's anti-secretory effect was found to have been maintained when it was retested in one patient after a year of continuous therapy.

Diarrhea↗
PubMed1987

Control of a single degree of freedom artificial hand.

A commercial single degree of freedom artificial hand has been fitted with touch, slip and position sensors, which permit low-level control tasks to be performed by a microprocessor; little conscious effort is required by the wearer. Hardware and software for the microprocessor system are described.

Biomedical Engineering↗
PubMed1980

An adaptive control system for a complete hand/arm prosthesis.

A complete hand/arm prosthesis is proposed in which the user has only supervisory control, the details of grip force, joint angles etc. being controlled automatically. By such a system it is possible in principle to control an eleven-degree of freedom prosthesis (four in the hand and seven in the arm) with only four inputs being provided by the patient. Thus increasing the flexibility of the system without putting too much strain on the patient.

Arm↗
PubMedDate not supplied

Sensory control of a multifunction hand prosthesis.

The current generation of prostheses that are fitted to limb deficient individuals have only a single degree of freedom which limits their functional range. Furthermore, electrically powered prostheses have a limited user input. Electrical signals generated by the contraction of muscles in the user's stump open and close the hand in an 'on and off' fashion. Since the only feedback is visual, the prostheses tend to be used less dexterously than body powered devices. A different approach has been adopted by the Control Engineering Group at Southampton University. They have retained a single electromyographic input channel, but added sensory feedback to an electronic controller, which decides on the grip posture and tension. Satisfactory operation of the hand depends on the sensors employed. A review of transducers used on previous prostheses at Southampton is followed by a description of recent sensor developments. Finally the intentions for a new generation of prostheses are outlined. These include combining sensory input with an integrated circuit microcontroller to provide a more reliable system.

Biomedical Engineering↗
PubMedDate not supplied

Management of patients with a short bowel.

Short bowel syndrome most commonly results after bowel resections for Crohn's disease. The normal human small intestinal length ranges from about 3 to 8 m, thus if the initial small intestinal length is short, a relatively small resection of the intestine may result in the problems of a short bowel. Two types of patient with a short bowel are encountered in clinical practice: those with their jejunum anastomosed to a functioning colon, and those with a jejunostomy. Both types of patient have problems absorbing adequate macronutrients, and both need long-term vitamin B12 therapy. Patients with a jejunostomy also have major problems with large stomal losses of water, sodium, and magnesium. This high-volume jejunostomy output is treated by restricting oral fluids, giving a glucose-saline solution to drink, and using drugs that either reduce gastrointestinal motility (loperamide or codeine phosphate) or secretions (H2 antagonists, proton pump inhibitors, or octreotide). Patients whose jejunal length is less than 100 cm, and whose stomal output is greater than their oral intake, benefit most from antisecretory drugs. In patients with a retained colon, bacterial fermentation of unabsorbed carbohydrate in the colon results in energy being salvaged. However, they have increased oxalate absorption and a 25% chance of developing calcium oxalate renal stones. Thus patients with a colon are advised to eat a high-energy diet rich in carbohydrate but low in oxalate. Patients with a jejunostomy need a high-energy iso-osmolar diet with added salt. Both patient types have a 45% prevalence of gallstones. With current therapy most patients with a short bowel have a normal body mass index and a good quality of life.

Adaptation, Physiological↗