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Biomedical subjects

M Deitel

Publications and source records attributed to M Deitel.

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

Hyperalimentation and cancer.

Over an 8-year period, 106 patients with cancer who were major operative risks received intravenous hyperalimentation (IVH). All were malnourished, had gastrointestinal obstruction or had postoperative complications such as fistulas, evisceration or intra-abdominal sepsis, which left IVH as the only means of achieving anabolism. When IVH was started preoperatively and continued postoperatively (34 patients), no deaths or major complications occurred. When IVH was first started after serious complications had occurred (62 patients), the incidence of recovery was high; the mortality was 17.7%. When IVH was given to cachectic patients whose cancer was inoperable to enable them to tolerate radiotherapy or chemotherapy (10 patients), the mortality was 40.0%. Although this last group is small, IVH is worthwhile in selected patients in whom good palliation life can be obtained. With careful IVH and improvement in the quality of technique, the risk of sepsis was no greater than in patients without cancer.

Adult↗
PubMed1980

Total parenteral nutrition in gynecology and obstetrics.

Although total parenteral nutrition (TPN) is accepted for the general surgical patient, it also has applications in management of certain gynecologic and obstetric patients. Over an 8.5-year period, 30 patients at a community hospital were referred for TPN from the obstetric and gynecologic service. The gynecologic patients were subdivided into 3 groups: those with rectovaginal fistulas, in whom colostomies were avoided; those with postoperative enterocutaneous fistulas and starvation; and those with postoperative prolonged ileus or mechanical intestinal obstruction and malnutrition, occasionally complicated by previous irradiation. Treatment with TPN obviated the need for surgery in many patients and improved the perioperative condition in others. In obstetrics, TPN was valuable in the treatment of severe hyperemesis gravidarum, inflammatory bowel disease, and the critically ill neonate. TPN can be an effective therapeutic tool in the management of a wide range of major nutritional problems facing the obstetrician-gynecologist.

Adolescent↗
PubMed1978

Specialized nutritional support in the cancer patient: is it worthwhile?

Over a 7 year period, 85 cancer patients were managed by the nutrition service of St. Joseph's Hospital, Toronto. All these patients were nutritionally depleted, had obstruction to the gastrointestinal tract, or had postoperative complications such as enterocutaneous fistulas, evisceration or intraabdominal sepsis, which left total parenteral nutrition (TPN) as the only means of achieving positive nitrogen balance. A prospective study started in 1970 has found that when cancer was resectable and TPN was started preoperatively and continued postoperatively (24 patients-group 1) until the patient could take a normal diet, no deaths or significant complications occurred. When TPN was first started after life-threatening complications had occurred (53 depleted patients-group 2), the mortality was 17.0%. This mortality was only 4.5% after complications following operations for colon cancer, but was much higher with esophageal, pancreatic and bladder cancer, and especially after complications following surgery where radiotherapy had previously been given to abdomen or pelvis. When TPN was used in inoperable, cachectic patients (8 patients-group 3) to permit them to tolerate radiotherapy or chemotherapy, the mortality was 37.5%. This latter group is small, but TPN is worthwhile in selected patients where significant palliation and improvement in the quality of life can occur.

Adult↗
PubMed1978

Specialized nutritional support and cancer.

Over a 7 1/2-year period, 94 cancer patients presenting considerable operative risk were managed by total parenteral nutrition (TPN). All were nutritionally depleted, had obstruction to the gastrointestinal tract or had postoperative complications such as enterocutaneous fistulas, evisceration or intra-abdominal sepsis, which left TPN as the only means of achieving anabolism. When TPN was started preoperatively and continued post-operatively (28 patients--Group 1), no deaths or significant complications occurred. When TPN was first started after life-threatening complications had occurred (58 patients--Group 2), the mortality was 17.2%, so that a high incidence of recovery was achieved. When TPN was used in inoperable cachectic patients (8 patients--Group 3) to enable them to tolerate radiotherapy or chemotherapy, the mortality was 37.5%. This latter group is small, but TPN is worthwhile in selected patients where significant palliation and improvement in the quality of life can occur. With careful technique, risk of sepsis with TPN was no greater than in noncancer patients.

Humans↗
PubMed1976

Nutritional management of external gastrointestinal fistulas.

From July 1969 to December 1975, 86 patients with 100 fistulas required one or a combination of three modern nutritional aids: central intravenous hyperalimentation; the peripheral intravenous, lipid-amino acid-carbohydrate system; and elemental, nutritionally complete liquid diets. Of the fistulas, 81 closed spontaneously, and in 11 operative closure was attempted; 89 fistulas healed. Eight patients died (9.3%). Before 1969, in an earlier comparable group of patients who had not received such nutrition, the mortality was 40.0%. Fistula drainage and sepsis were controlled. Abscesses were drained. Skin was protected. The most successful way of identifying the nature and origin of a fistula was by instillation of radiopaque liquid into the external opening. Prolonged fistula drainage occurred with distal bowel narrowing and inflammation; previous irradiation to the area; underlying granulomatous bowel disease; bowel adjacent to skin; and foreign bodies in the fistulous tract. Operative closure (resection) was necessary only for distal obstruction and wide breakdown or complete disruption of an anastomosis. Patients who did require operation were in a better nutritional state to withstand operation after receiving specialized nutritional support. Adequate calories and amino acids afforded healing and secretory and mechanical rest for the gastrointestinal tract.

Adolescent↗
PubMed1975

Nutritional support in the management of external fistulas of the alimentary tract.

A total of 56 patients with 65 fistulas was treated using one or a combination of three modern nutritional acids. Fifty-two of the fistulas (80 per cent) closed spontaneously and only 7 fistulas (10-8 per cent) required attempts at operative closure. The overall mortality was 7 patients (12-5 per cent), which compared favourably with a 40 per cent mortality in an earlier comparable group which had not received such nutrition.

Dietary Fats↗
PubMed1975

Growth of common bacteria and Candida albicans in 10% soybean oil emulsion.

Bacterial and fungal growth in 10% soybean oil emulsion (Intralipid) and 5% fibrin hydrolysate in 5% dextrose was studied at 4, 25 and 37 degrees C. Staphylococcus aureus, Streptococcus pyogenes, Str. fecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans were grown in broth at 37 degrees C, diluted in saline and inoculated into each of the two preparations as well as a mixture of the two. Growth was measured at 24, 48 and 72 hours. In 10% soybean emulsion, all bacteria except S. pyogenes multiplied, but in fibrin hydrolysate-dextrose solution the only organism of those studied to grow was S. aureus. In the hydrolysate-dextrose-lipid mixture, all organisms multiplied except S. pyogenes and P. aeruginosa. C. albicans grew in all solutions tested. While at 4 degrees C, organisms did not multiply. The fibrin hydrolysate-dextrose solutions given by infusion into a central vein for hyperalimentation have been shown to support predominantly fungal growth, and contamination of the solution and ultimately of the indwelling catheter is a constant hazard. Because both bacteria and C. albicans grew equally well in 10% soybean oil emulsion, its use as a caloric source when infused into a central vein may increase the occurrence of sepsis. When this emulsion is used to provide essential fatty acids or calories, it should be given via a peripheral vein, so that a central catheter will not be contaminated.

Bacteria↗
PubMed1974

Total nutrition by peripheral vein--the lipid system.

A means for providing total nutrition is described in which 10% soybean oil-eggyolk phosphatide-glycerol emulsion (Intralipid) and a solution of 5% dextrose in 5% protein hydrolysate are given simultaneously into a peripheral vein, utilizing two giving sets united by a Y-connector at the needle. No ketonuria occurred, and there were no side effects from the lipid emulsion. Advantages of this system include absence of significant peripheral phlebitis, avoidance of the hazards of caval catheters, and absence of the complications of hypertonic solutions. Disadvantages include restricted forearm movement and frequent regulation of flow-rates.This system was used in 23 patients for periods of 4 to 78 days (mean 16.3 days). Weight gain and healing occurred, and all survived but one patient who died of myocardial infarction following successful surgical closure of an enterocolocutaneous fistula. The lipid system adds another method to the measures available for the management of major nutritional problems.

Amino Acids↗
PubMed1973

Intestinal obstruction by an unusual foreign body.

The case is described of a patient with complete small bowel obstruction 13 days after swallowing a condom containing hashish. Treatment by enzymatic dissolution was obviously impossible. The small bowel was emptied preoperatively by a Dennis long-tube, and the impacted bolus was removed by enterotomy.

Adult↗