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Biomedical subjects

M E Shils

Publications and source records attributed to M E Shils.

At least 37 records · Page 2Linked to original sources
PubMed1979

Principles of nutritional therapy.

Provision of adequate nutrition makes a major contribution toward improvement of clinical, biochemical, cellular, and psychologic status of the cancer patient in the face of the disease process and the side effects of various treatments. The principles of nutrition support include the following: 1) Malnutrition induced by cancer and its treatment adversely affects the patient and complicates further treatment of the disease. 2) Malnutrition is not an obligatory response of the host to cancer. 3) A rational nutritional therapeutic program for a patient requires analysis of the factors inducing depletion in that patient. 4) Every patient should have an early and periodic assessment of nutritional status. 5) Nutrition therapy, when indicated, should be instituted early. 6) The application and effectiveness of therapeutic programs must become part of the medical audit and general clinical procedure for inpatients and outpatients. 7) The objectives of nutritional therapy are: a) supportive, b) adjunctive, and c) definitive. 8) Nutritional status, tumor growth and anti-tumor treatment are intimately related. 9) Nutritional therapy has the potential for difficulties as well as benefits. 10) The provision of optimal nutrition care requires a multidisciplinary approach with physicians, nurses, dietitians, and pharmacists working as a team with adequate laboratory facilities and administrative and financial support.

Adult↗
PubMed1977

Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection.

Eighteen patients are reported who have had a regional pancreatectomy. The pancreatic segment of portal vein was excised with en bloc total pancreatectomy and regional lymph node dissection in all 18. Venous repair was by end-to-end anastomosis without a graft. Five of the 18 also had various arterial resections and reconstructions. Sixteen of the 18 had been explored and deemed nonresectable elsewhere. This operation has doubled the resectability rate in this institution. The 30-day operative mortality rate was 16.6%. Acurarial survival is 62% at one year compared with 36% one year survival rate for patients undergoing pancreaticoduodenectomy for less advanced cancer in previous years. A more valid comparison would be between those who had a palliative procedure since most patients in the present series were initially considered unresectable. One year survival for these patients was 22%. The quality of life was good for most patients.

Adenocarcinoma↗
PubMed1977

Effects on nutrition of surgery of the liver, pancreas, and genitourinary tract.

Carcinoma of the pancreas is increasing in the United States and has a grave progonosis. Surgical treatment has moved from subtotal pancreatectomy to total pancreatectomy and now to en bloc resection and vascular replacement. Pancreatic exocrine and endocrine insufficiency following resection add to the nutritional problems presented by this major surgery and its high complication rate. Recognition of these problems and adequate treatment decrease morbidity and mortality. Major hepatic resection imposes metabolic problems in the immediate postoperative period that are minimized by improving preoperative nutritional status and by providing adequate postoperative support with albumin and carbohydrate. Urinary tract diversion for pelvic cancer involving the ureters and/or bladder has progressed from ureterosigmoidostomy with its high incidence of disturbances of electrolyte and acid-base balance to ureteroileostomy with its appreciably lower rate of complications.

Adult↗
PubMed1975

A program for total parenteral nutrition at home.

Total parenteral nutrition is of undisputed value in improving and maintaining patients who are otherwise unable to ingest food adequately by mouth or by tube. A relatively simple closed system for the preparation of solutions and their administration permits safe application of total parenteral nutrition at home. Selected patients who otherwise will remain in hospital or die are able to have an acceptable quality of life at home in a good state of nutrition and with freedom from their intravenous solutions for many hours per day. Based on experience with eleven patients maintained on total parenteral nutrition at home, recommendations are made for patient selection, training, total parenteral nutrition composition, and follow-up.

Ambulatory Care↗