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S DiCecco

Publications and source records attributed to S DiCecco.

4 recordsLinked to original sources
PubMed1991

Impact of malnutrition and its therapy on liver transplantation.

The consequences of malnutrition and impact of nutritional support on the liver transplant patient have not been adequately addressed in clinical research studies. As we have gained experience in assessing patients for transplantation surgery, the risks of malnutrition have been realized. Part of the success of liver transplantation today is related to improved timing of surgery, patient selection, and perioperative management. Malnutrition is one of the adverse risk factors that is potentially reversible and therefore specialized nutritional support techniques should be able to improve postsurgical outcome. However, the performance and interpretation of nutritional research has been impeded by difficulties in separating the effects of liver dysfunction from disturbances secondary to nutritional deficiencies; for example, hypoproteinemia would be a consequence of both. Through the use of multivariate prognostic formulas and development of better nutritional indices for patients with liver disease, it should be possible to identify those patients who will receive the greatest benefit from preoperative and perioperative nutritional support. Furthermore, the kinds of nutritional supplementation having the greatest impact could then be determined.

Diet Therapy↗
PubMed1988

Selective bowel decontamination to decrease gram-negative aerobic bacterial and Candida colonization and prevent infection after orthotopic liver transplantation.

Gram-negative bacterial and fungal infections are a major cause of morbidity and mortality following liver transplantation. We therefore used selective bowel decontamination (SBD) to eliminate the endogenous source of gram-negative aerobic bacteria and Candida pathogens in an attempt to reduce the high incidence of infection related to these organisms. Thirty consecutive patients undergoing liver transplantation were treated with SBD starting 3 days prior to donor search and continuing for 21 days postliver transplantation. Selective bowel decontamination consisted of administering nonabsorbable antibiotics (Polymixin E, gentamicin, Nystatin) and a low bacterial diet. Surveillance cultures of the throat and rectum were obtained to monitor efficacy of selective bowel decontamination. In addition, in the posttransplant period, tracheal, wound, blood, and bile cultures were obtained to screen for gram-negative bacterial and Candida colonization and infection. Our baseline surveillance culture revealed that 29/30 (97%) of recipients were colonized with gram-negative aerobic bacteria and 16/30 (53%) with Candida. Three days after selective bowel decontamination was started, 26/30 (87%) were free of gram-negative bacteria, and 100% were free of Candida colonization of the gastrointestinal tract. There was a similar reduction in the oropharyngeal gram-negative aerobic bacteria and Candida colonization. In the first 30 days following liver transplantation, gram-negative infections were not diagnosed in any of our patients. Following discontinuation of SBD, recolonization of the gastrointestinal tract with gram-negative aerobic bacteria and Candida occurred within 5 days in 26/28 (90%) and 11/28 (35%), respectively. Our study suggests that prophylactive administration of nonabsorbable antibiotics will markedly reduce gram-negative aerobic bacterial and Candida colonization and appears to reduce the high incidence of infection related to these organisms in the early posttransplant period.

Adolescent↗
PubMedDate not supplied

Nutritional intake of gut failure patients on home parenteral nutrition.

Nutrient intake patterns were analyzed in 23 patients with gut failure who were receiving home parenteral nutrition (HPN). All patients had stable weights without changes in intravenous calories or protein for 3 consecutive months. Our objectives were to assess oral intake of calories, carbohydrates, fat, and protein, to examine relationships between oral nutrient intakes and disease categories, and to compare oral and intravenous intakes to calculated resting energy expenditure (REE). Two patterns of oral nutrient intake were identified among the patients. Patients with short bowel syndrome, regardless of the underlying disease, consumed calories by mouth that clearly exceeded calculated resting energy expenditure (short bowel, non-Crohn's, 170% of REE; short bowel, Crohn's, 200 of REE); however, calories approximating the REE had to be given via HPN, suggesting that efficiency of absorption was at a very low level. Patients with diffuse gut diseases (radiation enteritis or pseudo-obstruction syndromes) had very low intakes of oral nutrients. The distribution of oral calories among carbohydrate, protein, and fat did not differ among the disease categories.

Adult↗