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Assessment of the nutritional state of patients with an intestinal fistula.

The arm muscle area, derived fat-free mass, urinary excretion of 3-methylhistidine and creatinine were measured serially in a group of patients with an intestinal fistula receiving prolonged nutritional support. While the two anthropometric tests appeared reasonable indicators of changes in muscle mass in these patients, the marked intra-individual variability in excretion of 3-methylhistidine and creatinine created problems in interpretation. It is suggested that more use be made of serial anthropometry in district general hospitals as an alternative, simple, measure of nutritional status.

Adolescent↗

[Aorto-intestinal fistula versus angiodysplasia. A difficult differential diagnosis in gastrointestinal bleeding].

A 63-year-old patient had recurrent tarry stools and haemoglobin levels of around 7.0 g/dl. Ten years previously he had undergone an aortobifemoral bypass operation for peripheral vascular disease in the legs. Eight gastroscopies and five coloscopies over ten weeks failed to discover a bleeding source. Although an aorto-intestinal fistula was considered early on, extensive diagnostic tests failed to reveal it. Digital subtraction angiography was suggestive of an angiodysplasia of the terminal ileum, a diagnosis supported when coloscopy during exploratory laparotomy visualized blood trickling from the terminal ileum. As a result of this finding a right hemicolectomy was performed. But recurrent bleedings necessitated relaparotomy which finally revealed a fistula between the ascending duodenum and the proximal bypass graft anastomosis. Nine months after resection of the proximal anastomotic area and interposition of a Dacron prosthesis the patient has been free of symptoms.

Angiodysplasia↗

Right common iliac arterio-intestinal fistula caused by tubercular peritonitis: report of a case.

A 59-year-old female was admitted with massive hematemesis and melena. A hematological examination revealed that the red blood cell count was 1.31 x 10(6)/mm3, Hb 3.4 g/dl, and Hct 12%. No source of bleeding was found by an emergency endoscopic examination of the esophagus, stomach and duodenum, or by superior mesenteric angiography. At laparotomy a right common iliac arterio-intestinal fistula was found. The microscopic examination of this part of the ileum, including the fistula, revealed the presence of tubercular peritonitis. An extra-anatomic bypass graft using a prosthetic graft was performed between the left and right femoral arteries because reconstruction of the right common iliac artery was impossible.

Blood Vessel Prosthesis↗

Metabonomics study of intestinal fistulas based on ultraperformance liquid chromatography coupled with Q-TOF mass spectrometry (UPLC/Q-TOF MS).

Ultraperformance liquid chromatography coupled with Q-TOF mass spectrometry (UPLC/Q-TOF MS) is an effective and sensitive analytical tool. A UPLC/Q-TOF MS-based metabonomics technique was employed to investigate sera from 40 patients with intestinal fistula and 17 healthy volunteers in an effort to find potential biomarkers of the disease and reveal their pathophysiological changes. After the UPLC/Q-TOF analysis, the retention time and m/z data pair for each peak were detected. Partial least squares discriminant analysis (PLS-DA) and coefficient of correlation analysis were used for marker selection and identification. According to the data, nine potential biomarkers were identified: glycochenodeoxycholic acid, glycocholic [corrected] acid, taurochenodexycholic acid, taurodeoxycholic acid, and two kinds of lysophosphatidyl choline (C16:0 and C18:2) were found with increased concentrations in the patients, and phenylalanine, tryptophan, and carnitine were found with decreased concentrations in the patients. The results suggested that a subclinical hepatic injury and abnormal metabolism of two essential amino acids (phenylalanine and tryptophan), and a key compound of fatty acid synthesis and beta-oxidation (carnitine), occurred in the fistula patients. This work demonstrates the utility of metabonomics as a top-down systems biology tool for understanding clinical problems.

Biomarkers↗

[Immediate complications of radical cystectomy. Intestinal fistula: our experience in the treatment with somatostatin].

During the period of time between November 1986 and May 1988, 14 total cystectomies with one-step urinary derivations were performed in our Service. The surgical techniques utilized include: 7 Bricker, 2 Camey, 1 ileocecal segment derivation, 2 cutaneous transureterostomies and 2 cutaneous ureterostomies. Among the complications observed there were 3 intestinal fistulas which were treated at first in a conservative way with parenteral nutrition and somatostatin. An immediate response was obtained in all three cases with a decrease in the fistula deficit. Surgical treatment was required in two patients after a lack of response to conservative treatment. The fistula closed in the third patient, to open again spontaneously 15 days later. It was controlled with conservative means and closed again 45 days later.

Aged↗