Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Enteritis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources
PubMed2003

Nutrition in the critically ill patient: part III. Enteral nutrition.

OBJECTIVE: To review the human nutrition in the critically ill patient in a three-part presentation. DATA SOURCES: Articles and published peer-review abstracts and a review of studies reported and identified through a MEDLINE search of the English language literature on enteral nutrition. SUMMARY OF REVIEW: Enteral nutrition is indicated in the critically ill patient when there is an inability to ingest adequate nutrients by mouth and where the gastrointestinal tract is otherwise normal. The commonly used polymeric feeding solutions provide a mixture of nutrients similar to that encountered in the normal diet, usually as an iso-osmolar low residue solution. Because lactose intolerance may be encountered during critical illness, most formulations are lactose free. Special glutamine formulations and immune enhancing enteral formula (e.g. enriched with 3 fatty acids, arginine and ribonucleic acids) have been used in critically ill patients. However there have been few studies to indicate that these diets are of greater benefit compared with normal enteral formulations. The daily nutritional requirements are often not met in critically ill patients largely due to delayed gastric emptying or diarrhoea. Prokinetic agents, special formulations containing fibre and probiotics, have been used in an attempt to improve the tolerance to the formulations, although there have been no comparative studies that allow firm recommendation to be made. In general, a standard enteral solution is usually prescribed first and instilled into the stomach using a fine bore nasogastric tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. CONCLUSIONS: Nutritional requirements for the critically ill patient should be delivered enterally in patients who have a normally functioning gastrointestinal system. A standard formulation is usually prescribed and instilled into the stomach using a fine bore tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. Diarrhoea caused by enteral pathogens may require specific treatment. If pathogens are excluded then fibre and probiotics may be considered. Motility reducing agents (e.g. opiates) may cause abdominal bloating.

Journal Article↗
PubMed1985

Specific antagonism of enteric neural serotonin receptors by dipeptides of 5-hydroxytryptophan: evidence that serotonin is a mediator of slow synaptic excitation in the myenteric plexus.

Research on the role of serotonin (5-hydroxytryptamine, 5-HT) in the function of the enteric nervous system has been impeded by the lack of specific inhibitors of the enteric neural actions of 5-HT. Saturable, reversible, high affinity enteric binding sites for 3H-5-HT have recently been characterized and radioautographically located. Affinity for the 3H-5-HT binding site requires an indole ring substituted with a free hydroxyl group. These 3H-5-HT binding sites have been proposed to be enteric neural 5-HT receptors. This hypothesis was tested in the current study by comparing the ability of compounds to inhibit the binding of 3H-5-HT with their electrophysiologically determined actions on myenteric neurons. 5-Methoxytryptamine did not inhibit the binding of 3H-5-HT to enteric membranes and neither mimicked nor antagonized the effects of 5-HT on the membrane potential of myenteric neurons. Two dipeptides of 5-hydroxytryptophan, N-acetyl- and N-hexanoyl-5-hydroxytryptophyl-5-hydroxytryptophan amide (5-HTP-DP and N-hex-5-HTP-DP) inhibited the binding of 3H-5-HT (K1 = 0.25 microM for 5-HTP-DP and 1.19 microM for N-hex-5-HTP-DP). 5-HTP-DP applied by pressure microejection or superfusion (10 microM) antagonized the slow postsynaptic depolarization of myenteric neurons evoked by microejection of 5-HT. 5-HTP-DP also blocked the 5-HT-induced presynaptic reduction in amplitude of nicotinic fast synaptic potentials; however, 5-HTP-DP itself did not affect these responses. Moreover, 5-HTP-DP also failed to affect responses of myenteric neurons to microejected substance P, their muscarinic response to acetylcholine, or antidromic action potentials. In contrast, both dipeptides blocked the slow synaptic potentials seen in type II/AH neurons following stimulation of fiber tracts in interganglionic connectives. These data support the hypotheses that enteric 3H-5-HT binding sites are enteric neural 5-HT receptors, that dipeptides of 5-hydroxytryptophan are specific antagonists at these receptors, and that 5-HT is one of the mediators of slow synaptic potentials in the myenteric plexus.

5-Hydroxytryptophan↗
PubMed1983

Astrocyte-like glia in the peripheral nervous system: an immunohistochemical study of enteric glia.

The similarities between the enteric nervous system of the gut and the central nervous system (CNS), both of which function as complex integrative nervous networks, include striking ultrastructural similarities between the glia of the enteric nervous system and the astrocytic glia of the CNS. In this paper we have determined whether this anatomical resemblance also extends to the molecular level by examining the enteric glial cells to see whether they express several surface and intracellular molecules which are highly restricted to glia and to astrocytes in particular. Indirect immunofluorescence was used to visualize the antigens in frozen sections of gut wall and in whole mount, tissue culture, and freshly dissected preparations of myenteric and submucous plexuses from rats of various ages. It was found that enteric glial cells expressed the intracellular proteins glial fibrillary acidic protein, glutamine synthetase, and vimentin both in situ and in culture. The surface antigen Ran-2 was expressed in situ but not in culture, and the surface antigen Ran-1 was expressed in culture but not in situ. Cultured enteric glial cells did not express fibronectin in significant quantity, nor did they make galactocerebroside. From these results we conclude that the adult phenotype of enteric glia in situ closely resembles that of astrocytes, while in culture some of their cell surface features change, reverting to those seen during development. Because these cells possess distinctive molecular features and numerically form one of the major populations of peripheral glia, it is appropriate to classify them as a third distinctive category of peripheral glial cells, in addition to satellite and Schwann cells. The molecular similarities between these cells and astrocytes, in addition to their anatomical resemblance, suggest that a further study of enteric glia will provide new insights into the role of glia in integrative nervous tissues.

Animals↗
PubMed1975

Study of the pattern of Widal test in infants and children; II. Pattern of Widal test in children with enteric fevers. An attempt to define the diagnostic titer for upper Egypt.

The study embodied 45 children with enteric fevers proved by bacteriological culture of blood, stools and urine and 20 children with rheumatic fever. Widal test was done for the rheumatic fever cases and was done repeatedly at weekly intervals for the enteric fever cases. The clinical features of children with enteric fevers was discussed. By contrasting the results of Widal test in children with enteric fever with the results in apparently normal infants and children from the same locality, a minimal diagnostic dual Widal titer was suggested. This combines "O" agglutinin in a titer of 1/160 provided that the other "H" agglutinins are at a lower titer. This suggested diagnostic titer improved the specificity of Widal test. This titer is encountered only in 0.58% of normal individuals and in none of 20 children with rheumatic fever. This titer also yielded an excellent sensitivity to diagnose actual enteric fever cases reaching up to 93.3%. Bacterial isolates from enteric fever cases were S. typhi in 55.5%, S. paratyphi A in 33.3% and S. paratyphi B in 11.1%. Chloramphenicol therapy resulted in a higher cure rate and a more rapid defervescence than ampicillin therapy. Regarding the effect of these antibiotic therapies on the rise of Widal agglutinin titers in children with enteric fevers there are two observations : 1--A four fold rise, is uncommon. A two fold rise is the common finding. 2--There is no consistent difference between chloramphenicol and ampicillin as regards their effect on the rise of agglutinin titers.

Ampicillin↗
PubMed1994

Urological complications and enteric conversion after pancreas transplantation with bladder drainage.

In summary, we feel that excellent 5-year patient and graft survival results can be obtained using SPK transplantation with bladder drainage technique. Despite the good results, a significant morbidity with prolonged hospitalization is seen after pancreas transplantation. This increased morbidity is due to infectious complications, rejection and urological complications. As a result of the popularity of bladder drainage, the complications after pancreas transplantation have shifted from intraabdominal to urological. Enteric conversion after SPK transplantation is the treatment of choice for chronic hematuria and a duodenal segment leak. In our hands this method appeared to be a safe and reliable procedure with a low complication rate. Enteric conversion should be considered in early leaks after failure of one attempt to suture repair the anastomotic site. In larger leaks or late leaks, it is advisable to perform an immediate enteric conversion. With the considerations above one might ask why enteric conversion is not our current primary choice for the initial transplant procedure. We have, however, noted a higher incidence of postoperative intraabdominal septic complications as well as mycotic aneurysms at the arterial suture line in a small series of 16 primarily enterically drained pancreas transplants. We also fear that the leakage rate after primary duodenoenteric drainage could be higher because of significant edema after transplantation in the preserved duodenal segment. We doubt, therefore, that the primary anastomosis with the bowel is as safe as one performed during enteric conversion when preservation injury has been resolved. At that point the patient is in stable condition and on significantly lower doses of immunosuppression than at the time of transplantation. This study demonstrates that urological complications constitute a major part of the morbidity after SPK transplantation. Despite this fact, appropriate treatment including enteric conversion can resolve most of the complications and prevent long-term morbidity or even graft loss.

Drainage↗
PubMed1996

Schistosoma mansoni in migrants entering South Africa from Moçambique--a threat to public health in north-eastern KwaZulu-Natal?

OBJECTIVES: To identify possible public health consequences of Schistosoma mansoni infections in migrants entering north-eastern KwaZulu-Natal and Mpumalanga and Northern Province from southern Moçambique. DESIGN: (i) Intestinal parasite surveys, one sample per person, within a 4-month period; (ii) temperature recordings and snail collections in an irrigation system. SETTING: North-eastern KwaZulu-Natal and Kruger National Park, Mpumalanga and Northern Province. PARTICIPANTS: Ninety-seven migrants (1-68 years) from north-eastern KwaZulu-Natal and 47 from the Kruger Park (1 - 70 years). MAIN OUTCOME MEASURES: The relatively high S. mansoni prevalence may cause problems on the rice paddy scheme in north-eastern KwaZulu-Natal. Ranges and prevalence rates of other parasites were recorded. RESULTS: S. mansoni prevalence in Moçambicans entering north-eastern KwaZulu-Natal was 14.4%, seven times more than in local residents. S. mansoni is not endemic to this region because most bodies of water become too warm for either the parasite or its snail host, Biomphalaria pfeifferi, to develop. Recordings in paddies suggest, however, that the rice modifies the temperature pattern as it grows and provides a suitable habitat for transmission. Migrants entering the Transvaal lowveld where S. mansoni is endemic may become more severely infected. Thirteen other parasite species were recorded from migrants entering KwaZulu-Natal and 8 from those entering Mpumalanga and Northern Province. CONCLUSIONS: The relatively high S. mansoni prevalence among migrants entering north-eastern KwaZulu-Natal may have public health implications as it could encourage transmission in a non-endemic area. The range of parasites carried by migrants entering KwaZulu-Natal, Mpumalanga and Northern Province was similar to that harboured by local people but prevalence rates were generally lower.

Adolescent↗
PubMed1998

Conversion from bladder to enteric drainage after pancreaticoduodenal transplantations.

BACKGROUND: Bladder drainage is the most common technique for managing the exocrine secretions of pancreaticoduodenal grafts. However, bladder drainage can cause urinary, pancreatic, and metabolic complications that may require conversion to enteric drainage. With enteric drainage, urinary amylase levels cannot be monitored as a marker for rejection. After enteric conversion, rejection is the major cause of graft loss. Timing the conversion to reduce immunologic graft loss would greatly improve patient and graft survival rates. Our study was designed to assess the incidence of, indications for, and complications of converting from bladder to enteric drainage after pancreaticoduodenal transplantations. METHODS: We retrospectively reviewed our experience with 80 recipients who underwent enteric conversion. We studied the recipient category, the interval from transplantation to conversion, the interval from the last rejection episode to conversion, the indications for conversion, the type of enteric drainage at conversion (loop versus Roux-en-Y), the results of the conversion, and postconversion complications. RESULTS: The major indications for conversion were metabolic acidosis (n = 26, 33%), recurrent urinary tract infections (UTIs) (n = 16, 20%), reflux pancreatitis (n = 15, 19%), and hematuria (n = 12, 15%). For most recipients, their symptoms resolved after conversion (n = 76, 95%). The cumulative probability of undergoing conversion was 13% at 12 months, 21% at 36 months, and 25% at 60 months. Of the recipients with surgical complications after conversion (n = 12, 15%), one lost his graft as a result of pancreatitis. Overall, of the 80 recipients who underwent conversion, 12 (15%) lost their graft, most due to rejection (n = 8, 75%). Immunologic graft loss was highest for recipients of pancreas transplants alone who underwent conversion < or = 6 months after transplantation or < or = 1 year after their last rejection episode. CONCLUSIONS: Enteric conversion is safe and therapeutic in recipients with complications related to the exocrine secretions of bladder-drained pancreas grafts. After conversion, rejection accounted for 75% of the grafts lost. However, waiting at least 1 year after the last rejection episode significantly reduced immunologic graft loss.

Acidosis↗
PubMed2005

Plasticity of the enteric nervous system during intestinal inflammation.

Inflammation of the bowel causes structural and functional changes to the enteric nervous system (ENS). While morphological alterations to the ENS are evident in some inflammatory conditions, it appears that relatively subtle modifications to the neurophysiology of enteric microcircuits may play a role in gastrointestinal (GI) dysfunction. These include changes to the excitability and synaptic properties of enteric neurones. The response of the ENS to inflammation varies according to the site and type of inflammation, with the functional consequences depending on the nature of the inflammatory stimulus. It has become clear that inflammation at one site can produce changes that occur at remotes sites in the GI tract. Immunohistochemical data from patients with inflammatory bowel disease (IBD) and animal models indicate that inflammation alters the neurochemical content of some functional classes of enteric neurones. A growing body of evidence supports an active role for enteric glia in neuronal and neuroimmune communication in the GI tract, particularly during inflammation. In conclusion, plasticity of the ENS is a feature of intestinal inflammation. Elucidation of the mechanisms whereby inflammation alters enteric neural control of GI functions may lead to novel treatments for IBD.

Animals↗
PubMed1965

COLIFORM ENTERITIS OF COTTONTAIL RABBITS.

Yuill, Thomas M. (University of Wisconsin, Madison), and Robert P. Hanson. Coliform enteritis of cottontail rabbits. J. Bacteriol. 89:1-8. 1965.-Mortality from enteritis occurred among 78 penned adult cottontail rabbits (Sylvilagus floridanus) during severe winter weather, and in 9 juvenile rabbits held in captivity during the summer. This mortality was associated with high numbers of Escherichia coli throughout the intestinal tract. Grossly normal cottontails from the laboratory, from the outdoor penned colony, and from the wild had few E. coli, and these were usually restricted to the lower gut. It was possible to induce mortality of adult rabbits by holding them at -20 C for 2 to 14 days. The animals that died during exposure to low temperatures had signs of enteritis and high numbers of E. coli throughout the intestinal tract. It was possible to prolong the life of cottontails held at -20 C by antibiotic suppression of their intestinal E. coli. A marked slowing in the rate of passage of materials through the intestine ensued after exposure at -20 C. This phenomenon may have been important in the alteration of the distribution of the intestinal microflora. Limited infection by E. coli occurs in rabbits in the wild. Of 47 serum samples from grossly normal cottontails collected in the wild, 42 contained E. coli agglutinins. The rabbit's defenses are apparently sufficient to control this organism under all but extremely unfavorable circumstances. The age of the rabbit appeared to influence its susceptibility to enteritis. Juvenile rabbits experienced enteritis, tissue invasion, and death under conditions which did not produce any enteric changes in adults.

Animals↗
PubMed2001

Enteral vs parenteral nutrition after major abdominal surgery: an even match.

HYPOTHESIS: Immediate enteral feeding following major abdominal surgery reduces postoperative complications and mortality when compared with parenteral nutrition. DESIGN: A prospective multicenter randomized trial. SETTING: A university hospital department of digestive surgery. PATIENTS AND INTERVENTIONS: Two hundred forty-one malnourished patients undergoing major elective abdominal surgery were randomly assigned to receive, after surgery, either enteral (enteral nutrition group: 119 patients) or parenteral nutrition (total parenteral nutrition group: 122 patients). The patients were monitored for postoperative complications and mortality. RESULTS: The rate of major postoperative complications was similar in the enteral and parenteral groups (enteral nutrition group: 37.8%; total parenteral nutrition group: 39.3%; P was not significant), as were the overall postoperative mortality rates (5.9% and 2.5%, respectively; P was not significant). CONCLUSION: The present study failed to demonstrate that enteral feeding following major abdominal surgery reduces postoperative complications and mortality when compared with parenteral nutrition.

Adult↗
PubMed2006

Bowel necrosis associated with early jejunal tube feeding: A complication of postoperative enteral nutrition.

HYPOTHESIS: Postoperative enteral nutrition may sometimes be responsible for severe complications such as mesenteri ischemia. DATA SOURCES: Studies in the English literature were identified by a computer-assisted search of the MEDLINE database using the key words "enteral feeding OR jejunostomy" AND "complications OR mesenteric ischemia." Cited references of each retrieved paper were checked for relevance. STUDY SELECTION: All reports of mesenteric ischemia in the setting of postoperative enteral feeding were included. In cases of multiple articles from the same institution with overlapping patients, the most exhaustive article was included. DATA EXTRACTION: All reports were abstracted for number of patients, presence of preoperative comorbidities, development of perioperative hypotension or mesenteric occlusion, and outcome. DATA SYNTHESIS: Nine studies were retrieved in which enteral feedings were responsible for bowel ischemia; we report an additional case. The common clinical picture is that of a patient without significant risk factors for mesenteric ischemia, which during the early postoperative course develops nonspecific abdominal symptoms and then rapidly progresses to septic shock and eventually to multisystem organ failure and death. Mesenteric ischemia may present in up to 3.5% of enterally fed surgical patients; the associated mortality approaches 100%. The lack of specific symptoms requires a high index of suspicion for diagnosis; prompt abdominal exploration and bowel resection are the only chance for survival. CONCLUSIONS: The benefits of enteral nutrition outweigh the likelihood of severe complications; when mesenteric ischemia develops, early diagnosis is challenging and the prognosis is poor.

Enteral Nutrition↗
PubMed1996

Cellular localization of Pan-trk immunoreactivity and trkC mRNA in the enteric nervous system.

The members of the trk family of tyrosine receptor kinases, trkA, trkB, and trkC, are the functional receptors for neurotrophins, a family of related neurotrophic factors. In this study, we investigated 1) the distribution of neurotrophin receptors in the developing and adult rat digestive tract with a pan-trk antibody that recognizes all known trks and 2) the cellular localization of trk-encoding mRNAs in the adult gut with single-stranded RNA probes specific for trkA, trkB, and trkC. In the developing myenteric plexus, trk immunoreactivity was present at embryonic day (ED) 14. Cells and fibers immunoreactive for trk could be visualized in the myenteric plexus at ED 16. At this age, dense staining was found in thick bundles of fibers in proximity to the myenteric plexus in the longitudinal muscle and in association with blood vessels in the mesentery. At ED 18, trk immunoreactivity was also seen in thin processes running from the myenteric plexus into the circular muscle, and in fibers and cells in intrapancreatic ganglia. By ED 20, immunoreactive staining was quite dense in both the myenteric and submucosal plexuses. At birth, virtually all enteric ganglia displayed strong trk immunoreactivity; the intensity of the staining at this age made it difficult to discern individual cells. During postnatal development, there was a decrease in cell body staining and an increase in the density of trk-containing fibers that became widely distributed to the gut wall and pancreas. The adult pattern of trk immunoreactivity was established between postnatal days 5 and 10. In adults, trk immunoreactivity was found in numerous enteric and intrapancreatic ganglion cells and in dense networks of fibers innervating all the layers of the gut, the pancreas, and vasculature. The trkC mRNA was expressed in adult enteric ganglion cells of both the myenteric and submucous plexus. By contrast, the trkA and trkB mRNAs could not be detected in enteric ganglia. All three trk mRNAs were expressed in dorsal root ganglia, which were used as positive controls. The density and wide distribution of trk immunoreactivity together with its persistence in adulthood support the concept that neurotrophins play a broad role in the digestive system from development through adult life, perhaps being involved in differentiation, phenotypic expression, and tissue maintenance. The presence of trkC mRNA in enteric neurons along with recent evidence that neurotrophin-3 plays a role in the development of the enteric nervous system suggest that trkC and neurotrophin-3 are a major neurotrophin system in the gastrointestinal tract.

Animals↗
PubMed1998

Fetal development of the enteric nervous system of transgenic mice that overexpress the Hoxa-4 gene.

Megacolon occurs in neonatal and adult transgenic mice that overexpress the Hoxa-4 gene. Abnormalities, which are restricted to the terminal colon of these mice, include a hypoganglionosis, abnormal enteric ganglia with a structure appropriate for extra-enteric peripheral nerve and not the enteric nervous system (ENS), and gaps in the longitudinal muscle occupied by ganglia. To investigate the developmental origin of these abnormalities, we analyzed the development of the pelvis and terminal colon in Hoxa-4 transgenic mice. Morphological abnormalities were detected as early as E13. These included an enlargement of the mucosa and the bowel wall, a thickening of the enteric mesenchyme, and the ectopic location of pelvic ganglion cells, which initially clustered on the dorsolateral wall of the hindgut. As the bowel enlarged, these ectopic cells become ventrolateral and, between days E17 and E18.5, appeared to become incorporated into the gut, leaving neuron-filled gaps in the longitudinal muscle layer. The ectopic ganglia retained extra-enteric characteristics, including the presence of capillaries, basal laminae, collagen fibers, and catecholaminergic neurons, even after their incorporation into the bowel. It is proposed that the abnormal and ectopic expression of the Hoxa-4 transgene in the colon causes signalling molecule(s) of the enteric mesenchyme to be overproduced and that the overabundance of these signals leads to mucosal enlargement and misdirection of migrating pelvic neuronal progenitors.

Animals↗
PubMed1984

Development and evaluation of enteric-coated penicillamine tablets.

Commercially available 250-mg penicillamine tablets were converted into enteric-coated tablets. Based on in vitro dissolution and disintegration tests, tablets coated with five layers of a cellulose acetate phthalate formulation by a modified pan coating technique were judged to be superior to other coated tablets. These tablets resisted disintegration in simulated gastric fluid over a 4-h period and disintegrated in an average of 21 min in simulated intestinal fluid. Enteric-coated penicillamine tablets were tested in vivo in nine weanling pigs divided into three groups: a negative control group, a test group dosed with enteric-coated penicillamine tablets, and a positive control group dosed with uncoated tablets. The incidence of GI tract bleeding, as determined by daily occult blood tests of the stools, was significantly less in the animals receiving the enteric-coated tablets when compared with the positive control group. The enteric-coated dosage form appeared to decrease GI tract irritation caused by penicillamine. Plasma concentration-time curves for penicillamine in the pigs were similar in shape to those reported in humans. Atypical double peaks occur in both species. Relative bioavailability of the enteric-coated tablet was found to be 67% when compared with the uncoated tablet. This apparent reduction is probably due to a large intrasubject variation in areas under the plasma concentration-time curves and not to a dosage form effect.

Animals↗
PubMed1978

Influence of food on the absorption of acetylsalicylic acid from enteric-coated dosage forms.

The absorption of acetylsalicylic acid (ASA) from two different enteric-coated dosage forms, tablets (Premaspin) and granules (Reumyl), was studied in healthy volunteers under fasting and non-fasting conditions by following the plasma concentration and urine recovery of salicylates after single doses of ASA 1 g. Conventional tablets (Aspirin) were used as the reference. Under fasting conditions the absorption of ASA from the two different enteric-coated preparations was complete. Taken with food the enteric-coated tablets gave much lower plasma concentrations than under fasting conditions, and absorption was not complete in all subjects. In contrast, absorption from the enteric-coated granules was not influenced by the intake of food. It was concluded that enteric-coated granules of ASA permit more reproducible absorption than enteric-coated tablets.

Adult↗
PubMed1992

Long-term outcome of severe radiation enteritis treated by total parenteral nutrition.

The outcome of 31 patients with severe radiation enteritis treated by total parenteral nutrition (TPN) was analyzed. Before initiation of parenteral nutrition, 18 of the patients had not had abdominal surgery, while 13 had either a resection or an intestinal bypass for radiation enteritis. Median follow-up was 2 1/2 years (range: 1 month to 12 years) from the time of initiation of parenteral nutrition. Surgery was required in 15 cases because parenteral alimentation could not be continued. Only eight of these 15 were able to resume a normal oral intake. Total parenteral nutrition allowed oral feeding to be resumed in 11 (36%) after a median follow-up of 40 months (range: 6-142 months). In general, total parenteral nutrition was well tolerated and was associated with low morbidity. Eighteen patients died, 13 of complications due to radiation therapy, four of cancer recurrence, and one of an unrelated cause. Survival probability was 58% at one year and 36% at five years. When possible, prognostic factors present either before or at initiation of total parenteral nutrition were analyzed. Age, predisposing vascular factors (hypertension, diabetes mellitus, or vascular disease), and enteric fistula and/or perforation were found to have prognostic value. The probability of clinical radiation enteritis recurrence was 34% at one year and 47% at two years. A clinical recurrence of symptoms was more frequent but not significantly so after parenteral nutrition as compared to surgical therapy of radiation enteritis. Although TPN corrected denutrition and allowed deferred surgery in some patients, severe radiation enteritis remains a poorly predictable progressive disease with numerous relapses.

Enteritis↗
PubMed1985

Clinical effects of enteral and parenteral nutrition preceding cancer surgery.

Parenteral and enteral nutrition have become major tools in the nutritional management of cancer patients perioperatively. The purpose of this article is to see if there is evidence from prospective controlled trials that parenteral and enteral nutrition preceding cancer surgery are of clinical benefit. From our investigation and from 8 other controlled, randomized clinical investigations the following conclusions can be drawn: Parenteral and enteral nutrition preceding cancer surgery improve nutritional parameters; Parenteral and enteral nutrition preceding cancer surgery may decrease postoperative morbidity and mortality, but this beneficial effect may not be limited to malnourished patients; If enteral nutrition can provide the same amount of proteins and calories as parenteral nutrition can, parenteral and enteral nutrition are equal with regard to clinical effects.

Combined Modality Therapy↗
PubMed2001

Pharmacokinetics of sequential intravenous and enteral fluconazole in critically ill surgical patients with invasive mycoses and compromised gastro-intestinal function.

OBJECTIVES: (1) To determine the pharmacokinetics of sequential intravenous and enteral fluconazole in the serum of surgical intensive care unit (ICU) patients with deep mycoses. (2) To determine the concentrations of fluconazole reached at the site of infection. (3) To determine if enteral administration of fluconazole, which has an important pharmaco-economic advantage, is justified in this specific patient group. DESIGN: Descriptive, sequential study as a part of a therapeutic drug monitoring programme. SETTING: Eighteen-bed surgical ICU in a referral centre. PATIENTS: Fourteen critically ill surgical patients with recent gastro-intestinal (GI) surgery and deep mycosis caused by a fluconazole-susceptible fungus and a calculated creatinine clearance of more than 40 ml/min. INTERVENTIONS: Fluconazole dosage regimen: 400 mg i. v. every 24 h with an extra dose of 400 mg i.v. after 12 h on day 1. If the clinical condition allowed enteral administration on day 4, the content of two capsules of 200 mg was given via the feeding tube with concomitant enteral feeds. MEASUREMENTS AND MAIN RESULTS: Serum, exudate from the site of infection and urine samples collected at assumed steady state ( after > or = 5 doses). Fluconazole concentrations were determined by high-performance liquid chromatography (HPLC). The mean area under the concentration curve (AUC0-24 h) in serum after enteral administration did not significantly differ from the AUC0-24 h during intravenous treatment. The elimination half-life was longer compared to healthy volunteers. The mean (95% CI) estimated bioavailability was 124 (90-158)%. The mean (95% CI) area under the concentration time curves (AUCs) achieved in the exudate from the site of infection were 67 (55-79)% of the AUCs reached in serum for both regimens. CONCLUSIONS: In critically ill patients with recent GI surgery and/or peritonitis the bioavailability of enteral fluconazole was adequate. The concentrations of fluconazole reached in exudate were lower than those in serum for both regimens, but adequate to treat most cases of deep mycoses in this specific patient group.

Antifungal Agents↗