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At least 1,063 records · Page 59Linked to original sources
PubMed1997

Endoscopic removal of nasogastric tube sutured unintentionally to gastrojejunostomy.

A nasogastric tube mistakenly sutured to the anastomotic site is a rare surgical error during gastrointestinal operation. When it does happen, proper management will prevent subsequent complications. If resistance is experienced when pulling the nasogastric tube after gastrointestinal surgery, it should never be pulled more forcefully. The endoscope should be introduced to document the etiology and to provide treatment after 2 weeks postoperation based on the wound healing process and strength of suture materials.

Endoscopy↗
PubMed2006

A rare but serious entity: nasogastric tube syndrome.

Since its first description by Hunter in 1790, the nasogastric tube has become a frequently used method of alleviating gastrointestinal symptoms. Because the morbidity associated with its use is low the risks of complications are often underestimated. We present a case of bilateral vocal cord paralysis and supraglottic edema following nasogastric tube insertion-also known as Nasogastric Tube Syndrome (NGTS). Although this complication is rare, it can be life threatening. We discuss this phenomenon in the context of a meta-analysis of reported cases, notably: presenting symptoms, time at development and resolution of symptoms in relation to nasogastric intubation and propose treatment options.

Female↗
PubMed2001

Gastric digestion of bovine lactoferrin in vivo in adults.

Lactoferrin (LF), an iron-binding glycoprotein present in milk and other endocrine and exocrine secretions, may exert a number of physiologic effects in the intestines. To study the effects of oral LF supplementation in vivo in the gastrointestinal tract, information about the gastric survival of LF in vivo is important. We tested 12 healthy volunteers (age 21 +/- 0.3 y) on 3 separate d according to a randomized, cross-over design. A test drink containing 4.5 g of bovine LF (20% iron-saturated LF; apoLF) in the presence of a gastric pH buffer (0.1 mol/L sodium citrate/citric acid; apoLFbuf), apoLF without the buffer (apoLF) or iron-saturated LF (holoLF) was administered into the stomach using nasogastric intubation. Gastric emptying rate, determined by a marker dilution technique, did not differ among any of these drinks. Gastric survival of LF, analyzed by gel permeation chromatography under denaturing conditions, was 64%, 62% and 79% after consumption of the apoLFbuf, apoLF and holoLF test drinks, respectively. Addition of the gastric pH buffer initially lowered intragastric pH because of its hydroxide buffering effect. However, it did not elevate intragastric pH over a prolonged period and thereby inhibit intragastric LF breakdown. We conclude that after oral administration, substantial amounts of apoLF and holoLF survive gastric transit.

Adult↗
PubMed2004

Evolving strategies for insulin delivery and therapy.

It has now been conclusively proven that adequate control of blood glucose delays or prevents the progression of diabetic complications. In order to achieve the suggested targets for glycaemic control necessary to reduce the incidence of diabetic complications, it has been established that a more intensive insulin regimen requiring multiple insulin injections is required for patients with type 1 diabetes mellitus. For patients with type 2 diabetes, oral antidiabetic therapy is generally used initially, but given the natural history of type 2 diabetes and the need to achieve improved glycaemic control, earlier use of insulin has been promoted. However, the use of insulin in more intensive regimens for the patient with type 1 diabetes or for earlier treatment of the patient with type 2 diabetes is not routine. Many factors are responsible for this observation. Nevertheless, available device options such as insulin pens or insulin pumps are routinely available for implementation of intensive insulin therapy. However, a major limitation for advancing to intensive insulin therapy is that the only viable way to administer insulin is through injection. Delivery options that use dermal, nasal and oral approaches have been explored. The oral approach may include gastrointestinal, buccal or pulmonary uptake. Recent evidence shows that delivery of insulin via the oral cavity with uptake occurring in the pulmonary alveoli may be the most viable clinical option in the future.

Administration, Oral↗
PubMed1980

Acute gastric volvulus. A study of 25 cases.

Twenty-five patients with acute gastric volvulus were studied. The two types, organoaxial and mesenteroaxial, are compared with respect to clinical characteristics, diagnosis, pathogenesis and treatment. An understanding of the varied features, including both thoracic and abdominal manifestations, is essential to early recognition and prompt treatment. In addition to Borchardt's triad, this study suggests three important features: (1) minimal abdominal findings when the stomach is in the thorax; (2) a gas-filled viscus in the lower chest or upper abdomen shown by chest radiography (Figure 8), and (3) obstruction at the site of volvulus shown by emergency upper gastrointestinal series. The high incidence of strangulation (28 percent) in this series attests to the urgency of this condition and is a compelling reason for the elective repair of paraesophageal hiatal hernias whenever possible.

Abdomen, Acute↗
PubMed1991

Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction.

We describe the use of hyoscine butylbromide as a subcutaneous infusion in 3 patients with inoperable malignant bowel obstruction. An objective reduction of drainage from the gastrointestinal tract was observed with the hyoscine butylbromide infusion (60-120 mg/day). We suggest that this effect can be useful in the palliative treatment of vomiting in inoperable bowel obstruction.

Aged↗
PubMed1993

The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient.

Nasoenteral tube feedings are often recommended in critically ill patients when gastrointestinal tract function is intact. Conventional methods of placement include turning the patient on the right side and the use of drugs that stimulate peristalsis to promote transpyloric passage. A prospective study was initially performed to assess the success of conventional methods used to promote transpyloric feeding tube placement in patients requiring assisted ventilation admitted to the Surgical Intensive Care Unit (SICU) (Part I of the study). In 68 critically ill ventilated patients, placement of nasoduodenal feeding tubes was attempted. Successful transpyloric placement was achieved in only ten patients. There was no correlation between age, gender, admitting diagnosis, time of tube placement and successful placement. The second part of the study was initiated to assess the safety of nasogastric feeding in critically ill ventilated patients. Forty-two patients admitted to the SICU were considered candidates for gastrointestinal tract feeding and were fed through the gastric route. Twenty-five patients reached enteral feeding goal rate within 72 hours, while 34 patients achieved goal rate by five days. Eight patients required total parenteral nutrition to meet nutritional needs because of an inability to achieve adequate nutritional support enterally. There were 11 complications noted in ten patients, including one episode of aspiration pneumonia. The presence of complications was not related to age, gender, admitting diagnosis, infusion method or type of formula used. Duodenal intubation using conventional methods in critically ill ventilated patients is unsuccessful in most patients. Nasogastric feeding in this group of patients can be safely administered in selected instances.

Critical Illness↗
PubMed1999

Apparent digestibility and glycaemic responses to an experimental induced viscosity dietary fibre incorporated into an enteral formula fed to dogs cannulated in the ileum.

The purpose of this study was to evaluate the apparent digestibility and postprandial glycaemic responses of ileal-cannulated dogs when fed an experimental induced viscosity dietary fibre (IVF) incorporated into a liquid enteral formula. Dietary treatments were: (1) control; (2) Glucerna; (3) Glytrol; (4) IVF; and (5) Jevity. Diets varied in concentrations of crude protein (CP), fat, starch and total dietary fibre (TDF). Dry matter and starch intakes by dogs fed the Glucerna and Glytrol treatments were lower (P<0.05) than for those consuming the other diets. However, daily intakes of CP and fat followed a reverse trend. Digestibility of nutrients at the ileum was high (>80%) for all dietary treatments. Mineral absorption proximal to the ileum and from the total tract was not significantly different among treatments. Mean incremental area under the serum glucose response curves for dogs fed Glytrol, Glucerna, and IVF treatments were lower (P<0.05) than the control treatment. Induced viscosity fibre appears to have no negative effects on nutrient digestion throughout the gastrointestinal tract. Its ability to moderate serum glucose concentrations would make it a potentially good choice for a diabetic liquid formula.

Animals↗
PubMed2001

Necrosis of the nasal ala after improper taping of a nasogastric tube.

Inserting a nasogastric tube during various abdominal procedures is a common maneuver to decompress the upper gastrointestinal tract. Improper placement and taping of the nasogastric tube results in excessive pulling on the nasal ala and subsequent pressure necrosis. This complication not only carries serious cosmetic morbidity, it is also preventable if a proper taping technique is employed.

Adult↗
PubMed1967

Studies on the low toxicity of reduced iron, B.P. 1932.

Reduced iron, B.P. 1932, an old form of medicinal metallic iron powder, was given by mouth to albino rats. Measurable toxic effects were not produced until the dose reached 10 g./kg. body weight, which is 10 times the LD(50) of iron similarly given as ferrous sulfate. Death occurred at three days and after from doses of 60 to 100 g./kg. and was due to hemoconcentration and vascular congestion of the liver and kidneys resulting from absorption of iron through an inflamed gastrointestinal mucosa. Larger doses produced death in one to three days from bowel obstruction due to impaction of iron in the stomach and intestines. The results suggest that reduced iron is the least toxic of all iron medicinal preparations and that re-investigation of its therapeutic value is warranted.

Animals↗
PubMed1980

[Preoperative preparation of the colon with special reference to orthograde intestinal lavage].

The effectiveness of the orthograde lavage of the colon with isotonic saline and 153-electrolyte solution, resp., was checked by means of a comparative prospective study. The most important factor in the pre-operative preparation of the colon is mechanical cleaning which is best performed by way of orthograde lavage leading in 90% of the cases to a complete emptying of the colon. Reduction of the intestinal flora can be improved in addition to lavage by a short prophylaxis with large doses of antibiotics. This method was applied to 100 operations performed in the colorectal region and only in 6% of the cases was an infectious complication observed. Lavage of the colon raises no problems and is well tolerated even by elderly patients. Ileus and the risk of perforation in the gastrointestinal tract are absolute contra-indications. Because of its almost iso-ionic composition the authors prefer the 153-electrolyte solution to isotonic saline. Due to the increase of the extracellular space some blood parameters tend to decrease.

Acid-Base Equilibrium↗
PubMed1980

Recovery of dietary iron and zinc from the proximal intestine of healthy man: studies of different meals and supplements.

The technique of marker perfusion of the upper gastrointestinal tract was used to measure intraluminal quantities of iron and zinc after test meals in healthy humans. Two different meals, one based on hamburger (with a predominance of heme iron, 7.5 mg/meal) and one based on cereal (containing inorganic iron; 1.4, 5.3, or 4.6 mg), were used. In addition, the luminal behavior of ferrous sulfate and hydrogen-reduced metallic iron (used as supplements to the cereal meal) were compared. Different meals also contained low (2.4 mg) or high (5.5 mg) amounts of zinc. The intubation techique allowed disappearance of metals from the duodenum and jejunum to be compared. The patterns of luminal flow were different for iron and zinc. Whereas iron was never recovered from the lumen at levels above those ingested in meals, zinc was recovered from the duodenum at levels greater than those ingested. These findings suggest that zinc, but little iron, is added to chyme in the upper gut during digesting and absorption. Bioavailability of different forms of iron, as judged by their luminal disappearance, were similar. Inorganic iron, ferrous sulfate, and hydrogen-reduced metallic iron were absorbed about as effectively as was heme iron. Iron disappeared preferentially from the duodenum but the site of zinc absorption appeared to be more distal.

Adult↗
PubMedDate not supplied

Nasointestinal tube for decompression or enteroclysis: experience with 150 patients.

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression of distended small bowel. In all patients with a preexisting nasogastric tube, the replacement by the decompression/enteroclysis tube was considered more comfortable by the patients. Successful placement of the tube in the jejunum was achieved in 147 of 150 consecutive patients on the initial attempt. The use of this tube obviates dual intubations for decompression and enteroclysis, the attendant discomfort on the patient, and it expedites subsequent performance of enteroclysis if needed. The complications reported with other long intestinal tubes were not observed with this device.

Adolescent↗
PubMed2005

The superior mesenteric artery syndrome in patients with spinal deformity.

STUDY DESIGN: A retrospective review. OBJECTIVE: To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems. SUMMARY OF BACKGROUND DATA: The SMAS is a known complication after surgery. METHOD: Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria. RESULTS: Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients. CONCLUSIONS: Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.

Adolescent↗
PubMed2002

Reduced feeding during water deprivation depends on hydration of the gut.

Removal of drinking water at the start of the dark period reduced food intake in freely feeding rats within 45 min. Both first and later meals were smaller during 7.5 h of water deprivation, but meal frequency did not change. Ingestion of a normal-sized meal (3 g) rapidly increased plasma tonicity when drinking water was withheld, but intravenous infusions of hypertonic NaCl causing similar increases in plasma tonicity did not reduce feeding. Feeding during 6 h of water deprivation was restored by slowly infusing the volume of water normally drunk into the stomach, jejunum, or cecum, but not in the vena cava or hepatic portal vein. The infusions did not alter water or electrolyte excretion or affect food intake in rats allowed to drink. We conclude that the inhibition of feeding seen during water deprivation is mediated by a sensor that is located in the gastrointestinal tract or perhaps in the mesenteric veins draining the gut, but not the hepatic portal vein or the liver. In the absence of drinking water, signals from this sensor provoke the early termination of a meal.

Animals↗
PubMed2004

The gastrointestinal tract "tastes" nutrients: evidence from the intestinal taste aversion paradigm.

To develop and use a behavioral paradigm for assessments of what nutrient properties are detected by intestinal chemoreceptors, we combined features of the "electronic esophagus" preparation (Elizalde G and Sclafani A. Physiol Behav 47: 63-77, 1990) and the conditioned taste aversion protocol (Garcia J and Koelling RA. Psychon Sci 4: 123-124, 1966). In four experiments, separate groups of food-deprived rats with gastric (experiments 1-4) or duodenal (experiment 4) catheters were infused with either carbohydrates (maltodextrin) or fats (corn oil) into their stomachs or small intestines, either while they consumed nonnutritive flavored solutions (experiments 1 and 2) or in the absence of any intake (experiments 3 and 4). For some animals, one of the macronutrient infusions was paired with lithium chloride injections shown to support conventional conditioned aversions. After training, in various oral preference test trials, animals were given opportunities to taste and consume the nonnutritive solutions that had served as oropharyngeal conditioned stimuli as well as the nutrients that had been infused intragastrically, with or without poisoning, but never sampled by mouth. As previously established, preferences for the nonnutritive flavors were enhanced by association with intragastric infusions of macronutrients, with carbohydrates producing the greater preference. On first exposure to the two macronutrients for oral consumption, animals reduced their intake of the nutrient that had been previously poisoned when it was infused into the gastrointestinal tract. These results, along with additional controls, suggest that nutrient tastes detected in the intestines can be recognized centrally based on oropharyngeal gustatory stimulation.

Animals↗
PubMed1994

Technique of upper gastrointestinal endoscopy.

In order to obtain the greatest amount of diagnostic information from upper gastrointestinal endoscopy, it is necessary to have a thorough understanding of the methods of navigation, preparation of the equipment and patient, and accessory diagnostic procedures. By continually recalling these basic principles while performing upper endoscopic examinations, the goal of a complete, safe, and cost-effective examination will likely be obtained.

Biopsy↗
PubMed1992

Gastric intramucosal pH: a noninvasive method for the indirect measurement of tissue oxygenation.

BACKGROUND: Monitoring the adequacy of tissue oxygenation is an important goal in the care of the critically ill patient. Global alterations in tissue oxygenation are inferred from changes in systemic oxygen transport (defined as the product of cardiac output and arterial oxygen content) and total oxygen consumption. These parameters, however, cannot measure the level of oxygenation of specific tissue beds, in particular those that are first affected by hypoxia, such as the gastrointestinal tract and the kidneys. DISCUSSION: Gastrointestinal tonometry is a new method for measuring the partial pressure of carbon dioxide of the gastrointestinal mucosa. This information can be used in conjunction with the arterial blood bicarbonate to calculate the pH of the mucosa. Mucosal acidosis correlates well with the onset of anaerobic metabolism in response to hypoxia or sepsis. This review discusses the basic principles of tonometry, the results of experimental and clinical studies, and the practical aspects related to the implementation and use of tonometers in patients in the critical care unit. CONCLUSION: Gastrointestinal tonometry is a relatively noninvasive device that appears capable of measuring metabolic changes produced by hypoxia. Because of the sensitive nature of the gastrointestinal mucosa, these changes often occur well in advance of other, more common, indices of hypoxia. The use of the tonometer may become a routine procedure in the overall monitoring of critically ill patients.

Anaerobic Threshold↗