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At least 163 records · Page 9Linked to original sources
PubMed1984

Total parenteral nutrition with the '3-litre bag': effect of fat emulsion on amino acid kinetics and nitrogen balance in patients with intestinal fistulae.

Three metabolically stable patients, receiving total parenteral nutrition as part of their management for post-surgical intestinal fistulae, were studied over a 16-d period in order to assess the effect of two different energy sources on protein metabolism. Nutrient intake was kept constant throughout except for the energy source: for half the time the patients received glucose alone, for the other half glucose plus fat emulsion (3:1 mixture). Amino acid metabolism, as indicated by rates of leucine turnover, was measured by constant infusion of [1-14C]-leucine for 24 h at the end of each of two 8-d periods. The rates of protein synthesis in the three patients (means of two measurements) were 5.15, 2.45 and 3.8 g/kg/d. No significant difference in nitrogen balance, plasma amino acid concentrations or amino acid kinetic rates could be detected whether energy was supplied as glucose alone or glucose plus fat. The extra expense of supplying energy as fat does not seem justified when total parenteral nutrition is given to stable patients for periods of up to 8 d.

Aged↗
PubMed1977

Treatment of intestinal fistulas.

There have been three major advances in the treatment of small bowel fistulas since 1960: irrigation with lactic acid; total or parenteral nutrition; and continuous low flow enteric nutrition. The causation and clinical features of these fistulas are reviewed. The different unfavourable prognostic features are evaluated with reference to a series of 384 cases published by Edelmann et al. (1975). The different methods of treatment, both medical and surgical, are analysed. In spite of the great progress in medical management, surgery retains an important place. The guidelines for this medicosurgical policy are laid down. The mortality of intestinal fistulas was around 60 per cent before 1960 and has now diminished by half. It should be possible to lower it still further to around 10 per cent in future years, by careful application of the methods described.

Enteral Nutrition↗
PubMed1975

The management of high-output intestinal fistulas.

A high-output gastrointestinal fistula is a surgical catastrophe of the first order of magnitude. Previously associated with an extraordinarily high mortality, the advent of parentaeral nutrition has markedly altered the management of these fistulas. Malnutrition and electrolyte imbalance formerly were the causes of death in the majority of patients. At the present time the mortality rate has decreased from approximately 40-60% to 6-20%, depending on the series. a suggested plan of therapy for high-output gastrointestinal fistulas is outlined. Good local care, sump drainage and nutritional support with or without the use of appropriate antibiotics, depending on the circumstances, are the keystones of management. Radiologic definition of the fistula is of primary importance. Certain criteria by which one may predict fistula closure aare outlined. The emphasis in this chapter is on an attempt at spontaneous closure with parenteral nutrition. In the event that this in not achieved, complete exclusion of the fistula from the gastrointestinal tract, either by excision or by total bypass, is mandatory to achieve satisfactory results. Causes of death remain sepsis and peritonitis related to the fistula, but an occasional patient will succumb to massive bleeding. Catheter-related sepsis and complications of hyperalimentation are largely preventable, and steps to prevent such complications are outlined.

Abdominal Muscles↗
PubMedDate not supplied

[Parenteral hyperalimentation in the treatment of esophageal, gastric and intestinal fistulas (author's transl)].

Parenteral hyperalimentation and complete bowel rest reduce fistula output, and permit sufficient caloric and nitrogen intakes needed for healing. It corrects metabolic and nutritional deficiencies due to digestive fistulas, and allows spontaneous closure of fistulas in two out of three patients. If spontaneous healing is not obtained after six weeks of parenteral alimentation, surgical treatment may be undertaken more safety, as the patient will be in better nutritional condition.

Adult↗
PubMed1989

[Correction of homeostasis indices in unformed small intestine fistulas].

Problems of the correction of indices of protein and water-electrolyte metabolism in unformed fistulas of the small intestine were studied in 44 patients. The authors show that the use of the Alvesin "Novyi" amino acid mixture in parenteral feeding is more promising than the use of preparations of protein hydrolysates. For correction of water metabolism the authors give tea infusion per os.

Adult↗