Jpen Parenter Enter
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A newly designed nasal bridle and rationale for its clinical use are described. Previous nasal bridles have been shown to reduce the 40 to 60% incidence of dislodgement of nasoenteral feeding tubes. ⋯ The newly designed nasal bridle described herein has the advantages of easy and rapid placement. Use of this bridle can promote safer and more effective enteral feeding while avoiding the complications and cost of parenteral nutritional and gastrostomies.
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Patients with alcoholic hepatitis are typically malnourished. A hypermetabolic state would explain, at least in part, the muscle wasting observed in these patients. However, data on hypermetabolism in liver disease are limited and conflicting. ⋯ The mean measured energy expenditure/predicted energy expenditure ratio was not increased in alcoholic hepatitis patients compared to controls. However, when related to urinary creatinine excretion, the alcoholic hepatitis patients had a mean measured energy expenditure that was 55% higher than controls. In conclusion, whereas the measured energy expenditure to predicted energy expenditure ratio was not elevated in alcoholic hepatitis patients compared to controls, the measured energy expenditure per gram of creatinine was significantly increased in alcoholic hepatitis patients, supporting the concept of alcoholic hepatitis as a hypermetabolic state.
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Jpen Parenter Enter · Jan 1989
Case ReportsIn situ breakage of a totally implanted venous access system.
Totally implantable systems for venous access are now in wide clinical use. They have been shown to have several advantages when compared with earlier systems. However, the advantages of total implantation also contain risks for new complications. ⋯ The catheter migrated into pulmonary artery and was removed with Odman catheter and foreign body extractor. The precise cause for the separation could not be ascertained. It is emphasized that during insertion the silicone catheter should not be handled with surgical instruments and that the continuity of the system should be checked prior to use.
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Jpen Parenter Enter · Nov 1988
Randomized Controlled Trial Clinical TrialImprovement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial.
Patients undergoing major gastrointestinal surgery who had a prognostic nutritional index (PNI) score of greater than 30% were randomized to receive a preoperative course of 10 days of intravenous nutrition or to undergo surgery at the next convenient operation list. Two groups of 17 patients were well matched for age, sex, and nutritional status. ⋯ There were only three major complications with one death in the treatment group but this was not significantly different from the control group which had six major complications and three deaths. This study suggests that patients with demonstrable nutritional depletion who require major gastrointestinal surgery will benefit from a preoperative course of parenteral nutrition, but to conclusively prove this a large and probably multicentre study will be required.
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Jpen Parenter Enter · Sep 1988
Case ReportsCatheter fracture and embolization in a totally implanted venous access catheter.
A totally implanted venous access system was placed in a 24-year-old male patient with Hodgkins disease for chemotherapy. Twelve months after implantation it was noted on chest x-ray that the catheter had fractured and the distal fragment embolized to the right ventricle. ⋯ It is an even rarer complication of implanted central venous catheters. With the increasing use of these new venous access systems this complication may become a more prevalent, but an avoidable complication.