Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery

PURPOSE: This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery. METHODS: Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days. RESULTS: Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups. CONCLUSION: The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients.

Comprehensive out-patient pulmonary rehabilitation: treatment outcomes in early and late stages of chronic obstructive pulmonary disease

The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation [PR] in chronic obstructive pulmonary diseases [COPD] and to establish whether in early disease stage PR is as effective as in late stages of disease. A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To elucidate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council [MRC]], body composition [body mass index [BMI], fat free mass [FFM], fat free mass index [FFMI]], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life [HRQoL] with St. George Respiratory Disease Questionnaire, psycohological status [Hospital anxiety-depression [HAD] scale] were evaluated before and after PR. At the end of PR in the early disease stage group, the improvement in forced vital capacity [FVC] reached a statistically significant level [P< 0.05]. In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements[P<0.001]. HRQoL and exercise capacity were significantly improved for the two groups [P<0.001]. Psychological status evaluated with the HAD scale improved after PR [P<0.001] both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program

Primary transpupillary thermotherapy of choroidal melanocytic lesions

To evaluate the role of primary transpupillary thermotherapy [TTT] in the treatment of choroidal melanocytic lesions. Retrospective chart review of 24 patients [24 eyes] with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. The mean initial tumor basal diameter was 6.6 [3.0-10.0] mm and the mean initial tumor thickness was 3.0 [1.0-5.0] mm. The mean number of TTT sessions was 2.5 [1-6]. The mean decrease in tumor thickness was 1.2 mm [from 3.0 to 1.8 mm] at a mean follow-up of 22.7 [range 3-90] months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients [20.8%]], focal cataract [5 patients [20.8%]], iris atrophy [4 patients [16.6%]] and posterior synechia [4 patients [16.6%]]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness <3 mm and juxtapapillary versus nonjuxtapapillary location [Fisher's exact test, P>0.05]. Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes [8.3%] were enucleated because of neovascular glaucoma and one eye [4.1%] was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients [87.5%]. One patient [4.1%] with extraocular tumor recurrence developed liver metastasis and expired. Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved