ABSTRACT
Nutritional support is an important means to treat the patients with chronic critical illness for commonly associated malnutrition. Refeeding syndrome is a serious complication during the process, mainly manifested as severe electrolyte with hypophosphataemia being the most common. Refeeding syndrome is not uncommon but it is often ignored. In our future clinical work, we need to recognize this chinical situation and use preventative and treatment measures. According to NICE clinical nutrition guideline, we discussed the risk factors, treatment methods and preventive measures of refeeding syndrome in patients with chronic critical illness. We argued that for patients with high risk refeeding syndrome, nutritional support treatment should be initially low calorie and slowly increased to complete requirement. Circulation capacity should be recovered, fluid balance must be closely monitored and supplement of vitamins, microelement, electrolytes should be noted. After the emergence of refeeding syndrome, we should reduce or even stop the calorie intake, give an active treatment for electrolyte disorder, provide vitamin B, and maintain the functions of multiple organs.
Subject(s)
Humans , Chronic Disease , Critical Illness , Nutritional Support , Refeeding Syndrome , Therapeutics , Risk Factors , Water-Electrolyte BalanceABSTRACT
Objective To investigate the characteristics and treatment of the complications of Crohn's disease. Methods The clinical data of 202 patients with Crohn's disease and relevant complications who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2007 were retrospectively analyzed. The main complications included intestinal obstruction, fistula, acute perforation,abscess, abdominal mass and et al. Results Of the 202 patients, 116 had more than two complications. Intestinal obstruction (72 patients) was the most common complication among the initial complications, and followed by fistula (31 patients), acute perforation (23 patients), abscess (22 patients), abdominal mass (22 patients),anal complications (21 patients) and gastrointestinal bleeding (11 patients). Fistula was mostly observed in patients with secondary complications during the early stage (≤three months), while obstruction (24 patients),fistula (22 patients) and obscess (11 patients) were prevalent during the mid-late stage (＞ three months). Of the 202 patients with primary complications, 170 received surgical treatment and 32 received non-surgical treatment. Of the 116 patients with secondary complications, 96 received surgical treatment and 20 received non-surgical treatment. A total of 127 patients were cured by surgical treatment, the condition of 33 patients was improved and six patients died. The condition of patients received non-surgical treatment was improved, and no patient died.Conclusions The incidence of complications of Crohn's disease is increasing steadily. Intestinal obstruction is the most common complication, and then followed by fistula. Surgery is important in the treatment of the complications of Crohn's disease.
ABSTRACT
Objective To study the pathogen spectra in patients with enterocutaneous fistula complicated with abdominal infection and their resistance to antibiotics. Methods The abdominal pus was collected from 226 patients with enterocutaneous fistula complicated with abdominal infection for bacterial culture and antibiotic susceptibility test. Results A total of 520 bacterial strains were harvested, including 333 strains of gram-negative bacteria, I 80 strains of gram-positive bacteria and 7 strains of fungi. The top 10 bacteria cultured were Escherichia coli (131 strains), Staphylococcus aureus (62 strains), Enterococcus (59 strains), Pseudomonas aeruginosa (50 strains), Klebsiella pneumoniae (23 strains), Acinetobacter baumannii (18 strains), Enterobacter cloacae (17 strains), Proteus mirabilis (15 strains), Morganella morganii (15 strains) and Enterococcus faecalis (12 strains). The extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae were 102 and 17 strains, respectively. Methicillin-resistant Staphylococcus aureus were 60 strains. Conclusions Gram-negative bacteria were the main pathogens in patients with enterocutaneous fistula complicated with abdominal infection. The positive rate of the extended spectrum beta-lactamase is high. Most of the Staphylococcus aureus were resistant to Methicillin.
ABSTRACT
Objective: To examine the effects of recombinant human growth hormone on the acute phase response in abdominal sepsis patients.Methods: Prospective unblinded trial was made with each patient serving as his/her own control.Eighteen abdominal sepsis patients were enrolled ranging in age from 24 to 60 yrs.All patients received 10 U/d of GH 48 hrs after performing drainage and for 7days.Results: Serum concentration of constitutive proteins,acute phase protein and cytokines were measured before and 1,3,5 and 7 days after GH administration.GH notablely increased serum constitutive protein levels(prealbumin,transferrin,fibronectin) and decreased serum acute phase protein level(CRP).Cytokine TNF-?,IL-1? and IL-6 had significant change after GH administration,but the changes were not relative to the change of acute phase response.Conclusion: Low-dose rhGH effectively modulated the acute phase response by attenuating production of the hepatic acute phase protein and increasing the synthesis of constitutive proteins.
ABSTRACT
Objective:Eph receptors constitute the largest sub-family of receptor tyrosine kinases(RTKs) and have an important role in oncogenic transformation and tumor progression.This study aimed to analyze the aberrant expression of EphA1 gene in gastric cancer and its correlation with clinical parameters,so as to explore the significance of EphA1 in the etiology and progression in gastric cancer.Methods: Expression of EphA1 protein was determined using immunohistochemical staining in 60 gastric cancer patients.Correlation between EphA1 protein expression and clinical parameters was evaluated by statistics.Results: Over-expression was more commonly observed in more advanced patients(P=0.015) and in those with lymph nodes metastases(P=0.032).There was no correlation between EphA1 expression and other clinical parameters.Conclusion: EphA1 gene could promote the progression of gastric cancer.
ABSTRACT
Objectives:To observe the efficacy of enteral nutrition with short peptide elemental diet(Pepti 2000) in patients with gastrointestinal fistulas and evaluate the sensitivity of nutrition associated index in nutrition monitoring. Methods:Ten cases with gastrointestinal fistulas were administered total enteral nutrition(TEN).They received 146 kJ/(kg?d) of non protein calorie(NPC) and 0.25 g/(kg?d) of nitrogen per day. Body weight,serum albumin, transferrin(TFN), prealbumin(PA),fibronectin(FN),triglyceride and cholesterol were monitored on before and 7th and 28th after TEN. Results:Seven days after TEN,serum PA and FN levels rised significantly( P