Nutritional insight into preduodenal pouch reconstruction one year after total gastrectomy.

BACKGROUND: Various types of reconstructions have been developed to improve the quality of life of patients following total gastrectomy. In addition, to ensure larger food-intake reservoirs and extend meal transit times, different types of pouch reconstructions have been developed and described. Our opinion is that the most important factor in providing better physiologic regulation of ingested food is restoration of the duodenal passage and enlargement of the gastric substituent. MATERIALS AND METHODS: In the present study, we compared standard a Roux-en-Y reconstruction and a preduodenal pouch (PDP) reconstruction. We evaluated the quality of life (QoL) for 60 patients during the first postoperative year, comparing serum albumin, protein, hemoglobin, iron, body weight, body mass index, and QoL. QoL was defined according to Korenaga's score scale, which has 14 questions, for better understanding of subjective patient perceptions of digestive function. RESULTS: Our study population did not differ in iron and hemoglobin levels at a 1-y follow-up. The difference between total serum albumin level was significant in all observed patients in the follow-up period in favor of the PDP reconstruction group (P = 0.001). The PDP reconstruction group also had a significantly higher serum protein level after 12 mo. The higher score difference between the two groups generally confirm the improved QoL in the PDP group (P = 0.001). CONCLUSION: The most important aspects of improved QoL after gastrectomy due to gastric carcinoma are maintenance of the duodenal transit and the addition of a pouch. Jejunal preduodenal pouches provide a better QoL than Roux-en-Y reconstruction. Our study results suggest preduodenal pouch reconstruction should be used as the method of choice.

[Transitory hypothermia as early prognostic factor in term newborns with intrauterine growth retardation].

INTRODUCTION: According to numerous researches, transitory hypothermia is a part of the neonatological energetic triangle and represents a significant prognostic factor within morbidity and mortality in newborns with intrauterine growth retardation (IUGR), that are, due to their characteristics, more inclined to transitory hypothermia. OBJECTIVE: The aim of the study was an analysis of frequency of transitory hypothermia in term newborns with IUGR, as well as an analysis of frequency of the most frequent pathological conditions typical of IUGR newborns depending on the presence of transitory hypothermia after birth (hypoglycaemia, perinatal asphyxia, hyperbilirubinaemia and hypocalcaemia). METHODS: The study included 143 term newborns with IUGR treated at the Neonatology Ward of the Gynaecology-Obstetrics Clinic "Narodni front", Belgrade. The newborns were divided into two groups: the one with registered transitory hypothermia--the observed group, and the one without transitory hypothermia--the control group. The data analysis included the analysis of the frequency of transitory hypothermia depending on gestation and body mass, as well as the analysis of pathological conditions (perinatal asphyxia, hypoglycaemia, hypocalcaemia, hyperbilirubinaemia) depending on the presence of hypothermia. The analysis was done by statistical tests of analytic and descriptive statistics. RESULTS: In morbidity structure dominate hypothermia (65.03%), hypoglycaemia (43.36%), perinatal asphyxia (37.76%), hyperbilirubinaemia (30.77%), hypocalcaemia (25.17%). There were 93 newborns in the observed group, and 50 in the control one. Mean value of the measured body temperature was 35.9 degrees C. 20 newborns (32.26%) had moderate hypothermia, and 73 newborns (67.74%) had mild hypothermia. In the observed group, average gestation was 39.0 weeks, and 39.6 (p < 0.01) in the control group. Average body mass at birth in the whole group was 2339 g: 2214 g in the observed and 2571 g in the control group. The frequency of hypoglycaemia in the observed group was 53.8%, and 24% in the control group (p < 0.01). In the observed group, the frequency of pH < 7.25 was 38.71%, and 14% in the control group (p < 0.05). The frequency of hyperbilirubinaemia was 38.71% in the observed group, and 16% in the control group (p < 0.01). The frequency of hypocalcaemia was 32.26% in the observed, and 12% in the control group (p < 0.01). CONCLUSION: Transitory hypothermia in the first ten hours of life represents a significant risk factor for deepening hypoglycaemia, asphyxia, hyperbilirubinaemia and hypocalcaemia in term newborns with IUGR.