[Nutritional assistance to patients during radiotherapy]. / Acompanhamento nutricional de pacientes em radioterapia.

With the aim of assessing the possible benefits of nutritional therapy, 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +/- 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100%, and a lymphocyte count diminished along this period (1933 +/- 1033 vs 1265 +/- 688, p. 0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases initially, significantly improved to just 40% inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21% of the patients, taste changes in 79%, xerostomy in 81%, anorexia in 66% and odinophagia in 59%. In the individuals selected for enteral feeding, side-effects were represented by technical problems (20%) and gastrointestinal disorders (13%). All patients completed the nutritional support program and there was no mortality in this series. It is concluded that; 1) Early nutritional support during radiotherapy was able to maintain or improve the nutritional status; 2) Tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; 3) Reduction of total lymphocytes could not be prevented by the mentioned therapy; 4) Complications of enteral alimentation were mild and affected a small proportion of the population; 5) Troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of food; 6) The compliance to the therapeutic plan was excellent and can be attributed to the efforts of the multidisciplinary team as well as to the help of the specialized home alimentation unit (PROSNED): Diet therapy. Cancer. Nutritional assessment. Radiotherapy. Nutritional support.

[Iron-deficiency anemia in enteral nutrition: correlation with tube position]. / Anemia ferropriva na nutrição enteral: correlação com o posicionamento da sonda.

Enteral alimentation is a commonly employed procedure for pre-operative rehabilitation and nutritional maintenance of depleted patients suffering from esophageal diseases. In a prospective study of 61 cases exhibiting benign (n = 38) and malignant (n = 23) conditions, a commercial polymeric diet was supplied in the proportion of 40 Kcal/kg/day during at least two weeks. The liquid preparation was infused by bolus technique at home, by the patients themselves, via nasogastric (n = 25) or nasoduodenal silastic tube (n = 36). Total food intake, that before treatment had been under 60% of estimated requirements, reached the expected range throughout the therapeutic period, and also iron input was adequate (0.3 mg/kg/day). Standart anthropometric and biochemical assessment of these cases, with included serum iron and hemoglobin concentration, indicated stabilization of general nutritional parameters, but with persistence of moderate anemia(hemoglobin 12.6 +/- 2.0 g/dl; iron 59.2 +/- 35.7 mg/dl). Stratification of the population according to enteral tube position demonstrated similar diagnoses and clinical conditions for both groups. Mean initial iron and hemoglobin concentration was also the same, but final serum iron was increased after gastric administration (p < 0.05) and diminished with duodenal diet (p < 0.05). It is concluded that: home enteral nutrition in malnourished patients with esophageal diseases is consistent with an acceptable nutritional status, but without significant recovery from anemia, serum iron in this population only increases after intra-gastric alimentation; it is probable that this last finding is related to impaired ionization and absorption of dietary iron, when food is introduced in a postpyloric site.

[Levels of care in nutrition]. / Níveis de assistência em nutrição.

The dietitian's role includes diverse activities such as planning of the nutritional assistance, teaching and researching. The nutritional strategy varies according to the levels of the dietetic assistance being related to the nature of the disease and to the medical treatment the patient is undergoing. The assistance level classification helps the standardization of the procedures.

[Degree of satisfaction in the users of the Central Institute of the Clinical Hospital-PAMB for the care received]. / Avaliação do grau de satisfação dos usuários do I.C.H.C.-PAMB com relação ao atendimento prestado.

Through a sample of 1346 ambulatory patients, correspondent to the 3% monthly attendance of the ICHC/PAMB in the first semester of 1992, the authors report the degree of satisfaction of the population assisted. The survey reveals the performance of the multiple professionals as well as the evaluation of the ambulatory facilities regarding signs, hygiene and general organization of services, etc. The parameters, specially those concerning the health professionals, demonstrate that its concept the patients of the ICHC-PAMB is considered good.