A double-blind randomized trial comparing outpatient parenteral nutrition with intravenous hydration: effect on resumption of oral intake after marrow transplantation.

BACKGROUND: Outpatient parenteral nutrition (PN) is often given to marrow transplant recipients after high-dose chemoradiotherapy until the resumption of adequate oral intake; however, it may adversely prolong resumption or oral calorie intake by contributing to early satiety. METHODS: A double-blind, randomized study compared standard PN (final concentration 25% dextrose, 5% amino acids) with a hydration solution (5% dextrose) during the first 28 days of outpatient treatment. Patients were eligible for the study if they were > or = 2 years of age, < 65 days posttransplant, had < 70% oral caloric intake at hospital discharge, and required < or = 10 U insulin/L PN. Solutions were provided until the patient's oral intake met > or = 85% caloric requirements for 3 consecutive days. RESULTS: Two hundred fifty-eight marrow transplant recipients (128, PN and 130, hydration solution) were studied. Age, donor type, and diagnoses were similar in the two groups. Time to resumption of > or = 85% oral caloric intake was 6 days sooner in the hydration group than in the PN group (median 10 vs 16 days, respectively; p = .049). When adjusting for sex, age, donor type, total body irradiation, previous oral intake, acute graft-versus-host disease, and prednisone therapy, the hydration group resumed oral intake sooner than the PN group (relative risk = 1.51; 95% confidence interval [CI] 1.04 to 2.19; p = .029). The percentage of weight change from pretransplant values, adjusted for the above covariates and the number of weeks of treatment, indicated that the hydration solution group lost weight (4.63%) compared with the PN group (1.27%) after 4 weeks of therapy (p = .004). Rates of hospital readmissions, relapse of malignancy, and survival did not differ between the two treatment groups. CONCLUSIONS: We conclude that outpatient PN delays resumption of oral intake and that its replacement with hydration solution does not result in adverse patient outcome.

Potential hearing loss resulting from MR imaging.

To determine if the loud noise generated by magnetic resonance (MR) imaging equipment is capable of inducing hearing loss, the hearing of 24 patients was tested before and after MR imaging. Fourteen patients were imaged without ear protection, and six (43%) suffered a temporary, mild loss of hearing (less than or equal to 15 dB at at least one frequency). Ten patients were imaged with ear protection, and only one experienced any hearing loss. Therefore, the noise generated by MR imagers may cause temporary hearing loss, and earplugs can prevent this loss. All threshold changes had returned to within 10 dB of baseline by 15 minutes after completion of the second audiometric test.

Relationship between uncomfortable loudness level and acoustic reflex threshold as a function of hearing loss.

While many studies examined the relationship between Acoustic Reflex Threshold (ART) and Uncomfortable Loudness Level (UCL) and the possibility of predicting one from the other, no study to the authors' knowledge has shown the relationship between these two measures with respect to hearing loss, and uses such a relationship to predict either measure from the other plus the hearing loss. To achieve these relationships and uses, 80 Ss were studied, 20 in each of 4 groups, with normal hearing and with mild, moderate, and severe noise-induced hearing loss. ARTs and UCLs were obtained at 0.5, 1, 2, and 4 kc/s. The results demonstrated that db sensation level (SL) of ART and UCL were highly correlated with pure-tone hearing threshold level (HTL). An equation was derived: UCL (in db SL) - ART (in db SL) = 6 - .05 HTL, which shows that the relationship between ART and UCL varies as a function of hearing loss. Data from other studies were compared and discussed.