ABSTRACT
Patients with acute pancreatitis usually present nutritional status impairment. In alcoholic pancreatitis this impairment is usually presented before hospital admission. In patients with long-term complicated pancreatitis, malnutrition develops during the course of the disease. Besides, these patients present an increased stress and protein hypercatabolism. Treatment of acute pancreatitis usually maintains patients in a short period of starvation. In mild pancreatitis, starvation is needed for a few days, beginning progressively oral feeding. These patients don't need special nutritional support, unless they were previously malnourished. Patients with severe acute pancreatitis should always receive artificial nutritional support in order to preserve the nutritional status as starvation will be maintained for more than one week. In this paper, we review the nutritional treatment in these situations, trying to answer some different questions: type of nutritional support, when it should be started and when it is indicated to withdraw.
Subject(s)
Nutritional Support , Pancreatitis/therapy , Acute Disease , Enteral Nutrition , Humans , Nutritional Status , Pancreatitis/metabolism , Pancreatitis, Alcoholic/therapy , Parenteral Nutrition , Starvation , Time FactorsABSTRACT
Los pacientes con pancreatitis aguda sufren con frecuencia un acusado deterioro de su estado nutricional. En algunos éste es ya anterior a su ingreso hospitalario, como ocurre en muchos casos de etiología alcohólica. En otras ocasiones la desnutrición se manifiesta posteriormente en el seno de una pancreatitis de larga evolución o complicada, que impide una correcta alimentación por un tiempo prolongado. A todo ello hay que sumar el hipercatabolismo proteico y el estrés que presentan estos enfermos. Es norma habitual en el tratamiento de la pancreatitis aguda mantener al enfermo en ayuno absoluto. En las pancreatitis leves este estado solo es necesario durante muy pocos días, iniciándose la realimentación por vía oral progresivamente, y no se requieren especiales cuidados nutricionales, salvo que presenten una desnutrición previa. Ahora bien, en los pacientes con pancreatitis moderada y/o grave en los que se prevé un ayuno prolongado por más de una semana, debemos siempre recurrir a un soporte nutricional artificial, que preserve el estado nutricional de estos enfermos, ya que no es suficiente la habitual reposición hidroelectrolítica. En este capítulo realizaremos una revisión actualizada del tratamiento nutricional en estas situaciones, intentando responder a diferentes preguntas entre las que se incluyen el tipo de soporte nutricional indicado, cuándo hay que instaurarlo y hasta qué momento
Patients with acute pancreatitis usually present nutritional status impairment. In alcoholic pancreatitis this impairment is usually presented before hospital admission. In patients with long-term complicated pancreatitis, malnutrition develops during the course of the disease. Besides, these patients present an increased stress and protein hypercatabolism. Treatment of acute pancreatitis usually maintains patients in a short period of starvation. In mild pancreatitis, starvation is needed for a few days, beginning progressively oral feeding. These patients dont need special nutritional support, unless they were previously malnourished. Patients with severe acute pancreatitis should always receive artificial nutritional support in order to preserve the nutritional status as starvation will be maintained for more than one week. In this paper, we review the nutritional treatment in these situations, trying to answer some different questions: type of nutritional support, when it should be started and when it is indicated to with draw
Subject(s)
Humans , Pancreatitis, Acute Necrotizing/surgery , Nutritional Support/methods , Enteral Nutrition , Parenteral Nutrition , Postoperative Complications/diet therapy , Nutrition AssessmentABSTRACT
Some patients with Parkinson's disease (PD) and fluctuations of motor response to levodopa therapy may benefit by avoiding proteins during daytime meals, while leaving them unrestricted until bedtime. The acceptance and benefits of a protein redistribution diet (PRD) was studied in 26 PD patients whose fluctuations were refractory to current medications. Only 15 patients (57.2%) were still adhered to the diet 3 months later. Non compliance was more often justified on the basis of the changes in alimentary habits, as a too heavy supper (37%), scanty variation of meals (27%) and difficulties in preparing the diet (18%), rather than do to adverse effects of the diet on PD which occurred in 2 patients (exacerbation of the dyskinesias and lack of effectiveness, respectively). The PRD proved beneficial to 67% of those patients able to keep adhered to it, 4 patients shifting to stable responses. Five diet-benefit patients who performed daily "on-off" charts decreased their mean daily "off" time from 13 to 3 % (p less than 0.05), but "on" time quality remained unimproved by the diet. The PRD introduces a heavy change in dietary habits which is not readily accepted by many PD patients. However, the fact that fluctuations disappeared in one fourth of those able to maintain the diet warrants a closely supervised, short-time trial to identify those in whom benefits override the inconveniences of such new changes in the patient's way of life.
Subject(s)
Dietary Proteins/administration & dosage , Dyskinesia, Drug-Induced/diet therapy , Parkinson Disease/diet therapy , Aged , Aged, 80 and over , Combined Modality Therapy , Dyskinesia, Drug-Induced/etiology , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Parkinson Disease/drug therapy , Parkinson Disease/physiopathology , Patient Acceptance of Health Care , Prospective StudiesABSTRACT
Study of 40 patients with no digestive pathology, 20 of whom were subjected to surgery of the larynx or maxillo-facial surgery, with regard to tolerance of an enteral diet with polysaccharides of soya which contribute 25 gr of dietetic fibre per 2,000 kilocalories, compared to that of an enteral diet poor in fibre and very often used due to good clinical tolerance. An increase in the frequency of bowel movement was observed, and in the quantity of motions, although there was no simultaneous change in number of motions per day, consistency or appearance of the faeces. Subjective tolerance to the diet was good, and patients felt less full and bloated than those on a diet which was poor in fibre. There were no significant differences between both diets with regard to nitrogen balance or plasmatic levels in the diet. The better tolerance of this diet with polysaccharides of soya leads us to recommend it, especially in patients with great needs with regard to energy or volume, provided that there are no malabsorption symptoms.
Subject(s)
Dietary Fiber/administration & dosage , Enteral Nutrition/methods , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Nutritional Status , Postoperative Care/methods , Surgical Procedures, OperativeABSTRACT
A girl with Bloom's syndrome is reported. We have not found chromosomic or inmunoglobulin alterations, in opposition to described by other. We remark, for the first time in medical literature, a deficit of GH secretion without response to several stimulus. The other hormonal explorations were normal. We don't know if, that finding will be of pathogenic importance for the stunted growth of Bloom's syndrome or this is a casual association. Anyway, the good therapeutic results with the exogenous human growth hormone administration, is of a great interest for the investigation of pituitary GH reserve in any case of Bloom's syndrome.
