[Postpyloric feeding tubes for surgical intensive care patients. Pilot series to evaluate two methods for bedside placement]. / Postpylorische Ernährungssonden bei operativen Intensivpatienten. Pilotserie zur Bewertung von zwei Methoden zur bettseitigen Anlage.

Bedside placement of postpyloric feeding tubes in surgical intensive care patients: a pilot series to evaluate two methods. Early enteral feeding is thought to be a key factor in maintaining the integrity of the gastrointestinal tract mucosal barrier associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcome in intensive care patients. Thus enteral feeding by nasogastric tubes is the preferred route of nutritional support for most surgical intensive care patients. However, intensive care patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from postpyloric feeding. Postpyloric feeding tube placement may be achieved by endoscopic procedures or different bedside techniques with variable success. In the present study two feeding tubes for bedside postpyloric placement without endoscopic assistance were compared. The time to successful positioning was compared for jejunal feeding tubes from the companies Cook (Tiger 2™) and PortaMedical (Corflo-Tube®). The description for the Tiger 2™ states that because of its design slight residual peristalsis can cause it to migrate from the stomach to the jejunum. The Corflo-Tube® is also positioned at the bedside with the help of a detector and a monitor which maps the movements of the magnetic tip of the mandrin as it is pushed forward. Patients receiving early enteral nutrition through a gastric tube and exhibiting enhanced reflux, in spite of the head of the bed being raised and the administration of prokinetics randomly received either a Tiger 2™ or a Corflo-Tube®. The study included 41 patients from an intensive care ward for surgical patients and 13 out of 20 Tiger 2™-Tubes (65%) and 16 out of 21 Corflo-Tubes® (76%) were successfully positioned (p>0.05). The median time to successful positioning with the Corflo-Tubes® was 0.83 h (range 0.06-2.5 h), which was significantly shorter than the 24 h (range 2-72 h) found with the Tiger 2™ (p<0.001). There was no significant difference between the groups with respect to the period between the insertion of the tubes and the attainment of complete enteral nutrition, corresponding to the calculated individual calorie requirements. These tubes offer a good alternative to more demanding procedures as they are easy to handle and rapidly available. They confer clinical and cost advantages in terms of the early establishment of enteral feeding, no routine X-ray confirmation in the case of the Corflo-Tube® and avoidance of endoscopic guidance for tube placement or parenteral nutrition. In addition they are always justified in the event of a lack of endoscopic positioning.

[Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance]. / Nasojejunale Ernährungssonden bei Intensivpatienten. Erfolgreiche Platzierung ohne technische Hilfsmittel.

BACKGROUND: Critically ill patients with early enteral feeding seem to profit from post-pyloric administration. Two feeding tubes were studied that, due to their construction, are able to move into the duodenum without the necessity of technical support. The duration until successful positioning, time until total enteral feeding and possible complications were compared. PATIENTS AND METHOD: Patients with naso-gastric tubes and early enteral feeding, who had an increased reflux despite head of bed elevation and prokinetic drugs, were randomly assigned to either a Tiger tube (Cook) or a Bengmark tube (Pfrimmer Nutricia). RESULTS: A total of 28 patients from the surgical intensive care ward were included. Of the 16 Tiger tubes 14 could be successfully placed but only 2 out of the 12 Bengmark tubes. With Tiger tubes total enteral feeding was established within 6 days (median), with Bengmark tubes within 4 days. CONCLUSION: In comparison to the Bengmark tube the Tiger tube has a higher success rate in terms of positioning in intensive care patients with impaired abdominal motility.

RANTES, eotaxin and eotaxin-2 expression and production in patients with aspirin triad.

BACKGROUND: Polyposis, asthma, aspirin-intolerance and aspirin-triad are mostly accompanied with eosinophilia of mucosal airways. Chemotactic cytokines, the CC-chemokines regulated on activation, normal T-cell expressed (RANTES), eotaxin, and eotaxin-2 activate and attract eosinophilic leukocytes to the site of inflammation. This points to the implication of CC-chemokines in eosinophilia of nasal tissue of these diseases. METHODS: Therefore, nasal polypous tissue specimens of patients suffering from chronic nasal polypous sinusitis (NP), intrinsic asthma (ATA), aspirin-intolerance (AINA), and aspirin-triad (TRIAD) were investigated. The amount of mRNA and protein of CC-chemokines was analyzed using semi-quantitative reverse transcriptase polymerase chain reaction and chemokine-specific enzyme-immuno-assays. The patterns of CC-chemokines were compared. RESULTS: The mRNA-expression as well as protein synthesis of CC-chemokines was quantified in all tissues investigated. The expression of RANTES-mRNA in NP, ATA, AINA, and TRIAD (averaging 148-324% D-glyceraldehyde-3-phosphate dehydrogenase) and protein synthesis (0.13-0.15 ng/mg tissue weight) did not differ significantly. But the protein synthesis of eotaxin- and eotaxin-2-mRNA was significantly (P < 0.05) higher in TRIAD (3.3 pg/mg and 3.4 ng/mg tissue weight) (4 ng/mg tissue weight), than in NP, ATA, or AINA (1.8 pg/mg and 2.1 ng/mg, 2.1 pg/mg and 1.6 ng/mg, or 1.7 pg/mg and 2.2 ng/mg tissue weight, respectively). CONCLUSION: Patients suffering from TRIAD in association with tissue eosinophilia were characterized by elevated eotaxin and eotaxin-2 mRNA-expression as well as protein-synthesis. This pointed to the implication of eotaxins and RANTES in eosinophilia-associated diseases. Further studies will have to prove, whether the analysis of these chemokines might improve the diagnosis of eosinophilia associated polyposis and initiate the development of new therapeutic strategies.

Expression scanning of an array of growth control genes in human tumor cell lines.

Analysis of gene expression on a medium- or large-scale is an increasingly recognized method for functional and clinical investigations based on the now extensive catalog of known or partially sequenced genes. The accessibility of this approach can be enhanced by using readily available technology (macroarrays on Nylon, radioactive detection) and the IMAGE resource to assemble sets of targets. We have set up such a medium-scale, flexible system and validated it by the study of quantitative expression levels for 120 genes in six cell lines, including three mammary carcinoma cell lines. A number of important parameters are identified as necessary for the assembly of a valid set and the obtention of good-quality quantitative data. The extensive data assembled in this survey identified potential targets of carcinogenesis, for example the CRABP2 and GATA3 transcription factor genes. We also demonstrate the feasibility of this procedure for relatively small tumor samples, without recourse to probe amplification methods.