Home sweet HEN--a guide to home enteral nutrition.

Initial experience of home enteral nutrition (HEN) was gained from malnourished patients with Crohn's disease. The rationale for HEN was to improve the patients' lifestyle by reducing the need for repeated admissions for nutritional support: this method is extremely useful in correcting nutritional problems. Over the past ten years the use of HEN has expanded to cover other clinical areas including correction of growth retardation secondary to gastrointestinal disease, cystic fibrosis, inborn errors of metabolism, congenital heart disease, and chronic renal failure, in addition to many types of neoplasia and chronic neurological diseases. At the present time, approximately 150 patients receive HEN within the catchment area of the Greater Glasgow Health Board (population 940,000). Despite the increasing availability of HEN many clinicians and dietitians are still reluctant to consider HEN as a 'routine adjunct' to clinical management, claiming that it is too dangerous or complicated. The aims of this article are to explain our method of running a HEN service, offer advice on practical problems and discuss further developments and potential difficulties.

Venous duplex scanning in the diagnosis and treatment of progressive superficial thrombophlebitis.

Venous duplex scanning, employing both B-Mode imaging and Doppler waveform analysis, is a valuable noninvasive technique for the evaluation of venous disorders of the lower extremities. During the past three years, 442 venous duplex scans were performed in our laboratory, evaluating both the deep and superficial venous systems. Sixty-four scans revealed deep venous thrombosis; twenty studies revealed superficial thrombophlebitis. A subgroup of six studies revealed progressive thrombophlebitis approaching or involving the deep venous system. Three of these six studies documented progression of superficial thrombophlebitis extending into the deep venous system, producing limited deep venous thrombosis. All six patients were treated with venous excision and local venous thrombectomy. None of the patients developed deep venous thrombosis on follow-up venous duplex scans. We conclude that venous duplex scanning is a valuable noninvasive method in the detection of progressive superficial thrombophlebitis. Therefore, prompt therapy may prevent the development of deep venous thrombosis and its sequelae. Additionally, venous duplex scanning provides a method for noninvasive follow-up of the results of therapy.