Intraoperative placement of the nasoenteric feeding tube: a practical alternative?

BACKGROUND: The provision of early postoperative enteral feeding may be enhanced by the placement of enteral feeding access during celiotomy, but surgeons are often reluctant to pursue this option because of the extra effort required. METHODS: We conducted a retrospective review of our 2-year experience with 60 sequential intraoperative nasoenteric feeding-tube placements and included data on demographics, diagnosis, surgery, type of feeding tube, formula, tolerance, and complications. Our surgeons placed intraoperative nasoenteric feeding tubes at their discretion in a variety of subjects who were undergoing elective or urgent celiotomies. RESULTS: The surgeries largely involved the upper gastrointestinal tract, and feeding-tube placements were readily accomplished. The majority of patients received enteral feedings within 3 postoperative days and achieved feeding rates of 50 mL/h or greater. The average duration of feeding-tube use was 1 week, accounting for 399 feeding days overall. There were no serious complications attributable to feeding-tube placement or use, but inadvertent tube removal by patients or staff was a limitation. CONCLUSIONS: Intraoperative placement of the nasoenteric feeding tube may be a reasonable option for treating the surgical patient at nutritional risk who faces a limited course of impaired oral intake postoperatively.

Lymphatic absorption of enterally fed structured triacylglycerol vs physical mix in a canine model.

The lymphatic absorption of a structured triacylglycerol vs an equivalent physical mixture of the constituent medium-chain triacylglycerol and fish oils was studied. Each of four canines served as its own control in a crossover feeding design with the investigators unaware of diet contents. Lymphatic absorption of n-3 and medium-chain fatty acids peaked within 4-8 h of feeding either diet. The lymph contained more 10:0 fatty acids than 8:0 despite an overall ratio of 10:0 to 8:0 of 0.3 for the diets. The mass of medium-chain fatty acids absorbed in the lymph at measured time points was 2.6 +/- 0.5-fold higher (mean +/- SE of 12 determinations) for the structured triacylglycerol compared with the physical mix. Molecular species analyses revealed that the medium-chain fatty acids in lymph were present as mixed triacylglycerols. The unique molecular structure of these mixed triacylglycerols and the fatty acids at the 2-position may account for the improved absorption.

Small cell carcinoma of the ovary.

A case of a 29-year-old woman with primary small cell carcinoma of the ovary associated with hypercalcemia is presented. Despite intensive surgical and chemotherapeutic intervention, the patient expired after 19 months. Literature review indicates that this rare tumor grows rapidly, with hypercalcemia occurring frequently. Absence of effective treatment results in early mortality.

Death from drug-induced hemolytic anemia.

Fatal hemolytic anemia occurred in a 71-year-old man after trimethoprim-sulfamethoxazole was given for presumed cystitis. Administration of this combination has previously caused multiple hematologic reactions by affecting folic acid metabolism. Megaloblastic anemia and neutropenia have been produced by both of these agents, while sulfamethoxazole alone has induced acute hemolytic anemia in patients with hereditary deficiency of glucose-6-phosphate dehydrogenase. Although hematologic complications of trimethoprim-sulfamethoxazole treatment usually follow long-term or high-dose therapy, acute reactions apparently may occur at lower doses as well.

The whole truth and nothing but the truth?

KIE: Two commentaries explore the question of how much information should be disclosed to a 16-year-old female patient about the genetic abnormality, testicular feminization (XY genotype), which renders her infertile. She has presented with precancerous testes that require surgical removal and also needs an operation on her vagina in order for her to be able to engage in intercourse. Minoque and Taraszewski argue that full disclosure creates no significant benefit to the patient's freedom to act in accordance with what she considers her own best interest, so that the physician has no obligation to convey the genetic information to the patient or to her parents. Elias and Annas contend that everyone's best interests will be best served only by a full explanation of the syndrome and of the risks and benefits of the suggested surgery for consent to the surgery to be informed.^ieng

Verapamil and lithium in maintenance therapy of manic patients.

A year-long double-blind cross-over study was used to compare the long-term therapeutic effects of lithium versus verapamil in a group of 20 manic volunteers. Subjects received each medication for six months. Before cross-over, verapamil patients showed a significant improvement after 60 days, lithium-treated patients after 180 days. After cross-over, verapamil-treated subjects showed improvement at day 240. Lithium-treated patients showed no improvement after cross-over. The data indicate that verapamil may be effective as an agent in the maintenance treatment of manic patients.