Lege Artis Medicinae

[Jejunal feeding of pancreatic patients with cosilat nutrient]

BÁLINT László1, STER Lászlóné1, PAP Ákos1, HAMVAS József1

APRIL 28, 1993

Lege Artis Medicinae - 1993;3(04)

[14 patients with acute pancreatitis and 24 patients with pancreatic pseudocysts were treated by jejunal feeding with Cosilat via an endoscopic drainage of the second jejunal loop for an average of 2 weeks. The nitrogen balance became positive on the second day, the body weight was stabilized, and the general condition of the patients remained satisfactory. Amylase levels and the clinical picture of acute pancreatitis ameliorated gradually and no complications occurred. One patient with a pancreatic pseudocyst healed during jejunal feeding. The diameter of other pseudocysts significantly diminished, and in 9 cases they disappeared spontaneously in several weeks. In 9 patients endoscopic drainage of remaining cysts was performed. No complications related to jejunal feeding were observed. This new method of nutrition seems to be beneficial in pancreatic diseases.]

AFFILIATIONS

  1. Fővárosi Önkormányzat Szent Imre Kórház-Rendelőintézet II. Belosztály Budapest

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[The nomenclature of morphogenetic anomalies]

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[Position of the College of Respiratory Medicine on the care and screening of people with chronic pulmonary diseases]

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[We present the case of a 43-year-od wo­man, with pancreatitis related to extreme - higher than 100 mmol/L - secondary hy­pertriglyceridemia. Fast clinical improvement and rapid regression of pancreatitis were achieved by appropriate therapy of pancreatitis, the diabetic metabolic disturbance, correcting microcirculation and treating hypertriglyceridemia with plasmapheresis. The authors underline, that the complex therapeutic approach and early plasmapheresis in pancreatitis related to hypertriglyceridemia may prevent necrosis and more severe, even fatal, outcome of the disease. ]

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[BACKGROUND - The main determinant of outcome in acute pancreatitis is the extent of inflammation and pancreatic necrosis. Early administration of n-3 polyunsaturated fatty acids (PUFAs) may prevent the development of severe complications through modulation of eicosanoid synthesis and cytokine release. PATIENTS AND METHODS - In the prospective, randomised clinical trial 14 patients with acute pancreatitis received n-3 PUFAs (3.3 g/day for 5- 7 days) as a supplement to their enteral formula in the form of fish oil, and another 14 patients receiving enteral nutrition served as a control group. Measurements of erythrocyte superoxidedysmutase activity, serum total antioxidant status, C-reactive protein and praealbumin concentrations were performed at admission and at day 3, 7 and 14. Beside routine laboratory and imaging examinations, the fatty acid and vitamin A and E concentrations of the serum lipid fractions were also determined at admission and at day 7 of the jejunal nutrition. The endpoints of the study were the duration of hospitalisation, the duration of jejunal nutrition and the frequency of complications. RESULTS - A significantly higher superoxidedysmutase activity was observed in patients receiving n-3 fatty acids at day 3 of the treatment. The n-3 to n-6 long chain PUFA ratio increased significantly in the serum lipids of the patients receiving n-3 PUFA supplementation, whereas remained unchanged in the controls. Supplementation resulted in a significant decrease in the length of hospitalisation (13.1±6.7 vs. 19.3±7.2 days, p<0.05) and jejunal feeding (10.6±6.7 vs. 17.6±10.5, p<0.05). Complications developed in 6/14 (42%) of the treated group and in 9/14 (64%) of the control patients. CONCLUSION - Enteral administration of n-3 PUFAs in acute pancreatitis may promote earlier recovery by moderating inflammation.]

LAM Extra for General Practicioners

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