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Biomedical subjects

B Messing

Publications and source records attributed to B Messing.

At least 91 records · Page 5Linked to original sources
PubMed1983

Does total parenteral nutrition induce gallbladder sludge formation and lithiasis?

To assess the prevalence of sludge formation and lithiasis during total parenteral nutrition, serial biliary ultrasonographic studies were performed during and after i.v. nutrition periods in 23 selected adult gastroenterological patients. All patients were free of hepatobiliary disease before i.v. nutrition. Initial sonograms of 19 patients taken at the 12th day +/- 2 days (mean +/- SEM) of i.v. nutrition were normal. Initial studies for the 4 remaining patients, which were performed on the 39th day +/- 10 days of i.v. therapy (p less than 0.001), showed gallbladder sludge but did not demonstrate lithiasis. Serial ultrasonographic studies indicated that the percentage of sludge-positive patients during parenteral nutrition increased from 6% during the first 3 wk to 50% between the fourth and the sixth weeks and reached 100% in patients receiving i.v. nutritional therapy for greater than 6 wk. Gallstone formation was demonstrated in 6 of 14 sludge-forming patients but was not observed in patients who were sludge-negative. Three of the 6 stone-forming patients underwent cholecystectomy because of complications secondary to cholelithiasis after a mean 43-day course of parenteral nutrition. Analysis of bile from these patients revealed thick bile-containing cholesterol crystals and small stones of mixed bilirubin-cholesterol type. Ultrasonographic studies were obtained for sludge-positive patients after the parenteral nutrition period. Sludge positivity decreased from 88% during the first 3 wk of oral refeeding to 0% by the end of the fourth week. This study, therefore, strongly suggests that bowel rest and bile stasis during parenteral nutrition lead to production of sludge, which can result in eventual gallstone formation. Consequently, during parenteral nutrition exceeding 1 mo, gallbladder stasis should be palliated to prevent cholelithiasis formation.

Adolescent↗
PubMed1983

[Endogenous steatorrhea during total parenteral nutrition. Study of 22 patients with gastrointestinal diseases].

Endogenous steatorrhea has only been evaluated in patients with non-pathological digestive tract. We decided, therefore, to study this parameter in 22 consecutive patients submitted to total parenteral nutrition for severe gastrointestinal diseases. The determination of steatorrhea, creatorrhea, and fecal clearance of alpha 1-antitrypsin was performed by three days stool collections. After 10 days of parenteral nutrition, 13 of the 22 patients still had measurable stool losses and 106 fecal collections were done. In these 13 patients, fecal weight was 610 +/- 130 g.d-1, (mean +/- SEM), steatorrhea was: 3.1 +/- 0.4 g.d-1, creatorrhea was: 1.7 +/- 0.6 g.d-1, alpha 1-antitrypsin clearance was: 58 +/- 13 ml.d-1 (N less than 10 ml.d-1). The mean endogenous steatorrhea was therefore 5 fold larger than normal and creatorrhea 1.8 fold larger than normal. This discrepancy could be due to metabolism of nutrients by colonic bacterial flora. The comparison of patients with and without increased endogenous losses showed significant differences in the mean number of intestinal lesions (1.4 +/- 0.3 versus 0.5 +/- 0.2) and in the presence or absence of ileal involvement (p less than 0.05). A positive correlation was found between steatorrhea and stool weight but not between steatorrhea and creatorrhea or fecal clearance of alpha 1-antitrypsin. This first study of pathological endogenous steatorrhea does not suggest a relationship of this parameter with protein losing enteropathy. The main contribution to increased endogenous losses may be related to increased epithelial cell renewal of the intestine associated with malabsorption. The role of bacterial overgrowth in the gut cannot be ruled out by the present data.

Celiac Disease↗
PubMed1982

Technical hazards of using nutritive mixtures in bags for cyclical intravenous nutrition: comparison with standard intravenous nutrition in 48 gastroenterological patients.

Three methods for dispensing nutritional solutions are compared in 48 patients with gastrointestinal diseases on intravenous nutrition during 3582 days. The protocol for intravenous nutrition applied by the nursing team and the solutions used were the same in the three groups. In group A standard bottles were used, while in group B, 31PVC-disposable bags were used--with fat emulsion included (group B1) or with fat excluded (group B2). When fat was excluded from the bags it was infused separately from a bottle. The mixtures were made under laminar flow by the nursing team who applied a strict protocol which included bacteriological testing. The infection rate observed in the bags was 0.046%. The rate of septic complications was not significantly reduced in group B2 or B1 compared with group A; the type of container used was therefore unimportant and the key was the aseptic handling of the intravenous solutions. The rate of mechanical complications, mainly due to catheter obstruction, was higher (p less than 0.001) when fat was included in the bags--that is, in group B1--than in groups B2 and A. For 26 patients a cyclical regime of intermittent feeding was easier to manage when bags were used. In group B, this system replaced the continuous method n 75% of all therapeutic days without adverse effect; it improved compliance and allowed ambulatory treatment. The use of cyclical feeding with separate fat infusions has further reduced the hazards of intravenous nutrition and allowed the development of a programme that can be implemented at home.

Adolescent↗
PubMed1979

[The venous route in total parenteral nutrition of the adult patient (author's transl)].

Total parenteral nutrition (T.P.N.) takes presently an important place in the therapeutic methods. Nevertheless multiple complications, directly related to the venous route can constitute a limiting factor in the application of such procedures. Therefore complications such as sepsis and venous thrombosis must be prevented during T.P.N. Some conditions issued from our experiences and from the results in the literature can be now well defined: 1) Surgical catheterization of the vein in cases of long term T.P.N. and transcutaneously in cases of short term T.P.N. with in all cases a long subcutaneous way of the catheter. 2) Silastic catheter must be systematically used. 3) The intravenous way of the catheter must be as short as possible. 4) Nutrients must be strictly infused in the superior vena cava. 5) The utilisation of nutritive mixtures must be prefered if possible. 6) Handling of the infusion line must be avoided. Finally the management of T.P.N. in the best conditions requires a specialized staff.

Adult↗
PubMed1979

Chronic non-specific ulcerative duodenojejunoileitis: report of four cases.

Four patients with chronic non-specific ulcerative duodenojejunoileitis (CNSUDJI) are reported. The clinical picture included abdominal pain, fever, and a malabsorption syndrome. Main rediological findings were diffuse narrowing of the jejunal loops with total effacement of the mucosal folds. Multiple peroral biopsies of the small intestine showed various degrees of mucosal abnormalities from total villous atrophy to normal villi, but ulcerations were diagnosed only by operative full thickness biopsies or resection of the small bowel. The ulcerative process was associated with well-documented coeliac disease in two patients: in one of them it occurred as a fatal complication involving also the colon, three years after the start of a gluten free diet, while the disease was in full clinical and histological remission. In the other case, coeliac disease was revealed by obstructive symptoms due to stenosing ulcerations; five months after surgical resection of the stenosis, institution of a gluten free diet induced a dramatic improvement. In the two other patients ulcerations were not associated with coeliac disease: one of them had a patchy villous atrophy and resisted a gluten free diet and total parenteral nutrition; she was improved by and dependent upon steroids but finally died. The last patient had normal villous height; ulcerations were located exclusively along the mesenteric border of the small bowel; he had a low-grade protracted evolution resisting any form of therapy and developed a peripheral neuropathy of unknown aetiology. On the basis of our cases and of a review of the literature the discussion focuses on the difficulty in diagnosing CNSUDJI, its relationship with coeliac disease, and its management and prognosis.

Adult↗
PubMed1977

[Total parenteral nutrition in the adult. Theoretical aspects (author's transl)].

When oral or enteral feeding becomes impossible or inadequate, total parenteral nutrition makes it possible to reduce the occurrence of malnutrition states as complications of medicosurgical disorders. From a practical point of view it should provide a minimum fluid intake of 30 ml/kg with a nitrogen intake of the order of 150 to 300 mg/kg/day with sufficient quantities of all essential amino acids in a balanced ration. In most instances the calorie intake should be 40 to 60 Kcal/kg/day. Non-protein calories are obtained from carbohydrates or fats but the ideal percentage of each of these two nutrients is not known. In order to be effective and well tolerated, intravenous nutrition of this sort must be adapted to each patient and should be administered by a qualified medical and nursing team in order to minimise the metabolic and septic risks secondary to the techniques used.

Amino Acids↗
PubMed1977

Ulcerative colitis in a patient with anti-B lymphocytotoxin and hypogammaglobulinemia.

Lymphocytotoxins (LCT) have been recently reported in the serum of patients with inflammatory disease of the bowel, but up to now these antibodies have shown no specificity for B or T lymphocyte subpopulations. A 32-year-old patient with chronic ulcerative colitis, primary hypogammaglobulinemia and a very low number (0.5 to 1.5%) of B lymphocytes in peripheral blood is described. The presence in the serum of a LCT reacting specifically with B cells was demonstrated by cytotoxicity and direct immunofluorescence experiments. Intestinal immunofluorescence studies indicated a dichotomy between blood and gut immunoglobulins, and showed a heterogeneous distribution of plasma cells of the three major classes from the jejunum to the rectum. The significance of the association of hypogammaglobulinemia, chronic ulcerative colitis, and anti-B LCT is discussed. To explain the dissociation between blood and gut immunoglobulins, it is suggested that the intestine was, in this patient, a privileged site for differentiation of B cells.

Adult↗
PubMed1976

Salivary immunoglobulin determinations: their diagnostic value in Sjögren's syndrome.

Salivary immunoglobulins (IgA, IgG, IgM) determinations are performed on 74 patients with and without Sjögren's syndrome (SS). In normal subjects IgA is the only immunoglobulin detected in saliva by classical immunodiffusion methods. Correlations between the presence of IgG and/or IgM in saliva and other functional and objective clinical parameters and hsitological aspects of minor salivary glands are studied. In SS the prescence of IgG and/or IgM is in close relationship with "sialography index" which is the most reliable clinical investigation. These results point out that salivary immunoglobulins determinations constitute a simple and specific complementary test for SS diagnosis; they may allow the clinicians to observe the progress of the disease or to evaluate effectiveness of drugs.

Humans↗