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Biomedical subjects

C Matuchansky

Publications and source records attributed to C Matuchansky.

At least 19 recordsLinked to original sources
PubMed1992

Long-term outcome of severe radiation enteritis treated by total parenteral nutrition.

The outcome of 31 patients with severe radiation enteritis treated by total parenteral nutrition (TPN) was analyzed. Before initiation of parenteral nutrition, 18 of the patients had not had abdominal surgery, while 13 had either a resection or an intestinal bypass for radiation enteritis. Median follow-up was 2 1/2 years (range: 1 month to 12 years) from the time of initiation of parenteral nutrition. Surgery was required in 15 cases because parenteral alimentation could not be continued. Only eight of these 15 were able to resume a normal oral intake. Total parenteral nutrition allowed oral feeding to be resumed in 11 (36%) after a median follow-up of 40 months (range: 6-142 months). In general, total parenteral nutrition was well tolerated and was associated with low morbidity. Eighteen patients died, 13 of complications due to radiation therapy, four of cancer recurrence, and one of an unrelated cause. Survival probability was 58% at one year and 36% at five years. When possible, prognostic factors present either before or at initiation of total parenteral nutrition were analyzed. Age, predisposing vascular factors (hypertension, diabetes mellitus, or vascular disease), and enteric fistula and/or perforation were found to have prognostic value. The probability of clinical radiation enteritis recurrence was 34% at one year and 47% at two years. A clinical recurrence of symptoms was more frequent but not significantly so after parenteral nutrition as compared to surgical therapy of radiation enteritis. Although TPN corrected denutrition and allowed deferred surgery in some patients, severe radiation enteritis remains a poorly predictable progressive disease with numerous relapses.

Enteritis↗
PubMed1992

[Hepatobiliary complications of total parenteral nutrition].

Total parenteral nutrition has showed his efficacy in severe digestive diseases. However, infections, metabolic and hepato biliary complications can appear. Aim of this study is to report hepato biliary complications in 200 adult patients, mean age 53 years, treated between 1979 and 1988. Three types of hepato biliary complications occurred in 138 patients initially free of hepato biliary disorders: 1) biochemical hepatic disorders (cholestasis and/or cytolysis) occurred in 58 patients (42%) with mean time of 27 days. In 40% these disorders disappeared after modifications or stop of parenteral nutrition. 2) Jaundice occurred in 9 patients (7%) with mean time of 73 days. Regression of Jaundice is possible only if enteral nutrition is reestablished. Sludge or cholelithiasis occurred in 34 patients (25%) with mean time of 43 days. In five of these patients cholecystectomy must be performed. Literature confirms high frequency of hepato biliary complications in total parenteral nutrition. Occurrence of these complications seems to be related to duration of total parenteral nutrition and to type of nutrition. Most complications decrease when we can stop total parenteral nutrition. Use of lipids in separated perfusion decreases significantly (p < 0.05) biochemical hepatic disorders occurrence. In conclusion, 1) biochemical hepatic disorders are very common, requiring biochemical hepatic tests weekly. 2) Jaundice is rare but serious, requiring stop of parenteral nutrition, and sometimes surgery to reestablish an enteral nutrition. 3) high frequency of cholelithiasis justifies ultrasonographic follow-up, and perhaps preventive cholecystectomy in operation leading total parenteral nutrition.

Adolescent↗
PubMed1992

[Metabolism of plasma cholesterol and lipoproteins after total resection of the small intestine in patients with parenteral nutrition. Effects of the amount of phospholipids infused].

The aim of this study was to investigate the plasma lipoprotein profile in 2 patients treated by parenteral nutrition for total small bowel resection over a 15 month period. According to the amount of infused phospholipids (6 g/d vs 3 g/d), infused during 4 non consecutive 6 month or 6 week periods, HDL-cholesterol, apolipoproteins AI and B plasma levels were 30 to 50% below normal values. During the higher phospholipid supply, cholesterolemia seemed normal; each phospholipid supply decrease was followed by a reduction of cholesterol, phospholipids and apolipoprotein B plasma levels of 40, 50 and 25%, respectively, while HDL-cholesterol and apolipoprotein AI plasma levels remained unchanged. Density gradient ultracentrifugation showed that plasma cholesterol changes were mainly due to cholesterol changes (as free cholesterol associated with phospholipids) located in the density range of 1.019-1.040, reflecting the presence of lipoprotein X-like particles, whose levels remained unchanged during each period. An apolipoprotein E, CII and CIII enrichment of plasma was observed and was more pronounced when patients received higher phospholipid infusion. These results show that, in patients without a small bowel, minor changes in phospholipids supply are responsible for serious alterations of the lipoprotein profile; formation of lipoprotein X-like particles could be favored by the low HDL levels in these patients.

Apolipoproteins↗
PubMed1991

[Enteral feeding in adults: indications].

In this overview article the author examines successively: (1) the effects expected from enteral nutrition in adults: general and/or local nutritional effects, temporary arrest in progressive intestinal lesions, partial intestinal function replacement; (2) indications in gastrointestinal and non-gastrointestinal pathologies and modalities of application to each indication (route of administration, elemental, semi-elemental or polymeric nutrients, incremental or non-incremental calorie intake, necessity or lack of necessity for addition of fibres, value of ambulatory methods); (3) results according to indications: chronic inflammatory intestinal diseases, notably Crohn's disease, short small bowel syndromes, fistulae and stomies, preoperative period in gastrointestinal surgery, support of heavy treatments in non-terminal cancers, hypermetabolic states, notably stress; (4) absolute or relative contraindications of enteral nutrition.

Adult↗
PubMed1989

[Exploration of the adult patient with chronic diarrhea].

This article describes the clinical approach to the aetiological diagnosis of chronic diarrhoea in adults, with a rational ranking of investigations starting with methodical questioning and careful physical examination. The purpose of the clinical stage is to find out whether the diarrhoea is truly chronic--and not the paradoxical diarrhoea so common in constipated subjects--, to evaluate its repercussions on nutrition and hydration, to try and determine its type (malabsorption or watery diarrhoea) and to elicit an obvious or probable cause. The paraclinical stage includes screening or confirmatory examinations separating watery diarrhoeas (due to colonic hypermotility or secretory of organic origin--mainly colonic, humoral or neurological--or functional origin) from malabsorption diarrhoeas; concerning the latter, the use respiratory tests with hydrogen is emphasized and conventional tests (D-xylose, assay of faecal fats and nitrogen) are mentioned.

Adult↗
PubMed1989

Severe hypoxemia in a case of midgut carcinoid tumor.

A 33-year-old woman treated for carcinoid tumor developed severe hypoxaemia. This hypoxaemia may have been related to an extracardiac right-to-left shunt. The pathogenic role of vasoactive agents is discussed and comparisons made with cirrhosis-associated hypoxaemia.

Adult↗
PubMed1988

[Home parenteral nutrition for adults. Results of a multicenter survey in France].

Home parenteral nutrition (HPN) is a growing therapy in North America and Europe. This first multicenter retrospective study of HPN in France has collected data on 81 patients sent home before December 31st, 1985. Intestinal failure, secondary to short bowel syndrome, small bowel stenosis or fistula, was the main indication for HPN. In 95 p. 100 of the cases, the clinical nutritional status during HPN was either normal or subnormal. The annual incidence of catheter change for technical complication was 0.78 and the mortality rate was 1.2 p. 100. Social rehabilitation was recovered during HPN in 60 p. 100 of patients. Thirty percent of the patients died of their primary disease during HPN but 43 p. 100 were off treatment, and 27 p. 100 were on HPN at the end of the study. The cost of HPN was reduced by 64 p. 100 in comparison with the cost of parenteral nutrition carried out in hospital.

Adult↗
PubMed1988

Diffuse small intestinal lymphoid infiltration in nonimmunodeficient adults from Western Europe.

In two white adults born, raised, and living in central France and presenting with long-lasting malabsorption, massive and diffuse lymphoid infiltrate of the lamina propria associated with crypt scarcity was found along the whole small bowel. It was mostly composed of mature lymphocytes, focally mixed with plasma cells and reactive germinal centers. There was no evidence of celiac disease, systemic or intestinal immune deficiency or alpha-chain disease, overt lymphoid malignancy, or stagnant-loop syndrome. By immunofluorescence the infiltrate was constituted in 1 case of polyclonal B cells and, in the other, of a large majority of T11, T8, T10, and class II-positive T cells associated with a population of monotypic B cells. A gluten-free diet and parenteral nutrition proved ineffective. A dramatic and protracted clinical response was observed in both patients after the onset of oral tetracycline therapy, and still persists after 8 and 5.5 yr, respectively, together with morphologically unchanged small bowel infiltrate. These cases may be the equivalents, in people from Western developed countries, of the predominantly lymphocytic variety of the immunoproliferative small intestinal disease described in people from developing countries.

Adult↗
PubMed1988

[Biological hepatic abnormalities, cholestatic jaundice and hospital artificial nutrition. A comparative study in adults with cyclic total parenteral nutrition and enteral nutrition].

Two hundred and fourteen hospitalized nonsurgical, nonacutely stressed adult patients, who were receiving, either prolonged (greater than 21 days) cyclic total parenteral nutrition (n = 106) or enteral nutrition (n = 108), including lipids, for gastrointestinal disorders, and who were free of prenutrition liver function test abnormalities were prospectively investigated for hepatic dysfunction: 41 p. 100 and 17 p. 100 of parenteral and enteral nutrition patients, respectively, developed abnormalities of liver function tests after 25 +/- 5 and 21 +/- 4 days (p less than 0.01). This prevalence was unrelated to catheter sepsis, blood transfusion, caloric load, site of digestive disease or initial nutritional status, and decreased by 50 and 40 p. 100 before the end of total parenteral nutrition and enteral nutrition respectively. In the parenteral nutrition group, separate infusion of lipids, as compared with mixed infusion, was associated with a lower rate of hepatic dysfunction (29 vs 54 p. 100; p less than 0.02). Nine (8.5 p. 100) parenteral nutrition but no enteral nutrition patients developed severe cholestatic jaundice, 47 +/- 39 days after the onset of liver function test abnormalities; no identifiable cause excepting parenteral nutrition per se was found in 3 patients with diffuse obstructive small intestinal disease; jaundice led to death from noncirrhotic hepatic failure in the 2 patients who remained totally parenteral nutrition-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗