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Biomedical subjects

Douglas L Seidner

Publications and source records attributed to Douglas L Seidner.

At least 19 recordsLinked to original sources
PubMed2005

An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial.

BACKGROUND & AIMS: N-3 fatty acids from fish oil, antioxidants, and short-chain fatty acids (SCFAs) produced during the fermentation of soluble fiber may attenuate inflammation associated with ulcerative colitis (UC). We assessed the efficacy of a nutritionally balanced oral supplement enriched with fish oil, fructooligosaccharides, gum arabic, vitamin E, vitamin C, and selenium on disease activity and medication use in adults with mild to moderate UC. METHODS: A total of 121 patients with UC and a disease activity index (DAI) from 3-9 on a 12-point scale were block randomized for extent of disease and smoking status. In addition to their usual diet, patients consumed 18 oz of the oral supplement or a carbohydrate-based placebo formula each day for 6 months. Clinical and histologic responses were assessed at 3 and 6 months or at the final visit. A change in average prednisone use between groups was tested by using a linear mixed-effects model. RESULTS: Eighty-six patients completed the study. Baseline characteristics were not different between groups except for a higher total DAI score in the oral supplement group (7.3 +/- 1.3; n = 36) compared with the placebo group (6.2 +/- 2.0; n = 50) ( P < .05). Both groups showed significant and similar degree of improvement at 6 months in DAI (-2.5 for oral supplement and -2.8 for placebo) and histologic index (-1.9 for oral supplement vs. -2.0 for placebo). Both intent-to-treat and completed patients given oral supplement had a significantly greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months as compared with the placebo group ( P < .001). CONCLUSIONS: The improvement in clinical response combined with a decreased requirement for corticosteroids suggest that this enriched oral supplement can be a useful adjuvant therapy in patients with UC.

Administration, Oral↗
PubMed2005

Management of a traumatic gastric ulcer with a low-profile gastrostomy tube.

Since the advent of percutaneous endoscopic gastrostomy (PEG) tubes in 1980, they have become the device of choice for providing long-term enteral nutrition. Despite their overall safety, a number of complications can occur after PEG placement. Bleeding is usually a minor complication associated with PEG placement that occurs soon after the procedure and is most often caused by puncture of an abdominal wall vessel. More severe bleeding can occur when a branch of one of the gastric arteries is punctured. There are only a few case reports of traumatic gastric ulceration secondary to the internal bolster of a PEG. The internal bolsters are either balloons or dome shaped, and are 1.5-2.0 cm in height. We report a case in which a patient developed hemorrhage from a gastric ulcer induced by a balloon-type PEG tube that was resolved only after replacement with a tube manufactured with a low-profile internal bolster that was only 0.3 mm in height. The protruding tip of a balloon-type gastrostomy tube was believed to have caused traumatic injury to the gastric mucosa in our patient, causing ulceration. Usually, removal of the tube and placement in a different location may solve the problem. However, we believe that the PEG tube fashioned with a low-profile internal bumper is a safer option.

Aged↗
PubMed2005

Practical guide to intestinal rehabilitation for postresection intestinal failure: a case study.

After massive small-intestinal resection or combined small-intestinal and colonic resection, diarrhea with resulting dehydration, electrolyte abnormalities, and malnutrition occur. Many patients become dependent on IV fluids and nutrition. An adaptation process manifested clinically by decreased diarrhea and improved nutrient absorption according to decreased parenteral nutrition and fluid requirements has been noted to occur over time. In some patients, adaptation is inadequate and may require special techniques to enhance and augment this process. This is a case of a 52-year-old woman who experienced increased stoma output 1 week after major intestinal resection, resulting in dehydration. She required IV fluids in order to maintain hydration. After the initiation of an intestinal rehabilitation program, which included modified diet, soluble fiber, oral rehydration solution (ORS), and medications, IV fluids were successfully weaned off in 3 months. She continues not to receive IV fluids and continues to follow the intestinal rehabilitation plan.

Crohn Disease↗
PubMed2004

Metabolic bone disease and parenteral nutrition.

Metabolic bone disease (MBD) is abnormal bone metabolism and includes the common disorders of osteoporosis and osteomalacia, which can develop in patients receiving long-term parenteral nutrition (PN). Patients who require long-term PN have significant gastrointestinal failure and malabsorption, which is generally caused by severe inflammatory bowel disease, intestinal ischemia, or malignancy. The exact cause of MBD in long-term PN patients is unknown, but its origin is thought to be multifactorial, with factors including underlying disease, effect of medications used to treat this disease (eg, corticosteroids), and various components of the PN solution. Caring for patients on long-term PN requires routine assessment and monitoring for MBD. Appropriate adjustments of the PN solution can help reduce the risk for developing PN-associated MBD and in some instances improve bone mineral density. Recent developments in pharmacologic treatment for osteoporosis show promise for patients with MBD receiving PN.

Bone Diseases, Metabolic↗
PubMed2004

Growth hormone, glutamine, and modified diet for intestinal adaptation.

Many patients who undergo extensive resection of the gastrointestinal tract develop intestinal failure from short-bowel syndrome that results in significant malabsorption of fluid, electrolytes, and other nutrients. This may result in dependence on long-term parenteral nutrition. It has been almost a decade since Byrne and colleagues published their research demonstrating enhanced absorption of nutrients, improved weight gain, and reduction in parenteral nutrition requirements with the administration of a combination of growth hormone, glutamine, and a modified diet. Other researchers have conducted similar studies with inconsistent results. A systematic search on electronic databases and the Internet for the purpose of identifying the evidence published to date on this subject was performed. The analysis suggests administering recombinant human growth hormone alone or together with glutamine with or without a modified diet may be of benefit when the appropriate patients are selected for treatment.

Adaptation, Physiological↗
PubMed2004

The pathophysiology of pancreatitis.

The pancreas is an exocrine and endocrine gland that is required for normal digestion and metabolism of proteins, carbohydrates, and fats. Acute pancreatitis (AP) is an inflammatory process of the pancreas that involves peripancreatic tissues and remote organs. Mild AP occurs in 80% of patients requiring hospitalization and severe AP occurs in the other 20%. Chronic pancreatitis (CP) is an inflammatory disorder that causes anatomic changes, including infiltration of chronic inflammatory cells and fibrosis of the pancreas. This review discusses biochemical and histologic features of pancreatic injury in AP and CP and some of the important clinical sequelae associated with these abnormalities.

Journal Article↗
PubMed2004

Perioperative nutrition support: who and how.

Perioperative nutrition support can reduce postoperative complications in some malnourished patients, but there are risks, such as a greater risk of infection. The decision to use nutrition support--either total parenteral nutrition or enteral feedings--before and after surgery depends on how severely the patient is malnourished, the type of surgical procedure, and whether the surgery is elective.

Enteral Nutrition↗
PubMed2003

Review of a potential role for zinc supplementation in oral rehydration solutions.

Patients with short bowel syndrome often present with diarrhea and significant fluid and electrolyte abnormalities. Management consists of the use of medication, dietary modification, and oral rehydration solutions. Zinc deficiency has been shown to result in diarrhea. Oral zinc has been used for the management of acute diarrhea primarily in underprivileged children in developing countries. The effectiveness and feasibility of adding zinc to oral rehydration solutions (ORS) to abate and control diarrhea for adult patients with intestinal failure caused by short bowel syndrome has not been studied. Based on studies evaluating the use of oral zinc supplementation in the treatment of acute diarrhea, recommendations are made for the composition of ORS in adults.

Journal Article↗
PubMed2003

The role of probiotics in gastrointestinal disease.

Patients with intestinal failure often have diarrhea for a variety of reasons. Treatment of diarrhea has centered on the use of antidiarrheal medications and antibiotic therapy. Recently, there has been interest in the oral administration of probiotics for these patients with small bowel bacterial overgrowth, inflammatory bowel disease, and radiation enteritis. This paper reviews the studies that have used probiotics to treat patients with short bowel syndrome and gastrointestinal disorders. Additionally, some of the specific issues regarding probiotics are addressed.

Journal Article↗
PubMedDate not supplied

Peripherally inserted central catheter malposition in a persistent left superior vena cava.

Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the superior vena cava system. Left superior vena cava exists in early embryonic development, but this vessel degenerates as the cardiovascular system matures. Failure of this process to occur results in PLSVC. If not associated with other cardiac malformations, PLSVC has no clinical signs or symptoms. This article discusses a case of PLSVC diagnosed after placement of two peripherally inserted central venous catheters that appeared to malposition outside the central circulation. After unsuccessful bedside placement of the two catheters, the patient was referred to interventional radiology for placement of a Hickman catheter. A contrast injection study showed the presence of a PLSVC with the absence of a normal right superior vena cava. The tip of the peripherally inserted central venous catheter was found to be at a satisfactory location within the PLSVC.

Adult↗
PubMedDate not supplied

Parenteral nutrition-associated metabolic bone disease.

The incidence of parenteral nutrition-associated metabolic bone disease is unknown. Initial reports from the early 1980s suggested that both osteoporosis and osteomalacia were quite common in patients who receive long-term parenteral nutrition. The findings described in these early surveys provide a snapshot into the many factors that contribute to the development of metabolic bone disease. More recent evidence suggests that bone loss may not be as great with the initiation of parenteral nutrition as once was thought, and that most of the metabolic bone disease that is noted may be related to the patient's underlying illness. Although this recent information is reassuring, it is of the utmost importance to provide parenteral nutrition that minimizes further bone loss and promotes the formation of new bone. This review will describe the general features of metabolic bone disease and the abnormalities noted with parenteral nutrition-associated metabolic bone disease, highlight the importance of preexisting illness and parenteral nutrition associated factors that contribute to the development of metabolic bone disease, and finally discuss an approach to avoid this debilitating complication of long-term parenteral nutrition.

Bone Diseases, Metabolic↗
PubMedDate not supplied

Body composition changes in cachectic patients receiving home parenteral nutrition.

BACKGROUND: The purpose of this study was to evaluate the initial body compositional changes experienced by malnourished patients requiring home parenteral nutrition (HPN) for repletion. METHODS: Eight patients were prospectively studied for 3 months. Body composition was determined by dual-energy X-ray absorptiometry (DXA), and a comprehensive nutrition assessment was performed including body weight, visceral proteins, triceps skinfold (TSF), midupper arm circumference (MUAC), midupper arm muscle circumference (MUAMC), body mass index (BMI), delayed hypersensitivity skin tests (DHST), and diet history. RESULTS: Body composition measured by DXA showed an increase in (mean +/- SD) total fat from 5770 +/- 2805 to 10581 +/- 1980 g (p < .001) and bone mineral content from 2155 +/- 429 to 2190 +/- 443 g (p = .047). Lean soft tissue remained unchanged. Body weight and BMI increased from 47.7 +/- 6.6 to 53.6 +/- 8.2 kg (p = .006) and from 16.6 +/- 1.5 to 18.6 +/- 1.5 kg/m2 (p = .005), respectively. TSF increased from 6.3 +/- 3.1 to 10.4 +/- 4.0 mm (p < .001), and MUAMC remained stable. There was a significant improvement in transferrin from 191 +/- 82 to 326 +/- 128 mg/dL (p = .043), and a trend toward improvement in albumin and DHST. Body weight was highly correlated with DXA weight at baseline (r = .997; 95% confidence interval [CI], 0.98 to 1.00; p < .001) and at 3 months (r = .988; 95% CI, 0.93 to 1.00; p <.001). TSF correlated with total fat as measured by DXA at baseline (r = .839; 95% CI, 0.33 to 0.97; p = .009) but not at 3 months (r = .693; 95% CI, -0.02 to 0.94; p = .057). MUAMC correlated with lean soft tissue measured by DXA both at baseline (r = .739; 95% CI 0.07 to 0.95; p = .036) and at 3 months (r = .870; 95% CI, 0.43 to 0.98; p = .005). Physical activity, on a subjective scale of 1 (low activity) to 3 (high activity), improved over the 3-month period from 1.3 +/- 0.5 to 2.2 +/- 0.8 (p = .031). CONCLUSIONS: Initial weight gain experienced by malnourished HPN patients is primarily fat. Bone mineral content increases, but lean soft tissue does not change. Overall nutritional status is improved as exhibited by significant improvements in body weight and serum transferrin and a trend toward improvement in albumin and delayed hypersensitivity skin tests.

Absorptiometry, Photon↗
PubMedDate not supplied

Clinical trial of interactive and videotaped educational interventions reduce infection, reactive depression, and rehospitalizations for sepsis in patients on home parenteral nutrition.

BACKGROUND: Patients receiving long-term home parenteral nutrition (HPN) have catheter-related infections, reactive depression, and other recurrent problems that decrease their quality of life. The aim of this study was to evaluate the Interactive Educational Videotaped Interventions (IEVI) designed to prevent HPN complications of catheter-related bloodstream infection (CR-BSI), to prevent reactive depression (from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition definition), and to increase patients' frequency of problem-solving with professionals. METHODS: A randomized placebo-controlled clinical trial was used to test IEVI that engaged patients in infection and depression prevention and problem-solving activities with professionals. The primary outcome measure was CR-BSIs, while reactive depression and problem solving were secondary outcomes. Quality of life and satisfaction with interventions, also secondary outcomes, were evaluated at 18 months. RESULTS: Compared with controls, there was a lower frequency in the experimental group of CRBSIs (chi2 = 4.82, p = .03), reactive depression (chi2 = 4.50, p = .03), and rehospitalization for CR-BSIs (chi2 = 5.73, p = .01). There was greater use of problem solving in the experimental group (chi2 = 4.33, p = .038). These differences occurred at the primary endpoint of 6 months after administration of the interventions. At the 18-month follow-up, there were fewer CR-BSIs (chi2 = 4.42, p = .035), and fewer hospitalizations for infection (chi2 = 5.729, p = .01). CONCLUSIONS: The IEVI reduced CR-BSIs and reactive depression and increased problem solving with professionals. IEVI use also can result in fewer hospitalizations and improved quality of life. Long-term improvement did not occur for reactive depression and problem-solving outcomes because patients used these less often.

Adolescent↗