We report a case of a tuberculous pancreatic abscess in a 47-year-old human immunodeficiency virus positive intravenous drug abuser. She had a prolonged febrile course and persistent abdominal pain. On CT and sonography the lesion lacked the usual ancillary features of an abscess such as diffuse pancreatic enlargement and a peripancreatic fluid collection, and more closely resembled a necrotic neoplasm.

Abscess↗

PubMedDate not supplied

Effect of early postoperative nutritional support on skin wound and colon anastomosis healing.

Improved healing occurs in nutritionally depleted rats given early postoperative compared with delayed feeding. The present study was designed to test the hypothesis that delay in postoperative feeding of rats normally nourished at the time of operation would also be detrimental to wound healing. Fully nourished rats weighing 288 to 342 g were divided into three groups (10 rats per group). All rats had central vein catheters inserted, celiotomy with division and reanastomsis of the colon and dorsal skin incisions, under ip pentobarbital anesthesia. With no oral intake allowed postoperatively, group 1 rats were maintained in iv 5% Dextrose electrolytes and vitamins (5% DSV); group 2 was given the 5% D/SV until the third postoperative day when they were placed on TPN (4.5% amino acids 15% Dextrose, 10% Intralipids); and group 3 was given TPN from the first postoperative day. Rats were sacrificed 6 days postoperatively and final weight, skin wound breaking strength (WBS) and colon anastomosis bursting pressure (CBP) were measured. Findings were % weight change -27.8 +/- 1.5 for Group 1, -12.6 +/- 1.0 for Group 2, and -6.9 +/- 8 for group 3 (p less than 0.0001). Wound measurements for STS on fresh specimens were 88.6 +/- 10.0 g for group 1, 89.1 +/- 8.4 g for group 2, and 87.1 +/- 11.1 g for group 3. WBS for formalin-fixed specimens were 313.5 +/- 29.7 g for group 1, 323.4 +/- 38.4 g for group 2, and 382 +/- 25.2 g for group 3 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗

PubMedDate not supplied

Infusion of enteral vs parenteral nutrients using high-concentration branch-chain amino acids: effect on wound healing in the postoperative rat.

Starting total parenteral nutrition (TPN) the day after acute surgical stress has beneficial effects on body weight, nitrogen balance, and colonic anastomosis bursting pressure in normally nourished rats. In view of the reported favorable utilization of high-concentration branch-chain amino acids (BCAA) following severe stress, we compared enteral (TEN) to parenteral (TPN) nutrient infusions containing increased BCAA starting the day of operation. Twenty-four male Sprague-Dawley rats, in two groups paired by weight under IP pentobarbital anesthesia underwent jugular vein catheter (CVP) insertion, laparotomy, gastrostomy, colon anastomosis, dorsal skin incision and SC polyvinyl alcohol sponge insertion. The rats were maintained for 6 days with continuous IV infusion in the TPN group (gastrostomy plugged) and continuous gastric infusion for the TEN group (CVP plugged). Urine and feces were collected daily. The infusions contained 1000 to 1002 Kcal, 847 to 845 nonprotein Kcal, 38 to 39 g of amino acids, 206 to 209 g of carbohydrates, and 2.8 to 2.9 g of rat per liter in the TEN and TPN, respectively, with identical ratios of dietary essential amino acids to nonessential amino acids (52/48), and 28.34% BCAA in the TPN and 33.10% BCAA in the TEN. There were 491 mg/100 mL of glutamine in the TEN and 170 mg of glutamic acid in the TPN. Amino acids were infused at 8.59 g/kg per day for TEN and 8.34 g/kg per day for TPN. The vitamins, minerals, and trace minerals were essentially the same in the TEN and TPN except for the absence of iron, iodine, selenium, and molybdenum in the TPN.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids, Branched-Chain↗