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Biomedical subjects

J Tresadern

Publications and source records attributed to J Tresadern.

5 recordsLinked to original sources
PubMed1985

Three years' experience with an intestinal failure unit.

The work of a purpose-built unit for the treatment of intestinal failure is described. In the 3 years following its opening the 4-bed unit treated 83 patients who were admitted for a mean of 35 days. Major indications for admission were difficult cases of Crohn's disease, intestinal fistulae and short bowel syndrome. Since the unit opened the mortality rate in this type of patient has fallen from 42% to 20%. The principal treatment used was total parenteral nutrition (TPN) although 52 of the 83 patients also required major surgery. Repeated experience with the same type of clinical problem has led to more efficient patient management and has reduced the complication rate associated with TPN. The unit has acted as a centre for the management of patients needing Home Parenteral Nutrition and has an active role in training nursing and medical staff in intravenous therapy. A plea is made for the establishment of regional intestinal failure units.

Adolescent↗
PubMed1983

The effect of sepsis on the oxidation of carbohydrate and fat.

Oxidative metabolism has been studied by indirect calorimetry in 27 patients with sepsis and in 7 non-septic patients while they were all receiving total parenteral nutrition. Glucose oxidation was reduced in the septic patients and fat oxidation continued despite the infusion of an excess of glucose. The extent of these changes depended on the severity of the septic state as measured by the scoring system described in the preceding paper. The mechanism of these changes is not known. They were not related to an elevation of the plasma nonesterified fatty acid concentration. Alterations must have occurred in the way fat was taken up and metabolized by the cells. Here insulin resistance and the highly significant positive relationship found between the plasma cortisol concentration and the sepsis score might be important.

Adult↗
PubMed1981

The benefits of central vein feeding and long term access to the circulation.

Although parenteral nutrition can be safely administered by peripheral vein for long periods most workers find it a difficult technique primarily because of phlebitis induced by the nutrient solutions. Additionally the need for immobilisation of an arm for at least part of the day restricts the patient's mobility. On the other hand, nutrition through a catheter inserted into a large vein, with its tip positioned in the superior vena cava, allows the infusion of large volumes of nutrients with only minimal risk of phlebitis. If the catheter is inserted through the subclavian or jugular veins there is no need to immobilise a limb and, using portable systems the patient can remain mobile, even whilst infusion is occurring. It is the development of these latter techniques that has led to Home Parenteral Nutrition being a feasible treatment. The hazards associated with central vein nutrition can be minimised by skillful insertion of the catheters and meticulous maintenance thereafter.

Catheterization↗