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Biomedical subjects

M Girvent

Publications and source records attributed to M Girvent.

12 recordsLinked to original sources
PubMed2006

The effect of bolus viscosity on swallowing function in neurogenic dysphagia.

AIM: To assess the pathophysiology and treatment of neurogenic dysphagia. METHODS: 46 patients with brain damage, 46 with neurodegenerative diseases and eight healthy volunteers were studied by videofluoroscopy while swallowing 3-20 mL liquid (20.4 mPa s), nectar (274.4 mPa s) and pudding (3931.2 mPa s) boluses. RESULTS: Volunteers presented a safe and efficacious swallow, short swallow response (< or =740 ms), fast laryngeal closure (< or =160 ms) and strong bolus propulsion (> or =0.33 mJ). Brain damage patients presented: (i) 21.6% aspiration of liquids, reduced by nectar (10.5%) and pudding (5.3%) viscosity (P < 0.05) and (ii) 39.5% oropharyngeal residue. Neurodegenerative patients presented: (i) 16.2% aspiration of liquids, reduced by nectar (8.3%) and pudding (2.9%) viscosity (P < 0.05) and (ii) 44.4% oropharyngeal residue. Both group of patients presented prolonged swallow response (> or =806 ms) with a delay in laryngeal closure (> or =245 ms), and weak bolus propulsion forces (< or =0.20 mJ). Increasing viscosity did not affect timing of swallow response or bolus kinetic energy. CONCLUSIONS: Patients with neurogenic dysphagia presented high prevalence of videofluoroscopic signs of impaired safety and efficacy of swallow, and were at high risk of respiratory and nutritional complications. Impaired safety is associated with slow oropharyngeal reconfiguration and impaired efficacy with low bolus propulsion. Increasing bolus viscosity greatly improves swallowing function in neurological patients.

Adult↗
PubMed2002

Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis.

BACKGROUND: The prevalence of enterococcal isolation and factors associated with postoperative enterococcal infection remain ill defined. METHODS: A prospective longitudinal observational study was conducted of consecutive patients with a first episode of intra-abdominal infection and a positive microbiological culture who did or did not develop a postoperative septic complication involving enterococci. The prevalence of initial enterococcal isolation was determined for each focus of infection. Postoperative enterococcal infections were related to whether appropriate (piperacillin--tazobactam), suboptimal (carbapenems) or inappropriate (cefotaxime plus metronidazole) antienterococcal therapy had been administered empirically. RESULTS: Enterococci were isolated in 42 (21 per cent) of the 200 patients investigated. The isolation rates were 11 per cent for community-acquired peritonitis, 50 per cent for postoperative peritonitis and 23 per cent for intra-abdominal abscesses of both origins. No enterococci were isolated from 49 patients with perforated appendicitis. Independent factors for postoperative enterococcal infection were type of intra-abdominal infection (P = 0.006), Acute Physiology And Chronic Health Evaluation (APACHE) II score greater than 12 (P = 0.04) and inappropriate empirical antibiotic cover (P = 0.05). Postoperative enterococcal infections were associated with a high mortality rate (21 versus 4 per cent; P < 0.0007). CONCLUSION: Enterococci are frequently isolated from intra-abdominal infections of non-appendiceal origin and are often involved in postoperative infectious complications, particularly peritonitis. Empirical antibiotic therapy covering Enterococcus faecalis should be contemplated in some circumstances.

Abdominal Abscess↗
PubMed2001

Influence of parenteral nutrition on postoperative recovery in an experimental model of peritonitis.

BACKGROUND AND AIMS: There seems to be no clear-cut indications for routine TPN support after major elective surgery. The present study was designed to investigate whether TPN could improve the results of standard surgical care for acute peritonitis (laparotomy plus antibiotics). ANIMALS AND METHODS: Peritonitis was induced in 48 New Zealand rabbits (day -2). On day 0, appendectomy and peritoneal lavage were performed, ceftriaxone (250 mg, i.m./24 h.) was started and animals were randomly assigned to receive regular fluids (RF), glucose-based TPN (G-TPN) or isocaloric fat-based TPN (F-TPN) for 6 days. MAIN OUTCOME MEASURES: Balance studies (days 1-3), s-albumin, thyroid hormones and urinary catecholamines were determined at various points of the experiment. At postmortem, wound infection, residual intra-abdominal infection and laparotomy wound breaking strength were recorded. RESULTS: Peritonitis produced a fall in weight, s-albumin and T3. At day 6, weight-loss was more pronounced in RF than in G-TPN or F-TPN (-7 vs 1.5 vs -1.2%;P=0.0001) but s-albumin and T3 concentrations were similar. Diuresis (377 vs 268 vs 269 mL/3 days; P=0.01) was higher and water balance lower (373 vs 511 vs 480 mL/3 days; P=0.01) in Group RF. Although the differences were not statistically significant (P<0.2), persistent infection and wound breaking strength were slightly worse in the pooled TPN groups compared with the RF group (19 vs 6% and 542 vs 701 g, respectively). CONCLUSIONS: TPN failed to improve relevant biochemical markers and clinical outcome after laparotomy for peritonitis.

Acute Disease↗
PubMed2000

Intestinal failure after surgery for complicated radiation enteritis.

Between 1983 and 1997, a total of 16 patients were referred to a tertiary Intestinal Failure Unit (IFU) following surgery elsewhere for complications of radiation enteritis. Eleven were female with a mean age of 43 years (range 21-71 years) and the most common primary site of malignancy was genitourinary (n = 13). Patients had undergone an average of two laparotomies (range 1-7 laparotomies) for complications of radiation enteritis prior to transfer to the IFU. On admission, the principal problem in eight patients was persisting intestinal fistulation, four patients had continuing intestinal obstruction and four had the short bowel syndrome after extensive intestinal resection. Only one patient had evidence of residual malignancy; this patient with short bowel syndrome was allowed home without invasive therapy. Of the remaining 15 patients, 12 required an abdominal surgical procedure, while three were discharged without further surgery after training for home parenteral nutrition (HPN). Following abdominal surgery, five patients died in hospital, but the remaining seven patients went home alive--including two further patients on HPN. Overall, of the 15 patients referred with intestinal failure after surgery for complications of radiation enteritis and actively treated, one-third died in hospital and a further third required institution of HPN before being able to be discharged home.

Adult↗
PubMed1999

Catheter-related bloodstream infections.

Catheter-related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections. Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenance of the catheter exit site or endoluminally during hub manipulation. CBI is heralded by spiking fever, malaise and rigors and should be promptly diagnosed to prevent endocarditis and septic metastasis. In about two-thirds of the cases the offending organisms are coagulase-negative staphylococci; Staphylococcus aureus, gram-negative bacilli, and Candida sp. are responsible for one-third of these infections and carry a worse prognosis. Diagnosis of CBI relies on proper bacteriologic techniques, some of which can be performed in situ avoiding withdrawal of the device. Prevention strategies should aim at avoiding extra- and endoluminal contamination and should be based on three main pillars: maximal aseptic barriers at insertion, appropriate site maintenance, and junctional (hub) care and protection. Treatment includes catheter withdrawal and appropriate antibiotic coverage. For long-term cuffed catheters, local treatment with intraluminal administration of antibiotics is effective and can save a significant number of catheters, particularly those colonized by coagulase-negative staphylococci.

Antibiotic Prophylaxis↗
PubMed1998

Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation.

BACKGROUND: Emergency operation in the elderly carries a high risk of death. We investigated the incidence of euthyroid sick syndrome (ESS) and associated nutritional and endocrine abnormalities and their relationship to postoperative outcome in this population. METHODS: Sixty-six patients older than 70 years of age requiring emergency operations were assessed before any therapeutic intervention. Values for thyroid hormones, catecholamines, cortisol, interleukin-6, interleukin-1, C-reactive protein, and the Acute Physiology and Chronic Health Evaluation II score were determined. Nutritional assessment was carried out. Mortality rates and duration of hospital stay were related to ESS and albumin concentrations. RESULTS: ESS was diagnosed in 34 patients (51.50%) and was associated with worse Acute Physiology and Chronic Health Evaluation II scores (10.9 vs 8.6; p = 0.004), hypoalbuminemia (34.7 vs 40.8 gm/L; p = 0.0001), lower triceps skinfold (11.8 vs 14.6 mm; p = 0.03), and higher cortisol and norepinephrine levels (937 vs 741 nmol/L [p = 0.04] and 358 vs 250 pg/ml [p = 0.02], respectively), interleukin-6 plasma concentrations (347 vs 113 pg/ml; p = 0.01), death rate (20% vs 0%; p = 0.02), and length of hospital stay (17.2 vs 11.8 days; p = 0.03). A serum albumin level less than 35 gm/L was virtually always associated with ESS. CONCLUSIONS: ESS is highly prevalent in the elderly with acute surgical problems and is associated with poor nutrition, higher sympathetic response, and worse postoperative outcome. The serum albumin level at admission is a specific marker of ESS.

APACHE↗
PubMed1998

[Hydatid cyst in the hepatic hilum causing a cavernous transformation in the portal vein].

Portal cavernomatosis consists in the substitution of the portal vein by many fine, twisting venules leading to the liver. This phenomenon is produced as a consequence of anterior thrombosis of the portal vein and is associated with chronic pancreatitis, cancer of the pancreas, intraabdominal sepsis and cholelithiasis. The symptomatology may be nul or present as obstructive jaundice or portal hypertension. Diagnosis is made by Doppler echography. The treatment is portal shunt when symptomatology is produced. In patients with cholelithiasis requiring surgery, the shunt is advised prior to biliary surgery since perioperative hemorrhage, if present, may be incoercible as in the case herein described. We present a 84-year-old woman with portal cavernomatosis the etiology of which was a hydatidic cyst located in the hepatic bifurcation and treated with mebendazol 10 years previously. This etiology has not been previously reported.

Aged↗
PubMed1997

Response of severely malnourished patients to preoperative parenteral nutrition: a randomized clinical trial of water and sodium restriction.

Preoperative parenteral nutrition (PPN) may be beneficial for severely malnourished patients who are candidates for a major elective surgical procedure. The response to PPN, however, has not been thoroughly investigated. Expansion of the extracellular water compartment may occur in some patients, producing a further decrease in the serum albumin concentration and increasing the postoperative complications. Our aims were to investigate the occurrence of and factors associated with water and sodium retention during PPN and its impact on postoperative respiratory complications. Forty-one patients with gastrointestinal cancer and severe malnutrition (weight loss > 15% and/or serum albumin < 35 g/L) were randomly allocated to two groups receiving isocaloric isonitrogenous PPN for 10 d. The Standard PPN Group (SG, n = 19) received 70% of nonprotein calories as glucose, 45 cc of water.kg-1.d-1, and 140 mEq/d of sodium chloride; and the Modified Group (MG, n = 22) received 70% of calories as fat, 30 cc of water.kg-1.d-1, and no sodium. Weight and albumin changes, diuresis, sodium and water balances, and postoperative complications were recorded. At the end of PPN, the SG showed a higher weight gain (0.8 versus -1.5 kg, P = 0.0001) and albumin decrease (-0.7 versus 2.3 g/L, P = 0.006). Diuresis and sodium balance were greater in the SG (1,230 versus 959 mL/d, P = 0.003 and 40 versus -27 mEq/d, P = 0.001). Weight changes correlated with water (r2 = 0.46, P = 0.001) and sodium (r2 = 0.62, P = 0.0001) balances. Inappropriate responses to PPN in both groups (expansion or depletion of the extracellular water compartment) were associated with a significant increase in pulmonary postoperative complications. During PPN, extracellular water expansion--as determined by increasing weight and lowering of the serum albumin concentration--and aggressive fluid therapy to treat water and sodium depletion seem crucial to the development of postoperative respiratory complications.

Aged↗
PubMed1995

Influence of nutrition, thyroid hormones, and rectal temperature on in-hospital mortality of elderly patients with acute illness.

The present study was undertaken to investigate the interrelation of nutrition, core temperature, and thyroid function and their influence on survival of patients aged > or = 70 y admitted to the hospital with acute conditions. Sixty-seven patients entered the study. Nutritional state, thyroid function, rectal temperature, and the APACHE II score were recorded at admission. The patients were followed until death or hospital discharge. Patients with a serum albumin concentration < 35 g/L showed a lower triiodothyronine (T3) concentration, a higher reverse triiodothyronine (rT3) concentration, and a higher death rate. Prior weight loss (> or = 10%) did not influence thyroid status but increased the mortality rate. Eleven patients were hypothermic (< 36.5 degrees C) and had a higher mortality, lower total T3 concentration, and higher rT3 concentration than the normothermic or hyperthermic subjects. Serum albumin, body weight, and total T3 concentration were higher in survivors (n = 51) than in nonsurvivors (n = 16). Ongoing weight loss and hypoalbuminemia at admission are highly prevalent in elderly people with acute disease, and influence their clinical outcome. Mild hypothermia was a good predictor of death. Hypoalbuminemia and hypothermia were associated with low T3 and high rT3 values.

APACHE↗
PubMedDate not supplied

Extracellular volume, nutritional status, and refeeding changes.

ECW, and particularly its interstitial component, expands easily with malnutrition, sepsis, and trauma and after aggressive intravenous fluid therapy. In this scenario, hypoalbuminemia is usually the result of both an increased capillary escape rate due to leaky endothelium and increased distribution volume; this can be worsened by artificial intravenous nutrition with sodium, water, and glucose. Monitoring ECW is essential during TPN. Short-term changes in weight and serum albumin concentration are helpful to control ECW volume and prevent ECW expansion. Tetrapolar bioimpedance analysis is a promising technique for accurate bedside measurement of changes in body fluid compartments.

Animals↗