PubMed Health⌕ Search

Biomedical subjects

M Keymling

Publications and source records attributed to M Keymling.

16 recordsLinked to original sources
PubMed2003

Colorectal stenting.

Intestinal stenting is a procedure that is rapidly coming into more widespread use. It is reported to be a safe and highly effective alternative in patients with unresectable intestinal obstruction. Recent reports show the value of this procedure in colorectal obstruction, as it is relatively safe and can avoid the need for high-risk emergency laparotomy and resection in two sessions. New stents can be inserted in a one-step procedure, with delivery through the scope during the initial diagnostic endoscopy. If examinations show that curative treatment is not possible, resection can be completely avoided, so that the initial stent already forms part of the palliative strategy. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary.

Alloys↗
PubMed1994

Technical aspects of enteral nutrition.

Advances in technical aspects of enteral feeding such as the manufacture of tubes from polyurethane or silicone have helped promote the science of enteral nutrition. Nasoenteral tubes have few complications, apart from a high unwanted extubation rate and some reluctance from patients because of cosmetic unacceptability. Needle jejunostomy has low morbidity but can only be placed at laparotomy. Percutaneous gastrotomy (in all its different guises) has been established as a low risk procedure and is the access route of choice for longterm enteral feeding, in particular for cancer, geriatric, and neurological patients.

Cachexia↗
PubMed1993

A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer.

BACKGROUND: Esophageal obstruction due to cancer can produce debilitating dysphagia. Rapid palliation is usually possible with endoscopic placement of a plastic esophageal prosthesis, but this device has a high rate of complications. A new alternative is a metal-mesh stent that collapses to 3 mm in diameter at placement but can then expand up to 16 mm. METHODS: Patients with esophageal carcinoma (39 patients) or malignant extrinsic obstruction (3 patients) were randomly assigned to treatment with either a plastic prosthesis (16 mm in diameter) or an expansile metal-mesh stent. The patients were evaluated every six weeks until death. The degree of palliation was expressed as a dysphagia score and a Karnofsky performance score. RESULTS: Complications were significantly less frequent with the metal stents than with the plastic prostheses (no complications vs. nine; P < 0.001). The dysphagia and Karnofsky scores improved significantly and to a similar degree in both treatment groups. The most common causes of recurrent dysphagia were migration of the plastic prostheses (five patients) and ingrowth or overgrowth of the metal stents by tumor (five patients). The rates of reintervention were similar in both treatment groups, as were the 30-day mortality rates. The period of hospitalization after placement of a prosthesis was significantly longer in the group given plastic prostheses than in the group given metal stents (mean +/- SE, 12.5 +/- 2.1 vs. 5.4 +/- 1.0 days; P = 0.005). Despite their higher initial cost, the metal stents were cost effective because of the absence of fatal complications and the decrease in the hospital stay. CONCLUSIONS: Expansile metal stents are a safe and cost-effective alternative to conventional plastic endoprostheses in the treatment of esophageal obstruction due to inoperable cancer.

Aged↗
PubMed1988

[Chemotherapy and enteral nutrition in stomach cancer].

Malnutrition is a frequent problem in cancer patients. About 45% of them lose more than 10% of their original weight at the various stages of their disease. The importance of nutritional support was repeatedly pointed out. In our study, 10 patients with metastatic gastrointestinal cancer received a combination treatment of long-term tube feeding with elemental diets and chemotherapy. The initially low Karnofsky index improved significantly. The results of the chemotherapy are comparable to those of 9 international studies between 1976 and 1979, using a comparable therapeutic scheme in patients with initially higher Karnofsky index. Ingestion-dependent abdominal pain disappeared in responders and non-responders during the time of tube feeding.

Adult↗
PubMed1988

[Reactions of the liver to high caloric enteral feeding with formula diets].

We studied serum hepatic enzyme alterations in 36 patients receiving continuous enteral hyperalimentation. In 50% of the patients studied a marked increase in liver enzymes could be noticed. Elevations returned to normal either spontaneously during enteral feeding or after feeding was discontinued. In 7 patients, alkaline phosphatase decreased significantly 21 +/- 13 days after institution of tube feeding. The rise in liver enzyme values could not be accounted for by preexistent hepatobiliary affection, caloric load or composition of the formula diet. Further studies are needed to determine whether cyclic isocaloric enteral nutrition will minimize complications and hepatic enzyme changes after enteral nutrition.

Adolescent↗
PubMed1986

[Possibilities for the use of formula diets for tumor patients].

Malnutrition is a frequent problem in cancer patients. Nearly 50% of all tumor patients lose more than 10% of their pre-illness weight during the various stages of their disease. Ingestion-dependent abdominal pain in patients with gastrointestinal tumor complications is a major problem among the causes which are under discussion. Elemental diet has a safe analgetic effect in these patients because of its quick and complete resorption in proximal parts oft the jejunum. Tube feeding with elemental diets can be provided fully ambulatory and leads to a significant increase in the quality of life of cancer patients. This was demonstrated in a group of 38 malnourished cancer patients. The effect of tube feeding combined with chemotherapy was investigated in a small group of 10 patients with low Karnofsky index. The outcome was compared to the results of 9 international chemotherapy studies using the same chemotherapeutic regime without artificial feeding.

Adult↗