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Biomedical subjects

P Thul

Publications and source records attributed to P Thul.

At least 19 recordsLinked to original sources
PubMed2003

Home enteral nutrition in adults: a European multicentre survey.

AIMS: This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe. METHODS: A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark (D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998. RESULTS: A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62-457). Age distribution was 7.5%, 16-40 years; 37.1%, 41-65 years; 34.5%, 66-80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges. CONCLUSIONS: In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.

Adolescent↗
PubMed2002

Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days.

RATIONALE: The purpose of this study is to report the frequency of central venous catheter (CVC) complications and to analyze the potential risk factors for complications requiring CVC removal in home parenteral nutrition (HPN) patients. METHODS: A questionnaire developed by the ESPEN HAN WORKING GROUP was distributed to 12 European centers to investigate the complications occurring during the period between January 1995 and December 2000 when HPN patients used their first CVC. The questionnaire collected informations related to the Home Parenteral Nutrition technique and the underlying disease. Factors affecting the time of CVC removal were jointly investigated using Cox's multivariable regression models. RESULTS: The study was performed on 447 patients for a total of 110869 CVC-days. Complications occurred in about 1/4 of patients, approximately half were infections and about half required Central Venous Catheter removal. The Cox analysis showed that using the CVC 7 times/week and implanted ports were associated with a hazard ratio of 3 and 2.8, respectively. A reduced risk of removal (of about 40%) was associated with using CVC also for non-nutritional purposes (P = 0.0016). CONCLUSIONS: Within the limits of this retrospective investigation, the type of CVC, the type of administration of HPN and the type of training are important factors associated with occurrence of complications or with CVC removal. However, in our opinion, proper care of the CVC, of preparation and administration of the nutritive admixture seem to be paramount for a safe management of HPN.

Adult↗
PubMed2001

Survey on legislation and funding of home artificial nutrition in different European countries.

RATIONALE: Home Artificial Nutrition (HAN) has been an expanding area over the last 30 years. HAN programs have been often developed prior to the regulation by the National Health Systems (NHS) leading to different policies within European countries. The aim of this study was to compare legislation regarding HAN in Europe. METHOD: The Group elaborated two structured questionnaires (one for Home Enteral Nutrition--HEN--and one for Home Parenteral Nutrition--HPN) which were presented to all the members of the HAN-Working group and to the 21 ESPEN Council members. RESULTS: Twelve questionnaires were returned, covering for more than 375 million inhabitants. HEN: regulated in seven countries, Italy and France being the first to implement reimbursement policy in 1988. Except in France, Croatia and the Czech Rep almost any physician can prescribe HEN. NHS totally or partially fund HEN, although in Austria and Israel expenses are paid for the patients. Provision of enteral diets and equipment varies widely within countries. As in HPN, most of the countries have written guidelines for health care workers and for patients. HPN: legislated in six countries, Denmark being the first in 1975. HPN programs are restricted to a few hospitals and patients are followed by Nutrition Support Teams (NST). The budget for HPN is 100% supported by NHS. Hospital pharmacy, private pharmacists and Home Care companies are involved in a different degree in providing and distributing solutions and disposables. CONCLUSIONS: HPN regulation preceded HEN regulation by 10-20 years. Due to this longer experience and high level of care, HPN patients are usually followed by NST. Despite different policies, funding is relatively uniform, NHS supporting most of the expenses for HAN. ESPEN could play a key role developing common standards for HAN all over Europe.

Enteral Nutrition↗
PubMed1999

Home parenteral nutrition in adults: a european multicentre survey in 1997. ESPEN-Home Artificial Nutrition Working Group.

A retrospective survey on home parenteral nutrition (HPN) in Europe was performed from January to December 1997. Data were compared to a similar study performed in 1993. A questionnaire of HPN practice was designed by the members of the ESPEN-HAN group. This involved adult patients (older than 16 years) newly registered in an HPN program between 1 January and 31 December 1997 and included: number of patients, underlying diseases and a 6-12 month outcome. Incidence and prevalence (at 1.1.1998) of adult HPN were calculated according to the estimated total population in 1997 for the countries in which more than 80% of HPN patients were reported.A total of 494 patients were registered in 73 centres from nine countries (Belgium (B), Denmark (D), France (F), Poland (P), Spain (S), Sweden (Sw), United Kingdom (UK), The Netherlands (N) and Germany (G). The underlying diseases for HPN in 494 patients were cancer (39%), Crohn's (19%), vascular diseases (15%), radiation enteritis (7%), AIDS (2%), other diseases with intestinal failure (18%). Incidence (patients/million inhabitants/year) were in N (3), F. (2.9), D. (2.8), B. (2.6), UK (1. 2), S (0.7) and P (0.36), respectively. Prevalence were in D. (12.7). U.K. (3.7), N. (3.7), F (3.6), B (3.0), P (1.1), S (0.65). After this 6-12 months follow-up (n=284), the mortality was respectively 4% in Crohn's disease, 13% in vascular diseases, 16% in others, 21% in radiaton enteritis, 34% in AIDS, 74% in cancer. Incidences and prevalences modestly increased in these seven European countries in 1997 in comparison to 1993. The percentages of underlying diseases in these countries remained similar except for AIDS that significantly decreased (from 7% to 2%). Outcomes did not significantly differ in the 4-year period except for AIDS (34% instead of 88% mortality) and could have been related to newer, more efficacious therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Intravascular disruption of central venous ports.

Intravasal catheter disruption is a rare complication of central venous ports. Main causes are chronic trauma due to compression of the catheter between clavicle and first rib, or primary damage by sharp instruments during insertion. Utilizing the subclavian route, a more lateral insertion can minimize the risk of catheter compression. Regular postoperative X-ray controls can help to recognize progressive catheter compression. In the case of significant compression, early replacement is advisable to avoid disruption. Percutaneous transvenous snare technique is the therapy of choice to retrieve dislocated fragments.

Aged↗
PubMed1997

[Perioperative nutritional therapy and its relevance for postoperative outcome].

The clinical effect of perioperative nutrition was analyzed from 28 controlled clinical trials. Preoperative nutritional support is indicated only in patients with high-grade malnutrition and can reduce the postoperative morbidity and mortality in these patients. If the nutritional status is normal preoperatively, artificial nutrition may influence the postoperative outcome negatively. A clinical benefit from postoperative nutritional support has been proven only in patients not able to eat an adequate oral diet within 1 week. In 20% of these case a cardiopulmonary complication was observed during total parenteral nutrition. The infusion of D5W is sufficient in the majority of surgical patients even after major procedures.

Enteral Nutrition↗
PubMed1996

[Ambulatory artificial nutrition: 15 years experiences at the Cologne University Surgical Clinic].

Beetween 1979 and 1994 629 respectively 223 patients were treated by home enteral and parenteral nutrition. The duration of the treatment on average was 361 days in case of enteral and 346 days for home parenteral nutrition, in special cases however up to 15 years. In enteral nutrition there were no metabolic complications and only minor technical problems. Catheter related problems represented the most challenging complications in parenteral feeding. 12 out of 14 patients treated more than 1 year with home parenteral nutrition because of non-cancerous disease died from recurrent pulmonary embolism or catheter-related septicemia.

Adolescent↗
PubMed1992

[Symptomatic stenoses following stapler anastomosis of the large intestine].

Since 1978 the stapled colonic anastomosis belongs to the technical standard in surgery of the rectosigmoid. It is followed by an extension of indications for sphincter-preserving excisional treatment. The main advantages of the mechanical suturing are the shortening of operation time as well as the practical and easy management, especially when the anastomosis is located low in the pelvis. Early respectively late postoperative strictures represent the most frequent complications of stapled anastomosis. From 1989 to 1991, the stapling technique was used for colorectal anastomosis in 196 cases in our hospital. Clinical stenosis occurred in 5 cases, an incidence of 2.5%. Causative the size of the cartridge, the healing by second intention because of the metallic staples, a disturbed microcirculation depending on the tension around the anastomosis, missing normal fecal dilation because of protective colostomy and an incongruity of the combined lumina are discussed. Independent of localisation and grade of the stricture, repeated dilation was a successful therapy in all 5 cases.

Adenocarcinoma↗
PubMed1990

[Monitoring and management of the central nervous system in treatment of tumor cachexia].

After palliative surgery artificial nutrition is indicated primarily in patients receiving postoperative chemotherapy or radiotherapy. The techniques of ambulatory enteral or parenteral nutrition have been standardized during the past decade. They can be used with minimal risk even in patients with advanced cancer. An improvement of the nutritional status can be expected in most of the patients. Further clinical trials are needed to determine whether the patients' quality of life improves.

Cachexia↗
PubMed1990

[Effect of errors (particularly one's own!) on making surgical decisions].

Looking for medical errors in clinical practice we reviewed several cases from our daily indication and case conference, 6 cases discussed in the lethality conference and 9 which were treated by legal institutions. The points of criticism were analysed. We discriminated between diagnostic, therapeutic failures and those of organisation. The basis were 4045 patients with 4583 operations during the year 1989. The overall lethality was 1.2%. The instruments of avoiding medical errors in individual and general sense were shown.

Clinical Competence↗
PubMed1989

[Does parenteral fat administration modify immunocompetence?].

Evidence from studies in carcinoma patients who received intravenous glucose or glucose-lipid solutions preoperatively indicates that fibrinogen, alpha-II-macroglobulin, and coeruloplasmin serum levels remain unchanged. On the other hand, parenteral administration of lipids or glucose induces an increase of IgM, IgG, IgA and complement C3 serum concentrations. Cutaneous allergy testing shows no significant difference whether only glucose was used or half of the calories were replaced by 2.4 g lipids/kg BW x day.

Antibody Formation↗
PubMed1989

[Continued education at a university clinic with integrated specialties].

During a 14 year period 145 medial doctors were employed at the Chirurgische Universitätsklinik Köln 45 became certified general surgeons after a mean of 7.2 years. 18 received a PhD. 4800 operations year permitted the training and qualification of 0.7 doctors for the subspeciality vascular surgery and 0.8 doctors for traumatology per year. Despite extended selection 53 did not accomplish board certification for surgery in the hospital of their initial training.

Curriculum↗
PubMed1987

The contribution of small gut to the 3-methylhistidine metabolism in the adult rat.

Twenty male adult Sprague-Dawley rats received parenteral nutrition following a duodenoileostomy which left only 8% to 10% of the small gut intact. On the first postoperative day, the urinary 3-methylhistidine (3-MH) excretion rose to 1.5 to 1.7 times the preoperative level but fell again within 12 to 14 days to the basal level. A control group of 10 rats with small gut anastomosis without resection yielded similar results. We conclude that, at least in rats, the small intestine does not make a significant contribution to 24-hour urinary excretion of 3-MH. The transient postoperative rise in 3-MH excretion is probably due to postinjury metabolism.

Animals↗
PubMed1987

[The acute physiology score as a stratification and prognostic criterion in patients in a surgical intensive care ward].

In order to compare different groups of intensive-care patients and therapeutic interventions a measuring system is needed reflecting the patient's pathophysiologic status with great accuracy. The APACHE-system designed by Knaus et al. (APS) meets the requirements when comparing groups of patients. This prospective study was undertaken to determine whether APS is useful to forecast survival and death of 764 individual patients of a surgical ICU. The results were compared to daily statements obtained from the head surgeon of the intensive-care department. Both the physician and APS gave true judgements in 95% of the cases. Overestimation of the operative procedures by the physician was revealed to be a major source of error in wrong statements. When a combination of APS and physician's judgement was used the forecasts were found true in 99% of the patients. The authors conclude that APS by itself is not able to give a sufficient prognosis in an individual ICU patient but is an excellent tool to assure or modify the physician's opinion.

Humans↗
PubMed1987

[Comparison of prognostic nutrition indices in preoperative detection of risk patients. A prospective trial].

Malnutrition must be considered as a factor of risk in surgery and therefore it has to be taken into account in surgical planning. Many authors aggregated several measurements into an index or another mathematical model by stepwise regression or discriminant analysis. Hitherto none of these approaches has been subjected to a critical analysis designed to determine whether the information gained differentiates patients with increased operative risk from those without, to a degree that is clinically relevant. In a prospective study the predictive values of nutritional assessment techniques of various authors were examined in 246 surgical patients undergoing a major surgical procedure. The specificity, sensitivity, and validity of each assessment technique were determined. The statistical analysis showed that none of the assessment techniques separated patients who were at high risk from those who were at low risk in a statistically significant predictive power. Serum albumin level was a quite accurate prognostic indicator of postoperative morbidity and mortality. The mean complication rate in this study was 26.8%. Concerning the specificity, sensitivity, and validity the single measurement of the serum albumin had a predictive value as high as all other determined assessment techniques in this study. We contend that combining measurements into a statistically derived index is time-consuming and expensive and does not produce an assessment technique with sufficient predictive power to identity high risk patients in a clinically relevant fashion.

Humans↗
PubMed1986

[Magnetic resonance tomographic findings in esophageal cancer].

The value of MRT and CT for staging and for determining operability of carcinoma of the oesophagus was assessed in 20 patients with histologically confirmed diagnoses. Both methods are limited in this respect. In some cases magnetic resonance provides more accurate concerning the extent of the tumour; this, however, is true only for lesions in the upper and middle thirds of the oesophagus. Where tumours of the distal third of the oesophagus are concerned, and particularly in those extending into the fundus of the stomach, CT is clearly superior. Both methods are of limited value in assessing the depth of tumour penetration, infiltration of neighbouring organs and involvement of regional lymph nodes.

Aged↗