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Biomedical subjects

S J Dudrick

Publications and source records attributed to S J Dudrick.

At least 19 recordsLinked to original sources
PubMed1991

Past, present, and future of nutritional support.

Early rudimentary attempts to provide adequate nutrition by mouth, intestinal tube, and vein in order to reduce morbidity and mortality have advanced to strategies designed to maintain the integrity of the body cell mass. Technology has progressed geometrically in recent years with the development of organ-specific enteral and parenteral substrate mixtures; sophisticated assessment, delivery, and monitoring systems; and improved safety and efficacy. Nutritional support is rapidly evolving into the practice of clinical biochemistry, in which nutrient substrates will be formulated to enhance or maximize cellular function, not only under normal conditions, but under a wide variety of pathophysiologic conditions.

Enteral Nutrition↗
PubMed1991

Nutritional support in liver failure.

The most important manifestations of advanced liver disease are malnutrition, encephalopathy, and hepatorenal syndrome. Appropriate and optimal nutritional and metabolic support with specially formulated solutions enriched in branched-chain amino acids, together with other advanced treatments such as plasmapheresis, hemofiltration, and continuous arteriovenous hemodialysis, can correct the most important metabolic and clinical aberrations and temporarily improve the quality of life. However, the ultimately poor prognosis of patients with severe liver failure has not been altered significantly to date by the provision of nonspecific or specifically tailored nutrient regimens. The prognosis appears to depend on the arrest, correction, or reversal of the primary pathophysiologic process.

Enteral Nutrition↗
PubMed1991

Nutritional management of acute and chronic pancreatitis.

Acute pancreatitis often results in a catabolic state characterized by profound hemodynamic, metabolic, cardiovascular, pulmonary, hematologic, and renal aberrations. Parenteral nutrition and metabolic support are essential if morbidity and mortality are to be minimized. In chronic pancreatitis, nutritional management ranges from fundamental dietary manipulation with or without administration of appropriate digestive enzymes to enteral supplementation with modular chemically defined diets to total parenteral nutrition, depending on the stage, severity, and manifestations of the disease. In prescribing nutrient substrates in both acute and chronic pancreatitis, consideration must be given to their effects on pancreatic enzyme secretion if optimal results are to be achieved.

Acute Disease↗
PubMed1991

Nutritional management of inflammatory bowel disease.

The etiology and specific treatment of Crohn's disease and ulcerative colitis are unknown, and the treatment strategy for patients with inflammatory bowel disease is essentially symptomatic and supportive. The malnutrition that frequently accompanies inflammatory bowel disease is a manifestation of intestinal failure and should be vigorously corrected with total parenteral nutrition, elemental diets, or both. Evidence exists for the value of total parenteral nutrition and elemental diets as primary therapy for inflammatory bowel disease in selected patients. Judicious nutritional therapy remains a cornerstone in the adjunctive management of these patients.

Enteral Nutrition↗
PubMed1991

Management of the short-bowel syndrome.

The patient with short-bowel syndrome after massive small-intestinal resection represents one of the greatest clinical challenges a general surgeon must face. Maintaining optimal nutritional and metabolic support until maximum bowel adaptation can occur is the top priority of therapy. Currently, no operative procedure for adjunctive management of the short-bowel syndrome is sufficiently safe and effective to recommend its routine use. Long-term parenteral nutrition remains the cornerstone of successful management.

Antacids↗
PubMed1991

Arrest and reversal of atherosclerosis with parenteral nutrition.

In a large subset of patients with atherosclerotic cardiovascular disease, all medical and surgical treatment alternatives have been exhausted or have proved to be ineffective. Intravenous infusion of specially formulated amino acid solutions, developed in the animal laboratory, has been efficacious in arresting and reversing atherosclerosis in humans for the first time. It is anticipated that the principles derived from these precise parenteral studies will eventually permit development of oral and enteral dietary formulations effective for the systemic control and management of atherosclerosis.

Animals↗
PubMed1979

Evaluation of nutritional indices as prognostic indicators in the cancer patient.

The nutritional and immunological status of 140 malnourished cancer patients who were to receive intravenous hyperalimentation (IVH) were evaluated prior to treatment with IVH and chemotherapy (CMX), surgery or radiation therapy (XRT). Subsequently, these indices were correlated with responses to treatment. Cell-mediated immunocompetent (CMI+) patients (41%) had lost an average weight of 10 +/- 2.2 lbs., while cell-mediated immunoincompetent (CMI-) patients (59%) had lost an average weight of 31 +/- 2.5 lbs. (p less that 0.05). Total lymphocyte count (TLC) averaged 1290 +/- 250 cells/mm3 in CMI+ patients and 900 +/- 140 cells/mm" in CMI- patients (p less than 0.05). Serum albumin concentration (SA) was 3.6 +/- 0.06 g/dl in CMI+ patients and 3.3 +/- 0.05 g/dl in CMI- patients (p less than 0.05). In the CMI+ group, 49% had a positive response to CMX, whereas only 27% of the CMI-group responded to CMX (p less than 0.01). In the surgery group, 88% of the CMI+ patients, but only 65% of CMI- patients, had uncomplicated postoperative recovery periods. Although nutritional repletion with IVH was undertaken in all patients, those patients with initial CMI- responses had greater body weight loss, lower SA and TLC and either a decreased response to CMX or an increase in postoperative morbidity and mortality when compared with patients who initially had CMI+ responses.

Adolescent↗
PubMed1979

Nutrition, cancer, and intravenous hyperalimentation.

In over 1000 cancer patients treated with intravenous hyperalimentation (IVH), tumor growth has not been identified and catheter-related sepsis has been minimal. Studies in rats demonstrated that the host benefits more than the tumor during nutritional repletion, and any stimulation of tumor growth in the rat-tumor model could be manipulated with DNA specific drugs to benefit the host. A study of 65 malnourished cancer patients undergoing oncologic therapy and treated with IVH indicated that much of the immune suppression in these patients was the result of malnutrition coincident with or secondary to oncologic treatment. Conclusions reached in this study were that nutritional repletion resulted in a return of skin test reactivity, proper wound healing in the surgical patient, and possibly an increase in response to chemotherapy. Certainly, the use of IVH allowed specific oncologic therapy to be administered to a group of malnourished patients who otherwise might not have been acceptable candidates for intensive antineoplastic therapy.

Animals↗
PubMed1979

A vest for ambulatory patients receiving hyperalimentation.

There have been no significant complications related to the use of this ambulatory hyperalimentation vest. The potential positive impact that increased use of this vest at home might have upon hospital stay and cost containment is obvious. It is further anticipated that, as advances are made in the technology of plastic bags, tubing, miniature pumps and microprocessors, ambulatory or home hyperalimentation delivery systems exemplified by this vest will achieve a much higher degree of sophistication, practical application, economy and favorable clinical results.

Ambulatory Care↗
PubMed1979

Enteral and parenteral feeding to evaluate malabsorption in intestinal parasitism.

General evidence of malnutrition such as loss in body weight associated with intestinal parasitism has been attributed to decreased food intake, to intestinal malabsorption, and to change in host basal metabolism. To establish the relative importance of these factors in this regard, rats with trichinosis were studied. The weights of infected and uninfected animals were followed after being placed on one of three feeding regimens for 1 week--stock diet ad libitum, intraduodenal nutrition, and intravenous nutrition. Infected rats on a stock diet lost weight whereas those on the other two regimens maintained the same weight pattern as uninfected counterparts. The maintainance of body weight occurred despite alterations at the level of the intestinal brush border as indicated by a depression of intestinal disaccharidase activities (sucrase and lactase) and by reduction of monosaccharide absorption (measured as accumulation of beta-methyl glucoside) in the proximal, heavily infected region of the small intestine. There was no compensatory increase in enzyme activity nor in the absorptive capacity in the distal gut. Results support the conclusion that inadequate oral food intake rather than changes in basal metabolism or intestinal pathophysiology accounts for weight loss during the intestinal phase of infection.

Animals↗
PubMed1979

The effects of nutrition and treatment of cancer on host immunocompetence.

Conventional approaches to therapy for cancer, such as chemotherapy, operative therapy and radiation therapy, can produce profound changes in host immunity. The effects of chemotherapy upon immune responses are related both to the dosage and duration of therapy and are readily reversible. Operative therapy likewise suppresses both humoral and cell-mediated immunity for two to three weeks, as manifested by in vitro and in vivo tests of these functions. Radiation therapy, however, seems to decrease host immune responses for more prolonged periods of time, up to ten years. Nutritional status may also affect both limbs of the immune system, and malnutrition is being recognized with increasing frequency as a clinical problem in patients with advanced primary malignant or metastatic disease, especially during antineoplastic therapy. Intravenous hyperalimentation is a safe and effective method for correcting nutritional deficits in patients with cancer; moreover, immunocompetence may be enhanced during adequate nutritional rehabilitation.

Animals↗
PubMed1978

Ten years experience with intravenous hyperalimentation and inflammatory bowel disease.

A retrospective analysis was conducted on 74 patients with inflammatory bowel disease who were treated with intravenous hyperalimentation at the Hospital of the University of Pennsylvania between the years 1967-1976. Intravenous hyperalimentation can ameliorate the inevitable protein-calorie malnutrition present in patients with inflammatory bowel disease. Combined with complete bowel rest, intravenous hyperalimentation can effectively function as the primary treatment or as an adjunct to the surgical management of the complications of inflammatory bowel disease. Intravenous hyperalimentation can be safely administered to these severely ill patients, almost certainly improving survival rates in the patients treated.

Adult↗
PubMed1978

Effects of protein depletion and repletion on cell-mediated immunity in experimental animals.

Protein-calorie malnutrition leads to depression of host cell-mediated immunity. Nutritional repletion initially results in rapid weight gain followed by a more gradual return of immunocompetence. Administration of a synthetic amino acid diet to normal animals did not preserve body weight or cell-mediated immunity any better than did a high carbohydrate, protein-free diet. Administration of a synthetic amino acid diet to malnourished animals maintained body weight, but did not restore immunocompetence. Proper nutritional repletion should provide both adequate protein and nonprotein calories if a return of immunocompetence is to be anticipated.

Amino Acids↗