RESUMO
Post-transplant diabetes mellitus is associated with long-term immunosuppression and weight gain, and is related to an increased risk of cardiovascular disease, accelerated loss of graft and increased mortality. There is an absence of strong evidence-based dietary guidelines for the prevention and management of post-transplant diabetes mellitus in kidney transplant recipients. The aim of this study was to systematically review all dietary evidence for kidney transplant recipients on clinical outcomes relating to diabetes, patient-reported outcomes and economic outcomes. A comprehensive literature search was conducted in August 2020 using the databases Medline, Embase, CENTRAL and CINAHL. Studies were critically appraised using Cochrane risk of bias tools and GRADE. A total of 12 studies and 1928 participants were included. Four papers focused on diet and exercise, one paper on diet only, two papers on magnesium supplementation, one paper on magnesium and fibre intake, two papers on Mediterranean diet, one paper on marine n-3 fatty acid supplementation and one paper on fruit and vegetable intake. There were no significant effects on outcomes relating to dietary counselling, magnesium supplementation, magnesium and fibre intake or marine n-3 fatty acid supplementation. Low-quality evidence supports the Mediterranean diet in reducing the risk of post-transplant diabetes mellitus and fasting plasma glucose levels. Low-quality evidence suggests vegetable intake being associated with a lower risk of post-transplant diabetes mellitus. This review demonstrates limited evidence for dietary interventions in the prevention and management of diabetes in post-kidney transplantation. The findings suggest that further high-quality research with robust study designs is required.
Assuntos
Diabetes Mellitus/dietoterapia , Diabetes Mellitus/prevenção & controle , Transplante de Rim , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/prevenção & controle , HumanosRESUMO
Chyle leak is a rare complication in colorectal surgery. It occurs due to disruption of the lymphatic drainage network in the abdomen or retroperitoneum. We describe the first reported case of chyle leak following total colectomy for inflammatory bowel disease. Our patient underwent total colectomy for severe ulcerative colitis not responsive to medical treatment. Four days postoperatively, a milky fluid was noted in the drainage bag. Analysis of the fluid confirmed chyle. The patient remained well and was successfully managed conservatively with a fat-free elemental diet and was discharged from hospital on day 12 postoperatively. A review of the literature suggests that conservative management with dietary modification is a common and effective management strategy; however, medical and surgical options exist for refractory cases.
Assuntos
Quilo , Colectomia/efeitos adversos , Colite Ulcerativa/cirurgia , Dieta com Restrição de Gorduras , Complicações Pós-Operatórias/diagnóstico , Adulto , Tratamento Conservador/métodos , Drenagem , Feminino , Humanos , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Postoperative early oral nutrition has increasingly been adopted for patients undergoing gastrectomy. However, intolerability to early oral nutrition remains a major concern, especially in older patients. This study aimed to investigate early oral nutrition intolerability in older patients who had undergone gastrectomy. METHODS: We retrospectively reviewed 825 patients who had undergone gastrectomy for gastric carcinoma between 2017 and 2019. All patients received an oral diet on postoperative day 1. Patients were divided into older (≥70 years) and younger (<70 years) adult groups, and short-term outcomes and intolerability to oral nutrition were compared. Intolerability to early oral nutrition was defined as oral diet cessation due to adverse gastrointestinal symptoms. RESULTS: Among the 825 patients (≥70 years, n = 286; <70 years, n = 539), 151 (18.3%) developed intolerability to early oral nutrition, of whom 100 patients were < 70 years old and 51 were ≥70 years old. The most common symptom causing intolerability was abdominal distension. The mean duration of fasting after developing intolerability was 2.8 ± 2.4 days. The incidence of intolerability in the older and younger adult groups was 17.8% and 18.6%, respectively (p = 0.799). In terms of sex, operative approach, gastric resection, lymph node dissection, reconstruction, and tumor stage subgroups, the older adult group did not exhibit a significant increase in intolerability. Postoperatively, the older adult group showed a higher incidence of systemic complications; however, anastomotic complications did not significantly differ between the two groups. CONCLUSIONS: Postoperative early oral nutrition can safely be adopted for older patients undergoing gastrectomy, with acceptable intolerability and surgical outcomes.
Assuntos
Dieta/métodos , Intolerância Alimentar/dietoterapia , Intolerância Alimentar/etiologia , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Perioperative enteral nutrition supports are recommended in esophagus cancer patients. Immunonutrition contains immuno-enhancing nutrients in addition to standard formula. These new nutrients are thought to be efficacious in reducing inflammatory response and improving postoperative immune response and they have been proved to be better than standard enteral nutrition in reducing postoperative complications in gastric cancer. However, if it would lead to a better clinical outcome in patients undergoing esophagectomy remains controversial. METHODS: A systematic literature search was performed in the online database of PubMed, Medline, EMBASE and Cochrane Library. The relevant studies were screened out of the results by reading titles and abstracts. Then, we read the full-texts to finally confirm the studies included in this meta-analysis. RESULTS: Six randomized controlled trials having enrolled 638 patients were included in the final analysis. The pooled analysis didn't show statistically significant difference between immunonutrition group and standard nutrition group in reducing postoperative complications. CONCLUSIONS: The postoperative complications are comparable between immunonutrition and the standard enteral nutrition in patients undergoing esophagectomy, but its value in severe malnutrition patients is undetermined, whereas the high tolerance and other advantages brought by the immunonutrition should not be overlooked and need to be further proved.
Assuntos
Nutrição Enteral/métodos , Esofagectomia/métodos , Imunoterapia/métodos , Complicações Pós-Operatórias/dietoterapia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
AIMS: Chylous fistula following neck surgery is a rare, but significant complication. Currently, there is no standardised treatment, which may comprise pressure dressings, oral dietary modification (ODM), surgery or a combination of such measures. Octreotide is a somatostatin analogue that has gained popularity in the management of cervical chyle leaks. The effectiveness of octreotide compared with ODM is unclear. We provide a comprehensive, systematic review of the literature pertaining to the management of chylous fistulae, comparing both treatment strategies. METHODS: The bibliographic databases MEDLINE, Cochrane, PubMed, EMBASE and Google Scholar were searched from inception to October 2019. Search terms included (chyle [title/abstract]) OR (chylous [title/abstract]) AND (fistula [title/abstract]) OR (fistulae [title/abstract]) OR (leak [title/abstract]) AND (neck [title/abstract]) OR (dissection [title/abstract]). The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Risk of bias was assessed using guidelines from the Joanna Briggs Institute. Outcome measures included the proportion of chylous fistulae that spontaneously resolved without the need for surgery and time taken until resolution, for both DM and octreotide, respectively. RESULTS: The primary search identified 20 articles for review, comprising 313 patients. Two studies were suitable for pooled analysis. There was no statistically significant difference in the time taken for chylous fistula to resolve between groups (octreotide 10.0 days; ODM 12.0 days; P = .38). The overall rate of resolution was 89.6% and 81.5%, respectively (P = .25). Surgery was highly effective in cases failing to resolve following intervention with either method (96% [53/55] patients). CONCLUSION: The use of octreotide for chylous fistula following neck dissection surgery is associated with a high rate of spontaneous resolution. However, significant heterogeneity, bias and concurrent use of ODM/TPN for patients in studies investigating octreotide precludes universal recommendation at this time. Further research in the form of randomised controlled trials is required to establish an independent treatment effect.
Assuntos
Quilo , Fístula/dietoterapia , Fístula/tratamento farmacológico , Esvaziamento Cervical , Octreotida/uso terapêutico , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/tratamento farmacológico , HumanosRESUMO
A 73-year-old Caucasian female with a history of obesity status post Roux-en-Y gastric bypass (RYGB) surgery presented with generalized weakness and was found to have acute kidney injury (AKI) with a creatinine peak of 9.1 mg/dL above her baseline of 1.2 mg/dL, and anemia with hemoglobin 5.7 g/dl. Kidney biopsy revealed oxalate nephropathy likely related to gastric bypass surgery four years prior. RYGB is a strong risk factor for hyperoxaluria, nephrolithiasis, and oxalate nephropathy which often progresses to end-stage renal disease (ESRD). Meaningful treatment strategies for this disease entity are lacking. We present a case in which dietary and pharmacological management without the use of renal replacement therapy resulted in stabilization of chronic kidney disease (CKD) stage 5 for seven years at the time of this writing.
Assuntos
Oxalatos/urina , Complicações Pós-Operatórias/urina , Insuficiência Renal Crônica/dietoterapia , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Feminino , Derivação Gástrica/efeitos adversos , Humanos , Hiperoxalúria/etiologia , Obesidade/cirurgia , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/tratamento farmacológico , Insuficiência Renal Crônica/etiologiaRESUMO
After a gastrectomy, the nutritional status of patients with gastric cancer has great effect on the treatment outcome and patients' quality of life. We investigated the changes in body composition and nutrient intake after gastrectomy in 288 gastric cancer patients. A multiple linear regression analysis was used for each time period to verify the effects of nutritional and clinical factors on weight and fat-free mass loss rates. Gastric cancer patients who underwent a gastrectomy continued to experience weight and fat-free mass loss until three months after surgery and became stagnant at six months. The marginal mean of calorie intake per weight was 24.5, 26.8, and 29.4 kcal at one, three, and six months. The protein intake per kg lean mass was 1.14, 1.14, and 1.16 g at one, three, and six months, respectively. One month after surgery, the rate of weight loss increased significantly in females who received chemotherapy (p < 0.001). At one to three months postoperative, females who had undergone chemotherapy tended to significantly lose weight (p = 0.016). Females with a history of chemotherapy also showed a reduction in fat-free mass for one to three months (p = 0.036). Calorie intake was a significant factor in preventing fat-free mass weight loss at one month after surgery. Chemotherapy was an independent factor affecting the weight and fat-free mass loss rate up to six months after gastrectomy. Careful monitoring of weight and muscle mass changes following active nutritional intervention for sufficient nutrition support could be helpful for patients after gastrectomy.
Assuntos
Gastrectomia/efeitos adversos , Complicações Pós-Operatórias , Neoplasias Gástricas/cirurgia , Redução de Peso/fisiologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Composição Corporal/fisiologia , Ingestão de Energia/fisiologia , Feminino , Humanos , Masculino , Desnutrição/dietoterapia , Desnutrição/etiologia , Desnutrição/prevenção & controle , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/tratamento farmacológicoRESUMO
BACKGROUND: Intestinal transplantation (ITx) is performed as an isolated ITx or as a part of multivisceral transplantation for intestinal failure secondary to short gut syndrome, inflammatory bowel disease, trauma, and sequelae of chronic parenteral nutrition dependence. Wound complications after ITx are very common, and abdominal wound closure cannot be immediately achieved in half of cases. CASE PRESENTATION: A 25-year-old man sustained an abdominal crush injury causing complete loss of his small intestine, requiring an isolated ITx in March 2016. He lost his graft because of early exfoliative rejection in November 2016. Five months after enterectomy and the immunosuppression-free period, he underwent multivisceral retransplantation in April 2017. His post-transplant course was complicated by wound healing problems that improved with treatment of his malnutrition, quantified by increasing albumin, total protein, prealbumin, weight, body mass index, and total psoas muscle area over a period of 19 months after retransplant. CONCLUSION: To our knowledge, this is the first case described of long-term wound follow-up after a multivisceral (re)transplantation, with corresponding nutrition information and images of the wound.
Assuntos
Intestinos/transplante , Transplante de Fígado/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Complicações Pós-Operatórias/dietoterapia , Estômago/transplante , Cicatrização , Traumatismos Abdominais/patologia , Adulto , Humanos , Masculino , Nutrição Parenteral Total , Complicações Pós-Operatórias/etiologia , ReoperaçãoRESUMO
BACKGROUND AND AIMS: Early post-operative feeding is recommended within enhanced recovery after surgery programmes. This study aimed to describe post-operative feeding patterns and associated factors among patients following colorectal surgery, using a post-hoc analysis of observational data from a previous RCT on chewing gum after surgery. METHODS: Data from 301 participants (59% male, median age 67 years) were included. Amounts of meals consumed on post-operative days (POD) 1-5 were recorded as: none, a quarter, half, three-quarters, all. 'Early' consumers were those who ate ≥a quarter of a meal on POD1. 'Early' tolerance was the consumption of at least half of three meals on POD1 or 2 without vomiting. Exploration of selected peri-operative factors with early feeding and tolerance were assessed using logistic regression. RESULTS: 222 people (73.8%) consumed solid food early, and 109 people (36.2%) tolerated solid food early. Several factors were associated with postoperative feeding: provision of pre-operative bowel preparation was associated with delayed consumption [odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83] and tolerance (OR 0.35, 95% CI 0.16-0.81) of food; and laparoscopic/laparoscopic assisted (vs. open/converted to open surgery) was associated with early tolerance of food (OR 1.99, 95% CI 1.17-3.39). CONCLUSIONS: While three-quarters of the study population ate solid food early, only one-third tolerated solid food early. Findings suggest that bowel preparation and surgery type are factors warranting further investigation in future studies to improve uptake of early post-operative feeding.
Assuntos
Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Comportamento Alimentar , Adulto , Idoso , Idoso de 80 Anos ou mais , Recuperação Pós-Cirúrgica Melhorada , Feminino , Alimentos , Humanos , Laparoscopia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/dietoterapia , Período Pós-Operatório , Adulto JovemRESUMO
Colorectal cancer (CRC) is a leading cause of morbidity and mortality. Post-CRC resection complications and lower quality of life (QoL) are associated with a lower long-term survival. Perioperative administration of probiotics/synbiotics might lower prevalence of side effects and improve QoL and survival among CRC patients. Medline, Web of Science, Cochrane database, Embase, and clinical trials registries were searched in January 2020. Altogether, 16 randomized placebo-controlled probiotic/synbiotic clinical trials that included patients undergoing CRC surgery and investigated postoperative complications and QoL side effects were found. Meta-analyses using random-effects model were performed on data from 11 studies to calculate the effects of probiotics/synbiotics on common CRC resection postoperative side effects and complications. Perioperative probiotics/synbiotics administration was associated with lower infection incidence (odds ratio [OR] = 0.34, P < 0.001), lower diarrheal incidence (OR = 0.38, P < 0.001), faster return to normal gut function (mean difference [MD] -0.66 days, P < 0.001), shorter postoperative antibiotics use (MD -0.64 days, P < 0.001), lower incidence of septicemia (OR = 0.31, P < 0.001), and shorter length of hospital stay (MD -0.41 days, P = 0.110). The results support the hypothesis that short-term perioperative administration of probiotics/synbiotics, which are easy to administer, have few side-effects, and are low cost compared with alternatives, might help to alleviate gastrointestinal symptoms and postoperative complications among CRC patients.
Assuntos
Colectomia/efeitos adversos , Complicações Pós-Operatórias/dietoterapia , Probióticos/administração & dosagem , Protectomia/efeitos adversos , Simbióticos/administração & dosagem , Neoplasias Colorretais , Humanos , Incidência , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
A retrospective observational study has been set up in order to compare feeding tolerance and energy delivery in children fed with a semi-elemental diet or a polymeric diet after congenital heart surgery. The study took place in the intensive care unit of a tertiary children's hospital. One hundred children were included: 56 received a semi-elemental diet and 44 received a polymeric diet. Patients were aged between 2 days and 6 years. Data from patients were obtained from medical files between February 2014 and May 2016. The feeding protocol was changed in March 2015 when a semi-elemental diet was substituted for the polymeric diet. Primary outcome was the feeding tolerance. Feeding intolerance occurs if the patient has more than two episodes of emesis or more than four liquid stools per day. Feeding tolerance in the semi-elemental and polymeric diet groups was comparable: emesis occurred in 14.3% versus 6.8% of patients, respectively (p = 0.338); diarrhea occurred in 3.6% versus 4.5% (p = 1000); post-pyloric feeding was necessary in 14% versus 9% (p = 0.542). Energy delivery was also comparable in the two groups: on postoperative day 2, the semi-elemental diet group reached 50% of the caloric target versus 52% in the polymeric diet group (p = 0.283); on day 5, 76% versus 85% (p = 0.429); and on day 10, 105% versus 125% (p = 0.397). Energy delivery was insufficient on postoperative days 2 and 5, but nutritional goals were achieved by day 10. No patient developed necrotizing enterocolitis in our population.Conclusion: the present study suggests that the feeding tolerance to a semi-elemental or a polymeric diet is similar after CHS.What is Known:â¢Nutrition can modify prognosis in PICUâ¢Different types of diet have been tested in children with intestinal disorders or with congenital heart disease. None of these diets have shown to be superior in terms of feeding tolerance.What is New:â¢Semi elemental and polymeric diets seem to have the same feeding tolerance in PICU after cardiac surgery for congenital heart disease.
Assuntos
Ingestão de Energia , Nutrição Enteral/métodos , Alimentos Formulados , Complicações Pós-Operatórias/prevenção & controle , Criança , Pré-Escolar , Nutrição Enteral/efeitos adversos , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/dietoterapia , Estudos RetrospectivosRESUMO
Objective of the present study was to investigate the effects of peripherally inserted central catheter (PICC) parenteral nutrition support on immune function and nutritional support in patients undergoing radical gastrectomy for gastric cancer. 140 patients who underwent radical gastrectomy for gastric cancer were selected as participants and were divided into study group and the control group by random number table, with 70 cases in each group. Patients in the two groups underwent standard gastrectomy under general anesthesia by the same group of doctors. The study group received postoperative PICC catheter parenteral nutrition, and the control group received central venous catheter (CVC) nutrition support. Comparative study was done using t test and Chi-square test. The serum levels of ALB, TFN, PA, Hb, CD4+, CD8+, CD4+/CD8+, IgA, IgG, IgM and CD3+ in the two groups were observed before and after treatment, and the postoperative complications of the two groups were compared. After treatment, the levels of ALB, TFN, PA and Hb in the two groups were significantly increased (P<0.05). Levels of CD3+, CD4+, CD4+/CD8+, IgA, IgG and IgM also amplified significantly after treatment in both the groups, while CD8+ decreased significantly (P<0.05). What's more, the improvement degree of the study group was significantly greater than that of the control group (P<0.05). The time of drawing drainage tube, recovering intestinal function, getting off bed and the length of hospital stay in the study group were significantly shorter than those in the control group (P<0.05). The incidence of postoperative complications in the study group and control group were 8.6% (6/70 cases) and 11.4% (8/70 cases) respectively, and there was no significant difference (P>0.05). PICC catheter parenteral nutrition support and improve the nutritional status of patients, it was proved a safe and effective nutritional support which improve the cellular immune function and accelerated the recovery of gastrointestinal function.
Assuntos
Nutrição Parenteral/métodos , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/cirurgia , Dispositivos de Acesso Vascular , Idoso , Antígenos de Diferenciação de Linfócitos T/sangue , Cateteres Venosos Centrais , Feminino , Gastrectomia , Humanos , Isotipos de Imunoglobulinas/sangue , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/instrumentação , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/imunologia , Resultado do TratamentoRESUMO
Bariatric surgery is a well-documented and good alternative for treatment of obesity with and without type 2-diabetes. One of the documented complications is postprandial hypoglycemia, with possibly serious consequences. We present such a case, what is known of underlying mechanisms, and treatment options.
Assuntos
Derivação Gástrica/efeitos adversos , Hipoglicemia/etiologia , Feminino , Humanos , Hipoglicemia/dietoterapia , Hipoglicemia/fisiopatologia , Pessoa de Meia-Idade , Obesidade/cirurgia , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/fisiopatologiaRESUMO
BACKGROUND: Hypoglycemia is an increasingly recognized complication of bariatric surgery. Mechanisms contributing to glucose lowering remain incompletely understood. We aimed to identify differentially abundant plasma proteins in patients with post-bariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB), compared to asymptomatic post-RYGB. METHODS: Proteomic analysis of blood samples collected after overnight fast and mixed meal challenge in individuals with PBH, asymptomatic RYGB, severe obesity, or overweight recruited from outpatient hypoglycemia or bariatric clinics. RESULTS: The top-ranking differentially abundant protein at 120 min after mixed meal was fibroblast growth factor 19 (FGF-19), an intestinally derived hormone regulated by bile acid-FXR signaling; levels were 2.4-fold higher in PBH vs. asymptomatic post-RYGB (mean + SEM, 1094 ± 141 vs. 428 ± 45, P < 0.001, FDR < 0.01). FGF-19 ELISA confirmed 3.5-fold higher concentrations in PBH versus asymptomatic (360 ± 70 vs. 103 ± 18, P = 0.025). To explore potential links between increased FGF-19 and GLP-1, residual samples from other human studies in which GLP-1 was modulated were assayed. FGF-19 levels did not change in response to infusion of GLP-1 and PYY in overweight/obese individuals. Infusion of the GLP-1 receptor antagonist exendin 9-39 in recently operated asymptomatic post-RYGB did not alter FGF-19 levels after mixed meal. By contrast, GLP-1 receptor antagonist infusion yielded a significant increase in FGF-19 levels after oral glucose in individuals with PBH. While plasma bile acids did not differ between PBH and asymptomatic post-RYGB, these data suggest unique interrelationships between GLP-1 and FGF-19 in PBH. CONCLUSIONS: Taken together, these data support FGF-19 as a potential contributor to insulin-independent pathways driving postprandial hypoglycemia in PBH.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Fatores de Crescimento de Fibroblastos/sangue , Hipoglicemia/sangue , Hipoglicemia/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/sangue , Adulto , Glicemia/metabolismo , Proteínas Sanguíneas/análise , Proteínas Sanguíneas/metabolismo , Estudos de Casos e Controles , Feminino , Derivação Gástrica/efeitos adversos , Hormônios Gastrointestinais/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Humanos , Hipoglicemia/dietoterapia , Hipoglicemia/tratamento farmacológico , Masculino , Refeições , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Fragmentos de Peptídeos/uso terapêutico , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/tratamento farmacológico , Proteoma/análise , Proteômica , Regulação para CimaRESUMO
BACKGROUND: Chylothorax after lung cancer surgery is relatively rare but must be considered as a complication of thoracic surgery. METHOD: Between January 2012 and June 2017, 818 patients underwent lung cancer surgery at our hospital. Among them, 14 (1.7%) patients with chylothorax were retrospectively reviewed. Three patients were treated with oral intake cessation except water and total parental nutrition( TPN)[TPN group], 11 patients were treated with a fat-free diet( fat-free diet group). RESULTS: The drainage period was similar in both group [group TPN;13 (12~14) days and group fat-free diet;15.7 (6~42) days]. In the TPN group, 3 patients underwent pleurodesis and no patient needed surgical intervention. In the fat-free diet group, 5 patients improved only with diet management. Pleurodesis was necessary in 5 of which 3 underwent surgical intervention. CONCLUSIONS: A fat-free diet is useful in treating chylothorax after lung cancer surgery.
Assuntos
Quilotórax/dietoterapia , Dieta com Restrição de Gorduras , Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/dietoterapia , Quilotórax/etiologia , Quilotórax/terapia , Humanos , Nutrição Parenteral Total , Pleurodese , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos RetrospectivosRESUMO
BACKGROUND: Surgery-induced neuroinflammation plays an important role in postoperative cognitive dysfunction (POCD). Gut microbiota is a key regulator of neurological inflammation. Nurturing with prebiotics is an effective microbiota manipulation that can regulate host immunity and cognition. The aim of the present study was to test whether administration of the prebiotic Bimuno® (galactooligosaccharide (B-GOS) mixture) could ameliorate POCD and attenuate surgery-induced neuroinflammation through the microbiota-brain-axis. METHODS: Adult rats undergoing abdominal surgery under isoflurane anesthesia were fed with water or prebiotic B-GOS supplementation (15 g/L) for 3 weeks. Novel objective recognition task was employed for testing cognitive changes on postoperative day three. Expression of microglial marker Iba-1 in the hippocampus was assessed by immunohistochemical staining. Expression levels of phenotypic gene markers of activated microglia (M1: iNOS, CD68, CD32; M2: Ym1, CD206, and SOCS3) in hippocampus were determined by quantitative polymerase chain reaction (qPCR). Inflammatory cytokines in the hippocampus were assessed using enzyme-linked immunosorbent assay (ELISA). Feces were collected for microbial community analysis. RESULTS: Rats exhibited an impairment in novel objective recognition 3 days after surgery compared with control rats (P < .01). In the hippocampus, expressions of Iba-1 and M1 markers of surgical rats were significantly upregulated. Similarly, expressions of SOCS3 and CD206 in the hippocampus were upregulated. Additionally, increasing levels of IL-6 and IL-4 were evident in the hippocampus. Administration of B-GOS significantly alleviated cognitive decline induced by surgery (P < .01). B-GOS-fed rats showed a significantly downregulated activation of microglia and expressions of M1-related genes and SOCS3 and IL-6. While there was no significant difference in expressions of CD206 and Ym1 and IL-4 between the surgical and B-GOS groups. Analysis of gut microbiome found that administration of B-GOS induced a significant change beta diversity of the gut microbiome and proliferation of Bifidobacterium and other potentially anti-inflammatory microbes. CONCLUSIONS: Administration of B-GOS has a beneficial effect on regulating neuroinflammatory and cognitive impairment in a rat model of abdominal surgery and was associated with the manipulation of gut microbiota.
Assuntos
Encéfalo/efeitos dos fármacos , Disfunção Cognitiva/dietoterapia , Galactose/administração & dosagem , Trato Gastrointestinal/efeitos dos fármacos , Oligossacarídeos/administração & dosagem , Prebióticos/administração & dosagem , Animais , Encéfalo/metabolismo , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/metabolismo , Trato Gastrointestinal/metabolismo , Inflamação/dietoterapia , Inflamação/etiologia , Inflamação/metabolismo , Masculino , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Ratos , Ratos Sprague-Dawley , Resultado do TratamentoRESUMO
This is a single case of a 65-year-old American woman who presented with substantial weight gain and insulin resistance (IR) post-Roux-en-Y gastric bypass (RYGB) surgery. Before RYGB, she had reached 340 lbs (155 kg) and a body mass index (BMI) of 56.6 kg/m2 The surgery resulted in a 70 lbs (32 kg) weight loss, bringing her BMI, per cent total weight loss (%TWL) and per cent excess weight loss (%EWL) to 44.9 kg/m2, 20.6% and 36.8%, respectively. Unfortunately, her BMI would return to 53.6 kg/m2, nearly her pre-RYGB BMI. It was then she sought the guidance of a primary care physician with expertise in nutrition and medical management of obesity, who placed her on a ketogenic diet. One year later, she had lost 102 lbs (46.4 kg), resulting in a BMI, %TWL and %EWL of 36.6 kg/m2, 31.7%, and 63.1%, respectively, also further resulting in significant improvements of her inflammatory biomarkers. This case presentation will explore current literature, covering the effects of obesity on IR, pre-diabetes and other disease-provoking inflammatory biomarkers.
Assuntos
Dieta Cetogênica , Resistência à Insulina , Obesidade Mórbida/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Derivação Gástrica , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/dietoterapiaRESUMO
Transcatheter aortic valve replacement has become a mainstream therapeutic option for patients with severe aortic stenosis who are at intermediate risk or high risk for surgical valve replacement. Computed tomography (CT) is now the standard imaging modality for preoperative vascular access planning an aortic annular sizing. This article reviews the established and potential future roles of CT in transcatheter aortic valve replacement.
Assuntos
Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Valva Aórtica/patologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/patologia , Meios de Contraste , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/patologia , Próteses Valvulares Cardíacas , Humanos , Tomografia Computadorizada Multidetectores/métodos , Imagem Multimodal/métodos , Tamanho do Órgão , Planejamento de Assistência ao Paciente , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Ajuste de Prótese/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologiaRESUMO
In the field of oncology, it is well recognized that a decrease in mass, density, strength, or function of skeletal muscle is associated to increased treatment toxicities and postoperative complications, as well as poor progression-free survival and overall survival. The ability of amino acids to stimulate protein synthesis in cancer patients is reduced. Considering nutritional intervention, this anabolic resistance could be in a part counteracted by increasing protein or by giving specific amino acids. In particular, Leucine might counteract this anabolic resistance not only by increasing substrate availability, but also by directly modulating the anabolic signal pathway. Few studies showed the possibility of increasing muscle protein synthesis by specific nutriments and/or by increasing amino acids or protein administration. In addition, whereas many studies provide evidence of a benefit of adapted physical activity in advanced cancer patients, it is difficult to specify the most appropriate type of exercise, and the optimum rhythm and intensity. Moreover, the benefits of physical activities and of protein support seem greater when it is started at the precachexia stage rather than at the cachexia stage, and their benefits are limited or nonexistent at the stage of refractory cachexia. Future approaches should integrate the combination of several complementary treatments in order to prevent (or improve) cachexia and/or sarcopenia in cancer patients.
Assuntos
Caquexia/prevenção & controle , Suplementos Nutricionais , Exercício Físico/fisiologia , Proteínas Musculares/biossíntese , Neoplasias/complicações , Complicações Pós-Operatórias/prevenção & controle , Animais , Antineoplásicos/efeitos adversos , Caquexia/dietoterapia , Caquexia/etiologia , Terapia Combinada , Proteínas Alimentares/administração & dosagem , Modelos Animais de Doenças , Terapia por Exercício/métodos , Humanos , Leucina/administração & dosagem , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Estadiamento de Neoplasias , Neoplasias/patologia , Neoplasias/terapia , Condicionamento Físico Animal , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/etiologia , Biossíntese de Proteínas/efeitos dos fármacosRESUMO
PURPOSE: Bowel dysfunction is a common, persistent long-term effect of treatment for rectal cancer survivors. Survivors often use dietary modifications to maintain bowel control. There are few evidence-based interventions to guide survivors on appropriate diet modifications for bowel symptom management. The purpose of this paper is to describe the development and design of the Altering Intake, Managing Symptoms (AIMS) intervention to support bowel dysfunction management in rectal cancer survivors. METHODS: The AIMS intervention is a ten-session, telephone-based diet behavior change intervention delivered by trained health coaches. It uses dietary recall, participant-completed food and symptom diaries, and health coaching guided by motivational interviewing to promote bowel symptom management and improved diet quality. Based on the Chronic Care Self-Management Model (CCM), the AIMS Intervention is designed to improve self-efficacy and self-management of bowel symptoms by coaching survivors to appropriately modify their diets through goal setting, self-monitoring, and problem-solving. The intervention targets survivors with stage I-III rectosigmoid colon/rectum cancer who are 6â¯months post-treatment, 21â¯years and older, and English-speaking. CONCLUSIONS: The design and development process described in this paper provides an overview and underscores the potential of the AIMS intervention to positively impact the quality of long-term survivorship for rectal cancer survivors. An ongoing pilot study will inform the design and development of future multi-site Phase II and III randomized trials.