Late gastrointestinal effects of pelvic radiation: a nurse-led service.

There are currently at least 2 million people in the UK living with and following a cancer diagnosis. Typically four out of every ten people with cancer will receive radiotherapy, but a large proportion of people who have pelvic radiotherapy may go on to develop gastrointestinal (GI) symptoms. This includes rectal bleeding and faecal incontinence, which can have a huge impact on quality of life. These problems often go under-reported by patients and are also under-recognised or under-treated by health professionals. Cancer survivorship is a growing topic that is likely to have a major impact on the NHS, with increasing numbers of patients presenting. A late GI effects of pelvic radiotherapy clinic was set up to address these growing needs of patients with GI symptoms following radiotherapy. This article also shares insights from a doctoral study that is underway looking at people's experiences of living with symptoms following their treatment, in order to improve awareness of the major impact that this can have.

Síndrome de intestino corto

El síndrome de intestino corto (SIC) es definido como malabsorción, pérdida de líquidos y electrolitos y malnutrición debidos a resección masiva de intestino delgado. Tanto como la mitad del intestino delgado puede perderse sin problemas significativos a largo plazo para mantener una nutrición normal, con tal, que sean conservados el duodeno, íleon distal y la válvula ileocecal (VIC). En contraste, resecciones ileales distales que incluyen la VIC pueden inducir diarrea severa aunque sólo el 25 por ciento del intestino delgado haya sido resecado. La resección del más del 75 por ciento del intestino delgado con la preservación de la VIC invariablemente produce malabsorción inicial intratable y diarrea (1). Hoy en los países desarrollados se ha informado de niños con SIC que sobreviven con tan poco 25 cm de intestino delgado sin VIC y 11 cm de intestino delgado con la VIC intacta (2). Varios factores influyen en la severidad del SIC (tabla 1).

Small intestinal complications in progressive systemic sclerosis.

A case report of a 33-year-old woman with progressive systemic sclerosis and polymyositis is presented. Admitted with a beta-hemolytic Streptococcus infection of the right knee joint, she had progressive systemic sclerosis with small intestinal involvement, which is rare. This led to more serious complications, malabsorption, pneumoperitoneum, and pneumatosis cystoides intestinalis, which forced a decision to treat her with home total parenteral nutrition. The diagnostic as well as treatment problems encountered in this patient illustrate the importance of nursing care in the overall management of patients with this disease.

Risks and benefits of home parenteral nutrition in the acquired immunodeficiency syndrome.

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient-months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter-related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies.