A review on the Role of Oral Nutritional Supplements in Chronic Obstructive Pulmonary Disease.

Due to the high smoking rate in developing countries and the rising aging population in high-income countries, the global prevalence of chronic obstructive pulmonary disease (COPD), estimated to be 11.7%, is increasing and is the third-leading cause of mortality. COPD is likely to be present in elderly individuals with impaired gastro-enteric functions. Gastrointestinal congestion, dyspnea, and anxiety are pathophysiological characteristics of COPD, contributing to poor appetite, reduced dietary intake, and high-energy expenditure. These factors are implicated in the progression of malnutrition in COPD patients. Malnutrition is detrimental to lung functions and is associated with an increased risk of infection, exacerbation and mortality, and a longer duration of hospitalization. Therefore, nutritional support to treat malnutrition in COPD patients is very vital. Oral nutritional supplements (ONS) may hold the key to COPD treatment. To clarify this statement, we review current evidence for ONS in COPD patients to benefit from clinical outcomes.

Biofeedback is effective therapy for fecal incontinence and constipation.

OBJECTIVE: To define the role of biofeedback in fecal incontinence and constipation. DESIGN: A case series of patients with fecal incontinence or constipation with pelvic floor dysfunction. SETTING: Tertiary care center with an anorectal physiology laboratory. PATIENTS: Patients with 1 of the following: (1) chronic or acute fecal incontinence, (2) fecal incontinence and neurologic injury, or (3) constipation with pelvic floor dysfunction. INTERVENTION: Electromyogram-guided biofeedback retraining of the pelvic floor. MAIN OUTCOME MEASURES: Resolution of electromyographic abnormalities and subjective resolution of fecal incontinence or constipation. RESULTS: Of the patients with fecal incontinence, 92% experienced significant improvement with biofeedback without significant improvement in electromyographic values. Of the patients with constipation and pelvic floor dysfunction 80% experienced improvement with biofeedback without significant change in electromyographic values. CONCLUSION: Biofeedback is effective in selected patients with fecal incontinence and constipation with pelvic floor dysfunction.

Safe ischemia time in free-flap surgery: a clinical study of contact-surface cooling.

Although the effectiveness of cooling in extending tolerable ischemia time is well-established experimentally, most free-flap surgeons are still concerned about this problem and try to limit the ischemic period to less than 1 hr. Clinically, contact-surface cooling has been used empirically to prolong the limits of ischemia time; however, its applications are unproven. It also remains unknown whether contact-surface cooling has detrimental effects on flap tissue, such as vessel spasm leading to thrombosis. The purpose of this study was to determine, in a clinical setting, if skin, muscle, and bone free flaps of considerable size could tolerate prolonged cold ischemia without adverse effects. Flap size, cold ischemia time, and surgical outcomes were studied in 189 consecutive free flaps. Microvascular thrombosis occurred in 5/378 (1.3 percent) of anastomoses. The overall flap complication/flap loss rate was 7/189 (3.7 percent). Mean ischemia time for all flaps was 2 hr and 6 min (range: 30 min to 5 hr, with one case at 6 hr and 8 min). The mean ischemia time for cases with flap complications was 2 hr 20 min, while ischemia time for cases with thrombosis averaged 2 hr 13 min. The one flap loss had an ischemia time of 1 hr 35 min. No statistically significant correlations existed between duration of ischemia time or duration of contact-surface cooling and the incidence of thrombosis, flap complication, or flap failure. Among the conclusions were that, within a 4-hr period of cold ischemia, the application of the surface-cooling technique is not detrimental to free flap surgery; thus, concern for ischemia, and especially the "no reflow" phenomenon, generally should not interfere with efficient and orderly free-flap surgery.