[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

Nutrición Parenteral Domiciliaria en España 2011 y 2012; informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA / Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones (AU)

Objective: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. Methodology: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Results: Year 2010: 184 patients from 29 hospitals, representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD. During 2012, 203 patients from 29 hospitals, representing a rate of 4.39 patients/million inhabitants/year 2012, a total of 211 episodes were recorded NPD. Conclusions: We observe an increase in registered patients with respect to previous years. Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications (AU)

Assessing risk screening methods of malnutrition in geriatric patients: Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Index (GNRI).

INTRODUCTION: Elderly subjects are considered a vulnerable group and they have more risk of nutritional problems. The risk of malnutrition increases in hospitalized geriatric patients. OBJECTIVES: To compare the correlation between MNA and GNRI with anthropometric, biochemical and Barthel Index in hospitalized geriatric patients and to test the concordance between MNA and GNRI and between Mini Nutritional Assessment Short Form (MNA-SF) and MNA. METHODS: It was a cross-sectional study on a sample of 40 hospitalized geriatric patients. For determination nutritional status we used MNA and GNRI; we evaluated the correlation between this both test with biochemical and anthropometric parameters and functional questionnaires. We used Pearson's simple correlation model, oneway ANOVA and multiple logistic regression to evaluate the relationship between MNA and GNRI. RESULTS: According to MNA, 17 patients (42.5%) were malnourished and according to GNRI, 13 patients (32.5%) had high risk of nutritional complications. The concordance of MNA and GNRI was 39% and between MNA-SF and MNA was 81%. The most significant differences were detected in weight, BMI, arm and calf circumference and weight loss parameters. Barthel index was significantly different in both tests. The MNA and GRNI had significant correlations with albumin, total protein, transferring, arm and calf circumference, weight loss and BMI parameters. CONCLUSIONS: In conclusion, it would be reasonable to use GRNI in cases where MNA is not applicable, or even use GRNI as a complement to MNA in hospitalized elderly patients. There is no reason why they should be deemed incompatible, and patients could benefit from more effective nutritional intervention.

Assessing risk screening methods of malnutrition in geriatric patients; Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Index (GNRI) / Evaluación de los métodos de cribaje de riesgo nutricional en pacientes geriátricos; Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Assessment (GNRI)

Introduction: Elderly subjects are considered a vulnerable group and they have more risk of nutritional problems. The risk of malnutrition increases in hospitalized geriatric patients. Objectives: To compare the correlation between MNA and GNRI with anthropometric, biochemical and Barthel Index in hospitalized geriatric patients and to test the concordance between MNA and GNRI and between Mini Nutritional Assessment Short Form (MNA-SF) and MNA. Methods: It was a cross-sectional study on a sample of 40 hospitalized geriatric patients. For determination nutritional status we used MNA and GNRI; we evaluated the correlation between this both test with biochemical and anthropometric parameters and functional questionnaires. We used Pearson's simple correlation model, oneway ANOVA and multiple logistic regression to evaluate the relationship between MNA and GNRI. Results: According to MNA, 17 patients (42.5%) were malnourished and according to GNRI, 13 patients (32.5%) had high risk of nutritional complications. The concordance of MNA and GNRI was 39% and between MNA-SF and MNA was 81%. The most significant differences were detected in weight, BMI, arm and calf circumference and weight loss parameters. Barthel index was significantly different in both tests. The MNA and GRNI had significant correlations with albumin, total protein, transferring, arm and calf circumference, weight loss and BMI parameters.Conclusions: In conclusion, it would be reasonable to use GRNI in cases where MNA is not applicable, or even use GRNI as a complement to MNA in hospitalized elderly patients. There is no reason why they should be deemed incompatible, and patients could benefit from more effective nutritional intervention (AU)

Antecedentes: La población anciana esta considerada como un colectivo vulnerable a sufrir problemas nutricionales. Entre estos, los ancianos hospitalizados tienen aun un mayor riesgo a sufrir malnutrición. Objetivos: Los objetivos de este estudio fueron comparar el grado de correlación entre dos índices de cribaje nutricional, el Mini Nutritional Assessment (MNA) y el Geriatric Nutritional Risk Index (GNRI) con los parámetros antropométricos, bioquímicos, el índice de Barthel y ciertas patologías relacionadas con el estado nutricional (infecciones y úlceras por presión). Metodología: Se llevó a cabo un estudio transversal en una muestra de 40 pacientes hospitalizados en una unidad geriátrica de agudos. Para la determinación del estado nutricional se usaron los índices del MNA y el GNRI. Se evaluó la correlación entre los parámetros bioquímicos, antropométricos, parámetros funcionales y problemas nutricionales relacionados con la malnutrición (úlceras por presión y infecciones). Para el modelo de correlación, se utilizó el grado de correlación de Pearson; para estudiar la relación entre los índices nutricionales (MNA y GNRI) y los diferentes parámetros se utilizó un análisis de la variancia y un modelo de regresión logística. Resultados: De acuerdo con el MNA, 17 pacientes (42,5%) estaban desnutridos y de acuerdo con GNRI, 13 pacientes (32,5%) tenían alto riesgo de complicaciones nutricionales. La concordancia de la MNA y la GNRI fue del 39% y entre MNA-SF y MNA fue de 81%. Las diferencias más significativas se detectaron en el peso, el IMC, el brazo y circunferencia de la pantorrilla y los parámetros de pérdida de peso. El MNA y GRNI mostró correlaciones significativas con la albúmina, proteínas totales, la transferencia, la circunferencia del brazo y de la pantorrilla, con el % de pérdida de peso y el índice de masa corporal (IMC). Los pacientes malnutridos según el MNA y los pacientes con riesgo elevado según el GNRI tenían mayor riesgo de sufrir úlceras por presión. Conclusiones: en conclusión, sería razonable utilizar el GNRI en los casos en que el MNA no fuera aplicable, o incluso utilizar GNRI como complemento al MNA en pacientes ancianos hospitalizados. No hay ninguna razón por la cual se deban considerar incompatibles, y los pacientes podrían beneficiarse de una intervención nutricional más efectiva (AU)

[Home-Based Parenteral Nutrition (HBPN)-associated hepatobiliary complications]. / Complicaciones hepatobiliares asociadas a la Nutrición Parenteral Domiciliaria (NPD).

Home-based parenteral nutrition (HBPN) allows recovering or maintaining the nutritional status of patients with chronic intestinal failure that cannot afford their nutritional requirements through the digestive route. Frequently, liver function impairments develop along the treatment, which in the most severe cases, and especially in premature and low-weight infants, may lead to an irreversible liver failure. The proper composition of the parenteral nutrition bag, avoiding an excess of energy intake, together with the use of new types of lipid emulsions (with lower content in -6 fatty acids and voided of phytosterols) as well as the use, although being minimal, of the enteral route, may contribute to a decrease in the occurrence of HBPN-associated liver disease. It is necessary to perform monthly clinical and biochemical checks to early detect liver function impairments in order to perform the appropriate changes in the treatment and assess the indication of a potential bowel transplant before the liver damage becomes irreversible.

Complicaciones hepatobiliares asociadas a la Nutrición Parenteral Domiciliaria (NPD) / Home-based parenteral nutrition (hbpn)-associated hepatobiliary complications

La Nutrición Parenteral Domiciliaria (NPD) permite recuperar o mantener el estado nutricional de los pacientes con insuficiencia intestinal crónica que no pueden cubrir sus requerimientos nutricionales por vía digestiva. Es frecuente que a lo largo del tratamiento aparezcan alteraciones de la función hepática que, en los casos más graves y sobretodo en niños prematuros y debajo peso, pueden condicionar un fallo hepático irreversible. La correcta composición de la bolsa de nutrición parenteral, evitando un excesivo aporte de energía, junto con el uso de nuevos tipos de emulsiones lipídicas (con menor contenido en ácidos grasos de la serie ω-6 y exentas de fitosteroles) así como la utilización, aunque sea mínima, de la vía digestiva pueden contribuir a disminuirla aparición de la hepatopatía asociada a la NPD. Es imprescindible realizar controles periódicos clínicos y analíticos para detectar precozmente las alteraciones de la función hepática con objeto de realizar los cambios adecuados en el tratamiento y valorar la indicación de un posible trasplante intestinal antes de que el fallo hepático sea irreversible (AU)

Home-based parenteral nutrition (HBPN) allows recovering or maintaining the nutritional status of patients with chronic intestinal failure that cannot afford their nutritional requirements through the digestive route. Frequently, liver function impairments develop along the treatment, which in the most severe cases, and especially in premature and low-weight infants, may lead to an irreversible liver failure. The proper composition of the parenteral nutrition bag, avoiding an excess of energy intake, together with the use of new types of lipid emulsions(with lower content in -6 fatty acids and voided of phytosterols) as well as the use, although being minimal,of the enteral route, may contribute to a decrease in the occurrence of HBPN-associated liver disease. It is necessary to perform monthly clinical and biochemical checks to early detect liver function impairments in order to perform the appropriate changes in the treatment and assess the indication of a potential bowel transplant before the liver damage becomes irreversible (AU)

Papel de la nutrición en la prevención y evolución de las enfermedades neurodegenerativas / Role of nutrition in prevention and course of neurodegenerative diseases

La importancia del estado de nutrición en el desarrollo del cerebro y en las funciones cognitivas es indiscutible.Pero a pesar de que existen numerosas evidencias de que la dieta tiene un papel importante en la patogenia de las enfermedades neurodegenerativas, existen múltiples problemas metodológicos para investigar la relación entre la dieta y la neurodegeneración. En las enfermedades neurodegenerativas más frecuentes, la inflamación parece ser un denominador común responsable de la naturalezaprogresiva de la neurodegeneración, y el objetivo de los tratamientos testados será modificar el estado inflamatorio crónico y sus mecanismos de acción. Las evidencias que sostienen la relación entre dieta y enfermedades neurodegenerativas con frecuencia derivan de estudios epidemiológicos, y los resultados no siempre han podido ser confirmados en estudios prospectivos debido a las dificultades en su diseño. Por otro lado, los estudios de intervención han mostrado resultados controvertidos. En la siguiente revisión se analizan las enfermedades neurodegenerativas más frecuentes: esclerosis múltiple,enfermedad de Parkinson, esclerosis lateral amiotrófica y enfermedad de Alzheimer, con las evidencias científicas que apoyan una relación con la dieta y por tanto una posibilidad de modulación nutricional (AU)

The importance of the nutritional status in brain and cognitive functions development is unquestionable.Although there are a number of evidences showing that the diet has an important role in the pathogenesis of neurodegenerative diseases, there exist many methodological issues when investigating the relationship between the diet and neurodegeneration. In the most common neurodegenerative diseases, inflammation seems to be a common denominator that accounts for the progressive nature of neurodegeneration, and the aim of the therapies being tested will be to modify the chronic inflammatory status and its mechanisms of action.The evidences supporting the relationship between the diet and neurodegenerative diseases are frequently derived from epidemiological studies, and the outcomes have not always been confirmed in prospective studies due to difficulties in their design. On the other hand,intervention studies have yielded controversial results.In the following review, the most common neurodegenerative diseases are analysed: multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis, and Alzheimer’s disease,with the scientific evidences supporting the relationship with the diet, and thus a possibility of nutritional modulation (AU)

Pauta nutricional en una fístula enterocutánea / Nutritional support in enterocutaneous fistulas

Las fístulas enterocutáneas en un alto porcentaje son consecuencia de una cirugía y se asocian a una elevada morbimortalidad. La tasa de mortalidad se estima entre el 5 y el 20%. El tratamiento de las fístulas enterocutáneas debería ir dirigido en primer lugar a la estabilización del paciente, corrección del equilibrio hidroelectrolítico, control de la infección, del débito de la fístula y la instauración de soporte nutricional. El uso sistemático de somatostatina en infusión continua o su análogo octreotida es controvertido. Aunque los datos indican una reducción en el tiempo de cierre de la fístula, hay poca evidencia a favor de una mayor probabilidad de cierre espontáneo. La desnutrición tiene una alta prevalencia y la instauración de soporte nutricional es esencial como tratamiento de soporte. La nutrición enteral será de elección siempre que sea posible, y en caso de aumento de las pérdidas en las fístulas de alto débito, se debería instaurar nutrición parenteral (AU)

A high percentage of enterocutaneous fistulas are due to previous surgery; these entities are associated with high morbidity and mortality. The mortality rate is estimated to be between 5 and 20%. The treatment of enterocutaneous fistulas should aim firstly at stabilizing the patient, correcting any hidroelectrolitic disorders, controlling possible infections and fistula output, and starting nutritional support. The widespread use of somatostatin in continuous infusion, or its analogue octeotride, is controversial. Although data suggest a reduction in the fistula closure time, there is little evidence that this treatment increases the probability of spontaneous closure. Malnutrition is highly prevalent and starting nutritional support is essential. Whenever possible, the first choice should be enteral nutrition and, if output loss increases in high output fistulas, parenteral nutrition should be started (AU)

[Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery]. / Nutrición precoz por vía oral en patología colo-rectal tributaria de cirugía asistida por laparoscopia.

UNLABELLED: Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy-assisted surgery. OBJECTIVE: to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance. SETTING AND PATIENTS: prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4), pT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment with QT or RT. RESULTS: Intestinal cleansing was poorly effective in 3 patients diagnosed with sub-occlusive neoplasm. Feeding was started within 24 hours in 13 patients, within 48 h in 7 patients, and at day 5 in one patient because of paralytic ileus. Hospital discharge was within the 3d-5th day in 60% of the patient, between 6th-10th day in 28%, and in 12% it occurred more than 20 days later due to complications. Progressive regimens were well tolerated by all patients, with no occurrence of diarrhea syndrome, the number of defecations varying from 2 to 4 and with a soft-normal consistency. In ponderal evolution, it is remarkable disease-related weight loss greater than 5% in 8 patients. By the end of the progressive diet, 5 patients had weight loss greater than 10% (4 for adjuvant therapy, 1 for depressive syndrome because of carrying a stoma). These patients were monitored 3 months later and they had recovered their regular weight. CONCLUSIONS: Early nutrition in colorectal surgery is possible. Following a progressive feeding regimen allows for a better digestive tolerance as well as a good physical and functional recovery of the patient.

Nutrición precoz por vía oral en patología colo-rectal tributaria de cirugía asistida por laparoscopia / Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery

Las actuales técnicas quirúrgicas menos invasivas, la utilización de nuevos fármacos analgésicos y anestésicos y la movilización precoz "multimodal surgical strategies" reducen la presencia de íleo paralítico postquirúrgico y emesis siendo posible la nutrición precoz por vía digestiva. Con estas premisas se diseño un protocolo de nutrición para su implementación en patología colo-rectal tributaria de cirugía asistida por laparoscopia. Objetivo: Evaluar la eficacia de dicho protocolo que consta de 3 fases. Fase I: preparación domiciliaria con una duración de 7 días: dieta con bajo contenido en residuos y fibra insoluble, suplementada con 400 ml de fórmula polimérica hiperproteica sin lactosa ni fibra, limpieza intestinal dos días antes de la intervención e hidratación con agua, infusiones azucaradas y caldo vegetal. Fase II: postoperatorio inmediato con dieta líquida durante 3 días con fórmula polimérica sin fibra. Fase III: dieta semi-sólida sin residuos, formula nutricional y reintroducción progresiva de la alimentación en 4 etapas de duración variable según cirugía y tolerancia digestiva Ambito y pacientes: Estudio prospectivo realizado en nuestro hospital con pacientes de nuestra área de influencia en el periodo de febrero/03 a mayo/04 que incluye 25 pacientes 19 varones y 6 mujeres con media de edad de 63.6 (r=33-79) e índice de masa corporal media de 26.25 kg / m2 (r=20.84-31.3 kg/m2) todos ellos afectos de patología colo-rectal tributarios de cirugía asistida por laparoscopia a los que se aplico el protocolo diseñado al efecto. Se practicaron 14 hemicolectomias izquierdas, 5 hemicolectomias derechas, 4 resecciones anteriores bajas con colostomia de protección y 2 colectomias subtotales e ileostomia lateral. Los diagnósticos definitivos fueron: 3 enfermedades diverticulares; 3 adenomas; 7 neoplásias rectosigmoideas y 12 neoplásias de colon de otras localizaciones. El estudio anatomo-patológico confirmó: pT3 N0 (n=7); pT3 N1 (n= 3); pT3 N2 (n =1) y pT3 N1 M1 (n = 1), pT1 N0 (n=4), pT1 N1 (n=2), pTis (n=1), indicándose tratamiento coadyuvante en 12 pacientes, de los cuales tres habían recibido un primer tratamiento con QMT y RDT. Resultados: La limpieza intestinal fue poco efectiva en 3 pacientes diagnosticados de neoplasia suboclusiva. La alimentación se inició a las 24 h en 13 pacientes, 7 la iniciaron a las 48h; 4 a las 72 h y 1 en paciente se inició el 5 día por persistencia de íleo paralítico. El alta hospitalaria entre el 3º y el 5º día se produjo en el 60% de los pacientes, entre el 6º y el 10º día fueron alta el 28 % y en el 12% se demoró más de 20 días por complicaciones. Las pautas progresivas fueron bien toleradas en la totalidad de la muestra, no presentándose ningún síndrome diarréico y oscilando el número de deposiciones entre 2-4 de consistencia blanda-normal. En la evolución ponderal destaca en 8 pacientes pérdida de peso superior al 5 % relacionada con la enfermedad. Al terminar la progresión de la dieta 5 pacientes presentaban pérdida de peso superior al 10 % (4 por tratamiento coadyuvante, 1 por síndrome depresivo al ser portadora de estoma). Estos pacientes fueron controlados a los 3 meses habiendo recuperado el peso habitual. Conclusiones: La nutrición precoz en cirugía colo-rectal es posible. El seguimiento de unas pauta de alimentación progresiva permite una mejor tolerancia digestiva así como una buena recuperación física y funcional del paciente (AU)

Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy- assisted surgery. Objective: to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance. Setting and patients: prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4) postoperapT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment with QT or RT. Results: Intestinal cleansing was poorly effective in 3 patients diagnosed with sub-occlusive neoplasm. Feeding was started within 24 hours in 13 patients, within 48 h in 7 patients, and at day 5 in one patient because of paralytic ileus. Hospital discharge was within the 3d-5th day in 60% of the patient, between 6th-10th day in 28%, and in 12% it occurred more than 20 days later due to complications. Progressive regimens were well tolerated by all patients, with no occurrence of diarrhea syndrome, the number of defecations varying from 2 to 4 and with a soft-normal consistency. In ponderal evolution, it is remarkable disease-related weight loss greater than 5% in 8 patients. By the end of the progressive diet, 5 patients had weight loss greater than 10% (4 for adjuvant therapy, 1 for depressive syndrome because of carrying a stoma). These patients were monitored 3 months later and they had recovered their regular weight. Conclusions: Early nutrition in colorectal surgery is possible. Following a progressive feeding regimen allows for a better digestive tolerance as well as a good physical and functional recovery of the patient (AU)

[Quality of the home parenteral nutrition program: 14 years of experience at a general university hospital]. / Calidad del programa de nutrición parenteral a domicilio: 14 años de experiencia en un hospital general universitario.

The quality of home parenteral nutrition (NPD in its Spanish acronym) depends on the frequency and type of complication associated with NPD treatment and the likelihood of survival. The present study assesses the quality of the NPD programme in place in our hospital in terms of survival, infections and mechanical complications. A retrospective study was carried out into the clinical follow-up data of all the patients (n = 24) included in our NPD programme since its start in 1985 until 1998 (14 years). An estimate is made for: a) the annual index of infectious complications (IAC in its Spanish acronym), b) the annual index of mechanical complications (MAC in its Spanish acronym) and c) the likelihood of survival by means of the Kaplan-Meier method. The quality specifications adopted are those of the literature reflecting the current provision of NPD programmes and the survival values of patients undergoing dialysis for chronic kidney failure. The most frequent pathology in our context is benign (70.8%), distributed as follows: small bowel syndrome of ischaemic origin (45.8%), small bowel syndrome of non-ischaemic origin (12.5%) and idiopathic intestinal pseudo-obstruction (12.5%). The patients with benign pathologies present a higher survival rate than patients with neoplastic disease (95% in the fifth year of treatment versus 45% at twenty months), with a statistically significant difference. The annual index of infectious complications is 0.6 (median value of the 14 years studied). Similarly, the annual indices of obstructions and thromboses are 0.11 and 0.0095, respectively. In our opinion, the quality of the NPD programme in place at our hospital is highly satisfactory because both the survival rate and the annual indices of mechanical and infectious complications are acceptable with regard to the programmes in place in the international sphere. In addition, in terms of survival, NPD seems slightly more effective than dialysis for chronic kidney disease.

Calidad del programa de nutrición parenteral a domicilio 14 años de experiencia en un hospital general universitario / Quality of home parenteral nutrition programme: 14 years's experience at a general teaching hospital

La calidad del tratamiento con nutrición parenteral a domicilio (NPD) depende de la frecuencia y tipo de complicaciones asociadas al mismo, así como de la probabilidad de supervivencia. En este trabajo se evalúa la calidad del programa de NPD existente en nuestro hospital en términos de supervivencia, complicaciones infecciosas y complicaciones mecánicas. Se realiza un estudio retrospectivo de los datos del seguimiento clínico de todos los pacientes (n = 24) incluidos en el programa de NPD de nuestro centro desde su inicio en 1985 hasta 1998 (14 años). Se estiman: a) el índice anual de complicaciones infecciosas (IAC), b) el índice anual de complicaciones mecánicas (MAC) y c) la probabilidad de supervivencia mediante el método de Kaplan-Meier. Se toman como especificaciones de calidad los datos bibliográficos que reflejan la prestación actual de los programas de NPD existentes y los valores de supervivencia de los pacientes en diálisis por fracaso renal crónico. La patología más frecuente en nuestro medio es la benigna (70,8 por ciento) distribuyéndose como sigue: síndrome de intestino corto de origen isquémico (45,8 por ciento), síndrome de intestino corto de causa no isquémica (12,5 por ciento) y seudoobstrucción intestinal idiopática (12,5 por ciento). Los pacientes con patología benigna presentan una supervivencia más alta que los pacientes con enfermedad neoplásica (95 por ciento al quinto año de tratamiento frente a 45 por ciento a los 20 meses), siendo la diferencia estadísticamente significativa. El índice anual de complicaciones infecciosas es 0,6 (valor mediano de los 14 años estudiados). De igual modo los índices anuales de obstrucciones y trombosis son 0,11 y 0,0095, respectivamente. En nuestra opinión la calidad del programa de NPD existente en nuestro hospital es muy satisfactoria porque tanto la proporción de supervivencia como los índices anuales de complicaciones infecciosas y mecánicas son aceptables respecto a la prestación de los programas existentes a nivel internacional. Además, en términos de supervivencia la NPD resulta ligeramente más efectiva que la diálisis por fracaso renal crónico (AU)

The quality of home parenteral nutrition (NPD in its Spanish acronym) depends on the frequency and type of complication associated with NPD treatment and the likelihood of survival. The present study assesses the quality of the NPD programme in place in our hospital in terms of survival, infections and mechanical complications. A retrospective study was carried out into the clinical follow-up data of all the patients (n = 24) included in our NPD programme since its start in 1985 until 1998 (14 years). An estimate is made for: a) the annual index of infectious complications (IAC in its Spanish acronym), b) the annual index of mechanical complications (MAC in its Spanish acronym) and c) the likelihood of survival by means of the Kaplan-Meier method. The quality specifications adopted are those of the literature reflecting the current provision of NPD programmes and the survival values of patients undergoing dialysis for chronic kidney failure. The most frequent pathology in our context is benign (70.8%), distributed as follows: small bowel syndrome of ischaemic origin (45.8% ), small bowel syndrome of non-ischaemic origin (12.5%) and idiopathic intestinal pseudo-obstruction (12.5%). The patients with benign pathologies present a higher survival rate than patients with neoplasic disease (95% in the fifth year of treatment versus 45% at twenty months), with a statistically significant difference. The annual index of infectious complications is 0.6 (median value of the 14 years studied). Similarly, the annual indices of obstructions and thromboses are 0.11 and 0.0095, respectively. In our opinion, the quality of the NPD programme in place at our hospital is highly satisfactory because both the survival rate and the annual indices of mechanical and infectious complications are acceptable with regard to the programmes in place in the international sphere. In addition, in terms of survival, NPD seems slightly more effective than dialysis for chronic kidney disease (AU)