RESUMO
BACKGROUND: Locally advanced rectal cancer is customarily treated with neoadjuvant chemoradiotherapy (CRT) followed by a total mesorectal excision. During the course of CRT, previously non-detectable distant metastases can appear. Therefore, a restaging CT scan of the chest and abdomen was performed prior to surgery. The aim of this study was to determine the frequency of a change in treatment strategy after this restaging CT scan. METHODS: Patients treated with neoadjuvant CRT for locally advanced rectal cancer between January 2003 and July 2013 were included retrospectively. To determine the value of the restaging CT scan, the surgical treatment as planned before CRT was compared with the treatment ultimately received. RESULTS: A total of 153 patients (91 male) were eligible, and median age was 62 (32-82) years. The restaging CT scan revealed the presence of distant metastases in 19 patients (12.4, 95 % confidence interval [CI] 7.0-17.8). In 17 patients (11.1, 95 % CI 6.1-16.1), a change in treatment strategy occurred due to the detection of metastases with a restaging CT scan. CONCLUSION: A restaging CT scan after completion of neoadjuvant CRT may detect newly developed metastases and consequently alter the initial treatment strategy. This study demonstrated the added value of the restaging CT scan prior to surgery.
Assuntos
Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND AIMS: Subjects with one first-degree relative (FDR) with colorectal cancer (CRC) <50 years old or two FDRs with CRC have an increased risk for CRC (RR 4-6). Current guidelines recommend colonoscopic surveillance of such families. However, information about the yield of surveillance is limited. The aim of the present study was to evaluate the outcome of surveillance and to identify risk factors for the development of adenomas. PATIENTS AND METHODS: Subjects were included if they fulfilled the following criteria: asymptomatic subjects aged between 45 and 65 years, with one FDR with CRC <50 years old (group A) or two FDRs with CRC diagnosed at any age (group B). Subjects with a personal history of inflammatory bowel disease or colorectal surgery were excluded. RESULTS: A total of 551 subjects (242 male) met the selection criteria. Ninety-five subjects with a previous colonoscopy were excluded. Two of 456 remaining subjects (0.4%) were found to have a colorectal tumour (one CRC and one carcinoid). Adenomas were detected in 85 (18.6%) and adenomas with advanced pathology in 37 subjects (8.1%). 30 subjects (6.6%) had multiple (>1) adenomas. Men were more often found to have an adenoma than women (24% vs 14.3%; p=0.01). Adenomas were more frequent in group B compared with group A (22.0% vs 15.6%; p=0.09). CONCLUSION: The yield of colonoscopic surveillance in familial CRC is substantially higher than the yield of screening reported for the general population.
Assuntos
Adenoma/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Adenoma/epidemiologia , Adenoma/genética , Fatores Etários , Idoso , Colonoscopia , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância da População/métodos , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
BACKGROUND: The optimal treatment of desmoid tumours is controversial. We evaluated desmoid management in Dutch familial adenomatous polyposis (FAP) patients. METHODS: Seventy-eight FAP patients with desmoids were identified from the Dutch Polyposis Registry. Data on desmoid morphology, management, and outcome were analysed retrospectively. Progression-free survival (PFS) rates and final outcome were compared for surgical vs non-surgical treatment, for intra-abdominal and extra-abdominal desmoids separately. Also, pharmacological treatment was evaluated for all desmoids. RESULTS: Median follow-up was 8 years. For intra-abdominal desmoids (n=62), PFS rates at 10 years of follow-up were comparable after surgical and non-surgical treatment (33% and 49%, respectively, P=0.163). None of these desmoids could be removed entirely. Eventually, one fifth died from desmoid disease. Most extra-abdominal and abdominal wall desmoids were treated surgically with a PFS rate of 63% and no deaths from desmoid disease. Comparison between NSAID and anti-estrogen treatment showed comparable outcomes. Four of the 10 patients who received chemotherapy had stabilisation of tumour growth, all after doxorubicin combination therapy. CONCLUSION: For intra-abdominal desmoids, a conservative approach and surgery showed comparable outcomes. For extra-abdominal and abdominal wall desmoids, surgery seemed appropriate. Different pharmacological therapies showed comparable outcomes. If chemotherapy was given for progressively growing intra-abdominal desmoids, most favourable outcomes occurred after combinations including doxorubicin.
Assuntos
Polipose Adenomatosa do Colo/terapia , Antineoplásicos/uso terapêutico , Colectomia , Fibromatose Abdominal/terapia , Fibromatose Agressiva/terapia , Polipose Adenomatosa do Colo/complicações , Adolescente , Adulto , Terapia Combinada , Feminino , Fibromatose Abdominal/complicações , Fibromatose Agressiva/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES AND DESIGN: Traumatic thoracic aortic injuries are serious and may be associated with high morbidity and mortality. Endovascular stent grafting is now an established treatment option which often requires proximal landing zone extension through left subclavian artery (LSA) origin coverage. This in turn can lead to downstream ischaemic complications which may be lessened by LSA revascularisation. This study investigates the consequence of LSA coverage and potential benefit of revascularisation. MATERIALS AND METHODS: Systematic literature review of studies between 1997 and 2010 identified 94 studies incorporating 1704 patients. Chronological trends in LSA management practice for trauma were sought. Designated outcomes of interest were prevalences of left arm ischaemia, stroke, spinal cord ischaemia, endoleak, stent migration, need for additional procedure and mortality. These outcomes were compared in patients with and without LSA coverage (taking account of the degree of coverage). The impact of revascularisation on these outcomes was also explored. Statistical analysis included examination with Chi-Square or Fisher's tests as appropriate. RESULTS: Isolated total LSA coverage without revascularisation increases the prevalence of left arm ischaemia [prevalence of 4.06% versus 0.0% (p < 0.001)]; stroke [prevalence of 1.19% versus 0.23% (p = 0.025)]; and need for additional procedure [prevalence of 2.86% versus 0.86% (p = 0.004). In contrast there were no reported cases of stroke, spinal cord ischaemia, endoleak, stent migration or mortality when the LSA origin was only partially covered. When the LSA territory was revascularised, again no cases of left arm ischaemia, stroke, spinal cord ischaemia, endoleak, or mortality were reported. CONCLUSION: Current evidence suggests that LSA coverage in patients undergoing endovascular stent grafting of the thoracic aorta for trauma should be avoided where possible to avoid ensuing downstream ischaemic complications. When coverage is anatomically necessary, partial coverage is better than complete in terms of avoiding these complications and revascularisation may be considered, however these decisions must be made in the context of the individual patient scenario.
Assuntos
Angioplastia , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artéria Subclávia/cirurgia , Lesões do Sistema Vascular/cirurgia , Humanos , StentsRESUMO
We present a patient who was diagnosed with retroperitoneal lymphangioleiomyomatosis (LAM) and who developed biliary tract obstruction caused by LAM in the papilla of Vater. After endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy, the patient's liver enzymes normalised. Disease progression was slowed down with gosereline and interferon alpha 2b (IF N-alpha 2b). In patients with LAM and signs of biliary tract obstruction, disseminated LAM should be considered. IFN alpha 2b can be a useful treatment in patients with widespread LAM.
Assuntos
Doenças Biliares/etiologia , Colestase/etiologia , Linfangioleiomiomatose/complicações , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/patologia , Fatores de RiscoRESUMO
A 77-year-old man, treated with risedronic acid to prevent corticosteroid-induced osteoporosis, was admitted to hospital with acute abdominal pain. The patient appeared to have an oesophageal perforation, which was treated with an endoprosthesis. Additional research showed a motility disorder of the oesophagus. Although bisphosphonates are considered a safe medication, the perforation was probably secondary to treatment with an oral bisphosphonate in combination with the motility disorder. Pre-existent gastrointestinal diseases such as motility disorders of the oesophagus occur more frequently among elderly. Therefore it is important to take the increased risk of complications to the gastrointestinal tract into account when prescribing bisphosphonates to these patients.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Esôfago/lesões , Ácido Etidrônico/análogos & derivados , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Ácido Etidrônico/efeitos adversos , Ácido Etidrônico/uso terapêutico , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Osteoporose/induzido quimicamente , Osteoporose/prevenção & controle , Ácido RisedrônicoRESUMO
BACKGROUND: Dumping syndrome is a serious complication occurring in 10% of patients after gastric surgery. Dumping symptoms are effectively reduced by subcutaneous application of the somatostatin analogue octreotide, but side-effects limit its use. AIM: To evaluate the efficacy of depot long-acting release octreotide (Sandostatin-LAR) vs. octreotide subcutaneous on dumping symptoms, quality of life and side-effects. METHODS: Twelve patients (five females, age 58 +/- 3 years) with severe dumping symptoms, requiring daily use of octreotide subcutaneous, were included in an open study and changed from octreotide subcutaneous after a 2 weeks washout to Sandostatin-LAR 10 mg i.m., every 4 weeks for 6 months. Symptoms (diary), body weight, fat excretion, food intake and Gastrointestinal Specific Quality of Life Index were evaluated. RESULTS: Gastrointestinal Specific Quality of Life Index increased significantly (P < 0.05) during Sandostatin-LAR treatment (88 +/- 4) compared with octreotide (74 +/- 4) and washout (75 +/- 6). During Sandostatin-LAR treatment, abdominal symptom score was lower compared with octreotide and washout, but not significantly. During Sandostatin-LAR treatment, body weight increased (66 +/- 4 to 70 +/- 3 kg; P = 0.19). CONCLUSIONS: Sandostatin-LAR is at least as effective as octreotide subcutaneous in suppressing symptoms in patients with severe dumping syndrome and is more effective than octreotide subcutaneous in increasing body weight and quality of life.
Assuntos
Síndrome de Esvaziamento Rápido/tratamento farmacológico , Fármacos Gastrointestinais/administração & dosagem , Octreotida/administração & dosagem , Peso Corporal , Doença Crônica , Preparações de Ação Retardada , Feminino , Fármacos Gastrointestinais/efeitos adversos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Octreotida/efeitos adversos , Qualidade de Vida , Resultado do TratamentoRESUMO
A case of intracardiac stabbing is reported. The victim sustained injuries disproportionate to his initial presentation. These included a ventricular septal defect and mitral valve leaflet perforation. The need for immediate referral to a cardiothoracic unit and the importance of the use of echocardiography is stressed. This enables the safest and most appropriate management of potentially lethal injuries.
Assuntos
Traumatismos Cardíacos/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Ecocardiografia Transesofagiana , Traumatismos Cardíacos/etiologia , Septos Cardíacos/lesões , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/lesõesRESUMO
UNLABELLED: Cholecystokinin (CCK) secretion may be affected in patients with chronic pancreatitis (CP), but little is known on the effect of pancreatic surgery on CCK secretion. We measured CCK secretion (radioimmunoassay, RIA) in response to bombesin infusion (100 ng/kg/20 min) for 120 min to test CCK secretory capacity, to ingestion of a liquid diet (400 kcal) for 120 min, and in response to a solid fat-rich meal (500 kcal) for 120 min. These studies were performed in 45 patients with CP (25 with exocrine insufficiency), 15 patients after duodenum-preserving pancreatic head resection (DPRHP), 18 patients after the Whipple operation, 12 patients after distal pancreatectomy (DP), and 35 control subjects. In CP patients, the CCK secretory capacity was preserved, but the postprandial CCK response was reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after Whipple's operation, CCK secretory capacity and postprandial CCK secretion were significantly (p < 0.05) reduced. In patients after DPRHP, CCK secretory capacity was not affected, but the postprandial CCK response was significantly (p < 0.05) reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after DPRHP, fasting plasma CCK levels were significantly (p < 0.01) increased, pointing to the absence of feedback inhibition on CCK secretion by intraluminal enzymes. After DP, the CCK secretory capacity was not affected. IN CONCLUSION: alterations in CCK secretion are observed in patients with chronic pancreatitis and after pancreatic surgery. These alterations are related not only to the disease process (exocrine insufficiency) but also to the type of surgery and type of stimulus.
Assuntos
Colecistocinina/metabolismo , Procedimentos Cirúrgicos do Sistema Digestório , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreatite/fisiopatologia , Adulto , Bombesina , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Colecistocinina/sangue , Doença Crônica , Duodeno/cirurgia , Ingestão de Alimentos , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Pancreatite/diagnóstico , Período Pós-Prandial , Valores de ReferênciaRESUMO
A female aged 62 yr developed a recurrence of chronic idiopathic thrombocytopenia 7 years after splenectomy. Two accessory spleens were identified and removed surgically. An increase in platelet count was seen. An analysis of the literature shows that extirpation of accessory spleens was successful in over 60% of the patients (32/52) with recurring idiopathic thrombocytopenia after splenectomy.
Assuntos
Coristoma/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Baço/diagnóstico por imagem , Esplenectomia , Trombocitopenia/cirurgia , Coristoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Cintilografia , Recidiva , Neoplasias Retroperitoneais/cirurgiaRESUMO
A 74-year-old woman was admitted with jaundice. She was suffering from generalised liver failure with a highly prolonged prothrombin time, a low albumin level and ascites. Further anamnesis revealed that she had been taking nitrofurantoin as a prophylactic agent for recurrent urinary tract infections every day for 5 years. Because of the indications for liver damage due to nitrofurantoin, the drug was discontinued immediately on admission. After withdrawal of nitrofurantoin there was a very gradual clinical and biochemical improvement. Liver biopsies to confirm the diagnosis revealed extensive liver damage with cirrhosis such as may be seen following long-term use of nitrofurantoin. Nitrofurantoin should be prescribed with caution as a prophylactic agent in elderly women and patients with renal dysfunction because the risk of liver damage as a serious side effect of nitrofurantoin is greatly increased in these patients.
Assuntos
Anti-Infecciosos Urinários/efeitos adversos , Cirrose Hepática/induzido quimicamente , Nitrofurantoína/efeitos adversos , Infecções Urinárias/prevenção & controle , Idoso , Anti-Infecciosos Urinários/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Fígado/efeitos dos fármacos , Fígado/patologia , Cirrose Hepática/diagnóstico , Nitrofurantoína/uso terapêutico , Fatores de Tempo , Infecções Urinárias/tratamento farmacológicoRESUMO
The dumping syndrome is encountered in approximately 10% of patients after gastric surgery. A postprandial peripheral and splanchnic vasodilatation and ensuing relative hypovolaemia are pivotal in the pathophysiology of early systemic symptoms. Late dumping symptoms are a consequence of a reactive hypoglycaemia, which results from an exaggerated insulin and glucagon-like peptide-1 release. The diagnosis of dumping syndrome can reliably be made with the aid of a provocation test using 50 g glucose orally. Most patients with dumping can be treated with advice on diet and lifestyle. Octreotide effectively controls the signs and symptoms of dumping in patients refractory to standard therapy. It acts through its inhibitory effects on insulin and gut hormone release, a delay of intestinal transit time and inhibition of food-induced circulatory changes. Its long-term use is somewhat limited by side effects, particularly diarrhoea and steatorrhoea.
Assuntos
Síndrome de Esvaziamento Rápido , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/etiologia , Síndrome de Esvaziamento Rápido/fisiopatologia , Síndrome de Esvaziamento Rápido/terapia , Humanos , Complicações Pós-Operatórias , Estômago/cirurgiaAssuntos
Bacteriemia/etiologia , Varizes Esofágicas e Gástricas/terapia , Ligadura/efeitos adversos , Cirrose Hepática Alcoólica/fisiopatologia , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cefotaxima/uso terapêutico , Gentamicinas/uso terapêutico , Humanos , MasculinoRESUMO
OBJECTIVE: Little is known about the long-term results of octreotide therapy in dumping syndrome. We report the results of an open study including 20 patients with severe dumping symptoms after gastric surgery treated with octreotide between 1987 and 1997 at the Leiden University Medical Centre. DESIGN: Patient selection was based on (1) the results of a dumping provocation test and (2) symptoms that were refractory to other therapeutic measures. At regular intervals the presence of dumping symptoms was evaluated together with measurement of body weight and faecal fat excretion. RESULTS: Mean follow-up was 37 +/- 9 months (range 1-107 months). Doses of octreotide ranged from 25 to 200 microg/day. Initial relief of symptoms was achieved in all subjects, but after three months of therapy symptom relief persisted in 80% of patients. Mean body weight increased by 2.4 +/- 1.2 kg despite a significant increase in faecal fat excretion from 10 +/- 2 g/24 h to 24 +/- 3 g/24 h. Reasons for discontinuation of therapy were diminished efficacy in the longer term in 4 patients and side-effects in 7 patients. Biliary complications were encountered in 3 patients. CONCLUSIONS: Self-administration of octreotide proves an effective symptomatic treatment of severe dumping, even on the long-term. Its use is frequently limited by the occurrence of side-effects.
Assuntos
Síndrome de Esvaziamento Rápido/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Octreotida/uso terapêutico , Adulto , Idoso , Análise de Variância , Glicemia/metabolismo , Doença Crônica , Estudos de Coortes , Síndrome de Esvaziamento Rápido/sangue , Síndrome de Esvaziamento Rápido/diagnóstico , Feminino , Seguimentos , Glucose , Frequência Cardíaca/efeitos dos fármacos , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.
Assuntos
Granuloma de Células Plasmáticas/complicações , Cardiopatias/complicações , Taquicardia Ventricular/etiologia , Adulto , Humanos , Angiografia por Ressonância Magnética , MasculinoRESUMO
UNLABELLED: Medium-chain triglycerides are known to induce diarrhea, possibly resulting from accelerated intestinal transit. We performed antroduodenal manometry and lactulose hydrogen breath testing simultaneously in eight healthy subjects in order to determine the effects of intraduodenally administered medium-chain triglycerides (MCT) and long-chain triglycerides (LCT) on gastrointestinal motility and small bowel transit time. LCT (15 mmol/hr) induced a fed motor pattern. In contrast, during MCT, in both equimolar (15 mmol/hr; MCT-1) and equicaloric (30 mmol/hr; MCT-2) amounts comparable to LCT, interdigestive motility was preserved but with a significantly (P < 0.05) shorter MMC cycle length (MCT-1, 65 +/- 7 min; MCT-2, 53 +/- 6 min) compared to control (saline infusion; 127 +/- 14 min). Duodenocecal transit time (DCTT) was significantly (P < 0.05) accelerated during administration of MCT (MCT-1, 56 +/- 6 min; MCT-2, 69 +/- 9 min) and was not affected by LCT (105 +/- 13 min) when compared to control (101 +/- 9 min). IN CONCLUSION: MCT, in contrast to LCT, preserve interdigestive motility with a shorter MMC cycle length and accelerate DCTT.
Assuntos
Motilidade Gastrointestinal/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Triglicerídeos/farmacologia , Dor Abdominal/induzido quimicamente , Adulto , Ceco/fisiologia , Colecistocinina/sangue , Diarreia/induzido quimicamente , Duodeno/fisiologia , Feminino , Humanos , Masculino , Manometria , Cloreto de Sódio/farmacologia , Triglicerídeos/administração & dosagem , Triglicerídeos/químicaRESUMO
BACKGROUND: In patients after gastric surgery it is often difficult to discern symptoms from dumping from other postcibal complaints. Strict criteria for dumping provocation test have not been defined. METHODS: The sensitivity and specificity of a dumping provocation using 50 g of glucose orally was assessed in 48 patients after gastric surgery, of whom 19 had a typical history of early dumping and 11 had a history of late dumping. Factors were heart rate, packed cell volume, breath hydrogen excretion, and blood glucose concentration. RESULTS: An increase in heart rate of > or = 10 beats/min in the 1st h had a sensitivity of 100% and a specificity of 94% in detecting early dumping. An early rise in breath H2 excretion showed a sensitivity of 84% and specificity of 94%. The nadir blood glucose concentration was not a sensitive or specific indicator for late dumping. CONCLUSIONS: Both an increase in heart rate of > or = 10 beats/min and a positive breath hydrogen excretion are sensitive indicators for early dumping. Late dumping is better recognized by the occurrence of subjective symptoms during provocation.
Assuntos
Síndrome de Esvaziamento Rápido/diagnóstico , Glucose , Complicações Pós-Operatórias/diagnóstico , Estômago/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome de Esvaziamento Rápido/etiologia , Síndrome de Esvaziamento Rápido/fisiopatologia , Feminino , Glucose/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
In patients after gastric surgery, early dumping symptoms can be provoked by oral glucose challenge. Octreotide effectively prevents the occurrence of dumping symptoms. We have studied plasma renin activity (PRA), aldosterone and atrial natriuretic peptide (ANP) concentrations in nine patients with early dumping, 10 surgical control subjects and nine healthy control subjects after an oral glucose challenge preceded by either placebo or 25 micrograms of octreotide subcutaneously (s.c.). In the dumping group, basal PRA was significantly (P < 0.01) higher (3.9 +/- 0.6 micrograms L-1 h-1) than in either surgical or healthy control subjects (1.1 +/- 0.3 micrograms L-1 h-1 and 1.1 +/- 0.2 micrograms L-1 h-1 respectively) and showed a significant rise after glucose ingestion to 5.4 +/- 0.9 micrograms L-1 h-1 that did not occur in control subjects. Aldosterone concentration showed a concomitant rise. In dumping patients, plasma ANP decreased after glucose ingestion from 31 +/- 6 ngL-1 to 21 +/- 5 ngL-1 (P < 0.05). This decrease did not occur in control subjects. Early dumping is associated with an activation of the renin-aldosterone axis and a decrease in plasma ANP, reflecting a hypovolaemic state. Octreotide prevents the occurrence of these changes.
Assuntos
Síndrome de Esvaziamento Rápido/sangue , Síndrome de Esvaziamento Rápido/tratamento farmacológico , Fármacos Gastrointestinais/administração & dosagem , Octreotida/administração & dosagem , Adulto , Idoso , Aldosterona/sangue , Fator Natriurético Atrial/sangue , Síndrome de Esvaziamento Rápido/induzido quimicamente , Hematócrito , Humanos , Pessoa de Meia-Idade , Placebos , Renina/sangueRESUMO
BACKGROUND: Gastrointestinal intolerance is observed more frequently during intraduodenal (ID) tube feeding than during intragastric (IG) feeding, possibly because it evokes a stronger gastrointestinal response and accelerates small bowel transit. We have investigated whether the accelerated small bowel transit during ID feeding results from alterations in antroduodenal motility pattern. DESIGN: The effect of IG and ID infusion of a polymeric diet (Nutrison, 125 kcal h-1) on antroduodenal motility, small bowel transit time (SBTT) and gastrointestinal hormone release was studied in nine healthy subjects. These subjects were studied on three occasions for 6 h during fasting, continuous IG or ID feeding. RESULTS: Phase III recurrence time was significantly prolonged during IG feeding compared with fasting (240 +/- 51 vs. 136 +/- 24 min; P < 0.05). None of the subjects had recurrence of phase III during ID feeding; the fed motor pattern remained present. Parameters of fed motility (mean amplitude and motility index) were not significantly different between IG and ID feeding, although the frequency of antral and duodenal contractions was lower during ID than during IG feeding. SBTT was significantly accelerated during ID compared with IG feeding and with fasting (58 +/- 8 vs. 73 +/- 9 and 83 +/- 10 min respectively; P < 0.05). Plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) levels were significantly higher during ID than during IG feeding. Peptide YY (PYY) levels were significantly higher during ID than during fasting, but not during IG feeding CONCLUSIONS: During intraduodenal feeding, a fed motility pattern is preserved, whereas during intragastric feeding transition from a fed to a fasting motor pattern is observed in over 50% of the subjects. These differences may be related to augmented hormone release during intraduodenal feeding.