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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although percutaneous transhepatic biliary drainage (PTBD) restores hepatic and renal function in patients with obstructive jaundice, it is not certain whether it reduces the rate of complications and death after biliopancreatic surgery. We studied the possibility that the operative risks of jaundiced patients are related to malnutrition and the usefulness of hyperalimentation with PTBD to reduce the incidence of complications. Sixty-four patients with obstructive jaundice and serum bilirubin greater than 200 mumol/l were randomized into two treatment groups (n = 32) with PTBD or PTBD + hyperalimentation. Four patients were withdrawn from the latter group, two for metastatic cancer and two for complications of PTBD. Before starting hyperalimentation, the incidence of malnutrition was assessed by biochemical, immunological and anthropometric tests: malnutrition was found in 70 per cent of the patients. All the patients had good recovery of hepatic function but patients treated with PTBD alone still had high mortality (12.5 per cent) and morbidity (46.8 per cent) after biliopancreatic surgery. When hyperalimentation was provided to patients on PTBD for a period of 20 days before the operation, the incidence of complications fell to 17.8 per cent and mortality to 3.5 per cent. These results suggest that the combined use of PTBD and hyperalimentation, improving both hepatic function tests and the nutritional status of jaundiced patients, can reduce the rate of complications after biliary and pancreatic surgery.
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PMID:Hyperalimentation of jaundiced patients on percutaneous transhepatic biliary drainage. 309 94

Sixteen patients given total pancreatectomy were experienced, and the essential points of postoperative management were reported. The morbid states after total pancreatectomy consist of: a deficiency of pancreatic endocrine function, a deficiency of pancreatic exocrine function, loss of the duodenum and upper jejunum, the influence of partial or total gastrectomy, and the influence of dissection around the superior mesenteric artery. These states influence each other and become more complicated. The management period is divided into five parts as follows; a period of intravenous nutrition, the early half; water replacement period, the late half; hyperalimentation period, a period of intravenous and enteral nutrition, a period of enteral, intravenous and oral nutrition, a period of oral and enteral nutrition, and a period of oral nutrition. In each period, a special form of management is needed. The essential points of long-term management are as follows: The use of suitable doses of pancreatic enzyme and antidiarrheal agents for the cure of severe maldigestion and malabsorption. Also, intermittent IVH or elemental diet are effective for recovery from deteriorative malnutrition. For the prevention of hypoglycemic attack, training of the patients and the maintainance of good nutrition are important. These patients have a high incidence of infection, and so speedy treatment must be given if this occurs. Fatty liver must be treated by intermittent IVH or elemental diet. As total pancreatectomy imposes a severe burden on the patient, including self-injection of insulin, the indications of this operation must be decided carefully giving due consideration to its radicality.
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PMID:[Postoperative management of total pancreatectomy]. 309 14

In summary, the association between malnutrition and infections, including respiratory infections, seems clear from consistent experience in developing nations. Young children are at the greatest risk, both of severe malnutrition and complicating infections. The cell-mediated immune system is the most affected by protein-calorie malnutrition, but antibody responses are also affected and complement levels are low. Infections with organisms handled by cell-mediated immunity would be the most predictable, but the immunoglobulin responses that are important for opsonization of invading microorganisms may also be impaired. The experience in developing nations has been extrapolated to patients in US hospitals, because hospitalized patients often have one or more abnormal nutritional parameters. However, severe malnutrition of the sort found in children in developing nations is uncommon in hospitalized patients, and the effects of malnutrition on host defenses in adults are likely to be less severe than in children. Whether the degrees of malnutrition that have been described in hospitalized patients produce clinically significant effects on antibacterial defenses in the lungs of adults remains uncertain. Despite the intuitive importance of nutritional support, and the repeated observation that nutritional parameters improve with nutritional support, a number of controlled trials have failed to show a clear improvement in patient outcome with aggressive nutritional therapy, including parenteral hyperalimentation. The results of these studies, together with the risks involved in parenteral alimentation have led some to suggest that "the emperor has no clothes," and that aggressive nutritional support is not worthwhile for most patients. The major problem in interpreting the data is the lack of clear clinical endpoints, and this may obscure potentially important responses to nutritional therapy. Nutritional status is only one of many interacting variables that may affect clinical outcome, particularly in patients in critical care units. Survival usually depends on many factors, particularly the status of major organ systems independent of nutrition, so that survival as an endpoint for nutritional studies is likely to be too insensitive. Prospective studies of the incidence and significance of infections, particularly pneumonia, in malnourished patients and the effects of nutritional therapy are lacking. At present, the prudent approach is to treat infections aggressively in malnourished patients, with antibiotics and drainage if necessary, and to provide nutritional supplementation in all patients via the gut as long as possible.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The relationship between malnutrition and lung infections. 311 82

Hospital malnutrition occurs in a majority of surgical patients and contributes to delayed wound healing, a longer recovery time, increased morbidity and mortality rates, an increased infection rate, and decreased stamina. With the advances in the past 10 years in safe delivery of amino acids and fat emulsions peripherally, and with the ability to deliver hyperalimentation by a central venous line, patients can be fed enough calories, fat, and protein to prevent malnutrition or to treat it. Recognition and prevention of hospital malnutrition is a mandatory aspect of delivering good patient care. Offering advanced technology, skilled surgeons, and advanced-practice nursing care to the patient, without acknowledging his basic needs, reminds one of the ironic saying, "The operation was a success, but the patient died." The nurse has a special role in assessment and treatment of malnutrition in the hospitalized patient.
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PMID:Malnutrition and wound healing. 327 49

Infection, particularly that involving the respiratory tract, is commonly seen in the patient with ARDS. It can be either an etiologic factor leading to the syndrome or a complicating factor leading to a high likelihood of mortality. Pneumonia develops in up to 70% of individuals with ARDS, and when present, converts the syndrome to its most severe and mortal form. In addition, when systemic injury coexists with any type of infection, ARDS will develop with an increased frequency. Nosocomial pneumonia results when upper and lower respiratory tract defenses fail and these sites are overwhelmed by bacteria. Colonization of the oropharynx and tracheobronchial tree, both of which are common in critically ill patients, precedes the development of pneumonia. In the patient with ARDS, all levels of host antibacterial defenses may be impaired, thus accounting for the high incidence of both colonization and pneumonia. These impairments result from the acute lung injury itself, coexisting systemic illnesses, therapeutic interventions, and acquired malnutrition. Once pneumonia develops in the course of acute lung injury, diagnosis is exceedingly difficult and potentially inaccurate. With proper application of the protected specimen brush, inserted bronchoscopically, diagnostic accuracy may improve. Therapy must be undertaken early and with agents directed at likely pathogens, particularly P. aeruginosa and other gram-negative bacilli. In the future, preventive efforts against pneumonia may be effective for the ARDS patient. Strategies that may be effective include hyperalimentation, judicious use of all pharmacotherapy, active and passive antibacterial vaccines, airway microenvironment manipulation, and the use of aerosolized antibiotics.
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PMID:The interaction of infection and the adult respiratory distress syndrome. 333 58

Diet-induced thermogenesis (DIT) is defined as a regulatory, facultative component of energy expenditure, stimulated by overeating, which helps maintain energy balance. DIT may play a central role in the regulation of energy expenditure and in the etiology of certain types of obesity. Most experiments testing the existence or the mechanisms of DIT have used the cafeteria diet for the purposes of stimulating hyperphagia, a requisite for studies of DIT. Yet such a diet is inappropriate for studies of thermogenesis because its use prevents researchers from obtaining an experimental outcome that can be clearly interpreted. The primary limitation of the cafeteria diet is that its nutritional composition is uncontrolled. The diet is self-selected from a variety of supermarket foods that tend to be high in fat and/or carbohydrate and low in protein, vitamins and minerals. Hence, the diets consumed by the animals are likely to be deficient in protein, vitamins or minerals. There is evidence that dietary deficiency of protein, vitamins and minerals can increase thermogenesis and in protein-adequate diets, the balance of fat and carbohydrate in the diet can also influence thermogenesis with high carbohydrate diets increasing thermogenesis more than isoenergetic high fat diets. Hence, an observed increase in thermogenesis in cafeteria fed animals might be interpreted incorrectly to be the result of increased energy consumption when it is attributable to dietary imbalance or deficiency. Because the diet is self-selected, it is possible for each animal to choose a diet that varies in nutritional composition from that selected by every other animal, so control of dietary intake is compromised.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The cafeteria diet--an inappropriate tool for studies of thermogenesis. 355 6

Seventy-six patients with closed head injuries alone were studied to define the relation between the severity of the head injury and secondary alterations of general metabolism. The effect of metabolic changes on neurological outcome and the importance of nutritional support on nutritional status and neurological outcome were also evaluated. Using a powerful statistical tool, convergence analysis, it was possible to take into consideration the effects of a number of confounding factors that obviously affected general metabolism. Most of the patients were hypermetabolic for prolonged periods. In addition, many did not receive even basal requirements of calories or protein for many days. Despite this, their outcomes were determined by their initial neurological status and the amounts that they were fed, admittedly relatively modest, did not influence their courses. Despite such feedings, their visceral protein levels, which often dropped initially, rose toward normal levels, indicating effective adaptation. Indeed, it could not be shown that these patients developed complications of malnutrition such as infections. However, it will require a sophisticated randomized clinical trial of vigorous intravenous hyperalimentation to determine whether this complex, dangerous, and expensive therapy is helpful for severely head-injured patients.
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PMID:General metabolism in head injury. 356 33

Undernutrition limited to the first two weeks (trimesters) of pregnancy in rats produces a delayed-onset enhancement of body weight and food intake in male but not female offspring. Adiposity measures (fat cell size, fat pad weight and carcass lipid content) however, were enhanced only in male offspring of previously deprived mothers maintained on a high-fat diet. Previous work had shown that although these adiposity differences are enhanced by this diet, hyperphagia was eliminated when animals were switched to the high-fat diet as adults. The current study demonstrates that if offspring of deprived animals are exposed to the high-fat diet early in life, hyperphagia ensues. Adipocyte number, and circulating triglyceride levels were unaffected by our nutritional manipulation.
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PMID:The effect of diet on food intake and adiposity in rats made obese by gestational undernutrition. 374 96

When scleroderma involves the small intestines, malnutrition with resulting immune incompetence and sepsis can occur. Two cases are presented in which patients with scleroderma involving the gastrointestinal tract were treated with cyclic home hyperalimentation, restoring their nutritional status and improving their quality of life.
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PMID:The use of cyclic home hyperalimentation for malabsorption in patients with scleroderma involving the small intestines. 393 Jul 71

Debilitating cancer cachexia is multifactorial, but many of the etiologies and most of the resulting effects are similar to those seen in malnourished patients without cancer. From the work in human beings and experimental animals, nutritional support of the tumor-bearing host can replenish lean body mass, visceral protein components, and immunocompetence. This induction of anabolism, however, depends on time, content, the method of administration of hyperalimentation solutions; the initial and continuing catabolic response of the patient, as well as the degree of initial malnutrition; the energy expenditure of the patient required during oncologic therapy; and the expertise of the physician administering nutritional support. Increased tumor stimulation resulting from intravenous hyperalimentation (IVH) has never been observed in humans; the stimulatory effects of IVH on animal tumor systems have been identified only in previously depleted animals, and then growth rates have not been out of proportion to that of the host or to that of otherwise healthy animals. Animal data suggest that tumor growth characteristics can be affected by nutritional state and the exact substrates administered, ie, amino acids, carbohydrates, or fat. Further evidence suggests that the apparent enhanced tumor growth can be used to increase responsiveness to cell cycle-specific chemotherapeutic agents during nutritional repletion. Current evidence supports the use of intravenous hyperalimentation in malnourished cancer patients who have effective oncologic therapeutic options; such patients should not be denied these options simply on the basis of severe nutritional cachexia.
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PMID:Intravenous hyperalimentation as nutritional support for the cancer patient--an update. 393 74


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