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

The history of burns treatment in Sweden shows that not until an organized Burns Unit was established in 1954 was there any real progress in this field. From that date and onward the treatment of burns has continuously been improved based on results from experimental and clinical research. It is interesting to note that most of the burn research during this period has slowly changed from description of different organ failures towards studies of functional disturbances on cell level. The resuscitation following thermal injury is nowadays usually under control. The greatest problems arise later, caused by hypermetabolism, malnutrition and burn wound sepsis. The combined treatment with aggressive surgery, hyperalimentation, environmental control, avoidance of multiple organ failure etc., mainly based on results from the last 20 years of burn research, has significantly increased the survival rate of severe thermal injuries.
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PMID:The history of burns treatment in Sweden. 642 48

The present study investigated the feasibility of basal continuous subcutaneous insulin infusion (CSII) in four patients with postoperative sepsis or extensive burns during continuous enteral hyperalimentation with 2,500 to 3,000 calories/day, containing approximately 390 g of simple carbohydrates. The mean duration of CSII treatment was 16.8 days (range, seven to 32 days). The mean capillary blood glucose level fell from 322 +/- 52 mg/dL during pre-CSII therapy to 195 +/- 33 mg/dL during CSII therapy. Only 1.3% of 1,254 capillary blood glucose values were less than 60 mg/dL. Most values (61.6%) were between 61 and 200 mg/dL. The mean insulin infusion rate was 2.5 +/- 1.5 units/hr. These preliminary observations suggest that basal infusion CSII is a safe and effective means of improving blood glucose control in patients receiving enteral hyperalimentation despite the high glucose intake and presence of insulin resistance. Thus, CSII therapy can enhance the metabolic response to hyperalimentation without requiring an intravenous access route.
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PMID:Insulin pump therapy improves blood glucose control during hyperalimentation. 643 58

Twenty-one consecutive patients with pancreatic abscess were managed by an open packing technique. Despite an anticipated mortality of less than 65 per cent predicted by Ranson's prognostic signs, the mortality in this group of patients was only 14 per cent. The marked improvement in results was attributed to several factors: earlier diagnosis and surgical intervention based upon serial abdominal tomography; prevention of persistent or recurrent sepsis by frequent scheduled dressing changes, and prevention of frequently related complications. Seven patients were found to have significant anaerobic involvement. All wounds were permitted to heal by secondary intention, and each patient received intravenous hyperalimentation. The average duration of hospitalization was 76 days, a period not differing significantly from that required by conventional closed methods of drainage. Open packing of pancreatic abscesses appears to represent a significant advance in the management of these difficult patients.
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PMID:Open treatment of pancreatic abscess. 643 21

The coexistence of malignancy and dysphagia makes nutritional deprivation especially serious in patients with carcinoma of the esophagus. Intravenous hyperalimentation (IVH) is often given and should be of particular value in these patients. Sixty-four patients with carcinoma of the esophagus seen between January, 1975, and February, 1982, were studied retrospectively during their first hospitalization for the disease. Thirty-seven patients received IVH, and 27 did not. There were no significant differences at the time of admission to the hospital between the two groups with respect to age, sex, pathological status, and location of the carcinoma. Also, there was no difference in the incidence of hypoalbuminemia (less than 3 gm/dl) or lymphocytopenia (less than 1,500/mm3). More patients in the IVH group underwent surgical resection of the esophagus. Surgical intervention did not significantly influence hospital mortality. The IVH therapy reduced weight loss (p less than 0.05), but was associated with an increased incidence of pulmonary sepsis (p less than 0.05) and longer hospital stay. The incidence of hypoalbuminemia and lymphocytopenia increased between admission and the end of hospitalization, but it did not significantly differ between the groups. Thus, one cannot assume the effectiveness of IVH in this clinical setting, as its value was not demonstrated in this retrospective series. A prospective randomized study is warranted in view of the high cost and the doubtful clinical impact of an IVH regimen in patients with carcinoma of the esophagus.
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PMID:Clinical impact of intravenous hyperalimentation on esophageal carcinoma: is it worthwhile? 643 36

The treatment for pulmonary edema with the adult respiratory distress syndrome is aimed at the early supportive management of hypovolemic shock. The addition of massive corticosteroid dosage, Methylprednisolone Succinate, of 30 mg/kg body wt/dose ever six hours for a 24-48 hour period has been shown in our investigation to be efficacious, particularly in the traumatic and septic shock groups of patients but not in patients with multiple system diseases. Ventilator care utilizing constant positive pressure breathing or constant positive airway pressure in the patient who has spontaneous respirations is of prime importance. The recent utilization of hyperalimentation has also been very effective as an adjunctive therapy and should be used in the management of this problem in the future in conjunction with the steroids. Hemodynamic monitoring employing the specific parameters as delineated in our discussion are all major steps that should be pursued on a routine basis in the vast majority of these patients. The most important factor in the prognosis of this condition is the severity and number of injuries that have occurred at the time of the initial trauma. Other factors affecting the outcome are age, prolonged shock, associated degenerative cardiovascular disease, metabolic imbalance, severe multiple system involvement, and sepsis. We now feel that the utilization of massive corticosteroid therapy is indicated with the first earliest clinical signs of this condition in order to attempt to prevent complications and probably improve survival rate.
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PMID:Acute pulmonary edema with respiratory failure--newer concepts in therapy. 675 Nov 64

Over an 8-year period, 106 patients with cancer who were major operative risks received intravenous hyperalimentation (IVH). All were malnourished, had gastrointestinal obstruction or had postoperative complications such as fistulas, evisceration or intra-abdominal sepsis, which left IVH as the only means of achieving anabolism. When IVH was started preoperatively and continued postoperatively (34 patients), no deaths or major complications occurred. When IVH was first started after serious complications had occurred (62 patients), the incidence of recovery was high; the mortality was 17.7%. When IVH was given to cachectic patients whose cancer was inoperable to enable them to tolerate radiotherapy or chemotherapy (10 patients), the mortality was 40.0%. Although this last group is small, IVH is worthwhile in selected patients in whom good palliation life can be obtained. With careful IVH and improvement in the quality of technique, the risk of sepsis was no greater than in patients without cancer.
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PMID:Hyperalimentation and cancer. 676 42

Management of protein-calorie malnutrition found in 32 patients with severe liver diseases such as fulminant hepatitis and cirrhosis of the liver was carried out using 2 types of synthetic amino acid solution (Hep-OU and Fischer solution) for intravenous and enteral alimentations with rapid monitoring of serum aminogram. Intravenous hyperalimentation of these cases resulted in maintenance of nutritional status with improvement of nitrogen balance and normalization of impaired serum aminogram. During this study, however, nutritional support was initiated only when intractable ascites, upper gastrointestinal bleeding and hepatic encephalopathy were observed. In 2 cases of fulminant hepatitis with sepsis and 3 hepatoma patients with ascites, elemental diet containing maltose and amino acids was used to supply sufficient amounts of nutrients in a minimum volume of water. These techniques with simultaneous monitoring of urinary excretion of 3-methylhistidine and creatinine height index as nutritional parameters make nutritional management easy for patients with liver disease.
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PMID:Nutritional management of patients with severe liver disease by using intravenous hyperalimentation and elemental diet. 676 41

This case exemplifies the severe gastrointestinal manifestations of scleroderma. Esophageal, gastric, small intestinal, and colonic motility disorders were present. The patient was unable to survive on oral feedings or tube feedings. He was clinically resistant to the pharmacologic stimulation of gastrointestinal motility. After considerable discussion the patient was begun on intravenous hyperalimentation to be performed at home. Approximately 1 hr later, he has done remarkably well. He has maintained his weight and has had only one brief hospitalized for a sepsis most likely related to the intravenous feedings. He is still unable to take oral feedings. Other organs have remained clinically uninvolved, and the skin and joint disease have remained stable. It is our feeling that intravenous home alimentation has provided a useful adjunct to management in this patient with severe gastrointestinal involvement of scleroderma. It is hoped that the newer therapeutic modalities described by Dr. Jimenez may be effective in patients with this disease who can now be nourished parenterally.
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PMID:The gastrointestinal manifestations of scleroderma: pathogenesis and management. 676 49

Immunocompetence was measured in 320 gastrointestinal surgery patients using the delayed hypersensitivity test. The frequency of complications and death from sepsis was greater (p less than 0,001) in anergic patients (39%) than in patients with normal response (5%). A close correlation was observed between anergy and malnutrition as determined on the basis of biological criteria (triceps skinfold, arm circumference, ratio between actual and deal weights). This double correlation led to study the influence of hyperalimentation on immune response and prognosis. Parenteral hyperalimentation with nitrogen and calories was administered to 26 anergic patients with heavy or complicated intestinal surgery (peritonitis) for from 10 to 37 days (av.: 19, 2 days). One or more test(s) had turned positive by the 10th day in 7 patients; by the 30th day in 16 and by the 69th day in 20. Out of 26 anergic patients, 19 were nutritionally normal; hyperalimentation had no influence on biological criteria and began to modify body measurements only after 17 days; in the 16 anergic malnourished patients,, hypernutrition led to the development of a positive nitrogen balance (3,60 +/- 1,7 days) and to a return within normal range of biological criteria (7,2 +/- 2,3 days), and body measurements (14,3 +/- 9,2 days). Death from sepsis in anergic patients with hyperalimentation was lower (11,2% and 44,4%; p less than 0,01) than in anergic ones without hyperalimentation. Hyperalimentation with nitrogen and calories modified the nutritional status, immunological response and improved prognosis in anergic patients.
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PMID:[Hyperalimentation after digestive surgery: influence on immune state and on prognosis (author's transl)]. 678 Sep 72

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84


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