Prolonged enteral nutrition in malnourished patients with nonelemental feeding. Reappraisal of surgical technique, safety, and costs.

Abstract:

:In a 2 year period, 60 consecutive feeding enterostomies were placed in malnourished patients. The major complication rate was 1.6 percent. Total complications were 8 percent. Thirty day mortality was 13 percent. Nearly all patients were given isosmotic nonelemental diets. The incidence of diarrhea was 2 percent with this regimen. Four of five patients given elemental diets had diarrhea. Serum albumin levels increased significantly from a preoperative mean of 2.75 to 3.03 g/dl. Best overall results were achieved in patients undergoing upper gastrointestinal surgery or pancreatobilary procedures for nonmalignant lesions. More than $60,000 was saved in 2 years by substituting isosmotic formulas for elemental ones. It appears that many patients are given elemental formulas who do not actually require them. Since isosmotic solutions will not infuse through needle catheters, we advocate placing 12 F. catheters and have documented the safety of this change. By using these larger catheters, the surgeon will not lose the option of using isosmotic preparations. We have shown these preparations to be nutritionally effective with a marked lessening of diarrhea and a cost approximately a sixth of that of elemental products.

journal_name

Am J Surg

authors

Hinsdale JG,Lipkowitz GS,Pollock TW,Hoover EL,Jaffe BM

doi

10.1016/s0002-9610(85)80102-1

subject

Has Abstract

pub_date

1985-03-01 00:00:00

pages

334-8

issue

3

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(85)80102-1

journal_volume

149

pub_type

杂志文章
  • Does donor race still make a difference in deceased-donor African-American renal allograft recipients?

    abstract:BACKGROUND:Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss. METHODS:We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n=35) versus a Caucasian donor (C group; ...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2009.08.025

    authors: Brown KL,Doshi MD,Singh A,Mehta K,Morawski K,Cincotta E,West MS,Gruber SA

    更新日期:2010-03-01 00:00:00

  • Verrucous carcinoma, then and now.

    abstract::The salient clinical and pathological features of verrucous carcinoma, as first described by Ackerman in 1948, are reviewed. Two case reports are presented. The first concerns a personal experience with a patient who had five surgical procedures for multifocal oral verrucous carcinoma and remains alive and well 28 yea...

    journal_title:American journal of surgery

    pub_type: 传,历史文章,杂志文章

    doi:10.1016/s0002-9610(98)00232-3

    authors: Spiro RH

    更新日期:1998-11-01 00:00:00

  • Temporary closure of the abdomen using a new composite prosthesis (PL-PU99).

    abstract:BACKGROUND:Temporary abdominal wound closure is sometimes desirable when tension-free approximation of the wound edges is impractical or when reexploration is planned. METHODS:The behavior of a composite prosthesis (PL-PU99) designed by our group was evaluated as a method of temporary abdominal closure in white New Ze...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2004.06.014

    authors: Bellón JM,García-Honduvilla N,Carnicer E,Serrano N,Rodríguez M,Buján J

    更新日期:2004-09-01 00:00:00

  • Necrotizing pancreatitis: A review for the acute care surgeon.

    abstract:BACKGROUND:Necrotizing pancreatitis is a common condition with high mortality; the acute care surgeon is frequently consulted for management recommendations. Furthermore, there has been substantial change in the timing, approach, and frequency of surgical intervention for this group of patients. METHODS:In this articl...

    journal_title:American journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1016/j.amjsurg.2020.08.027

    authors: Leonard-Murali S,Lezotte J,Kalu R,Blyden DJ,Patton JH,Johnson JL,Gupta AH

    更新日期:2020-08-26 00:00:00

  • George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer?

    abstract:BACKGROUND:We sought to determine the number of patients with known breast cancer who were found to have an additional, mammographically occult lesion detected on breast-specific gamma imaging (BSGI). METHODS:An institutional review board-approved review of all patients who underwent BSGI at Beth Israel Medical Center...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2009.06.016

    authors: Killelea BK,Gillego A,Kirstein LJ,Asad J,Shpilko M,Shah A,Feldman S,Boolbol SK

    更新日期:2009-10-01 00:00:00

  • Possible mechanism of the synergistic effect of heparin and dihydroergotamine.

    abstract::A combination of heparin and dihydroergotamine mesylate (Heparin-Dihydergot) has been shown to be more effective than either of these drugs alone in preventing postoperative venous thromboembolism. The possible mechanism for the synergistic effect of heparin and dihydroergotamine was assessed. Phlebograms obtained aft...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:

    authors: Kakkar VV,Welzel D,Murray WJ,Malone P,Jones D

    更新日期:1985-10-08 00:00:00

  • Pancreatic islet autotransplantation: results in dogs with chronic duct ligation.

    abstract::The influence of pancreatic acinar cell atrophy and fibrosis on islet tissue autotransplantation was studied in dogs. Thirty-nine dogs underwent pancreatic duct ligation. After 6 weeks marked acinar cell atrophy and fibrosis developed, similar to that in human chronic pancreatitis. Intravenous glucose tolerance testin...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/0002-9610(80)90248-2

    authors: Mehigan DG,Zuidema GD,Eggleston JC,Cameron JL

    更新日期:1980-02-01 00:00:00

  • Variations in the utilization of immediate post-mastectomy breast reconstruction.

    abstract:BACKGROUND:For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical locat...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2019.07.025

    authors: Nayyar A,Strassle PD,Reddy KG,Jameison DI,Moses CG,Roughton MC,McGuire KP,Gallagher KK

    更新日期:2019-10-01 00:00:00

  • Using a video conference to teach clinical clerks in a one-week cardiothoracic clerkship.

    abstract:BACKGROUND:Students report that their operating room experience during specialty clerkships has been less than satisfactory. To deal with this and other problems in a 1-week cardiothoracic clerkship, a video conference system was introduced. METHODS:Three teaching strategies were used: a seminar dealing with the disea...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/s0002-9610(96)00387-x

    authors: Amiel GE,Cohen R,Amar R,Sarafov I,Safadi T,Saute M,Porat E,Sharony R,Bolotin G,Tann M,Uretzky G

    更新日期:1997-04-01 00:00:00

  • Timing of treatment for nonneutropenic patients colonized with Candida.

    abstract::There has been a continuing evolution of the clinical spectrum of Candida infection in nonneutropenic patients. With better understanding of the predisposing factors for fungemia in critically ill patients, interest now centers on indications for early therapy, prior to the progression of colonization to fungemia. Rec...

    journal_title:American journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1016/s0002-9610(96)00350-9

    authors: Solomkin JS

    更新日期:1996-12-01 00:00:00

  • A retrospective study of diagnosis and management of mesenteric vein thrombosis.

    abstract:BACKGROUND:Mesenteric vein thrombosis (MVT) is an uncommon type of intestinal ischemia associated with significant mortality and morbidity because of its delay in diagnosis. METHODS:A retrospective analysis of 9 patients treated surgically for MVT during 1982 to 1997 was performed. RESULTS:Nine patients underwent sur...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/s0002-9610(00)00532-8

    authors: Divino CM,Park IS,Angel LP,Ellozy S,Spiegel R,Kim U

    更新日期:2001-01-01 00:00:00

  • Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism.

    abstract:BACKGROUND:The aim of this study was to determine whether minimally invasive radioguided parathyroidectomy (MIRP) and intraoperative parathyroid hormone-guided parathyroidectomy (ioPTH) have equivalent intermediate-term outcomes in primary hyperparathyroidism (PHPT). METHODS:A retrospective study of 244 patients who u...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2010.10.015

    authors: Nagar S,Reid D,Czako P,Long G,Shanley C

    更新日期:2012-02-01 00:00:00

  • Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication.

    abstract:BACKGROUND:It has been suggested that division of the short gastric vessels (SGV) provides a more floppy Nissen fundoplication, for the treatment of reflux disease. The aim of the study was to assess whether Nissen fundoplication with division of SGV is associated with improved clinical outcome and laboratory findings....

    journal_title:American journal of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0002-9610(01)00695-x

    authors: Chrysos E,Tzortzinis A,Tsiaoussis J,Athanasakis H,Vasssilakis J,Xynos E

    更新日期:2001-09-01 00:00:00

  • Thrombotic thrombocytopenic purpura: indications for and results of splenectomy.

    abstract:BACKGROUND:Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder of unknown pathophysiology. The role of splenectomy in the multimodality therapy of TTP is controversial. MATERIALS AND METHODS:All charts of patients with TTP at the University of Utah between 1984 and 1994 were reviewed to eval...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/s0002-9610(99)80015-4

    authors: Winslow GA,Nelson EW

    更新日期:1995-12-01 00:00:00

  • Surgical significance of the histopathology of the common bile duct.

    abstract::Silver biopsies of the common bile duct were obtained from 15 patients with clinical and surgical evidence of cholangitis. The most pronounced histologic changes were edema, congestion, and marked mucous gland hypertrophy and hyperplasia. No ulceration, intramural abscess, or areas of necrosis were found. Clinical cho...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/0002-9610(79)90089-8

    authors: Schein CJ,Mahadevia P

    更新日期:1979-06-01 00:00:00

  • Results of BCG adjuvant immunotherapy in 100 patients with epidermoid carcinoma of the head and neck.

    abstract::One hundred patients with advanced, recurrent, or metastatic squamous cell carcinoma of the head and neck were treated with chemotherapy and BCG as adjuvant immunotherapy. The overall response rate was 35 per cent, and the median duration of response was seventeen weeks. BCG does not prolong duration of remission or s...

    journal_title:American journal of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/0002-9610(77)90381-6

    authors: Suen JY,Richman SP,Livingston RB,Hersh EM,Craig R,Tonymon K

    更新日期:1977-10-01 00:00:00

  • Innovative introduction to surgery in the preclinical years.

    abstract:BACKGROUND:Lack of exposure to surgery in the preclinical years of medical school contributes to students' negative opinions of the field and to low application rates to categorical surgical programs. METHODS:Forty preclinical medical students attended a series of 16 seminars and practice sessions covering the gamut o...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2006.12.038

    authors: Riboh J,Curet M,Krummel T

    更新日期:2007-08-01 00:00:00

  • The blood supply of experimental liver metastases. V. Increased tumor perfusion with epinephrine.

    abstract::The effects of epinephrine on the vascular perfusion of solitary Walker tumors implanted in the liver were studied in Sprague-Dawley rats. Colored silicone rubber (Microfil) solutions were injected into the arterial and portal circulations in each animal, and specimens were studied under a stereomicroscope. Internal v...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/0002-9610(80)90044-6

    authors: Ackerman NB,Hechmer PA

    更新日期:1980-11-01 00:00:00

  • Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures.

    abstract:BACKGROUND:We hypothesized that early use of external mechanical compression (EMC) reduces hemorrhage and mortality associated with pelvic fractures. METHODS:Patients with pelvic fractures and one of the following risk factors for hemorrhage were studied retrospectively: (1) unstable fracture pattern, or (2) any fract...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2007.08.040

    authors: Ghaemmaghami V,Sperry J,Gunst M,Friese R,Starr A,Frankel H,Gentilello LM,Shafi S

    更新日期:2007-12-01 00:00:00

  • Rurality and cancer surgery in the United States.

    abstract:BACKGROUND:Rurality adversely impacts the continuum of cancer care. However, investigations of rural cancer surgery are notably absent. We examined patterns and outcomes of oncologic resections at rural US hospitals. METHODS:We identified 928,370 hospital admissions in which 1 of 20 oncologic resections was performed ...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2012.07.012

    authors: Markin A,Habermann EB,Chow CJ,Zhu Y,Vickers SM,Al-Refaie WB

    更新日期:2012-11-01 00:00:00

  • Educational intervention is effective in improving knowledge and confidence in surgical ethics-a prospective study.

    abstract:BACKGROUND:Professionalism and ethics are Accreditation Council for Graduate Medical Education (ACGME) core competencies, but there is little evidence regarding the effectiveness of ethics education. METHODS:General surgery residents at the University of Pittsburgh completed questionnaires measuring attitudes and know...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2010.08.002

    authors: Thirunavukarasu P,Brewster LP,Pecora SM,Hall DE

    更新日期:2010-11-01 00:00:00

  • Why saying what you mean matters: An analysis of trauma team communication.

    abstract:BACKGROUND:We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork. METHODS:Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded fo...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2017.11.008

    authors: Jung HS,Warner-Hillard C,Thompson R,Haines K,Moungey B,LeGare A,Shaffer DW,Pugh C,Agarwal S,Sullivan S

    更新日期:2018-02-01 00:00:00

  • Mental skills training effectively minimizes operative performance deterioration under stressful conditions: Results of a randomized controlled study.

    abstract:BACKGROUND:Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress. METHODS:Twenty-four residents were stratified then randomized to receive mental skills and FLS tr...

    journal_title:American journal of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.amjsurg.2017.09.039

    authors: Anton NE,Beane J,Yurco AM,Howley LD,Bean E,Myers EM,Stefanidis D

    更新日期:2018-02-01 00:00:00

  • Control of postcarotid endarterectomy hypotension with baroreceptor blockade.

    abstract::The reported incidence of hypotension after carotid reconstruction ranges from 21 to 50 percent. To evaluate baroreceptor dysfunction, 283 carotid reconstructions were studied. During 181 consecutive reconstructions, a transcutaneous Teflon catheter was positioned intraoperatively at the carotid bifurcation for postop...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/0002-9610(84)90196-x

    authors: Pine R,Avellone JC,Hoffman M,Plecha FR,Swayngim DM Jr,Urban J

    更新日期:1984-06-01 00:00:00

  • Weekly e-mailed teaching tips and reading material influence teaching among general surgery residents.

    abstract:BACKGROUND:A nonintrusive e-mail reminder incorporating teaching tips and manuscripts was developed to supplement resident-as-teacher curricula. METHODS:Ten high-yield manuscripts and 10 teaching tips exemplifying the themes of mentorship or role modeling, teaching methods, adult learning theory, feedback, and the res...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2016.05.004

    authors: Watkins AA,Gondek SP,Lagisetty KH,Castillo-Angeles M,Gangadharan SP,Cahalane MJ,Kent TS

    更新日期:2017-01-01 00:00:00

  • Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection.

    abstract::A series of 168 patients who underwent 177 inguinal lymph node dissections from 1979 to 1989 were retrospectively reviewed to determine the incidence and severity of postoperative complications as well as the perioperative risk factors associated with them. Operative mortality was 0%, whereas the incidence of moderate...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/s0002-9610(05)81181-x

    authors: Beitsch P,Balch C

    更新日期:1992-11-01 00:00:00

  • Impact of intraoperative myocardial tissue acidosis on postoperative adverse outcomes and cost of care for patients undergoing prolonged aortic clamping during cardiopulmonary bypass.

    abstract:BACKGROUND:This study examined the impact of intraoperative myocardial acidosis and adverse postoperative outcomes on the cost of cardiac surgical care. METHODS:Myocardial tissue pH corrected to 37 degrees C (pH(37C)) was measured in 162 patients with cross-clamp (XC) duration of 119 minutes or longer. Perioperative d...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/j.amjsurg.2008.01.023

    authors: Healey CM,Kumbhani DJ,Healey NA,Crittenden MD,Gibson SF,Khuri SF

    更新日期:2009-02-01 00:00:00

  • A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement.

    abstract:BACKGROUND:Percutaneous endoscopic gastrostomy and jejunostomy tube placement have long been considered the standard for supplying enteral nutrition when oral intake is not possible. Both have well-documented roles and limitations and are associated with a higher than generally appreciated incidence of aspiration. A di...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/s0002-9610(98)00298-0

    authors: Rosser JC Jr,Rodas EB,Blancaflor J,Prosst RL,Rosser LE,Salem RR

    更新日期:1999-01-01 00:00:00

  • Screening for lower extremity deep venous thrombosis. An improved plethysmographic and Doppler approach.

    abstract::Noninvasive screening of the lower extremities for deep vein thrombosis was performed bilaterally on 1,118 patients. Impedance plethysmography alone was used in 868. Venography in 135 revealed an accuracy of 88%, with a false-negative rate of 5.3% and a false-positive rate of 18.6%. A combined ultrasonic Doppler and m...

    journal_title:American journal of surgery

    pub_type: 杂志文章

    doi:10.1016/0002-9610(78)90032-6

    authors: Lepore TJ,Savran J,Van De Water J,Harrower HW,Yablonski M

    更新日期:1978-04-01 00:00:00

  • Hume Memorial lecture. Prevention of spinal cord complications in aortic surgery.

    abstract::Paraplegia or paraparesis after operations on the thoracic and abdominal aorta is a devastating event, both for the patient and the surgeon. While its incidence varies from under 1% with operations at the top and bottom of the aorta, its occurrence in the midportion of the aorta, just above the diaphragm, even in the ...

    journal_title:American journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1016/s0002-9610(98)00133-0

    authors: Connolly JE

    更新日期:1998-08-01 00:00:00