Glucose-based versus fat-based total parenteral nutrition (TPN): Effects on hepatic function in septic patients complicated with cholestatic jaundice

A prospective study of two types of total parenteral nutrition (TPN) was carried out in 34 patients suffering from sepsis and complicated liver dysfunction. Group 1 (18 patients) received non-protein energy as glucose plus fat emulsion in a caloric ratio of 19:1, while group 2 (16 patients) received the same energy intake but with a ratio of 1:1. Group 1 exhibited higher levels of bilirubin and alkaline phosphatase with values of 93.5 ± 25.5 μmol/l and 160 ± 30 IU/l respectively compared to Group 2, in which the corresponding values were 81.6 ± 32.3 μmol/l and 120 ± 10 IU/l (p < 0.05). On the other hand, group 1 had lower levels of serum albumin and serum transferrin with values 25 ± 1.3 g/l and 40 ± 20% of normal, compared to group 2 in whom the corresponding values were 28 ± 8 g/l and 48 ± 30% of normal (p < 0.05). There were no differences between the two groups, in the absolute number of T-lymphocytes and in transaminase levels. In sepsis complicated by liver dysfunction a 50:50 glucose: fat regimen caused less disturbance of liver function than one consisting almost entirely of glucose. © 1990

Extended esophagolaryngeal resection with parathyroid autotransplantation

Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must he accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy

Long chain versus medium chain lipids in patients with ARDS: effects on pulmonary haemodynamics and gas exchange

Objective:To compare pulmonary haemodynamic and gas exchange alterations in septic patients with ARDS receiving long-chain triglycerides (LCT) versus medium-chain triglycerides (MCT). Design: Prospective, randomised, clinical study. Setting: Surgical ICU patients in a University Hospital. Patients: Twenty-one septic patients with ARDS were randomly assigned to receive 50 % of their non-protein caloric requirements as either 20 % LCT (group 1, n = 10) or 20 % 1 : 1 mixture of LCT/MCT (group 2, n = 11). Intervention: Intravenous infusion of LCT and LCT/MCT combinations at a rate of 12 g . h(-1). Measurements and results: The LCT infusion was associated with an increase of pulmonary venous admixture (Qva/Qt) from 24 % +/- 5 % to 37 % +/- 6 %, an increase of mean pulmonary artery pressure (MPAP) from 25 +/- 5 to 33 +/- 4 mmHg and decrease of PaO2/FIO2 from 240 +/- 30 to 180 +/- 35. LCT/MCT administration was only associated with an elevation of oxygen consumption (VO2) from 329 +/- 14 to 396 +/- 12 ml/ min. During lipid infusion group 1 patients presented higher Qva/Qt (37 % +/- 6 % vs 25 % +/- 4 %), MPAP (33 +/- 4 vs 27 +/- 3 mmHg) and VO2 (359 +/- 11 vs 396 +/- 12 ml/min) and lower PaO2/FIO2 (180 +/- 35 vs 235 +/- 30) values compared to group 2. Conclusion: In conclusion, we have shown that, in septic patients with respiratory failure, LCT administration was associated with more significant changes of Qva/Qt, MPAP and PaO2/FIO2 compared to infusion of an LCT/MCT 1 : 1 emulsion. Clinically, these transient alterations might cause serious problems in patients with marginal arterial oxygenation and cardio-respiratory impairment

Incidence of vein thrombosis in peripheral intravenous nutrition: effect of fat emulsions

The relative risk of thrombophlebitis induced by either Long-chain Triglycerides (LCTs) or Medium-chain Triglycerides (MCTs) during peripheral i.v. nutrition (PIN) was evaluated. A total of 76 patients were randomly assigned into group A (n = 40) and group B (n = 36). The nutritional requirements in both groups were covered by a standardized regime of osmolality 1130 mOsm and pH 5.2, which provided 14 kg/day(-1) nitrogen, 600 kcal/day(-1) of carbohydrates and 1000 kcal/day(-1) of lipids. Group A received the lipids as pure LCTs while group B received a mixture of LCTs/MCTs at a ratio 1:1. The infused nutritional volume was 2000 ml and was delivered via a suitable vein in a proximal forearm, using a fine bore polyurethane 22G catheter. The two standardized regimes were evaluated over a 10 day period regarding the incidence of thrombophlebitis. The cumulative risk of thrombophlebitis was documented to be significantly lower in group A compared to group B (17.5% versus 44.4%, P < 0.05). LCTs appear to prolong peripheral vein feeding by lessening the reaction of venous endothelium to the irritating nutritional infusate

Serious game design for vehicular language learning addressing work needs

In today’s open business environment peer communication across borders is the norm. It is commonplace in face-to-face interaction as well as on-line communities that facilitate work related collaboration of cross-border teams. To effectively work in these international surroundings, individuals resort to commonly understood, vehicular languages. In work-related contexts, impeccable use of a language is less important than effective communication towards addressing common goals. This work departs from typical professional language learning approaches by introducing a serious game for building language and cultural communication skills in a lingua franca. The game exposes professionals to typical deployment of a lingua franca by native and non-native speakers. Learners build communication competence through situated learning approaches that draw inspiration from the real world, which is both multilingual and multicultural. At the same time they become aware of the cultural wealth that is manifested in the individualized uses of vehicular languages by individuals with diverse backgrounds. © Springer International Publishing Switzerland 2014