Experimental and Clinical Evaluation of Capsular and Parenchymal Total Liver Perfusion

Liver blood flow measurements obtained from both the liver surface and deep within the parenchyma, were correlated in an effort to assess the usefulness of laser-Doppler flowmetry for non-invasive monitoring of total liver blood flow, the probe being positioned on either the surface or within the liver parenchyma

What Surgeon Should Know about Probiotics

Back in the 1980s, Fuller R, when working on gut flora, concluded that “there is good evidence that the complex microbial flora present in the gastrointestinal tract … is effective in providing resistance to disease; however, the composition of this protective flora can be altered by dietary and environmental influences, making the host susceptible to disease” [...

Why Give My Surgical Patients Probiotics

Although there are various hypotheses on the health-promoting roles probiotic supplementation play—via targeting the gut microbiota and/or regulating the systemic immune and metabolic responses—the precise nature of this benefit in restitution of health following surgery remains under discussion and in doubt [...

Endoscopic Salvage of Gastrointestinal Anastomosis Leaks—Past, Present, and Future—A Narrated Review

Background: Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. Methods: A narrative review of the international literature took place, including PubMed, Scopus, and Google Scholar, utilizing specific search terms such as “Digestive Surgery AND Anastomotic Leakage OR leak OR dehiscence”. Results: In the present review, we try to describe and analyze the pros and cons of the various endoscopic techniques: from the very first (and still available), fibrin gluing, to endoclip and over-the-scope clip positioning, stent insertion, and the latest suturing and endoluminal vacuum devices. Finally, alongside efforts to improve the existing techniques, we consider stem cell application as well as non-endoscopic, and even endoscopic, attempts at intraluminal microbiome modification, which should ultimately intervene pre-emptively, rather than therapeutically, to prevent leaks. Conclusions: In the last three decades, this search for an ideal device for closure, which must be safe, easy to deploy, inexpensive, robust, effect rapid and stable closure of even large defects, and have a low complication rate, has led to the proposal and application of a number of different endoscopic devices and techniques. However, to date, there is no consensus as to the best. The literature contains reports of only small studies and no randomized trials, failing to take into account both the heterogeneity of leaks and their different anatomical sites

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN DEMENTIA SUFFERING GREEK INDIVIDUALS

Dementia in geriatric patients is a major cause of malnutrition. In this article, the impact of Percutaneous Endoscopic Gastrostomy placed in these persons is explored in order to understand the choices of the relatives leading to their placement. A retrospective analysis of the epidemiologic, clinical and demographic data of 51 persons with PEG placement is performed. The patients’ mean age was 74 years, most of them came from another hospital department (64.71%), all returned home but three, who went to a rehabilitation center. All their relatives had a university education or higher, and in 26 cases the relative was a doctor. Lack of major common complications, easier and faster feeding has increased the decision of the PEG placement, according to the family, who can have more “constructive time” with their relative without great psychological burdens

Prognostic Indices of Poor Nutritional Status and Their Impact on Prolonged Hospital Stay in a Greek University Hospital

Background. To ascertain the potential contributors to nutritional risk manifestation and to disclose the factors exerting a negative impact on hospital length of stay (LOS), by means of poor nutritional status, in a nonselected hospitalized population. Materials and Methods. NutritionDay project questionnaires were applied to 295 adult patients. Study parameters included anthropometric data, demographics, medical history, dietary-related factors, and self-perception of health status. Body Mass Index (BMI) and Malnutrition Universal Screening Tool (MUST) were calculated for each participant. MUST score was applied for malnutrition assessment, while hospital LOS constituted the outcome of interest. Results. Of the total cohort, 42.3% were at nutritional risk and 21.4% malnourished. Age, gender, BMI, MUST score, autonomy, health quality, appetite, quantity of food intake, weight loss, arm or calf perimeter (P<0.001, for all), and dietary type (P<0.01) affected nutritional status. Poor nutrition status (P=0.000), deteriorated appetite (P=0.000) or food intake (P=0.025), limited autonomy (P=0.013), artificial nutrition (P=0.012), weight loss (P=0.010), and arm circumference <21 cm (P=0.007) were the most powerful predictors of hospital LOS >7 days. Conclusion. Nutritional status and nutrition-related parameters such as weight loss, quantity of food intake, appetite, arm circumference, dietary type, and extent of dependence confer considerable prognostic value regarding hospital LOS in acute care setting