The effect of total parenteral nutrition on plasma immunoglobulin levels in surgical patients: Prospective clinical study

In this prospective clinical study the ability of total parenteral nutrition (TRN) to restore plasma immunoglobulin levels was studied in surgical patients who showed clinical malnutrition at the time of their initial presentation. The study was performed on three groups of randomly selected patients. Group A was consisted of 40 pts suffering benign G.I. surgical diseases, group B of another 40 pts suffering malignant G.I. surgical diseases, and group C of 8 surgical pts who were not malnurished at the time of presentation and were used as controls. Plasma immunoglobulins (IgG, IgA and IgM) were measured in all the patients in groups A and B before starting and after completing the 7 days course of TPN either pre-operatively or post-operatively. In the control group these were measured before the operation immediately after (1st post-op day) and seven days later. It was found that: 1. Before starting TPN, IgG, IgA and IgM levels were significantly decreased in all the malnurished pts (groups A & B) 2. The 7-day TPN pre-op administration resulted in high increase (p<0.001) of all the immunoglobulins measured, irrespective of the underlying disease. 3. Immediately after the operation there was a very significant (p<0.001) fall of all the immunoglobulins. 4) The 7-days TPN postoperative administration resulted again in very significant increase (p<0.001) of all immunoglobulins measured, irrespective of the under disease. 5. From the clinical point of view the incidence and severity of the post-op infections complications were very low and not different from those in the control group. It is concluded that in malnurished patient a 7-days TPN pre-op or/and postoperative course is sufficient in restoring the levels of all the immunoglobulin levels to those of non-malnurished or normaly fed surgical patients irrespective of the type of the operation and the nature of the underlying disease.Μελετήθηκε η συμβολή της ολικής παρεντερικής διατροφής (Ο.Π.Δ.) σε 88 χειρουργικούς ασθενείς 51 άνδρες (58%) και 37 γυναίκες (48%), Μ.Η. 62,7 χρόνων με κλινική υποθρεψία. Χωρίστηκαν σε τρεις ομάδες: α. Ασθενείς με καλοήθεις παθήσεις 40, β. με κακοήθεις παθήσεις 40 και γ. Ομάδα ελέγχου 8. Μετρήθηκαν οι ανοσοσφαιρίνες του ορού IgG, IgA και IgM πριν την εφαρμογή Ο.Π.Δ. και μετά την Ο.Π.Δ. προεγχειρητικά αμέσως μετεγχειρητικά και μετά το τέλος της Ο.Π.Δ. μετεγχειρητικά. Σε ανάλογα χρονικά διαστήματα μετρήθηκαν και οι αιμοσφαιρίνες ορού της ομάδας ελέγχου. Αποτελέσματα: 1. Η Ο.Π.Δ. τόσο σε καλοήθεις όσο και σε κακοήθεις παθήσεις αύξησε τις τιμές των ανοσοσφαιρινών σημαντικά p<0,001. 2. Οι ανοσοσφαιρίνες του ορού ελαττωθήκαν αμέσως μετεγχειρητικά σε επίπεδα στατιστικά λίαν σημαντικά p<0,001 και p<0,05. 3. Στους ασθενείς που έλαβαν μετεγχειρητικά Ο.Π.Δ. οι ανοσοσφαιρίνες του ορού αυξήθηκαν στατιστικά λίαν σημαντικά p<0,001. Η αύξηση αφορούσε όλες τις ομάδες των ασθενών. Συμπέρασμα: η Ο.Π.Δ. μπορεί να αποκαταστήσει τα επίπεδα των ανοσοσφαιρινών IgG, IgA και IgM σε φυσιολογικά επίπεδα όταν χορηγείται προ ή/και μετεγχειρητικά σε ασθενείς με καλοήθη και κακοήθη πάθηση. Η αποκατάσταση αυτή είναι ανάλογη αυτής που παρατηρείται σε αρρώστους που σιτίζονται φυσιολογικά πριν και μετά την εγχείρηση

Tuberculosis in the Peritoneum: Not Too Rare After All

Peritoneal tuberculosis is rare with increased incidence rates in recent years. The absence of characteristic clinical features of the disease often makes its diagnosis difficult and elusive. We present the case of 61-year-old female with peritoneal tuberculosis. The patient suffered from abdominal pain for a period of 5 months prior to admission. The diagnosis was established on the basis of findings from an abdominal computed tomography scan, a chest radiograph and histopathological analysis of the laparoscopic resection of the two masses. The patient was discharged from hospital receiving a fourfold antituberculous treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. A high index of suspicion and a combination of radiologic, endoscopic, microbiologic and histopathological examination achieves diagnostic accuracy and prevents clinical mismanagement

Crohn’s Disease Associated Pyoderma Gangrenosum Treated with Adalimumab

Pyoderma gangrenosum is a known, though infrequent, ulcerative skin lesion that is often associated with systemic inflammatory and immunologic diseases. Objective: To present the efficacy of Adalimumab, a fully human Tumour Necrosis Factor-α antagonist, in the treatment of pyoderma gangrenosum associated with Crohn’s disease. Methods: A young male patient with pyoderma gangrenosum of the shin as the first sign of clinically active Crohn’s disease, who was treated with Adalimumab, is herein presented. Results: Almost complete healing of the lesion was achieved after 12 weeks of treatment. Conclusions: Successful treatment outcome suggests that Adalimumab is not only a therapeutic option for Crohn’s disease but may also be a safe and effective therapy for Pyoderma gangrenosum associated with the disease. Pyoderma gangrenosum should be suspected in any cutaneous ulcerative lesion occurring in patients with Crohn’s disease

Prediction of lumbar disc herniation patients' satisfaction with the aid of an artificial neural network

AIM: To identify key determinants of lumbar disc herniation (LDH) patients' satisfaction and to evaluate the efficiency of an artificial neural network (ANN) model to prognosticate satisfaction derived from the hospital stay in this specific patient group. MATERIAL AND METHODS: A single item question was used to assess patient satisfaction. Principal component analysis evaluated several aspects of care (15 items). An ANN encompassed all variables and its prediction ability was tested. The ANN performance was correlated to a binary logistic regression (BLR) model. RESULTS: Higher levels of satisfaction were reported by females, older patients, Greeks, and patients with elementary education staying in not rural areas. A history of a single previous hospitalisation was correlated with more satisfaction. The accuracy of ANN was 96% for satisfaction prediction outperforming the BLR model. CONCLUSION: Satisfactory health services are influenced by sex, age, nationality, and number of prior admissions. The self-perceived health state plays also a crucial role. The current study is the first one reporting on the capability of an ANN to accurately predict the satisfaction levels of LDH patients

Clinical Study Is Post-ERCP Pancreatitis a Genetically Predisposed Complication?

Background/Objectives. Pancreatitis remains the most common complication of ERCP. History of post-ERCP pancreatitis is an independent risk factor for a new episode, suggesting a genetic background. The N34S mutation in serine protease inhibitor Kazal type 1 (SPINK 1) gene may downregulate the threshold for the development of pancreatitis. The aim of the present study is to evaluate the presence of this mutation among patients with post-ERCP pancreatitis. Methods. During a period of four years, thirty patients with post-ERCP pancreatitis entered the study. Patients and procedural data were collected, focusing on risk factors for pancreatitis. Blood samples were taken for genetic testing for the presence of N34S mutation in SPINK 1 gene. After DNA extraction, we used an allele-specific polymerase chain reaction as an initial screening method for the N34S mutation, and in order to confirm the results and to determine the hetero-and homozygosity genotype status, we used a restriction fragment length polymorphism (RFLP) method. Results. None of the thirty patients was found to carry the N34S mutation, with both of the applied methods. Patients had an average of two of the known risk factors. Conclusion. SPINK1 N34S mutation does not seem to play a role in post-ERCP pancreatitis, but larger studies needed to confirm our results

Is Post-ERCP Pancreatitis a Genetically Predisposed Complication?

Background/Objectives. Pancreatitis remains the most common complication of ERCP. History of post-ERCP pancreatitis is an independent risk factor for a new episode, suggesting a genetic background. The N34S mutation in serine protease inhibitor Kazal type 1 (SPINK 1) gene may downregulate the threshold for the development of pancreatitis. The aim of the present study is to evaluate the presence of this mutation among patients with post-ERCP pancreatitis. Methods. During a period of four years, thirty patients with post-ERCP pancreatitis entered the study. Patients and procedural data were collected, focusing on risk factors for pancreatitis. Blood samples were taken for genetic testing for the presence of N34S mutation in SPINK 1 gene. After DNA extraction, we used an allele-specific polymerase chain reaction as an initial screening method for the N34S mutation, and in order to confirm the results and to determine the hetero- and homozygosity genotype status, we used a restriction fragment length polymorphism (RFLP) method. Results. None of the thirty patients was found to carry the N34S mutation, with both of the applied methods. Patients had an average of two of the known risk factors. Conclusion. SPINK1 N34S mutation does not seem to play a role in post-ERCP pancreatitis, but larger studies needed to confirm our results