Dénutrition en diatlyse: vers la fin d'une fatalité [Malnutrition on dialysis: the end of a fatality].

Protein-energy malnutrition in patients treated with haemodialysis (HD) is a complex, multifactorial and prevalent problem, starting well ahead of the dialysis program. It is associated with an increased morbidity and mortality. Uraemic patients are relatively resistant to nutrients because of metabolism abnormalities. Prevention of malnutrition is therefore more efficient than treatment per se. Classical supplementation including oral nutritional supplements, intradialytic parenteral nutrition and enteral nutrition remain efficient, if applied for a sufficient time. A global approach coupling supplementation and strategies designed to optimise metabolism abnormalities should increase treatment efficacy and improve the outcome and quality of life of these patients

Management of true aneurysms of the pancreaticoduodenal arteries.

OBJECTIVE: To review the authors' recent experience and that of the literature since 1973 and to provide management guidelines for true aneurysms of the pancreaticoduodenal arteries (PDA). SUMMARY BACKGROUND DATA: True aneurysms of the PDA are rare, with a total of only 52 cases reported since 1973. METHODS: Six patients were admitted to the authors' institution between 1985 and 1995 for rupture of a true aneurysm of the PDA. They were analyzed with regard to the mode of presentation, preoperative workup, management, and outcome. RESULTS: All patients had severe epigastric pain from retroperitoneal hemorrhage. Computed tomography scanning and angiography were performed in all cases. Aneurysms ranged from 0.7 to 1.2 cm (median 0.9 cm). The celiac axis was stenotic or occluded in five cases. Three patients underwent emergency pancreatoduodenectomy. Two of them survived. In one case, section of the median arcuate ligament was associated with the procedure, and the patient died from an aortic dissection. Embolization was performed in the last three patients. The procedure was definitive in two cases. In one, hemorrhage recurred 8 days later and required surgical ligation of the bleeding artery. CONCLUSIONS: The authors recommend rapid treatment of all true aneurysms of the PDA. Because most of these aneurysms result from a stenosis of the celiac axis, selective embolization may help to preserve patency of the PDA and should, therefore, be the primary therapeutic choice in ruptured aneurysms. Close follow-up is mandatory because of possible recurrent bleeding. Appropriate and expeditious management of true PDA aneurysms should help reduce the mortality rate

Dénutrition en diatlyse: vers la fin d'une fatalité [Malnutrition on dialysis: the end of a fatality].

Protein-energy malnutrition in patients treated with haemodialysis (HD) is a complex, multifactorial and prevalent problem, starting well ahead of the dialysis program. It is associated with an increased morbidity and mortality. Uraemic patients are relatively resistant to nutrients because of metabolism abnormalities. Prevention of malnutrition is therefore more efficient than treatment per se. Classical supplementation including oral nutritional supplements, intradialytic parenteral nutrition and enteral nutrition remain efficient, if applied for a sufficient time. A global approach coupling supplementation and strategies designed to optimise metabolism abnormalities should increase treatment efficacy and improve the outcome and quality of life of these patients