Background: Supplemental nutrition improves long-term outcomes/mortality in acute pancreatitis, with Enteral Nutrition (EN) superior to Total Parenteral Nutrition (TPN). Differences in EN/TPN based upon etiology or di...Background: Supplemental nutrition improves long-term outcomes/mortality in acute pancreatitis, with Enteral Nutrition (EN) superior to Total Parenteral Nutrition (TPN). Differences in EN/TPN based upon etiology or disease severity have never been established. Methods: We performed a randomized retrospective case control on subjects admitted to Cooper University Hospital from 06/2007 to 01/2010 with acute pancreatitis who received supplemental nutrition (n = 161). These subjects were examined for caloric and protein demands. Subjects were matched for demographics, weight, albumin, prealbumin eliminating confounders. Demands among disease etiology/severity subgroups and statistical significance were determined. The incidence of EN v.TPN was determined. Results: Significant differences were found in total caloric demands, namely gallstone (n = 50) and alcohol (n = 36) (p = 0.04). Differences in protein demand were not established between these two groups (p = 0.24). Differences in caloric demand were found in bed-side index for severity in acute pancreatitis (BISAP) of 1, 2 and 3 versus 5. Protein demands were different between BISAP of 0 versus all others. 24% of the sample received EN. Conclu: sion: There are significant differences in total caloric demands for subjects with acute pancreatitis by disease severity and in gallstone versus alcohol-induced pancreatitis. These differences are not variations in the sample populations. Finally, EN is under-utilized despite knowledge of its value.展开更多
Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between s...Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy. Methods: Records of patients admitted to Cooper University Hospital from January 2001-December 2005 with LGIB who had 99mTc scan were analyzed. Results: 164 of 170 patients were eligible to be evaluated. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of 45 patients with positive scans had angiography. 7 patients (33.3%) had positive and 14 (66.6%) negative angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99 m Tc scan (p = 0.125). 20 patients, in the positive scan group, required surgery. In 15 (75%) the findings at surgery correlated with the scan result (p = 0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p < 0.001). The patients with (+) scan received a total of 372 (8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (–) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (–) scans had similar rates of colonoscopy (73.35% vs 76.4%), hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%) respectively, Conclusion: 99 m Tc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.展开更多
文摘Background: Supplemental nutrition improves long-term outcomes/mortality in acute pancreatitis, with Enteral Nutrition (EN) superior to Total Parenteral Nutrition (TPN). Differences in EN/TPN based upon etiology or disease severity have never been established. Methods: We performed a randomized retrospective case control on subjects admitted to Cooper University Hospital from 06/2007 to 01/2010 with acute pancreatitis who received supplemental nutrition (n = 161). These subjects were examined for caloric and protein demands. Subjects were matched for demographics, weight, albumin, prealbumin eliminating confounders. Demands among disease etiology/severity subgroups and statistical significance were determined. The incidence of EN v.TPN was determined. Results: Significant differences were found in total caloric demands, namely gallstone (n = 50) and alcohol (n = 36) (p = 0.04). Differences in protein demand were not established between these two groups (p = 0.24). Differences in caloric demand were found in bed-side index for severity in acute pancreatitis (BISAP) of 1, 2 and 3 versus 5. Protein demands were different between BISAP of 0 versus all others. 24% of the sample received EN. Conclu: sion: There are significant differences in total caloric demands for subjects with acute pancreatitis by disease severity and in gallstone versus alcohol-induced pancreatitis. These differences are not variations in the sample populations. Finally, EN is under-utilized despite knowledge of its value.
文摘Purpose: Technetium 99 m (99 m Tc) labeled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy. Methods: Records of patients admitted to Cooper University Hospital from January 2001-December 2005 with LGIB who had 99mTc scan were analyzed. Results: 164 of 170 patients were eligible to be evaluated. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of 45 patients with positive scans had angiography. 7 patients (33.3%) had positive and 14 (66.6%) negative angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99 m Tc scan (p = 0.125). 20 patients, in the positive scan group, required surgery. In 15 (75%) the findings at surgery correlated with the scan result (p = 0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p < 0.001). The patients with (+) scan received a total of 372 (8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (–) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (–) scans had similar rates of colonoscopy (73.35% vs 76.4%), hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%) respectively, Conclusion: 99 m Tc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.
