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Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

World Journal of Gastroenterology 2006年第4期12卷 582-587页

作者： Robert J Fraser Marc Ritz Addolorata C Di Matteo Rosalie Vozzo Monika Kwiatek Robert Foreman Brendan Stanley Jack Walsh Jim Burnett paul jury John Dent Department of Medicine University of AdelaideSouth Australia Department of Gastroenterology Royal Adelaide HospitalAdelaide South Australia Vascular Unit Royal Adelaide Hospital AdelaideSouth Australia Gastrointestinal Investigation Unit Repatriation General Hospital Daw Park South Australia Vascular Unit Repatriation General Hospital Daw Park SouthAustralia

AIM： To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm （AAA） repair surgery, METHODS： Nine patients （aged 35-78 years; body mass index （BMI） range： 23-36 kg/m2） post-surgery for AAA repair, and seven healthy control subjects （20-50 years; BMI range： 21-29 kg/m^2） were studied, Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding （Nutrison）. Recordings were analyzed for the frequency, odgin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the ^13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200μL ^13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for ^13CO2 concentration. RESULTS： The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions （P〈 0.005）. In patients there was a higher proportion of abnormally propagated bursts （71% abnormal）, which began to normalize by d 3 （25% abnormal） *** absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects （AUC ^13CO2 1323±244 vs 2646±365; P〈0.05, respectively）, and was reduced to the one-fitch that of healthy controls by d 3 （AUC ^13CO2 470±832 vs 2646±365; P〈 0.05, respectively）. CONCLUSION： Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intralumi

关键词： Critical illness Small intestine Motility Lipid absorption

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Hydrocortisone, ascorbic acid and thiamine for sepsis: Is the jury out?

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World Journal of Diabetes 2020年第4期11卷 90-94页

作者： paul Ellis Marik Joseph Varon Salim R Surani Division of Pulmonary and Critical Care Medicine Eastern Virginia Medical SchoolNorfolkVA 23507United States Department of Critical Care United Memorial Medical ServiceHoustonTX 77030United States Texas A and M University Corpus ChristiTX 78413United States

Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care *** is a major risk factor for the development of *** global mortality of sepsis remains high,despite significant interventions and *** has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin ***,experimental data has demonstrated multiple beneficial effects of vitamin C in *** addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin *** data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of ***,this intervention has met with much resistance and has not been widely ***,we await the final jury verdict on this simple,safe and cheap intervention.

关键词： Diabetes Vitamin C Ascorbic acid Sepsis Thiamine Septic shock Global burden of disease

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