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Acute phase reactants in malnourished patients with Crohn's Disease
PATIENT-YEARS OF AMBULATORY HOME TOTAL PARENTERAL NUTRITION (TPFI) IN THE MANAGEMENT gF DIFFICULT GASTROINTESTINALDISORDERS. SJ Dudrick, JJ O’Donnell, DM Englert, ER St. Luke’s Episcopal Hospital, Houston, Texas, USA. Blume, RM Belloso, C Peters.
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experience has been acquired with ambulatory home TPN in More than 150 patient-years’ 173 patients since May, 1974. Indications for “permanent” home TPN have been short bowel syndrome (43j, malabsorption (Z’i’j, enteral scleroderma (4) and ‘\IIP syndrome !I). Indications for “temporary” home TPN have been Crohn’s disease (38j, GI malignancies ulcerative colitis (II), chronic pancreatitis (3) (24), alimentary tract fistulas (17j, and other problems (IO). 109 patients with acute disorders were treated via percutaneously placed catheters, and the 64 patients with chronic (lifetime) disorders have been treated thus far with implanted dacron-cuffed, silicone rubber catheters for a rumulative total of 54,930 patient-days. Of 149 implanted catheters, 138 were placed in the superior vena cava and 11 in the inferior vena cava for an average duration of 302 days, one catheter remaining in situ for more than 101 years. Sepsis occurred 32 times with the implanted catheters, or once per 3.2 catheter-years. 130 temporary catheters were placed percutaneously in the superior vena cava via a subclavian vern for an average duration of 76 days, a longest duration of 213 days and a sepsis rate of once per 3.4 catheter-years. Total catheter-related complications were remarkably low and included venous thrombosis (13j, clotted catheter (II>, catheter rupture (6), catheter compression (6j, and inadvertent catheter removal (5). 28 catheters were repaired or spliced when the external portion was inadvertently damaged, or deteriorated secondary to long-term material fatigue. One extraordinary patient has been maintained entirely by TPN originally as an inpatient and subsequently as an outpatient for his entire 15& years of life. As economic pressures rise to decrease hospitalization time and costs, the lessons and principles derived from this extensive experience of ambulatory home TPN management of patients with high-order and life-threatening alimentary tract icondit ions, can prove invaluable when applied to the favorabJe risk:benefit, and cost,effective outpatient management of these and other less critical gastrointestinal disorders.
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ACUTE PHASE REACTANTS IN MALNOURISHED PATIENTS WITH CROHN'S DISEASE. R.H.R. PARK, A. DUNCAN, A. HUTCHISON, A. SHENKIN, R.I. RUSSELL. Gastroenterology Unit and Department of Biochemistry, The Royal Infirmary, Glasgow, SCOTLAND. The acute phase reactants, C-Reactive Protein (CRP) and alpha one acid glycoprotein, are elevated in active Crohn's Disease and can be used as markers of disease activity. It is unknown whether the acute phase response is impaired in patients with malnutrition. We have compared serum concentrations of acute phase reactants in malnourished Crohn's patients (n=lO), defined as being less than 80% ideal body weight (% IBW), with well nourished Crohn's patients (n=ll). The malnourished patients (group I) had a significantly lower % IBW (72fl meanfSEM) than the well nourished patients (group II) (95+3 %IBW) (p
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0.1 7150
experience has been acquired with ambulatory home TPN in More than 150 patient-years’ 173 patients since May, 1974. Indications for “permanent” home TPN have been short bowel syndrome (43j, malabsorption (Z’i’j, enteral scleroderma (4) and ‘\IIP syndrome !I). Indications for “temporary” home TPN have been Crohn’s disease (38j, GI malignancies ulcerative colitis (II), chronic pancreatitis (3) (24), alimentary tract fistulas (17j, and other problems (IO). 109 patients with acute disorders were treated via percutaneously placed catheters, and the 64 patients with chronic (lifetime) disorders have been treated thus far with implanted dacron-cuffed, silicone rubber catheters for a rumulative total of 54,930 patient-days. Of 149 implanted catheters, 138 were placed in the superior vena cava and 11 in the inferior vena cava for an average duration of 302 days, one catheter remaining in situ for more than 101 years. Sepsis occurred 32 times with the implanted catheters, or once per 3.2 catheter-years. 130 temporary catheters were placed percutaneously in the superior vena cava via a subclavian vern for an average duration of 76 days, a longest duration of 213 days and a sepsis rate of once per 3.4 catheter-years. Total catheter-related complications were remarkably low and included venous thrombosis (13j, clotted catheter (II>, catheter rupture (6), catheter compression (6j, and inadvertent catheter removal (5). 28 catheters were repaired or spliced when the external portion was inadvertently damaged, or deteriorated secondary to long-term material fatigue. One extraordinary patient has been maintained entirely by TPN originally as an inpatient and subsequently as an outpatient for his entire 15& years of life. As economic pressures rise to decrease hospitalization time and costs, the lessons and principles derived from this extensive experience of ambulatory home TPN management of patients with high-order and life-threatening alimentary tract icondit ions, can prove invaluable when applied to the favorabJe risk:benefit, and cost,effective outpatient management of these and other less critical gastrointestinal disorders.
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ACUTE PHASE REACTANTS IN MALNOURISHED PATIENTS WITH CROHN'S DISEASE. R.H.R. PARK, A. DUNCAN, A. HUTCHISON, A. SHENKIN, R.I. RUSSELL. Gastroenterology Unit and Department of Biochemistry, The Royal Infirmary, Glasgow, SCOTLAND. The acute phase reactants, C-Reactive Protein (CRP) and alpha one acid glycoprotein, are elevated in active Crohn's Disease and can be used as markers of disease activity. It is unknown whether the acute phase response is impaired in patients with malnutrition. We have compared serum concentrations of acute phase reactants in malnourished Crohn's patients (n=lO), defined as being less than 80% ideal body weight (% IBW), with well nourished Crohn's patients (n=ll). The malnourished patients (group I) had a significantly lower % IBW (72fl meanfSEM) than the well nourished patients (group II) (95+3 %IBW) (p
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