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Nutritional assessment of neurosurgical patients
International Notes
International Abstracts Postoperative intraabdominal abscess: Treatment and evaluation of various diagnostic methods. Iba TC, Fukunaga M, Kidokoro A, et al. Jpn J Acute Med 1989;13:1813-1817. This study was based on 15 cases of postoperative intraabdominal abscess that were experienced during the 4-year period between November, 1984 and October, 1988. The results are summarized as follows. (1) Abscess was most frequently caused by the leakage of the gastrointestinal anastomosis or by trouble with the drainage tube that was put in place after tissue dissection. (2) Abscess was most frequently found under the left diaphragm, followed by the greater curvature side of the gastrointestinal anastomosis. (3) CT studies provided the most excellent diagnostic result. However, ultrasonography not only provided good results but also was particularly useful for puncture drainage and should be the first choice when puncture drainage is considered. Although gallium scintigraphy has the disadvantage of consuming much time for preparation, it can often provide decisive information in cases where no distinct evaluation can be made by other diagnostic methods. Analysis of suicide attempts treated at an emergency center. Ishida T, Kuroda S, Yoshinaga K, et al. Jpn J Acute Med 1989;13:1819-1822. Fact finding of those attempting suicide was conducted at the Emergency Center of Hyogo College of Medicine from April, 1980 to March, 1987. These patients were divided into two groups: poisoning and nonpoisoning groups. The authors also investigated the preventive measures from the result of a follow up study of survivers. In the poisoning group, female attempters were significantly great in number (P < .05). The mortality of those who inhaled carbon monoxide or who took agricultural chemicals was significantly higher than that of those taking sleeping or psychotropic pills (P < .Ol). In the follow up study, the authors found that the number who consulted a psychiatrist was small: 10 out of 36 (27.8%) in the poisoning group, and 4 out of 14 (28.6%) in the nonpoisoning group. Therefore, the authors concluded that physicians approach the preventive measures of suicide from both social and psychiatric aspects. Operative indication of elderly patients with putaminal hemorrhage. Konno K, Kanno T, Hoshino M, et al. Jpn J Acute Med 1989;13:1823-1826. In this aging society, the reality of a sudden increase of elderly patients and progress of therapeutic technic has naturally prompted reevaluation of the operative indication as to age in the field of neurosurgery. In the present study the authors evaluate the operative indication for the elderly (those above the age of 70) with reference to hemorrhage into the putamen. This study was conducted on 24 patients
above the age of 70 with hemorrhage into the putamen. Surgery was performed on 8 of these patients. In order to match these patients, the same number of patients in their 60s were also studied similarly. To ensure a strict comparison, the degree of severity was evaluated into four grades, and the number of patients with each grade of severity was kept the same. These two age groups were compared as to prognosis (ADL) and complications. In view of the importance of complications, seven items were specified and the severity of each was evaluated in four grades. Each grade was given a score and the total of the scores served as the index for the degree of severity or aggravation of the general condition. Prognosis was generally favorable in the 6Os, and the score for complications tended to be high above the age of 70 years. As to the items of complications, disturbance of pulmonary and cardiac function was more pronounced in advanced age. Since complications occurred more frequently in higher age with a tendency of aggravation after surgery, the authors conclude that operative indication should be more strict in patients over the age of 70. Nutritional assessment of neurosurgical patients. Yamaraka C, Uozumi T. Jpn J Acute Med 1989;13:1827-1831. There have been many studies in the field of nutrition and metabolism of general surgical patients. However, only recently has there been an appreciation of benefits of adequate nutrition for neurosurgical patients. In this review, the authors attempted to assess the nutritional state of the neurosurgical patients. Twenty patients suffered from neurosurgical diseases and 19 underwent surgical treatment. Nutritional assessment, physical state, biochemical parameters, and immunological parameters, were analyzed in 20 patients. Some parameters were compromised in (1) late starting group with delayed nutritional starting, (2) group with complication, and (3) poor ADL group. The authors suggest that nutritional starting time, complications, and neurological deficits have some effects on the nutritional state of a neurosurgical patient. Clinical study on 37 cases with traumatic injuries of the jejunum, ileum, and mesenterium. Fujmasa A, Kitasato S, Kobayashi R, et al. Jpn J Acute Med 1989;13:1833-1838. Thirty-seven cases with traumatic injuries of the jejunum, ileum, and mesenterium were investigated and the following results were obtained. The causes of trauma were blunt injuries in 84% of cases and penetrating injuries in 16%. The patients were 31 males and 6 females, and the commonest age group was the fourth decade (49%). The average time until admission and operation was 5.4 hours for the penetrating injuries and was 17.4 hours for the blunt injuries, which took longer until diagnosis and treatment. Intestinal injuries were found in 28 cases, and type II b injuries based 555
International Abstracts Postoperative intraabdominal abscess: Treatment and evaluation of various diagnostic methods. Iba TC, Fukunaga M, Kidokoro A, et al. Jpn J Acute Med 1989;13:1813-1817. This study was based on 15 cases of postoperative intraabdominal abscess that were experienced during the 4-year period between November, 1984 and October, 1988. The results are summarized as follows. (1) Abscess was most frequently caused by the leakage of the gastrointestinal anastomosis or by trouble with the drainage tube that was put in place after tissue dissection. (2) Abscess was most frequently found under the left diaphragm, followed by the greater curvature side of the gastrointestinal anastomosis. (3) CT studies provided the most excellent diagnostic result. However, ultrasonography not only provided good results but also was particularly useful for puncture drainage and should be the first choice when puncture drainage is considered. Although gallium scintigraphy has the disadvantage of consuming much time for preparation, it can often provide decisive information in cases where no distinct evaluation can be made by other diagnostic methods. Analysis of suicide attempts treated at an emergency center. Ishida T, Kuroda S, Yoshinaga K, et al. Jpn J Acute Med 1989;13:1819-1822. Fact finding of those attempting suicide was conducted at the Emergency Center of Hyogo College of Medicine from April, 1980 to March, 1987. These patients were divided into two groups: poisoning and nonpoisoning groups. The authors also investigated the preventive measures from the result of a follow up study of survivers. In the poisoning group, female attempters were significantly great in number (P < .05). The mortality of those who inhaled carbon monoxide or who took agricultural chemicals was significantly higher than that of those taking sleeping or psychotropic pills (P < .Ol). In the follow up study, the authors found that the number who consulted a psychiatrist was small: 10 out of 36 (27.8%) in the poisoning group, and 4 out of 14 (28.6%) in the nonpoisoning group. Therefore, the authors concluded that physicians approach the preventive measures of suicide from both social and psychiatric aspects. Operative indication of elderly patients with putaminal hemorrhage. Konno K, Kanno T, Hoshino M, et al. Jpn J Acute Med 1989;13:1823-1826. In this aging society, the reality of a sudden increase of elderly patients and progress of therapeutic technic has naturally prompted reevaluation of the operative indication as to age in the field of neurosurgery. In the present study the authors evaluate the operative indication for the elderly (those above the age of 70) with reference to hemorrhage into the putamen. This study was conducted on 24 patients
above the age of 70 with hemorrhage into the putamen. Surgery was performed on 8 of these patients. In order to match these patients, the same number of patients in their 60s were also studied similarly. To ensure a strict comparison, the degree of severity was evaluated into four grades, and the number of patients with each grade of severity was kept the same. These two age groups were compared as to prognosis (ADL) and complications. In view of the importance of complications, seven items were specified and the severity of each was evaluated in four grades. Each grade was given a score and the total of the scores served as the index for the degree of severity or aggravation of the general condition. Prognosis was generally favorable in the 6Os, and the score for complications tended to be high above the age of 70 years. As to the items of complications, disturbance of pulmonary and cardiac function was more pronounced in advanced age. Since complications occurred more frequently in higher age with a tendency of aggravation after surgery, the authors conclude that operative indication should be more strict in patients over the age of 70. Nutritional assessment of neurosurgical patients. Yamaraka C, Uozumi T. Jpn J Acute Med 1989;13:1827-1831. There have been many studies in the field of nutrition and metabolism of general surgical patients. However, only recently has there been an appreciation of benefits of adequate nutrition for neurosurgical patients. In this review, the authors attempted to assess the nutritional state of the neurosurgical patients. Twenty patients suffered from neurosurgical diseases and 19 underwent surgical treatment. Nutritional assessment, physical state, biochemical parameters, and immunological parameters, were analyzed in 20 patients. Some parameters were compromised in (1) late starting group with delayed nutritional starting, (2) group with complication, and (3) poor ADL group. The authors suggest that nutritional starting time, complications, and neurological deficits have some effects on the nutritional state of a neurosurgical patient. Clinical study on 37 cases with traumatic injuries of the jejunum, ileum, and mesenterium. Fujmasa A, Kitasato S, Kobayashi R, et al. Jpn J Acute Med 1989;13:1833-1838. Thirty-seven cases with traumatic injuries of the jejunum, ileum, and mesenterium were investigated and the following results were obtained. The causes of trauma were blunt injuries in 84% of cases and penetrating injuries in 16%. The patients were 31 males and 6 females, and the commonest age group was the fourth decade (49%). The average time until admission and operation was 5.4 hours for the penetrating injuries and was 17.4 hours for the blunt injuries, which took longer until diagnosis and treatment. Intestinal injuries were found in 28 cases, and type II b injuries based 555