Conversion of choledochojejunostomy stents to jejunal feeding tubes for postoperative enteral alimentation

The problem of protein calorie malnutrition following major gastrointestinal surgery can be treated with central venous or enteric alimentation, with the latter being preferred. The authors describe a simple technique for the conversion of biliary stents placed after pancreaticoduodenal surgery into jejunal feeding tubes when the stenting function is no longer needed. Three illustrative cases are presented. In each case, the procedure took less than 30 min and had no associated morbidity. This technique allows early conversion from central venous to enteric alimentation without the need to create a second surgical enterostomy.     

The effect of naloxone on the preoperative gastric volume and pH

The effect of 4 mg oral naloxone on preoperative gastric volume and pH of gastric aspirate was studied in a double-blind, randomized study. Twenty patients received 10 ml of naloxone (4 mg) mixed with 10 ml of orange juice, and 20 patients received 10 ml of isotonic saline mixed with 10 ml of orange juice, 2 h before surgery. Gastric content was obtained immediately after intubation of the trachea. No significant difference in gastric volume and pH of gastric aspirate was found between the two groups. It is concluded that naloxone does not affect gastric emptying and gastric acid secretion to a degree great enough to protect against aspiration of gastric contents into the lungs.     

Effect of TPN on bone marrow kinetics--therapeutic implications

Stimulation of tumor and host tissue proliferation occurs with nutritional support of the tumor-bearing host. This study was performed to determine the effect of parenteral nutrition on bone marrow cytokinetics in tumor-bearing animals. Forty-three Lewis/Wistar rats with subcutaneous mammary tumor implants (AC-33) were protein-depleted for 8 days, underwent superior vena cava cannulation and were randomized to receive intravenous saline or total parenteral nutrition (TPN). Animals receiving TPN were sacrificed after 2, 6, 12, 24, and 48 hr and bone marrow cells were harvested for cell cycle analysis by flow cytometry. Compared to control animals, a significant increase in bone marrow cells in S (DNA synthetic) phase was demonstrated after 24 hr of TPN. The ratio of sensitive/resistant bone marrow cells to chemotherapy specific for cells actively synthesizing DNA was increased after 24 hr of TPN. This alteration in bone marrow cytokinetics was transient and distinct from the previously documented stimulation of tumor growth kinetics. The potential therapeutic implications of differentially stimulating host tissue and tumor growth kinetics with TPN are discussed.