Faculty Opinions recommendation of ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults.

Author(s):  
Simon Lal
Keyword(s):  
Gut ◽  
2020 ◽  
Vol 69 (10) ◽  
pp. 1787-1795 ◽  
Author(s):  
Loris Pironi ◽  
Ezra Steiger ◽  
Francisca Joly ◽  
Geert J A Wanten ◽  
Cecile Chambrier ◽  
...  

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.


2019 ◽  
Vol 2 (31) ◽  
pp. 33-36
Author(s):  
A. S. Ermolov ◽  
O. A. Alekseechkina ◽  
E. S. Vladimirova ◽  
A. P. Shakotko

Objective: to identify ultrasound (US) signs of intestinal failure syndrome (IFS) in patients with combined trauma and to determine their compliance with the clinical classification of IFS. In the process of dynamic ultrasound monitoring in 18 patients on the 5–7th day, gastrointestinal motility recovered with a decrease in intra-abdominal pressure (IAP) to normal, which corresponded to stage I of IIS. In 12 patients, gastrostasis and expansion of the small intestine, an increase in the linear blood flow velocity in the portal vein up to 30 cm/sec, IAP up to 20 mm Hg were observed which corresponded to stage II of IFS. On the 15–20th day, 3 patients with stage III of IFS recovered gastrointestinal motility, 9 patients died due to multiple organ failure. Ultrasound revealed an increase in the liver and spleen with portal hypertension, edema of the walls of the small and large intestines was observed, intra-abdominal pressure increased, which corresponded to stage III of intestinal failure.Results. The results of ultrasound in dynamics with an assessment of the morphological and functional state of the gastrointestinal tract confirm their compliance with the stages of the clinical classification of intestinal failure syndrome. With the help of ultrasound with dopplerography and measurement of IAP, it was possible to objectify the clinical classification of intestinal failure syndrome.


2015 ◽  
Vol 34 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Loris Pironi ◽  
Jann Arends ◽  
Janet Baxter ◽  
Federico Bozzetti ◽  
Rosa Burgos Peláez ◽  
...  
Keyword(s):  

2020 ◽  
Vol 40 ◽  
pp. 531
Author(s):  
O.M. Elfadil ◽  
S. Velapati ◽  
R.T. Hurt ◽  
S. Lal ◽  
M.S. Mundi

1966 ◽  
Vol 24 ◽  
pp. 21-23
Author(s):  
Y. Fujita

We have investigated the spectrograms (dispersion: 8Å/mm) in the photographic infrared region fromλ7500 toλ9000 of some carbon stars obtained by the coudé spectrograph of the 74-inch reflector attached to the Okayama Astrophysical Observatory. The names of the stars investigated are listed in Table 1.


Author(s):  
Gerald Fine ◽  
Azorides R. Morales

For years the separation of carcinoma and sarcoma and the subclassification of sarcomas has been based on the appearance of the tumor cells and their microscopic growth pattern and information derived from certain histochemical and special stains. Although this method of study has produced good agreement among pathologists in the separation of carcinoma from sarcoma, it has given less uniform results in the subclassification of sarcomas. There remain examples of neoplasms of different histogenesis, the classification of which is questionable because of similar cytologic and growth patterns at the light microscopic level; i.e. amelanotic melanoma versus carcinoma and occasionally sarcoma, sarcomas with an epithelial pattern of growth simulating carcinoma, histologically similar mesenchymal tumors of different histogenesis (histiocytoma versus rhabdomyosarcoma, lytic osteogenic sarcoma versus rhabdomyosarcoma), and myxomatous mesenchymal tumors of diverse histogenesis (myxoid rhabdo and liposarcomas, cardiac myxoma, myxoid neurofibroma, etc.)


Author(s):  
Irving Dardick

With the extensive industrial use of asbestos in this century and the long latent period (20-50 years) between exposure and tumor presentation, the incidence of malignant mesothelioma is now increasing. Thus, surgical pathologists are more frequently faced with the dilemma of differentiating mesothelioma from metastatic adenocarcinoma and spindle-cell sarcoma involving serosal surfaces. Electron microscopy is amodality useful in clarifying this problem.In utilizing ultrastructural features in the diagnosis of mesothelioma, it is essential to appreciate that the classification of this tumor reflects a variety of morphologic forms of differing biologic behavior (Table 1). Furthermore, with the variable histology and degree of differentiation in mesotheliomas it might be expected that the ultrastructure of such tumors also reflects a range of cytological features. Such is the case.


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