Search

Amelioration considerable du taux de survie grâce a la selection minutieuse des malades et des donneurs, a la technique operatoire, au traitement pre- et post-operatoire par l'introduction en particulier de la cyclosporine. Les principales indications sont l'atresie des voies biliaires, certains troubles metaboliques, la cirrhose apres hepatite, l'insuffisance hepatique aigue, les tumeurs malignes du foie, la fibrose hepatique congenitale

The effect of chronic ethanol ingestion on the ability of the small intestine to absorb zinc was examined in male Sprague-Dawley rats. Six rats were fed the Lieber-Decarli liquid rat diet for 1 month during which 36% of their total calories were provided as ethanol, while their pair fed controls received these calories as carbohydrate. Zinc absorption was then examined simultaneously in duodenal and ileal segments by in vivo perfusion. Net absorption of zinc in the ileum was reduced by 16% following chronic ethanol feeding. Duodenal absorption of zinc was significantly less than in the ileum and was unaffected by chronic ethanol ingestion. These results demonstrate that chronic ethanol ingestion significantly impairs net zinc absorption in the ileum of the rat, the most active area of zinc uptake as measured by in vivo perfusion, and suggest that malabsorption of zinc may contribute to the zinc deficiency seen following chronic ethanol ingestion.

Jejunoileal bypasses were performed in rats to determine the effect of improved absorption on the development of liver dysfunction occurring after this procedure. Several parameters of liver function were measured in rats 7 weeks after both the standard 85% small-bowel bypass and an 80% bypass in which an extra 5 cm of intact bowel was retained. Animals having undergone 80% bypass had a lesser degree of lowering of serum protein and triglyceride levels, hepatic cytochrome P-450 content, and hepatic glucose-6-phosphatase activity than did the animals undergoing 85% bypass. Abnormalities found in 85% bypass animals were only partially reproduced by reducing food intake in another group of 80% bypassed animals. These findings emphasize the importance of nutritional factors in the etiology of bypass-induced liver disease and militate against toxin production in the defunctionalized bowel as the sole cause of liver dysfunction following bypass.

Zinc absorption was evaluated six weeks after massive small-bowel resection in rats. Forty rats were divided into four groups. Ten were subjected to proximal small-bowel resection, 10 to distal resection, and 20 served as pair-fed controls. Intestinal perfusion studies were performed using a recirculation technique. Twenty ml of a solution containing 10 microgram/ml of zinc as zinc sulfate, isotonic sodium chloride, and polyethylene glycol 5 g/liter was perfused for 2 hr through 10 cm of remaining bowel in resected animals and comparable segments in control animals. Zinc uptake was determined and expressed per 0.1 g mucosal dry weight. In control animals, zinc absorption was greatest in the ileum. Animals undergoing distal bowel resection had a compensatory increase in zinc absorption in the proximal small intestine. However, animals undergoing proximal resection did not demonstrate an increase in zinc absorption in the distal bowel. The proximal small intestine appears capable of increasing its capacity for zinc absorption in the response to distal small-bowel resection.

End-stage liver disease affects nearly 300 children annually in the United States. Based upon the annual birth rate in the United States of 3.1 million, the incidence of the most prominent causes of liver disease in children (biliary atresia, alpha 1-antitrypsin deficiency, Wilson's disease, and neonatal hepatitis), and the frequency of end-stage liver disease in each disorder. Liver transplantation now offers these children at least a 65%, and in some series as high as 85%, chance of surviving at least 2 years postoperatively. Much of this improvement is attributable to advances in immunosuppression. However, one must not underestimate the importance of the tremendous knowledge that has been gained in the care of a large number of these patients over the last decade. The major barriers standing in the way of wider application of liver transplantation include the reluctance of primary care physicians to refer patients for early consideration, the growing crisis in the availability of donor organs, and the lack of adequate numbers of centers involved in performing adequate numbers of procedures. The major hurdles to overcome in order to affect further improvements in results include more specific immunosuppression, more accurate means of diagnosing rejection, better techniques of organ preservation, and further optimization of the care of both candidates preoperatively and recipients after transplantation.

The stability of several vitamins and minerals of a new formula for premature infants, Similac Special Care, was examined following passage through a simulated continuous infusion apparatus designed to duplicate that used for continuous enteral feeding in infants. The concentrations of calcium, iron, zinc, copper, magnesium, vitamin A, vitamin C, and vitamin E were measured before and after infusion at rates appropriate for delivering 120 calories/kg to infants weighing 733 and 1,000 g. Following passage through this apparatus, significant reductions were noted for calcium (44-54%), iron (23-34%), and zinc (18-32%). Concentrations of copper, magnesium, and vitamins A, C, and E remained stable. When another formula commonly used for premature infants, Similac 24LBW, was subjected to similar analysis, the concentrations of all vitamins and minerals studied remained stable. Our study demonstrates that infants fed Similac Special Care by continuous infusion may not receive the quantity of calcium, iron, and zinc implied by the product label.

Little is known concerning the effects of elemental diets on bowel adaptation following massive resection. Fourteen of 28 Sprague-Dawley rats (40-45 g) were subjected to a 60% jejunoileal resection. Seven of the resected animals and seven sham-operated controls were then placed on a diet containing all protein in the form of casein hydrolysate. The remaining seven resected animals and seven sham-operated controls were placed on a comparable diet in which all the protein was casein. Each control animal was paired with a resected animal. After 2 weeks, unidirectional glucose and leucine transport was determined from intestinal sacs made from the proximal 3 cm and distal 3 cm of the remaining bowel. The midportion was used for the determination of mucosal weight and protein and sucrase content. When expressed as a percent increase over control values per centimeter of bowel, only sucrase levels were significantly elevated in the distal bowel in casein hydrolysate-versus casein-fed animals. The mucosal protein level, mucosal weight, and glucose uptake did not differ from control values when expressed as a percent change. Leucine uptake was significantly decreased in casein hydrolysate-fed animals when compared to that in casein-fed animals in both the proximal and distal bowel, again when expressed as a percent change from the control values. The administration of protein in the form of casein hydrolysate following massive bowel resection does not adversely affect mucosal hyperplasia occurring after resection but may have an adverse effect on the enhancement of amino acid absorption.

Pancreatic secretions have been shown to be important in zinc absorption in experimental animals. Recently, complete surgical diversion of biliary and pancreatic secretions from the functioning small intestine has been utilized in Europe to treat morbid obesity. To determine the importance of pancreatic secretions in zinc absorption in the human, we measured hair and serum zinc levels in 14 patients having undergone complete biliopancreatic bypass 12–56 months earlier and compared these values with those obtained from 11 patients subjected to only partial biliopancreatic bypass as well as to six morbidly obese controls. No differences were observed in either hair or serum zinc levels between any of these groups of patients. Pancreatic secretions do not appear to be necessary for adequate zinc absorption in humans.

A case of primary intestinal lymphangiectasia is presented in which multiple blind peroral jejunal biopsies were unable to document any abnormality, despite strongly suggestive clinical history and radiographic findings. Endoscopically directed biopsy was necessary to document the characteristic pathologic lesion. This report documents the importance of endoscopy in the diagnosis of intestinal lymphangiectasia when clinical history is suggestive of intestinal lymphangiectasia but standard small bowel biopsy fails to show any abnormality.

Eleven infants with complex congenital heart lesions were given continuous enteral infusions after failure to gain weight adequately despite use of hypercaloric formulas and nutritional supplementation. Formulas used before institution of enteral feedings were continued. Dietary and caloric intake and weight measurements were obtained at weekly or monthly intervals. Both mean daily caloric intake and mean daily weight gain were greater after initiation of continuous enteral feedings. Rate of weight gain improved in all 11 children after institution of enteral feedings. Continuous enteral feeding increases weight gain in babies with complex congenital heart disease, allowing earlier and safer surgical intervention.

• Gastric emptying in normal newborns was studied with use of a double marker technique. The volume of 200 to 400 mOsm carbohydrate solutions emptied from the stomach in 30 minutes was determined. To evaluate isocaloric solutions of different osmolalities, the osmolality of a 400-mOsm glucose solution was decreased to 300 and 200 mOsm/L by replacing a portion of the glucose with glucose oligosaccharides (GOSs). Because GOSs could be rapidly hydrolyzed in the duodenum, the effect of osmolality alone was studied by adding xylose to a 200-mOsm glucose solution to increase the osmolality to 300 and 400 mOsm/L. The volumes of the various solutions emptied in 30 minutes were not significantly different. These findings suggest that decreasing formula osmolality from 400 to 200 mOsm offers no intrinsic advantage with regard to gastric emptying. ( Am J Dis Child 1982;136:448-451)

Nasojejunal feedings are frequently advocated for ill preterm infants on the basis of lower esophageal sphincter (LES) in competence. We previously evaluated LES pressures in healthy term infants and found them to be indicative of sphincter competence. We have now measured LES pressures in 7 ill preterm infants receiving respiratory assistance. Pressure recordings were obtained using a single lumen side opening perfused catheter, and compared with pressures from healthy term and preterm infants (see table). The groups differed in gestational age (GA), and postnatal age (PA) but LES pressures were unaffected by these two variables. Even the smallest infant studied (720gm, pH 7.20) exhibited normal LES pressure (40 mmHg). Subsequent to studies, all infants were fed by continuous drip gastric lavage without any clinical evidence of regurgitation or aspiration. Our data indicates that the LES is competent at an early developmental age. The use of nasojejunal instead of nasogastric feedings can not be justified on the basis of suspected LES incompetence.

Osmolality of oral glucose-electrolyte solutions may be reduced without altering caloric content if glucose oligosaccharides (GOS) are substituted for glucose. To evaluate the effect of glucose vs GOS on gastric emptying in newborns, GOS were substituted for glucose in a 400 mosm glucose solution to reduce osmolality to 200 or 300 mosm. To assess the effect of osmolality alone on gastric emptying, a 200 mosm glucose solution was increased to 300 or 400 mosm by adding the nonmetabolized pentose xylose. Effect of glucose concentration alone was assessed by comparing 200 vs 400 mosm glucose solutions. On the second day of life, six groups of 5 healthy term newborns were fasted 3 hours. Sixty cc of the test solution containing 5g/1 polyethylene glycol 5000 (PEG) as a marker was instilled into the stomach. After 28 minutes, 3 mg of phenol red was instilled and allowed to equilibrate for 2 minutes. Contents were then aspirated and assayed for PEG and phenol red. The following milliliters of original solution remained in the stomach: We conclude that osmolality does not effect gastric emptying in the range of 200-400 mosm in newborns and substitution of glucose by GOS will not enhance gastric emptying of infant formulas or infant glucose-electrolyte preparations.