La pratique de la prescription de la nutrition parentérale en phase palliative d’un cancer soulève différentes réactions chez le malade. Dans ce travail, nous proposons d’orienter notre réflexion vers une approche psychologique de l’image inconsciente du corps. En interrogeant des patients qui acceptent ou refusent ce nouveau type d’alimentation, nous viendrons questionner le rôle de certaines fonctions du « Moi-peau » définit par Didier Anzieu. Effectivement, la création d’une zone artificielle de nutrition vient perturber l’image du corps dans le registre pulsionnel de l’oralité. Comment le Moi du sujet peut-il économiquement investir ou non cette nouvelle zone du corps ? / The practice of prescribing parenteral nutrition in the palliative phase of cancer leads to different reactions in patients. In this work, we will take a psychological approach to the experience of body image in this phase of cancer. Interviewing patients who accept or refuse this parenteral nutrition, we will focus on certain functions of the “Moi-peau” concept defined by Didier Anzieu. Indeed, creating an artificial area of the body for nutrition purposes disturbs body image in the field of orality. How will the “me” of the subject invest in this new body economically ?

Bakgrund: Parenteral nutrition kan ges vid i stort sett alla tillstånd när magtarmkanalen ej fungerar eller kan utnyttjas tillfredställande. Benigna tarmsjukdomar, t ex Morbus Crohn eller short bowel syndrome av annan anledning är den vanligaste orsaken till HPN (home parenteral nutrition). En europeisk studie från 1997 visar att incidensen för HPN i Danmark är 2,8 patienter/miljoner invånare/år. Vanligen är patienten uppkopplad till HPN-utrustningen 12-14 timmar/dygn. WHO (World Health Organisation) har utarbetat en definition av livskvalitet; ”Quality of life is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” Syfte: Syftet med denna litteraturstudie är att undersöka och beskriva hur patienter med parenteral nutrition i hemmet upplever sin livssituation och behandlingens inverkan på livskvaliteten. Metod: Studien är en litteraturstudie där tio kvantitativa/kvalitativa artiklar valts ut från PubMed och granskats enligt Carlssons & Eimans bedömningsmallar. Resultat: Tre teman framkom; fysiska faktorer, psykiska faktorer och sociala faktorer. Resultatet visar en negativ påverkan på livskvaliteteten i olika aspekter. Dock visar en av studierna att livskvaliteten förbättras efter HPN. Slutsats: I jämförelse med normalbefolkningen och patienter med korttarmssyndrom utan behov av HPN tyder denna litteraturstudie på låg livskvalitet hos patienter med HPN.

Background: It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure–associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving parenteral support, namely home parenteral nutrition (HPN) and home intravenous fluids (HIVFs). Methods: We retrospectively reviewed charts of patients with intestinal failure who received HPN or HIVF for >2 weeks at our tertiary center between January 2005 and August 2016. We excluded patients <18 years of age, patients with other causes of liver disease, patients who used probiotics for <30 days, patients with <6 months' follow-up, and those who had long-term antibiotic use (>30 days). Bivariable and multivariable logistic regression analyses were used in this study. Results: A total of 282 patients who received parenteral support were included. Eighty-five percent of our sample received PN. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotics was 35.9% vs 54.4% in patients who did not use probiotics, P =.005. In multivariable analysis, only small-bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, odds ratio (OR) = 4.394 (95% confidence interval [CI], 1.635-11.814; P =.003) and OR = 4.502 (95% CI 1.412-14.351; P =.011), respectively. Conclusion: Our study revealed that the prevalence of IFALD was comparable among the probiotic users and nonusers. Only small bowel length of 1090 cm and HPN use showed a significant impact on IFALD.

No description available.

Introduction: Medical advances have resulted in reduced mortality of pediatric patients with Intestinal Failure. Consequently, more patients go home on parenteral nutrition (PN) for extended durations. This time-consuming and complicated therapy necessitates persistent vigilance in monitoring and response to potential life-threatening side effects. These issues may impact quality of life (QOL) for patients, caregivers and families. Methods: This observational, cross-sectional, mixed-methods analysis of multidimensional QOL used a quantitative battery assessment and a qualitative focus group. Questionnaire results were compared to published norms, published small bowel transplant (SBTx), and institutional SBTx patients. Results: Home PN proxy assessments scored children lower than published norms but similar to SBTx. The child self-reports were similar to both normative and SBTx populations, except lower general and overall health. Generic questionnaires did not capture disease-specific issues. Conclusion: QOL is compromised in children on home PN and caregivers compared to norms but is similar to SBTx.

Introduction: Medical advances have resulted in reduced mortality of pediatric patients with Intestinal Failure. Consequently, more patients go home on parenteral nutrition (PN) for extended durations. This time-consuming and complicated therapy necessitates persistent vigilance in monitoring and response to potential life-threatening side effects. These issues may impact quality of life (QOL) for patients, caregivers and families. Methods: This observational, cross-sectional, mixed-methods analysis of multidimensional QOL used a quantitative battery assessment and a qualitative focus group. Questionnaire results were compared to published norms, published small bowel transplant (SBTx), and institutional SBTx patients. Results: Home PN proxy assessments scored children lower than published norms but similar to SBTx. The child self-reports were similar to both normative and SBTx populations, except lower general and overall health. Generic questionnaires did not capture disease-specific issues. Conclusion: QOL is compromised in children on home PN and caregivers compared to norms but is similar to SBTx.

Except for tyrosine, the amino acid requirement of parenterally fed (PN) human neonates has not been derived. Methionine and cysteine are indispensable and dispensable sulphur amino acids respectively. Cysteine is synthesized from methionine. Cysteine is unstable in solution, and is left out or added in very small amounts to amino acid solutions. Methionine is added to compensate for the lack of cysteine, assuming that the neonate will convert methionine to cysteine to meet the body’s metabolic demand. Methionine is hepatotoxic and there is evidence that the neonate has limited ability for its conversion to cysteine. To determine the requirement of the neonate for methionine, PN-fed, stable, post-surgical neonates received graded intakes of methionine. The mean methionine requirement was estimated to be 49 mg.kg-1.day-1, which is 48 to 90% of the methionine content of current commercial amino acid solutions. Because cysteine is the rate limiting substrate for glutathione (GSH) synthesis and current methods of determining amino acid requirement measure requirement for protein synthesis, SAA requirements for maintenance of GSH status was deleniated in healthy adult males and in PN-fed human neonates. GSH kinetics was measured in healthy men receiving the mean methionine requirement and graded intakes of cysteine. GSH synthesis did not change with the addition of cysteine. Additionally, PN-fed post-surgical neonates recieved a methionine-adequate cysteine-free PN followed by cysteine supplemented PN for two 3-day periods and GSH kinetics measured on days 3 and 6. There was no change in GSH synthesis in response to cysteine supplementation. It is concluded that the PN-fed human neonate is capable of synthesizing enough cysteine from methionine not only for protein synthesis but for GSH synthesis. For both healthy men and stable post-surgical neonates, the requirement for GSH synthesis is met at the sulphur amino acid requirement derived using the indicator amino acid technique

Except for tyrosine, the amino acid requirement of parenterally fed (PN) human neonates has not been derived. Methionine and cysteine are indispensable and dispensable sulphur amino acids respectively. Cysteine is synthesized from methionine. Cysteine is unstable in solution, and is left out or added in very small amounts to amino acid solutions. Methionine is added to compensate for the lack of cysteine, assuming that the neonate will convert methionine to cysteine to meet the body’s metabolic demand. Methionine is hepatotoxic and there is evidence that the neonate has limited ability for its conversion to cysteine. To determine the requirement of the neonate for methionine, PN-fed, stable, post-surgical neonates received graded intakes of methionine. The mean methionine requirement was estimated to be 49 mg.kg-1.day-1, which is 48 to 90% of the methionine content of current commercial amino acid solutions. Because cysteine is the rate limiting substrate for glutathione (GSH) synthesis and current methods of determining amino acid requirement measure requirement for protein synthesis, SAA requirements for maintenance of GSH status was deleniated in healthy adult males and in PN-fed human neonates. GSH kinetics was measured in healthy men receiving the mean methionine requirement and graded intakes of cysteine. GSH synthesis did not change with the addition of cysteine. Additionally, PN-fed post-surgical neonates recieved a methionine-adequate cysteine-free PN followed by cysteine supplemented PN for two 3-day periods and GSH kinetics measured on days 3 and 6. There was no change in GSH synthesis in response to cysteine supplementation. It is concluded that the PN-fed human neonate is capable of synthesizing enough cysteine from methionine not only for protein synthesis but for GSH synthesis. For both healthy men and stable post-surgical neonates, the requirement for GSH synthesis is met at the sulphur amino acid requirement derived using the indicator amino acid technique

No description available.

L'exposition à la lumière des solutions de nutrition parentérale (NP) génère des peroxydes tels que l'H2O2 et l'ascorbylperoxyde (AscOOH). Cette absence de photo-protection provoque une augmentation des triglycérides (TG) plasmatique chez les enfants prématurés et chez un modèle animal, ayant un stress oxydatif et une stéatose hépatique indépendante de l’exposition au H2O2. Nous pensons que l'AscOOH est l'agent actif conduisant à l'élévation des TG. Le but est d'investiguer le rôle de l'AscOOH sur les métabolismes du glucose et des lipides à l'aide d'un modèle animal néonatal de NP. / The light exposure of parenteral nutritive solutions generates peroxides such as H2O2 and ascorbylperoxide. This absence of photo-protection is associated with higher plasma triacylglycerol concentration (TG) in premature infants and, in animals, with oxidative stress and a H2O2 independent hepatic steatosis. We hypothesized that ascorbylperoxide is the active agent leading to high TG. The aim was to investigate the role of ascorbylperoxide on glucose and lipid metabolism in an animal model of neonatal parenteral nutrition.