Friday, July 17, 2009

NEW TREATMENT FOR SHORT BOWEL SYNDROME

In a first of its kind study, scientists have found that an extract from green algae Chlorella may turn out to be an effective treatment for short bowel syndrome (SBS).

SBS is a clinical condition characterized by diarrhea, dehydration, electrolyte imbalance, malabsorption, and progressive malnutrition related to a wide resection of the small intestine.

One of the most important therapeutic objectives in the management of SBS is to maintain the patient's calorie intake and nutritional status.

But, some enteral nutrition (EN) products use for energy supports in order to reduce total parenteral nutrition (TPN) demand. .

Chlorella is a species of green algae that grows in fresh water. It has been consumed as a food source for centuries in mainly Japan and other Far East countries, besides, it's healing properties has enhanced it's consumption too. Several EN products have been used for SBS.

Led by Mustafa Kerem from Gazi University Experimental Surgery Center, the study showed that there's a positive effect of chlorella crude extract (CCE) on intestinal adaptation of rats which had undergone short bowel syndrome.

The researchers saw that administration of CCE led to significant increase in intestinal villi height and villi width, intestinal protein and DNA amount, and serum citruline levels, which is a sign of improved intestinal absorption.

Utilising this information, one can say that algs which are easily found widely in salt and fresh waters and can be generated easily, can be used in clinical settings.

CCE has beneficial role in intestinal adaptation. It seems that it can be an alternative to the other commercial enteral and parenteral products.

The study was published in the World Journal of Gastroenterology. (ANI)

source:

http://www.khabarexpress.com/12/10/2008/Green-algae-extract-may-offer-short-bowel-syndrome-treatment-news_47868.html

Monday, July 13, 2009

HEPATOADRENAL SYNDROME

Adrenal failure is common in critically ill patients, particularly those with sepsis. As liver failure and sepsis are both associated with increased circulating levels of endotoxin and proinflammatory mediators and reduced levels of apoprotein-1/high-density lipoprotein, it is not surprising that adrenal failure is common in patients with liver disease also. Liver failure is well recognized to cause renal (hepatorenal syndrome) and pulmonary syndrome (hepatopulmonary syndrome). However, the association between liver failure and adrenal insufficiency is less well studied. In septic patients, a blunted response to adrenal stimulation identifies patients with a poorer prognosis who may benefit from corticosteroid supplementation. This condition has been termed relative adrenal insufficiency (RAI). Given the similarities between septic shock and liver failure, a number of groups have now studied the incidence of RAI in various forms of liver disease. Recently at least 5 studies have shown that adrenal insufficiency is common in critically ill patients with liver disease even in the absence of clinical sepsis. Although different definitions of RAI exist, the current literature suggests that RAI is common, being seen in 33% of acute liver failure patients and up to 65% of patients with chronic liver disease and sepsis. The finding that RAI can exist in the absence of sepsis and may be as high as 92% of patients undergoing liver transplantation using a steroid free protocol has led one group to propose the term hepatoadrenal syndrome.

Singh and colleagues reported a single case of adrenal insufficiency following liver transplantation. Harry and coworkers demonstrated an abnormal high dose cosyntropin stimulation test in 28 of 45 (62%) patients with acute liver failure. In a cohort of 38 “nonstressed” patients with end-stage liver disease, McDonald et al reported a 64% reduction in peak plasma cortisol following insulin-induced hypoglycemia and a 39% reduction following a high-dose cosyntropin test when compared with healthy controls. In patients with adrenal insufficiency, the mortality rate was lower in those patients treated with glucocorticoids. Hence, untreated patients with adrenal insufficiency (low cortisol levels) and patients with a very high cortisol level may have a high mortality rate. The association between low serum HDL levels and adrenal insufficiency observed in many studies supports the notion that liver disease may lead to impaired cortisol synthesis. The adrenal gland does not store cortisol; increased secretion arises due to increased synthesis under the control of adrenocorticotropin. Cholesterol is the principal precursor for steroid biosynthesis in steroidogenic tissue. Experimental studies suggest that HDL is the preferred lipoprotein source of steroidogenic substrate in the adrenal gland. Recently, mouse SR-B1 (scavenger receptor) and its human homologue (CLA-1) have been identified as the high-affinity HDL receptors mediating selective cholesterol uptake. These receptors are expressed at high levels in the parenchymal cells of the liver and the steroidogenic cells of the adrenal glands, ovary, and testis. CLA-1 m-RNA is highly expressed in human adrenals, and the accumulation of CLA-1 m-RNA is regulated by adrenocorticotropin. Apolipoprotein (apo) A-1, the major protein component of HDL, is synthesized principally by the liver and to a lesser degree in the intestine. Cicognani and coauthors demonstrated a striking decrease in the level of serum HDL in patients with cirrhosis that was related to severity of liver disease. Thus low levels of HDL in patients with liver disease may be pathogenetically related to the high incidence of adrenal insufficiency. Van der Voort and colleagues demonstrated that in critically ill patients, low HDL levels were associated with an attenuated response to cosyntropin. Apart from low HDL levels and the reduced delivery of substrate for cortisol synthesis, other mechanisms may contribute to the pathophysiology of the hepatoadrenal syndrome. Patients with acute and chronic liver disease have increased levels of circulating endotoxin (lipopolysaccharide) and proinflammatory mediators such as tumor necrosis factor (TNF)-alpha. It is postulated that intestinal bacterial overgrowth with increased bacterial translocation together with reduced Kupffer cell activity and porto-systemic shunting results in systemic endotoxemia with increased transcription of proinflammatory mediators. Endotoxin has been shown to bind with high affinity to the HDL receptor (CLA-1) with subsequent internalization of the receptor. Lipopolysaccharide may therefore limit the delivery of HDL cholesterol to the adrenal gland. Furthermore, TNF-alpha as well as interleukin- 1 and interleukin-6 has been demonstrated to decrease hepatocyte synthesis and secretion of apoA-1. In addition to its effects on apoA-1, TNF-alpha has been demonstrated to directly inhibit cortisol synthesis in a dose-dependent manner as well as to cause tissue resistance to cortisol by decreasing the number of glucocorticoid receptors or by up-regulating binding proteins. Tsai et al studied adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (P < .001) and the cortisol response to corticotropin was inversely correlated with MELD score, and Child-Pugh scores. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (P < .001), and a higher proportion of these patients required vasopressors (P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In another study 25 cirrhotics with septic shock were studied and RAI was found in 68%. Quicker resolution of shock and apparent survival benefit was seen with low dose hydrocortisone.

In conclusion, relative adrenal insufficiency (RAI) is common in critically ill patients with cirrhosis with or without sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality. Low dose hydrocortisone may be beneficial in this condition. However, current data doesn’t suffice to recommend steroids in liver disease. Furthermore, assays for free cortisol will be more realistic in this setting as both cortisol binding globulin & S. albumin decrease in this setting and total cortisol level may be misleading. Occult infection must be ruled out in culture negative patients & dose of ACTH for SST should be standardized. Hence, more studies are required in this field, especially from Indian subcontinent.


source:
http://hepatologyindia.org/hepatoadrenalsyndrome.php

SMALL INTESTINE TRANSPLANTATION IN INDIA

Intestine is a segment of the digestive tract extends from stomach to the anus. It has two parts small intestine and large intestine which has further sub-divided parts. In the whole body anatomy intestine is one of the most important parts. Intestine transplant means replacement of a diseased intestine with a healthy one donated from another person.

Who needs an intestine transplant ?
Children or adults with intestinal failure require an intestine transplant surgery. Children may require intestinal transplant for several reasons like :

Short Bowel Syndromes like :

Gastroschisis
Necrotizing Enterocolitis (NEC)
Volvulus
Aganglionosis/ Hirschsprung’s Disease
Intestinal Atresia
Other conditions like :

Pseudo-Obstruction
Microvillus Inclusion
Malabsorption
Tumor
An intestinal transplant is also done to children or adults who suffer from intestinal failure from total parenteral nutrition (TPN), an intravenous nutrition supply system through a catheter or needle inserted into a vein in the arm, groin, neck or chest. Long-term TPN can also result in complications like bone disorders, catheter-related infections and liver failure.

Tests of the Patient :
Before intestinal transplant, the medical teams examine the physical health of the patient which is called evaluation process. A person has to do a thorough medical examination like Upper gastrointestinal and small bowel X-ray series, Barium enema, Endoscopy, Abdominal CT scan, Motility studies, EKG and echocardiography, Ultrasound of the circulatory system, Blood tests for liver function, electrolytes, kidney function and antibodies to certain viruses, etc.

Evaluation of the Transplant :
Intestine transplant is a complex medical procedure done by expert transplant specialists. The surgery of intestine transplant takes 12 hours. It may be three types such as- single intestinal transplant, combined liver intestine transplant, multi-visceral transplant. However the type of intestine transplant depends on the cause of the intestinal failure and results of the medical examination.

In intestine transplant, the blood vessels of the patient are connected to the donor's blood vessels to establish a blood supply to the transplanted intestine. Then to the gastrointestinal tract the donor's intestine is connected.

Recovery from the Surgery :
Unlike the transplant, the recovery also differs to each patient which overall depends on the medical history, type of transplant and medical condition at the time of their transplant. The recovery may take several weeks or months. Immediately after the transplant, the patient is monitored in an intensive care unit (ICU). During the post surgery period, the patient is constantly monitored through frequent blood draws, biopsies of the transplanted intestine through the ileostomy and radiologic testing. Post surgery monitoring is important like in any other organ transplant surgery. One can withdraw the total parenteral nutrition (TPN) and slowly can start the oral diet.

Organ transplantation surgery in India is updated now with all modern infrastructure and transplant specialist. One can take intestine transplant surgery in India with the help of our medical team. Our team offers this surgery at an affordable price along with free consultation by the experts as well as treatments with no waiting periods. Medical treatments in India is now easily accessible.

SOURCE:

http://www.indian-medical-center.com/intestine-transplant.html

HE LIVES WITHOUT SMALL INTESTINE

Laying down in his hospital bed and watching each drop of protein supplement entering his body, 17-year-old Ramesh Babu dreams of becoming an IAS officer one day.

Ramesh, who hails from Tamil Nadu is currently undergoing a treatment at Church of South India (CSI) hospital in Bangalore for a rare disease, short bowel syndrome. He does not have the small intestine which absorbs and digests food. It was surgically removed.

In December 2008, he complained about severe abdominal pain and the doctors at first thought it was Appendicitis. But while operating on him, they found gangrene in his small intestine and diagnosed that he was suffering from the Superior Mesenteric Artery (SMA) syndrome, a rare and life threatening gastrointestinal disorder caused by the compression of the third portion of the duodenum.

Speaking to DNA, Dr Sathyasheelan, assistant surgeon at the CSI hospital, said, "Patients with SMA syndrome had rarely come out of the operation theatre. But he survived for more than six months after the surgery.It is a miracle."

His father Naganathan, who is a weaver by profession and from the lower socio-economic stratum of the society find it difficult to meet his hospital expenses. "So far we had spent Rs3 lakh for his treatment. I haven't worked for last seven moths as I have been travelling all over Tamil Nadu for his treatment.We have taken loans to meet the expenses," said his father.

According to Dr Sathyasheelan, there is only one option left before Ramesh, the small bowel transplantation. "The surgery will cost around Rs8-10 lakh and it is difficult to get a living potential donor for the transplantation," he said, adding, "This will be the first small bowel transplant in India, if it happens."

Ramesh's family is planning to get him discharges as they cannot afford the hospital expenses. So far, the treatment was given free of cost from the Bible Society funds.

SOURCE:
http://www.dnaindia.com/bangalore/report_boy-lives-without-small-intestine_1273058

PANCREAS TRANSPLANTATION IN INDIA

Pancreas is a gland organ in human body responsible for the secretion of digestive juice and production of hormones like glycogen, insulin. It is a 6 inches long gland located between the stomach and spine. It is divided into three parts- head (widest part), body (middle) and thin end (tail). The hormones produced by pancreas help to regulate the blood sugar levels. Pancreas transplant means surgical replacement of diseased pancreas with a healthy one of a donor. A pancreas may fail to perform its function and then pancreas transplant surgery is recommended.

Causes behind Pancreas Transplantation :
Who requires a pancreas transplant? The doctors recommend pancreas transplantation surgery to those who suffer from complication of Type 1 diabetes like severe hyperglycemia, Hypoglycemia, etc. The islet cells in the pancreas could not produce insulin in patient with this type of diabetes.

Types of Pancreas Transplantation :
Though the main types are categorized as whole pancreas transplantation and partial pancreas transplantation, some medical groups divide it into three types. In the whole process, a complete pancreas is transplanted usually along with kidney transplantation but in some cases it is done after kidney transplantation as well. In the partial process, half pancreas of a donor person is transplanted into the patients’ body.

Simultaneous pancreas-kidney transplant (SPK) : It means simultaneaous transplant of both kidney and pancreas for diabetis patient suffer from end stage kidney failure.
Solitary pancreas transplant : It is done to prevent the onset of diabetic complications in the kidney, after kidney transplantation.
Islet transplant : It is a minor surgical procedure for pancreas transplant.
Risks of Pancreas Transplantation :
Unlike any organ transplantation surgery in India , pancreas transplantation has also some risks. Before transplantation the doctors test the patient and the donor’s type of Human leukocyte antigen (HLA) type. The matching of the HLA type helps into acceptance of the new pancreas. Rejection of pancreas may happen as a new organ is considered by the body as foreign. To fight the rejection of pancreas, drugs are given to the patients. Even the drugs may cause side effects.
People those of who has no heart or blood vessel disease, can take pancreas transplant safely. The side effects of surgery may be bleeding and infection.

Procedure of Surgery of Pancreas Transplant :
Usually the surgery of pancreas transplantation takes 12 to 15 hours. The new pancreas is attached to the blood vessels and to the bladder, intestine to drain digestive juice. New surgical methods are developed for pancreas transplant. Laparoscopic surgery is less painful as little incision is done in this surgery. After surgery, constant monitoring is done to study the function of the new pancreas as well the other side effects. A healthy lifestyle is urgently required for the patient after surgery for proper rehabilitation.

India is sought by the foreign travelers for its medical treatments including organ transplantation surgery in India. Our team will guide one to undergo pancreas transplant under the surgery specialists of Apollo Hospitals. One will avail treatments at an affordable price along with free consultation and no waiting periods. Medical treatments in India are now accessible and affordable.

SOURCE:

http://www.indian-medical-center.com/pancreas-transplant.html

Thursday, July 9, 2009

DIET IN ULCERATIVE COLITIS

There is no specific Ulcerative Colitis Diet plan available with the physicians. However, diet can play key role in curing a person suffering from Ulcerative Colitis. While advising a diet regimen to a patient suffering from Ulcerative Colitis several factors are taken into consideration. The physician first tries to determine the severity of the disease. Then, individual nutrient needs and the food tolerance of the patient are found out.


Well-balanced diet required

A well-balanced diet is highly recommended to Ulcerative Colitis patients. The patients can also take food supplements to avoid malnutrition which is a common phenomenon in this condition. In India, Ulcerative Colitis is also treated with the help of Ayurvedic treatment which recommends vegetables and fruits like cabbage, cauliflower, carrot, potato, pumpkin, gourd, banana, papaya and water melon as Ulcerative Colitis Diet.

A patient suffering from Ulcerative Colitis must adhere to the following dieting tips. If followed properly, these tips can perform miracle.

Keep watch on the foods which can aggravate the disease.
Keep written account of the diet taken and its concerned symptoms.
Eat nutritious and high fiber foods like whole grain breads, low-fat dairy products, lean meats, vegetables and fruits.
Increase fluid intake.
Allow small intake of meals and snacks at regular intervals.
Change dietary preferences after consulting the doctor.

General belief
It is a general belief that patients suffering from Ulcerative Colitis should limit the in-take of dairy products as they can aggravate the condition. The latest study in this respect has revealed that dairy products and fiber rich food do not pose any threat to the patients. In this respect milk and products rich with dairy fat are exception. It is, however, advisable to note the reactions of the foods given to the patients. If it is noticed that one particular food is causing deterioration, the consulting physician must be informed with immediate effect.


source:

http://nutrition.headlinesindia.com/diet-nutrition/ulcerative-colitis-diet.html