LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.
Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
-Context -Malnutrition is frequently observed in inpatients with malignant diseases and may contribute to longer hospital stays. Objective -To compare the nutritional status, lymphocyte count, hemoglobin values and length of hospital stay of patients with and without malignant diseases. Methods -This comparative study assessed indicators of nutritional status, namely body mass index, recent weight loss, lymphocyte count, hemoglobin and length of hospital stay, of 928 surgical patients with and without malignant diseases (50.2% females and 49.8% males). The chi-square test was used to compare proportions and the Mann-Whitney test was used to compare continuous measurements between two groups. The significance level was set at 5%. Results -Patients with malignant diseases had longer hospital stays (P<0.0001), furthermore, a higher percentage of patients with malignant diseases had body mass index <18.5 (P<0.0001) and experienced recent weight changes (P<0.0002). Lymphocyte count also differed statistically between the groups (P = 0.0131), which lower levels were identified among patients with malignant diseases. Conclusion -The lymphocyte count, hemoglobin values and weight loss are important findings of nutritional depletion in patients with malignant diseases. HEADINGS -Nutritional status. Weight loss. Blood cell count. Length of stay.
-Context -The investigation of risk factors associated with nutritional status could contribute for better knowledge of the malnutrition. Objective -To investigate the incidence of malnutrition and its possible association with many parameters that assess nutritional status and to identify the associated risk factors. Methods -The nutritional status was assessed in 235 hospitalized patients. Malnutrition was defined as present when the patient presented at least two anthropometric criteria below the normal range and habitual energy intake below 75% of the energy requirement (HEI/ER<75%). Gender, age, type of disease, recent weight change and dental problems were investigated as possible associated risk factors. The chi-square and Mann-Whitney tests were used to compare the data and univariate and multiple logistic regressions were used to identify the factors associated with malnutrition. The odds ratio (OR) and confidence interval (CI) of 95% were calculated with the significance level set at 5% (P<0.05). Results -One-fifth (20%) of the patients were malnourished on admission to the hospital and 27.5% reported recent weight loss. Malnutrition (P<0.0001) was greater in patients with malignant diseases. The only variables significantly associated with malnutrition according to univariate logistic regression were recent weight loss (P = 0.0058; OR = 2.909; IC95% = 1.362; 6.212) and malignant disease (P = 0.0001; OR = 3.847; IC95% = 1.948; 7.597). When multiple regression was used in the model which included type of disease, malignant disease was shown to increase the chance of malnutrition fourfold (P = 0.0002; OR = 3.855; IC95% = 1.914; 7.766). When disease was excluded, recent weight loss also increased malnutrition fourfold (P = 0.0012; OR = 3.716; IC95% = 1.677; 8.236). Conclusion -Patients with a history of recent weight loss and those with malignant diseases are more susceptible to malnutrition.
BACKGROUND Older patients are commonly malnourished during hospital stay, and a high prevalence of malnutrition is found in hospitalized patients aged more than 65 years. OBJECTIVE To investigate whether total lymphocyte count is related to other nutritional markers in hospitalized older adults. METHODS Hospitalized older adults (N=131) were recruited for a cross-sectional study. Their nutritional status was assessed by the Nutritional Risk Screening (NRS), anthropometry, and total lymphocyte count. The statistical analyses included the chi-square test, Fisher's exact test, and Mann-Whitney test. Spearman's linear correlation coefficient determined whether total lymphocyte count was correlated with the nutritional markers. Multiple linear regression determined the parameters associated with lymphocyte count. The significance level was set at 5%. RESULTS According to the NRS, 41.2% of the patients were at nutritional risk, and 36% had mild or moderate depletion according to total lymphocyte count. Total lymphocyte count was weakly correlated with mid-upper arm circumference (r=0.20507); triceps skinfold thickness (r=0.29036), and length of hospital stay (r= -0.21518). Total lymphocyte count in different NRS categories differed significantly: older adults who were not at nutritional risk had higher mean and median total lymphocyte count ( P =0.0245). Multiple regression analysis showed that higher lymphocyte counts were associated with higher triceps skinfold thicknesses and no nutritional risk according to the NRS. CONCLUSION Total lymphocyte count was correlated with mid-upper arm circumference, triceps skinfold thickness, and nutritional risk according to the NRS. In multiple regression the combined factors that remained associated with lymphocyte count were NRS and triceps skinfold thickness. Therefore, total lymphocyte count may be considered a nutritional marker. Other studies should confirm these findings.
The best parameters to determine nutritional risk in relation to the MNA were AC, BMI and CC. However, these nutritional assessment parameters should be used to replace the MNA for the assessment of hospitalized elderly patients with their current cut-off points.
OBJETIVO: Avaliar os resultados do tratamento cirúrgico em uma série de pacientes submetidos ao tratamento prévio para megaesôfago que evoluíram com recidiva de sintomas. MÉTODO: Analisou-se os resultados das diversas técnicas operatórias realizadas em 47 pacientes pelo Serviços de Cirurgia Geral e Torácica do HMCP-PUC-Campinas. A morbidade pós-cirúrgica, mortalidade, o alívio ou nova recidiva de sintomas e o tempo de seguimento foram os principais indicadores. Dividiu-se a série em três grupos, de acordo com o grau da afecção: Incipiente (nove casos), Não-avançado (18 casos) e avançado (20 casos). As técnicas operatórias utilizadas foram: à cardiomiectomia com fundoplicatura anterior, esofagocardioplastia à Tahl, esofagocardioplastia à Serra-Dória, Esofagectomia Subtotal e Mucosectomia com conservação da túnica muscular esofágica. RESULTADOS: Obteve-se índices de resolutividade satisfatórios com a técnica de cardiomiectomia com fundoplicatura para o megaesôfago Incipiente, com baixa morbidade. Nos megaesôfago não-avançado, as cardiopatias, em especial a esofagocardioplastia à Serra-Dória mostram se mais adequadas. A terapêutica do megaesôfago avançado apresentou as maiores taxas de morbidade e demonstrou superioridade das técnicas mais agressivas em relação às técnicas conservadoras, em especial a mucosectomia com preservação da túnica muscular, sendo esta a técnica com menor morbidade dentro do grupo avançado. CONCLUSÃO: A difícil padronização do tratamento cirúrgico do megaesôfago recidivado deve-se às inúmeras técnicas disponíveis, às habilidades pessoais dos cirurgiões e atenta para a criação de protocolos terapêuticos.
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