This study has demonstrated the current nutritional practices employed in Australia and New Zealand for patients undergoing major upper gastrointestinal surgery. Questions remain regarding the noted differences between procedures as well as the optimal means and duration of perioperative nutritional support.
Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.
Pseudomyxoma peritonei (PMP) is a rare mucinous disease most commonly arising from the appendix. Pleural involvement arising from established PMP is seen in a small number of cases. Combined cytoreductive surgery and hyperthermic intrathoracic chemotherapy is the treatment of choice when managing intra-thoracic PMP. In cases of recurrence, surgical intervention may be technically challenging and carry higher rates of complications, morbidity, and mortality. Bromelain and acetylcysteine (BromAc<sup>®</sup>) is a novel treatment modality that has demonstrated mucolytic properties. When injected directly into mucinous disease, it facilitates tumour dissolution and allows it to be aspirated. It has recently been tested in the treatment of inoperable peritoneal mucinous disease, with an acceptable safety profile and positive objective response. Here we describe the first two cases of BromAc<sup>®</sup> administered directly into pleural adenomucinosis, with striking differences in response between the two patients likely due to differences in tumour hardness.
Objectives: (1) Examine past and current risk reduction/awareness strategies implemented among Middle Eastern populations in Australia with a focus on New South Wales (NSW), (2) evaluate contributing risk factors between diabetes and the Middle Eastern nationality, and (3) propose new risk reduction/awareness strategies for diabetes in NSW, Australia with an emphasis on high prevalence areas. Research Design & Methods: A systematic review from freely available information from both literature and non-literature sources. Selected papers had to include interventions involving cultural aspects on lifestyle improvements. Outcomes included qualitative or quantitative reports of increased patient satisfaction, patient sense of self-management, weight-loss or changes in HbA1c. Studies included in this review had to (1) be from January 1995 onwards, (2) be carried out in Australia and (3) involve a Middle Eastern target audience. Five studies of pilot interventions in Australia involving culturally-specific means were identified and selected. Results: Five small-scale community programs using Middle Eastern-specific groups (involving dance, swimming, fitness or nutrition) were introduced with varying successes in different cohorts. One intervention reported changes in weight and waist circumference respectively whilst the remaining interventions were not appropriately followed up. Conclusion: Recruiting and training bilingual teachers can have clinically significant changes in weight scores in high-risk type II diabetes patients and weight reduction as well as increase overall patient knowledge. Further Australian trials including scale cohorts and higher quality end-point studies are encouraged in this area.
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