Publications by authors named "Magdalena Pietka"

11 Publications

  • Page 1 of 1

From hospital unit to intestinal failure center: Twenty years of history.

Clin Nutr 2021 Jun 27;40(6):3787-3792. Epub 2021 Apr 27.

Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Care, Jagiellonian University, Krakow, Poland.

Aim: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study.

Methods: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation.

Results: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days.

Conclusions: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances.
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http://dx.doi.org/10.1016/j.clnu.2021.04.027DOI Listing
June 2021

Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: Results after 5 y of home parenteral nutrition.

Nutrition 2021 02 18;82:111029. Epub 2020 Oct 18.

Second Department of General Surgery, Jagiellonian University Medical College, Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.

Objectives: Intravenous lipid emulsions (ILE) are an essential component of parenteral nutrition (PN); however, pure soybean oil emulsion is considered a risk factor for intestinal failure-associated liver disease (IFALD). Limited data are available on the effect of different ILEs on the liver during long-term PN, and to our knowledge, no study has evaluated outcomes beyond 12 mo. Therefore, the aim of the present study was to assess the influence of mixed ILEs on liver function during long-term PN.

Methods: A randomized, open-label clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (35 F, 32 M; mean age, 53.2 years) receiving home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one of the following three ILEs: medium/long-chain triacylglycerides (MCT/LCT), olive oil/soybean oil (OO/SO), or a combination of SO/MCT/OO/fish oil (FO) (SMOFlipid). Patients were followed for 5 y. Liver function was assessed clinically and with biochemical parameters (total bilirubin, serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase) at baseline and after 24 and 60 mo.

Results: The most common etiology for CIF was vascular, followed by Crohn's disease, surgical complications, and radiation enteritis. HPN was effective in improving nutritional status and was associated with low rates of catheter infections and clinical complications. No significant differences were observed between groups in median concentrations serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, or alkaline phosphatase at 24 or 60 mo. A significant reduction in median bilirubin concentration was observed in the SMOFlipid group at 60 mo compared with baseline (6.8 umol/L; interquartile range, 5.2-8.5 versus 7.7 umol/L; interquartile range, 4.9-12.4; P = 0.0138).

Conclusions: Mixed ILEs are safe and effective for use in patients on long-term HPN. A multicomponent ILE with FO can provide additional benefits in terms of liver function during long-term HPN.
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http://dx.doi.org/10.1016/j.nut.2020.111029DOI Listing
February 2021

High Dose Intravenous Fish Oil Reduces Inflammation-A Retrospective Tale from Two Centers.

Nutrients 2020 Sep 19;12(9). Epub 2020 Sep 19.

General Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050 Skawina, Poland.

Aim: Patients on parenteral nutrition (PN) are prone to inflammation. This may aggravate an existing proinflammatory state and become a critical factor in the development of liver dysfunction (LD). Intravenous fish oil may attenuate this inflammatory state, but data on its use in adults are scarce. The aim of this study was to investigate the effects of adding a pure fish oil intravenous lipid emulsion (ILE) into short- and long-term PN in patients either at risk of, or with existing, inflammation.

Methods: A retrospective analysis of 61 patients (32 female, 29 male, mean age 51.5 ± 12.6 years) who received all-in-one PN, including amino acids, glucose, and lipids supplemented with pure fish oil ILE, was performed. Pure fish oil ILE (Omegaven®, Fresenius Kabi, Bad Homburg, Germany) was used along with the standard ILE to reach a fish oil dose of 0.4-0.5 g fish oil/kg/d. Diagnoses were chronic intestinal failure (CIF, = 20), Crohn's disease (CD, = 22), and ulcerative colitis (UC, = 19). The observation period was 12 months for CIF and 21 days for UC and CD.

Results: A reduction in inflammation was noticeable in all patients and became statistically significant in CD (hsCRP < 0.0001, ESR = 0.0034, procalcitonin = 0.0014, Il-6 = 0.001) and UC groups (hsCRP and ESR < 0.0001, Il-6 = 0.0001, TNF-α = 0.0113). In the CIF group, the total bilirubin concentration ( = 0.2157) and aspartate transaminase SGOT ( = 0.1785) did not vary over time.

Conclusions: PN with pure fish oil ILE reduces some inflammatory parameters in IBD and maintains liver function parameters in CIF patients. Fish oil might become a valuable ingredient in both short- and long-term PN in patients at risk of liver dysfunction.
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http://dx.doi.org/10.3390/nu12092865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551918PMC
September 2020

Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects.

JPEN J Parenter Enteral Nutr 2020 02;44 Suppl 1:S74-S81

and the Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.

A number of topics important to the handling of intravenous lipid emulsions (ILEs) were discussed at the international summit. ILE handling includes the preparation and the administration steps in the typical use of parenteral nutrition (PN). The discussion and consensus statements addressed several issues, including standardization of the PN process, use of commercially available multi-chamber PN or compounded PN bags, the supervision by a pharmacist with expertise, limiting ILE repackaging, and infusion duration.
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http://dx.doi.org/10.1002/jpen.1737DOI Listing
February 2020

Evaluation of Y-site compatibility of home total parenteral nutrition and intravenous loop diuretics.

Medicine (Baltimore) 2019 May;98(21):e15747

General Surgery and Oncology Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland.

In chronic kidney disease (CKD), the design of the parenteral nutrition (PN) regimen becomes more challenging where only individualized PN is appropriate, coupled with the increased risk of unintended interactions with diuretic therapy. In an effort to ensure safe therapy in the home, we assessed the physical stability of bespoke PN formulations intended for use in CKD in the simultaneous presence of Y-site compatibility of furosemide and torasemide. The patient's daily needs were determined based on both metabolic demands as well as the demand for fluids.Complete admixtures were subjected to physical stability analysis consisting of visual inspection, a validated light microscope method, pH measurement, zeta potential measurement, and characterization of oily globule size distribution. Y-site compatibility of furosemide and torasemide with the formulated admixtures was also performed.The total parenteral admixture was stable over 7 days at +4°C and 24 h at +25°C and compatible via the Y-line together with furosemide and torasemide over 12 h at +25°C.The stability assessment guarantees the safety and efficiency of home PN with loop diuretics therapy in CKD patients. This means that these patients do not need long hospitalization and they can be safely treated at home. Furthermore, this study proved that torasemide is the same safety diuretic as furosemide, which has a great impact on clinical practice.
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http://dx.doi.org/10.1097/MD.0000000000015747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571370PMC
May 2019

Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: results from a randomized clinical trial.

Nutrition 2018 11 22;55-56:45-50. Epub 2018 Mar 22.

Second Department of General Surgery, Jagiellonian University Medical College, Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.

Aim: Intravenous lipid emulsion (ILE) can become a risk factor for intestinal failure associated liver disease (IFALD). Many ILEs are commercially available, however, a direct comparison of their impact on liver has, to our knowledge, never been performed. The aim of the study was to analyse that clinical problem during long term parenteral nutrition (PN).

Methods: A randomized, controlled clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (37 F, 30 M, mean age 53.9 years) enrolled in home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one the following for 12 months: long-chain triglycerides (LCT), medium/long-chain triglycerides, olive oil/LCT (OO/LCT) and a mix of LCT/MCT/OO/fish oil. Clinical evaluation and biochemical tests (total bilirubin, SGOT, SGTP, GGPT, alkaline phosphatase) were performed at enrolment and after 6 and 12 months.

Results: the most common reason for intestinal failure (IF) was short bowel due to mesenteric ischaemia, followed by Crohn's disease, surgical complications and radiation enteritis. PN stabilized liver parameters in all patients. No essential fatty acids deficiency was diagnosed. All four ILEs demonstrated comparable influence on liver in all study periods. The only exception was the decrease in total bilirubin concentration after 12 months (28.1 ± 25.3vs 11.1 ± 4.5, p = 0.0023) and GGTP (222.5 ± 205.8vs 146.6 ± 197.7, p = 0.0079) when OO/LCT was in use.

Conclusions: All four ILEs tested may be safe even during long-term parenteral nutrition. OO/LCT may be more effective than the others, but more studies in the field are needed.
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http://dx.doi.org/10.1016/j.nut.2018.03.008DOI Listing
November 2018

Parenteral nutrition admixtures for pediatric patients compounded with highly refined fish oil-based emulsion: Assessment of physicochemical stability - Letter to Editor.

Clin Nutr 2015 Aug 14;34(4):781-2. Epub 2015 Apr 14.

Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland. Electronic address:

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http://dx.doi.org/10.1016/j.clnu.2015.04.009DOI Listing
August 2015

Nutritional support teams: the cooperation among physicians and pharmacists helps improve cost-effectiveness of home parenteral nutrition (HPN).

Nutr Hosp 2014 Sep 12;31(1):251-9. Epub 2014 Sep 12.

Stanley Dudrick's Memorial Hospital, General Surgery and Oncology Unit, 15 Tyniecka Str., 32-050 Skawina, Poland..

Introduction: Modern home parenteral nutrition (HPN) requires the preparation of tailored admixtures. The physicians' demands for their composition are often at the variance with pharmaceutical principles, which causes the necessity of either the preparation of ex tempore admixtures or stability testing ensuring long shelf life. Both approaches are not cost-effective. The aim of the study was to use the cooperation among physicians and pharmacists to assure both: cost-effectiveness and patient-tailored HPN admixtures.

Methods: The first part of the study consisted of the thorough analysis of prescriptions for the most demanding 47 HPN patients (27 females and 20 males, mean age 53.1 year) treated at one HPN center to create few as possible long-shelf life admixtures. The second part of the study consisted of stability testing and modifications.

Results: The analysis showed over 137 variations needed to cover all macro- and micronutrients requirements. Their cost as ex-tempore solutions was extremely high (over 110 000 EURO/month) due to logistics and similarly high if stability test for variation were to be performed (68 500 EURO). Therefore prescription was prepared de novo within team of physicians and pharmacists and four base models were designed. Water and electrolytes, particularly magnesium and calcium showed to be the major issues. Stability tests failed in one admixture due to high electrolytes concentration. It was corrected, and the new formula passes the test. Five basic models were then used for creation of new bags. Cost of such an activity were 3 700 EURO (p<0.01) CONCLUSIONS: The cooperation within the members of nutritional support team could improve the cost-effectiveness and quality of HPN.
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http://dx.doi.org/10.3305/nh.2015.31.1.8012DOI Listing
September 2014

Solid tumours of perimeningeal region in children--diagnostic and therapeutic difficulties.

Ann Univ Mariae Curie Sklodowska Med 2003 ;58(2):111-5

Department of Children Hematology and Oncology, Medical University of Lublin.

Thirteen patients, aged 2-17 years, were treated because of primary solid tumours of head and neck location at the Department of Children Hematology and Oncology in Lublin. The authors analyzed clinical symptoms before diagnosis and the duration of these symptoms as well as the kind of tumours. In all cases the tumour was diagnosed on histopathological examination: soft tissue sarcomas--9 children, lymphoepithelioma--4 ones. The prognosis and treatment were estimated.
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October 2004

High frequency ultrasound diagnostics of right lower quadrant abdominal pain in children.

Ann Univ Mariae Curie Sklodowska Med 2003 ;58(1):437-43

Paediatric Radiology Department, Medical University of Lublin.

In our study we tried to assess the usefulness of high frequency ultrasound examinations in the diagnostics of right lower quadrant abdominal pain, focusing on the differential diagnosis of appendicitis. Ultrasound examinations were performed on 152 patients aged 1 to 19 with abdominal pain. All the children underwent standard abdominal ultrasound examination with B mode of abdominal parenchymal organs as well as the evaluation of the intestines with the linear transducer of changeable frequency with the possibility of creating sector format. The tissue harmoning imaging (THI), Power and Colour Doppler modes were also applied in the examinations. As a result, 21 (13.8%) of 152 examined patients did not demonstrate any abnormalities in ultrasound examination. In the group the appendix was not visible. In the other 131 (86.2%) patients we observed a number of pathologies such as following: in 96 (73.3%) patients visible appendix, in 8 (6.1%) enlarged mesenteric lymph nodes, in 6 (4.6%) pathological broadening of the distal ileum wall, in 6 (3.2%) pathological broadening of the caecum wall and others. All these symptoms might be treated as indirect symptoms of appendicitis. In conclusion, we would like to state that high frequency ultrasound examination is very useful in the diagnostics of appendicitis.
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November 2004

The application of ultrasound contrast, 3D imaging and tissue harmonic imaging in the differential diagnosis of lymph nodes enlargement in children.

Ann Univ Mariae Curie Sklodowska Med 2002 ;57(2):131-42

Department of Pediatric Radiology, Department of Hematology and Oncology, Department of Otolaryngology, Medical University of Lublin.

The application of Power Doppler mode examination introduced the assessment of vascularisation and measurement of blood flow parameters in lymph node's vessels as a differentiating criterion of benign and malignant lymphadenopathy. However, those criteria appeared insufficient in evaluation of the malignancy grade of enlarged lymph nodes, especially in the cases of lymph nodes with invisible or scantly visible vascularisation in Power Doppler mode. Introducing contrast media in ultrasonographic examinations enabling intensification of the Doppler signal even by 20 dB creates the hope of increasing diagnostic efficacy of ultrasonography in evaluation of vascularisation in lymph nodes enlargement. The purpose of the study was to define the usefulness of ultrasonographic contrast media (Levovist), 3D presentation and harmonic imaging in differential diagnosis of lymph nodes enlargement in children. 32 children with cervical lymph nodes enlargement underwent examination with ultrasonography. In the examinations, Levovist by Schering was used in concentration 300, the amount depending on patient's body mass. The analysis of results obtained in the study revealed that application of contrast media enables better visualisation of lymph node vascularisation. Localisation of the vessels which were not shown in conventional Doppler mode enables visualisation of the vessel architecture in the lymph node and better defining of vascularisation pattern. Application of the new methods of THI and 3D imaging and contrast media in Power Doppler examinations increases the diagnostic efficacy of ultrasonography in differentiating lymph nodes alternations.
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December 2003
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