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Objective: To find out if early closure of a defunctioning small bowel stoma (day 10) was feasible and safe., Design: Prospective non-randomised study., Setting: University hospital, France., Interventions: During a 42-month period (January 1998-June 2001), all patients with a temporary small bowel stoma were elected for early closure on postoperative day 10 in a non-randomised prospective study. The procedure was considered only if the patient was not taking steroids, was in good condition, and had not developed wound or general sepsis after the initial operation. Other patients' stomas were closed after the usually recommended delay (>8 weeks)., Main Outcome Measures: Postoperative complications, delay to recover bowel activity, and to resume oral feeding, and duration of hospital stay., Results: Thirty-six patients were included in the study: 14 patients in the early group and 22 in the delayed group. There were no postoperative deaths. Three patients developed wound abscesses, two in the early group and one in the delayed group. The median (range) duration of hospital stay was longer in the delayed group: 36 (14-84) days, than in the early group: 22 (18-29) days (p < 0.01)., Conclusions: Small bowel stomas can be closed in selected healthy patients on postoperative day 10 without major complications.

Fish oil supplementation is suggested as possible mean to improve neurological manifestations of chronic diseases and cytokine immunotherapies. Preclinical and clinical studies show that fish oil supplementation seems able to reduce disease-associated anorexia and body weight loss. This improvement could be due to shifts in metabolism and changes in proinflammatory cytokine production and action. ω-3 Polyunsaturated fatty acids (PUFAs), especially eicosapentaenoic acid, are used as substrates for eicosanoid synthesis, competing for enzymes with arachidonic acid, which is a substrate for the synthesis of proinflammatory immunomodulators, such as prostaglandin E2. Fish oil supplementation is generally found to lower production of cytokines including interleukin-1 and tumor necrosis factor-α, thereby reducing various immune responses, including inflammation. However, conflicting results regarding the effects of fish oil interventions have been reported. The main factor that emerges from the contradictory reports is the variety of models, assays and methodologies that have been used. This brief review presents an overall perspective on the potential use of ω-3 PUFAs as a nutritional intervention to ameliorate disease-associated and cytokine-induced neurological manifestations. We conclude that substantial further research is required to understand the exact nature of n-3 PUFA-induced immunomodulation in health and disease.