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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 24 (2000), S. 1514-1518 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Growth factors enhance protein synthesis and thus reduce the catabolic response to injury. As a result of bioengineering and new manufacturing techniques several anabolic agents have become available for clinical use and have been evaluated in surgical patients with catabolic illness. Data support the anabolic effects of growth home in such patients, but its expense and possible deleterious effects during the acute phase of illness limit its use to selected patient groups. Insulin-like growth factor-1 has also been studied, but specific indications for its use have not been identified in catabolic patients. Testosterone and derivatives of this hormone exert anabolic effects, but few randomized trials include catabolic surgical patients, and higher doses of some derivative compounds are associated with hepatic dysfunction. Nonetheless, as we move into the future, studies will determine the specific doses for administration of these and other anabolic factors in specific patient groups. Anabolic therapy will shorten the length of therapy and improve the outcome in the future.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 2 (1978), S. 213-214 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 23 (1999), S. 545-552 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Postoperative nitrogen sparing refers to a therapy that decreases net nitrogen loss from the body following an operation. Protein sparing has long been regarded as a surrogate marker for improved outcome, but a critical review of the evidence indicates that this relation is difficult to establish, especially in the short term. Thus, specific endpoints that evaluate outcome are needed to determine the efficacy of a specific therapy that spares protein. Cost effectiveness must also be considered. A variety of therapies were evaluated using protein-sparing, efficiency, and cost criteria. Evidence was reviewed for glucose, amino acids, parenteral nutrition, enteral nutrition, growth hormone, and glutamine administered during the perioperative period. Only three areas could be identified that spared nitrogen and provided efficacy: (1) preoperative total parenteral nutrition (TPN) for 7 to 10 days before operation in a depleted patient (≤15% body weight loss); (2) the use of growth hormone with nutritional support to promote wound healing (especially in burns) and possibly to enhance muscle strength (particularly in the elderly); and (3) the use of glutamine-supplemented TPN in severely ill surgical patients to decrease mortality. The issue of early tube feeding in trauma patients is still confusing. This therapy must be evaluated by an appropriate study in trauma patients that compares a tube-fed group with an unfed control group. Only by demonstrating improved outcomes and enhanced cost saving with our protein-sparing therapy can we continue to enhance the care of our surgical patients.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 24 (2000), S. 705-711 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Severe surgical illness results in metabolic responses that mobilize substrate (amino acids and fatty acids) from body stores to support vital organs, enhance resistance to infection, and ensure wound healing. Central to this process is the redistribution of body protein, which moves from skeletal muscle to support the central viscera. If unsupported, this protein-wasting state could result in prolonged convalescence, diminished immunity, and poor wound healing. Present evidence suggests that the central nervous system plays a major role in regulating this protein catabolic response. Infusing exceedingly small quantities of the proinflammatory cytokines into the brain can mimic injury responses, and central cytokine blockade may be one therapeutic approach to attenuating these responses safely in the future. Additional evidence also demonstrates that the function of the hypothalamus and anterior pituitary is dampened during the later stages of severe surgical illness, and the possibility of hormonal replacement therapy needs to be explored.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 24 (2000), S. 1486-1492 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The short bowel syndrome is a symptom complex that occurs in adults who have less than 200 cm of jejunum-ileum remaining after intestinal resection. Similar symptoms are observed in infants and children following massive bowel resection or congenital anomalies and in individuals with longer segments of intestine with severe mucosal disease. Initial care should focus on a thorough excision of nonviable bowel, an exact measurement of the remaining viable bowel, placing all intestine in continuity at the initial or subsequent operation, and controlling initial food intake. With time, adaptation of the remnant intestine occurs, and absorptive function may be maximized by enhancing the enteral diet and minimizing parenteral nutrition. Growth factors and specialized nutrients may also enhance this process. Intestinal transplantation should be considered in selected individuals with the short bowel syndrome who fail intestinal rehabilitation protocols.
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  • 6
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé On a comparé, suivant une méthode basée sur des marqueurs radioactifs dilués et multiples, l'eau corporéale totale, l'eau extracellulaire, le volume plasmatique, et le volume globulaire dans une population de Chinois en bonne santé et celle de patients chinois en attente d'une intervention chirurgicale pour des maladies gastrointestinales diverses récemment diagnostiquées. On n'a pas pu mettre en évidence, parmi les données recueillies dans ces différents groupes, de différence significative en ce qui concerne la composition des départements hydriques du corps, ce qui suggère qu'il n'y a pas de changement majeur dans les stades précoces de maladies gastrointestinales étudiées. Qui plus est, on a ensuite comparé ces données chez certains Chinois en bonne santé à celles des Américains en bonne santé explorés selon la mÊme méthode. Chez les hommes, le poids corporéal (kg) des Chinois était considérablement plus bas (62.1±2.0) comparé au poids des Américains (72.5±4.1) (p〈0.02). Cette disparité pouvait s'expliquer par une différence en poids gras (12.4±1.3 chez les Chinois pour 19.2±2.2,p〈0.02 chez les Américains) et en eau extracellulaire (14.4±0.5 chez les Chinois pour 16.8±0.8,p〈0.02 chez les Américains). Le poids des tissus fonctionnels (masse cellulaire corporéale) était comparable dans les 2 groupes, ce qui suggère que la composition hydrique des Chinois ne différait de celle des Américains que par la surcharge en graisses. La mésure de la composition hydrique du corps par des traceurs multiples utilisant de l'oxyde de deutérium, du bromure de sodium, du bleu Evans, et du Cr51 s'avère précise mais chère et compliquée. Il convient, donc, de trouver d'autres méthodes de mesure systématique, faisables au lit du malade, mais plus économiques.
    Abstract: Resumen Se utilizó un método de dilución de mÚltiples trazadores que mide el agua corporal total, el agua extracelular y los volumenes plasmático y de glóbulos rojos para estudiar la composición corporal. Se comparó un grupo de individuos chinos sanos con pacientes chinos con una variedad de desordenes gastrointestinales recientemente diagnosticados y programados para cirugía electiva. Los datos de la composición corporal en los 2 grupos no mostró diferencias significativas en cuanto a compartimentalización, lo cual sugiere ausencia de cambios mayores en el curso de los estados tempranos de ciertas enfermedades gastrointestinales. Además, se comparó a los sujetos chinos sanos con un grupo de norteamericanos previamente valorados mediante métodos de dilución similares. En los hombres el peso corporal (kg) difirió en forma considerable (chinos=62.1±2.0 versus norteamericanos=72.5±4.1,p〈0.02), lo cual se podría explicar por las alteraciones en la grasa corporal (chinos=12.4±1.3 versus norteamericanos = 19.2±2.2,p〈0.02) y el agua extracelular (chinos=14.4±0.5 versus norteamericanos=16.8±0.8,p〈0.02). El tejidos funcional (“masa celular corporal”) apareció similar en los 2 grupos, lo cual sugiere que los chinos poseen una composición corporal comparable sin carga adicional de grasa. La técnica de mÚltiples trazadores utilizando óxido de deuterio, bromuro de sodio, azul de evans, y Cr51 para la determinación de la composición corporal es precisa aunque costosa y laboriosa. Se requieren métodos igualmente precisos pero más económicos para ser utilizados al lado de la cama, para el análisis rutinario de composición corporal.
    Notes: Abstract A multiple tracer dilution method measuring total body water, extracellular water, plasma volume, and red cell volume was used to study body composition. Healthy Chinese subjects were compared to a group of Chinese patients with various newly diagnosed gastrointestinal disorders scheduled for elective operation. Compositional data obtained from these groups showed no significant differences in compartmentalization, suggesting absence of major changes during the early stages of certain gastrointestinal diseases. In addition, healthy Chinese subjects were compared to a group of healthy Americans previously evaluated by similar dilutional methods. In males, body weight (kg) differed considerably (Chinese=62.1±2.0 versus American = 72.5±4.1,p〈0.02) and could be explained by alterations in body fat (Chinese=12.4±1.3 versus American=19.2±2.2,p〈0.02) and extracellular water (Chinese=14.4±0.5 versus American=16.8±0.8,p〈0.02). Functional tissue (“body cell mass”) was similar in the 2 groups which suggested that Chinese have comparable body composition without an additional fat burden. The multiple tracer technique using deuterium oxide, sodium bromide, Evans dye, and Cr 51 for body compositional assessment is accurate but expensive and laborious. Therefore, equally precise but more economical bedside methods are needed for routine compositional analysis.
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  • 7
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Pour étudier le rôle des hormones dans la protéolyse posttraumatique de muscle squelettique, des volontaires de sexe mâle en bonne santé ont été perfusés pendant 76 heures avec les 3 hormones “de stress“: hydrocortisone, glucagon, et adrénaline. En contrôle, chaque patient a reÇu une perfusion de sérum physiologique pendant quatre jours. Dix études appariées ont été faites. Pendant les deux études, l'alimentation était la mÊme et constante. La perfusion des 3 hormones a provoqué une concentration semblable à celle qu'on observe après un traumatisme moyen. Après 72 heures, le taux de glutamine dans les muscles squelettiques était plus bas dans l'étude hormonale que dans l'étude contrôle (N=4). La concentration en acides aminés libres dans le sang artériel et notamment l'arrivée de sang dans l'avant-bras n'étaient que peu influencées par la perfusion hormonale. Ainsi, la perfusion avec augmentation de la concentration des 3 hormones “de stress“ ne suffisait pas pour provoquer la protéolyse musculaire squelettique que l'on observe lors des maladies graves. Puisque d'autres études ont montré que le blocage neurohormonal diminue nettement la protéolyse musculaire, les hormones “de stress“ semblent donc nécessaires mais non suffisantes dans la réponse catabolique protéinique au traumatisme.
    Abstract: Resumen Con el propósito de investigar el papel de las hormonas como agentes mediadores de la proteolisis muscular neta que se presenta en el trauma y en otros estados críticos, se administró una infusión de las 3 “hormonas del estrés,“ hidrocortisona, glucagón, y epinefrina, a voluntarios sanos por períodos continuos de 76 horas. Como control, cada individuo recibió una infusión de solución salina durante otro período de 4 días. Se condujeron 10 estudios apareados, con dietas constantes y similares en ambas ocasiones. La infusión triple de hormonas produjo concentraciones sanguíneas hormonales similares a las observadas en pacientes con trauma leve-moderado. A las 72 horas de la infusión las concentraciones intracelulares de glutamina en el mÚsculo esquelético aparecieron menores que en los estudios de control (N=4). Las concentraciones de aminoácidos libres en la sangre arterial y el flujo de salida de aminoácidos en el antebrazo resultaron mínimamente afectados por la infusión hormonal. Por lo tanto, la alteración del medio hormonal producida por infusión triple de hormonas no representa un estímulo suficiente para inducir la totalidad de las alteraciones en la proteolisis del mÚsculo esquelético que se observa en la enfermedad crítica. Puesto que los estudios con bloqueo neurohumoral han demostrado una disminución en la proteolisis muscular neta, las hormonas del estrés parecen ser necesarias, pero no suficientes de por sí, para la respuesta catabólica a la injuria biológica.
    Notes: Abstract To investigate the role of hormones as mediators of net skeletal muscle proteolysis following injury, healthy normal male volunteers received a continuous 76-hour infusion of the 3 “stress“ hormones: hydrocortisone, glucagon, and epinephrine. As a control, each subject received a saline infusion during another 4-day period. Ten paired studies were conducted. Diets were constant and matched on both occasions. Triple hormone infusion achieved hormone concentrations similar to those seen following mild-moderate injury. After 72 hours of infusion, skeletal muscle intracellular glutamine concentrations were lower in the hormone studies than in the control group (N=4). Free amino acid concentrations in arterial whole blood and forearm amino acid efflux were little affected by hormonal infusion. Thus, alteration of the hormonal environment by the triple hormone infusion was not a sufficient stimulus to induce all of the changes in skeletal muscle proteolysis observed in critical illness. Since studies utilizing neurohormonal blockade have shown diminished net muscle proteolysis, the stress hormones appear to be necessary but not sufficient for the protein catabolic response to injury.
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  • 8
    ISSN: 1573-2592
    Keywords: Endotoxin ; cellular immunity ; interleukin 1 (IL-1) ; IL-2 ; tumor necrosis factor ; prostaglandin E2 ; cyclooxygenase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Studies of the immune response of patients following major injury have identified significant abnormalities, some of which may be due to the effects of endotoxin. To evaluate the effect of endotoxin on the immune system without conflicting variables, we studied 18 normal, healthy male volunteers each on two occasions. In one study,Escherichia coli endotoxin was administered intravenously at a dose of 4 ng/kg. In the other, saline was given. Blood for immune function studies was obtained at either 0, 4, or 24 hr (seven volunteers), 0, 1, and 4 hr (five volunteers), or 0, 4, and 6 hr (six volunteers) postinfusion. Peripheral blood mononuclear cells (PBMC) were isolated and adjusted to the same concentration. Measurements following endotoxin infusion were compared with those of the same volunteers following saline infusion and with those from normal ambulatory laboratory volunteers. Interleukin 1 (IL-1) production by adherent cells was significantly reduced at 1 hr post endotoxin infusion. Significant decreases in number of mononuclear cells, response to phytohemagglutinin (PHA), and production of IL-2 and IL-1 were observed by 4 hr after endotoxin infusion. No significant changes in percentages of monocytes, lymphocytes, or CD3, CD4, or CD8 lymphocytes were observed at any time. By 24 hr postinfusion all values had returned to normal or, in some cases, supranormal levels. Response to PHA by PBMC from volunteers 4 hr following endotoxin was completely restored byin vitro addition of recombinant human IL-2 but was only marginally improved by IL-1.In vitro addition of indomethacin to PBMC cultures responding to PHA reduced the suppression observed afterin vivo endotoxin but also was not as effective as IL-2. In a fourth study, seven volunteers were treated as above either with two doses (800 mg each) of the cyclooxygenase inhibitor ibuprofen before endotoxin infusion or with ibuprofen alone. Ibuprofen pretreatment completely restored the PBMC response to PHA to normal and caused a significant decrease in the endotoxin-induced suppression of IL-2 production. However, the decrease in circulating PBMC number and adherent cell secretion of IL-1 was not affected by inhibition of the cyclooxygenase pathway. These results suggest that endotoxin has immunomodulatory effects on both adherent mononuclear-cell and T-lymphocyte function and that more than one mechanism is involved.
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  • 9
    ISSN: 1573-2592
    Keywords: Natural killing ; trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Depressed cell-mediated and humoral immune functions have been reported to occur following severe thermal and traumatic injury. In this study we have questioned whether another immune function, natural killing (NK), is also disturbed in these injured patients. Twenty-two thermally injured patients with burns ranging from 5 to 75% of the total body surface area and 15 traumatically injured patients with injury severity scores ranging from 9 to 56 were followed postinjury and compared to 29 age-matched controls. NK activity was measured as the percentage cytotoxicity in chromium-51 release assays with K562 target cells. The more severely burned patients had significantly depressed NK activity for the 40-day period following injury that remained reduced for the duration of the study. Patients with lesser burns had reduced NK-cell function for the initial 10-day period postburn that returned slowly to the normal range. Traumatically injured patients had depressed NK-cell function during the 3- to 6-day period postinjury. The percentage of cells bearing phenotypic markers for the groups in which Nk cells are found was either normal or elevated in these patients. A correlation was found between NK activity and interleukin 2 generation by mononuclear cells from these patients. In order to investigate the mechanism of NK suppression in these patients, NK-cell function was studied following the infusion of cortisol, epinephrine, and glucagon into volunteer subjects in amounts known to reproduce serum levels seen following injury of moderate severity. NK-cell function was reduced an average of 66% following infusion, suggesting that the inhibition of NK-cell function seen in patients may be mediated by the stress response to injury.
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