Infusionstherapie und klinische Ernahrung. Sonderheft最新文献

The author reports the successful treatment with Vivasorb, the bulk-free, balanced synthetic diet, of patients with severe forms of ulcerative colitis and Crohn's disease, indigenous sprue and condition after small bowel resection, and of one patient with a Cronkhite Canada syndrome. The duration of the treatment was from a few weeks to 34 months. The patients received between 320 and 640 g/day, according to their requirements and their tolerance. Because of the relatively low content of essential fatty acids, long-term exclusive administration of Vivasorb may lead to symptoms of essential fatty acid deficiency, which disappear after the administration of Lipofundin S. The successful treatment of patients with malabsorption syndrome was verified histologically. Particles of mucosa taken from different small bowel sections showed the development of villi after only four weeks of treatment, whereas, before the treatment, subtotal villi atrophy had been observed.

The authors report excellent results with Vivasorb in the treatment of 9 patients with enterocutaneous fistulae. During exclusive alimentation with Vivasorb, there was a spontaneous closure in all 9 cases. With this form of therapy, all the risks of a long-term complete parenteral nutrition can be avoided.

The jejunoileal bypass is, of all the current therapeutic possibilities, the only permanent method for the successful treatment of a patient with hypothalamic obesity. Pre-operatively, it is advisable, however, to reduce the body weight by exclusive alimentation with Vivonex, in order to improve lung function and diminish the operation risks. Putting a smaller section of the bowel at rest will prevent major weight loss, as well as more severe complications. The disturbances of the calcium and potassium metabolism and of liver function, which frequently occur after jejunoileal bypass operation, were not observed, when on both sides of the immobilised bowel section a section of small bowel 23 to 38 cm long was maintained in normal function.

With Vivasorb, the surgical patient's full alimentation can be maintained up to a few hours before the operation. In the postoperative phase, the nitrogen balance of patients having undergone minor surgical intervention and in a state of moderate catabolism can be kept under control in a slightly negative range by the exclusive administration of Vivasorb. In patients with more severe catabolism, the oral supply of Vivasorb cannot fully replace parenteral nutrition, it can, however, support it.

The stomach clearance following the administration of 210 g Vivasorb in 700 ml water was ascertained in a 22-year-old healthy test subject. In the first hour, 50 g Vivasorb left the stomach, in the second hour 40 g and in the third and fourth hours, 30 g each. By doubling the dilution, the stomach clearance is not accelerated. An isocaloric glucose solution is cleared from the stomach just as rapidly as the Vivasorb solution.

The problem of sufficient nitrogen and caloric supply for surgical patients with pronounced protein catabolism under the working conditions of a surgical department in a developing country is discussed. The authors report good success with Vivonex in the postoperative nutrition of patients with a small bowel perforation with typhoid fever and of patients with diffuse peritonitis following a perforated appendix. Vivonex proved its usefulness also in the alimentation of patients with tropical myositis and extensive burns.

Experiences with Vivasorb in the treatment of gastrointestinal diseases are reported. The author successfully treated severe cases of Crohn's disease and distal ulcerative colitis. In severe total ulcerative colitis, marked improvement with Vivasorb could be achieved in only one of three cases. The administration also proved successful in one case of agnogenic chronic diarrhea. No effect could be achieved in two patients with internal and external bowel fistulae, nor in three patients with short bowel syndrome in the immediate postoperative phase.

The authors report on the treatment of children with kwashiorkor, using Vivonex or Casilan. With Vivonex, all patients were bottle-fed as early as the 2nd or 3rd day, whereas Casilan had to be administered by stomach tube for about a week. Children fed Casilan vomited much more frequently than patients receiving Vivonex. When Casilan was given, the albumin level rose after 8 days, whereas with Vivonex, this did not occur unitl 15 days. On the other hand, only the Vivonex fed children showed an increase of hemoglobin in the first 3 weeks of treatment. With Vivonex, the patients reached their minimum weight much faster and at a lower albumin level than with Casilan. In both groups, the frequency of diarrhea was similar; the relatively high glucose concentration of Vivonex and the disturbance of resorption, even of monosaccharides, which is frequently observed in severe cases of kwashiorkor may be responsible for the diarrhea of the children receiving Vivonex.