Infusionstherapie (Basel, Switzerland)最新文献

We investigated the influence of different oral premedication given to 50 male and 50 female patients on the plasmaconcentration of free fatty acids (FFA) as an indicator of preoperative stress and compared them with patients given no premedication at all. FFA are measured with a gaschromatographic method. FFA were measured four times: Time 1 (t1): the first day in hospital, t2: After the anesthesiologist's visit, t3: In the morning of the operation, t4: Before starting anesthesia. The groups are: I. 20 male and 20 female patients without any premedication; II. every 10 patients of both sexes given 2 mg Flunitrazepam (p.o.) on the preoperative night; III. every 10 patients given Morphium (0.15 mg i.m.) and Promethazin (50 mg i.m.) and, last, IV. every 10 patients getting the same premedication as group II and IV. 98 patients had a significant decrease of FFA from t1 to t2. The FFA of all increased from t2 to t3. Moreover, there was an increase from t3 to t4. We conclude from this that no premedication we had investigated is able to lower the physiological and biochemical stress-response as far as shown by FFA. Apart from myristic-acid, there was no difference in the groups. However, with no statistic significance, both 'Flunitrazepam-groups' showed the lowest increase. Further, in 28 from 32 cases, females had a higher FFA-level than males (in 16 cases with statistical significance).

In a prospective clinical study the safety of two hydroxyethylstarch preparations (HES steril 10%, Fresenius AG, Oberursel = HES-A; Haemufusin, Kabi-Pfrimmer, Erlangen = HES-B) were assessed. In 60 patients with fetal growth retardation and/or gestational hypertension, hematocrit, aPTT, factor VIIIR: Ag, fibrinogen, uric acid, cord blood hemoglobin, hematocrit, pH-value and the fetal/maternal hydroxyethylstarch concentration before and after eight (HES-B) or nine (HES-A) days of treatment were monitored. 500 ml HES-A (n = 36) or HES-B (n = 24) together with the same volume electrolyte solution, were infused daily. Both substances lowered significantly the maternal and fetal hematocrit. Histopathological changes of placenta (trophoblast cells and stroma) taking place after the infusion of HES-A or HES-B were depicted by light microscopy. Administration of HES-A or HES-B was associated with lower values of factor VIIIR: Ag and a prolongation of aPTT, but only HES-B demonstrated a significant effect (31% vs. 12%, p less than 0.01). We observed in 4 (16.7%) cases severe uterine bleeding complications and one woman (4.2%) with abruptio placentae in the group HES-B. Light microscopy shows vacuoled trophoblast and stroma cells after HES infusions. The marked vacuolisation of the placenta after HES-B is due to differences in the physicochemical characteristics of HES-A and HES-B. For this reason, we prefer to administer HES-A in the dilution treatment of patients with placental insufficiency.

After abdominal surgery there is a postoperative small bowel ileus. We evaluate whether the duration of the small bowel ileus is depending on the kind of surgery or not. Over a needle catheter jejunostomy a 3-tip transducer was placed into the distal jejunum. At the end of the operations a pressure detector was connected to measure the intraluminal pressure continuously over five days. Group A consisted of three patients undergoing explorative laparotomy because of inoperable gastric cardia cancer, and group B of eight patients who underwent gastrectomy. In none of the patients a normal empty stomach motility pattern, determined by the activity of a migrating myoelectric complex (MMC) was detectable. In group A the normal MMC-activity returned after 24 +/- 4.5 h and in group B after 82 +/- 25 h. Therefore the duration of the loss of the interdigestive myoelectric complex appeared to be dependent upon the type of surgery.

In six renally insufficient children and adolescents (age: 8-21 years) on hemodialysis the effect of L-carnitine supplementation at two dose levels (10 mg/kg/d vs. 100 mg/kg/d) on parameters of lipid metabolism was investigated. L-Carnitine substitution was carried out over four weeks per dose level. Under this regime a significant increase of the serum carnitine concentration occurred together with a decrease in the AC/FC-ratio (x: 1.59 to x:0.83). During the same period a significant decrease in serum triglyceride levels as well as an increase in serum HDL-cholesterol were observed. An inverse correlation (r = -0.63; p less than 0.0008) was found between HDL-cholesterol and the AC/FC-ratio. L-carnitine supplementation and its increasing effect on HDL-cholesterol in patients with renal insufficiency may be considered as antiatherogenic.

Due to repeatedly described incidents in patients with undiscovered hereditary fructose intolerance, the application of fructose and sorbit-containing parenteral solutions is a topic vehemently discussed. This paper presents a survey of the literature dealing with the inborn defect of fructose-1-phosphate aldolase. The physiology and pathophysiology of fructose metabolism are described as well as the clinical appearance and diagnostic possibilities. The acute course of a fructose incompatibility is determined by a threatening decrease in the blood glucose level, which is attributed to the inhibition of several enzymes of glycolysis and gluconeogenesis by an intracellular accumulation of fructose-1-phosphate. Within hours a global functional breakdown of organs, which normally have the enzyme, occurs. The impairment of the liver function finds expression in a severe coagulopathy, the damage of the kidney leads to anuria. In chronic oral fructose supply, damage of the liver and small intestinal mucosa with corresponding gastrointestinal symptoms determine the clinical course. Concerning diagnosis, contrary to the liver biopsy and the fructose tolerance test, the mucosal biopsy with determination of fructose-1-phosphate aldolase activity has the advantage of greater specificity and is better tolerated by the patient. A total abstinence to fructose and sorbitol-containing solutions is not considered to be necessary when the rarity of the illness is taken into account and certain precautions are taken. These include a specific anamnesis of nutrition as well as a total abstinence from fructose and sorbitol in infants and in the unconscious patient. For clinical routine a simple fructose tolerance test is suggested.

Medium-chain triglycerides are generally assumed to be metabolized independently of carnitine. The effects of infusing medium-chain triglycerides on plasma concentrations of carnitine derivatives and beta-hydroxybutyrate was studied in four healthy male adults. Glucose and amino acids were infused alone for three hours, then continued for another 5.5 hours together with a lipid emulsion containing only long-chain triglycerides or a mixture of medium-chain and long-chain triglycerides (50:50; w/w). During the fat-free infusion, the concentration of free carnitine rose, while the level of acylcarnitines decreased. Infusion of the mixed emulsion over 5.5 hours reduced free carnitine to lower values (32.4 +/- 4.7 mumols/L) than long-chain triglycerides infusion (44.4 +/- 2.7 mumols/L). By contrast, the plasma concentrations of short-chain acylcarnitines (12.1 +/- 3.3 vs. 5.4 +/- 1.9 mumols/L; p less than 0.01) and of beta-hydroxybutyrate (93 +/- 32 vs. 47 +/- 14 mumols/L; p less than 0.01) became significantly higher with the mixed emulsion than with long-chain triglycerides. These findings suggest that oxidation of medium-chain fatty acids is to some extent carnitine-dependent, whether or not transport into mitochondria is carnitine-mediated.

The central venous catheter, on the one hand, and the peripheral venous cannula, on the other hand, are available as fundamental access possibilities for parenteral nutrition. While the implantation of a central venous catheter is technically tiresome and subject to a complication rate up to 5%, the peripheral venous cannulization, in general, does not represent any technical problem. However, in case of peripheral venous access, due to the local venous compatibility, not only the duration of application is generally limited to 4-6 days, but the feeding of nutritious substances as such (excepting fat emulsions) is restricted, too. This means a limitation of the applicability in temporary and acute phases of a disease, as well as its application as a supplementary therapy in the event of oral or enteral nutrition. The advantage of the central venous parenteral nutrition refers to the possibility of a long-term high-doses, and thus to a complete parenteral, nutritional therapy. It is, however, subject to an aggravating rate of thrombotic (0.5-5%) and septic complication (3-6%), so that the indication and duration of application should be looked upon very closely and critically. The low-risk alternatives of a peripheral venous parenteral nutrition should be observed more closely.

Important criteria for assessing a cell separator are thrombocyte yield, separation efficiency, and purity of the thrombocyte concentrates. Based on a Multicentric Counting Study, in which 12 centers participated, we conclude that it is very difficult to compare the results of the various centers in regard to the separation efficiency. This is especially true for the comparison of different separation procedures. In Marburg we compared three different cell separators of the newest generation: COBE Spectra (n = 71), Fresenius AS-104 (n greater than 1100) and Fenwal CS-3000 TNX (n = 79). The COBE Spectra exhibited the best separation efficiency with the lowest leukocyte contamination (thrombocytes 4.3 x 10(11) (72.2%), leukocytes 0.5 x 10(7)) on the condition that the ACD-blood ratio did not differ more than -15% from the required algorithm. In order to reduce the risk to the donor, the system correspondingly reduces the donor's blood flow, resulting in a longer donation time (on the average 89-100 min). When the ACD ratio was reduced further, a considerable number of spontaneous and sometimes irreversible platelet aggregation occurred, increasing the risk of shortened survival through reduced platelet function. The AS-104 and the modified CS-3000 (TNX) had similar separation efficiencies (approx. 60%). While the platelet concentrates (PC) of the AS-104 almost reached the purity of that from the COBE Spectra, the leukocyte contamination of the CS-3000 PC's was still about four times as high. Other results published show that morphology, in-vitro function and in-vivo survival of thrombocytes collected with the AS-104 are significantly better than those from the CS-3000.(ABSTRACT TRUNCATED AT 250 WORDS)

Application of carbohydrates in pediatric infusion therapy has recently been limited to glucose and xylitol. Fructose and sorbitol, which formerly had been used widely as energy sources in parenteral nutrition, have meanwhile been banned in order to prevent fatal complications in patients with undiscovered hereditary disturbances in fructose metabolism. The aim of this review is to focus the attention on potential side effects and limitations of glucose administration in pediatric infusion therapy. With special regard to total parenteral nutrition in preterm infants, sufficient glucose conversion to N-acetylneuraminic acid and other carbohydrate building blocks of glycoproteins and gangliosides is to be placed in question. This might have consequences for normal brain development and can be considered a challenge for future research work in this field.