Infusionstherapie (Basel, Switzerland)最新文献

Zinc speeds up a lot of metabolic processes because it is essential for a lot of enzymatic reactions. A modification of the zinc pool may influence the tumor growth. We used an animal model where we applied the Yoshida sarkoma intraperitoneally in its ascites form to parenterally fed Sprague-Dawley rats. Four groups with ten tumor bearing (TBR) and ten non-tumor-bearing rats (NTBR) each received different parenteral nutrition. The normocaloric Group 1 and the hypocaloric (reduced to 1/3 energy) Group 2 were fed without zinc. In Groups 3 (normocaloric) and (hypocaloric) high doses of zinc (0.519 mg/500 g Kg/d) were substituted. In Group 3 we found the quantitatively and qualitatively highest proof of tumor mass. The nitrogen content of the ascites wasn't significantly changed within the groups. We found a weight loss of the NTBR with zinc substitution. Zinc improves the synthesis of the tumor and leads to a weight loss of the host in our animal model.

Optimal storage of platelet concentrates is still an unsolved problem. The present paper demonstrates changes in morphology and function of stored platelets. Transmission microscopy reveals a loss of organelles as well as a progredient destruction of cell membranes during storage. At the same time in vitro aggregability is clearly diminished. Therefore, further investigations seem to be necessary to improve storage conditions of platelets.

Definite suspensions of malignant cells from three human tumor cells lines (bladder, prostate and renal cell carcinom) were passed through a cell saver (Althin Mediplast) and a leucozyte removal filter (PALL RC 100) under standard conditions. The examination of the solutions did not detect any malignant cells at all. If investigations with malignant cells in the blood will confirm these results, the use of intraoperative autotransfusion in urological tumor surgery would be possible.

Options in parenteral therapy increasingly require administration of several medications simultaneously. Very little is known about the compatibility and pharmacological stability of such mixtures. We investigated how widespread this practice is, which carrier solutions are most commonly used, and whether specific medication mixtures ('cocktails') or constant formulations for TPN are applied. Upon our request, physicians and nursing staff of 54 general hospital wards (19 surgical, 18 internal medicine, 17 intensive care) in 17 Austrian hospitals recorded the parenteral admixtures for one week under the supervision of a hospital pharmacist. We found that: 1. Admixing is commonly practiced in all wards. In all but one of the wards two or even more medications are added into one single infusion. 2. Carrier solutions were: Dextrose/fructose (87% of the wards), electrolytes (90%), amino acids (40%), fat emulsions (26%), colloids (14.8%), albumin (5.5%) and Solcoseryl (5.5%). 3. Fixed combinations for i.v. therapy are practiced in 70% of the wards (mostly analgetics with corticosteroids or vitamins) 4. In almost half of the units constant formulations for TPN exist (46%). Only few of the combinations named have been investigated or tested for stability. The compatibility of most of the admixtures is unknown, while a few are clearly incompatible. Admixtures to one of the carrier solutions (Solcoseryl) are known to have caused serious complications before. For several admixtures, conflicting data about compatibility were found in the literature. The theoretical basis for incompatibilities is discussed together with some typical examples. Also some rules for admixtures are given. Questions concerning the compatibility of simultaneous parenteral drug applications are too specific to be answered for most physicians. Advice and counseling on this subject should become a new task for clinical pharmacists.

Tumor-caused weight loss is frequently associated with a high rate of lipolysis and fat oxidation. In order to differentiate the effect of weight-loss from the tumour-dependent regulation of fat metabolism, we studied weight-stable and well nourished patients (ideal body weight 109 +/- 4% (+/- SEM), body mass index 25.1 +/- 0.9 kg/m2). Parameters of lipolysis (glycerol-, fatty acid concentrations) and the calorimetric determined fat oxidation rate of five male tumor patients were examined before and during an euglycaemic insulinclamp (0.2 mU insulin/kg/min). Concomitant with a high rate of lipolysis (glycerol concentration 112 +/- 20 mumol/l, free fatty acid concentration 0.72 +/- 0.13 mmol/l) and fat oxidation (60% of energy expenditure) there was a low normal insulin level (5.9 +/- 0.5 mU/l). Insulin reduced lipolysis and fat oxidation and stimulated glucose oxidation. Weight-stable tumor patients have a high basal rate of lipolysis and fat oxidation; yet the insulin dependent regulation of the fat metabolism is intact, as we have already shown for weight-losing cancer patients.

The concentrations of anti-A and anti-B IgM and IgG antibodies have been studied in the serum of a patient with blood group AB who received a type A donor liver. A newly developed ABO-ELISA was used for this purpose and the values were compared to hemagglutination titers. During the postoperative study period over 8 weeks, the anti-A and anti-B levels showed a higher fluctuation than was measured in preoperative samples. Thus, in this AB-type patient, anti-A IgM varied 10-fold, anti-A IgG 20-fold and anti-B IgG 16-fold. Peak values corresponded to rejection episodes. Immunoactivation in the patient was further documented by the presence of abnormally high levels of soluble interleukin-2 receptors (sIL-2R) in serum samples. The study shows that monitoring of anti-A/B antibodies may represent a further criterion to follow-up transplanted patients during the critical postoperative graft acceptance period.

To assess the loss of drugs to in-line filters, concentrations of tobramycin, vancomycin, and phenobarbitone were determined in vitro in samples recovered upstream and downstream of the filter. Binding of the drugs to new filters was higher than to used filters. With bolus administration, the concentrations of vancomycin and phenobarbitone were reduced by 1% when using old filters and by 4% when using new filters. Tobramycin concentrations were reduced by 7 and 12%, respectively. With continuous administration of the drugs, binding was highest during the first half hour. Differences between new and used filters were also seen with continuous administration: The cumulative loss was 5% higher with new than with old filters. This difference in binding between filters may stem from a saturation of free binding sites. Tobramycin showed the highest binding to the in-line filter. The extent of adsorption of tobramycin to intravenous filters may be considered moderately important in adult patients. The adsorption of vancomycin and phenobarbitone is not clinically relevant in adult patients.