Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSafety and efficacy of increasing dosages of glycyl-glutamine for total parenteral nutrition in polytrauma patients.
Supplementation of parenteral nutrition with glutamine (GLN) has been suggested to improve the efficacy of nutritional support by stimulating protein synthesis and improving immunocompetence. In the present study we investigated the impact of infusing the dipeptide glycyl-glutamine (GLY-GLN) at increasing dosages on plasma amino acid concentrations in patients with polytrauma. Nine polytraumatized patients were randomly assigned according their age and their trauma score to three experimental groups. ⋯ We conclude from this first available dose finding study on glutamine-containing dipeptides that in polytraumatized patients infusion of 570 mg/kg/day of GLY-GLN (corresponding to 28 g glutamine or 40 g dipeptide/70 kg, respectively) is necessary to induce a sustained effect on plasma glutamine concentrations. No pathological accumulation of free glycine or of the dipeptide was seen with any of the three dosage steps of GLY-GLN. Thus, the administration of even high doses of GLY-GLN is feasible and safe in patients with polytrauma and is not associated with any relevant renal substrate loss.
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Wien. Klin. Wochenschr. · Jan 1996
Review[Glutamine: effects on the immune system, protein balance and intestinal functions].
Glutamine is the most abundant free amino acid of the human body. In catabolic stress situations such as after operations, trauma and during sepsis the enhanced transport of glutamine to splanchnic organs and to blood cells results in an intracellular depletion of glutamine in skeletal muscle. Glutamine is an important metabolic substrate for cells cultivated under in vitro conditions and is a precursor for purines, pyrimidines and phospholipids. ⋯ Moreover, glutamine exerted a trophic effect on the intestinal mucosa, decreased the intestinal permeability and thus may prevent the translocation of bacteria. In conclusion, glutamine is an important metabolic substrate of rapidly proliferating cells, influences the cellular hydration state and has multiple effects on the immune system, on intestinal function and on protein metabolism. In several disease states glutamine may consequently, become an indispensable nutrient, which should be provided exogenously during artificial nutrition.
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Wien. Klin. Wochenschr. · Jan 1996
Review[The value of adjuvant and neoadjuvant chemotherapy in treatment of stomach carcinoma].
The incidence of gastric adenocarcinoma has decreased dramatically in most Western countries over the past five decades. However, the five-year survival rate remains poor and late diagnosis is one of the main reasons for the lack of marked improvement in outcome. More than 50% of the patients found to have advanced local (stage T III), or systemic (stage T IV) gastric cancer at the time of diagnosis. ⋯ The efficacy of neoadjuvant chemotherapy in potentially resectable gastric carcinoma cannot be definitely assessed at the present time since only scant, preliminary findings are available. Future goals for the treatment of gastric carcinoma should include studies evaluating preoperative chemotherapy using effective, but less toxic substances, based on exact tumor-staging by means of endoluminal sonography. Furthermore, research projects investigating the value of intraperitoneal therapeutic regimens such as hyperthermic chemoperfusion or intraperitoneal instillation of the requisite substances in the prevention of intraperitoneal carcinomatosis and local recurrence will be of great importance.
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Wien. Klin. Wochenschr. · Jan 1996
[Predictive value of score parameters of the Simplified Acute Physiology Score (SAPS)-II for the duration of treatment of intensive care patients].
Length of intensive care therapy and the total length of stay in hospital are important determinants of hospital costs. We therefore analysed the correlation between score parameters of SAPS-II with the time spent in the intensive care unit (ICU), and also in the hospital, for 604 general medical intensive care patients (ICU group) and 510 coronary care patients (CCU group). The mean stay in the ICU was 3.68 days for ICU patients and 2.67 days for CCU patients. ⋯ In ICU patients duration of intensive treatment and hospital stay correlated with age, heart rate, maximum systolic blood pressure, body temperature, BUN, serum bilirubin, and sodium (all signs of systemic inflammatory reaction and organ dysfunction); in CCU patients length of intensive treatment and hospital stay correlated with body temperature, diuresis, BUN, bicarbonate, minimum systolic blood pressure (as signs of organ perfusion). A low Glasgow Coma Score was correlated with prolonged intensive care in all patients. In conclusion, score data, appear a suitable tool to predict the duration of intensive care treatment and length of hospitalization, in addition to outcome, and thus serve as gauge of efficiency.
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Wien. Klin. Wochenschr. · Jan 1996
Intensive care management of acute pancreatitis: recognition of patients at high risk of developing severe or fatal complications.
The clinical spectrum of acute pancreatitis ranges from mild, self-limiting disease of fulminant illness that may rapidly lead to multiple organ failure and death. To identify factors associated with a subsequent severe course and/or high mortality we investigated retrospectively 91 patients admitted to the medical intensive care unit (ICU) with acute pancreatitis during a 2 year period. 67% of the attacks were mild (< or = 1 complication). The overall mortality rate was 9%, whereby 3% of patients with alcoholic and 13% with biliary pancreatitis died. 75% of the patients in the group with a fatal outcome were aged over sixty and 30% in the group with a mild course (p < 0.05). ⋯ The RANSON scoring system provided further a significant differentiation between survivors with a severe course of pancreatitis when compared to deaths on day 2, whereas the APACHE-III scoring system did not. Advanced age, female sex, biliary obstruction and elevated RANSON and APACHE-III scores are risk factors for an increased rate of life-threatening complications in acute pancreatitis. The daily assessment of such scoring systems may allow the recognition of such patients and may be helpful in the routine clinical management and monitoring of acute pancreatitis.