Journal of the American College of Surgeons
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Review Randomized Controlled Trial Clinical Trial
Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance.
In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. ⋯ Postoperatively, M values decreased by 55 +/- 3 percent (control group) and by 32 +/- 4 percent (glucose group) (p < 0.01). Plasma levels of insulin, c-peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.
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A significant number of gynecologic oncologic patients require intravenous chemotherapy. Peripheral venous access frequently becomes difficult, necessitating reliable central venous access. This study was done to retrospectively review our experience with completely implanted venous access ports (ports). ⋯ Catheter performance in 77 percent of the patients was impeccable. We conclude that implantable ports are a safe and reliable method of chronic venous access in gynecologic oncologic patients requiring intravenous chemotherapy. Although ports reduce the number of complications and manipulations associated with percutaneous catheters, they are not devoid of problems.