Nutritional support of patients with intravenous hyperalimentation

Synthesis of catechol estrogens by human uterus and leiomyoma

Homogenates of human endometrial, myometrial and leiomyoma tissues were incubated with (2,4,6,7-3H)-estradiol and tritiated catechol estrogens were isolated and identified. Though 2- and 4-hydroxylations were about the same in endometrium, 4-hydroxylation was two to four fold higher than 2-hydroxylation in myometrium and leiomyoma. However, endometrium showed greater capacity to form both 2- and 4-hydroxyestrogens than the other two tissues. Both 2- and 4-hydroxylations were significantly less than in myometrium. In view of the reports indicating that inhibitors of catechol 0-methyl transferase (COMT) might act as antineoplastic agents due to their interference with t-RNA methylases and since catechol estrogens inhibit COMT, the present results suggest that endogenous synthesis of catechol estrogens may play an important role in the pathophysiology of uterine leiomyoma.

[Behavior of the metabolism in gastric patients during a 4-day-long postoperative complete parenteral feeding with amino acids and a glucose-levulose-xylitol combination solution]

In a clinical study we tested the following parameters: free fatty acids, beta-hydroxybutyrate, acid-base-balance, lactate, bilirubin, uric-acid, fructose, xylitole, glucose in blood and urine. The tests were executed in 9 patients who were undergoing stomac operations. The cardio pulmonary system of all patients was normal, and there was a homeostasis in water and electrolytes preoperatively. In combination with the amino-acids we received a ratio of 1:1:1 for glucose, levulose and xylitole. Totally, the patients received 0.36 g per kg body weight and per hour of carbohydrates. Beta-hydroxybutyrate, aceto-acetat, and free fatty acids show normal values under conditions of parenteral nutrition as well as lactate, uric acid, and acid-base-balance. The ratio of the different carbohydrates in serum and urine prove that the infusion time and volume were extremely favourable. The loss of carbohydrates in urine was very low.

Suitability of non-glucose-carbohydrates for parenteral nutrition

Postoperative parenteral nutrition can only be optimally effective if the characteristics of post-traumatic metabolism are taken into account. Two main possibilities are discussed for the carbohydrate component of parenteral nutrition during this phase: glucose with high doses of insulin or non-glucose carbohydrates (sugar substitutes) possibly in a suitable combination with glucose. The risks as well as the technical and organisational problems involved in the use of them are discussed and the authors prefer the second of the two alternatives. Possible side effects of non-glucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of frucose : glucose : xylitol in a ratio of 2 : 1 :1 with a total dose of 0.50 g/kg/hour has been studied most thoroughly. This combination normalises the fat metabolism and improves glucose tolerance without requiring exogenous insulin. Experiences with this combination as well as individual non-glucose carbohydrates on operated patients have been given continuously for up to 7 days and in some cases even for several weeks. No side effects, no deviations from a steady state and no abnormal changes of the laboratory values occurred. The authors are of the opinion that non glucose carbohydrates are necessary if the facilities for frequent blood sugar controls are not available.