[Does parenteral linoleic acid modify tumor growth? Studies with the Yoshida sarcoma model]. / Beeinflusst parenterale Linolsäurezufuhr das Tumorwachstum? Untersuchungen am Beispiel des Yoshida-Sarkoms.

In an experimental study with sprague-dawley-rats we tested the effect of parenteral substituted LCT-fats on tumor growth of the Yoshida sarcoma in its ascites form. Therefore we tested 4 groups with 10 tumor-bearing and 10 non-tumor-bearing rats. We added group 1-3 LCT-fats in different doses. Group 4 was fed enterally. We found that tumor-bearing rats had a higher nitrogen retention than non-tumor-bearing rats. Non-tumor-bearing rats showed a higher nitrogen concentration in the muscles. The portion of nitrogen increased with increasing portion of fat. The content of nitrogen in the ascites, the quantity and the number of tumor cells was reversed in proportion to the portion of fat. For the host we showed that he cannot make use of the energy directly. The tumor does not grow in proportion to the available energy but has to support itself from the catabolism of the host.

[Nitrogen balance in tumor and host in the animal model]. / Die Stickstoffbilanz zwischen Malignom und Wirt im Tiermodell.

The importance of malnutrition as major cause of morbidity and mortality in cancer patients is well documented. It has been shown that nutritional therapy improves well-being and nutritional status of the patient, but the tumor can also be accelerated by hypercaloric nutrition. Our study does not confirm the induction of tumor growth. A high positive metabolic rate of the host lowers the tumor's growth rate and its tendency to spread. The retention of nitrogen in host increase with decreasing rate of energy and nutrition. Our results show that the tumor itself uses energy and nutrients from host cell catabolism and does not directly exploit exogenous nutrient substrates. It should not be forgotten that the animal model leads to specific changes affecting the energy and nutrient metabolism.

Anthropometric parameters for preoperative screening to predict high-risk patients.

Prediction of serious postoperative complications by using standard anthropometric variables was attempted in 460 patients undergoing a major surgical procedure. Handgrip dynamometry was also carried out in 249 of the patients. None of the preoperative variables were of predictive value to postoperative complications, relating the method to its specified, sensitivity and validity. Upper arm anthropometry and handgrip dynamometry are rapid and inexpensive tests for detecting malnutrition, but they are not useful for preoperative screening to predict postoperative morbidity because appropriate standards are locking.

[The effect of the small intestine on 3-methylhistidine metabolism in the human]. / Der Einfluss des Dünndarms auf den 3-Methylhistidin-Stoffwechsel des Menschen.

20 male adult Sprague-Dawley rats were fed exclusively parenterally. After achieving metabolic equilibrium they received a duodenoileostomy and subtotal resection leaving only 8-10% of the small gut. On the 1st postoperative day the urinary 3-MH excretion rose to 1.5-1.7 times the preoperative level, but on the 12th-14th postoperative day it fell again and was equal to the preoperative basal level. A control group of 10 rats undergoing a small gut anastomosis without resection yielded similar results. We conclude that the small gut source does not make a significant contribution to 24h-urinary 3-MH excretion in the adult rat. The transient postoperative increase in urinary 3-MH excretion is probably due to post-injury metabolism. In contrast to these are the measurements in two male patients with a short bowel syndrome because of an occlusion of the superior mesenteric artery. Both patients have a body weight of 60 kg, are aged 44 and 45 years respectively, and have a 24h-urinary 3-MH excretion of 120.7 +/- 28 mumol. More than 1 year after operation they are being nourished parenterally in metabolic equilibrium. The 24h-urinary 3-MH excretion in a similar control group of 8 healthy male volunteers is 229.4 +/- 25 mumol (measurements for 6 days after a 1-week meat-free diet). We conclude that the small gut source makes a significant contribution to 24h-urinary 3-MH excretion in the adult human. There is no evident correlation between the rat model and measurements in human.

[Comparison of prognostic nutrition indices in preoperative detection of risk patients. A prospective trial]. / Der Vergleich prognostischer Ernährungsindizes zur präoperativen Erfassung von Risikopatienten. Eine prospektive Prüfung.

Malnutrition must be considered as a factor of risk in surgery and therefore it has to be taken into account in surgical planning. Many authors aggregated several measurements into an index or another mathematical model by stepwise regression or discriminant analysis. Hitherto none of these approaches has been subjected to a critical analysis designed to determine whether the information gained differentiates patients with increased operative risk from those without, to a degree that is clinically relevant. In a prospective study the predictive values of nutritional assessment techniques of various authors were examined in 246 surgical patients undergoing a major surgical procedure. The specificity, sensitivity, and validity of each assessment technique were determined. The statistical analysis showed that none of the assessment techniques separated patients who were at high risk from those who were at low risk in a statistically significant predictive power. Serum albumin level was a quite accurate prognostic indicator of postoperative morbidity and mortality. The mean complication rate in this study was 26.8%. Concerning the specificity, sensitivity, and validity the single measurement of the serum albumin had a predictive value as high as all other determined assessment techniques in this study. We contend that combining measurements into a statistically derived index is time-consuming and expensive and does not produce an assessment technique with sufficient predictive power to identity high risk patients in a clinically relevant fashion.

[Ambulatory parenteral nutrition in short bowel syndrome: a retrospective study]. / Ambulante parenterale Ernährung bei Kurzdarm-Syndrom. Eine retrospektive Analyse.

Parenteral nutrition via an indwelling central venous catheter was undertaken at home over a total period of 24,747 days in 34 patients with the short-bowel syndrome (of various causes). In some of the patients there developed complete adaptation of the residual intestine so that parenteral nutrition could be terminated. Complications were: infection, thrombosis, pulmonary embolism and metabolic problems. But the method proved to be suitable for improving the quality of life of these patients.

Experiments with a biological material for the closure of incisional hernias.

A new preparation process was studied which should allow the implantation of collagen type I in its native structure in reconstructive surgery, in this special case for closure of incisional hernias. As experimental animals we used 30 female Lewis rats. A defect of the anterior abdominal wall measuring 3 cm X 4 cm was closed with our collagen substitute. Biopsies taken after 4, 6 and 8 weeks were examined morphologically. As criteria for revitalization and revascularization we used the type of infiltrating cells, the depth and density of infiltration and the formation of new blood vessels. After 4 weeks the implants were infiltrated by fibroblasts that decreased in density towards the centre. Good revascularization could be seen on the muscle-implant interface. After 6 weeks the density of infiltrating cells had increased markedly even to the centre of the collagen implant. Sporadically small vessels could be seen. Eight weeks after implantation the density of infiltrated cells was at the same high level, and capillary bundles could be seen within the whole implant. We believe that this collagen implant is suitable for the closure of hernias as shown by its physical and morphological properties. In particular it appears to guarantee and earlier and tighter closure of hernias than other materials.

The contribution of small gut to the 3-methylhistidine metabolism in the adult rat.

Twenty male adult Sprague-Dawley rats received parenteral nutrition following a duodenoileostomy which left only 8% to 10% of the small gut intact. On the first postoperative day, the urinary 3-methylhistidine (3-MH) excretion rose to 1.5 to 1.7 times the preoperative level but fell again within 12 to 14 days to the basal level. A control group of 10 rats with small gut anastomosis without resection yielded similar results. We conclude that, at least in rats, the small intestine does not make a significant contribution to 24-hour urinary excretion of 3-MH. The transient postoperative rise in 3-MH excretion is probably due to postinjury metabolism.

[The bovine pericardium for closing abdominal wall defects]. / Bovines Pericard zum Verschluss von Bauchwanddefekten.

A preparation procedure by making of biologic implants in their biologic texture was investigated in using closures of abdominal wall defects. Defects of the ventral trunk wall of 10 to 20 cm dimension were closed with a collagen implant of the equal size. The morphologic investigation was carried out after 12 respectively 24 months. The kind of the immigrated cells, the revascularisation, and the integration of the implants were criteria for the reutilization. Exclusive fibrocytes with regular cell density in the whole implant were provable after 12 months. The revascularization was demonstrable by numerous vessels and capillaries. The light-histologic findings were unchanged after 24 months, a distinction between implant and surrounding tissue was possible only in an electro-optical way.

[Initial clinical experience using Dermodress, a new temporary biological skin substitute]. / Erste klinische Erfahrungen bei der Verwendung von Dermodress, einem neuen temporären biologischen Hautersatz.

A chemically treated bovine skin, Dermodress, is presented as a long-term skin substitute. Dermodress was applied over denuded surfaces of debrided deep burns and was kept in place up to 56 days. At this time it was totally replaced by autograft, so we have no idea yet of how much longer it could have remained. It adheres to all contours of the debrided area, has hemostatic effect, and does not present any sign of infection or rejection. Dermodress can be removed in stages according to the availability of autografts, which may be applied immediately, since the exposed areas are clean and suitable for immediate grafting. Our clinical experience shows that Dermodress has most of the required properties of a long-term temporary skin substitute.

[Value of preoperative risk factors in patients with resectable esophageal cancers]. / Die Aussagekraft präoperativer Risikofaktoren bei Patienten mit resezierbaren Oesophaguscarcinomen.

Since 1. 1. 1964 245 patients with oesophageal carcinoma underwent resection at the department of surgery of the university of Cologne. A significant correlation between stage, localisation or type of carcinoma and the postoperative mortality was not found. It was possible to develop organ specific scores which were able to detect groups of patients with a high postoperative mortality, but the predictive value of these scores was too small for relevant clinical decision making.

[Anthropometric parameters]. / Anthropometrische Parameter.

Anthropometry is defined as the comparative measurement and study of the human body. Anthropometric measurements have been used for many years to assess the nutritional status of individuals and populations in the United States. More recently anthropometric measurements have become a routine part of the nutrition assessment of surgical patients. Upper arm anthropometry and handgrip dynamometry are rapid and inexpensive tests for detecting malnutrition, but they are not useful for preoperative screening to predict postoperative morbidity because appropriate standards are missing in Europe. In a prospective study none of these preoperatively measured variables were of predictive value to postoperative complications, relating the method to its specificity, sensitivity, and validity.

[Pigmented villonodular synovitis]. / Die pigmentierte villo-noduläre Synovialitis.

During a 8-year period, recurrent swelling of the right knee-joint was observed in a 31-year-old female. Although only minimal pain was present, flexion of the knee-joint was severely limited. Bearing in mind the extent of the swelling, the initial diagnostic procedures were suggestive of a malignant neoplasm. Biopsy of the knee-joint led however to the diagnosis of a pigmented villo-nodular synovitis. The postoperative course after synovectomy of the knee-joint was uneventful. Although benign, this lesion has to be followed-up closely, due to the recurrence-rate of 33%.

A simple technique for long-term intravenous feeding in unrestrained rats.

A model for parenteral nutrition of unrestrained rats is described. Apparatus and nutrient solutions are very simple, inexpensive, and commonly available. The major survival time is at least 6-8 weeks. During the parenteral nutrition the rats gain weight and are in a excellent general health. The cumulative nitrogen balance is highly positive with a retention of 95%.

[Adjuvant artificial nutrition in tumor surgery]. / Adjuvante künstliche Ernährung in der Tumorchirurgie.

Malnutrition can effect negatively the results of major cancer surgery. Adequate preoperative nutritional therapy helps to overcome the catabolic situation of malnourished cancer patients and leads to a reduction of postoperative morbidity and mortality. The beneficial effect of nutritional therapy after major cancer surgery is generally accepted, despite there is a lack of comparative clinical trials which could support this opinion. Forced feeding stimulated tumor growth in certain animal models. These findings seem to have not any clinical relevance in cancer surgery.

[Assessment of nutritional status for surgical planning]. / Die Erfassung des Ernährungszustands zur Operationsplanung.

72 patients with gastro-intestinal carcinomas were involved in a retrospective study in which 97 metabolic parameters were pre-operatively determined from each of them and subsequently tested by stepwise discriminant analysis for their bearings on clinical mortality. A discriminant function of seven parameters was obtained and can be used as a prognostic nutritional index for successful subdivision of patients into differentiated risk groups. Two prospective control studies were conducted into 605 patients consecutively operated on for benign and malignant diseases for the purpose of testing the nutritional index for its prognostic information potential. The discriminant function proved to be applicable to differentiation between patients with high, moderate, and low surgical risk. Findings were unambiguous. The nutritional index can thus be used as an aid for decision-making in cases in which alternatives exist between several surgical approaches. The importance of malnutrition as a possible causative factor of complications is likely to grow along with the invasiveness of the intervention.