Relationship between dobutamine echocardiography and the elevation of cardiac troponin I in patients with acute coronary syndromes.

An elevated cardiac troponin I (cTnI) and a positive dobutamine echocardiography are powerful predictors for future cardiac events in patients with coronary artery disease. Investigating their correlation also should be helpful in understanding their clinical usefulness in evaluating patients with acute coronary syndromes (ACS). Dobutamine echocardiography and a blood sampling for cTnI were performed on 117 patients with ACS 70 +/- 2 hours after arriving at the hospital. CTnI was considered elevated when its value was greater than 2.0 ng/ml. Dobutamine echocardiography was positive in 86 (73.5%) patients, and cTnI was elevated in 37 (31.6%). The occurrence of positive dobutamine echocardiography in patients with elevated cTnI was significantly higher than in those with normal cTnI (86.5% vs. 67.5%, P = 0.042). More patients in the elevated cTnI group developed myocardial ischemia before or at the stage of dobutamine 20 microg/kg/min (43.2% vs. 15%, P = 0.002). When compared with patients with normal cTnI, patients with elevated cTnI had a lower ischemic threshold during dobutamine echocardiography, and more frequently had baseline echocardiographic wall-motion abnormalities, a history of myocardial infarction, and a positive dobutamine echocardiography. Using multivariate analysis, we found that only a lower dobutamine echocardiography ischemic threshold (P = 0.0008) and baseline wall-motion abnormalities (P = 0.0004) were associated independently with the elevation of cTnI. Our results suggest that in patients with ACS, dobutamine echocardiography can offer information regarding wall-motion abnormalities and ischemic threshold, which are suggested to have a clinical value similar to elevated cTnI.

Regulation of cell proliferation, inflammatory cytokine production and calcium mobilization in primary human T lymphocytes by emodin from Polygonum hypoleucum Ohwi.

OBJECTIVE AND DESIGN: This study was designed to elucidate action mechanisms of four anthraquinones identified from Polygonum hypoleucum Ohwi (P. hypoleucum Ohwi) on primary human T lymphocytes. MATERIAL AND METHODS: The cells were isolated from peripheral blood. TREATMENT: T cells were treated with 5 to 60 microM of four anthraquinones with or without phytohemagglutinin (PHA; 5 microg/ml) for 3 days. Effects of 4 anthraquinones on T lymphocyte proliferation, production and gene expression of inflammatory cytokines and intracellular free Ca2+ concentration ([Ca2+]i) were determined. Data were assessed with Student's t-test. RESULTS: On a percentage basis, emodin had the highest suppressing activity on T lymphocyte proliferation with an IC50 of 11.2 +/- 0.6 microM. Emodin decreased cytokine production, IL-2 mRNA expression, and [Ca2+]i in activated T cells. CONCLUSIONS: We hypothesize that the inhibitory mechanisms of emodin on activated T cells proliferation are related to the impairment of cytokine production, IL-2 mRNA level and [Ca2+]i in the cells.

Immune reponses in human mesangial cells regulated by emodin from Polygonum hypoleucum Ohwi.

In the hope of identifying agents of therapeutic value in glomerulonephritis from Chinese herbs, we found that methanolic extracts of Polygonum hypoleucum Ohwi (P. hypoleucum Ohwi) inhibit human mesangial cells proliferation activated with interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) previously. This study was designed to identify bioactive components from P. hypoleucum Ohwi and elucidate their action mechanisms. We tested four anthraquinones emodin, emodin 1-O-beta-D-glucoside (49A), physcion (62A), and physcion 1-O-beta-D-glucoside (50A) purified from P. hypoleucum Ohwi for their effects on human mesangial cell proliferation and cytokines production in vitro. On a percentage basis, emodin had the highest suppressing activity on the human mesangial cells proliferation activated by IL-1beta and IL-6. The IC50 of emodin on human mesangial cells proliferation were 17.9+/-1.2 microM. In contrast to 49A, 50A, and 62A, emodin also decreased IL-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha) production in human mesangial cells activated with IL-1beta and IL-6. The IC50 of emodin on IL-1beta, IL-6 and TNF-alpha production in activated human mesangial cells were 16.6+/-1.8 microM, 8.2+/-1.3 microM, and 9.5+/-1.6 microM, respectively. Moreover, IL-1beta and TNF-alpha mRNA expression in activated human mesangial cells was impaired by emodin. The intracellular free Ca2+ concentration ([Ca2+]i) in IL-1beta and IL-6 activated human mesangial cells was decreased by emodin. It is unlikely that cytotoxicity was involved because no cell deaths were observable. We hypothesize that the inhibitory mechanisms of emodin on activated human mesangial cells proliferation may be related to the impairments of gene expression and production of cytokines and [Ca2+]i in the cells.

Characteristics of endoscopic retrograde cholangiopancreatogram in patients with primary biliary cirrhosis.

BACKGROUND: The findings of cholangiopancreatograms in patients with primary biliary cirrhosis vary markedly in literature. We tried to evaluate the changes of endoscopic retrograde cholangiopancreatograms in Chinese patients with primary biliary cirrhosis. METHODS: Twenty-nine patients with primary biliary cirrhosis underwent endoscopic retrograde cholangiopancreatography over the past 8 years. Three patients with a negative antimitochondrial antibody test were excluded. Well opacified cholangiograms and pancreatograms were obtained in 24 patients. Meanwhile, 16 subjects with normal cholangiopancreatogram served as controls. The characteristics and prevalence of abnormal cholangiopancreatograms in the patients and the correlation of radiography with clinical severity of the disease were evaluated. RESULTS: The maximum diameters of the common bile duct (9.7 +/- 4.0 vs. 7.6 +/- 0.9 mm, NS), right (5.0 +/- 1.6 vs. 4.4 +/- 1.2 mm, NS) and left (5.1 +/- 1.2 vs. 4.9 +/- 1.4 mm, NS) intrahepatic ducts did not show significant difference between the patients with primary biliary cirrhosis and the controls. Abnormal intrahepatic cholangiograms were obtained in 12 (50%) patients including eight with diminished arborization and focal stenosis, three with crowding and tortuous branches and one with focal stenosis alone. A hepatic hilum notch on the common hepatic duct was found in eight (33.3%) patients. The abnormalities of intrahepatic ducts did not correlate with age, sex, Pugh's scores, various liver function tests or histologically cirrhotic change. One (4.2%) patient had an abnormal pancreatogram. CONCLUSIONS: Abnormal intrahepatic cholangiograms are present in half of patients with primary biliary cirrhosis, but are not related to clinical severity.

Transjugular liver biopsy: comparison with percutaneous liver biopsy.

A transjugular liver biopsy was performed on 60 patients. Specimens were successfully obtained from 57 (95%) patients. Specimens obtained from cirrhotic patients were frequently small-sized/fragmented. The wedge hepatic venous pressure and hepatic venous pressure gradient were higher in patients with small-sized/fragmented specimens than those with non-fragmented specimens (16.3 +/- 6.4 vs 12.3 +/- 4.9 and 10.9 +/- 6.2 vs 7.3 +/- 3.4 mmHg, P < 0.05, respectively). During the same period of time, percutaneous liver biopsies were consecutively performed on 277 patients. The liver specimens by transjugular method were generally smaller (0.63 +/- 0.58 vs 1.50 +/- 0.86 cm, P < 0.001) and more fragmented (63% vs 16%, P < 0.01) than those obtained by percutaneous method. Biopsy specimens obtained for diagnosis by the former method were inadequate from 6 (10%) patients and by the latter route were inadequate from 7 (2%) patients. Subcapsular haematoma in one patient was associated with the transjugular liver biopsy. Minor complications occurred in three patients: neck haematoma in two and paroxysmal supraventricular tachycardia during the procedure in one. In comparison, percutaneous liver biopsy was followed by minor complications in 20 patients and major complications in four patients. It is concluded that transjugular liver biopsy is a safe, valuable and alternative procedure to obtain liver specimens, especially in patients who were contraindicated for percutaneous liver biopsy.

Prolonged bleeding time in cirrhotic patients: relationship to peripheral vasodilation and severity of cirrhosis.

A prolonged bleeding time (> 540 s), measured with a Simplate single template device, was found in 0% of 50 patients with chronic hepatitis and 38% of 154 cirrhotic patients. Cirrhotic patients with a prolonged bleeding time (n = 59) had lower platelet counts (P < 0.001) and a longer prothrombin time (P < 0.001) and activated partial thromboplastin time (P < 0.001) compared with cirrhotic patients with a normal bleeding time (n = 95). A weak but significant negative correlation existed between the bleeding time and platelet count in cirrhotic patients (n = 154, r = -0.3668, P < 0.001). Patients with decompensated cirrhosis had a longer bleeding time in comparison to patients with compensated cirrhosis (621 +/- 39 vs 478 +/- 27 s, respectively, P < 0.01). The prolonged bleeding time was also discovered in 25% of 83 cirrhotic patients with a platelet count > 80 x 10(9)/L and a prothrombin time < 17 s (usually taken as safe limits for invasive procedures). Twenty-seven of the 83 cirrhotic patients received a haemodynamic study by Swan-Ganz catheterization. A lower systemic vascular resistance was found in cirrhotic patients with an abnormal bleeding time than in cirrhotic patients with a normal bleeding time (844 +/- 57 vs 1171 +/- 60 dyne.s.cm-5, respectively, P < 0.001), whereas both groups had similar hepatic venous pressure gradient (16.2 +/- 1.2 vs 18.1 +/- 1.4 mmHg, respectively, P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of octreotide on postprandial systemic and hepatic hemodynamics in patients with postnecrotic cirrhosis.

The effects of octreotide on postprandial hemodynamic responses were evaluated in 20 patients with postnecrotic cirrhosis. They were randomly assigned to receive either a 100-micrograms bolus with a 100-micrograms/h infusion of octreotide or a placebo. Placebo administration did not affect any of the hemodynamic values. However, after a liquid meal of 500 kcal, postprandial increases in the hepatic venous pressure gradient and hepatic blood flow were observed in patients receiving placebo, while the systemic hemodynamic values remained unchanged. In contrast, in patients receiving octreotide, the hepatic blood flow was significantly decreased 30 min after administration, while the hepatic venous pressure gradient and the systemic hemodynamic values were not affected. After ingestion of a meal, the mean values of the hepatic blood flows were not significantly different from basal values. Moreover, the wedged hepatic venous pressure, the hepatic venous pressure gradient and the systemic hemodynamic values were not affected by meal ingestion. However, during octreotide infusion, hepatic blood flow 30 min after the meal had a tendency to increase compared to before the meal. In conclusion, octreotide inhibited the postprandial increase in portal pressure in patients with postnecrotic cirrhosis. In addition, octreotide decreased hepatic blood flow in the fasting state. When given before a meal, the increase in blood flow induced by the meal restored the hepatic blood flow to basal levels.

Relationships between the severity of cirrhosis and haemodynamic values in patients with cirrhosis.

The relationship between the severity of cirrhosis and systemic and hepatic haemodynamic values was evaluated in 193 patients with cirrhosis, most of whom were diagnosed with post-necrotic cirrhosis. It was found that the hepatic venous pressure gradient and cardiac output in Pugh's A patients (13.6 +/- 4.8 mmHg and 6.2 +/- 1.6 L/min, mean +/- s.d.) were significantly lower than in both Pugh's B (16.8 +/- 4.3 mmHg and 7.3 +/- 2.1 L/min) and Pugh's C (18.8 +/- 5.5 mmHg and 7.4 +/- 2.3 L/min) patients (P < 0.01), respectively. In contrast, the systemic vascular resistance in Pugh's A patients (1232 +/- 369 dyn/s per cm5) was significantly higher than in both Pugh's B (1016 +/- 345 dyn/s per cm5) and Pugh's C (935 +/- 234 dyn/s per cm5) patients (P < 0.01), respectively. Additionally, not only was there a positive correlation found between Pugh's score and cardiac output and hepatic venous pressure gradient, but a negative correlation was found between Pugh's score and systemic vascular resistance. It was also confirmed that the degree of portal hypertension and the hyperdynamic circulation were more severe in patients with ascites than in those without ascites. However, there were no statistically significant differences in hepatic venous pressure gradient among patients with F1, F2 and F3 esophageal varices (15.7 +/- 4.0, 17.0 +/- 4.8 and 18.0 +/- 4.8 mmHg, respectively). It is concluded that in those patients with cirrhosis, the severity of cirrhosis is closely related to the degree of the hyperkinetic circulatory state and portal hypertension.

Intestinal, pancreatic, and hepatic effects of gastrointestinal hormones in a total parenteral nutrition rat model.

The adverse effects of long-term total parenteral nutrition (TPN) are well documented. Lack of gastrointestinal (GI) stimulation from oral feeding, reduction of GI hormone secretion, and interruption of enterohepatic circulation of bile may be found. TPN results in atrophy of the digestive system, intestinal bacterial overgrowth and translocation, liver cell damage, and gallstone formation. In addition, the increase incidence of sepsis of gut origin may lead to an increase in mortality. In some studies, results of the administration of GI hormones to patients receiving prolonged TPN suggest the possibility of reducing some of the adverse effects of long-term TPN. To evaluate the role of GI hormone in the prevention of adverse effects of TPN, we designed the following study: 50 young adult male Wistar rats, weighing approximately 200 g, were divided into five equal groups. All animals received identical TPN infusate for 7 days. GI hormone was added to the TPN infusate as follows: Group A (control) received no GI hormone, group B was given glucagon at a dosage of 330 micrograms/kg per day, group C was administered cholecystokinin 2 Ivy dog units twice a day, group D received secretin 2 clinical units twice a day, and group E was given both cholecystokinin and secretin at the dosages stated for groups C and D. Maintenance of mucosal brush-border hydrolase activity was found in group B. Neither atrophy of the pancreas nor hypoplasia of intestinal villi was observed in groups C and D. Group C showed improvement of liver function-associated tests, better weight gain, and acceleration of enterohepatic circulation of bile.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of hepatic and systemic haemodynamics following somatostatin administration in patients with hepatitis B-related cirrhosis.

Somatostatin has been used to effectively control acute variceal haemorrhage, with conjectured mechanisms on portal hypertension. We, therefore, evaluated the effects of somatostatin on hepatic and systemic haemodynamics in 15 patients with hepatitis B-related cirrhosis and portal hypertension. All patients received an intravenous, continuous infusion of somatostatin 250 micrograms/h, following a bolus injection of 250 micrograms. In systemic haemodynamics, the mean arterial pressure (MAP) increased (P < 0.05), associated with a reflex bradycardia within 3 min following bolus injections, compared with basal values. The right atrial pressure, pulmonary capillary wedge pressure, inferior vena cava pressure, cardiac index, and systemic vascular resistance remained unaffected after drug infusion. In hepatic haemodynamics, the wedge hepatic vein pressure remained unchanged after drug administration. However, there was an increase in free hepatic vein pressure (FHVP; P < 0.05), and a trend toward a decrease in the hepatic vein pressure gradient (HVPG; P = 0.063), within 3 min after bolus injection. Furthermore, the hepatic blood flow decreased significantly at 10 and 30 min after somatostatin infusion (P < 0.05). The effective sinusoidal perfusion assessed by indocyanine green infusion also decreased progressively at 10 min (P = 0.057) and 30 min (P < 0.05). We concluded that somatostatin, at the dose used in this study, caused a transient and bolus-related vasoconstrictive effect, resulting in increases in MAP and FHVP, a decrease in heart rate, and a trend toward lower HVPG. In addition, somatostatin reduced the hepatic blood flow and effective sinusoidal perfusion which may be hazardous to cirrhotic patients during variceal haemorrhage.

Octreotide decreased liver metabolic activity in patients with hepatitis B surface antigen-positive cirrhosis.

The influence of octreotide and somatostatin on liver metabolic activity were studied in 16 patients with cirrhosis that was positive for hepatitis B surface antigen (HBsAg). In patients receiving a 50 micrograms bolus and a 50 micrograms/hr infusion of octreotide, the hepatic blood flow, hepatic clearance, and the maximum velocity/metabolic elimination rate constant (Vmax/km) were significantly reduced after octreotide infusion compared with basal values. Similarly, the hepatic blood flow, hepatic clearance, and Vmax/km were significantly decreased in patients receiving a 250 micrograms bolus and a 250 micrograms/hr infusion of somatostatin. The extraction ratio and the systemic hemodynamic values, including cardiac index, heart rate, mean arterial pressure, and systemic vascular resistance, showed no significant changes in patients receiving either octreotide or somatostatin. These findings suggest that, as with somatostatin, octreotide reduced hepatic blood flow and impaired liver metabolic activity in patients with HBsAg-positive cirrhosis. These effects may have important clinical implications in the management of bleeding esophageal varices in patients with cirrhosis.

The effect of three intravenous fat emulsions containing different concentrations of linoleic and alpha-linolenic acids on the plasma total fatty acid profile of neonates.

We determined the fatty acid profile of total plasma lipids in infants who received one of three intravenous fat emulsions that differed primarily in their linoleic and alpha-linolenic acid content: (I) a safflower oil emulsion, (II) a 50:50 mixture of safflower and soybean oils, or (III) a soybean oil emulsion. After 2 weeks of fat therapy, oleic acid, expressed as a percentage of total plasma lipid fatty acids, decreased in all groups, but less so in group III (p less than 0.01). The linoleic acid percentage increased in all groups, but group I had the greatest increase (p less than 0.05). Group II patients had higher percentages of the linoleic acid metabolites, dihomo-gamma-linolenic acid (II greater than I, p less than 0.05; II greater than III, p less than 0.01) and arachidonic acid (II greater than III, p less than 0.05). Group II patients also had higher levels of alpha-linolenic acid (II greater than I, p less than 0.05) and its metabolite, eicosapentaenoic acid (II greater than I, p less than 0.05). Another alpha-linolenic acid metabolite, docosahexaenoic acid, however, increased in group III, remained stable in group II, and decreased in group I (III and II greater than I, p less than 0.05). We conclude that the content of linoleic acid and alpha-linolenic acid in intravenous fat emulsions results in statistically significant changes in the fatty acid profile of total plasma lipids in infants receiving total parenteral nutrition.

Pulsed white light dye laser system: a theoretical study.

A new configuration of a pulsed white light dye laser system is proposed. Design and detailed calculation of the laser cavity are presented. A special coated prism is used inside the cavity to guide the tricolor light. The output beam is expected to be a colinear balanced white light. Numerical values of laser design parameters are also given as an example.

Significance of eicosapentaenoic acid (EPA) in nutritional support.

Changes in the fatty acid profile of plasma total lipids in patients maintained on TPN were determined in 2 studies. In the first study, 20 newborns, 2-25 days of age, receiving comparable nitrogen, calories and fat were divided into 2 groups of 10 in each. A safflower oil emulsion (Liposyn 20%) containing no alpha-linolenic acid was given to the Group 1 subjects, while a modified emulsion containing 3% of alpha-linolenic acid in safflower oil supplying 5.6% of total calories was given to those of Group 2. Plasma alpha-linolenic acid of the Group 1 infants was 0 throughout. The decrease in EPA and DHA was 85% and 65%, respectively, after 10-15 days of therapy. In the subjects of Group 2, there was an increase in both alpha-linolenic acid and EPA. A similar decrease (63%) in DHA similar to that of Group 1 infants was observed. In the second study, results of 2 representative adult patients are reported. One patient was given a soybean oil emulsion (Intralipid, 10%) that contains 7-8% of alpha-linolenic acid in the oil, furnishing about 11% of total calories. The other patient received a safflower oil emulsion (Liposyn, 10%) that contains no alpha-linolenic acid. Each patient received 500 ml of the respective emulsion daily for 3 weeks. The plasma alpha-linolenic acid of the patient who received the safflower oil emulsion remained 0 throughout. EPA showed a 67% decrease in 21 days. DHA remained at low levels throughout.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the clinical and biochemical effect of increased alpha-linolenic acid in a safflower oil intravenous fat emulsion.

We report the results of a randomized comparison of two intravenous safflower oil (fat) emulsions in neonates who required total parenteral nutrition. The fat emulsions differed only in their content of alpha-linolenic acid: in one emulsion the alpha-linolenic acid content of the oil was 0.1% of fatty acids, while in the other emulsion the alpha-linolenic acid content of the oil was 3.0 +/- 1.5% (SD) of fatty acids. Group 1 and 2 patients received the "low" and "high" alpha-linolenic acid emulsions, respectively. Ten patients were studied in each group. The mean daily fat dosage was 1.70 g/kg in patients of Group 1 and 1.56 g/kg in those of Group 2. No significant difference in the clinical effects of either fat emulsion could be detected between the two study groups. Both emulsions prevented or corrected biochemical signs of essential fatty acid deficiency. The major statistically significant difference between study groups was in the level of alpha-linolenic acid and its metabolite, eicosapentaenoic acid. After 2 weeks of fat therapy, these fatty acids were increased in the high alpha-linolenic acid group; however, another metabolite of linolenic acid, docosahexaenoic acid, decreased during intravenous fat therapy in both study groups. Both study groups had significantly decreased arachidonic acid levels and increased linoleic to arachidonic acid ratios.

Comparison of Intralipid 10% and Intralipid 20% as a source of energy and essential fatty acids--a multicenter study.

A multicenter clinical study was done which directly compared efficacy and safety of Intralipid 10% and Intralipid 20%. Twenty-nine patients received the 10% concentration, 30 patients received the 20% concentration. Both groups of patients received equivalent amounts of calories, amino acids, dextrose and fat for seven day study periods. Analysis of nitrogen balance data showed that the two preparations were equally effective in maintaining nitrogen balance. Both concentrations of fat emulsion were effective in reversing or correcting the changes of essential fatty acid deficiency. Analysis of clinical laboratory data indicated that both preparations were equally well tolerated by the patients. No adverse effects attributed to the fat emulsions were observed.

Experimental wound healing in essential fatty acid deficiency.

Clinical reports have suggested that essential fatty acid deficiency (EFAD) may cause delayed healing. One hundred weanling rats were placed on normal or EFAD diets. After 4 wk in control and 6 wk in EFAD animals comparative studies were performed as follows: (1) skin and fascial incisions were tested for tensile strength up to 5 wk, (2) single layer small bowel, (3) colonic anastomoses were studied for anastomotic bursting strength to 14 days, ana (4) 20% partial thickness burns were followed to healing and autoradiographic analysis of healing epiothelium performed. After 4 wk on diet, EFAD rats showed chemical and clinical evidence of deficiency, while control rats remained normal. There was no significant difference in tensile strength of ventral skin incisions with underlying fascial incisions between control and EFAD rats during the study, but solitary dorsal skin incisions were significantly stronger after three weeks in control animals. Bursting pressures in colonic and small bowel anastomoses were not significantly different between control and EFAD groups. However, colonic suture line disruption occurred in 42% of EFAD rats as opposed to 17% of control animals. Highly significant differences in the healing rate of partial-thickness burns were noted. Control rats healed completely by 21 days while EFAD rats had not completely healed at 120 days postburn. Observation of the burn wounds indicated that wound contraction was impaired. These studies suggest that skin healing is the prime area affected by EFAD although colonic healing may have been affected as well.

Parenteral safflower oil emulsion (Liposyn 10%): safety and effectiveness in treating or preventing essential fatty acid deficiency in surgical patients.

The safety and effectiveness of a 10% safflower oil emulsion in treating or preventing essential fatty acid deficiency was tested in a prospective study of 15 surgical patients requiring total parenteral nutrition for two to four weeks. Three dosage regimens were evaluated including: Group I: 4% of calories as linoleate daily (five patients), Group II: 4% of calories as linoleate every other day (two patients), and Group III: 8% of calories every other day (eight patients). Patients were monitored for laboratory changes from baseline specifically in those areas where previous fat emulsions have caused serious deviations. No significant changes were noted in hematologic parameters, coagulation studies, cholesterol and triglyceride serum levels. Although there were sporadic mild deviations in liver function changes in several patients, no clinically significant adverse effects could be directly attributed to infusion of the fat emulsion. Three patients had baseline triene/tetraene ratios of 0.4 or greater, indicative of essential fatty/acid deficiency, and these ratios dropped to less than 0.4 within eight days of beginning therapy with the parenteral fat emulsion. The remaining 12 patients maintained a normal triene/tetraene ratio of less than 0.4 throughout the 28 day study period. All three dosage regimens were considered effective for treatment and prevention of essential fatty acid deficiency.

[Parenteral feeding with varying nitrogen and caloric levels in esophageal cancer]. / Parenterale Ernährung mit verschiedenen Stickstoff- und Kalorienmengen bei Patienten mit Osophaguskarzinom.

Eighteen male patients with operable esophagus carcinoma received parenteral nutrition during 4 preoperative and 14 postoperative days in three different infusion regimens. It was possible to demonstrate that a preoperative positive N-balance can be achieved in all patients of each group in comparison to 2 of the 3 groups postoperatively. Side effects were not observed in the course of this study.