Changes in the nutritional state and immune-serological parameters of esophagectomized patients fed jejunaly with glutamine-poor and glutamine-rich nutriments.

BACKGROUNDS/AIMS: In our former study we investigated the effect of glutamine-rich (I) and glutamine-poor (II) jejunal diet in operated patients with acute pancreatitis. In the glutamine-rich diet group clinical benefit and fast recovery of IgG, IgM, serum proteins, retinol-binding protein, albumin could be measured. In the present study the effects of the two types of jejunal diets I and II have been compared on the basis of changes in some immune parameters of 36 patients treated with subtotal esophagectomy for malignancy. METHODOLOGY: In randomized controlled trial data of two groups, I. patients with glutamine-rich Stresson Multi Fibre diet (23 patients) and II. patients with Nutrison Multi Fibre glutamine-poor diet (13 patients) were analyzed. Levels of serum proteins were measured by laser nephelometry, CD markers of lymphocytes by flow cytometry, phagocyte activity by chemiluminescence. RESULTS: Level of proteins decreased on the 2nd postoperative day in both groups, then gradually increased postoperatively. In increase of level of serum protein, retinol-binding protein, prealbumin there was no difference between the two groups. CONCLUSIONS: In patients treated with subtotal esophagectomy, the glutamine-rich enteric diet did not result in faster recovery in levels of prealbumin, retinol-binding protein, immunoglobulins and in outcome of patients than the glutamine-poor nutriment.

Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis.

BACKGROUND/AIMS: We have compared the effects of glutamine-rich Stresson Multi Fibre and of Nutrison Fibre nutrients on the changes of some immunological parameters of 16 patients with acute pancreatitis. Laboratory parameters included: total protein, albumin, prealbumin, retinol binding protein, IgG, IgA, IgM, IgE, complement components: C3, C4, acute phase proteins: C-reactive protein, transferrin, CD-markers of peripheral lymphocytes and activity of peripheral phagocytes. METHODOLOGY: Nine patients were supplied with Stresson Multi Fibre and 7 patients with Nutrison Fibre, using a nasojejunal tube. The levels of serum proteins were measured with laser nephelometry, the CD markers of lymphocytes with flow cytometry and the phagocytic activity with chemiluminescence. RESULTS: The treatment with glutamine-rich Stresson resulted in significant elevations in the serum levels of IgG, retinol binding protein, compared to the effects of Nutrison Fibre. In addition, the recovery of treated patients was significantly shorter in the Stresson Multi Fibre group than in the Nutrison Fibre group. CONCLUSIONS: The Stresson Multi Fibre nutrient treatment of patients treated for acute pancreatitis seems to have clinical benefit based upon the fast recovery of IgG, IgM proteins which take part in the immunological defense mechanisms.

[Treatment of acute necrotizing pancreatitis: a comparative study]. / Az akut nekrotizáló pancreatitis kezelésének összehasonlító vizsgálata.

The authors compared the therapeutic results of acute necrotizing pancreatitis during two separate time periods involving 97 and 24 patients, respectively. In the group "A", the time period lasted between May 31, 1991 and December 31, 1997. This group consisted of 97 patients, who, in addition to undergoing intensive treatment and antibiotic prophylaxis, later underwent late necrectomy and closed peripancreatic drainage. Jejunal nutrition only occurred in a limited number of 52 patients (53.6%), and was mostly used after a second operation. The group "B" consisted of patients from the time period between January 1, 1999 and December 31, 1999, and consisted of 24 patients treated in each case with intensive treatment in addition to antibiotic prophylaxis, early nasojejunal nutrition, and if necessary CT-guided percutaneous peripancreatic drainage was used. In the case of surgical intervention necrectomy and closed peripancreatic rinsing drainage was used. In group "A", significantly more early operations were performed than in group "B" (31 patients, 32.0% vs. 2 patients, 8.3%). In group "A" the number of reoperations was also higher as a total of 91 (83.5%) were reoperated as compared to group "B" in which a total of 18 (75.0%) reoperations took place. In the group "B", mortality was also lower (12.5%), than in the "A" group (17.5%). The authors attribute the successful therapy to the early jejunal nutrition, CT-guided percutaneous peripancreatic drainage and to the introduction of prophylactic antibiotics.

[CT-guided percutaneous drainage in the treatment of acute necrotizing pancreatitis]. / CT-vezérelt perkután drenázs alkalmazása az akut nekrotizáló pancreatitis kezelésében.

The authors analysed the results of the treatment of 24 patients with acute necrotizing pancreatitis. Besides intensive and operative treatment prophylactic antibiotics, early naso-jejunal feeding, CT guided percutaneous peripancreatic drainage are favourable to avoid septic complications and to postpone the first operation. In 11 patients percutaneous drainage was performed. Using percutaneous drainage three patients (33.3%) recovered without operation, the mean drainage time was 23.4 days. The first operation could be postponed in the other 8 patients after percutaneous drainage. No complications occurred as result of the interventions, although in one patient the drain slipped out spontaneously. Due to the complex treatment the total mortality rate was 12.5%.

Technique and results of duodenum-preserving resection of the head of the pancreas in the treatment of chronic pancreatitis.

Surgical treatment of chronic pancreatitis is either by ductal decompression or resection of the pancreas. Among various resection operations the duodenum preserving resection of the head of the pancreas is the newest surgical technique. At the 2nd Dept. of Surgery of Debrecen Medical University duodenum preserving resection of the head of the pancreas with simple modified reconstruction was performed in 22 patients with chronic pancreatitis. The authors evaluate the early and late results: there was no mortality. The rate of complication was 27.2%. Considering late results complete relief of pain was found in about 80% of patients. The authors suggest that this type of resection can be well applied in the treatment of chronic pancreatitis with low risk and relatively good late results.

Why the internal mammary artery is an ideal graft for myocardial revascularisation? (an experimental model with omentoplasty).

Ten dogs underwent coronary artery bypass grafting through a right thoracotomy. Free internal mammary artery grafts (IMA) was used for aortocoronary bypass to right coronary artery (RCA) without temporary cardiopulmonary bypass. In upper median laparotomy approach, mobilization and lengthening of the omentum was performed through the retrosternal part of the diaphragm. An epiploic muff was effectuated surrounding the IMA graft. After three months the animals were sacrificed and the grafts folded by omentum were used for microscopical study. The histological evaluation has shown that the omentum has formed a new adventitia around the graft. In the new-formed adventitia, newly formed vessels can be found and these are grouped around the adventitia-media border zone, very rarely penetrating into the external layer of the media. This graft-omentoplasty offer a good experimental model which facilitates to investigate in vivo the blood supply needed by free IMA grafts through the adventitia in experimental conditions. The biological mechanism of angiogenesis in graft wall can be investigate as well.