Continuity of long-term medication use after surgical hospital stay.

OBJECTIVES: To investigate changes in long-term medication during the transfer between surgical hospital and primary care. To examine differences in defined daily doses (DDDs) versus real prescribed daily doses (PDDs). METHODS: During a 15-month period, patients from three surgical wards in a university-based teaching hospital were asked about their medication at admission (T1), at discharge (T2), and 3 months after discharge (T3). Complete data were obtained for 299 patients (169 women, 130 men; mean age 69.5 years). Both DDD and PDD were calculated for each drug. Analysis of data was performed using a relational database. RESULTS: Patients took 3.6 drugs (+/-2.2) at T1, 5 (+/-2.4) at T2, and 3.8 (+/-3.1) at T3. After surgical intervention, a discontinuation of analgesic, anti-rheumatic, and thyroid medication was observed frequently (35% of discontinued drugs at T2). We found more drug alterations at T3 than at T2 (263 versus 87). Family doctors mostly changed medications prescribed for the cardiovascular system (22% of all cardiovascular agents were discontinued and/or started at T3). We could not determine those changes to be methodical. The total of PDDs and DDDs did not differ, but the mean PDDs of statins and beta-blocking agents were significantly below the DDDs (P<0.005). CONCLUSION: The observed changes in medication after hospitalization can be only partially attributed to a successful surgical intervention and to the hospital stay. Those alterations seemed not to be initiated by the intention of saving costs.

Stereoselectivity of lipases: esterification reactions of octadecylglycerol.

Stereoselectivity of several triacylglycerol lipases (EC 3.1.1.3) has been investigated in the enzymatic esterification of rac-1-O-octadecylglycerol with oleic acid in the presence of organic solvents, such as hexane. X-1(3)-O-Octadecylmonooleoylglycerols were the only products formed with most lipases; considerable proportions of X-1(3)-O-octadecyldioleoylglycerols were also formed with the lipase from Candida cylindracea. The mixtures of unesterified enantiomeric substrates, i.e., X-1(3)-O-octadecylglycerols were converted to their 3,5-dinitrophenylurethane derivatives and subsequently resolved into sn-1 and sn-3 enantiomers by HPLC on a chiral stationary phase (Sumichiral OA 2100). The data on enantiomeric excess (ee) and enantiomeric ratio (E) in the unesterified substrate revealed for the lipases from porcine pancreas, Rhizopus sp., Pseudomonas sp., Candida cylindracea, Chromobacterium viscosum and Penicillium cyclopium a distinct preference for 1-O-octadecyl-sn-glycerol over its enantiomer indicating stereoselectivity for the sn-3 position. For the lipase from Rhizomucor miehei a slight stereoselectivity for the sn-1 position was observed. Solvents, such as diethyl ether and dichloromethane, strongly inhibited the esterification reaction, but the enzymatic activity could be restored upon removal of such solvents by washing with hexane indicating reversible inhibition.

[The characterization of microbial lipases. 2. The determination of lipase specificity]. / Die Charakterisierung mikrobieller Lipasen 2. Mitt. Zur Bestimmung der Lipasespezifität.

Types of lipase specificity are as follows: Positional specificity; fatty acid specificity; stereospecificity; substrate specificity (different rates of lipolysis of different glyceride classes. The acylglycerol used for determination of lipase specificity must be so structured, that specificities are not confused and unambiguous results are obtained. Different substrates and methods for detection of specificity are reviewed and advantages and disadvantages are discussed. Positional specificity can be determined with synthetic dialkylacylglycerols and 2,3-dioleoyl butanediol. Stereospecificity can be detected with enantiomeric dialkylacylglycerols or diacylalkylglycerols.

[The characterization of microbial lipases. 1. The determination of lipase activity]. / Ubersichtsartikel. Die Charakterisierung mikrobieller Lipasen. 1. Mitt. Zur Bestimmung der Lipaseaktivität.

In the selection of an appropriate method for activity determination of lipases existing technical equipment, kind of enzymes, number of samples investigated (e.g. in routine analysis), and expected sensitivity range have to be taken into account. Titrimetric methods and above all copper salt methods with their high detection sensitivity are the most suitable procedures for activity determination of lipases used in laboratories and institutions without equipment for radiochemical analysis.

[Water binding of adsorptive immobilized lipases]. / Zur Wasserbindung adsorptiv immobilisierter Lipasen.

It is supposed that not only the total water content of lipase preparations but more their state of water binding is of technological importance in enzymatic interesterification reactions in systems nearly free from water. The isotherms at 65 degrees C of two microbial lipases immobilized on various adsorbents as well as different adsorbents themselves are shown. The water binding capacity in the range of water content of technological interest decreases from the anion exchange resin Amberlyst A 21 via nonpolar adsorbent Amberlite XAD-2 to kieselguhr Celite 545. It is demonstrated that water binding by lipases is depending on temperature but is also affected by adsorptive immobilization. Adsorptive immobilized lipases show hysteresis, which is very important for preparing a definite water content of the enzyme preparations.

[Progress report. Lipid peroxidation. 2. Secondary reactions]. / Fortschrittsbericht. Lipidperoxydation. 2. Mitt. Sekundäre Reaktionen.

Lipids and lipid containing foods are altered by autoxidative processes resulting in the formation of hydroperoxides which are considered as the actual primary autoxidation products. These hydroperoxides cause a variety of secondary reactions giving di- and trihydroperoxides, hydroperoxyepidioxides, endoperoxides and hydroperoxyepoxides, so called secondary autoxidation products at a primary level. Sometimes they are only minor substances. The formation of primary autoxidation products is accelerated by reaction conditions as increased temperature, oxygen, metal ions and sensibilizers but is inhibited by natural and synthetic antioxidants. The decomposition of hydroperoxides and secondary autoxidation products at the primary level results in volatile substances decreasing the flavour quality of lipid containing foods. Simultaneously there are other cleavage and decomposition products remaining in the lipid causing a reduction of its oxidative stability.