[What is catabolism?]. / Was ist Katabolismus?

Disease can be differentiated from health by some stereotype phenomena of which catabolism is one of the most fundamental. It is not only a feature of the postaggression syndrome but also of the pathophysiological activity observed with chronically consuming diseases, including starvation. Any catabolic state ultimately leads to a malnutrition syndrome. Without catabolism the total vegetative switch-over to development of ergotropy as described by Hoff, is inconceivable. Ergotropy fundamentally ensures that emergency situations can be overcome, in other words, ensures survival in spite of risk to vital systems. Due to disturbed regulations, for example risk to vital systems. Due to disturbed regulations, for example induced by secondary diseases, malnutrition syndromes occurring as a result of catabolism will themselves ultimately jeopardize vital systems. Thus, they may become factors determining prognosis. The art of managing such situations is part of the progress currently available to modern-day medicine through the therapeutic device of requirement-adapted nutrition.

[Alanine as a nitrogen sparing and gluconeogenetic substrate in the postoperative state (author's transl)]. / Alanin als stickstoffsparendes und glukoneogenetisches Substrat im postoprativen Zustand.

UNLABELLED: An alanine infusion (90 mg/kg/h) for eight hours was administered to seven patients after cholecystectomy in order to investigate the influence of elevated plasma alanine levels on the postoperative metabolism. The following metabolites and hormone concentrations were analysed in plasma: glucose, urea, free fatty acids, ketone bodies, amino acids, insulin and glucagon. Compared to the pre-infusion values on the 1. postoperative day after an overnight fasting, the following changes were monitored. The plasma glucose concentrations reached a maximum after four hours of infusion (p less than 0.05). Of the amino acids, significant elevated levels were found for alanine (300%, p less than 0.001), glutamine (36%, p less than 0.05), and alpha-aminobutyrate (61%, p less than 0.01). The free fatty acids and ketone bodies concentrations decreased immediately after the onset of the infusion of alanine (p less than 0.05), the increased again during the last four hours of infusion. The secretion of insulin and also the secretion of glucagon were stimulated by the increased alanine levels. The stimulation of insulin reached a maximum after only five minutes, but the glucagon levels increased continuously until the end of the infusion. During the administration of alanine a nitrogen homeostasis was achieved, which was a significant improvement (p less than 0.001) when compared to saline infusions before and after the alanine infusion. CONCLUSIONS: (1) Postoperative increased plasma levels of alanine stimulate gluconeogenesis and reduce the plasma levels of lipolytic metabolites. The induced stimulation of insulin and glucagon is dependent on the duration of the alanine infusion for during extended infusion of alanine the insulin stimulation diminishes while the glucagon secretion continuously increases. (2) Alanine is a potent anabolic substrate in the immediate postoperative situation.

[Stress-metabolism after myocardial infarction-demonstrated by means of the behaviour of plasma proteins with short half-life (author's transl)]. / Postaggressionsstoffwechsel nach Herzinfarkt--dargestellt am Verhalten kurzlebiger Plasmaproteine.

The kinetics of plasma proteins with short half-life during stress-metabolism in patients after myocardial infarction with and without clinical complications and after angina pectoris were compared. The acute-phase proteins alpha1-antitrypsin, C-reactive protein (CRP), fibrinogen, haptoglobin, and the transport proteins prealbumin and transferrin were analyzed with the method of radial immunodiffusion. Whereas angina pectoris doesn't influence the protein kinetics, one can recognize after myocardial infarction a continuous increase of the acute-phase proteins to maxima between the 3rd and 5th day after the attack. Parallel to these changes, the transport proteins decrease with subsequent increase. The changes, which are similar to those seen after surgical trauma, are dependent on the severity of illness, and can be used as prognostic parameters. During stress metabolism, the concentrations of the proteins depending on nutrition, prealbumin and transferrin, are modified by the type and severity of stress, and by nutritional influences. The mechanisms of these changes and the consequences for their use as diagnostic parameters are discussed.

[Improvement of pathological glucose tolerance by bradykinin in diabetics and in surgical patients (author's transl)]. / Verbesserung der gestörten Glukoseverwertung durch Bradykinin bei Diabetikern und bei Patienten im postoperativen Stress.

Intravenous glucose tolerance tests (GTT) were performed in 13 metabolically healthy patients at the first and second day after abdominal surgery. GTT were carried out during an additional infusion of bradykinin (BK) (80 microgram/h) in six of these patients at the first day (group A) and in seven patients at the second day (group B). Furthermore, GTT were performed in six patients with chemical diabetes with and without BK-infusion. In addition, the effect of BK on blood glucose concentration in the postabsorptive state was investigated in nine maturity onset diabetics and in five healthy volunteers. As a control, another nine diabetics received physiological saline. In both groups of surgical patients BK improved glucose tolerance (k-values: group A without BK 1.03 +/- 0.12, with BK 1.31 +/- 0.07; group B without BK 0.85 +/- 0.18, with BK 1.25 +/- 0.21). This was also true in chemical diabetics (without BK 0.81 +/- 0.03, with BK 1.08 +/- 0.04). While BK did not change blood glucose concentration in healthy volunteers, it reduced that of diabetics by 12.2 +/- 1.4% continuously during 100 min. No spontaneous drop of blood glucose was observed in diabetics receiving saline. These results are in good accord with the present view that kinins may play a role within the regulation of carbohydrate metabolism.

[B. Parenteral feeding. Metabolic dysfunction in the postoperative and post-traumatic phase]. / B. Parenterale Ernährung. Der entgleiste Stoffwechsel in der postoperativen und posttraumatischen Phase.

A fundamental knowledge of postaggression metabolism, i.e., postoperative and posttraumatic metabolism, is necessary for prophylaxis and treatment of its deleterious dysfunctions. These may be due to disturbed regulation of the water, electrolyte, and acid-base balance, the oxygen supply to cells, energy metabolism as well as structural and functional metabolism (with special emphasis on protein metabolism), and vitamin and trace-element metabolism. This schematic synopsis is a preliminary introduction to this topic.

[Modification of postoperative glucose-tolerance disorders using bradykinin]. / Beeinflussung der postoperativ gestörten Glucosetoleranz durch Bradykinin.

Glucose tolerance after abdominal operation was studied with and without infusion of bradykinin. With bradykinin a normalization of the postoperative decreased assimilation of glucose was found.

[Substrate metabolism of muscles during the early postoperative period: the effect of glucose infusions]. / Der Substratstoffwechsel der Muskulatur während der frühen postoperativen Phase: Einfluss einer Glucoseinfusion.

Muscle substrate metabolism was studied by measuring arterial deep-venous substrate concentration differences across the forearm in metabolically healthy volunteers 3 h after abdominal surgery. Despite elevation of insulin levels following glucose infusion, no effect on muscular fractional extraction of glucose and no decrease of lactate and alanine production was found, whereas muscular lipolysis was inhibited to a normal extent and ketone utilization was reduced.

[Metabolically adapted nutrition following the concept of clinical nutrition therapy--success and prospects]. / Stoffwechseladaptierte Ernährung im Konzept der klinischen Ernährungstherapie--Erfolge und Ausblick.

Modern dietetics abandon the traditional, mainly hypothetically based special types of nutrition. A better knowledge of the physiological and pathological metabolic reactions and the technical possibilities to produce defined, tailor-made dietetics products require a new way of thinking. It is attempted to establish a simple scheme according to the composition and use of balanced and defined diets and to outline future tendencies. In summary, it is concluded that the consequent use of modern nutritional physiology and the application of the actual technologies allow to supply patients with a metabolicly adapted nutrition even under difficult conditions.

Metabolic investigations after xylitol infusion in human subjects.

Evidence has been sought for minor degrees of thiamin and pyridoxine deficiency in patients undergoing surgery who have been infused with xylitol as a parenteral nutrient. Some metabolic changes which are associated with this practice have been studied; the findings are compared with those obtained in similar patients infused with glucose solutions. The thiamin status of all of the subjects was normal. Some of the patients showed slight biochemical evidence of pyridoxine deficiency, but there were no untoward effects of xylitol infusion. The concentration of oxalate in the blood and the excretion of oxalate in the urine did not exceed the normal range in any patient. The plasma and urine orthophosphate and urinary pyrophosphate levels decreased in association with the infusion of both xylitol and glucose. Plasma pyrophosphate and calcium levels, and the urinary calcium level, were essentially unaltered. A detailed quantitative study of the urinary organic acid excretion by means of gas chromatography/mass spectrometry showed that there was an abnormal glycolic aciduria and tetronic aciduria associated with xylitol infusion, but not with glucose infusion. There was no evidence of increased oxalate excretion in any patient by this method. The biochemical and clinical significance of these findings is discussed.

[Efficacy of parenterally administered fat emulsions]. / Effizienz parenteral verabreichter Fettemulsionen

Efficiency and tolerance of parenteral fat emulsions are determined essentially by the fate of the fat particles after entry into the circular system. - Although small quantitatively, unwanted phagocytosis by the reticulo endothelial system which may occur must not be disregarded and may lower the state of resistance of the organism. However, the plasma is mainly cleared of emulgated fat by extracellular liberation of fatty acids, the smaller part of which is oxidized immediately, the major part being reesterified to storage fat in adipose tissues by energy requiring process. - In order to avoid an "overloading syndrome" because of saturation of these mechanisms-which is easily possible-recommended dosages must not be exceeded (up to 30% of total daily calories in normal adults, up to 50% in infants, maximum infusion rate 150 mg/kg body weight and hour). - Achievable efficiencies of parenteral fat emulsions can be preestimated roughly depending on parameters of the individual cases. The most important ones among these parameters are the amount and the differently activated intracellular mobilisation of the body's own fat stores in relation to its oxidative capacity or requirement, resp. The indications which result from the efficiencies estimated individually are identical from the viewpoints of application of essential fatty acids as well as of fat emulsions as a calorie source (figure 7a and b).

[Osmo-oncotherapy in brain edema]. / Zur Osmo-Onkotherapie bei Hirnödem

The treatment of cerebral edema must be directed towards improving the volume regulation of the brain cell which is disturbed due to reduced blood flow and hypoxia and towards restoring the disturbed function of the blood-brain barrier. Onco-osmotherapy increases the effective intracranial blood pressure difference and improves cerebral blood supply and oxygen absorption, thus exerting a positive effect on sodium concentration in the brain cell which is responsible for the intracellular corticocerebral edema. After renal excretion of the osmotherapeutic agent, however, water may again flow into the brain cell, depending on the osmotic gradient. When the function of the blood-brain barrier is disturbed, osmotherapy may lead to an undesired increase of the osmotic pressure in the tissue. In spite of this, onco-osmotherapy is one of the most effective measures in the treatment of cerebral edema. Choice of therapeutic agents, dosage, infusion rates, side effects and contraindications are dealt with in detail.

[Dietetic adaptation with semi-digested food--parenteral nutrition, chemically defined diet, formula diet]. / Diätetische Adaptation durch aufgeschlossene Nahrung--parenterale Ernährung, chemisch-definierte Diät, Formuladiät

The fundamentals of parenteral nutrition and the possibilities of oral nutrition with chemically defined diets are described. The possibilities are discussed against the background of a review of nutritional pathophysiology and the use of the available preparations set out.