Comparison of estimated energy requirements in severely burned patients with measurements by using indirect calorimetry.

Severe burn injuries give rise to an extreme state of physiological stress. No other trauma results in such an accelerated rate of tissue catabolism, loss of lean body mass, and depletion of energy and protein reserves. A heightened attention to energy needs is essential, and the significance of adequate nutritional support in the complex management of patients with major burns is very important. The purpose of this study is to compare the results obtained by three of the most popular methods of estimating energy requirements in severely burned adult patients with the measurements of resting energy (REE) expenditure by indirect calorimetry (IC). A prospective study was carried out of 20 patients (male/female ratio, 17/3; mean age, 37.83 ± 10.86 yr), without accompanying morbidities, with burn injuries covering a mean body surface area of 34.27 ± 11.55% and a mean abbreviated burn severity index of 7.44 ± 1.58. During the first 30 days after trauma, the energy requirements were estimated using the Curreri, Long, and Toronto formulas. Twice weekly measurements of REE by IC were obtained. It was found that the Curreri and Long formulas overestimated the energy requirements in severely burned patients, as found by other investigators. However, no significant difference was found between the daily energy requirements calculated by the Toronto formula and the measured REE values by IC. It is concluded that the Toronto formula can be used as an alternative method for estimating the energy requirements of patients with major burns in cases where IC is not available or not applicable.

Effect of early nutritional support on clinical course and septic complications in patients with severe burns.

Retrospective and prospective analyses of methods for nutritional support were carried out to assess their efficiency in covering the calculated caloric and protein needs of patients with severe burns. The energy and protein needs of the patients in Group 1 (study group) with nutritional support started 24 h after the thermal trauma were determined by the Toronto formula or by means of indirect calorimetry. Nutritional support of patients in Group 2 (control group) were initiated on day 4 post-trauma. The patients in the two groups were similar in respect to age, gender, body surface area burned, and injury severity score. We found statistically significant differences in the metabolic response of both groups as measured by nitrogen balance, serum proteins, and absolute lymphocyte count. Significant differences were also registered in body weight loss, number of positive haemocultures, and the complications rate.

[Treatment of chronic renal failure by means of routine hemodialysis]. / Nashiat opit lechenieto na khronichnata bubrechna nedostatuchnost chrez programna khemodializa.

The authors share their eight-and-a half-year experience in the treatment of 136 patients with terminal chronic renal insufficiency (CRI), treated via programmed hemodialysis. The programmed hemodialysis was established to considerably prolong the lives of the patients with terminal CRI. Many of them were rehabilitated to a state, making them feel complete citizens. The authors established that the patients with Balkan endemic nephropathy, as compared with those with chronic pyelo-nephritis and glomerulonephritis were adapted and rehabilitated far faster. It was also established that the earlier the hemodialysis treatment was performed, the faster those patients were adapted and rehabilitated and the longer they lived. The effectiveness of hemodialysis therapy was negligible in patients with poor general state. According to their observations blood urea should not be higher than 180-200 mg%, creatinin--over 10-12 mg%, hematocrit--under 25% and hemoglobin under 8 g%.

[Study of kidney function by radioisotopic methods in Balkan endemic nephropathy]. / Izsledvane funktsiiata na bubretsite chrez radioizotopni metodi pri bolni ot balkanska endemichna nefropatiia.

The authors studied the renal function in 80 patients with Balkan endemic nephropathy (BEN), 27 males and 53 females, aged from 29-67, by radioisotope clearance (EDTA--16 9yb and hippuran--131J) and isotope nephrogram (ING). The patients were subdivided into four groups according to the creatinine level: first group--creatinine up to 1,5 mg%, 20 patients: second group--creatinine from 1,6 to 8 mg%, 34 patients, third group--creatinine from 8,1 to 15 mg%--16 patients and in the fourth--with creatinine over 15 mg%--10 patients. The examinations revealed that radioisotope clearances, provide significant information about renal function with various stages of nitrogen decompensation. EDTA clearance, according to the authors, can detect the changes in glomerul filtration of patients with BEN at an early compensated stage. The authors compare the results obtained from the investigation of the glomerular filtration by creatinine and EDTA clearance and found the radioisotope clearance more accurate. The effective renal plasma flow in patients with BEN at the early stage of the disease, was established not to be disturbed. That provides grounds to admit that in BEN glomeruli are very likely damaged earlier as compared with the tubules. Isotope nephrogram, according to the authors, is not changed at the early BEN stages. The changes are most frequently bilateral in the advanced stages of the disease.