Efficacy of amino acid infusion for improving protein metabolism after surgery: a prospective randomized study in patients undergoing subtotal gastrectomy.

BACKGROUND: Appropriate regimens of peripheral parenteral nutrition (PPN) have been proposed for the improvement of protein metabolism after surgery. When evaluating the efficacy of administered nutrients, it is vital to consider the severity of surgical stresses to avoid confounding effects of the trauma on the postoperative metabolism. This study was designed to evaluate protein-sparing regimens through PPN in patients who had undergone subtotal gastrectomy. STUDY DESIGN: Patients hospitalized at our institutes for gastric cancer were randomly divided into the following five groups and received PPN for 7 days after surgery: 1. G group (n = 9), 200 g glucose (per day); 2. AG group (n = 10), 54 g amino acids + 150 g glucose; 3. AGG group (n = 9), AG + 110 g glucose; 4. AGF group (n = 10), AG + 40 g fat; and 5. AGL group (n = 7), 58 g amino acids + 60 g glycerol. Biochemical studies were done before and after surgery. RESULTS: In comparison to G group patients, AG group patients showed less negative cumulative nitrogen balances. No significant differences in cumulative nitrogen balances were observed between AGG, AGF, and AGL groups. Restoration of the reduced serum rapid turnover protein occurred earlier in the AGL group than in either the AGG or the AGF groups. Hyperglycemia, glucosuria, and hyperinsulinemia were prominent in the AGG group, and less prominent in the AGL group. Marked ketosis together with an increase in serum-free fatty acid levels was found in the AGL group. CONCLUSIONS: These results suggest that in patients who have undergone major elective surgery, infusion of amino acid solutions is advantageous for improving protein metabolism after surgery, and nonprotein energy source and intake are not essential when combined with amino acid solutions for improving nitrogen balance after surgery.

[Morphological study of the genesis and development of gastric intestinal metaplasia].

We stained 77 resected stomachs with Alcianblue and studied the distribution and the morphological features of intestinal metaplasia by macroscopic and stereoscopic observation using a clinical point drying method. And we made complete serial sections of minute metaplastic foci to study the reason why intestinal metaplasia show different features in particular areas of the stomach. The results are: Intestinal metaplasia exists both in pyloric gland area and intermediate zone in 92.2% of all cases (71/77). In intermediate zone, almost all metaplastic foci consist of complete type of intestinal metaplasia and in contrast incomplete type of it is more prevalent in pyloric gland area. The ratio of the 2 histological types in each area is not different in cases which metaplastic foci are sparse and in cases which they are extensive. Metaplastic foci are usually elevated in pyloric gland area and depressed in intermediate zone. By serial sections, many goblet cell metaplasias are observed at the flat portions of the mucosa in pyloric gland area. In intermediate zone, all minute metaplastic foci are observed at the bottoms of the grooves of the mucosa.