[Nutritional therapy using tubes and pumps in cancer patients]. / Ernährungstherapie mittels Sonde und Pumpe bei Malignompatienten.

The success in the therapy of patients suffering from malignant tumours is among others depending on nutritional treatment. If correctly indicated, the enteral nutrition is more economic, complication reduced, easier to maintain and a biologically optimal alternative method to the parenteral nutrition. Nutritional solutions via tube have to be given continuously or intermittently. For that purpose a pump had been developed meeting certain special requirements. It is reported on the technique of an electronically controlled, partly net independently working pump.

[Postoperative small intestine absorption--principles for enteral nutrition]. / Postoperative Dünndarmresorption--Grundlagen für die enterale Ernährung.

The intestinal absorption of nutrients is disturbed to an extent dependent on the degree of trauma in the immediate postoperative period. In a clinical study, the d-xylose absorption was investigated in 3 groups of patients after cholecystectomy. On the day of surgery a significant restriction of the absorption could be observed after intraduodenal administration. After gastric and duodenal administration of d-xylose and simultaneous enteral early nutrition a significant restriction of absorption could be observed on the day surgery was carried out. Optimal conditions for early nutrition can be achieved by combining intraduodenal feeding and a continuous decompression of the stomach. In cases of a gastric drainage an improvement of the postoperative absorptive function can be supported by the results of the nitrogen balance. In 4 pigs (type: country race) the step-by-step normalization of the absorptive kinetics could be demonstrated after catheters were implanted into the portal and subclavian veins.

[The Aubaniac subclavian catheter in surgical intensive care]. / Der Subklavia-Katheter nach Aubaniac in der chirurgischen Intensivtherapie.

The subclavian catheter according to Aubaniac has worked extremely well in surgical intensive therapy through a four-year period of prospective studies. The complication rate was as 13.2 per cent, which was found to be acceptable, provided stringent observance of indications.

[Assessment of risk status using nutrition diagnostic studies in surgical patients. 1. Determination of preoperative risk status in patients with stomach cancer]. / Erfassung der Gefährdungslage mit Hilfe ernährungsdiagnostischer Untersuchungen bei chirurgischen Patienten. 1. Mitteilung. Bestimmung der präoperativen Gefährdungslage bei Patienten mit Magenkarzinom.

The diagnosis of the nutritional state is an essential component in determining the risk in patients with carcinoma of the gastrointestinal tract. Based on the results of multivariate, statistical analyses of numerous biochemical, anthropometric and immunologic parameters in 63 patients with gastric carcinoma, we can now simplify the determination of the nutritional state considerably. With the help of cluster analysis and together with clinical aspects, the nutritional state can be divided into 2 groups ('normal' and 'disturbed'), in contrast to the former classification ('normal' and several degrees of disturbed). Using discrimination analysis, a combination of parameters was found which allows a sufficiently good classification of subjects into either the 'normal' group or the 'disturbed' group, and in this way characterizes the nutritional state. Classification of the patients is accurate in 97% of the cases. 6 practically relevant parameters were determined with the discrimination analysis: serum albumin, serum transferrin, hemoglobin, upper arm circumference, triceps skin fold thickness, and the intracutaneous skin test quotient. The nutritional quotient, EQ2, can be determined from these values (in comparison to the nutritional quotient, EQ1, which is based on the 33 point evaluation scale), thus enabling a quantification of the nutritional state. The use of only individual parameters yields major differences from the results obtained with 6 parameters. However, a relation between the nutritional state and the existing immuno-competence can be suspected when the results - especially of the skin test reactions - are in agreement with the results of the lymphocyte transformation. The test results of cell-mediated immunity in particular represent the extent of a reduced immunological reaction as opposed to the results of humoral immunity. Inclusion of less complex immunological investigation procedures must be reserved for future studies. The determination of daily urea production (urea production rate; dependent on protein supply) can be implemented as a practically relevant and reliable supplemental test for the evaluation of the existing metabolic state.

[Nutritional status and small intestine absorption]. / Ernährungszustand und Dünndarmresorption.

A high percentage of hospitalized patients are malnourished. By means of biochemical examinations (visceral proteins), anthropometric measurements (body mass, triceps skinfold, arm muscle circumference, creatinine index) and immunological methods (total lymphocyte count in the blood, skin testing with test antigens) it is possible to classify nutritional conditions in severity and kind of malnutrition. 158 patients with chronic inflammatory diseases of the GI-tract and cancer without generalization were studied by means of an exact nutritional assessment and by means of the modified D-xylose test. There was no significant correlation between the degree of malnutrition and the extent of intestinal absorption. Only in 5.7 per cent of malnourished patients existed a malabsorption.

[Nutritional therapy in cancer patients of advanced age]. / Ernährungstherapie bei Krebskranken im höheren Lebensalter.

The reduced nutritional state of cancer patients can be influenced by a purposeful feeding, which decreases the rate of complicating factors and diminishes side effects resulting from the often aggressive cancer therapy. Multimorbidity, a change in the need for nutritive substances in advanced age and senile functional changes in numerous organs make it a necessity to adapt elderly cancer patients trophotherapy to these conditions.

[Functional diagnosis of intestinal absorption in gastroenterology surgery]. / Funktionsdiagnostik der Dünndarmresorption in der Gastroenterochirurgie.

Clinical tests for measuring the intestinal absorption in abdominal surgery, especially surgery of the GI-tract, are of great importance. The absorption of the proximal small intestine can be investigated via a modified D-xylose-test. The distal small intestine may be studied by using the vitamin-B12 urinary excretion test. The bacterial overgrowth syndrome and the absorption of bile salts can be diagnosed on the basis of a 14C-glykocholate test.

[Current aspects of the diagnosis of the nutritional status in surgery]. / Moderne Aspekte der Diagnostik des Ernährungszustandes in der Chirurgie.

An exact nutritional assessment is a prerequisite for parenteral, enteral or parenteral-enteral nutrition, especially after extended operations or during conservative therapy. By using biochemical methods (visceral proteins), anthropometric measurement (body mass, triceps skinfold, arm muscle circumference, creatinine-index) and immunological procedures (total lymphocyte count and skin testing with recall-antigens) it is possible to determine exactly the nutritional status, severity and type of malnutrition. Furthermore the patients immunocompetence can be evaluated. Determining the digestion and resorption capacity enables the route of application to be chosen.

[Basis of early enteral feeding in the postoperative period]. / Grundlagen der enteralen Frühernährung in der postoperativen Phase.

Since the conception of a postoperative generalised inhibition of motility of stomach and gut has been disproved, there is a growing support for early enteral nutrition at present. The stomach should be evacuated from increased secretion by tube drainage. This should be combined with intraduodenal tube feeding. Immediately after surgery a sufficient absorption capacity of the small gut also makes early enteral nutrition possible.

[Nutrition diagnosis and therapy in chronic inflammatory intestinal diseases]. / Ernährungsdiagnostik und -therapie bei chronisch entzündlichen Darmerkrankungen.

Malnutrition can be detected by evaluating the nutritional situation of the patient. It can be influenced by special nutritional support in the pre- and postoperative period. A good nutritional status will lower the rate of postoperative complications.

[Catheter jejunostomy -- a contribution to artificial enteral feeding in surgery]. / Die Katheterjejunostomie - ein Beitrag zur künstlichen enteralen Ernährung in der Chirurgie.

Catheter-jejunostomy is a new approach for long-term enteral nutrition. This kind of nutrition can be performed in hospital as well as at home.

[Amino acid metabolism in post-stress metabolism]. / Untersuchungen zum Aminosäurenmetabolismus im Postaggressionsstoffwechsel.

During the first four days after cholecystectomy 5 patients were nourished totally parenterally with the amino acid solution INFESOL 40 and carbohydrates. The utilization of the applied amino acids were observed by nitrogen balances, amino acid pattern in plasma and urine and other data. It was achieved a positive nitrogen balance at the 3rd postoperative day. The utilization of the amino acids typically was influenced by postaggression metabolism. For the application of INFESOL 40 in the postoperative period (posttraumatic period) some modifications of the amino acid pattern were recommended.

[The nutritional status in malabsorption syndrome following gastrointestinal operations]. / Ernährungsstatus bei Malabsorptionssyndrom nach gastrointestinalen Operationen.

The nutritional status which includes selected biochemical, anthropometric and immunologic parameters was determined in 36 patients with malabsorption syndromes following gastrointestinal operations. The examinations revealed: Postoperative malabsorption syndromes often lead to considerable nutritional disturbances which cannot be sufficiently estimated by the sole determination of body mass. The nutritional status is a precious tool in judging deficiency symptoms, in instituting a targeted alimentary or substitutive therapy,and in evaluating the therapeutic accomplishment. Optimal long-time alimentary or substitutive therapy permits to achieve and maintain a good or sufficient nutritional status in patients with malabsorption syndromes even if the syndromes are due to extended gastrointestinal operations.

[Importance of the modern hospital diet in medical practice]. / Stellenwert der modernen Krankenernährung in der medizinischen Praxis.

Hospital diet is an essential part of modern therapy in all medical departments. It comprises both the so-called normal diets which are prepared according to modern nutritional knowledge, dietetic foods and the various forms of artificial nutrition (nutrient-defined and chemically defined diets, parenteral and combined nutrition, i.e. enteral and parenteral nutrition). The integration of nutritional therapeutic problems into the treatment of patients requires optimal scientific and practical forms of organisation of nutrition in the clinic. For that purpose, cooperation of clinical, technical, economic and pedagogic divisions is of prime importance. The organisation of patient nutrition in the St. Georg District Hospital in Leipzig is described as a feasible model.

[Use of tube feeding in surgery]. / Praxis der Sondenernährung in der Chirurgie.

Tube feeding is a simple and safe method for nutritional support. The efficiency of this procedure depends on the digestion and absorption of the small intestine, optimal choice and nutrients, effective technique and exact supervision. Correct tube feeding can be considered to be an alternative to parenteral nutrition.

[General practice of nutrition diagnosis]. / Praxis der Ernährungsdiagnostik.

Important condition for a parenteral, enteral or parenteral-enteral nutrition, especially in patients before extended operations of during conservative therapy, is an exact nutritional assessment before beginning of this therapy. By means of biochemical examinations (visceral proteins), anthropometric measurements (body mass, triceps skinfold, arm muscle circumference, creatinine index) and immunological methods (total lymphocyte count in the blood, skin testing with test antigens) it is possible to classify nutritional conditions in severity and kind of malnutrition. By evaluating the digestive and resorptive capacity it is possible to determine the way of application.

[Enteral resorption in the immediate postoperative phase following selective proximal vagotomy]. / Enterale Resorption in der unmittelbar postoperativen Phase nach selektiv proximaler Vagotomie (SPV).

The postoperative absorption of the small intestine after selective proximal vagotomy was found out by means of the modified D-xylose absorption test in 23 patients on operating day, and on 1st, 5th, 8th, 9th and, 10th postoperative day. The constant of the adsorption speed was reduced on the operating day and decreased further to the 4th postoperative day. Afterwards the preoperative value was obtained approximately. The temporal state of the relative maximum of the curve of serum concentration (the moment tm) occurred in the same time interval. The tm-value obtained the preoperative value approximately. The dimensions of the absorption in the small intestine was reduced by 36% on the operating day, by 20,5% on the 1st postoperative day, and by 10% on the 4th postoperative day on the arithmetical average. The influence of the gastric emptying after SPV and of gastro-intestinal hormones on the process of absorption was discussed.

[Parenteral nutrition - present status and modern trends]. / Parenterale Ernährung -- Stand und moderne Trends.

In the present paper practical references for the use of aimed balanced nutrition, particularly of parenteral nutrition, in surgery are given. The complete and total parenteral nutrition is an intervening therapeutic form for the patient. Before the beginning of the nutrition a possibly comprehensive diagnosis of the condition of the nutrition with the help of the state of nutrition is necessary, the volume of which will be depend on the existing diagnostic possibilities of an institution. Moreover, the success and the effectivity of the parenteral nutrition depend on the optimum composition of the nutrient and on a good nutritional technique as well as on an optimum control of the course of nutrition. Taking into consideration the high use for the improvement of the results of treatment a considerable expenditure must be put up with. This means a very strong indication.

[A technic for parenteral feeding in a rat model]. / Technik der parenteralen Ernährung im Rattenmodell.

About the method of central vein catheterisation in rats is reported. The catheterisation takes place after operative lay open by way of the external jugular vein. So it is possible to perform successfully an effective longterm infusion therapy in animal experiments, too.