[Nutritional habits and protein status of surgical patients during the preclinical phase]. / Ernhrungsgewohnheiten und Proteinstatus von chirurgischen Patienten in der präklinischen Phase

In this study the importance of nutrition during the preoperative period has to be find out. Three methods are helpful in it: 1. anamnesis of nutrition; 2. status of the subcutaneous fat tissue by measuring the skinfolds with a Harpenden-Caliper; 3. proteinstatus. 24 patients after gastric surgery and 20 patients of a control group were investigated. There was found a loss of weight inabout half of these 24 "gastric patients" preoperatively. These special patients showed a malnutrition in their anamnesis, thin skinfolds, low serum albumin and total protein concentration and a decreased concentration of immunoglobulins. They got six times more infectious complicationes than the patients without a preoperative loss of weight. It is proposed to develop an adequate plan for preoperative and post-operative nutrition.

[Generalised herpes simplex virus infection presenting as an "acute abdomen" (author's transl)]. / Generalisierte Herpes-simplex-Virus-Infektion unter dem Bild eines "akuten Abdomens"

A 23-year-old patient developed acute upper abdominal symptoms during in-patient treatment for vulvo-vaginitis. Clinical picture, scintigraphy and angiography suggested a space-occupying process of the liver. Laparotomy showed ascites and a congested liver covered with cell necroses. The patient died the day after the operation from circulatory failure. Virological investigations of liver and spleen cell suspensions as well as the ascites fluid led to the demonstration of herpes virus type 2. The complement binding reaction gave a titre of 1:20 to herpes simplex virus. Disseminated herpes simplex virus infection is rare and in this case spread from the genital area.

Suitability of non-glucose-carbohydrates for parenteral nutrition.

Postoperative parenteral nutrition can only be optimally effective if the characteristics of post-traumatic metabolism are taken into account. Two main possibilities are discussed for the carbohydrate component of parenteral nutrition during this phase: glucose with high doses of insulin or non-glucose carbohydrates (sugar substitutes) possibly in a suitable combination with glucose. The risks as well as the technical and organisational problems involved in the use of them are discussed and the authors prefer the second of the two alternatives. Possible side effects of non-glucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of frucose : glucose : xylitol in a ratio of 2 : 1 :1 with a total dose of 0.50 g/kg/hour has been studied most thoroughly. This combination normalises the fat metabolism and improves glucose tolerance without requiring exogenous insulin. Experiences with this combination as well as individual non-glucose carbohydrates on operated patients have been given continuously for up to 7 days and in some cases even for several weeks. No side effects, no deviations from a steady state and no abnormal changes of the laboratory values occurred. The authors are of the opinion that non glucose carbohydrates are necessary if the facilities for frequent blood sugar controls are not available.

[Modern tube feeding]. / Moderne Sondenernährung

Feeding by tube is indicated when changing from parenteral to oral nutrition of the patient. Tube feeding preparations should contain all basic nutrients in optimal relation to each other and in an easily decomposable, well reabsorbable form. Moreover, in the production of tube feeding the sufficient supply of the patient with essential alimentary ingredients and vital trace elements should be taken into account.