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  • 1
    Keywords: CANCER ; tumor ; CELL ; Germany ; liver ; SAMPLE ; SAMPLES ; TISSUE ; TUMORS ; SURGERY ; PATIENT ; IMPACT ; ACID ; ACIDS ; MALIGNANCIES ; PATTERNS ; PLASMA ; AGE ; GAS ; fatty acids ; DIET ; IMPROVES ; SMALL-INTESTINE ; nutrition ; COMPLICATIONS ; FATTY-ACID ; MALIGNANCY ; PATTERN ; FRACTION ; LEADS ; PHOSPHOLIPIDS ; WEIGHT ; SUPPLEMENTATION ; TUMOR TISSUE ; LEVEL ; methods ; PLASMA-LEVELS ; TISSUE SAMPLES ; USA ; phospholipid ; uptake ; EICOSAPENTAENOIC ACID ; ENTERAL NUTRITION ; EVALUATE ; GUT ; IMMUNONUTRITION ; MAJOR SURGERY ; PARENTERAL FISH-OIL ; POSTOPERATIVE TRAUMA ; TREATED RATS
    Abstract: Background: The uptake of omega-3 polyunsaturated fatty acids (PUFAs) into the liver, gut mucosa, and tumor tissue and plasma levels after preoperative administration of supplemented enteral nutrition was investigated in patients with malignancies of the upper gastrointestinal tract. The objective of the study was to evaluate the incorporation of preoperatively administrated PUFAs, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) into cell phospholipids. Methods: Patients undergoing major gastrointestinal surgery (n = 40) were prospectively randomized to receive a PUFA-supplemented liquid oral diet 5 days preoperatively or an isocaloric control diet. The planned diet intake was 1000 mL/d providing 3.7 g of PUFA. The diet was given in addition to the usual hospital diet. The phospholipid fractions in plasma were analyzed on the day of surgery. Tissue samples of liver, gut mucosa (small intestine), and tumor were taken during surgery and homogenized. EPA and DHA content was analyzed using liquid gas chromatography. Results: Both patient groups (PUFA group: n = 20; control group: n = 20) were similar in age, weight, and surgical procedures. As compared with the control group, the PUFA group had significantly increased levels of EPA in liver tissue (0.4 vs 1.3 weight %), gut mucosa (0.3 vs 1.0 weight %), and tumor tissue (0.3 vs 0.8 weight %). Also, the DHA levels in the PUFA group were significantly higher than the control group: liver tissue (4.1 vs 7.5 weight %), gut mucosa (2.1 vs 3.7 weight %) and tumor tissue (1.9 vs 4.2 weight %). Conclusions: This study suggests that administration of PUFA-enriched diets leads to increased incorporation of EPA and DHA not only in liver and gut mucosa tissue, but also in tumor tissue in patients with solid gastrointestinal tumors. Thus, preoperative administration of oral PUFA-enriched diets could have an impact on the postoperative inflammatory response after major abdominal surgery
    Type of Publication: Journal article published
    PubMed ID: 15961678
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  • 2
    Keywords: Germany ; METABOLISM ; SURGERY ; PATIENT ; SERA ; IMPACT ; treatment ; ACID ; ACIDS ; ERYTHROCYTES ; PLASMA ; MEMBRANE ; GAS ; PARAMETERS ; SAFETY ; DOUBLE-BLIND ; nutrition ; ARACHIDONIC-ACID ; MEMBRANES ; COMPLICATIONS ; SERUM ; PATTERN ; LEADS ; LEVEL ; methods ; EVENTS ; USA ; prospective ; uptake ; EICOSAPENTAENOIC ACID ; ENTERAL NUTRITION ; MAJOR SURGERY ; POSTOPERATIVE TRAUMA ; TREATED RATS ; DOCOSAHEXAENOIC ACID ; colorectal ; N-3 ; lipid ; polyunsaturated fatty acid ; ESTERS ; CARE UNIT ENVIRONMENT ; CONTAINING LIPID EMULSIONS ; FISH-OIL EMULSION
    Abstract: Background: The clinical safety and the uptake of omega-3 polyunsaturated fatty acids (PUFA) into the serum phospholipids and erythrocyte membranes after administration of fish-oil-supplemented parenteral nutrition (PN) was investigated in colorectal surgical patients. Methods: Forty patients undergoing colorectal surgery (n = 40) and with an indication for PN were enrolled in a prospective, double-blind, randomized study to receive an w-3 PUFA-supplemented 20% lipid emulsion (Lipoplus; B. Braun Melsungen, Melsungen, Germany; test group, n = 19) for 5 days postoperatively. The control group received a standard 20% fat emulsion (Lipofundin MCT/LCT, B. Braun Melsungen, Melsungen, Germany, control group, n = 21). Clinical outcome parameters and safety were assessed by means of adverse events recording clinical parameters and hematologic analyses. The contents of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as arachidonic acid (AA), in phospholipid fractions in plasma and in erythrocytes were analyzed preoperatively, on postoperative days 1, 6, and 10 using liquid gas chromatography. Results: Both fat emulsions were well tolerated, and none of the adverse events was considered to be related to treatment. Postoperative infectious complications occurred in 4 patients of the w-3 PUFA group vs 7 patients in the control group. As compared with the control group, the w-3 PUFA group had significantly increased levels of EPA in the membranes of the erythrocytes in postoperative day 6 (2.0% +/- 0.9% vs 0.8% +/- 0.5% fatty acid methyl esters, [FAME]) and postoperative day 10 (2.1% +/- 0.8% vs 0.9% +/- 0.7% FAME, p 〈.05). Also, the EPA levels in the serum phospholipids were significantly higher than in the control group on the same postoperative days (7.0% +/- 2.6% vs 1.3% +/- 0.8% and 3.6% +/- 1.0% vs 1.0% 0.4% FAME, p 〈.05). The DHA levels in the serum phospholipids were significantly higher in the (o-3 PUFA group compared with the control on postoperative days 6 and 10 (11.8% +/- 1.9% vs 8.4% +/- 1.5% and 11.2% +/- 1.6% vs 8.5% +/- 1.4% FAME, p 〈.05). AA levels were not significantly different in the both groups. Conclusions: i2-3-fatty-acids-supplemented fat emulsions for parenteral administration are safe and very well tolerated. This study demonstrates that parenteral administration of omega-3-PUFA-enriched fat emulsions leads to increased incorporation of EPA and DHA into phospholipids in serum and erythrocytes, whereas AA levels remain unchanged. Thus, postoperative parenteral administration of omega-3-PUFA-enriched lipid emulsions could have an impact on the postoperative inflammatory response after abdominal surgery and could be used in standard postoperative care when PN is indicated
    Type of Publication: Journal article published
    PubMed ID: 17202435
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  • 3
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  124. Kongress der Deutschen Gesellschaft für Chirurgie; 20070501-20070504; München; DOC07dgch7292 /20071001/
    Publication Date: 2007-10-02
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 4
    Publication Date: 2009-11-18
    Description: The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within 〈=7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (alpha-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25-40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7-1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels 〉400 mg/dl (〉4.6 mmol/l) and interruption of lipid infusion at levels 〉1000 mg/dl (〉11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.
    Description: Die Infusion von Lipidemulsionen erlaubt die Zufuhr einer hohen Energiedichte, ermöglicht die Vermeidung hoher Glukoseinfusionsraten und ist unverzichtbar für die Bedarfsdeckung mit essentiellen Fettsäuren. Zur Vermeidung eines Mangels an essentiellen Fettsäuren ist die Gabe von Lipidemulsionen innerhalb 〈=7 Tage nach Beginn der PE (parenteralen Ernährung) erforderlich. Eine fettarme PE mit hoher Glukosezufuhr erhöht das Risiko für eine Hyperglykämie. Bei parenteral ernährten Patienten mit Neigung zur Hyperglykämie sollte eine Erhöhung des Verhältnisses zwischen Lipid- und Glukosezufuhr erwogen werden. Bei kritisch Kranken sollte die Glukosezufuhr auf nicht mehr als etwa 50% der Energiezufuhr begrenzt werden. Lipidemulsionen mit einer niedrigen Phospholipid/Triglyzerid-Ratio werden empfohlen und sollten mit der üblichen PE verabreicht werden, um einer Verarmung an essentiellen Fettsäuren vorzubeugen, das Risiko stark erhöhter Blutzuckerwerte zu vermindern und eine verstärkte Hepatosteatose zu vermeiden. Biologisch aktives Vitamin E (alpha-Tocopherol) sollte regelmäßig zusammen mit Lipidemulsionen zugeführt werden, um einer Lipidperoxidation vorzubeugen. Die parenterale Lipidzufuhr sollte in der Regel etwa 25-40% der parenteralen Nicht-Protein-Energiezufuhr betragen. In bestimmten Situationen (z.B. bei kritisch Kranken, respiratorisch insuffizienten Patienten) kann eine Fettzufuhr bis zu 50 oder 60% parenteraler Nicht-Protein-Energiezufuhr sinnvoll sein. Die empfohlene Tagesdosis für die parenterale Gabe von Lipidemulsionen bei Erwachsenen liegt bei 0,7-1,3 g Triglyzeride/kg KG. Die Serum Trigylzeridkonzentrationen sollten regelmäßig kontrolliert werden, um eine Dosisreduktion bei Triglyzeridkonzentrationen 〉400 mg/dl (〉4,6 mmol/l) und eine Unterbrechung der Lipidinfusion bei 〉1000 mg/dl (〉11,4 mmol/l) vornehmen zu können. Auswirkungen der Auswahl aus den verschiedenen verfügbaren Lipidemulsionen sind derzeit nicht eindeutig belegt.
    Keywords: lipid emulsions ; alpha-tocopherol ; hepatic steatosis ; polyunsaturated fatty acids ; critically ill ; Fettemulsionen ; alpha-Tocopherol ; hepatische Steatose ; mehrfach ungesättigte Fettsäuren ; kritisch Kranke ; ddc: 610
    Language: English
    Type: article
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  • 5
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    German Medical Science; Düsseldorf, Köln
    In:  121. Kongress der Deutschen Gesellschaft für Chirurgie; 20040427-20040430; Berlin; DOC04dgch0168 /20041007/
    Publication Date: 2004-10-07
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 6
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Klinische Ernährungstherapie ; Ernährungsteams ; Kostenreduktion ; Key words Clinical nutrition ; Nutritional support teams ; Costs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Procedures in clinical nutrition have gained both invasiveness as well as the complexity. Thus improved education of professionals and their alliance in hospital based nutritional support teams (NST) is demanding. Two forms of collaboration, the “interdisciplinary nutritional committee” and the “department for nutritional therapy”, are discussed. It is the goal of this contribution to present structure and tasks of an independently working department for nutritional support therapy. The pertinent areas of activity are composed as followed: clinical nutritional therapy, home nutrition, education, research, and quality management. The team members include the physician, the dietitian, the nurse, the nutritionist, and the pharmacist. The individual tasks as well as the areas of responsibility are presented. We discuss, whether nutritional support teams might be suitable to achieve cost reduction, provided adequate working conditions are available. Issues like “performance related reimbursement” and “NST certification” by health care organizations are discussed. We also elude to the option to merge services with other health care providers in order to built up an inter-disciplinary organization system. We conclude that nutritional support teams have to be prepared to meet hospital needs. Costs/benefit balances have to be assessable and must be documented. Although the effectiveness of selected nutritional support teams was clearly shown, it is the challenge of each individual team to produce proof of effectiveness for itself. Acceptable working conditions, however, should be provided as they have to be considered indispensable to achieve high quality performance.
    Notes: Zusammenfassung In der klinischen Ernährungstherapie hat sowohl die Invasivität als auch die Komplexität der Verfahren zugenommen. Daraus ergibt sich die Forderung nach verbesserter Ausbildung von Fachkräften und deren Zusammenschluss in Ernährungsteams. Zwei mögliche Organisationsformen, das “interdisziplinäre Ernährungskomitee” und die “eigenständige Abteilung für Ernährungstherapie”, werden diskutiert. Es ist das Ziel dieses Beitrags, Struktur und Aufgaben einer eigenständigen Abteilung für Ernährungstherapie darzustellen. Das Leistungsangebot einer solchen Organisationsform gliedert sich in die Bereiche klinische Ernährungstherapie, Heimernährung, Aus- und Weiterbildung, Forschung sowie Qualitätssicherung. Zum Kreis der Mitglieder gehören der Arzt, die Diätassistentin, die Plegekraft, der Ökotrophologe sowie der Apotheker. Die einzelnen Aufgaben- und Verantwortungsbereiche werden dargestellt. Wir diskutieren zudem, ob eigenständige Ernährungsteams zur Kostenreduktion geeignet sind, sofern geeignete Rahmenbedingungen sowie Leistungsanreize geschaffen werden. Die leistungsbezogene Vergütung sowie das Modell der Zertifizierung von Ernährungsteams durch die Kostenträger werden erörtert. Auch die Option des Zusammenschlusses mit anderen inner- und außerklinischen Leistungsanbietern zu einem fachübergreifenden Organisationsverbund wird diskutiert. Zusammenfassend wird festgestellt, dass Ernährungsteams ihr Angebot an den bestehenden klinischen und außerklinischen Bedürfnissen zu orientieren haben. Dabei müssen Kosten und Nutzen medizinischer Leistungen dokumentiert und bewertet werden können. Obwohl die Effektivität wirkungsvoll arbeitender Ernährungsteams bereits gezeigt werden konnte, ist es die Aufgabe jedes einzelnen Teams diesen Nachweis für sich zu erbringen. Akzeptable Rahmenbedingungen stellen dazu jedoch die unabdingbare Voraussetzung dar.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-0932
    Keywords: Percutaneous discectomy ; Osteomyelitis ; Haematogenous spondylodiscitis ; Aspiration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14–59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1573-7373
    Keywords: mitoxantrone ; malignant human brain tumors ; DNA strand breaks ; alkaline elution ; flourescence spectrophotometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this study mitoxantrone (Mtx) induced DNA strand breaks were measured with the alkaline elution technique in short term cell cultures derived from human gliomas. Glioblastomas or astrocytomasfrom 5 patients who underwent intracranial surgery were cultured and incubated 1 h with different concentrations of Mtx (0, 0.01, 0.1 and 1.0 μg/ml). The alkaline elution methodwas modified to measure DNA lesions in human gliomas. Mtx inducedDNA strand breaks in a dose dependent manner in all cell culturestested. There was a linear increase of DNA strand break frequencyinduced by Mtx between 0.01—1.0 μg/ml. Concerning these in vitro data, Mtx might be potentially useful for the treatment ofpatients with malignant brain tumors.
    Type of Medium: Electronic Resource
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