Immunohistochemical identification of amyloid, using an anti-human serum amyloid P component (SAP) antibody, is possible in ruminants but not in dogs and cats

Amyloidosis represents a heterogenous group of diseases that have in common the deposition of fibrils composed of proteins of beta-pleated sheet structure, a structure which can be specifically identified by histochemistry using the Congo red or similar stains. Amyloid consists primarily of the amyloid fibrils but also of the amyloid P component (AP). This component, which is identical with the serum counterpart (SAP), is found in all types of human amyloid, and immunohistochemical identification of AP has been proposed as an adjunct to the universal, type-independent diagnosis of human amyloidosis. In the present study of animal amyloidosis, we compared the amyloid-specific Congo red stain with an immunohistochemical protocol using an anti-human SAP antibody for the identification of amyloid in formalin fixed tissue samples. The species and types of amyloidoses investigated were: (i) seven cows, one yak (Bos grunniens), and one sheep affected with amyloidosis of presumed AA type, (ii) one dog with a pancreatic endocrine tumour producing amyloid of presumed AIAPP type, (iii) two cats with presumed AIAPP-amyloidosis of the islets of Langerhans, one cat with presumed AA-amyloidosis, and one cat with an amyloid-producing odontogenic tumour. Intense immunostaining co-localized with amyloid, identified by its congophilia and green birefringence, using a protocol without any antigen retrieval in each of the seven cows, the yak and the sheep. The method seemed more sensitive in the ruminants than the Congo red stain, but was unable to detect amyloid in the dog and the cats regardless of the application of various antigen retrieval protocols. However, specific identification of amyloid still rests on the Congo red method or similar histochemical techniques.

A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain

The clinical value of amylase and lipase measurement for the diagnosis of acute pancreatitis was evaluated in 253 patients presenting with acute abdominal pain. Acute pancreatitis was detected in 32 patients by computed tomography or ultrasound. In the serum samples collected on days 0-1 after the onset of symptoms, lipase was elevated in 100% and amylase in 95%. A 95% sensitivity/specificity was reached at a lipase cutoff near twofold above normal. The receiver-operating characteristics (ROC) showed similar curves for both enzymes, lipase being slightly superior to amylase. The ROC curves from days 2-3 demonstrated a much lower sensitivity/specificity of both enzymes. Lipase, however, was notably superior to amylase: at a sensitivity of 85% the specificity of lipase (amylase) was 82% (68%). In samples from days 4-5 the accuracy of the enzyme assays was even worse; at a sensitivity of 60% the specificity did not increase above 70%. The diagnostic value of simultaneous measurement of amylase and lipase was tested at different cutoffs in two groups: the OR group, in which one of the two parameters had to be elevated, and the AND group, in which both parameters had to be above normal. Combination of both parameters mainly improved the specificity of the assay (from 91 to 98% on days 2-3 and from 93 to 97% on day 4-5) but only when, in the OR group, twofold elevated amylase was combined with lipase. We conclude that the simultaneous determination of serum lipase and amylase marginally improved the diagnosis of acute pancreatitis in patients with acute abdominal pain, however, the sensitivity of the assay with samples collected 4-5 days after onset of the disease remained low.

Measurement of albumin synthesis in perfused rat liver using stable isotopes: [15N] hippurate as a measure of the intracellular [15N] glycine precursor enrichment

Rat livers were perfused by the non-recirculating technique with medium containing [15N] glycine and sodium benzoate. At various times, the 15N-concentration and the isotopic enrichment of perfusate hippurate, albumin, globulines, urea, creatinine and other fractions were measured by MS. Hippurate was used to represent the intracellular precursor pool for albumin synthesis. After start of glycine administration the ratio APE product/APE precursor pool had reached approximately maximal values. After 30 min, the precursor pool size and its use in protein synthesis decreased due to amino-acid-deficient perfusion with no further decrease between 30 and 105 min. Additionally, rates of protein synthesis were determined. The albumin synthesis rate was 3.27 mg/g liver weight per hour.

Intestinal absorption of D-xylose in the early post-operative period

To assess intestinal absorption in the early post-operative period, portal and subclavian vein catheters were implanted into 8 pigs. For direct d-xylose infusion into the upper small intestine a feeding tube was inserted via a gastrostomy. Four control animals (Group 1) underwent an open and close laparotomy after catheter and tube implantation. Four pigs (Group 2) underwent a standardised ileocoecostomy. At 6, 24, 36, 48 and 72 h after surgery, d-xylose was infused into the small intestine in both groups of animals. After single-dose administration the absorption kinetics were measured in the pre- and post-hepatic blood compartment. With increasing time after operation the rate and extent of d-xylose absorption returned towards normal but there were significant differences in the d-xylose kinetics between the two groups. The absorption kinetics and d-xylose uptake recovered more rapidly in the control group than in those who underwent ileocoecostomy. Effective enteral feeding in controls after 36 h was achieved, but in Group 2 was delayed until 48 h post-operatively. Absorption capacity returned to normal after 48 h in controls and after 72 h in Group 2.

[Studies of solutions with various branched-chain amino acid contents on protein metabolism in the postoperative period. 1. A 15N tracer kinetic animal model for evaluating the effect of parenteral amino acid administration on nitrogen metabolism]

We were able to estimate nitrogen or protein metabolism on the basis of a 15N metabolic model that delivered a high amount of data during a parenteral nutrition period over 72 h. We describe the basic principles of the necessary N or 15N-analyses in blood, as well as in sera, in urine, in tissues of selected organs and in hepatocytes. This 15N-metabolic model allows the estimation of the utilization of amino acid infusion solutions. Because of the great similarity of parameters of the N or protein turnover between man and pig it is possible to provide relevant information for the clinical practice regarding amino acid infusion solutions.

[Postoperative small intestine absorption--principles for enteral nutrition]

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.

Evaluation of protein metabolism in clinical practice

The application of stable isotopes creates further possibilities for our understanding of the metabolism. New concepts especially for non-invasive diagnostic procedures could be developed. An important step in our research program was the performing of a 1-year experiment on a volunteer. On the basis of a 10-pool model we received a lot of informations. Based on this knowledge we developed 2 simplified methods for calculating whole body protein turnover. Knowing the problems with whole body protein calculations we intensified our intentions for determining the protein enrichment in organs and isolated cells (hepatocytes), estimating at the same time the precursor pool in the cells. Of special importance was an extensive study, wherein all those 15N-estimations were performed we are able to do up to now. We calculated whole body protein, but especially we studied the enrichment of the cellular protein fractions in hepatocytes, of plasmaproteins, and of the intracellular precursor pool. This study is the base for further tracer investigations.

[Value of various amino acid mixtures for the treatment of chronic liver damage]

A reproducible liver lesion was caused in 28 pigs by intermittent, intraperitoneal administration of thioacetamide. The morphological degree of the liver lesion was checked by histological investigations (material drawn from the liver by biopsy). During a 3-day infusion period a so-called liver solution (Aminofusin hepar) was given to one group of animals, a normal solution (Infesol) to a second group, and only an electrolyte infusion solution under oral nutrition ad libitum to a third one. The solutions were labelled with (15N) glycine. The amounts of total N, total 15N, 15N with single non-protein fractions, a number of enzymes of 15N incorporated into the liver protein were measured in urine, and the following points were established: 1. The catabolic situation of metabolism is eliminated both by the so-called normal solution and the specific amino acid solution. The two mixtures of L-amino acids thus have a nutritive effect. 2. The toxic liver lesion is an indication for parenteral nutrition. Oral nutrition alone is not sufficient. 3. The so-called liver solution influences the liver metabolism of the protracted liver lesion more than the so-called normal solution does, and considerably more than an electrolyte infusion solution under oral nutrition ad libitum.

[Assessment of risk status using nutrition diagnostic studies in surgical patients. 1. Determination of preoperative risk status in patients with stomach cancer]

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.

Erfassung der Gefährdungslage mit Hilfe ernährungsdiagnostischer Untersuchungen bei chirurgischen Patienten

Die Diagnostik des Ernährungszustands ist ein wesentlicher Bestandteil der Erfassung der Gefährdungslage bei Patienten mit Karzinomen des Verdauungstrakts. Nach den Ergebnissen multivariater statistischer Analysen zahlreicher biochemischer, anthropometrischer und immunologischer Parameter bei 63 Patienten mit Magenkarzinom können wir heute die Bestimmung des Ernährungszustands wesentlich vereinfachen. Mit Hilfe der Clusteranalyse und zusammen mit klinischen Aspekten kann der Ernährungszustand im Gegensatz zur bisherigen Klassifizierung («normal» und mehrere Störungsgrade) in 2 Gruppen («normal» und «gestört») eingeteilt werden. Mit Hilfe der Diskriminanzanalyse wurde eine Merkmalskombination gefunden, die eine hinreichend gute Diskrimination der Probanden in eine der Gruppen «normal» und «gestört» zuläβt und damit den Ernährungszustand charakterisiert. Die Zuordnung der Patienten trifft in 97% der Fälle zu. Bei der Diskriminanzanalyse konnten 6 praxisrelevante Merkmale ermittelt werden, und zwar Serumalbumin, Serumtransferrin, Hämoglobin, Oberarmmuskelumfang, Trizepshautfaltendicke und der intrakutane Hauttestquotient. Daraus kann der Ernährungsquotient EQ₂ ermittelt werden (im Vergleich zum Ernährungsquotienten EQ₁ nach dem 33-Punkte-Bewertungsschema), womit eine Quantifizierung möglich ist. Die Verwendung nur einzelner Parameter ergibt gröβere Differenzen von den gewonnenen Ergebnissen mit 6 Parametern. Allerdings kann durch die Ergebnisse besonders der Hauttestreaktionen übereinstimmend mit den Ergebnissen der Lymphozytentransformation ein Zusammenhang zwischen Ernährungszustand und der aktuellen Immunokompetenz vermutet werden. Die Untersuchungsergebnisse der zellvermittelten Immunität repräsentieren insbesondere das Ausmaβ einer herabgesetzten immunologischen Reaktion gegenüber den Ergebnissen der humoralen Immunität. Die Einbeziehung weniger aufwendiger immunologischer Untersuchungsverfahren bleibt zukünftigen Erhebungen vorbehalten. Als eine praxisrelevante und verläβliche Zusatzuntersuchung für die Beurteilung der aktuellen Stoffwechsellage kann die Bestimmung der täglichen Harnstoffproduktion (Harnstoffproduktionsrate; in Abhängigkeit von der Eiweiβzufuhr) herangezogen werden.

[Nutritional therapy in cancer patients of advanced age]

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.

[Methodological aspects of the determination of nitrogen metabolism parameters from 15N-tracer experiments on swine based on nitrogen metabolism models. 2. Calculation of N metabolism parameters from the time of urinary excretion of 15N]

After a 45-hour infusion of 15N-lysine and 15N-glycine resp. with pigs of 25 kg live weight, the infusion of the tracer was disrupted and a 3-day reduction phase was made part of the experiment. The N-metabolism parameters such as protein synthesis and decomposition quotas were calculated on the basis of the temporal development of 15N-amounts excreted in urine. The labelling and reduction phases were evaluated simultaneously. By means of including the total N-amount of the animal body the balance calculation becomes more stable. The possible influence of the tracer amino acid in connection with the 3-pool-model is discussed on the basis of the ascertained parameters.

[Modern aspects of enteral and parenteral feeding of newly operated patients]

In a decisive degree the modern trophotherapy further the decrease of the lethality from operation and of the rate of postoperative complications. In the differential indication between parenteral and enteral nutrition at present an international change takes place. The early enteral nutrition after operative interventions of medium severity is a real alternative to the parenteral nutrition. Therapy concepts for the balanced nutrition of newly operated patients are presented. The intake of nutrition via small intestine is less dangerous than via veins and is clearly more economical.

A modified D-xylose absorption test

A modified D-xylose-test is described which enables intestinal absorption to be assessed independently of renal and hepatic function. The speed of appearance of the peak of D-xylose-concentration in plasma after an oral administrated dose and the extent of absorption in the small intestine as a time-function, were analysed by graphic-mathematical evaluation of the kinetics of plasma D-xylose concentration after oral and intravenous administration. Small intestinal functional integrity was assessed in 172 normal individuals (aged from 3 to 96 years), also in 9 patients with coeliac disease. The speed and the extent of D-xylose absorption were significantly reduced in all cases of untreated coeliac disease and during relapse. There were no differences between normal individuals and treated patients. Experience over many years indicates that the modified D-xylose-test is a simple, reliable and inexpensive standard method for detecting changes in intestinal absorption.

[The thyrotropic function of the hypophysis and peripheral thyroid hormones after removal of bland and autonomous nodular goiters]

Bilateral subtotal resection or enucleation or unilateral resection was performed in 60 patients (36 with bland nodular goitre, 24 with autonomic adenoma). The thyrotropic pituitary activity and the peripheral thyroid function were examined in all patients preoperatively and followed up for 12 months postoperatively. The results show that all patients with bilaterally resected bland nodular goitre require postoperative administration of thyroid hormone, since enhanced thyrotropic activity is seen not later than three months after surgery. Since thyrotropic function remains normal in unilaterally operated nodular goitre, thyroid hormone administration does not appear generally necessary. In patients with autonomic adenoma there is postoperatively variability of function, independent of the surgical method employed. In view of possible functional recompensation, final decision on the administration of thyroid hormones should not be made before the end of the sixth postoperative month. These results can be considered as guidelines for a differentiated postoperative management.

[Small intestinal absorption in cancer patients--basis for enteral feeding therapy in oncology]

A deteriorating nutritional condition combined with the loss of body mass is one of the most noticeable symptoms of cancer. In order to answer the question to what extent absorption disorders in the small intestine are responsible for the malnutrition which develops, we studied 54 oncologic patients using modified D-xylose absorption tests. After the oral and intravenous administration of 10 g D-xylose at different times, the degree of absorption dependent on time was determined on the basis of a biophysical model. When accompanied by general nonspecific tumor symptoms, the frequency of absorption restrictions was increased. An established relation was found between the extent of small intestinal absorption, on the one hand, and the degree of spreading (staging) and the degree of histological differentiation of the carcinoma, on the other hand. Enteral absorption disorders represent a partial cause for the development of malnutrition in cancer patients and must be viewed as a result of a metabolic situation which is distinctly catabolic.

[Protein turnover in liver failure--determination using the stable isotope 15N]

The 15N-tracer technique gives new opportunities to medical research for investigation of normal and pathological nitrogen metabolism. Analysis of 15N kinetic data derived from total nitrogen excretion in the urine allows to calculate quantitatively certain parameters of protein synthesis and protein metabolism. At the same time analysis of serum samples will allow measurement of 15N-nitrogen incorporation into particular protein or non-protein fractions of the plasma. In the study reported here patients with different liver parenchyme lesions (acute hepatitis, chronic active hepatitis, biliary obstruction, cirrhosis of the liver, hepatic coma) were investigated with a standardized 15N-tracer method developed by us. It could be shown, that protein turnover in patients with liver insufficiency is significantly decreased as compared to healthy persons. Decrease of protein synthesis is associated with a still more pronounced decrease of protein catabolism. There are significant differences in dynamics of 15N in patients with hepatic coma as compared to other patients with liver parenchyme disease without portal encephalopathy. Nevertheless, even in hepatic coma 15N incorporation into plasma proteins can be shown. Differences in the 15N elimination kinetics of the non-protein pool between patients with chronic active hepatitis, biliary obstruction and hepatic coma could be found.

[Importance of the modern hospital diet in medical practice]

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.

[Protein synthesis following experimental injuries in the pig as disease model. Comparison of infusion solutions with various amino acid patterns]

This study compares the effect of two amino acid solutions on protein metabolism after injury by measuring nitrogen balance, 15N-elimination, total body protein synthesis and utilisation of administered nitrogen in an experimental study using pigs. Protein synthesis and nitrogen utilisation were determined using a 15N-tracer technique with recourse to mathematical model concepts. The non-surgical control animals had a lower urinary nitrogen excretion, a more favourable nitrogen balance, a higher 15N-retention, greater total body protein synthesis and utilisation of the infused amino acids during infusion of an amino acid solution with a standard amino acid pattern (A) than the operated animals (solution B). Comparison of the post-operative data shows that if solution A is compared with solution B whose amino acid content takes account of changes in plasma amino acid metabolism following trauma, solution B yields the better results in respect of 15N-retention as well as total body protein synthesis and nitrogen utilisation.

[Standardized 15N-tracer method for the assessment of protein metabolism in clinical practice]

A standardized 15N tracer method is described for the assessment of the nitrogen and protein metabolism in healthy and pathological changed organism. The method represents an isotope technical procedure for the application in the clinical research and practice. The single parts of this routine method are: --the clinical preparation of the patient/proband by means of a standardized nutritional regime, --the tracer administration (single dose) and the sampling (urine, blood), --the 15N-tracer technique (sample chemistry, emissions-spectrometric isotope analysis), --the mathematical evaluation of 15N tracer data.

Protein synthesis after experimental injury in pigs. A comparison of infusion solutions with different amino acid patterns

This study compared the effect of three amino acid solutions on protein metabolism after injury by measuring plasma amino acid pattern, nitrogen balance, total body protein synthesis and utilisation of administered nitrogen in an experimental protocol using pigs. Protein synthesis and nitrogen utilisation were determined using a 15N-tracer technique with recourse to mathematical model concepts. Control animals which had not undergone surgery had a lower urinary nitrogen excretion, a more favourable nitrogen balance, greater total body protein synthesis and utilisation of the infused amino acids during the infusion of an amino acid solution with a standard pattern of amino acids (A) than the operated animals infused with either solution A or two other test amino acid solutions B and C. Comparison of the post-operative data showed that if solution A is compared with solution (B) whose amino acid content takes account of changes in plasma amino acids following trauma and a solution (C) which contains a high fraction of branched chain amino acids, solution (B) yields the best results in respect of total body protein synthesis and nitrogen utilisation.

[General practice of nutrition diagnosis]

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.

[Hepatic coma - experimental study with swine (part 1)]

An acute coma hepaticum was produced in 8 pigs by means of one intraperitoneal dose of thioacetamide. Distinct changes in the behaviour of the animals, changes of the biochemical parameters inclusively the enzyme pattern with a typical lesion pattern of the liver parenchyma and a displacement of the plasma amino acids were shown. All pathological changes in comparison with the normal animal characterize the liver insufficiency after 24 hours as a comatose state. This acute toxic model serves as the base for investigations within the physiology of nutrition about parenteral feeding of L-amino acid mixtures in coma hepaticum. The nearly exclusive hepatotropic lesion degree of thioacetamide is suitable as an experimental model for this purpose.

[Enteral resorption in the immediate postoperative phase following selective proximal vagotomy]

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]

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.

Insulin secretion in maturity-onset-diabetes. Function of isolated islets

An impaired insulin response to glucose is a characteristic finding in maturity onset diabetes (MOD). To clarify whether the decreased insulin response in vivo is related to a primary defect of the beta-cells, isolated islets of MOD - obtained by intraoperative biopsy - were examined for their insulin content, biosynthesis and release. The in vitro experiments showed that despite a missing or significantly reduced insulin response in vivo the isolated beta-cells of the same patients had a normal insulin content, a normal or even high biosynthesis, and insulin release could be induced by glucose. These results suggest that the primary defect in MoD cannot be related to an intrinsic failure of the beta-cells to response to glucose; extrapancreatic factors seem to influence their reaction to glucose. These factors may be of a higher level in those patients or the reaction of the beta-cells is more inhibited by the same concentrations in diabetic patients.

[Postoperative small intestinal absorption after cholecystectomy]

The postoperative resorption in the small intestine after cholecystectomie was found out by means of the modified D-xylose resorption test on the 2-th, 4-th, 6-th an 8-th postoperative day for 14 patients. The velocity and the dimension of the enteral resorption of D-xylose was lower in the immediate postoperative phase. The dimension of the D-xylose resorption was normalized on 4. p. o. day and obtained the preoperative starting-value on the 8-th postoperative day. The myoelectrical activity of the small intestine normalized in a shorter time after cholecystectomy than the enteral resorption. A formal parallelism consists between the normalisation of the motoric activity of the stomach and the xylose-resorption in the immidiate postoperative phase. For the small intestine resorption in the postoperative phase completely clarified and required further investigations. The influences of electrolyte displacement and disturbances of the microcirculation in the postoperative period in the small intestine resorption were discussed.

[Intestinal absorption in the short-bowel syndrome]

An extreme diminution of the absorption surface by resection or exclusion of the small intestine leads to the clinical picture of the short-intestine-syndrome. The absorption effect of the proximal small intestine can be exactly established with the help of the modified D-xylose-test. On the basis of three typical examples the high evidence of this functional test can be demonstrated. The pathophysiological principles of the intestinal adaptation after by-pass-operations and resections of the small intestine are discussed.

Zur Verwertung von Aminosäuren-Infusionslösungen beim Gesunden und bei Patienten im Streß, untersucht an ¹⁵N-Glyzin

Unter Anwendung des stabilen Isotops ¹⁵N wurde die Verwertung von Aminosäureninfusionslösung bei Gesunden und bei Patienten im Streß (Zustand nach Cholezystektomie) untersucht. Die Ergebnisse beziehen sich auf Infusionsgeschwindigkeit, Dosierung, Infusionslösung und Glyzin als Tracersubstanz. Es konnte nachgewiesen werden, daß Aminosäuren auch im Streß zur Eiweißsynthese herangezogen werden, wenn auch in geringerem Maße als bei Probanden in ausgeglichenem Stoffwechselzustand. Vom infundierten ¹⁵N verblieben 72 bis 77 % bei ausgeglichener Bilanz und 56 bis 58 % bei kataboler Stoffwechsellage im Organismus. Die Harnstoffbildung lief im Streß verstärkt und beschleunigt ab. Die gefundenen Werte passen gut zu den Resultaten früherer Zufuhr-Bilanz-Versuche an Patienten in verschiedenen Streßlagen. Sie gestatten Aussagen über die Effektivität der parenteralen Aminosäurenzufuhr im Streß.