Milan Kaska

Zinc is an important intracellular ion with many important biological effects, including preventing DNA fragmentation due to apoptotic cell death. We have successfully achieved blockage of DNA fragmentation in apoptosis induced by bloodless perfusion in IPRL. Our model of apoptosis involves perfusion of rat liver with modified Krebs solution containing glucose and hydroxyethyl starch at 37°C. either after tlushing with cold UW and 24 hour storage at 4°C in the same solution. or tlushing only without preservation. Perfusion tlow rate was 2·5-3 ml/gm/min. Liver specimens were collected at 0. I, 3, 5 hours and freeze clamped in liquid N2 . DNA was isolated using standard phenol chloroform extraction and electrophoresed on 1·5 per cent w/v agarose gel. stained with ethidium bromide 40 J.lg/L (w/v) and visualized by UV light. A single hand of genomic DNA close to the loading point was found in all livers perfused with zinc 25 J.!M + zinc ionophore 4 J.!M rich solution (n=8) between 0-5 h...

Background: This retrospective clinical study would like to objectively denote a quality of life of persons afflicted by an abdominal catastrophe and managed by an extensive surgery can be almost as well conformable as those of healthy people in a similar age group. Methods: A set of eighteen patients who were successfully surgically treated and cured enjoyed a relatively good convalescence after their surgery and returned to a satisfactory standard of life from the point of view of organ function and psychosomatic state. Statistical analysis of the data collected over a period of 1 to 6 years after this complex therapy using special questionnaire for QOL assessment SF-36 was performed. Results: Almost half of the patients evaluated their state similarly to the rest of the population of comparable age and general health status. The remainder of the patients declared significantly worse evaluations in the majority of the observed domains of the questionnaire. Conclusion: Therapy of t...

Acute bowel ischemia continues to have a high mortality rate. The main factor related to this poor outcome is considered to be the delay in diagnosis. The ability to detect ischemia early and to assess the extent of bowel involvement, are the most important aspects of successful treatment. The combination of ultraviolet (UV) light and fluorescein dye would be considered a simple, reliable and technically easy procedure for diagnosis of intestinal ischemia. The method can be used both for laparotomy when the source of UV light is a Wood's lamp as well for laparoscopy when the optical filters are placed to the light source of laparoscopic set to produce UV light. Present clinical experience shows that the method is precise, objective and accessible and that it gives a greater amount of independence to the surgeon allowing him to make the diagnosis of intestinal ischemia without having to rely on the assistance of other specialists.

Rationale: There are no reports about the differences of energy metabolism in UC patients between active and remission stages. We analyzed the energy expenditure of hospitalized UC patients before and after induction therapy. Methods: Eleven hospitalized patients (8 males and 3 females; mean age 39.4 years old; mean BMI 19.3 kg/m2) with severe or moderate UC were enrolled in this study. We measured the resting energy expenditure (REE), respiratory quotients (RQ) of these patients before and after induction therapy by using indirect calorimetry. We examined the relationship between energy metabolism and activity index (Seo’s CAI and Lichtiger’s CAI), nutritional status and serum inflammatory cytokine levels. Prednisolone was administered in all patients. Cyclosporine or taclorimus therapy had just been started in 3 patients, and anti-TNF-a antibody therapy had been started in 2 patients. Results: The REE of severe or moderate UC patients was 26.5±3.4 kcal/kg/day in active stage, and significantly decreased to 23.4±2.3 kcal/kg/day after induction therapy (p < 0.01). RQ also were increased after induction therapy (p = 0.08). The REEs significantly correlated with activity index and with inflammatory cytokine IL-6. However, there was no significant correlation between REE and serum albumin levels or BMI. Conclusion: Severe or moderate UC patients showed a hyper-metabolic status, and energy expenditure dramatically decreased after induction therapy. It is likely that disease activity affect energy metabolism of UC patients via inflammatory cytokine IL-6. From our result, we recommend that nutritional management with 30 34 kcal/kg/day for hospitalized UC patients.

Rationale: Remarkable decrease of blood glucose occurs immediately after partial hepatectomy (PH). This study evaluated the role of insulin, glucagon and the epidermal growth factor (EGF) on liver regeneration (LR) after PH. Methods: Male Wistar rats weighed around 200 g were used. A 67% PH was performed on the control and seven hormone treated groups: insulin, glucagon, EGF, Insulin + glucagon, insulin + EGF, glucagon + EGF, and a combination of the three hormones. The hormones were administered subcutaneously 2 days prior to PH. All rats were killed at 6, 24, 48 and 72 h after PH. Remnant liver weight, deoxyribonucleic acid (DNA) content, DNA synthetic rate, mitotic index, blood glucose and insulin levels were measured. Results: The effects of single hormone on posthepatectomy LR were not obvious. Combined insulin and glucagon increased the remnant liver weight, DNA content, and DNA synthetic rate. The combined insulin, glucagon, and EGF even significantly increased mitotic index. No concordance between the change of blood glucose levels and the effect of hormones during LR.

The improving performance of the laser-induced breakdown spectroscopy (LIBS) triggered its utilization in the challenging topic of soft tissue analysis. Alterations of elemental content within soft tissues are commonly assessed and provide further insights in biological research. However, the laser ablation of soft tissues is a complex issue and demands a priori optimization, which is not straightforward in respect to a typical LIBS experiment. Here, we focus on implementing an internal standard into the LIBS elemental analysis of soft tissue samples. We achieve this by extending routine methodology for optimization of soft tissues analysis with a standard spiking method. This step enables a robust optimization procedure of LIBS experimental settings. Considering the implementation of LIBS analysis to the histological routine, we avoid further alterations of the tissue structure. Therefore, we propose a unique methodology of sample preparation, analysis, and subsequent data treatmen...

Management of the therapy of life-threatening bacterial infection is extremely based on an optimal antibiotic treatment. Achieving the correct vancomycin dosage in blood and target tissues can be complicated in special situations, e.g., where large fluid sequestration and/or acute renal failure occur. A UHPLC-MS/MS method operating in electrospray (ESI) positive ion mode was applied for the determination of vancomycin in serum, urine and peritoneal/pleural effusion. Sample pretreatment was composed of dilution and simple protein precipitation where only a small volume (50μL) of serum, urine or peritoneal/pleural effusion was required. The separation of vancomycin was performed on a Meteoric Core C18 BIO column (100×4.6mm, 2.7μm) by gradient elution with 0.1% formic acid in water and acetonitrile. The total time of analysis was 4.5min. The method was found to be linear in the range of 2-60μM (or 0.5-10μM) for serum, 0.27-10μM (or 2-60μM) for peritoneal/pleural effusion and 25-300μM for urine, which was adequate for the determination of vancomycin in patient samples. The intra- and inter-day precision was below 8% RSD, and accuracy was from 89 to 104%. The UHPLC/MS-MS method offers a fast and reliable approach to determine vancomycin concentrations in three different human body fluid samples (serum, urine and peritoneal/pleural effusion) with a simple sample pretreatment that was the same for all selected specimens. This method should be applicable to large sample series in clinical (pharmacokinetic/pharmacodynamic) studies.

A patient with an advanced carcinoma in the recto-sigmoideum was taken for urgent operation because of abdominal pain, significant distension of colon, clinical symptoms and radiological proofs of ileus. The cause of the complete obstruction of the proximal rectum which was significantly narrowed by a tumour was one tablet of Tralgit SR 100, which had been administered to the patient for 4 weeks after osteosynthesis of the right femur neck following fracture. According to the radiologist between 45 and 50 tablets of the medicament had been found in the digestive tract. The mechanical ileus was solved by operation according to Hartmann. This case has two aspects: 1) surgical--mechanical ileus resulting from a rare set of circumstances, and 2) pharmacological and metabolic--disorder of medicament absorption in the digestive tract. The cause of maldigestion (disorder of absorption) of the Tralgit tablets is further investigated.

Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients(n=117)undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP), citrulline, D-lactate, exhaled hydrogen,Escherichia coligenomic DNA, and ischemia modified albumin (IMA) were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out...

Vancomycin is a glycopeptide antibiotic used in the therapy of severe bacterial infection. The monitoring of vancomycin levels is recommended because of its narrow therapeutic index and toxicity. This measurement is especially appropriate in patients with unstable renal functions, who receive high doses of vancomycin or present serious bacterial infections accompanied by important sequestration of liquids when it could be difficult to achieve the optimal therapeutic dose. Most of the methods for vancomycin determination in routine practice are immunoassays. However, chromatography-based techniques in combination with UV or mass spectrometry detection provide results with greater accuracy and precision also in complicated biological matrices. This review provides detailed overviews of modern approach to the chromatographic separation of vancomycin in various biological samples and useful sample preparation procedures for vancomycin determination in various biological fluids. This art...

An investigation of some relationships of routinely and rarely used biochemical markers to surgical (operating) trauma. A group of 37 patients was divided to two subgroups according type of disease with need a resection of large bowel for malignant or benign malady. Large bowel adenocarcinoma was dominated in a subgroup of malignancies (23 patients, mean BMI 25.59, mean age 63.65 years) and Crohn's disease and complicated diverticullary disease were the reasons to operate in the second subgroup of benignities (14 patients, mean BMI 21.21, mean age 39.5 year). Blood samples were taken before an operation, postoperatively (immediately) and at 6:00 a.m. the 1st, 3rd and 5th postoperative day. The routine methods (albumin, CRP, cholinesterase, haptoglobin, cholesterol), special methods (SOD, glutathion) and ELISA methods (leptin, IL-2r, IL-8, TNF)were used for evaluation markers. The results were estimated by statistic methods Sigma-Stat, One Way ANOVA and linear regression test. Th...

The authors describe the case of a 86-year-old female patient admitted to hospital with acute abdomen of the inflammatory type. The condition developed in the course of cca three days with sudden deterioration on the day of admission to hospital. Contrast X-ray examination revealed perforation of the distended jejunum and surgery revealed diffuse peritonitis the source of which was the mentioned perforation associated with mechanical ileus caused by malrotation and adhesions of the small intestine. An additional finding which, however, dominated on X-ray examination of the gastrointestinal tract when using contrast material and on revision of the peritoneal cavity was multiple diverticulosis of the small intestine. The uncommon finding on the small intestine and the relatively sparse data in the literature on diverticulosis of the jejunum and ileum made us submit the case-history for publication.

Wound dehiscence complicated by gastrointestinal (GI) fistula to belong ,,abdominal catastrophe". Therapy is prolonged and connected with high morbidity and mortality rate. In the period from October 2006 to July 2009 we performed 12 reconstructive surgical procedures on gastrointestinal tract in patients with abdominal catastrophe. Treatment of 12 consecutive patients (9 men, 3 women) was managed according to a standardize protocol. The protocol consists of treatment of septic complications, optimisation of nutritional state, special wound procedures, diagnosis of gastrointestinal fistulas and GI tract, timing of surgical procedures, reconstruction of GI tract and postoperative care. Reconstructive surgery of GI tract was successful on 11 patients. One patient developed recurrence of early GI fistula. In four patients we let open abdomen to heal per secundam. We observed no deaths after operation. With regard to complex character of therapy of abdominal catastrophe there is a ...

The aim of this article is to summarize the current actual knowledge in possibilities of examination of patients' condition before surgery with respect to development of present operation risks and of a recovery phase in increased patients' co-morbidity and age. Not only a profile of our patients has changed partially as was mentioned above, but also the new diagnostics methods, non-invasive and miniinvasive techniques have appeared, too. Also the new methods of preparation of surgical patients for surgery are arising during the last few years. They answer the previously presented points witch are established on an increased interest in the patients during the perioperative time period (ERAS-enhanced recovery after surgery/fast track). New methods appreciated an operation trauma, which has a substantial influence on the result of an operation. The most frequent risks of an operation must be presented: anaesthetic, respiratory, cardial, nutritive, thromboembolic, and other sp...

The clinical studies carried out leads to the hypothesis that the starvation of patients for several hours prior to a surgical procedure has a negative influence on the internal metabolic environment of a patient. It also has an impact on the psychosomatic disposition of the patient's physiology of metabolic processes and the proper functioning of vital organs and systems. This hypothesis was already stated by doctors specialized in Intensive Care Units in other European countries. In the frame of methodology, ERAS (enhancement recovery after surgery) also known as fast track, solves this problem not only on the level of clinical studies but also clinical practice. METHODOLOGY AND GROUP OF PATIENTS: The group of patients selected had been surgically treated for disease of the colon (both benign and malignant) and were divided into 3 groups: A--basically starving from mid-night of the day of operation, B--patients secured the night before the operation and on the day of the opera...

This article deals with the current knowledge on the possibilities of intraperitoneal adhesion prophylaxis in correlation with intraperitoneal interventions in abdominal surgery. The up-to-date experimental possibilities and other known methods are presented. These include: Intraperitoneal perfusion by certain special simple solutions--Dextran, Carboxymethycellulose, Crystalloid solutions, and Hyaluronidase. Intraperitoneal or other administration of certain drugs--Tetracyclines, Cephalosporins, Corticosteroids, Non-Steroidal Anti-inflammatory drugs, Histamine agonists, Ca-channel blockers, Heparin, Citrates and Oxalates, Streptokinase, Urokinase, Plasminogen activators, and application of special synthetic or natural materials intraperitoneally--Surgicel, Interceed, Gore-Tex, Fibrin Glue, or various combinations of the above mentioned. Rats, rabbits, and mousses were used, first of all, as an animal model in presented experiments.

The authors present a case of an elderly man, who was admitted to the hospital due to unusual cause of massive bleeding into digestive tube. During diagnostic work-up the source of gastrointestinal bleeding was localized into jejunal divertuculum. The patient was operated on and resection of involved jejunal segment with primary anastomosis was performed. The possible complications ofjejunal diverticulosis are discussed.

To assess dynamics of serum leptin concentrations (as a possible marker of stress) at some surgical patients during short perioperative period. The serum leptin concentrations were estimated in group of patients with trauma or large bowel diseases in stress of both own disease and next elective or urgent surgery. The subgroups of patients were: a) monotrauma (13), b) polytrauma (10), c) malignant (20) or d) inflammatory disease (13) of large bowel. The serum leptin concentrations were evaluated preoperatively and during 16 hours postoperatively-immediately after surgery, after 8 and 16 hours after operation. The serum IL-6 concentrations were estimated immediately and 48 hours postoperatively. The serum leptin concentrations showed a time depending dynamic phase: they decreased postoperatively and increased during the first 16 hours postoperatively. It was more expressed in the malignant bowel disease subgroup. A correlation between age and serum leptin concentrations was not found ...

A 30-year-old woman was operated for ovarian teratoma and repeatedly for adhesive ileus during 1995-1999. A partial left ovarectomy, extirpation of an intrauterine device (IUD) in malposition (greater omentum) and appendectomy were performed during the first operation. Early adhesive ileus developed on the fourth postoperative day. Adhesectomy was performed in the region of the terminal jejunum. A new adhesive ileus developed after twenty seven months when patient underwent laparoscopy for gynaecological problems with conversion to laparotomy because of greater adhesions intraperitoneally another adhesectomy was performed. During the next eleven months new adhesive obstructions of the bowel developed and a third operation had to be performed incl. resection of the dolichosigmoideum on account of chronic problems during defaecation. A special tube as a intraluminal splint was inserted as prophylaxis of mechanical ileus in the postoperative period. But during next thirteen months subi...

This study aimed to investigate the effects of intravenous anesthetics on hepatosplanchnic microcirculation in laparotomized mechanically ventilated rats using Sidestream Dark-field (SDF) imaging. Thirty male Wistar rats were divided into 5 groups (n = 6 each). All rats were initially anesthetized with 60 mg/kg pentobarbital (i.p.) for instrumentation. This was followed by either ketamine, propofol, thiopental, midazolam or saline+fentanyl (iv bolus over 5 min and then maintenance over 90 min). SDF imaging of the liver and distal ileum microcirculation was performed at the baseline and at t = 5, 35, 65 and 95 min. In propofol group there was increase of functional sinusoidal density (FSD) following induction (+25%, P < 0.05) and maintenance at t = 95 min (+10.3%, P < 0.05), in ketamine and midazolam group decrease of FSD was observed after induction (-20.4%, P < 0.05; -10.1%, P < 0.05) and during maintenance at t = 65 min (-11.6%, P < 0.05; -11.4%, P < 0.05) when compared to baseline. Following induction with propofol functional capillary density (FCD) of ileal longitudinal muscle layer increased (+10.6%, P < 0.05) and returned to baseline values during maintenance. Ketamine and midazolam decreased FCD of longitudinal layer after induction (-24.6%, P < 0.05; -21.1%, P < 0.05) and remained decreased during maintenance at t = 95 min (-10.8%, P < 0.05; -15.5%, P < 0.05). In thiopental and control group, changes in microcirculatory parameters were not significant throughout the study. In conclusion, intravenous anesthetics affect the hepatosplanchnic microcirculation differentially, propofol has shown protective effect on the liver and intestinal microcirculation.

A patient with an advanced carcinoma in the recto-sigmoideum was taken for urgent operation because of abdominal pain, significant distension of colon, clinical symptoms and radiological proofs of ileus. The cause of the complete obstruction of the proximal rectum which was significantly narrowed by a tumour was one tablet of Tralgit SR 100, which had been administered to the patient for 4 weeks after osteosynthesis of the right femur neck following fracture. According to the radiologist between 45 and 50 tablets of the medicament had been found in the digestive tract. The mechanical ileus was solved by operation according to Hartmann. This case has two aspects: 1) surgical--mechanical ileus resulting from a rare set of circumstances, and 2) pharmacological and metabolic--disorder of medicament absorption in the digestive tract. The cause of maldigestion (disorder of absorption) of the Tralgit tablets is further investigated.

HINTERGRUND UND ZIEL DER STUDIE: In letzter Zeit mehren sich die Hinweise, dass präoperatives Fasten, wie es seit mehreren Jahrzehnten klinische Praxis ist, von ungünstigen Folgen begleitet sein könnte. Im Gegenteil könnte eine standardisierte präoperative Nahrungsaufnahme sogar von Vorteil sein. Tatsächlich stellt eine solche Nahrungsaufnahme eine Komponente des ERAS ("enhanced recovery after surgery") Konzeptes dar. Wir erhoben daher in einer randomisierten kontrollierten Studie bei chirurgischen Patienten mit kolorektalen Erkrankungen die Wirkung einer präoperativen oralen oder intravenösen Gabe von Kohlehydraten, Elektrolyten und Wasser auf verschiedene biochemische, psychosomatische und echokardiographische und muskuläre Parameter in der perioperativen Phase im Vergleich zu präoperativ nüchternen Patienten. Außerdem untersuchten wir die Nebenwirkungsfreiheit einer peroralen Nahrungsaufnahme kurz vor der Operation. PATIENTEN UND METHODEN: Insgesamt wurden 221 elektive chirurgische Patienten mit einer kolorektalen Erkrankung in diese an zwei Zentren durchgeführte, randomisierte, prospektive und verblindete klinische Studie aufgenommen. Die Patienten wurden in 3 Gruppen eingeteilt: A: Patienten, die ab Mitternacht vor der Operation fasteten (Kontrollgruppe); B: Patienten, denen Glukose, Magnesium und Kalium intravenös verabreicht wurde; C: Patienten, die präoperativ oral ein speziell zusammengesetztes Nahrungssupplement einnahmen. ERGEBNISSE: Klinisch war der perioperative Allgemeinzustand der Patienten der Gruppen B und C signifikant besser als der der Kontrollgruppe. Der psychosomatische Zustand war am besten bei den Patienten der Gruppe C (p < 0,029). Der Anstieg des Insulin-Resistenz-Index (QUICKI) von vor der Operation zu postoperativ war in Gruppe A signifikant (p < 0,05). Die systolische und diastolische Linksventrikelfunktion besserte sich in Gruppe C signifikant im Vergleich zu Gruppe A (p < 0,04) – auch die Auswurffraktion war postoperativ signifikant höher (p < 0,03). Das gastrale Residualvolumen betrug 5 ml, der pH des Magensafts lag in allen Gruppen bei 3,5–5 ohne statistisch signifikanten Unterschied zwischen den Gruppen. Die Komplikationsrate, sowie die Dauer des stationären Aufenthaltes unterschied sich ebenfalls nicht zwischen den Gruppen. SCHLUSSFOLGERUNGEN: Präoperatives Fasten bringt für chirurgische Patienten keinen Vorteil. Im Gegenteil könnte die Einnahme einer entsprechenden aus Wasser, Elektrolyten und Kohlehydraten zusammengesetzten Nahrung den Patienten einen gewissen Schutz gegen das Operationstrauma bieten – vor allem in Bezug auf den Stoffwechsel, aber auch auf die Funktion des Herzens und auf den psychosomatischen Zustand. Die kurz vor der Operation erfolgte perorale Einnahme erhöhte das gastrale Residualvolumen nicht und war auch sonst mit keinem Risiko verbunden. BACKGROUND AND AIMS: Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery. METHODS: A total of 221 elective colorectal surgery patients in this bicentric, randomized, prospective and blinded clinical trial were divided into three groups: A – patients fasting from midnight (control group); B – patients supported preoperatively by glucose, magnesium and potassium administered intravenously; C – patients supported preoperatively by oral consumption of a specifically composed solution (potion). RESULTS: The general perioperative clinical status of patients in groups C and B was significantly better than those in group A. Psychosomatic conditions postoperatively were found to be best in group C (P < 0.029). The rise in the index of insulin resistance (QUICKI) from the preoperative to the postoperative state was significant in group A (P < 0.05). The systolic and diastolic function of the left ventricle improved postoperatively in group C vs. group A (P < 0.04), and the ejection fraction was also significantly higher postoperatively in group C vs. group A (P < 0.03). The gastric residual volume was 5 ml and the pH of stomach juice was 3.5–5 in all groups without statistically significant difference. No difference was found in the length of hospital stay or the rate of complications. CONCLUSIONS: Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.

Severe acute pancreatitis is prevalent in Eastern Bohemia (a part of the Czech Republic) and remains a very difficult problem to manage. Recent studies in treatment there are quite frequent but a direct view into the pancreas during its inflammatory process is very rare. Only information about a normal pancreatic microvascular bed appears to be available. This study was designed to explore pathomorphological changes in pancreatic microcirculation at the start and during the development of acute pancreatitis. A group of 50 laboratory white rats was studied. The acute pancreatitis was induced by the modified method of Siech et al. The method of clamping of biliopancreatic duct and stimulation of external secretory tissue by a cholecystokinin and secretin and oral (orogastric tube) ethanol administration was performed. The pancreatic microvascular patterns were observed by using histochemical and corrosion casts methods. The study of the corrosion casts of pancreatic microcirculation in the scanning electron microscope and histochemical studies demonstrated the visible reduction of the pancreatic microvascular bed 18 hours after induction of acute pancreatitis. The microvascular bed is not fully destroyed until 48 hours of acute pancreatitis. The model of acute pancreatitis using postoperative application of ethanol to the digestive tract after stimulation of pancreas by cholecystokinine and secretin in the rats seems to be real and useful. The study of the corrosion casts of microcirculation in the scanning electron microscope and histochemical studies demonstrated the visible reduction of the pancreatic microvascular bed 18 hours after induction of acute pancreatitis. The microvascular bed is not fully destroyed until 48 hours of running acute pancreatitis, as some &amp;quot;islets&amp;quot; of the vital tissue still have undestroyed microvessels at this time. Despite the above-mentioned serious changes, restricted pancreatic microcirculation enables blood and medicament distribution to the still intact pancreatic tissue.

Background: Intraoperative and early postoperative complications in patients operated for morbid obesity were assessed. Methods: 114 morbidly obese patients underwnent gastric banding (non-adjustable or adjustable). The influence of body mass index (BMI), age and preoperative morbidity on the occurrence of postoperative ventilatory disturbances was evaluated. Results: Risk of postoperative ventilatory disorders increased with preoperative cardiovascular disease (p < 0.01), diabetes (p < 0.05), and increasing BMI (p < 0.01). Age, hypertension and pulmonary disease did not influence significantly the risk of complication in this series.There have been no deaths. Conclusion: In patients undergoing banding for morbid obesity, the potential for ventilatory complications increases with higher BMI, diabetes and cardiovascular disease in the preoperative comorbidities. Principles for postoperative care were developed.

This clinical study compared the dynamics of antioxidants levels in patients with acute pancreatitis (AP), patients operated for colorectal cancer (CA), and healthy control subjects.This prospective descriptive study enrolled 21 AP and 14 CA patients and 17 healthy controls. Blood was collected from AP patients on days 1, 5, and 9 and from CA patients before surgery and on days 1, 5, and 9 after surgery. We measured concentrations of selenium in plasma, red blood cells (RBCs), and big-toe nails, vitamin A (retinol) in serum, α-tocopherol in serum and in RBCs, vitamin C in serum, concentration ratio of 9,11- and 10,12-octadecanoic acids to linoleic acid in RBC membrane, activity of superoxide dismutase, and glutathione peroxidase in RBCs.Plasma concentrations of selenium, vitamin A, and vitamin C were significantly lower in AP and CA patients than in healthy controls over the monitored period (P < 0.05). Patients with severe AP had a significantly lower concentration of selenium in RBCs than did healthy controls and CA patients (P < 0.05). The concentration of selenium in toe nails of AP patients was significantly lower than that in CA patients and healthy controls (P < 0.001). The marker of increased reactive oxygen species activity the ratio of 9,11- and 10,12-octadecanoic acids to linoleic acid in RBCs was significantly higher in AP and CA patients than in healthy controls (P < 0.05).Low levels of measured antioxidants and increased activity of reactive oxygen species occurred during the course of AP. These findings applied in particular to patients who had severe AP. Levels of measured antioxidants seemed to be similar in AP and CA patients except for lower levels of selenium in toe nails in AP patients and lower selenium concentrations in RBCs in patients with severe AP.

HINTERGRUND UND ZIEL DER STUDIE: In letzter Zeit mehren sich die Hinweise, dass präoperatives Fasten, wie es seit mehreren Jahrzehnten klinische Praxis ist, von ungünstigen Folgen begleitet sein könnte. Im Gegenteil könnte eine standardisierte präoperative Nahrungsaufnahme sogar von Vorteil sein. Tatsächlich stellt eine solche Nahrungsaufnahme eine Komponente des ERAS ("enhanced recovery after surgery") Konzeptes dar. Wir erhoben daher in einer randomisierten kontrollierten Studie bei chirurgischen Patienten mit kolorektalen Erkrankungen die Wirkung einer präoperativen oralen oder intravenösen Gabe von Kohlehydraten, Elektrolyten und Wasser auf verschiedene biochemische, psychosomatische und echokardiographische und muskuläre Parameter in der perioperativen Phase im Vergleich zu präoperativ nüchternen Patienten. Außerdem untersuchten wir die Nebenwirkungsfreiheit einer peroralen Nahrungsaufnahme kurz vor der Operation. PATIENTEN UND METHODEN: Insgesamt wurden 221 elektive chirurgische Patienten mit einer kolorektalen Erkrankung in diese an zwei Zentren durchgeführte, randomisierte, prospektive und verblindete klinische Studie aufgenommen. Die Patienten wurden in 3 Gruppen eingeteilt: A: Patienten, die ab Mitternacht vor der Operation fasteten (Kontrollgruppe); B: Patienten, denen Glukose, Magnesium und Kalium intravenös verabreicht wurde; C: Patienten, die präoperativ oral ein speziell zusammengesetztes Nahrungssupplement einnahmen. ERGEBNISSE: Klinisch war der perioperative Allgemeinzustand der Patienten der Gruppen B und C signifikant besser als der der Kontrollgruppe. Der psychosomatische Zustand war am besten bei den Patienten der Gruppe C (p < 0,029). Der Anstieg des Insulin-Resistenz-Index (QUICKI) von vor der Operation zu postoperativ war in Gruppe A signifikant (p < 0,05). Die systolische und diastolische Linksventrikelfunktion besserte sich in Gruppe C signifikant im Vergleich zu Gruppe A (p < 0,04) – auch die Auswurffraktion war postoperativ signifikant höher (p < 0,03). Das gastrale Residualvolumen betrug 5 ml, der pH des Magensafts lag in allen Gruppen bei 3,5–5 ohne statistisch signifikanten Unterschied zwischen den Gruppen. Die Komplikationsrate, sowie die Dauer des stationären Aufenthaltes unterschied sich ebenfalls nicht zwischen den Gruppen. SCHLUSSFOLGERUNGEN: Präoperatives Fasten bringt für chirurgische Patienten keinen Vorteil. Im Gegenteil könnte die Einnahme einer entsprechenden aus Wasser, Elektrolyten und Kohlehydraten zusammengesetzten Nahrung den Patienten einen gewissen Schutz gegen das Operationstrauma bieten – vor allem in Bezug auf den Stoffwechsel, aber auch auf die Funktion des Herzens und auf den psychosomatischen Zustand. Die kurz vor der Operation erfolgte perorale Einnahme erhöhte das gastrale Residualvolumen nicht und war auch sonst mit keinem Risiko verbunden. BACKGROUND AND AIMS: Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery. METHODS: A total of 221 elective colorectal surgery patients in this bicentric, randomized, prospective and blinded clinical trial were divided into three groups: A – patients fasting from midnight (control group); B – patients supported preoperatively by glucose, magnesium and potassium administered intravenously; C – patients supported preoperatively by oral consumption of a specifically composed solution (potion). RESULTS: The general perioperative clinical status of patients in groups C and B was significantly better than those in group A. Psychosomatic conditions postoperatively were found to be best in group C (P < 0.029). The rise in the index of insulin resistance (QUICKI) from the preoperative to the postoperative state was significant in group A (P < 0.05). The systolic and diastolic function of the left ventricle improved postoperatively in group C vs. group A (P < 0.04), and the ejection fraction was also significantly higher postoperatively in group C vs. group A (P < 0.03). The gastric residual volume was 5 ml and the pH of stomach juice was 3.5–5 in all groups without statistically significant difference. No difference was found in the length of hospital stay or the rate of complications. CONCLUSIONS: Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.