Click here to load reader

Normal surgery increases and complicated surgery decreases urea synthesis capacity in rats

Embed Size (px)

Citation preview

Page 1: Normal surgery increases and complicated surgery decreases urea synthesis capacity in rats

P.9 I.Kmm WRGER!fINCFE'GESANDaMpLICXTEDSURGTWD~~uREA SYImEsIS cWAc1lYINmTS Hsns IIf3heff, lInTas Alllrhl, Hendrik Vilstmp Divisimof Hepatolcgy, Rigskepitalet, Copenhagen, tkmnark

Surgicalstresshxessesureasynthesisarxitherebydacreasesblood ~Ncclloentration.Ibstudyifthisdepends~theextentof thestresswe examined two gmqs of rats of 225 g: a~ was hyste- mctmizedandtheatherheduterussndspleenligated,crushed, andleftinsitu. The kineticsofhepatic amim-N can3ersimwas assessedbytheCapaci.tyof Urea-N Syntksis (CUNS). ‘IhiswaScal- ~atedasurea~~israte~ngalaninel~totheblood smim acid interval 8-12 ml/l, where the process issaturated and independent of substrate effects. A charge tianvS implies that the mount of urea synthetized at any amino acid cmcentratim chan- ges simmr1y.

CUNS FW(min.100 9) precp. 1. postop. 3. postop. 66m.

Ky&erectany (n=5) - 10.2+0.6a 7.7+0.5 Cmshed organs (n=5) - 4.83.6b 4.53.6b 3:7&3b m-huls (n=51 7.5+0.3 - Results are nrzan+D. a=hi-&er than control, b=la+ar (p<O.O5)

-surg=Y ixmasesaMsforthsfixstFcstcp.days,whereas surgerycxxq~licetedwithtissue necrosis has thopposite effect. 'Ihismayexplainsaneofthe~lictsamngdata~~~a~~c mine-Nmetabolism.

P.10 CONVALESCENCE AFTE.9 ?IAJOF SUPCISAL ILLNESS. S. Johnscr ’ .,’ ) ,?..“_.I. al!? , :rszCrrlC LJr.rt, St,. :,‘ary’s SosDital, London, 'I'K.

Twelve patients who underwent rajor surgery for a variety? of non-progressive Intestinal diseases and required active nutritional support In hospita; nave foilowed up in a Nutritional Assessment Clinic for a ?lax~mu~~ of 350 days after discharge. !!easurements of <weight, triceps skin fold thickness (TSF) ant z:d-ar-: muscle circumference (YAK; were made; energy Intake was assessed by dietary hrstory and an index of activity derived by evaluating the return to normal partlcipatioc in a possible thirteen activities (gardening, driving, etc.). There were eight females and four males. The mean age was 62 + 10 yrs (mean A SD) and they had a pre-illness estimated (Fleisch's tables) energy expenditure o? 1728 + 371 kcal/day, a hospital stay of 36 + 13 days and a discharge weight 85 + 7% of usual weight. -

Day after discharge O-50 51-100 101-150 >150 Number of patients 12 9 6 5 % usual weight 86+6 90+7 89+6 Activity index 0.380.27 0.64+0.30

92~5 0.62+0.28 0.74co.24

Fnergy intake kcal/day 1725&b 1850:322 195G341 1705-t480 TSF mm 9.4T4.0 9.8y4.1 lO.OS5.0 11.8T5.5 MAW cm 20.652.8 19.9a.2 21.6T3.9 2 20.6-1.5 -

This study demonstrates that after major surgical illness there is little change in weight during the first six months, TSF gradually increases, MAMC remains the same, a-tivity improves but does not return to normal (1.0) and energy intake is marginally more than is required for maintenance but probably not enough for repletion. Clearly patients do recover out of hospital but this is a very slow process.