I Hessov

BACKGROUND: Surgery is succeeded by long-lasting state of relative peripheral insulin resistance, which is reduced by giving glucose infusion or oral carbohydrate-rich drinks immediate before operating instead of fasting. The aim of the present study was to investigate whether oral carbohydrate or carbohydrate with peptide drinks preoperatively instead of fasting would improve postoperative voluntary muscle strength, nutritional intake and ambulation, decrease postoperative fatigue, anxiety and discomfort, and reduce the endocrine response to surgery. METHODS: Forty-eight patients were included and randomized into three groups to receive 2 x 400 ml of carbohydrate-rich drinks or to fast overnight and allowed only water. Voluntary grip and quadriceps strength, body composition, pulmonary function, VAS-score of eight parameters of wellbeing, muscle biopsies and insulin, glucagon, IGF-1 and free fatty acids were measured before and after the operation. The basic postoperative regimen for all groups were immediate oral nutrition and early enforced mobilization. RESULTS: Significant postoperative decrease in glycogen synthase activity in the muscle biopsies was reduced in the intervention groups, and in combination, the intervention groups had a less reduced quadriceps strength after one week (-10% vs. -16%, NS) and one month (-5% vs. -13%, P < 0.05). Minor changes in the endocrine response to surgery were found without differences between the groups, and there were no differences between the groups in ambulation time, nutritional intake or subjective measures of wellbeing.

Colonic biopsy specimens were obtained from patients undergoing surgery for carcinoma of the rectum. Colonic resistance arteries (internal diameter 178-345 microns) were dissected out under the microscope and mounted in a microvascular myograph capable of measuring isometric tension development. Experiments were designed to test compounds trophic to the gastrointestinal tract--namely, glutamine and the three short chain fatty acids, acetic, propionic, and butyric acid, for effects on vascular tone. Glutamine in concentrations up to 30 mM neither constricted nor dilated the resistance arteries. The three short chain fatty acids alone and in combination, however, caused a concentration-dependent (range 0.1-30 mM) dilatation of resistance arteries preconstricted with 50 mM K+, and this relaxant effect was unaffected by removal of the endothelium, presence of indomethacin, and preconstriction with vasopressin. These data suggest that the trophic effect of glutamine on intestinal mucosa cannot be explained through actions of this compound on the resistance vasculature. In contrast, the relaxant effect of short chain fatty acids on resistance arteries in vitro suggests that these compounds may be able to improve the colonic microcirculation in vivo, thereby providing an explanation for their trophic effect on intestinal mucosa.

The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer was examined through a randomized controlled trial. One hundred and thirty-nine patients with newly diagnosed breast cancer were enrolled in the study. Sixty-two (45%) had Breast Conserving Therapy and 77 (55%) had Modified Radical Mastectomy (Axillary dissection of level I and II was included in both procedures). Enrolled patients were randomized to either group A or group B. Group A was offered, team instructed physiotherapy consisting of 12 sessions of 60 min, two sessions a week. The treatment was instituted between the sixth and eight postoperative week. Group B was also offered team instructed physiotherapy, consisting of 12 sessions of 60 minute two sessions a week, but not until the 26th postoperative week. The patients were seen for follow-up examinations four times during the first postoperative year (after 7, 13, 26 and 56 weeks). Shoulder function was assessed by the Constant Shoulder Score preoperatively and at the four follow-up examinations. Team instructed physiotherapy was found to improve the shoulder function significantly in patients treated surgically for breast cancer. The effect of the treatment was influenced by the type of surgery performed, and in mastectomised patients, also by the application of radiation therapy. Compromised shoulder function is a less frequent and less severe side effect to breast conserving therapy as compared to modified radical mastectomy.

The recovery of inulin, a naturally occurring beta (2-->1)-fructan isolated from Jerusalem artichoke (Helianthus tuberosus L.), in the small intestine of man was studied in ileostomy subjects. The ileostomists were given a low-dietary-fibre diet based on white wheat bread and virtually free of inulin, and the same diet with the addition of 10 g and 30 g inulin product respectively, and the recovery and mean transit time (MTT) of inulin were estimated by tracking inulin in ileal effluent. The recovery of inulin was approximately 87% at both ingestion levels. MTT was 4.9 (SE 0.6) h at an intake of 10 g inulin product decreasing to 3.4 (SE 0.3) h at an intake of 30 g inulin product. A significant change in the fructose:glucose ratio of inulin from ingestion (4.1) to recovery in ileal effluent (4.5-4.7) and a lower recovery of the glucose residue than of the fructose residue of inulin indicate that the low-molecular-weight inulins are more sensitive to hydrolysis than the high-molecular-weight fragments. The loss of inulin during passage through the small intestine is presumably due to hydrolysis by either acids or enzymes and to microbial degradation by the microflora permanently colonizing the distal small intestine. The concentrations of lactic acid (LA) and short-chain fatty acids (SCFA) in frequently collected ileal effluents on the control day were approximately 6 nmol/l and approximately 55 mmol/l respectively. During periods with inulin ingestion the concentration of LA increased to 18-26 mmol/l (P < 0.052), while the concentration of SCFA ran converse and decreased to 18-32 mmol/l (P < 0.023). The osmotic loads (68 and 204 mosmol/l) associated with the ingestion of inulin product caused minor malabsorption of low-molecular-weight sugars.