Karl-Oskar Mosebach

Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients

A comparative nutritional study in brain-injured patients (BIP) was performed to assess the influence of a combined enteral-parenteral nutrition (CN) and a total parenteral nutrition (TPN) on protein catabolism in the early posttraumatic period. 20 male BIP (Glasgow coma scale 5–7) were randomized to one of the two feeding regimes. Nutritional support was based on 150–175% basic energy expenditure. Amino acid intake was 1.4 g/kg/day in the TPN and 2.4 g/kg/day in the CN group. Negative nitrogen balance (NNB) averaged x (SEM=3.06 g/m2/day) in the TPN group and x (SEM=2.33 g/m2/day) in the CN group. Between both feeding regimes not statistically significant differences could be observed concerning mortality, N-balance, creatinine and 3-methylhistidine excretions. Protein concentration of the regurgitated gastric fluid was significantly higher in the CN than in the TPN study group. Data imply that both alimentary regimes are of similar value, but BIP with imparired gastric function, such as high tube reflux, are better treated by TPN.

Anabolic steroids in polytrauma patients. Influence on renal nitrogen and amino acid losses: a double-blind study

Severe trauma leads to considerable losses of nitrogen in the first days after the accident. As nutritional efforts cannot reduce these losses sufficiently, an adjunctive therapy using the anabolic steroid nandrolone decanoate (Nd) was applied. In a double-blind study 10 male multiple-traumatized patients each received 50 mg of Nd on day 3 and 25 mg of Nd on day 6 after the trauma, an additional 10 patients received placebo only. Both groups had identical nutritional support. Nitrogen balance, total nitrogen excretion as well as plasma amino acid concentration, and urine amino acid excretion were measured daily. The anabolic agent improved the nitrogen balance mainly by reducing nitrogen excretion. 3-Methylhistidine excretion and renal amino acid losses were decreased. Nandrolone decanoate increased the concentration of total plasma amino acids. The underlying principle seems to be an amino acid-saving mechanism with a renal site of action. It is shown that in the early posttraumatic period nandrolone decanoate improves nitrogen metabolism. Further studies are required to determine whether this offers a clinical benefit to trauma patients.

Pharmacokinetic Evaluation of a New Maintenance Solution for Severely Injured Patients

Nine severely injured patients (SIP) and 9 healthy controls received 20 min iv infusions of Aminoplasmal-LS-10 (2.15 ml/kg body wt containing 0.215 g amino acids). Employing the values of the plasma amino acid (AA) concentrations 3, 7, 15, 30, 45, 70, and 150 min after the end of the infusion, we calculated the elimination half-life (t 1/2), the elimination constant (k2), the total clearance (Cltot), and the transfer of the individual AA. The AA showed t 1/2 between 6 (Glu) and 23 (Thr) min. Comparing the metabolic kinetics of healthy controls and SIP, there were no statistical differences in t 1/2 or in k2. In the SIP, nearly all plasma AA showed increased transfer and Cltot, significantly for Thr (p < 0.05), Pro, Gly, Ala, Arg (p < 0.02), Glu (p < 0.01), and Met (p < 0.005). In contrast, the Cltot for Phe and Tyr were decreased. Except for Phe, Tyr, Met (enhanced values) and Arg (no change), the fasting values of AA concentrations in the SIP were diminished compared to those in the healthy controls. Based on the measured transfer, we have developed a new maintenance solution adapted to SIP. Compared with Aminoplasmal, it is necessary to apply AA concentrations which are increased in Lys, His, Phe, Tyr, Val, Ala, and Ser, and reduced in Arg, Pro, Leu, Ile, and Gly.

Enteral-parenterale Ernährung mit hohem Eiweißangebot bei schwerem Schädel-Hirn-Trauma

In einer prospektiven Studie an Patienten mit Schadel-Hirn-Trauma wurden Untersuchungen zum Ausmas der Proteinkatabolie unter einer kombinierten enteral-parenteralen Ernahrung mit hohem Eiweiβanteil (

Primäre Conjugate von Testosteron und Metaboliten in der Leber unreifer Ratten

We studied the initially conjugated metabolites of testosterone in the liver of 30 days old male rats. 2/3 of all metabolites are conjugates. We mainly found sulphates, only 10% glucuronides. Double labeling (testosterone-3H, sulphate-35S) revealed combined activities in the sulphate fraction and in the “lipophile conjugate fraction”. Solvolysis of sulphates showed androsterone, unchanged testosterone, 5β -androstane-3α-ol-17-one and 5α -andro-stane-17β -ol-3-one.