PubMed Health⌕ Search

Biomedical subjects

H J Günther

Publications and source records attributed to H J Günther.

12 recordsLinked to original sources
PubMed1995

Substrate balances across colonic carcinomas in humans.

To investigate the utilization of nutrients by malignant tumors in humans, the balances of energy-yielding substrates and amino acids across colonic carcinomas were assessed in 17 patients during surgery. Blood samples were taken from an artery and the main tumor-draining vein, which was also used for determining tumor blood flow (direct venous outflow technique). Additionally, the substrate exchange by peripheral tissues was studied (femoral arteriovenous differences, venous occlusion plethysmography). Mean blood flow was greater in the carcinomas than in the leg tissues (43.2 versus 2.5 ml/100 ml/min; P < 0.001). There was a negative correlation between tumor blood flow and tumor weight (r = -0.87; P < 0.001). Glucose net uptake and lactate release by the malignancies exceeded the peripheral exchange rates 30- and 43-fold, respectively (mean values different at P < 0.001). The molar ratio of lactate output to glucose consumption was 0.78 in the tumors and 0.48 in the leg tissues (P < 0.05). Regarding free fatty acid and ketone body balances, no significant tumor-periphery differences were noted. The carcinomas utilized branched chain amino acids and serine, while alanine and, in particular, ammonia were released in large amounts. Net glutamine retention was not consistently observed. It is concluded that the energy metabolism of human colonic carcinomas relies predominantly on glucose, with fat-derived calories making no appreciable contribution. The impaired nutritive perfusion of malignant tumors appears to favor glycolysis and to limit both glucose oxidation and glutaminolysis. The present study has shown that the procedure chosen for the assessment of trans-tumor substrate flux rates is a workable and valid model for analyzing metabolic balances across human colonic cancers in vivo.

Adult↗
PubMed1995

Protein metabolism in human colon carcinomas: in vivo investigations using a modified tracer technique with L-[1-13C]leucine.

To quantify the protein anabolism of tumors it is not sufficient simply to determine the level of protein synthesis. The decisive factor is the net balance. This is the first attempt to establish this parameter in human tumors in vivo. Intraoperative tumor leucine/protein metabolism was studied in 15 patients with resectable malignant colon tumors using a balance model and L[1-13C]leucine as the tracer substance. Comparative measurements were also carried out simultaneously for peripheral tissue (forearm); in addition, protein kinetics parameters were established for the whole body using a proven two-pool model (with the same tracer as above). In view of the frequently conflicting data on amino acid metabolism in tumors, the tumoral and peripheral exchange rates of 20 amino acids were also determined. In tumors, essential and branched-chain amino acid uptakes were found to be 1.68 +/- 0.59 (SE) and 1.52 +/- 0.23 mumol/100 g tissue/min, respectively; in peripheral tissue there was overall an amino acid release [-0.11 +/- 0.06 and -0.05 +/- 0.04 mumol/100 g/min; in either case P < 0.01 (tumor versus periphery)]. Tracer analyses yielded a net retention for the tumors but a protein loss for peripheral tissue (8.941 +/- 3.113 versus -0.557 +/- 0.53 g/kg/24 h; P < 0.01) and for the whole body (-0.363 +/- 0.04 g/kg/24 h). The tumors were divided into two prognostic groups on the basis of their histology. Significant differences were found between the two groups in terms of the net retention rate for 10 amino acids, including leucine; retention was elevated in tumors with an unfavorable prognosis, possibly due to a higher amino acid requirement because of more rapid growth or for export processes (mucus production). The protein balance model used here has proved satisfactory for our purposes and could also be used to directly evaluate dietary measures (e.g., adjuvant parenteral nutrition in connection with chemotherapy).

Aged↗
PubMed1992

[Acute biliary and alcoholic pancreatitis: two different diseases?].

An analysis of 174 patients with an acute biliary or alcoholic pancreatitis who were admitted to the Surgical University Clinic Mannheim from 1986 until 1989 showed significant differences in the course of the disease and surgical treatment. 77.2% of our patients with an acute alcoholic pancreatitis were men. Mean age of all patients was 45.7 years. 72.3% of our patients had a mild pancreatitis and 27.7% a necrotising pancreatitis. In 26.8% of the patients an operation was necessary (necrosectomy, lavage of the lesser sac). In 35% of these patients occurred complications. Total lethality was 9.9% (mild pancreatitis: 0%, severe pancreatitis: 17.6% and total necrosis of the pancreas: 63.6%). 58.9% of our patients with an acute biliary pancreatitis were women. Mean age of all patients was 62.4 years. In 50% of all cases an operation was necessary (in most cases cholecystectomy and extraction of a prepapillary concrement but also necrosectomy and lavage of the lesser sac). In 17% of these patients occurred complications. Total lethality was 11.0% (mild pancreatitis: 0%, severe pancreatitis 8.3% and total necrosis: 77.7%). The conclusion is a surgical therapy depending of the cause of the pancreatitis and also a different prognosis of the disease.

Acute Disease↗
PubMed1991

Acute pancreatitis: the role of early surgery.

Conservative treatment for an attack of acute pancreatitis still takes priority. The treatment of choice in biliary pancreatitis is endoscopic papillotomy with extraction of any bile duct stones. After this procedure the patient usually recovers quickly and cholecystectomy should be done as an interval operation. An early operation has to be done when conservative treatment fails and organ failure occurs. The 'gold standard' of surgical therapy today is the opening of the lesser sac with continuous postoperative lavage and drainage, digital elimination of necrotic tissue and drainage of the paracolic areas. Other described surgical procedures do not produce significantly better results. Necrotizing pancreatitis still has a high mortality in contrast to mild oedematous pancreatitis, which is rarely a problem.

Acute Disease↗
PubMed1991

[Autopsy of count Jakob 3d of Baden. The earliest forensic medicine case of the Freiburg University in 1590].

In 1590 Markgrave Jakob III. of Baden died, 28 years old, after a sudden disease which had lasted nine days. A necropsy was performed by two professors of the Freiburg University faculty of medicine. A written report amazingly accurate for the time, exists. It points at poisoning by arsenic powder. This is the first existing written protocol of a forensic autopsy, performed by professors of the faculty of medicine of Freiburg in 1590, 26 years after Vesalius' death.

Adult↗
PubMed1990

[Peripheral vein requirement-adjusted parenteral feeding: renaissance of maltose?].

A requirement-adapted peripheral-venous parenteral nutrition was developed by exchanging the conventional carbohydrates like glucose, etc., for disaccharide maltose in combination with a fat emulsion (650 mosm/l; 2,000 kcal). In a clinical randomised study, we compared this nutrition regimen with a common requirement-adapted parenteral nutrition regimen, which was applicated by central-venous catheter (2,000 mosm/l; 2,000 kcal). All results, including the results of tracer-investigations with the strable isotope 13C-leucine, showed no metabolic difference between these two nutrition regimens.

Blood Glucose↗