Nutritional support is an important aspect of the multidisciplinary approach to critical care medicine. During stress, visceral protein turnover is increased. However, muscle and connective tissue proteolysis is obligatory if the stressful condition persists. Through nutritional support, peripheral protein breakdown is minimized and visceral protein synthesis maximized. A delivery system of 15% to 20% dietary protein, 30% fat, 50% to 55% carbohydrate, complemented by moderate amounts of vitamins and minerals, is considered best. Optimal nutritional care depends on objective assessment of the patient's nutritional status before and during nutritional support, particularly the nutritional status of the body cell mass and the energy required for maintenance and support of reparative processes. Indicators least disturbed by factors should be selected for assessment. Individual indicators vary in critical states. After resuscitation, excess body water may increase body weight; after surgery, stress may depress albumin levels. Biometric markers of nutritional status and measurements that adequately validate and evaluate response to nutritional support are discussed.
Adrenal cysts are generally rare clinical entity, but due to advances in imaging diagnostic methods, detection incidental cases are increasing. Therefore, discussions about the therapeutic management of these cases are more numerous, due to the growing number of cases. We present a case of a 29-year-old woman who has had complaints of headaches and right low back pain in the last week. She had a history of high blood pressure in the past 6 months. Clinical examination was essentially normal. Routine blood investigations including a workup for pheochromocytoma was normal. CT abdomen and pelvis showed 8x8x8cm cyst in the right adrenal gland. We decided to perform a laparoscopic excision of the adrenal cyst and successfully excised the adrenal cyst, fully saving the adrenal gland. Laparoscopic excision of the adrenal cyst seems to be the best recommended treatment option for these pathologies. The probability of recurrence after surgical excision is low.
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