In gynaecology the problems of parenteral nutrition have become increasingly important, especially in view of the advanced methods of radical surgery and the intensification of radiotherapy. Furthermore, more older patients in a poor state of health also undergo major surgery. In many of these patients food cannot be given by the oral route or can ~nly be given inadequately. If this situation continues for any significant period, parenteral nutrition will be necessary. In gynaecology, long-term complete parenteral nutrition is seldom necessary; short-term complete parenteral nutrition, however, is required more often. Especially in ultraradical surgical procedures, an adequate metabolic control -and this means in many cases parenteral nutrition -is certainly necessary and decisive for therapeutic success.In the Department of Obstetrics and Gynaecology at the University of Frankfurt/Main, about 4.500 women receive clinical treatment every year. On the average, about 150 to 200 of these women receive parenteral nutrition for short or long periods.
INDICATIONSComplete parenteral nutrition becomes necessary in almost every case of radical and ultraradical surgery in gynaecology. After ultraradical operations and frequently also second-look operations, short-term or long-term parenteral nutrition is one of the most essential conditions for any success. After radical operations for cancer of the cervix uteri, we generally give short-term parenteral nutrition for four or five days. If, however, complications such as infections, ileus or renal failure occur, complete parenteral nutritioh becomes necessary for a longer period. Further indications for total parenteral nutrition in gynaecology are cancerous cachexia, patients undergoing chemotherapy and anorexia nervosa.In obstetrics, parenteral nutrition is seldom indicated. It becomes necessary in cases of severe eclampsia with acute renal failure, in cases of septic
Postoperative parenteral nutrition can only be optimally effective if the characteristics of post-traumatic metabolism are taken into account. Two main possibilities are discussed for the carbohydrate component of parenteral nutrition during this phase: glucose with high doses of insulin or non-glucose carbohydrates (sugar substitutes) possibly in a suitable combination with glucose. The risks as well as the technical and organisational problems involved in the use of them are discussed and the authors prefer the second of the two alternatives. Possible side effects of non-glucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of frucose : glucose : xylitol in a ratio of 2 : 1 :1 with a total dose of 0.50 g/kg/hour has been studied most thoroughly. This combination normalises the fat metabolism and improves glucose tolerance without requiring exogenous insulin. Experiences with this combination as well as individual non-glucose carbohydrates on operated patients have been given continuously for up to 7 days and in some cases even for several weeks. No side effects, no deviations from a steady state and no abnormal changes of the laboratory values occurred. The authors are of the opinion that non glucose carbohydrates are necessary if the facilities for frequent blood sugar controls are not available.
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