Immunomodulation with fumaric acid. Systemic therapy in psoriasis

The treatment of psoriasis vulgaris with fumaric acid esters has been controversial for more than 30 years. Recently the fumaric acid derivatives are marketed antipsoriatics in many European countries. In this paper the clinical efficacy, the side effects as well as the mode of action of these highly potent substances are summarized.     

Experience with continuous arteriovenous hemodiafiltration for acute kidney insufficiency in intensive care patients]

Acute renal failure is a frequent complication at the Intensive Care Department. For this complication dialysis is often necessary. In our Intensive Care Department we have opted for continuous arteriovenous hemodiafiltration (CAVHD) as the treatment of first choice for patients with acute renal failure. We describe the results in 18 patients treated with CAVHD. In all patients an arterious and a venous catheter were placed, in most cases in the femoral artery and vein. A capillary hemofilter was placed between the catheters. In the filter a counterflow mechanism took place. All patients were successfully treated with CAVHD. Haemodynamic instability as an effect of the treatment did not appear. The fluid and electrolyte balance was perfectly under control. Renal function was recovered in 7 patients. Twelve patients died. The cause of death was never associated with the renal failure or with the CAVHD treatment.     

Respiratory insufficiency in patients with progressive neuromuscular disease can sometimes be treated effectively with ventilatory support

Three patients with myotonic dystrophy (MD) developed respiratory failure. The first was a 55-year-old man with MD who had been admitted elsewhere with pneumonia and respiratory failure. After discharge he was re-admitted with respiratory failure due to respiratory pump failure. Ultimately, he was given a tracheostomy and was ventilated during the night. The second patient was a 38-year-old man who was admitted to the intensive care unit when he could not be weaned off the ventilator following cholecystectomy for symptomatic gall stones. It appeared that he had partial respiratory failure due to MD and overweight. Ultimately he was able to be weaned during the day with nightly non-invasive ventilation. The third patient was a 55-year-old woman who was admitted with recurrent pneumonia and respiratory failure. She appeared to have chronic respiratory failure due to MD. She was ventilated at night via a tracheostomy. All three patients reported a gradual decline in physical and mental performance in the years preceding this acute episode. All three experienced a remarkable recovery of performance after the institution of mechanical ventilatory support. Respiratory failure that develops over a number of years can be easily missed in aging patients with slowly progressing neuromuscular disease. Timely recognition may lead to improved survival and quality of life by the application of non-invasive ventilatory support.     

Acute respiratory insufficiency in children

Acute respiratory distress in children is often a consequence of asthma. Other causes are subglottic laryngitis, epiglottitis, aspiration of a foreign body, acute bacterial pneumonia or pneumothorax. History and physical examination should differentiate between the various diseases. Asthma is characterized by recurrent symptoms and signs, while this is not the case with the other causes of acute breathlessness described. An asthma exacerbation is often preceded by one or more prodromes. In case of aspiration of a foreign body, like a peanut, immediate action is needed to prevent irreversible damage to the airways. Subglottic laryngitis and epiglottitis are both characterized by an inspiratory stridor; in case of epiglottitis immediate action is needed, while in case of subglottic laryngitis observation time is available in most cases. Pneumothorax as a cause of acute breathlessness is rare in childhood; it should be considered in male smoking leptosomic asthmatic adolescents.     

Splanchnic exchange of amino acids after amino acid ingestion in patients with chronic renal insufficiency

Splanchnic exchange (net uptake or release) of amino acids (AAs) was evaluated by measuring arterial-hepatic venous differences for AAs and hepatic blood flow in patients with chronic renal insufficiency (CRI) and control subjects before and for 70 min after the ingestion of an AA mixture simulating an animal protein meal. In CRI after AA ingestion, splanchnic exchange area for total nonessential AAs (NEAAs) is increased 135% over control subjects because of an augmented escape of proline, glutamate, serine, glycine, alanine, and cyst(e)ine; contrarily, glutamine shows an increased splanchnic uptake. Splanchnic exchange area for total essential AAs (EAAs) is increased only by 67% over controls because of a higher escape of threonine, isoleucine, phenylalanine, and histidine. Abnormalities in arterial areas for AAs parallel those in splanchnic areas except for glutamine and isoleucine. Data indicate that in CRI, at least for 70 min after an AA meal, splanchnic organs metabolize abnormally ingested AAs and export an increased and unbalanced bulk of AAs, severely affecting postprandial arterial profile of AAs.     

Evaluation of amino acid patterns in recipes for kidney disease patients.

OBJECTIVE: To examine first-limiting amino acids in EAA patterns of a low-protein diet from card-style printed recipes on the market in Japan. In addition, this research explored practical knowledge about which combination of foods could cause an imbalance, if any, of amino acids, and seek to further improve diets for patients with kidney disease. METHODS: Thirty-nine card-style printed recipes for patients with diabetic nephropathy or chronic renal disease or those already on dialysis were chosen for this study. These recipes are available at major book stores in Japan. From each recipe, the first-limiting amino acid, if any, and corresponding amino acid score were investigated and identified. To determine them, the reference amino acid scoring pattern in Report of a Joint FAO/WHO Ad Hoc Expert Committee, 1973, was used as a reference. RESULTS: Among the 39 cards (recipes) examined, we found threonine to be the first-limiting amino acid in 59% of those samples, followed by valine in 8%, methionine + cystine in 3%, lysine in 3%, and leucine in 3%. In the remaining 26%, we did not find any limiting amino acids. Amino acid scores ranged from > or = 100 (26%) to 90-99 (54%), 80-89 (18%), and 70-79 (3%). QUALITY: In 26% of the samples, no deficits in regard to amino acid patterns were found in our analysis of these recipes. Valine, which is an index of malnutrition, was found to be among the first-limiting amino acids. However, because amino acid scores of less than 79 represented only 3% of all recipes chosen, EAAs in protein-controlled diets might not necessarily be deficient. CONCLUSION: The majority of the tested sample recipes were not balanced in EAA pattern, especially for threonine as the first-limiting amino acid of a meal. To prevent malnutrition in chronic renal disease, especially for those following low-protein diets, well-balanced meals on a daily basis as well as adequate energy intake are considered to be necessary.     

心功能不全患者的临床营养支持

合理的营养支持能有效延缓心功能不全向心功能衰竭的发展过程,延长生存期,提高生活质量.本文总结了心功能不全患者的营养代谢特点、营养风险筛查与营养状态评估方法、营养素需求及营养支持的应用等方面的进展,并对急性心功能不全的营养代谢支持进行讨论.     

心功能不全患者的临床营养支持

合理的营养支持能有效延缓心功能不全向心功能衰竭的发展过程,延长生存期,提高生活质量.本文总结了心功能不全患者的营养代谢特点、营养风险筛查与营养状态评估方法、营养素需求及营养支持的应用等方面的进展,并对急性心功能不全的营养代谢支持进行讨论.

Abstract：

Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.