205 research outputs found
The metabolic pathway of (alanyl-)glutamine into citrulline and arginine in surgical patients
No full textLeeuwen, P.A.M. van [Promotor]Dejong, C.H.C. [Copromotor
Ammonia and glutamine metabolism during liver insufficiency: the role of kidney and brain in interorgan nitrogen exchange.
No full textAmmonia and glutamine metabolism during liver insufficiency: the role of kidney and brain in interorgan nitrogen exchange. Dejong CH, Deutz NE, Soeters PB. Dept. of Surgery, University Hospital Maastricht, The Netherlands. BACKGROUND: During liver failure, urea synthesis capacity is impaired. In this situation the most important alternative pathway for ammonia detoxification is the formation of glutamine from ammonia and glutamate. Information is lacking about the quantitative and qualitative role of kidney and brain in ammonia detoxification during liver failure. METHODS: This review is based on own experiments considered against literature data. RESULTS AND CONCLUSIONS: Brain detoxifies ammonia during liver failure by ammonia uptake from the blood, glutamine synthesis and subsequent glutamine release into the blood. Although quantitatively unimportant, this may be qualitatively important, because it may influence metabolic and/or neurotransmitter glutamate concentrations. The kidney plays an important role in adaptation to hyperammonaemia by reversing the ratio of ammonia excreted in the urine versus ammonia released into the blood from 0.5 to 2. Thus, the kidney changes into an organ that netto removes ammonia from the body as opposed to the normal situation in which it adds ammonia to the body pools. Publication Types: Review Review, Academi
Nutrition in patients with acute pancreatitis
No full textNutrition in patients with acute pancreatitis. Dejong CH, Greve JW, Soeters PB. Department of Surgery, Academic Hospital Maastricht, NL-6202 Maastricht, The Netherlands. [email protected] Acute pancreatitis is a disease with varying severity. Patients with the mild form do not require nutritional support because oral intake is resumed rapidly. Studies on nutritional support in acute pancreatitis have included patients with both mild and severe disease. In this heterogeneous group, total parenteral nutrition did not improve outcome compared with no nutrition at all. This is caused in part by an increase in septic complications during total parenteral nutrition. Likewise, no benefit from enteral nutrition was observed compared with no nutrition, probably because the group was heterogeneous or because nutritional goals were not achieved. Patients with severe acute pancreatitis become profoundly catabolic. This group undoubtedly requires nutritional support to treat undernutrition. The limited available data indicate that enteral nutrition, if well tolerated, is superior to parenteral nutrition for patients with severe acute pancreatitis. Based on current knowledge, a combination of early total parenteral nutrition and enteral nutrition is advisable as soon as enteral nutrition is tolerated. Monitoring of gut function is crucial in this situatio
Intestinal adaptation in short bowel syndrome
No full textIntestinal adaptation in short bowel syndrome. Welters CF, Dejong CH, Deutz NE, Heineman E. Department of Surgery, Academic Hospital and University of Maastricht, The Netherlands. Regaining enteral autonomy after extensive small bowel resection is dependent on intestinal adaptation. This adaptational process is characterized by hyperplastic growth of the remaining gut, which is accompanied by both an increase of cell division at the level of the crypt cells and by an increased rate of programmed cell death (apoptosis). Apart from the absorptive function, the small bowel also has a barrier function and plays an important role in interorgan metabolism. Also, these functions are greatly affected by a massive intestinal resection and subsequent recovery by intestinal adaptation. This review aims to give an overview of the debilitating effects of massive intestinal resection on gut function and subsequently discusses intestinal adaptation and possible factors stimulating adaptation
Haruspices in het heden
No full textRede uitgesproken bij de aanvaarding van het ambt van hoogleraar in de chirurgie, in het bijzonder de hepato-pancreato-biliaire chirurgie aan de Universiteit Maastrich
Intestinal function and metabolism in the early adaptive phase after massive small bowel resection in the rat
No full textIntestinal function and metabolism in the early adaptive phase after massive small bowel resection in the rat. Welters CF, Dejong CH, Deutz NE, Heineman E. Department of Surgery, University Hospital Maastricht, Maastricht University, Maastricht, The Netherlands. PURPOSE: The aim of this study was to investigate the early adaptive responses in metabolism and gut function after massive small bowel resection. METHODS: Male Wistar rats underwent an 80% small bowel resection (Ent group, n = 9) or a transection and reanastomozing (Sham group, n = 7). After 24 hours, substrate fluxes across the gut were determined together with intestinal protein synthesis, polyamine concentrations in gut tissue, and gut function by testing intestinal permeability using the urinary recovery of lactulose and rhamnose. To test for the effect of starvation, healthy starved rats were studied. RESULTS: In the Ent group, intestinal uptake of glucose, lactate, glutamine, phenylalanine, branched chain amino acids, and total amino acids were equal to or higher than that in Sham rats. Intestinal protein synthesis increased, accompanied by an increase in spermidine to spermine polyamine ratios in the ileum and in the jejunal muscular layer. The urinary lactulose to rhamnose ratio also increased, suggesting increased intestinal permeability. CONCLUSIONS: 24 hours after massive small bowel resection, adaptive responses in metabolism and gut function already can be observed, as indicated by increased intestinal uptake of substrates and increased protein synthesis. This, however, is accompanied by an increase in intestinal permeability, which may indicate impaired intestinal barrier function. J Pediatr Surg 36:1746-1751. Copyright 2001 by W.B. Saunders Company
The metabolic pathway of (alanyl-)glutamine into citrulline and arginine in surgical patients
No full text
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