The utilization of a 4:2:1 mixture of glucose, fructose, and xylitol (GFX) was studied by indirect calorimetry in patients undergoing abdominal surgery. Sixteen patients undergoing gastrectomy under general anesthesia received GFX intravenously at 0.25 g/kg h-1 during surgery. VO2, VCO2, and RQ were measured continuously for 150 min using an Engström metabolic computer, and urea nitrogen excretion was determined at 30-min intervals during surgery. Blood levels of glucose, fructose, and xylitol plateaued after 1 h. The RQ decreased over the first 90 min from 0.84 +/- 0.06 to 0.75 +/- 0.05 and then gradually increased to 0.79 +/- 0.04 at 150 min. VO2 did not change significantly over the 150-min period. From the RQ, VO2, and nitrogen excretion data, carbohydrate oxidation was estimated. The amount of carbohydrate oxidized was 9.7 +/- 6.9 g during the first 30-min period, 3.5 +/- 5.2 g during the 60 to 90-min period, and 7.5 +/- 4.5 g in the 120 to 150-min study period. Simultaneously, lipid oxidation increased. These observations suggest that the GFX solution is adequately metabolized during surgery and therefore may be a suitable energy source for patients.

Abdomen↗

PubMedDate not supplied

Socket-cup arthroplasty.

Socket-cup arthroplasty gives a painless hip and allows a sufficient range of motion for the daily activities of the average patient. Arthrodesis and total hip replacement are clearly possible in the cases in which the operation is a failure. The procedure therefore is relatively conservative. There are 2 major causes of failure. One is atrophy and necrosis of the femoral head and neck covered by the cup. The other is loosening between the acetabular bone and cement in dysplastic hips. The results of clinical trials with socket-cup arthroplasty were disappointing. Reoperation by total hip replacement between 1--5 years after implantation (mean 3 years) was required for 7 of 12 cases. Failure was associated with fracture of the femoral neck secondary to osteonecrosis in one hip and with the loosening of the acetabular socket in 6 hips. To overcome these difficulties, improvements in materials, design and surgical procedure are necessary. The indication for the present designs and materials for socket-cup arthroplasty should be strictly limited.

Adult↗