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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 nonglucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of fructose : 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 in the postoperative phase are mentioned. Controlled infusions of 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.

Summary Stress ulcer means an acute mucosal lesion of the upper gastrointestinal tract in sick patients, who have not had gastroduodenal ulcer before. Most often stress ulcers follow big operations, burns and different types of shock. Complications as respiratory insufficiency, paralytic ileus or infections favor the ulcer formation. The average age is 53 years, males are more often affected. The main localisation is the proximal stomach, less frequently the lesions are located in the duodenum and terminal oesophagus. The macroscopic type is an erosion or a superficial ulceration, a solitary ulcer is typically situated in the duodenum. From the view of pathogenesis three factors are mainly involved: hydrochlorid acid, a disturbance of microcirculation due to shock and a duodenogastric reflux of bile acids and lysolecithin. Most frequent symptom is upper gastrointestinal bleeding, but more than 50% are symptomless. Medical treatment is successful in 60–70%. The surgical treatment of choise is vagotomy in combination with circular sature or resection. Prevention of shock or respiratory insufficiency, permanent gastric suction, early food administration and intragastral application of antacids and cholestyramin are the essentials of stress ulcer prophylaxis.

Since 1970 all postoperative bacteriological findings recorded in surgical patients have been analyzed and compared with the postoperative course. There are also regular checks of bacterial invasion in the operating suites and in the intensive care units. By such means as systems of double lock for personnel and equipment, regular surface disinfection, frequent hand disinfection, cleaning of the respirators with antiseptics, etc., the authors have been able to reduce the incidence of hospital infection very drastically. These measures also almost eliminated cross-infections in patients on long-term ventilation and complications with long-term indwelling catheters. Seit 1970 werden bakteriologische Befunde operierter Patienten analysiert und mit den regelmäßigen Kontrollen der Keime in den Operations-und Intensivpflegeeinheiten, ferner mit dem klinischen Verlauf verglichen. Durch Schleusensysteme, regelmäßige Flächendesinfektion, häufige Händedesinfektion, Antiseptik an den Atemtherapiegeräten u. a. konnte die Rate der Hospitalinfektionen stark reduziert werden. Durch diese Maßnahmen konnten außerdem Kreuzinfektionen bei Langzeitbeatmeten und Komplikationen durch Venenverweilkatheter weitgehend verhindert werden.

Summary Severe trauma, disease, or operations can give rise to gastric stress bleeding. Heterogeneous etiologic factors lead by way of different pathophysiologic disturbances to ischemia of the gastric mucosa and increased back diffusion of hydrogen ions with consecutive formation of erosions. The high incidence of this type of hemorrhage among patients under intensive care makes prophylaxis mandatory. Therapy is basically conservative. Operative treatment is centered around vagotomy. Results are dominated by the severity of the underlying disease process.

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