J.Jpn. Surg. Soc.. 56(4): 479-516, 1955
STUDIES ON CARBOHYDRATE METABOLISM IN RELATION TO ADRENOCORTICAL FUNCTIONS IN SURGERY
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2nd Surgical Department, Tokyo University School of Medicine (Prof, Seiji Kimoto) Sumio SAITO |
Results obtained are as follows:
1) The changes of carbohydrate metabolism following surgical operations are usually influenced by the severity of the operation, which is the sum of duration, hemorrhage, anesthesia and actual handling during surgery. Postoperative hyperglycemia during the short period of forty-eight or seventy-two hours after surgery is parallel to the severity of procedures. Carbohydrate metabolism is also influenced by adrenocortical function and its changes, which include hyperglycemia, decrease of insulin sensitivity, glucose tolerance and glycosuria, are similar to the diabetes of ACTH or Cushing's syndrome type.
2) Glycosuria continues even with the slight elevation of blood sugar and the ratio of GFR to TmG increases. Postoperative glycosuria is considered to be connected with tubular reabsorption of glucose and adrenocortical functions. Overadministration of glucose solution immediately after surgery causes hyperglycemia, glucosuria and dehydration in the condition of hyperfunction of adrenals, and water-intoxication in adrenal insufficiency.
3) In liver disease, malnutrition, and cancerous diseases, adrenocortical functions are reduced and hypoglycemia continues after surgery.
4) In the pancreatectomized dogs, diabetic symptoms are marked with hyperfunction of adrenals. Diabetic symptoms are often seen in diseases of the thyroid gland, i. e., hyperthyroidism, thyrotoxicose and even Basedow's disease.
5) Disturbances in the metabolism of water and electrolytes also accompany the changes of carbohydrate metabolism in the condition of postoperative adrenal insufficiency.
6) In patients of the post-gastrectomy dumping syndrome, carbohydrate and electrolyte metabolism, adrenaline secretion and adrenocortical functions were examined. Rapid passage of foodstuff, glucose administration and standing posture are proved to increase the adrenaline liberation. Adrenaline causes the decrease of the serum potassium level and the occurrence of later symptoms, such as muscular weakness, dizziness, or drousiness. Adrenocortical functions are related to the genesis of the dumping syndrome.
7) Effect of some hormones were examined to improve the carbohydrate metabolism during and after surgery and the administration of cortisone or ACTH is proved to be effective in the postoperative changes of carbohydrate metabolism.
(author's abstract)
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