Background. There is a wide spectrum of metabolic and toxic disorders that can cause acute encephalopathy in cancer patients. In routine clinical practice, hypoglycemia, vitamin B1 (thiamine) deficit, fulminant liver failure, uremia, severe hypoand hypernatremia should be primarily excluded. Central neurotoxicity associated with hyperammonemia in patients receiving 5-fluorouracil (5-FU) and oral fluoropyrimidines should be considered in differential diagnosis. In this case, the analysis of the blood acid-base status and the detection of B-type hyperlactatemia can facilitate the diagnosis of the cause of encephalopathy. Case description. We present two cases of hyperlactatemia and encephalopathy in stage IV cancer patients with continuous infusion of 5-FU via a portable infusion pump. Conclusion. Diagnosis of the frequent fluoropyrimidin-related adverse effects, such as myelosuppression, anorexia, diarrhea, mucositis, and palm-plantar syndrome, are routine and mastered by an oncologist at the very beginning of his/her professional activity. Specific fluoropyrimidinerelated encephalopathy or hyperlactatemia are difficult to suspect and recognize. We hope our description will be useful to prevent possible diagnostic errors.

Background. There is a wide spectrum of metabolic and toxic disorders that can cause acute encephalopathy in cancer patients. In routine clinical practice, hypoglycemia, vitamin B1 (thiamine) deficit, fulminant liver failure, uremia, severe hypoand hypernatremia should be primarily excluded. Central neurotoxicity associated with hyperammonemia in patients receiving 5-fluorouracil (5-FU) and oral fluoropyrimidines should be considered in differential diagnosis. In this case, the analysis of the blood acid-base status and the detection of B-type hyperlactatemia can facilitate the diagnosis of the cause of encephalopathy.Case description. We present two cases of hyperlactatemia and encephalopathy in stage IV cancer patients with continuous infusion of 5-FU via a portable infusion pump.Conclusion. Diagnosis of the frequent fluoropyrimidin-related adverse effects, such as myelosuppression, anorexia, diarrhea, mucositis, and palm-plantar syndrome, are routine and mastered by an oncologist at the very beginning of his/her professional activity. Specific fluoropyrimidinerelated encephalopathy or hyperlactatemia are difficult to suspect and recognize. We hope our description will be useful to prevent possible diagnostic errors.

Objective: to estimate blood glucose levels during complete parenteral nutrition (CPN), by using the three-in-one system with a high glucose level. Subjects and methods. Thirty adult patients without diabetes mellitus (including 18 men) were examined. Twelve and 18 patients were operated on for colonic and gastric cancers, respectively. CPN (Oliclinomel No. 7 — 1000, 1500 ml; glucose, 240 g in 1500 ml, Baxter, Belgium) was carried out at the Surgery Department in the early postoperative period (3-5 postoperative days) with stable hemodynamics and no organ dysfunction (acute respiratory, renal, hepatic failure). The preparation was administered at a rate of about 83 ml/h over 18 hours. Insulin was not used. Serum glucose concentrations were measured before the study and then for 24 hours at an interval of 6 hours. Results. Glucose concentrations were not found to exceed the allowable values in the majority of patients during CPN at the given rate. In 5 (16.7%) patients, short-term glucose increases up to 13.3 mmol/l were corrected, by decreasing the infusion rate. There was no hypoglycemia or other complications during CPN. Conclusion. Our findings suggest that three-in-one parenteral feeding is safe and causes no metabolic disturbances if simple principles are followed, the basic ones of which are to observe the intake of an adequate total dose and the rate of administration of nutrients. Key words: parenteral feeding, hyperglycemia, metabolic disturbances.

Objective: to study the efficacy of third- versus secondary-generation fatty emulsions as part of parenteral nutrition in patients operated on for gastric cancer. Subjects and methods. Envelope randomization was used to make up two groups, each comprising 10 patients, operated on for gastric cancer in the scope of gastrectomy. A control group received parenteral nutrition having the following components: Lipofundin MST/LST 20%, (500 ml daily) + Nutriflex 48/150 (B. Braun) (1000 ml daily, 1744 kcal/day). The study group patients were given Lipoplus 20% (500 ml daily) + Nutriflex 48/150 (1000 ml daily, 1745 kcal/day). Parenteral nutrition was used on postoperative days 1 to 5. Results. Nutritional status evaluation revealed a significant increase in the concentration of total protein and albumin in the control and study group patients on postoperative day 6. The use of both second- and third-generation fatty emulsions caused a significant increase in the concentration of triglycerides on day 6 after surgery; no differences were found between the groups. On day 6 following surgery, there was a significant decrease in IL-4 in both groups (p<0.05). At the same time the Lipofundin MST/LST group showed a significantly lower concentration of IL-4 than did the study group (p<0.05). After termination of a parenteral nutrition course, the study and control groups showed a significant decrease in one of the major pro-inflammatory cytokines — IL-6. Conclusion. In the study group, the serum anti-inflammatory activity of IL-4 was more evident than that in the control group and the proinflammatory activity (IL-6 concentration) decreased, which can support that as compared with the second-generation fatty emulsions, third-generation ones with a balanced omega 3 to omega-6 fatty acid ratio (1:2.7) had a normalizing effect on systemic inflammatory processes and cytokine balance with increased anti-inflammatory and reduced proinflammatory activities. Key words: third-generation fatty emulsions, omega-3/omega-6 fatty acids, pro and anti-inflammatory cytokines.

Surgery for cancer of the esophagus and cardia is rather often associated with organ failure, especially pulmonary injury, and infectious complications. Hypoalbuminemia is a significant risk factor leading to decrease in colloid osmotic pressure and impairment of toxin and drug transport. Early postoperative infusions of high-dose concentrated albumin solution help to reduce occurrence of acute pulmonary disease and to stabilize central hemodynamics. This effect may be due to both increased plasma colloid osmotic (oncotic) pressure and recovery of albumin disintoxication function.