摘要:

Alterations in metabolism in the tumor‐bearing host can be explained by: 1) alterations of metabolic processes in the tumor itself, and/or 2) tumor effects on host metabolism. Tumor effects on host liver metabolism were studied using an isolated perfused rat liver preparation. The livers of fasted female Lewis Wistar rats with and without transplanted subcutaneous mammary tumors were perfused for 1 hr with medium containing 5 mM glucose and physiological levels of amino acids. The rate of gluconeogenesis, as measured by conversion of14C‐lactate to14C‐glucose, showed a significant increase in the rate of glucose production from lactate in tumor‐bearing rats (2.40 vs 2.00 μmol/min/100 gm). Hepatic glycogen and14C‐glycogen content were not significantly different between the two groups. In order to evaluate whether this tumor model exhibits characteristic changes in metabolism previously reported in other animal tumor models, serum lactate, triglyceride, glucose, and blood urea nitrogen were measured in non‐perfused animals. The serum concentration of lactate and triglycerides were significantly higher in tumor‐bearing rats (0.9 mM vs 2.7 mM lactate; 244 mg % vs 365.5 mg % triglycerides). Serum glucose and blood urea nitrogen were not significantly different in the two groups. An effect of tumor on host energy metabolism and serum metabolite levels is demonstrated. A method for the study of host‐tumor metabolic interactions is described.

ISSN:0148-6071    

DOI:10.1177/0148607183007002105

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Preterm infants requiring prolonged intravenous feeding frequently develop pathologic fractures and rickets. Infants who receive large amounts of calcium have fewer fractures. This observation led us to determine the maximal amounts of calcium and phosphate that can be added to parenteral nutrition solutions without the precipitation of calcium phosphate and to determine the optimal ratio of calcium to phosphate in these solutions.Clinical observations andin vitroexperiments indicate that the product of calcium × phosphate (CaxP) in the dextrose‐amino acid solution should not exceed 75 square millimolar (square millimole per square liter) to prevent calcium phosphate precipitation in barium‐impregnated silicone rubber catheters and should not exceed 100 square millimolar in solutions administered through peripheral veins. Seven intake and output studies were performed in preterm infants to determine the ratio of calcium to phosphate (Ca/P) in the total parenteral nutrition solutions that minimized urinary losses. A Ca/P ratio of 5.0 minimized the sum of the calcium plus phosphate losses in the urine. However, experience with long‐term total parenteral nutrition in preterm infants, awareness of the acute and life‐threatening effects of body phosphate depletion, and an unmeasured endogenous enteric calcium secretion all suggest that a Ca/P ratio of approximately 3.0 provides a safer compromise between the acute and serious complications of phosphate deficiency and the chronic problems of fractures and rickets due to calcium deficiency.

ISSN:0148-6071    

DOI:10.1177/0148607183007002110

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Previous work has shown that an abdominal trauma index (ATI) based on anatomic severity of injury reliably predicts complications following abdominal trauma, whereas the Prognostic Nutritional Index (PNI) does not. This study was undertaken to reconcile the disparity between the PNI and ATI as predictors of postoperative morbidity and mortality. Twenty‐four patients undergoing immediate laparotomy following acute abdominal trauma were evaluated. Their mean age was 32.8 years (range 18–59 years); 18 were men. All patients underwent nutritional assessment within 12 hours of surgery. A statistical comparison of blood replacement, operating time, ATI, and PNI was performed. The mean PNI was 51 and mean blood replacement was 12.5 units. Using linear regression the PNI and amount of blood replacement correlated significantly (r= 0.44,p<0.05). Operating time and ATI did not correlate with PNI. In conclusion, the PNI was more strongly influenced by blood loss than severity of intraperitoneal injury. For this reason it is relatively ineffective in predicting complications following trauma.

ISSN:0148-6071    

DOI:10.1177/0148607183007002115

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Daily infusion of a total parenteral nutrition (TPN) formulation containing 1 liter of 5.5% Travasol provides less than 0.1 milligrams of iron. By comparison, a formulation which includes a liter of 10% Travamin provides 2 milligrams of iron per day. To meet iron requirements in patients infusing formulations containing Travasol, iron was added as ferrous citrate. Inin vitroexperiments, 74% of this iron was available to transferrin. In seven patients in whomin vivoavailability was tested by red cell incorporation, the mean availability was 81%. Ferrous citrate is recommended as a safe, effective additive to TPN solutions for adult patients requiring iron supplements.

ISSN:0148-6071    

DOI:10.1177/0148607183007002117

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Twelve normal low birth‐weight newborns weighing between 1100 and 1765 grams (means ± SD, 1614 ± 191) were fed by continuous intragastric drip a semi‐elemental diet, providing per kilogram and per day 120 kilocalories, 2.9 grams of proteins, 17.5 grams of carbohydrates, 4.2 grams of fat and 2.4 milliequivalents of sodium. The diet contained a lactalbumin hydrolysate, dextrin maltose, and medium and long chain triglycerides. The newborns regained their birthweight between 6 and 16 days (mean ± SD, 10.4 ± 3.1) and gained 14 to 37 grams/day (mean ± SD, 25.4 ± 6.8) during the first month of life. The diet proved to be safe and clinically well‐tolerated in low birth‐weight infants and induced a weight gain similar to the intrauterine growth, once the birthweight had been regained.

ISSN:0148-6071    

DOI:10.1177/0148607183007002121

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The rate of fat emulsion clearance from the blood of 10 healthy adult male volunteers administered 0.1 gram of fat per kilogram body weight as 10% or 20% safflower oil emulsion (Liposyn) was studied. The subjects were hospitalized for 2 days and each was given the predetermined amount of one of the two fat emulsions (10% or 20%) by rapid injection into a peripheral vein and the rate of clearance of the emulsion determined over a 60‐minute period, beginning when half of the emulsion had been injected. There was no significant difference in the clearance rate between the two emulsions. It is concluded that 20% fat emulsion is as safe as 10% fat emulsion for use in intravenous nutritional support.

ISSN:0148-6071    

DOI:10.1177/0148607183007002126

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The systemic absorption from topical applications of 40% zinc oxide ointment was investigated in a series of healthy subjects (phase one) and in patients receiving total parenteral nutrition (phase two). In the first phase, six subjects completed a controlled, cross‐over trial involving 3 hourly serum sample determinations for zinc concentration following a massive application of 40% zinc oxide ointment and plain petrolatum ointment. There was a mean increase in serum zinc from 107.3 ± 5.32 to 116.1 ± 5.02 μg/dL 1 hr after application of 40% zinc oxide ointment (p>0.05). Three patients receiving total parenteral nutrition completed phase two of the protocol in which 40% zinc oxide ointment was applied daily to a specified area of the thigh. Analysis of these patients' serum revealed that the zinc concentrations remained relatively constant over the 10‐day study period. These findings suggest that topical applications of 40% zinc oxide ointment do not result in significant absorption. This study serves as a starting point for further investigation.

ISSN:0148-6071    

DOI:10.1177/0148607183007002131

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

This two phase study evaluates nitrogen utilization by the body as a function of fixed caloric intake but different nitrogen loads. Nitrogen use by the body was estimated from measures of nitrogen balance, net protein utilization, and urea accumulation rate.Phase 1 of this study included 411 measurements of nitrogen use in 120 patients assigned, according to clinical condition, to receive one of the four following therapies: dextrose (D) 25%, amino acids (CAA) 4.25% (Group 1); D 35%, CAA 4.25% (Group 2); D 25%, CAA 2.13% (Group 3); or D 35%, CAA 2.13% (Group 4). Forty patients in Phase 2 were assigned in a randomized, prospective, double blind manner, to receive one of the following regimens: D 35%, CAA 2.75% (Group 5); D 25%, CAA 2.75% (Group 6); D 35%, CAA 4.25% (Group 7); or D 25%, CAA 4.25% (Group 8).In Phase 1, positive nitrogen balance was achieved with the exception of Group 3 where neither the estimated caloric nor nitrogen needs of the patients were met. It appeared that protein utilization was maximal in patients receiving the therapy of highest calorie:nitrogen ratio (Group 4). Phase 2 patients achieved positive nitrogen balance to the same extent (p>0.05) and although net protein utilization improved from 53 to 71%/d as the calorie:nitrogen ratio was increased, the differences were not significant (p>0.05). There was a significant improvement in total iron binding capacity in Phase 2 patients (p<0.01) that was most prominent at the lower concentrations of amino acids (high cal:n ratio) (Groups 5 and 6).Smaller amounts of nitrogen appear adequate in producing a positive nitrogen balance and may be better utilized in hospitalized patients if the patients' caloric requirements are achieved.

ISSN:0148-6071    

DOI:10.1177/0148607183007002136

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Changes in the fatty acid pattern of plasma lipids in four different groups of polytraumatized patients were investigated. All of the patients received amino acid solutions containing 0.24 gN/day/kg body weight and 30 kal/day/kg body weight (BW). In group 1, all calories were administered as carbohydrates (glucose and fructose). In group 2, 30 to 40% of the calories were provided as a fat emulsion. When compared to the control group, a reduction in the essential fatty acid concentration in the phospholipid fraction was detected in both groups during the early post‐traumatic period. In group 1, a continuous decline was observed during the remainder of the trial period. In group 2, however, the concentration of essential fatty acids remained constant after the initial decline and increased slightly from the 7th day on. In the second part of the investigation, the effect of human growth hormone (HGH) administration on the fatty acid pattern was evaluated. Groups 3 and 4 received intravenous feedings identical to the patients in group 2; in group 4, however, 10 mg of HGH per day were added to the infusion.The results of this study confirm the hypothesis that supplemental infusion of a fat emulsion prevents a continuous reduction of essential fatty acids in plasma lipids. An effect of 10 mg/ day of HGH on essential fatty acid concentration or composition, however, could not be observed. There were no detectable differences in the percentage of essential fatty acids between those patients receiving and those not receiving HGH.

ISSN:0148-6071    

DOI:10.1177/0148607183007002142

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The total plasma clearance of essential amino acids was studied in 9 non‐dialyzed patients with stabile chronic renal failure and 20 healthy young adult volunteers after a bolus infusion of 0.28 g amino acids per kg of body weight in a solution containing essential L‐amino acids in the proportions suggested by Rose and supplemented by L‐histidine. After the infusion, the plasma concentrations of amino acids were observed for 6 hr. The pharmacokinetic analysis was performed by a polyexponential parameter estimate computer program, capable of analyzing up to five‐compartment models. Wide individual variation in the capability to clear the given amino acid load from the plasma was observed. Expressed as a fraction of the sum of the total plasma clearances of the infused amino acids, the total plasma clearance of valine and phenylalanine had decreased in renal failure while that of histidine had increased. These alterations reflect the complex disorder of the protein metabolism and the observations may be of help in designing optimal nutritional regimens in renal failure.

ISSN:0148-6071    

DOI:10.1177/0148607183007002146

出版商:SAGE Publications    

年代:1983

数据来源: WILEY