摘要:

In order to quantitate the effect of sepsis and skeletal trauma on gluconeogenesis, four septic and five skeletal trauma patients were evaluated for their ability to convert14C‐L‐alanine to14C‐glucose while receiving 5% dextrose by peripheral vein. In the septic group, the mean glucose pool size increased by 35% and the glucose turnover rate increased by 85% over normal. The alanine conversion averaged 11.1% of the dose. The skeletal trauma group showed a glucose pool size increase of 61%, a 100% increase in glucose turnover rate and a 11.7% conversion of the alanine dose to glucose. The increased conversion of14C‐alanine to14C‐glucose in both sepsis and skeletal trauma in the face of an exogenous glucose infusion indicates an abnormal unsuppressible response. Each of the above parameters when compared to normal values was found to be significant at levels greater than 97.5%. The percentages of the dose expired as14CO2in three hours were not significantly different from the normals.

ISSN:0148-6071    

DOI:10.1177/014860717800200501

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

The aim of the study was to compare the effects of fructose, sorbitol and xylitol with those of glucose on blood glucose and insulin levels and carbohydrate utilization in man. The experiment was performed by means of continuous indirect calorimetry in five groups of five to six normal volunteers during infusion of either glucose, fructose, sorbitol, xylitol or a mixture of fructose, glucose and xylitol in the proportion of 2:1:1. Glucose and insulin did not present any important variations during the fructose, sorbitol and xylitol infusions. However, carbohydrate oxidation rose significantly during administration of these substrates. Carbohydrate oxidation rose 80mg/min for fructose, 27mg/min for sorbitol, 39mg/min for xylitol and 75mg/min for the carbohydrate mixture, in comparison to 101mg/min for glucose. It is concluded that fructose, sorbitol and xylitol provoke an increase in carbohydrate utilization without a corresponding rise in glycemia and insulinemia.

ISSN:0148-6071    

DOI:10.1177/014860717800200502

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

Twenty patients, after major injuries or elective abdominal surgery, were studied with respect to essential fatty acids in total serum and lipoprotein fractions. The regimen of total parenteral nutrition was altered in its content of energy, carbohydrates or fat. In all patients the linoleic acid levels decreased and the 20:3/20:4 ratio increased. Serum low density lipoproteins developed remarkable alterations of the biochemical composition and of morphology by electronmicroscopy. The degree of these alterations depended on the kind of illness, the amount of carbohydrates infused, special hormonal situation due to surgery and linoleic acid supply. As a consequence of these results, the supply of a sufficient amount of linoleic acid should be considered in every case of total parenteral nutrition.

ISSN:0148-6071    

DOI:10.1177/014860717800200503

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860717800200504

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

The preparation of single‐bottle parenteral nutrition solutions for neonates has long posed a problem for pharmacists. Frequent formulation changes and the need for rapid supply of solutions after prescription has led to a variety of preparation techniques being developed. An interactive computer program is described which enables a nonspecialist pharmacist staff to safely and quickly produce the formula, label and fully document it from a prescription for parenteral nutrition. Ordered quantities are expressed in amounts required per kilogram per 24 hours, and are input to a computer using a “prompt” system. Features of the program include automatic compensations for all non‐amino acid ingredients of a variety of commercial amino acid solutions; specified or unspecified chloride anion input; and logic checks which are tied to physiologic “danger” levels, signaling to the operator when “greater than a critical level” has been requested by the prescriber, as well as the conventional check of the logic. The program has allowed infinite variability to prescribing of all ingredients of parenteral nutrition, extremely rapid and accurate production of formulae and allows the computer storage of data about nutritional input to patients. The program is extremely simple in operation, and gives significant cuts in lag time between prescription and the commencement of the new formula.

ISSN:0148-6071    

DOI:10.1177/014860717800200505

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860717800200506

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

The treatment for acute mechanical intestinal obstruction is a timely operation. A select group of patients may, however, be nutritionally supported with continual administration of elemental diet proximal to long tube decompression under two sets of circumstances: 1. while awaiting spontaneous or treatment‐induced resolution of the underlying process, and 2. while reversing catabolism during evaluation prior to operation. Eleven patients with chronic intermittent bowel obstruction were studied: six with obstruction involving radiated small bowel, three with an acute exacerbation of chronic inflammatory bowel disease, one with obstruction secondary to an intra‐abdominal phlegmon and one with a segmental motility problem. They received nutritional support with continual gastrointestinal administration of elemental diet proximal to long tube decompression after initial observation for signs or symptoms of altered intestinal viability and stabilization of fluid and electrolyte status. Six of the 11 patients eventually required operation. All patients maintained body weight and three gained weight. Mean nutritional input was 1,873 calories and 12.6 gm nitrogen/day. There were no complications related to the technique of proximal feeding and distal decompression because of careful patient selection and appropriate administration of elemental diet under carefully controlled guidelines.

ISSN:0148-6071    

DOI:10.1177/014860717800200507

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

In six patients, the phagocytic and catabolic functions of the RES (reticuloendothelial system), as measured by using125I‐micro‐aggregated human serum albumin as a test substance, were not affected by Intralipid infusion. The nitroblue tetrazolium (NBT) reduction of granulocytes, the NBT reduction and the bac‐plasma, was significantly lower in eight patients during Intralipid infusion than before this treatment. When heat‐killedE. coliwere added for phagocytic stimulationin vitro, the same result was obtained only in the absence of plasma. The bactericidal capacity of granulocytes was significantly decreased in six patients during Intralipid infusion. When Intralipid was addedin vitroto granulocytes, the NBT reduction, and the bactericidal capacity of these cells were decreased and the effect was mainly dose‐dependent. Electron micrographs show that granulocytes phagocytize Intralipid. The loading of granulocytes with lipid particles may block the engulfment of bacteria and may be a reason for the decreased bactericidal capacity of these cells. An influence exerted by the lipid on the cell membrane is the most conceivable reason for the decreased NBT reduction.

ISSN:0148-6071    

DOI:10.1177/014860717800200508

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

Over a 7 1/2‐year period, 94 cancer patients presenting considerable operative risk were managed by total parenteral nutrition (TPN). All were nutritionally depleted, had obstruction to the gastrointestinal tract or had postoperative complications such as enterocutaneous fistulas, evisceration or intra‐abdominal sepsis, which left TPN as the only means of achieving anabolism. When TPN was started preoperatively and continued postoperatively (28 patients–‐Group 1), no deaths or significant complications occurred. When TPN was first started after life‐threatening complications had occurred (58 patients–‐Group 2), the mortality was 17.2%, so that a high incidence of recovery was achieved. When TPN was used in inoperable cachectic patients (8 patients–‐Group 3) to enable them to tolerate radiotherapy or chemotherapy, the mortality was 37.5%. This latter group is small, but TPN is worthwhile in selected patients where significant palliation and improvement in the quality of life can occur. With careful technique, risk of sepsis with TPN was no greater than in noncancer patients.

ISSN:0148-6071    

DOI:10.1177/014860717800200509

出版商:SAGE Publications    

年代:1978

数据来源: WILEY

摘要:

Malnutrition is a recognized problem in cancer patients. It remains to be determined whether nutritional support can prevent or delay the onset of nutritional deterioration which is usually associated with an increased susceptibility to infectious disease and poor response to therapy. In the present study, well‐nourished breast cancer patients undergoing chemotherapy have been followed for 3 to 12 months to determine the effects of nutritional support on their nutrient intake, nutritional status, immune function and disease state. For the present, eight patients have been given a nutritional supplement (S–‐Isocal or Sustacal) to be taken along with self‐selected regular foods and nine patients were maintained on self‐selected regular foods only (US). Information was obtained on a regular basis concerning dietary intakes. Records of taste and appetite changes and GI complaints were kept along with weights and estimates of protein intake. The differences between the S and the US groups have been: 1. The S group met their protein allowance according to the RDA and the US group did not; 2. The S group reported fewer taste abnormalities and the US group reported strong tastes and desires for cold, sweet, protein free drinks; 3. Immune competency improved in one S patient and deteriorated in one US patient; and 4. Mid‐arm muscle circumferences increased or remained the same in six S patients and decreased in 7 US. One might reasonably expect that this continued course of dietary pattern in the US group, deficient protein intake, would lead to nutritional deterioration.

ISSN:0148-6071    

DOI:10.1177/014860717800200510

出版商:SAGE Publications    

年代:1978

数据来源: WILEY