摘要:

Severe trauma leads to considerable losses of nitrogen in the first days after the accident. As nutritional efforts cannot reduce these losses sufficiently, an adjunctive therapy using the anabolic steroid nandrolone decanoate (Nd) was applied. In a double‐blind study 10 male multiple‐traumatized patients each received 50 mg of Nd on day 3 and 25 mg of Nd on day 6 after the trauma, an additional 10 patients received placebo only. Both groups had identical nutritional support. Nitrogen balance, total nitrogen excretion as well as plasma amino acid concentration, and urine amino acid excretion were measured daily. The anabolic agent improved the nitrogen balance mainly by reducing nitrogen excretion. 3‐Methylhistidine excretion and renal amino acid losses were decreased. Nandrolone decanoate increased the concentration of total plasma amino acids. The underlying principle seems to be an amino acid‐saving mechanism with a renal site of action. It is shown that in the early posttraumatic period nandrolone decanoate improves nitrogen metabolism. Further studies are required to determine whether this offers a clinical benefit to trauma patients.

ISSN:0148-6071    

DOI:10.1177/0148607190014002111

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

In a previous study, we analyzed the roles of the estimated basal energy expenditure (EBEE) calculated by the Harris‐Benedict equation, caloric intake (CI), total burn surface area (TBSA), body temperature (Temp) and number of post‐burn days (PBD) in order to estimate the resting energy expenditure (EE) of burn patients. By multiple regression analysis we found that the measured EE (MEE) is best approximated by the following formula: ‐4343 + (10.5 x %TBSA) + (0.23 x CI) + (0.84 x EBEE) + (114 x Temp (degree C)) ‐ (4.5 x PBD), r = 0.82, p less than 0.001, (Toronto formula (TF)). To validate this, 10 patients with a mean TBSA of 49.1 +/‐ 5.5% had their resting MEE done by indirect calorimetry when fed either by the TF or by 2 x EBEE. The caloric intake when on 2 x EBEE was 3260 +/‐ 45 kcal/day which significantly exceeded the MEE (2765 +/‐ 101 kcal/day, p less than 0.001). The caloric intake when on the TF was 2542 +/‐ 52 kcal/day and matches the MEE which was 2537 +/‐ 86 kcal/day (NS). These results show that the TF matches the MEE very closely. With the addition of a factor of activity for the 24‐hr EE, it can be used to accurately feed individual burn patients.

ISSN:0148-6071    

DOI:10.1177/0148607190014002115

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

In cancer patients controversy exists as to the nature of changes in resting metabolic rate (RMR) and their contribution to cachexia. This study describes the fasting indirect calorimetry, and nutritional measurements made on a homogeneous group of Black patients with carcinoma of the esophagus. It compares them with a reference group. All cancer patients had localized disease and were markedly malnourished. They were on average 20 to 25% lighter than reference subjects. In the cancer patients, the triceps skinfold thickness (TSF) in mm and the hand grip strength in kg/m2, mean and SD, were, respectively, 7.3 +/‐ 2.8 and 28 +/‐ 6 for men and 12 +/‐ 5 and 22 +/‐ 3.5 for women, and were significantly lower than those of the reference subjects. Fat‐free mass was calculated from the TSF measurements. In men with cancer RMR (6.06 MJ/day +/‐ 0.56) was significantly lower than the reference subjects values (7.07 MJ/day +/‐ 0.64) p = 0.002. In women with cancer RMR was on average 2 MJ/day less than in controls but this difference failed to reach significance. However, when expressed per kg fat free mass, or per kg body weight this difference is no longer apparent the RMR being 0.14 MJ/kg/fat free mass in both groups. Our interpretation is that there is no direct effect of the tumour on RMR and that energy expenditure changes are secondary to body composition changes.

ISSN:0148-6071    

DOI:10.1177/0148607190014002119

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

In two experiments, treatment of tumor‐bearing (TB) rats with the glutamine antimetabolite, acivicin, reduced tumor growth during 14 days of total parenteral nutrition (TPN) that supplied 120% and 130% of the nutritional intake of non‐TB control rats. The acivicin treatment or combination of acivicin with TPN produced increased carcass weights and decreased tumor/carcass ratios. Significant muscle saving was observed in TB rats receiving TPN or TPN and acivicin as compared to acivicin‐treated TB rats maintained on rat chow. Tumor growth was not stimulated by TPN at 130% of ad libitum. intake with a calorie/nitrogen ratio of 102:1. However, when the calorie/nitrogen ratio was increased to 143:1, tumor growth was increased by TPN at 120% of ad libitum. intake. These results suggest that acivicin may prove useful in the stabilization of tumors in situations where tumor growth may be stimulated, such as during TPN.

ISSN:0148-6071    

DOI:10.1177/0148607190014002122

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Body composition was measured in 112 surgical patients and eight normal subjects by bioelectrical impedance analysis (BIA), and the results compared with our standard five‐compartment method utilizing in vivo neutron activation analysis and tritium dilution space to measure fat‐free mass and total body water. In a population with a mean fat‐free mass of 49.2 kg by the latter method, BIA underestimated fat‐free mass by 1.3 kg, with a standard deviation (SD) of 4.0 kg. Total body water was overestimated by 0.5 liter, with SD of 0.47 liter, when compared to a mean tritium dilution space of 36.7 liter. Changes in total body water which occurred over a treatment period of at least 1 week were also measured by the two methods. The change as measured by isotopic dilution could be estimated from the change as measured by BIA with a standard error of 2.25 liter. Although the results suggest that BIA should not be used as a research tool, it is concluded that in clinical practice, when nutrient requirements are being estimated, fat‐free mass measured by BIA may have a useful place.

ISSN:0148-6071    

DOI:10.1177/0148607190014002129

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

To evaluate the efficacy of nonglucose energy substrates in promoting nitrogen retention and survival in stressed states, two series of studies were done. In study 1, 50 rats underwent cecal ligation/perforation and subsequent infusion for 24 hr with one of four isocaloric (220 kcal/kg/day), isonitrogenous (1.4 g/N/kg/day), isovolemic regimens which differed in caloric source: Glucose (GLU) + long‐chain triglycerides (LCT) (50%:50%), GLU + LCT + medium‐chain triglycerides (MCT) (50%:32%:18%), GLU + LCT/Carnitine (10 mg/dl) or GLU + LCT + Xylitol (XYL) (33%:33%:33%). The nitrogen‐sparing effect of GLU + LCT was not enhanced by the addition of carnitine to facilitate LCT mitochondrial uptake or by MCT to bypass carnitine‐dependent transport. In contrast, relative to GLU + LCT GLU + LCT + XYL decreased urinary 3‐methylhistidine (3MH) excretion (p less than 0.01), and enhanced nitrogen retention (p less than 0.01 vs GLU + LCT). For study 2, 24 male rats were anesthetized, cannulated for TPN, and given a 25% burn. They were then randomized into three dietary groups. The diets were isocaloric (103 kcal/kg/day) and isonitrogenous (2.0 g N/kg/day) but differed in nonprotein calorie source: GLU + LCT (51%:49%), GLU + Glycerol (51%:49%) and XYL + LCT (51%:49%). As in the septic animals, N balance was best with the xylitol regimen (p less than 0.01). The polyol, xylitol, appears to have a significant nitrogen sparing effect in stressed animals.

ISSN:0148-6071    

DOI:10.1177/0148607190014002134

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Metabolic bone disease occurs in patients receiving prolonged home total parenteral nutrition (HTPN). We studied bone‐mass status in 10 patients (seven males, three females, age 19–66 years) who had been receiving HTPN for 0 to 67 months (mean 24 months), mostly for short‐bowel syndrome. Four patients had spinal osteoporosis on radiograms. The density of various bone components at the wrist was measured noninvasively using a novel technique based on Compton scattering effect. The density of the cancellous and cortical bone was decreased in nine and six patients, respectively. During a follow‐up period of up to 19 months, a further significant decrease in the density of both bone components was found. We conclude that prolonged HTPN is associated with an ongoing bone diminution, affecting mainly the cancellous bone.

ISSN:0148-6071    

DOI:10.1177/0148607190014002139

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Fifty‐eight episodes of catheter‐related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram‐positive cocci, 25% were Gram‐negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram‐negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram‐positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase‐negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram‐negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter‐related infections caused by coagulase‐negative staphylococcus.

ISSN:0148-6071    

DOI:10.1177/0148607190014002143

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

A 7‐year experience with home parenteral nutrition (HPN) in 35 children and adolescents suffering from severe gastrointestinal diseases is reported. The average duration of HPN was 577 days with a mean of 2.9 catheters per patients. There was a total of 82 episodes of proven catheter‐related sepsis, an average of 1.5 septic episodes per patient year. In about half of these instances, the catheter had to be removed. Coagulase‐negative and ‐positive staphylococci were the most common organisms isolated. All four Candida infections led to removal of the catheter. Children requiring HPN from early infancy had a higher frequency of catheter‐related infections than those started on HPN after the first year of life. In four cases, clinically significant thrombotic complications occurred. The results suggest that even under optimal conditions of catheter placement and with extensive education in aseptic catheter handling, infection is still relatively common in children receiving HPN. However, there was no mortality related to this complication.

ISSN:0148-6071    

DOI:10.1177/0148607190014002148

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems associated with insertion. Although cardiac arrhythmia has been acknowledged as a possible complication, its incidence has never been quantified. We performed cardiac monitoring on patients during 51 central venous catheter insertions or exchanges to determine the incidence of cardiac arrhythmias during guidewire insertion. Forty‐one percent of procedures resulted in atrial arrhythmias and 25% produced some degree of ventricular ectopy, 30% of these were ventricular couplets or greater. Ventricular ectopy was significantly more common in shorter patients (160 +/‐ 8 vs 168 +/‐ 11 cm, p less than 0.05) and when the catheter was inserted from the right subclavian position (43% ventricular ectopy vs 10% at the other sites). Other variables such as age, cardiac history, serum potassium, type of procedure, and catheter brand were not significant. It is our conclusion that over‐insertion of the wire causes this cardiac stimulation. Despite the absence of morbidity or mortality in this study, this incidence of ventricular ectopy indicates that there is a distinct possibility of a malignant arrhythmia being precipitated by a guidewire. Some modification of the current protocol for these procedures seems indicated.

ISSN:0148-6071    

DOI:10.1177/0148607190014002152

出版商:SAGE Publications    

年代:1990

数据来源: WILEY