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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malnutrition in surgical patients is associated with an increased incidence of postoperative mortality and morbidity. Preoperative nutritional support has been shown to be efficacious in reducing the incidence of these complications, although the postoperative complication rate in these patients continues to be greater than in their wellnourished counterparts. This study attempts to determine whether the postoperative course can be either influenced by or predicted from the preoperative response to nutritional support. Thirty-two patients with nutritional depletion who received an average of 1 week of total parenteral nutrition prior to a major abdominal operation were studied. These patients were followed for postoperative complications. Of the 16 patients who exhibited the characteristic response to early nutritional support, diuresis of the expanded extracellular fluid compartment with a resultant loss of weight (127.9 +/- 5.7 to 124.6 +/- 5.8 (SEM) lbs, p less than .001) and rise in serum albumin (3.21 +/- 0.14 to 3.46 +/- 0.15 gms%, p less than 0.001), only one developed a complication in the postoperative period. The other 16 patients did not exhibit this response. They retained additional fluid, gained weight (119.3 +/- 8.1 to 121.3 +/- 8.2 lbs, p less than .025), and showed a decrease in serum albumin levels (3.14 +/- 0.14 to 3.00 +/- 0.14%), p less than 0.01). Eight of these patients developed a total of 15 postoperative complications (p less than 0.01). This study demonstrates that the response to preoperative TPN is an important factor in assessing operative risk and morbidity. The need to individualize preoperative nutritional support and the timing of surgical intervention is clearly demonstrated.
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PMID:The response to TPN. A form of nutritional assessment. 641 93

Using the method of Capella and Kaufman, the authors propose an original cryopreservation technique of human corneas. Sixty biomicroscopically normal corneas were obtained from cadavers (50-70 years) within six hours after death. Initial protocol involves four phases: 1) cryoprotection is carried out in three baths of three minutes each with human plasma and DMSO (dimethylsulfoxide) at 2-4-7%; 2) freezing is performed with 10 ml of the final cryoprotective fluid in a controlled rate freezer, the "Minicool" (CFPO). The cornea is cooled at a rate of 2 degrees C/min from + 6 degrees C down - 40 degrees C then at 5 degrees C/min down - 140 degrees C; 3) a tank containing liquid nitrogen at - 150 degrees C is used for a long term storage; 4) thawing is carried out in a water-bath at 37 degrees C for one minute, then in serum albumin 25% for three minutes and in M-K medium for thirty minutes. Effects of three cryobiological parameters are studied: cryoprotection: DMSO is diluted with human plasma at the following increasing concentrations: 2-4-7% or 4-6-10%; freezing medium: the cornea is frozen with or without the final cryoprotective bath. Thus freezing is carried out either in dry or liquid phase; thawing: initial temperature and the osmolar decrease of the dilution are modified in order to obtain four protocols: n degrees 1, initial protocol; n degree 2, an additional step using Hanks 5% - SA 25% for three minutes (1 000 mosm); n degree 3, after initial step reheating the cornea is directly placed in M-K medium; n degree 4, temperature of 50 degrees C for ten seconds precedes the initial protocol. For each protocol change, the endothelial viability is controlled by histological and/or SEM studies results: For each protocol change, the endothelial viability is controlled by histological and/or SEM studies results: cellular osmotic lesions are greater for DMSO concentrations of 10%; dry phase freezing induces more intense and more diffuse nuclear damage than in liquid phase; thawing under protocols 4 and 2 cause a high degree of nuclear damage associated with diffuse cytoplasmic vacuole formation. Histological and SEM studies clearly show endothelial cell lesions due to the cryoconservation. The human cornea endothelium is affected by any modification of the cryobiological parameters.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Corneal cryopreservation in man: a proposal for an original technic]. 649 Nov 71

Female CBA/H-T6T6 mice were given daily i.p. injections of 1 ml of saline containing 250 mg of human serum albumin (HSA) for 7 consecutive days. Control mice received the same volume of saline only. At approximately 24 hourly intervals for the 10 days after the first injection, groups of mice (3 HSA and 1 saline-injected) were killed and kidney tissue was taken for light (LM) scanning (SEM) and transmission (TEM) electron microscopy. Small numbers of glomeruli with Bowman's space filled with protein and fine, radially-disposed casts in collecting tubules were observed by LM. SEM revealed focal changes in both endothelium and epithelium, and in a few cases severely damaged epithelial cells were seen. TEM showed numerous small regions of loss or change in shape of foot processes. Epithelial cell branches became increasingly swollen. By the third day after the last injection glomerular morphology appeared to have returned to normal. Although the cause of the proteinuria was attributed to the effects of HSA-induced increased blood viscosity, the focal distribution of the observed morphological changes remains unexplained.
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PMID:Morphological changes in the kidneys of mice with proteinuria induced by albumin-overload. 661 9

We have studied the gallbladder and its contents by ultrasonography in 31 patients with acute viral hepatitis and 23 age-matched controls. Liver cell necrosis was assessed by raised transaminase levels within 24-48 hr of ultrasonography in all patients. Gallbladder wall (GBW) measured 5.16 +/- 0.4 mm (mean +/- SEM) in patients and 2.0 +/- 0.06 mm in controls (P less than 0.001). GBW was thickened (greater than 3 mm) in 21 patients (68%), with double wall appearance in 5 (16%), and sludge was seen in the gallbladder cavity in 7 (23%). GBW thickness was significantly related to serum albumin (r = -0.45, P less than 0.01) and bilirubin (r = 0.50, P less than 0.004), but not to the serum transaminase levels. On repeat measurements after recovery in 13 patients, GBW thickness fell from 5.84 +/- 0.49 mm during acute hepatitis to 2.46 +/- 0.21 mm (P less than 0.001).
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PMID:Gallbladder abnormalities in acute infectious hepatitis. A prospective study. 669 64

This prospective study evaluated host resistance in a surgical population who walked into the hospital for elective surgery. Patients were stratified into Hospital Reactive (HR, n = 19) if they reacted to two or more of five recall skin test antigens and Walk-in Anergic (WA, n = 26) if they did not react to the antigens. The WA patients were slightly older (74.4 +/- 1.8 years, +/- SEM versus 66.7 +/- 2.7 p less than 0.05). Diagnosis in the HR and WA group were: tumors 13/19 versus 21/26, diverticulitis 3/19 versus 0/19, and miscellaneous 3/19 versus 5/26. Twenty-five laboratory normal controls (LN) were also studied. There were no significant differences in the following parameters between the HR and WA groups: stage of disease; hemoglobin; circulating leukocyte count; polymorphonuclear cell counts; total lymphocyte counts (both groups lower than LN, p less than 0.05), monocyte counts (both higher than LN, p less than 0.05); per cent E-rosettes and lymphocyte blastogenesis to mitogens (phytohemagglutinin, concanavalin-A) and antigens (purified protein derivative and tetanus); phagocytosis of preopsonised Staphylococcus aureus 502A, at 5, 10, and 20 minutes; alpha, beta, and gamma globulins; C3, and total hemolytic complement (CH50) levels; C-reactive protein; and ANA and DNA levels. The HR group demonstrated an increase in the rate of killing of Staphylococcus 502A at 10, 20, 40, and 80 minutes compared to the LN group but the WA group did not show this augmentation (p less than 0.001). The serum albumins were: LN = 4.46, HR = 3.98, WA = 3.43 g/dl (p less than 0.05). Degree and duration of surgery was the same in the HR and WA groups. There were no major sepsis episodes (bacteremia or proven intracavitary abscess) in the HR patients versus 25% in the WA patients (p less than 0.05). There was one death (6%, pulmonary embolus) in the HR group and 8 (40%) in the WA group (p less than 0.05). Antibiotic prophylaxis was equal but the WA patients received therapeutic antibiotics more frequently (65% versus 11% p less than 0.05). Of all the host immunocompetence tests measured in this study, the delayed type hypersensitivity skin test response and the serum albumin were variables abnormal between the survivors and those who died.
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PMID:The walk-in anergic patient. How best to assess the risk of sepsis following elective surgery. 671 20

In 10 patients with active gastroenterological disease and protein-malnutrition (weight: 77.3 +/- 2.6 (mean +/- SEM) percent of ideal body weight, serum-albumin levels: 2.59 +/- 0.17 mg/100 ml) a randomized crossover study was performed to assess the effects of two energy:nitrogen ratios on body cell replenishment. After at least 3 days for equilibration, the total parenteral nutrition (TPN) study carried out with 354 +/- 5 mg of casein hydrolysate-nitrogen/kg/day, divided in two 7-day periods during which two nonprotein calorie supplies of 47 +/- 1 kcal/kg/day and 81 +/- 4 kcal/kg/day were given. The same 50 +/- 5% dextrose and fat emulsion energy sources were used in the two periods. Nitrogen (Kjeldahl method) and potassium retention, and weight and serum albumin concentration gains were all significantly better (Student t test) during the hypercaloric regimen than during the normocaloric regimen. In the 10 patients, the protein-sparing effect of nonprotein calories "added" during the hypercaloric regimen was demonstrated and represented 17% of the constant infused nitrogen. The more catabolic patient was prior to TPN, the more energy-dependent was the protein-sparing effect observed (r = +0.638). Preliminary data obtained with 3-methylhistidine urine determination suggests that the protein-sparing effect of "added" calories was due to an increased protein synthesis. Finally, body cell replenishment was better with the higher 230 +/- 6 energy:nitrogen ratio than with the lower 132 +/- 4 energy:nitrogen ratio, which suggests that the hypercaloric TPN regimen was useful in such patients.
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PMID:Effects of two energy: nitrogen ratios in patients with gastroenterological disease and malnutrition. 677 8

Bilirubin diglucuronide (BDG) may be formed in vitro by microsomal UDP glucuronosyl transferase (EC 2.4.1.17)-mediated transfer of a second mole of glucuronic acid from UDP-glucuronic acid, or by dismutation of bilirubin monoglucuronide (BMG) to BDG and unconjugated bilirubin, catalyzed by an enzyme (EC 2.4.1.95) that is concentrated in plasma membrane-enriched fractions of rat liver. To evaluate the role of these two enzymatic mechanisms in vivo, [(3)H]bilirubin mono-[(14)C]glucuronide was biosynthesized, purified by thin-layer chromatography, and tracer doses were infused intravenously in homozygous Gunn (UDP glucuronyl transferase-deficient) rats or Wistar rats. Bilirubin conjugates in bile were separated by high-pressure liquid chromatography and (3)H and (14)C were quantitated. In Gunn rats, the (14)C:(3)H ratio in BDG excreted in bile was twice the ratio in injected BMG. In Wistar rats the (14)C:(3)H ratio in biliary BDG was 1.25 +/- 0.06 (mean +/- SEM) times the ratio in injected BMG. When double labeled BMG was injected in Wistar rats after injection of excess unlabeled unconjugated bilirubin (1.7 mumol), the (14)C:(3)H ratio in BDG excreted in bile was identical to the ratio in injected BMG. Analysis of isomeric composition of bilirubin conjugates after alkaline hydrolysis or alkaline methanolysis indicated that the bile pigments retained the IX(alpha) configuration during these experiments. The results indicate that both enzymatic dismutation and UDP glucuronyl transferase function in vivo in BDG formation, and that dismutation is inhibited by a high intrahepatic concentration of unconjugated bilirubin. This hypothesis was supported by infusion of [(3)H]bilirubin-monoglucuronide in isolated perfused homozygous Gunn rat liver after depletion of intrahepatic bilirubin by perfusion with bovine serum albumin (2.5%), and after bilirubin repletion following perfusion with 0.34 mM bilirubin. From 20 to 25% of injected radioactivity was recovered in BDG in bile in the bilirubin-depleted state; only 8-10% of radioactivity was in BDG in bile after bilirubin repletion. After infusion of [(3)H]bilirubin di-[(14)C]glucuronide in homozygous Gunn rats, 5-7% of the injected pigment was excreted in bile as BMG. The (14)C:(3)H ratio in the injected BDG was 10% greater than the (14)C:(3)H ratio in BMG excreted in bile. These results indicate that in vivo, dismutation rather than partial hydrolysis, is responsible for BMG formation. Incubation of [(3)H]bilirubin, BDG and a rat liver plasma membrane preparation resulted in formation of BMG (3.3 nmol/min per mg protein) indicating that dismutation is also reversible in vitro.
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PMID:Bilirubin diglucuronide formation in intact rats and in isolated Gunn rat liver. 680 Oct 91

Serum zinc concentrations and urine zinc excretion have been studied in 10 patients with severe Crohn's disease before and during 59 patient-weeks of intravenous nutrition. Before serum zinc concentrations (9.9 +/- 1.0 mumol/l: mean +/- SEM) and urine zinc excretion (3-3 +/- 0.6 mumol/24h) were less than controls (p less than 0.01). No patients had clinical signs of zinc deficiency before intravenous nutrition and none developed signs during it. There was no overall change in serum zinc concentrations, despite improvements in body weight, skinfold thickness, and mid-arm circumference in all patients, and increased serum albumin and serum transferrin concentrations during all but two periods of intravenous nutrition. Nor was there any relationship between serum zinc concentrations and zinc uptake (up to 220 mumol/day), serum zinc concentrations remaining significantly lower than control levels. Urine zinc excretion during the first week of intravenous nutrition showed a 1.2 to 53-fold increase (mean 11-fold) over pre-intravenous nutrition levels, and a positive relationship was demonstrated between zinc intake and urine zinc excretion. It is suggested that zinc supplied by the intravenous route is inefficiently transported to the tissues, and that some is excreted in the form of small molecular weight chelates into urine. Recommendations are made for the supply of intravenous zinc, based on monitoring urine zinc excretion in individual patients.
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PMID:Clinical experience of zinc supplementation during intravenous nutrition in Crohn's disease: value of serum and urine zinc measurements. 681

Skeletal muscle function and standard nutritional assessment parameters were measured in six obese patients. Base-line measurements were made on a weight-maintaining diet, and further measurements after 2 wk of a 400-cal diet, followed by 2 wk of fasting and then after 2 wk of refeeding. The function of the adductor pollicis muscle was assessed by electrical stimulation of the ulnar nerve. The objective parameters of muscle function measured were: 1) force of contraction expressed as a percentage of the maximal force obtained with electrical stimulation at 10, 20, 30, 50, and 100 Hz. 2) Maximal relaxation rate expressed as percentage force loss/10 ms. 3) Endurance expressed as percentage force loss/30 s. Standard nutritional assessment parameters (serum albumin and transferrin, creatinine height index, anthropometry and total body nitrogen and potassium) were also measured. There was a significant increase in the force of contraction at 10 Hz from a base-line of 29.6 +/- 1.0% to 49.0 +/- 2.8% (mean +/- SEM) after 2 wk of a 400-cal diet (p less than 0.01). These was a significant slowing of the maximal relaxation rate from a base-line of 9.8 +/- 0.03% force loss/10 ms to 8.2 +/0 0.3% force loss/10 ms (mean +/- SEM) (p less than 0.01) after 2 wk of a 400-cal diet. After a further 2 wk of fasting these abnormalities in muscle function persisted. There was a significant increase in muscle force loss from a base-line of 3.9 +/- 0.8% force loss/30 s to 13.7 +/- 3.4% force loss/30 s (mean +/- SEM) after fasting (P less than 0.01). After 2 wk of refeeding all aspects of muscle function measured were normal. During the study the standard nutritional assessment parameters did not change significantly.
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PMID:Skeletal muscle function during hypocaloric diets and fasting: a comparison with standard nutritional assessment parameters. 684 74

Mitochondria were isolated from the hepatopancreas of the Florida spiny lobster Panulirus argus using a high osmolarity medium containing 600 mM mannitol, 83 mM sucrose, 5 mM 4-morpholinepropanesulfonic acid, pH 7.6, 0.5% bovine serum albumin (BSA), and 1 mM EDTA. O2 uptake and Ca2+ transport were measured by electrode methods in similar media (plus 4 mM KPi, 3.3 mM MgCl2, and 0.67 mg/ml BSA, with 80 mM KCl replacing a portion of the osmotic support). Substrate-supported respiration was observed to be coupled to phosphorylation of ADP or uptake of Ca2+ ions. State 3 rates (nanogram atoms O X minute-1 X milligram protein-1 +/- SEM (N)) were: 49.2 +/- 3.9 (19), succinate; 30.9 +/- 3.9 (6), DL-palmitoyl carnitine; 29.0 +/- 2.7(9), L-malate; 40.0 +/- 2.3(3), L-glutamate; 27.7 +/- 2.2(5), D-3-hydroxybutyrate; and 26.4 +/- 2.4 (18), L-proline +/- pyruvate. alpha-Glycerol phosphate was not oxidized. Ca2+ uptake driven by succinate oxidation proceeded with Ca:O ratios of 4.0 +/- 0.2 (SEM). Hepatopancreas mitochondria were not uncoupled by Ca2+ uptake in excess of 1100 ng atoms X mg protein-1. Ca2+ efflux could be induced by ruthenium red, indicating the presence of an active Ca2+ cycle. These mitochondria may provide a favorable model system in which to study regulation of the Ca2+ cycle.
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PMID:Respiratory and calcium transport properties of spiny lobster hepatopancreas mitochondria. 687 Feb 85


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