Energy expenditure, nitrogen balance, and norepinephrine excretion after injury.

In this study we examine the effect of different hypocaloric nutritional regimens on nitrogen balance in patients following total hip replacement and compare it to that of normal subjects on strict bed rest. The interrelationship between nitrogen balance, energy expenditure, and urinary free norepinephrine excretion is analyzed with emphasis on the effects of nutrition on these relationships. Amino acid infusions following major elective orthopedic surgery had no nitrogen-sparing effect above that of 5% dextrose.

Metabolic consequences of hypercaloric glucose infusions.

Recent studies have demonstrated that an altered pattern of substrate mobilization and fuel utilization exists in patients who are acutely ill secondary to either injury or infection. These studies have important implications regarding the nutritional support of these patients. This review addresses some of the metabolic sequelae of total parenteral nutrition with hypertonic glucose as the primary source of non-protein calories.

Glycerol turnover and kinetics of exogenous fat in surgical patients.

In the United States, glucose has been until recently the sole non-protein energy substrate utilized in total parenteral nutrition (TPN). However, recent reports show that the administration of massive glucose loads to surgical patients cause a high incidence of pulmonary and hepatic complications. Indirect calorimetry data indicate that these hypermetabolic patients seem to utilize endogenous fat preferentially to carbohydrate.

The asthmatic airway response to inhaled antigen.

The airway response to inhaled antigen was measured in asthmatic patients at 5, 10 ad 20 minutes following bronchial challenges. The over-all frequency of positive responses in the 26 individual challenges was 27%. There were no significant differences between the 5-, 10- or 20-minute responses.

Increased body temperature secondary to total parenteral nutrition.

Administration of total parenteral nutrition (TPN) (glucose/amino acids), on the 2nd day after surgery, to a 26-year-old male with multiple fractures resulted in a rise in rectal temperature from 37.6 to 39 degrees C. Resting energy expenditure showed a sustained 23% increase when the nutritional intake was changed from 5% dextrose to TPN.

The effect of carbohydrate intake on the lipolytic rate in depleted patients.

The effect of intravenous carbohydrate intake on glycerol turnover and fat metabolism was estimated in six nutritionally depleted surgical patients requiring total parenteral nutrition. Two diets were given. Nitrogen intake was the same in both diets.

Plasma clearance of fat emulsion in trauma and sepsis: use of a three-stage lipid clearance test.

Total parenteral nutrition (TPN) is now widely available, but there is a relatively little data relating to the optimal substrate support in different types of patients. In critically ill patients who require parenteral nutrition, underlying metabolic alterations will influence the capacity for substrate utilization; in them, fat emulsion may serve as a useful energy source but may also have deleterious effects. The intravenous fat tolerance test has been widely used as a measure of the capacity of the organism to clear exogenous fat from the bloodstream.

Effect of injury and sepsis on high-energy phosphates in muscle and red cells.

Changes in muscle high-energy phosphates in varying degrees of resting hypermetabolism were studied. Eleven patients were investigated before and 4 days after total hip replacement. The postoperative results were compared with those seen in major traumas and sepsis.

The vision of submariners and National Guardsmen: A longitudinal study.

This study was designed to differentiate among possible causes of an increased incidence of myopia and related symptoms among submariners by making a longitudinal comparison of the visual functions of two groups of subjects, submariners and National Guardsmen. Refractive error, visual acuity, phorias, accommodation, and depth perception were measured. Submariners showed statistically significantly greater losses in visual acuity, accommodation, and depth perception over a 3.

Muscle and plasma amino acids following injury. Influence of intercurrent infection.

The present study was undertaken to determine intracellular amino acid patterns in patients with multiple trauma, whether or not complicated by sepsis and during convalescence. A percutaneous muscle biopsy was performed three to four days following major accidental injury in ten patients and analyzed for muscle free amino acids. Venous blood was drawn at the time of the biopsy and analyzed for plasma free amino acids.

The effects of astigmatism on sensitivity to sinusoidal and square wave gratings.

Contrast thresholds for different spatial frequencies were measured for four individuals with optimum optical correction and with 2 D of astigmatism induced at various meridians. Sensitivity for sine waves of low spatial frequencies was unaffected by the astigmatism; however, gross changes were found at high spatial frequencies when the astigmatism was induced with the power meridian perpendicular to the orientation of the stripes. For square waves, the results were comparable at high spatial frequencies, but astigmatism also produced a decrement at 0.

Respiratory distress secondary to a high carbohydrate load: a case report.

The high carbohydrate load of total parenteral nutrition (TPN) caused a 67% increase in CO2 production which precipitated respiratory distress in the 59-year-old man reported on herein. TPN given inappropriately can serve as a physiological stress rather than nutritional support.

Respiratory changes induced by the large glucose loads of total parenteral nutrition.

Total parenteral nutrition (TPN) using glucose as nonprotein calories was associated with increases in O2 consumption (VO2) and CO2 production (VCO2). The magnitude of the changes was a function of the patient's clinical state and glucose load. Depleted patients showed a minimal increase in VO2, while VCO2 increased 23%.

Effects of respiratory apparatus on breathing pattern.

The effects of ventilatory apparatus on breathing pattern and gas exchange were studied in normal supine subjects. Using a canopy system, measurements of O2 consumption, CO2 production, tidal volume (VT), frequency (f), minute ventilation, mean inspiratory flow, and inspiratory, and expiratory time (TI and TE) were made and compared to data obtained with the use of a mask (m) and mouthpiece plus noseclip (mp + nc). Use of the m or mp + nc caused a 32.

Muscle and plasma amino acids after injury: hypocaloric glucose vs. amino acid infusion.

This study examines the effect of three different hypocaloric diets on the patterns of muscle and plasma amino acids in patients undergoing total hip replacement. Group I (seven patients) received 90 g/day of glucose, Group II (seven patients) received 70 g/day of amino acids, Group III (eight patients) received both 90 g of glucose and 70 grams of amino acids per day. Utilizing the percutaneous biopsy technique of Bergström, free amino acid patterns in muscle and plasma were analyzed pre- and postoperatively (day 4).

A comparison of diluent and methacholine challenge with spirometry and the body plethysmograph.

Bronchial reactivity to inhaled diluent and methacholine was determined for asthmatics using automated spirometry. These data were compared with challenge data from a matched group of asthmatics previously studied plethysmographically. High correlations were obtained between all indices both groups, suggesting that spirometry is adequate for the clinical characterization of the methacholine response.

Factor analysis of perceptual and cognitive abilities tested by different methods.

A battery of visual, perceptual, and cognitive tests, believed to be important for operation of visual sonar displays, was administered to 100 sonar technicians. The measures varied from standard paper-and-pencil tests to computer-administered perceptual tasks. The results of 33 different measures on these men were compiled and subjected to a factor analysis.

Use of the ventilatory equivalent to separate hypermetabolism from increased dead space ventilation in the injured or septic patient.

Normal subjects and surgical patients were studied with a noninvasive canopy-spirometer system which provides prolonged measurements of gas exchange and pattern of breathing. Values for normal subjects agreed with published values. Twenty-nine patients undergoing uncomplicated elective operation had a mean preoperative minute ventilation of 3.

Some metabolic effects of fat infusions in depleted patients.

Severely depleted surgical patients were given total parenteral nutrition, providing an average of 34.6 kcal and 266 mg nitrogen/kg body weight. Two diets were used, one with glucose as sole source of nonprotein energy, the other with a fat emulsion, Liposyn 10%, substituted isocalorically for one-third of the glucose.

Influence of total parenteral nutrition on fuel utilization in injury and sepsis.

Total parenteral nutrition with hypertonic glucose/AA solutions given to eighteen nutritionally depleted patients resulted in a rise in the respiratory quotient (RQ) from 0.83 to 1.05 (p less than .