Are events after endotoxemia related to circulating phospholipase A2?

Objective: The authors sought to determine whether the signs and symptoms of endotoxemia were related to the endotoxin-stimulated increase in circulating phospholipase A2 (PLA2) activity.

Background: Because hypotension and pulmonary injury have been associated with elevated PLA2 activity in septic shock and PLA2 levels are reduced with the administration of glucocorticoids, the PLA2 response to endotoxin was investigated in volunteers pretreated with and without hydrocortisone.

Methods: Carefully screened human subjects were studied under four conditions: (1) saline, (2) hydrocortisone, (3) endotoxin, and (4) hydrocortisone administration before endotoxin exposure.

Anabolic therapy with growth hormone accelerates protein gain in surgical patients requiring nutritional rehabilitation.

Objective: The authors investigated the effects of exogenous growth hormone (GH) on protein accretion and the composition of weight gain in a group of stable, nutritionally compromised postoperative patients receiving standard hypercaloric nutritional therapy.

Summary Background Data: A significant loss of body protein impairs normal physiologic functions and is associated with increased postoperative complications and prolonged hospitalization. Previous studies have demonstrated that standard methods of nutritional support enhance the deposition of fat and extracellular water but are ineffective in repleting body protein.

Patients receiving glutamine-supplemented intravenous feedings report an improvement in mood.

Nutritional effects have traditionally focused on outcomes, such as nitrogen balance, wound healing, or muscle strength. Little emphasis has been placed on how biochemical or physical improvements translate into functional changes as perceived by the patient. Because glutamine (GLN)-supplemented nutrition promotes protein synthesis and improves nitrogen balance, we assessed the mood of individuals participating in a randomized controlled blinded trial receiving GLN solutions.

Elaboration of interleukin 1-receptor antagonist is not attenuated by glucocorticoids after endotoxemia.

The body's response to infection/inflammation is initiated by the elaboration of cytokines, such as tumor necrosis factor, interleukin 1-beta (IL-1-beta), IL-6, and IL-8. Cytokines, in turn, stimulate the pituitary-adrenal axis, and it has been suggested that the corticosteroids elaborated serve as negative feedback signals to diminish inflammatory events. To test this hypothesis, we administered hydrocortisone shortly before endotoxin administration to normal volunteers.

Identifying body fluid distribution by measuring electrical impedance.

The effects of critical illness on extracellular water (ECW) and total body water (TBW) were measured using (1) a multiple dilutional technique, and (2) whole body and regional bioelectrical impedance analysis (BIA) in a group of stable patients. Total body water and body resistance (R) were similar in patients when compared with normal healthy subjects (TBW: 45.1 +/- 4.

Growth hormone attenuates the abnormal distribution of body water in critically ill surgical patients.

Background: Catabolic illness is associated with fluid retention and extracellular space expansion. To determine the effect of human growth hormone (GH) on body water compartments, critically ill surgical patients were studied for a 2-week period during which they either continued to receive standard intensive care unit support, or in addition, received GH, 10 mg/day.

Methods: Body water compartments were measured at the beginning and end of the period by the indicator dilution technique with sodium bromide and heavy water used as the indicators of extracellular (ECW) and total body water (TBW), respectively; intracellular water (ICW) was calculated by subtraction.

Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study.

Objective: To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation.

Design: Double-blind, randomized, controlled clinical trial.

Setting: University teaching hospital.

Insulin-like growth factor-I response is comparable following intravenous and subcutaneous administration of growth hormone.

Subcutaneous (sq) administration of recombinant human growth hormone (r-hgh) has an anabolic effect and increases systemic insulin-like growth factor (IGF-I) in surgical patients. IGF-I is a mediator of growth hormone (gh) anabolic effects. To determine the effect of intravenous (iv) administration of r-hgh on systemic IGF-I, 11 patients were given 14 1-week courses of daily 8-hr infusions of r-hgh (10 mg in 500 ml D5W).

Glutamine-enriched intravenous feedings attenuate extracellular fluid expansion after a standard stress.

A double-blind, randomized controlled trial was performed to determine the effect of glutamine (GLN)-enriched intravenous feedings on the volume and distribution of body fluids in catabolic patients. Subjects with hematologic malignancies in remission underwent a standard treatment of high-dose chemotherapy and total body irradiation before bone marrow transplantation. After completion of this regimen, they were randomized to receive either standard parenteral nutrition (STD, n = 10) or an isocaloric, isonitrogenous nutrient solution enriched with crystalline L-glutamine (0.

Alterations in body fluid content can be detected by bioelectrical impedance analysis.

The electrical resistance across the whole body and its segments to the conduction of a weak alternating current was determined in human subjects under three different conditions: (1) during bed rest, (2) during infusion of 1 liter of saline, and (3) during donation of 1 unit of blood. During bed rest, extracellular and total body water were measured by dilution of bromide and heavy water, respectively. Electrical resistance obtained from electrodes placed on proximal portions of extremities ("proximal resistance") accounted for less than 50% of that determined by electrodes positioned on routinely used portions of a hand and foot ("whole body resistance").

Impedance electrodes positioned on proximal portions of limbs quantify fluid compartments in dogs.

Body resistance and reactance to the conduction of an alternating electrical current were measured using electrodes attached to distal and proximal portions of limbs in anesthetized dogs. Body impedance was calculated from these measurements obtained at 30-min time intervals during a control period and after intravenous administration of 0.9% saline.

Synthesis, mechanism of action, and biological evaluation of mitosenes.

Mitosenes of both the pyrrolo- and pyrido[1,2-a]indole type have been prepared via modification of these heterotricyclic compounds. Several mitosenes have been studied for their reactions with nucleophiles under reductive conditions. The results of these experiments show that the biological activity of mitosenes is based on the mechanism of bioreductive activation.