Stimulation of oxidative drug metabolism by parenteral refeeding of nutritionally depleted patients.

To determine whether intravenous nutritional repletion can influence oxidative drug metabolizing capacity, antipyrine metabolism was studied in 6 malnourished patients on the second day of a 2-day baseline period and on the last day of two sequential, 8-day intravenous nutritional repletion periods. During the baseline period they received 5% dextrose, 440 kcal per day, intravenously. During the repletion periods they received 20 mg of nitrogen per kilocalorie of baseline resting energy expenditure and, in random order, dextrose to provide a total caloric intake of either 0.

Effect of routine intensive care interactions on metabolic rate.

The alterations in metabolic (oxygen consumption [VO2] and carbon dioxide production [VCO2]) and hemodynamic (heart rate and blood pressure) parameters caused by various common intensive care activities were examined in a group of 23 mechanically-ventilated critically-ill patients. The observed variations in metabolic rate can be classified into four categories as follows: (a) the lowest energy expenditure, which was associated with sleeping in the majority (83 percent) of instances; (b) resting, which was defined as a state where the patient was lying motionless with eyes open and responding to surrounding events, where VO2 and VCO2 averaged 9.1 +/- 7.

Abdominal aortic cross-clamping. Metabolic and hemodynamic consequences.

We address the question of whether an oxygen debt develops during a period of abdominal aortic cross-clamping that may explain observed hemodynamic changes. Group 1 received morphine sulfate (1 mg/kg) during induction of anesthesia. Group 2 received same dose of morphine sulfate.

Chemotherapy for metastatic non-small cell bronchogenic carcinoma: cyclophosphamide, doxorubicin, and etoposide versus mitomycin and vinblastine (EST 2575, generation IV).

Between March and December 1979, the Eastern Cooperative Oncology Group (ECOG) compared the CAVP16 (cyclophosphamide, doxorubicin, and etoposide) and MV (mitomycin and vinblastine) regimens in 200 patients with metastatic non-small cell bronchogenic carcinoma. Most patients were ambulatory (ECOG performance status, 0, 1; 75%) and had not received prior radiation therapy (76%). The CAVP16 regimen resulted in one complete and 13 partial responses (14%) and the mitomycin and vinblastine regimen resulted in two complete and 11 partial responses (13%).

Ventilatory effects of biceps vibration during leg exercise in healthy humans.

The ventilatory effects of biceps tendon vibration were studied in healthy human subjects at rest and at two levels of light leg exercise. This was performed with intent to add the ventilatory effects of selective stimulation of muscle spindles to nervous and humoral respiratory inputs from contracting muscles. Tendon vibration performed in individuals at rest elicited a marked increase in respiratory frequency and in the ratio between inspiratory time and total breath duration with variable changes in tidal volume; this was in agreement with previous results (Jammes et al.

Arachidonic acid metabolism by retinas of rats with streptozotocin-induced diabetes.

Arachidonic acid metabolism via the cyclooxygenase pathway and the effects of aspirin and indomethacin were studied in whole retinas of rats with streptozotocin-induced diabetes. Diabetes was induced by intravenous injection of streptozotocin (60 mg/kg) and the animals were examined 5-6 weeks later. Whole retinas of nondiabetic and diabetic animals were incubated for 1 1/2 hours, and the amounts of prostacyclin and prostaglandin E2 (PGE2) accumulated in the media were measured.

Effect of respiratory apparatus on respiration.

A mouthpiece plus noseclip (MP + NC) is frequently used in performing measurements of breathing patterns. Although the effects the apparatus exerts on breathing patterns have been studied, the mechanism of the changes it causes remains unclear. The current study examines the effects on respiratory patterns of a standard (17-mm-diam) MP + NC during room air (RA) breathing and the administration of 2 and 4% CO2 in normal volunteers and in patients 2-4 days after abdominal operation.

Effects of parenteral nutritional regimens on oxidative drug metabolism.

To determine whether the caloric source of intravenous nutrition can influence oxidative drug metabolizing capacity, antipyrine metabolism was studied in six healthy volunteers, who were taking no food or liquid by mouth, after they had been administered an intravenous nutritional regimen of 5% dextrose, 440 kcal/day, for 4 days and after they had been switched to an essentially isocaloric intravenous nutritional regimen of amino acids ( Aminosyn 3.5%) for 1 day. The change in intravenous nutritional regimen resulted in a 21% decrease in mean half-life (range: 3-32%), a 20% decrease in mean area under the concentration-time curve (range: 4-42%), and a 24% increase in mean metabolic clearance rate (range: 2-71%) for antipyrine.

Effect of protein intake on ventilatory drive.

Previous studies have demonstrated that if isotonic amino acid infusions were administered at a rate that approximated normal daily protein requirements, a leftward shift of the minute ventilation X PaCO2 relationship occurred. This study examined the effect of the administration of parenteral nutrition, at a fixed caloric intake and two levels of nitrogen (N) intake, on the ventilatory response to CO2 in nutritionally depleted patients. The intent was to determine whether increasing protein intake from normal to twice normal requirements would result in a further enhancement of the ventilatory response to CO2.

Morphine and postoperative rewarming in critically ill patients.

Morphine sulfate (MSO4) has been demonstrated to attenuate the stress response. MSO4 might be useful in minimizing the stress associated with the perioperative period, particularly that due to awakening from anesthesia and rewarming. Two groups of critically ill patients who developed hypothermia (35.

Nutritional support of the acutely ill patient.

Administration of nutritional support in acutely ill patients can be seen as a balance between the need to provide nutrients and the known complications associated with infusions of each of the three major nutrients--glucose, fat, and protein. It is prudent to maintain calorie intake within reasonable limits. If facilities for measurements of O2 consumption and hence metabolic rate are available, these should be utilized.

Artifacts in measurement of resting energy expenditure.

Measurements of gas exchange have been demonstrated to be clinically useful in the care of critically ill and malnourished patients. Using principles of indirect calorimetry, resting energy expenditure (REE) can be calculated from gas exchange data and used as the basis for designing a nutritional support regimen as well as for following the patient's metabolic state. This study demonstrates that a relatively minor procedure, such as percutaneous muscle biopsy, can induce temporary but major increases in gas exchange and lead to an overestimation of REE.

Hypercalcemia and hypercalciuria in a critically ill patient.

A case of unexplained intermittent hypercalcemia and hypercalciuria in a patient with a prolonged critical illness is presented. The differential diagnosis and workup of this disorder under such circumstances are discussed. The influences of immobilization and total parenteral nutrition (TPN) are explored.

Physiologic requirements during rewarming: suppression of the shivering response.

Intraoperative hypothermia has become a common occurrence. Postoperative rewarming often is accompanied by shivering and results in increased metabolic and circulatory demands. We examined the metabolic, hemodynamic, and biochemical variables in 2 groups of hypothermic (greater than 35.

Nutrients and ventilation.

Nutritional support of the patient with respiratory failure may play a key role in recovery. Nutritional intake not only indirectly influences lung function by altering body composition and most defense mechanisms but interacts directly with respiratory function in a variety of ways. This review will focus on 2 such interactions; the effect of glucose on CO2 production and the effect of protein on ventilatory drive.

Amino acids and respiration.

Parenteral nutrition containing glucose and amino acids may stimulate respiration. To ascertain the effects of these solutions on respiration, eight normal subjects received an infusion of 5% dextrose (100 mL/h) for 7 days followed by an infusion of 3.5% amino acids (125 mL/h) for 24 hours.

Massive perioperative polyuria.

A 25-year-old man with a spinal cord transection secondary to a gunshot wound underwent surgical repair of a perforated prepyloric ulcer on the eighth hospital day. He received 68 liters and excreted 43 liters of intravenous fluid during the perioperative period. Causes of this massive polyuria during and after the second operation are unknown, although iatrogenically induced glycosuria and natriuresis may have contributed to its severity.

Effect of posture on the ventilatory response to CO2.

The effect of sitting and supine posture on breathing patterns and gas exchange during room air breathing and administration of 2 and 4% CO2 was studied in nine normal subjects using a noninvasive canopy system. During air breathing minute ventilation (VE) was 21% (P less than 0.005) higher in the sitting position.

A systematic method for validation of gas exchange measurements.

The measurement of gas exchange is useful, but thus far, has not been practical during the mechanical ventilation of critically ill patients. To validate two new commercial instruments, (Siemens-Elema Servo Ventilator 900B, Beckman Metabolic Cart), the authors constructed a lung model into which they delivered CO2 and N2 at precise rates to simulate Co2 production (Vco2) and O2 consumption (Vos). The model consists of 13.

Group B streptococcal pharyngitis in the compromised adult: therapeutic considerations.

Group B streptococci (GBS) have been infrequently recognized as a cause of pharyngitis. We report three cases of GBS pharyngitis in patients with underlying diseases, two of whom were treated with and responded incompletely to oral beta-lactam antibiotics. The susceptibility of 20 clinical isolates of GBS was tested by a broth dilution method to six antibiotics which could conceivably be used in the therapy of GBS pharyngitis.

Treatment of advanced colorectal carcinoma with AMSA.

AMSA in a dose of 120 mg/m2 iv every 4 weeks was evaluated in 26 patients with advanced measurable colorectal cancer, 13 of whom had had no prior chemotherapy. The schedule was tolerated well except by those patients who had prior irradiation or chemotherapy, in whom a dose reduction to 90 mg/m2 was required. No significant antitumor response was observed.