ABSTRACT
This study was undertaken to compare the efficacy of four different types of perioperative intravenous nutritional support. Fifty-five patients undergoing routine major surgery were studied. They were prospectively assigned to one of four study groups. Group 1 received formal total parenteral nutrition (90 g amino acids, 3,000 calories as glucose, per day); Group 2, 100 g glucose per day; Group 3, 90 g amino acids per day; and Group 4, peripheral parenteral nutrition (90 g amino acids plus 1,600 calories, 60 percent as fat per day). Group 1 was maintained on therapy for 3 weeks and the other groups for 8 days. Nitrogen balance, maintenance of body cell mass, serum albumin levels, and maintenance of exercise capacity were measured. Patients receiving peripheral parenteral nutrition maintained their nutritional parameters, as did those receiving total parenteral nutrition. These infusions were both markedly superior to those receiving glucose alone or those receiving amino acids alone. Nitrogen balance was not correlated with maintenance of function, but maintenance of body cell mass was correlated with maintenance of exercise capacity (r = 0.66, p less than or equal to 0.01). We conclude that perioperative peripheral parenteral nutrition, in contradistinction to hypocaloric infusions of glucose or amino acids, is capable of maintaining postoperative muscle mass and function close to preoperative levels after major surgery, and in situations of relatively mild surgical stress, approaches the efficacy of total parenteral nutrition in this regard. A significant correlation exists between changes in body cell mass determined from isotope dilution and changes in the exercise capacity of large muscle masses.
Subject(s)
Muscles/pathology , Parenteral Nutrition , Physical Exertion , Surgical Procedures, Operative , Adult , Aged , Aged, 80 and over , Body Water/analysis , Body Weight , Energy Intake , Humans , Male , Middle Aged , Nitrogen/metabolism , Parenteral Nutrition/methods , Parenteral Nutrition, Total/methods , Potassium/metabolism , Serum Albumin/analysisABSTRACT
A case of eosinophilic pneumonia and eosinophilic infiltration of the small bowel and colon is reported. The patient presented with nonspecific chest and abdominal symptoms, and lack of response to therapy for presumed pneumonia. Further investigation including lung, muscle, and gastrointestinal tract biopsies revealed eosinophilic infiltration of the lung and gastrointestinal tract, an association that does not appear to have been previously documented.
Subject(s)
Enteritis/complications , Eosinophilia/complications , Pulmonary Eosinophilia/complications , Adult , Enteritis/diagnostic imaging , Enteritis/pathology , Eosinophilia/diagnostic imaging , Eosinophilia/pathology , Female , Humans , Intestine, Small/diagnostic imaging , Intestine, Small/pathology , Lung/diagnostic imaging , Lung/pathology , Pulmonary Eosinophilia/diagnostic imaging , Pulmonary Eosinophilia/pathology , RadiographyABSTRACT
In a prospective, randomized, double-blind, placebo-controlled, cross-over study of forty-one patients we found that oral ingestion of 1,248 mg a day of L-Lysine monohydrochloride shows evidence of decreasing the recurrence rate of herpes simplex attacks in nonimmunocompromised hosts. A dose of 624 mg a day was not effective. L-Lysine may also be capable of decreasing the severity of symptoms associated with recurrences. Neither dosage showed any evidence of shortening the healing time compared to placebo.
Subject(s)
Herpes Simplex/drug therapy , Lysine/therapeutic use , Administration, Oral , Arginine/administration & dosage , Clinical Trials as Topic , Double-Blind Method , Electrolytes/blood , Herpes Simplex/blood , Herpes Simplex/diet therapy , Herpes Simplex/pathology , Humans , Lysine/administration & dosage , Prospective Studies , Random Allocation , RecurrenceABSTRACT
Six female patients with stage I and II vascular scleroderma and Raynaud's phenomenon were treated with plasma exchange and placebo plasma exchange. Placebo exchange consisted of the return of the patient's own separated plasma. No consistent long-term objective improvement was demonstrated in patients treated with either plasma exchange or placebo plasma exchange. Immediate increases in pulse volume, digital blood pressure, and skin temperature occurred in some patients with both procedures. Mechanisms of change remain unexplained, and further study is warranted.
Subject(s)
Plasma Exchange , Adult , Blood Pressure , Blood Proteins/analysis , Blood Proteins/physiology , Clinical Trials as Topic , Female , Follow-Up Studies , Humans , Immunoglobulins/analysis , Immunoglobulins/physiology , Middle Aged , Placebos/pharmacology , Raynaud Disease/therapy , Scleroderma, Systemic/therapySubject(s)
Ileal Diseases/diagnosis , Intussusception/diagnosis , Jejunal Diseases/diagnosis , Ultrasonography , Adult , Chronic Disease , Female , HumansABSTRACT
Systemic blastomycosis may rarely involve the larynx, and it most likely is a result of hematogenous dissemination or direct inoculation from a currently or previously active pulmonary infection. Often, laryngeal blastomycosis has been confused with squamous cell carcinoma because of the clinical and histopathologic similarities, and this confusion has led to inaccurate diagnosis and inappropriate therapy. The etiologic agent, Blastomyces dermatiditis, may be seen in infected tissue with routine and special stains; however, cultural proof remains the sine qua non for diagnosis.
