Giant pulmonary cyst simulating tension pneumothorax.

Giant pulmonary cyst is a rare clinico-pathological entity. It was described as a "windy tumor" by John Floyer in 1726. Since that time, there have been numerous reports on this unique manifestation of emphysema by many authors. In this report, we report one such interesting case who was diagnosed as tension pneumothorax.

Infusion of branched chain-enriched amino acid solutions in sepsis.

The goal of nutritional support in sepsis is, as in other conditions, to prevent the use of endogenous protein as an energy substrate and, ideally, to promote the synthesis of proteins specifically required in responding to the particular insult or stress at hand. This entails provision of an utilizable fuel, in sufficient quantity, that does not inhibit the use of endogenous nonprotein sources; preservation of the existing protein mass by minimizing skeletal muscle and visceral proteolysis; provision of amino acids in sufficient quantity and in the appropriate proportions such that protein synthesis is optimized. Specifically, this includes the synthesis of those proteins required to maintain hyperdynamic function of the essential organs as well as the hepatic and leukocytic synthesis of proteins required in immunologic defense. This study has assessed one aspect of this goal during the administration of nutrient solutions differing primarily in branched chain amino acid content. We conclude that leucine is fundamental among the branched chain amino acids for reducing skeletal muscle proteolysis. Solutions designed for sepsis or stress should, therefore, contain adequate amounts of this amino acid.

Effect of total hepatectomy and administration of branched-chain amino acids on regional norepinephrine, dopamine, and amino acids in rat brain.

In rats after total hepatectomy, the effect of infusing glucose alone or combined with branched-chain amino acids on amino acid concentrations in plasma and cerebral cortex and on catecholamine levels in eight different regions of the brain was studied. Infusion of branched-chain amino acids reduced the accumulation of tryptophan, phenylalanine, and tyrosine in plasma, while in cerebral cortex, the concentrations of phenylalanine and tyrosine were normalized and that of tryptophan was reduced greatly. In rats with hepatectomy and glucose infusion alone, norepinephrine levels were decreased in seven of eight brain regions with the exception of striatum, while dopamine was reduced significantly in striatum only. Infusion of branched-chain amino acids resulted in higher norepinephrine in cortex, mesencephalon, and hypothalamus and higher striatal dopamine 18 hours after hepatectomy. Thus, infusing branched-chain amino acids and reducing the accumulation of various neutral amino acids in brain may partially prevent the loss of norepinephrine from brain after total hepatectomy.

The effect of parenteral and enteral nutrition on portal and systemic immunoreactivities of gastrin, glucagon and vasoactive intestinal polypeptide (VIP).

To compare the effect of parenteral with enteral nutrition on gastroentero-pancreatic hormones, hypercaloric and hypocaloric nutrient preparations, commonly used clinically, were administered to rats either through cannulae in the jugular vein or gastrostomies. Control rats were fed orally ad libitum. Portal and aortic plasma was collected for radioimmunoassay with antibodies to C-terminal regions of gastrin and glucagon and to N-terminal-to-central regions of glucagon and VIP. Levels of all immunoreactivities were significantly lower in aortic than portal plasma. Apparent clearance of glucagon and gastrin by liver or lung both was enhanced by administration of the hypercaloric nutrient intravenously. Only intragastric hypercaloric nutrition maintained levels of VIP immunoreactivity close to those of control rats. Intragastric administration of either preparation appeared to maintain adequate levels of gastrin. Differences in the levels of glucagon immunoreactivities may be related to the stimulatory effects of metabolites in the lower gut and pancreas.

Effect of infusing the branched-chain amino acids on concentrations of amino acids in plasma and brain and on brain catecholamines after total hepatectomy in the rat.

In totally hepatectomized rats supported by infusion of glucose, the concentrations of many amino acids in plasma and brain rose progressively over time, while the brain levels of norepinephrine decreased. Infusion of a solution containing glucose, leucine, isoleucine, and valine after hepatectomy greatly reduced the accumulation of other essential amino acids in plasma and brain. However, the decrease in brain norepinephrine content was not significantly affected by this infusion, suggesting that high brain concentrations of monoamine precursor amino acids are not the primary cause of norepinephrine depletion after hepatectomy.