Effects of ketoacids on liver glutathione and microsomal enzymes in malnourished rats.

The progression of chronic renal failure is delayed by the use of low protein diets, but such diets are deficient in essential amino acids. In order to maintain good nutritional status, branched-chain ketoacids (BCKA) can be added to these diets. The effects of BCKA on protein metabolism in skeletal muscle is well established, but there is little information about their effects on liver metabolism. Protein deprivation affects some aspects of liver function such as drug metabolism (glutathione, cytochrome P-450 and enzymes). In a chronic protein malnutrition model, we have tested the efficacy of BCKA to correct these abnormalities when they are added to a low protein diet. RNA/DNA, liver proteins, microsomal proteins and glutathione were markedly improved; cytochrome P-450 was only partly improved, and aminopyrine demethylase was not affected. In conclusion, this study suggests that BCKA have a beneficial effect and may prevent the deterioration in the nutritional state of the liver in uremic patients.

Age influence on sucrose hydrolysis and on monosaccharide absorption along the small intestine of rat.

The consequences of aging on the hydrolysis and absorption of hexoses was assessed in vitro using everted intestinal segments. Glucose and fructose were given either as a mixture of free monosaccharides or as a disaccharide solution (sucrose). The jejuno-ileum of 3- and 24-month-old rats was everted and divided into four equal segments. For each segment, the mucosal medium contained either sucrose (140 mM) or an equimolar mixture of glucose and fructose (70 mM). Monosaccharide concentrations in the mucosal ans serosal media were measured after 1 h of incubation at 37 degrees C. In the young adult, glucose absorption was enhanced when given as sucrose. In contrast, in the aged rat, free glucose or glucose released from sucrose hydrolysis were similarly absorbed. Independently of age, fructose was better absorbed when provided in a mixture of free monosaccharides. The intestinal segments (and especially the ileum), of the aged animals exhibited higher abilities to hydrolyse sucrose and to absorb monosaccharides indicating a normal or increased intestinal hydrolytic activity and absorptive capacity for dietary sugars.

Rehabilitation of microsomal enzymes in malnourished rats: comparison of parenteral versus oral refeeding.

Protein malnutrition decreases the activity of drug-metabolizing liver microsomal enzymes. In the first part of our study, we evaluated those enzymes during malnutrition and refeeding. Then we compared the effects of different nutritional patterns on these parameters. During malnutrition (M), rats were fed a 5% casein diet. During refeeding, they were randomized in 3 groups: oral refeeding (20% casein diet: A), continuous total parenteral nutrition (TPN: B) and oral energy refeeding (glucose + lipids) + continuous amino-acid infusion (C). Rats were sacrificed before and at various times during malnutrition and refeeding (2 to 28 days). There was no difference in caloric intake between the 3 groups. Nitrogen balance was not different in A and B. It was lower in C, though nitrogen intake was not different. Body and liver weights were not different between the 3 groups. Microsomal proteins and cytochrome P-450 were improved in A and B but not in C compared to M. Our results suggest that TPN (but not continuous amino-acids infusion + oral energy intake) is as effective as oral nutrition on rehabilitation of microsomal enzymes in malnourished rats.

Age related increase of brush border enzyme activities along the small intestine.

Intestinal morphology and brush border hydrolase activities were determined along the small intestine of young adult (three months, n = 10), mature (12 months, n = 10), and senescent (29 months, n = 15) rats. The intestinal segments of the senescent rats contained higher mucosal mass and protein content (p less than 0.05) compared with the young and mature animals. A significant reduction of villus height and crypt depth (p less than 0.05) was found in the proximal intestine during aging. A 35% increase in villus height (p less than 0.05) without changes in crypt depth, was observed in the distal ileum in senescent rats. The activities of sucrase and isomaltase were significantly increased during aging in the duodenum and jejunum (p less than 0.05). Lactase and aminopeptidase activities which showed only minor changes between young and mature animals were significantly enhanced in senescent animals (p less than 0.05) with aminopeptidase exhibiting a three-fold increase in activity in the proximal ileum. The results when combined with those of previous studies suggest that in the aged animal, the increased level of intestinal hydrolase activities may be the consequence of prolonged cellular maturation along the villi in the proximal intestine, and of adaptation to increased concentrations of intraluminal substrates in the distal intestine.

[Should undernutrition be corrected prior to surgery in patients with cancer of the oesophagus or cardia? (author's transl)]. / Faut-il corriger la dénutrition des malades ayant un cancer de l'oesophage ou du cardia en période pré-opératoire?

A prospective study of 40 patients with cancer of the oesophage or cardia considered for surgery showed that 27 had no evidence of protein or calorie deficiency, while 13 had undernutrition. The 18 patients who benefited from ablative surgery belonged to the group with normal nutritional status; none of the undernourished patients could have benefited from resection. Only controlled studies will show whether or not correcting undernutrition is advantageous, but the number of people with both resectable tumour and corrigible undernutrition is probably very small.

[Hemothorax during subclavian catheterization. Risk factors not be neglected]. / Hémothorax au cours du cathétérisme sous-clavier. Des facteurs de risque à ne pas négliger.

In the post operative course of a peritonitis, the need for a central venous catheter. A 800 ml hemothorax in the left pleura occurred. It could not be relieved with a chest-tube, and had to be evacuated through a thoracotomy. The risk factors to be considered in this case were sequellae of an inner third clavicle fracture and an arterial hypertension; although the patient was given a minimal dose of calcium heparinate.

[Acute post-operative hemolysis related to a G6DP deficiency. Report of one case (author's transl)]. / Hémolyse aiguë post-opératoire liée à un déficit en glucose- 6- phosphodéshydrogénase. A propos d'un cas.

Many drugs used during resuscitations, are mighty oxidants able to induce intravascular hemolysis in patient with G6PD deficiency. Reversible and not immediately recurrent, hemolysis should be avoided by systematic (prevention) using specific blood tests. This paper was suggested by the case of a 37-year-old (Malgache) patient, with no history sustaining an acute hemolysis with kidney failure, appearing after intra-operative phenothiazine injection.