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Biomedical subjects

C Pichard

Publications and source records attributed to C Pichard.

At least 91 records · Page 5Linked to original sources
PubMed1996

Recombinant human growth hormone in chronic and acute respiratory insufficiency.

Chronic respiratory insufficiency leads to protein-calorie malnutrition (PCM). PCM results in increased morbidity (e.g., infection), which in turn promotes further body wasting. The latter leads to respiratory muscle dysfunction and acute respiratory failure. Nutritional support alone is generally insufficient to counterbalance this hypoxemic and stress-related muscle catabolism. Recombinant human growth hormone (rhGH) can preserve or replenish nitrogen reserves, mostly contained in body muscle mass. It was hypothesized that rhGH, through its ability to improve muscle mass and function, could be a valuable therapeutic adjunct in both chronic and acute respiratory insufficiency. The results are controversial, and the beneficial effects of rhGH in patients with chronic and acute respiratory insufficiency, in terms of improvement of respiratory function, morbidity, and quality of life, remain to be shown. Well-designed studies, specifically targeting these end points as well as cost-effectiveness, are needed to better define the place of rhGH in the nutritional support of these patients.

Acute Disease↗
PubMed1996

[Chemodectoma secreting carotid glomus: characteristics and contribution of magnetic resonance imaging. Apropos of 2 cases].

Two cases of carotid glomus chemodectomas with production of catecholamines are reported. The place of chemodectomas among the neuroendocrine tumors called paragangliomas is recalled. Chemodectomas only very infrequently produce catecholamines (1 to 10%). Magnetic resonance imaging is superior to computerized tomography and metaiodobeuzylguanidine scintigraphy in the detection and the characterization of adrenal and extra-adrenal functioning paragangliomas of the orthosympathic system. Few data are available for the imaging of functioning parasympathetic paragangliomas (chemodectomas). The two case reports illustrate the contribution of the magnetic resonance imaging in the detection and the characterization of chemodectomas.

Adult↗
PubMed1995

[Practical guidelines for the administration of artificial nutrition at home (home nutrition) (SAEPE; Swiss Work Group for Enteral and Parenteral Nutrition)].

The number of outpatients with major difficulties in feeding themselves is constantly growing. This results into severe malnutrition resulting in increased infection rate, physical disabilities, skin sores, increased therapeutic costs and poor quality of life. Home nutritional support can cover all nutritional needs but requires appropriate indications, optimal technical management and cautious ethical evaluation. In addition, the overall costs should be covered by an insurance at the time of home nutritional support prescription. Swiss home nutritional support recommendations for practising physicians are presented.

Enteral Nutrition↗
PubMed1995

[Role of anabolic hormonal factors in surgery in adults].

Hormonal agents with anabolic effect are virtually able to limit or even to counteract the adverse effects of stress and to act in synergy with nutritional support. Hormones with a high theoretic anabolic power include recombinant human growth hormone (rGH), insulin, insulin-like growth factor and testosterone. Other molecules favour anabolism in modifying the catabolic effect of diseases (anti-cytokines, beta-adrenoceptor agonists), in promoting intestinal absorption of substrates or in stimulating epithelial growth (EGF). The results of preliminary studies cannot be transferred into routine clinical practice. The rGH favours the preservation of body mass integrity and various functions. Therefore it could improve postoperative outcome and decrease the duration of hospital stay. A study in severely burnt children showed the metabolic benefits of rGH as well as a shortening of hospital stay because of a decrease of cicatrisation delay after skin grafting. Finally it demonstrated that rGH allows major financial savings in severe burns. The IGF-1 stimulates host defences and decreases the rate of wound infections. The rGH potentiates nitrogen sparing effect of IGF-1 and decreases hypoglycaemia induced by IGF-1. However a study on patients in stress is yet lacking. A combination of growth factors could be virtually efficient, however the cost seems exorbitant. An unquestionable evidence of their clinical efficiency is required before a clinical use in routine can be considered. The postoperative protein catabolism could be decreased by nandrolone decanoate or its derivatives. On the other hand, it has not been proven that protein synthesis, the muscle function or clinical prognosis can be improved by such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Longitudinal measurement of regional and whole body bone mass in young healthy adults.

The so-called peak bone mass (PBM) represents the highest amount of bony tissue achieved during life at a given site of the skeleton. It has been suggested that PBM might be achieved as late as the fourth decade, but recent data have indicated that PBM is already achieved by the end of sexual maturation, namely at the end of the second decade. The solving of this apparent controversy is of interest for a better understanding of bone homeostasis and for defining the cohort of normal subjects to be evaluated in order to establish a PBM reference range--necessary for the diagnosis of osteoporosis and evaluation of the fracture risk. To study bone mass evolution in young healthy adults and to determine whether such a cohort can be used to establish PBM reference values, we measured bone mineral density (BMD) in sixty 20- to 35-year-old young healthy adults by dual-energy X-ray absorptiometry at the levels of the lumbar spine (in both anteroposterior and lateral views), femoral neck, trochanter region, total hip and of Ward's triangle, as well as whole-body BMD and bone mineral content (BMC) in cross-sectional and longitudinal studies. In the cross-sectional analysis, none of the bone mass variables was dependent on age using linear regression analysis. The longitudinal study indicated that the mean changes in lumbar spine, proximal femur and whole body BMD or BMC determined after a 1-year interval were not statistically different from zero in either females or males aged 20-35 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

Body composition analysis by dual-energy x-ray absorptiometry in adults with cystic fibrosis.

Assessment of nutritional status is important in cystic fibrosis (CF). We performed body composition analysis by dual-energy x-ray absorptiometry (DXA) in 12 adults with CF, 7 of them with malnutrition as defined by percentage of ideal body weight (IBW) lower than 90. The DXA allowed for determination of bone body mass (BBM), lean body mass (LBM), and fat body mass (FBM). A deficit in BBM and LBM was found to be present in all seven patients with malnutrition when compared with a group of young normal adults. By contrast, deficit in FBM was inconstant. Deficits in bone and lean were associated with each other. They did not depend on the severity of steatorrhea, but were highly correlated to ventilatory impairment. In conclusion, DXA provides new and potentially useful information on the nutritional status of these patients. In addition, it confirms the close association of malnutrition and lung disease in CF.

Absorptiometry, Photon↗
PubMed1992

Assessment of whole-body composition with dual-energy x-ray absorptiometry.

Dual-energy x-ray absorptiometry (DXA) allows noninvasive direct measurement of the three major components of body composition: lean body mass (LBM), fat body mass (FBM), and bone mineral body mass (BBM). To study the accuracy and short-term and long-term precision of body composition measurements, the authors measured body composition with DXA in 60 healthy young adults. Independent measurement of LBM (LBMK-40), obtained from the determination of the whole-body content of potassium-40 with a whole-body scintillation detector, was highly correlated with LBM determined with DXA (LBMDXA) (LBMK-40 = 1.069.LBMDXA,R2 = .996). Assessment of body composition in 10 patients with acquired immunodeficiency syndrome (AIDS) and 10 patients with cystic fibrosis was performed with DXA. The AIDS patients showed a marked decrease in LBM, while in patients with cystic fibrosis, LBM and BBM were decreased. DXA measurements of body composition appeared accurate and precise enough to be of clinical relevance in detecting specific alterations of body composition.

Absorptiometry, Photon↗
PubMed1991

Intracellular potassium and membrane potential in rat muscles during malnutrition and subsequent refeeding.

Nutrition alters total body potassium (TBK) and muscle potassium but little is known about in vivo intracellular K+. We measured free intracellular potassium-ion activity (aKi+), membrane potential (Em), and total potassium (Kt) and calculated intracellular potassium concentration [K+]i in predominantly slow- (soleus) and fast- (extensor digitorum longus) twitch muscles in rats undergoing underfeeding and subsequent refeeding. After underfeeding, aKi+ and Em decreased (P less than 0.025 and P less than 0.006, respectively) only in soleus muscle with restoration after refeeding, whereas [K+]i decreased in both muscles (P less than 0.005) and remained low after refeeding. K+ supplementation did not significantly change these indices or the ratio of free to total intracellular potassium (gamma Ki+). The data show that aKi+ behaves differently from [K+]i during malnutrition and that changes in aKi+ occur especially in slow-twitch fibers, suggesting that previously observed changes in TBK and muscle function are the result of fundamental alterations in muscle-cell energetics and membrane functions, not just mass.

Animals↗
PubMed1991

Body composition and metabolic rate in rat during a continuous infusion of cachectin.

Changes in brain metabolites, energy balance, resting metabolic rate, body composition, and organ histology were studied over 10 days in control (C), cachectin-infused (CIR), and pair-fed (PFR) (in relation to CIR) rats. The cachectin was continuously infused for the 10 days into the superior vena cava at the rate of approximately 100 micrograms.kg-1.day-1. The brain of the CIR had significantly more tryptophan and 5-hydroxyindole-3-acetic acid than C and PFR. The CIR rats were anorexic, hypermetabolic, relatively hyperglycemic, and had raised blood urea nitrogen with comparable creatinine levels when compared with similarly wasted PFR. They had significant loss of muscle mass, especially in muscles with a predominance of type II fibers. However they gained liver, heart, and lung mass. The loss of muscle mass could be ascribed to dietary deficiency, but the gain in visceral mass was associated with an increase in organ DNA and protein. Histology showed that there was cell proliferation in the liver, heart, and kidneys. The data are consistent with centrally mediated anorexia with nutritionally mediated muscle wasting but with visceral hypermetabolism, protein accumulation, and cell proliferation.

Animals↗
PubMed1989

Muscle carnitine pools in cancer patients.

Muscle and plasma concentrations of free and acylated carnitine (short-chain acylcarnitine and long-chain acylcarnitine) were determined by employing an optimized radiochemical-enzymatic assay in 14 healthy volunteers and in 10 patients with oesophageal carcinoma prior to elective operation. No significant correlations between total carnitine and its subfractions in muscle and plasma were observed and no sex differences were apparent. The estimated total carnitine pool in the patients (75.0 +/- 27 mmol) was significantly reduced compared to controls (130 +/- 24.3 mmol). The reduction was still present when expressed per kg muscle tissue (3.5 +/- 1.0 mmol versus 4.5 +/- 0.7 mmol) in order to consider age related decreased muscle mass in the patients. The muscular ratio of acylcarnitines to free carnitine was higher in the patients (0.23 +/- 0.10) than in healthy subjects (0.15 +/- 0.07), whereas the corresponding plasma quotient in the patients (0.22 +/- 0.09) was lowered compared to controls (0.30 +/- 0.10), indicating that instead of glucose, oxidation of fatty acids can be maintained, resulting in a preservation of the glycogen stores and thus an energy-conserving metabolic adaptation as a response to prolonged energy deficit.

Journal Article↗
PubMed1989

Adverse effects of high dose carnitine supplementation of total parenteral nutrition on protein and fat oxidation in the critically ill.

The aim of the present study was to investigate the effects of continuous and acute L-carnitine supplementation of total parenteral nutrition (TPN) on protein and fat oxidation in severe catabolism. A critically ill and severely malnourished male patient received TPN (non protein energy = 41 kcal/kg/day, provided equally as fat and glucose) over 38 days, without L-carnitine for 23 days and with carnitine supplements (15 mg/kg/day) for the following 15 days. Subsequently, he was given carnitine-free enteral nutrition for 60 more days. A four-hour infusion of 100 mg L-carnitine was given on day 11 of each TPN period. Indirect calorimetry was carried out after 11 days of either carnitine-free or supplemented TPN and at the initiation of enteral nutrition. Additional measurements were performed 4 hours and 24 hours after the acute infusions of carnitine. The rate of protein oxidation and the respiratory quotient were found to be higher, and the rate of fat oxidation to be lower, with carnitine-supplemented TPN, than with either carnitine-free TPN or enteral nutrition. Acute infusion of carnitine resulted in an increased rate of protein oxidation and a reduced rate of fat oxidation on both TPN-regimens. These unfavourable effects on protein metabolism may be due to an impairment of fat oxidation by excess amounts of carnitine.

Journal Article↗
PubMed1989

Clinical relevance of L-carnitine-supplemented total parenteral nutrition in postoperative trauma. Metabolic effects of continuous or acute carnitine administration with special reference to fat oxidation and nitrogen utilization.

Carnitine-free total parenteral nutrition (TPN) is claimed to result in a carnitine deficiency with subsequent impairment of fat oxidation. The present study was designed to evaluate the possible benefit of carnitine supplementation on postoperative fat and nitrogen utilization. Sixteen patients undergoing total esophagectomy were evenly randomized and received TPN without or with L-carnitine supplementation (74 mumol.kg-1.d-1) during 11 postoperative days. On day 11, a 4-h infusion of L-carnitine (125 mumol/kg) was performed in both groups. The effect of supplementation was evaluated by indirect calorimetry, N balance, and repeated measurements of plasma lipids and ketone bodies. Irrespective of continuous or acute supplementation, respiratory quotient and fat oxidation were similarly maintained throughout the study in both groups whereas N balance appeared to be more favorable without carnitine. We conclude that carnitine-supplemented TPN does not improve fat oxidation or promote N utilization in the postoperative phase.

Adult↗
PubMed1988

[Effect of L-carnitine supplemented total parenteral nutrition on postoperative lipid and nitrogen utilization].

During episodes of trauma carnitine-free total parenteral nutrition (TPN) may result in a reduction of the total body carnitine pool, leading to a diminished rate of fat oxidation. Sixteen patients undergoing esophagectomy were equally and randomly divided and received isonitrogenous (0.2 gN/kg.day) and isocaloric (35 kcal/kg.day TPN over 11 days without and with L-carnitine supplementation (12 mg/kg.day). Compared with healthy controls, the total body carnitine pool was significantly reduced in both groups prior to the operation. Without supplementation carnitine concentrations were maintained, while daily provision of carnitine resulted in an elevation of total carnitine mainly due to an increase of the free fraction. Without supplementation the cumulative urinary carnitine losses were 11.5 +/- 6.3 mmol corresponding to 15.5% +/- 8.5% of the estimated total body carnitine pool. Patients receiving carnitine revealed a positive carnitine balance in the immediate postoperative phase, 11.1% +/- 19.0% of the infused carnitine being retained. After 11 days of treatment comparable values for respiratory quotient, plasma triglycerides, free fatty acids, ketone bodies, and cumulative nitrogen balance were observed. It is concluded that in the patient population studied here carnitine supplementation during postoperative TPN did not improve fat oxidation or nitrogen balance.

Adult↗
PubMed1988

What energy level is required to avoid nutrient depletion after surgery in oropharyngeal cancer?

The rate of energy expenditure was repeatedly measured by indirect calorimetry both in the basal state (BMR) and in the resting fed state (RMR) in 8 middle-aged male patients operated for oropharyngeal cancer. In the postsurgical phase, two sequential energy levels were administered by nasogastric tube: (1) a 'maintenance' level (days 3-5) at 1.4 X measured presurgery BMR; (2) a 'supramaintenance' level (days 6-9) at 1.7 X measured BMR on day 6. Before surgery the patients had a BMR averaging (23.7 +/- 1.0 kcal/kg.day). After surgery BMR increased to 27.6 +/- 2.7 kcal/kg.day (day 6), then it decreased to 24.4 +/- 1.4 kcal/kg.day (day 10). The difference between RMR and BMR yielded a nutrient-induced thermogenesis averaging 5 +/- 1 and 8.5 +/- 2% (p less than 0.05) on levels 1 and 2, respectively. It is concluded that an energy level corresponding to 1.4 X presurgery BMR is sufficient to maintain energy and substrate equilibrium in nondepleted patients, whereas 1.7 X BMR induces positive protein and fat balances concomitant to a decrease efficiency of energy utilization.

Adult↗