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Biomedical subjects

G Svaninger

Publications and source records attributed to G Svaninger.

30 records · Page 2Linked to original sources
PubMed1986

Thermic effect and substrate oxidation in response to intravenous nutrition in cancer patients who lose weight.

This study examined oxidative metabolism and thermogenesis in the acute response to controlled intravenous nutrition in seven cancer patients who lost weight. Six weight-losing and malnourished patients without cancer served as controls. Indirect calorimetry was used and measurements of arterial concentrations of various substrates, metabolic end products, and insulin were performed. Resting energy expenditure (REE) was measured after an overnight fast. The resting energy need was calculated for each patient according to REE. The nutrition program consisted of glucose and lipids (Intralipid KabiVitrum AB, Stockholm, Sweden) each as 50% of nonprotein calories and amino acids (6.9 mg N/kcal). These substrates were infused simultaneously at rates equivalent to one, two, and three times REE, over periods of 6.5 hours on 3 consecutive days after a 12-hour fast. Arterial substrate levels and energy expenditure were measured between 6 and 6.5 hours after the start of the infusion. The cancer patients had well-recognized metabolic changes in the fasted state, such as elevated plasma levels of glycerol, triglycerides, free fatty acids, and lactate, and higher energy expenditure than predicted. The cancer patients responded to strictly defined substrate challenge in a similar way as the malnourished patients without cancer. Whole body oxidative capacity and the proportion of infused glucose and lipids that were oxidized at different levels of infusion rates were not decreased in cancer patients compared with control patients. Similar arterial substrate concentrations among the groups during infusions argues for a maintained plasma clearance of the substrate in the cancer patients. This study supports the suggestion that cachectic cancer patients can generate and conserve energy normally in response to intravenous nutrition. This refers to cancer patients with a history of weight loss up to 15% of their normal body weight. Therefore, weight loss due to altered tumor-host metabolism in cancer patients is of quantitative importance in the fasted state rather than in the fed state.

Aged↗
PubMed1986

Thyroid hormones and experimental cancer cachexia.

The relationship between circulating thyroid hormones and nutritional status was studied in sarcoma-bearing inbred C57BL/6J mice and control mice. Supplementation with exogenous thyroxine (T4) was also evaluated. Tumor-bearing animals had depressed levels of circulating thyroid hormones. This was also found in food-restricted (pair-fed and pair-weighed) controls. Plasma levels of thyroid hormones decreased with increased tumor burden. Thyrotropin-releasing hormone caused an increased response of thyroid-stimulating hormone in tumor-bearing animals. Low levels of thyroid hormones in sarcoma-bearing mice were due to depressed hormone production by the thyroid gland rather than to increased clearance rate of hormones. Plasma levels of triiodothyronine (T3) correlated to the amount of whole-body nitrogen among sarcoma-bearing mice and food-restricted controls. Exogenous T4 increased food intake by 20% in sarcoma-bearing mice. The benefit of this was probably counteracted by an increased metabolic rate, since reversal of plasma levels of T3 and free T4 had no net effect on body composition of freely eating sarcoma-bearing mice, although it had a negative effect on body and muscle composition in food-restricted controls. Exogenous T4 did not stimulate tumor growth. The results indicate that low circulating levels of thyroid hormones in experimental cancer cachexia are probably caused by the reduced food intake (anorexia), which is in agreement with findings in clinical cancer. Depression of thyroid hormones is probably a physiological means to reduce energy expenditure and to preserve substrates in progressive cancer disease.

Animals↗
PubMed1985

Continent cecostomy. An account of 30 patients.

In this paper, an account is given of our experience with continent colostomy in man. In five patients, the end-sigmoidostomy was provided with an intussusception valve. Evacuation of the bowel by irrigation through a catheter was laborious and time-consuming and this method was abandoned. In another group of 30 patients, the cecum was isolated from the rest of the colon and its distal end was provided with an intussusception valve. Of the 30 patients, eight were later given continent ileostomies, two were converted to conventional sigmoidostomies, and one patient with fecal incontinence preferred to have intestinal continuity reestablished. Thus, 19 patients still have continent cecostomies and are satisfied with their function. When comparing the function of the continent cecostomy with that of the continent ileostomy, however, it is obvious that the ileostomy function is superior. The experience obtained with this group of patients has resulted in a widening of the indications for constructing a continent ileostomy, including selected patients with various anorectal disorders.

Animals↗
PubMed1985

Thyroid hormones in conditions of chronic malnutrition. A study with special reference to cancer cachexia.

Circulating levels of thyroid hormones (T4, free T4, T3) and reverse tri-iodo thyronine (rT3) and thyroid-hormone binding globulin were related to the nutritional state of patients with cancer cachexia, patients with malnutrition due to other reasons and to well-nourished patients with acute illness. Hospitalized weight-stable and well-nourished patients served as controls. Malnourished patients with or without cancer and acutely ill patients had a low T3 syndrome involving both peripheral metabolism of thyroid hormones and the hypothalamus-pituitary-thyroid gland axis. T3 levels were correlated to altered protein metabolism and protein nutritional state. There were pronounced elevations of circulating rT3 concentrations in patients with serum albumin concentration less than 35 g/l irrespective of diagnosis. The results indicate that the low T3 syndrome in our patients is secondary to insufficient caloric intake. It seems to be maintained by the abnormal nutritional state and is related closely to protein metabolism. The authors found no differences between the low T3 syndrome in cancer patients suffering from cachexia compared with that of patients with malnutrition caused by other factors.

Acute Disease↗
PubMed1984

Facts about the Kock continent ileostomy.

A great number of publications on the results obtained by different techniques employed for construction of the continent ileostomy have been published over the years. Unfortunately, many reports are incomplete or presented in such a way that they do not allow for proper interpretation or mutual comparison. Analysis of the collective results obtained from studies where the different techniques employed are accurately described and complications properly specified demonstrates more clearly what measures may improve the success rate and which factors have to be taken into account for anyone who is going to adopt the method.

Humans↗
PubMed1984

Flux of amino acids across the leg in weight-losing cancer patients.

Flux of amino acids across the leg was measured in malnourished cancer patients and three control groups: (a) malnourished patients without cancer; (b) well-nourished but acutely ill patients; and (c) well-nourished controls hospitalized for minor elective surgery. All patients were examined after an overnight fast, and some patients were reexamined 2 weeks later during enteral nutrition by gastric infusion of a formula diet. The efflux of amino acids did not differ qualitatively or quantitatively between malnourished cancer patients and malnourished patients without cancer. Well-nourished patients with acute illness had the greatest release of amino acids after an overnight fast. The leg efflux of amino acids did not correlate with plasma insulin levels in any of the patient groups, either in the fasting or in the fed state. Enteral nutrition decreased the efflux of amino acids from the leg in malnourished patients without cancer, but not in the malnourished cancer group. Enteral nutrition resulted in an increased peripheral uptake of energy precursors as glucose, free fatty acids, and the branched-chain amino acids. This was concomitant with increase in plasma level of triiodothyronine in malnourished patients without cancer. This study demonstrates that malnourished cancer patients do not differ from malnourished patients without cancer or from well-nourished patients after an overnight fast with respect to amino acid efflux from peripheral tissues, and thus shows normal adaptation for protein conservation. The results also suggest that conventional nasogastric tube-feeding was not sufficient alone to support normal replenishment of peripheral tissue in malnourished patients with and without cancer.

Acute Disease↗
PubMed1984

Resting energy expenditure in malnourished patients with and without cancer.

Resting energy expenditure was measured in a heterogeneous group of weight-losing cancer patients (n = 28) in comparison with noncancer patients with (n = 26) and without (n = 17) weight loss. Energy expenditure was measured in a ventilated hood after an overnight fast. The results are presented in relationship to the nutritional state of the patients. Cancer patients had elevated energy expenditure compared to noncancer patients when compared on several different bases. The slopes of the regressions between the degree of malnutrition and energy expenditure differed between cancer and noncancer patients. Depleted cancer patients had similar resting energy expenditure as predicted for healthy well-nourished individuals, but significantly higher compared with hospitalized malnourished noncancer patients. However, the differences in resting energy expenditure seemed to be less pronounced when very severely depleted cancer and noncancer patients were compared. The results indicate that a small but statistically significantly elevated energy expenditure occurs in a considerable number of cancer patients. It may, therefore, add to weight loss due to anorexia, but anorexia is considered to be quantitatively the more important factor of the two.

Aged↗
PubMed1983

Lack of evidence for elevated breakdown rate of skeletal muscles in weight-losing, tumor-bearing mice.

Protein degradation was measured as tyrosine release rate from proteins of extensor digitorum longus (EDL) muscles and as urinary excretion of 3-methylhistidine in freely fed adult nongrowing C57BL/6J mice with sarcomas, to study protein degradation in cancer-induced wasting of skeletal muscles. Whole muscle protein breakdown rate was unchanged, whereas protein synthesis was depressed, leading to an increased net degradation of skeletal muscles with loss of soluble, myofibrillar, and collagen proteins. Starvation for 24 hours elevated whole muscle protein breakdown in mice with and without sarcomas. Subsequent refeeding for 24 hours normalized the degradation. Adaptation to anorexia in pair-fed controls was achieved by a decrease in muscle protein turnover evaluated by urinary excretion of 3-methylhistidine over 5 days. The measurement of "catabolic decrease" of muscle protein breakdown protected the muscle mass in mice without tumors, but it was ineffective in tumor-bearing animals. The unchanged rate of breakdown of proteins in whole EDL muscles from tumor-bearing mice was accompanied by increased maximum cathepsin D activity and by elevated autolytic activity at acid pH in some muscles. Therefore, cathepsin D activity and net protease activities did not reflect whole muscle protein degradation in tumor-induced malnutrition. The results demonstrate that wasting of skeletal muscles in experimental cancer was not dependent on increased degradation but was dependent on depressed protein synthesis.

Animals↗
PubMed1983

Functional results after subtotal colectomy and caecorectal anastomosis.

Subtotal colectomy, preserving the ileocaecal valve and caecum, and caecoproctostomy has been recommended by some authors in the past and hypothetically it is a good a priori argument on the grounds of function for its use. The procedure has been employed in nine patients on different indications and the functional results assessed. When employed for treatment of chronic constipation or diverticular disease of the colon the functional results were poor. If the operation should be used at all it should probably be restricted to patients with an otherwise normal colorectal function. Even when employed on these indications, bowel habits differ little from those experienced by patients with a conventional ileorectal anastomosis.

Adult↗
PubMed1982

Autosuture of low colorectal anastomosis.

The safety of low colorectal anastomosis constructed with autosuture technique (U.S. EEA-stapling device, USSC) and the functional results were assessed in consecutive series of patients operated upon for rectal carcinoma. The operative procedure was greatly facilitated and certainly, many of the patients would otherwise have been subjected to abdominoperineal resection with permanent colostomy. Clinical leaks were observed in 4 of the 25 patients (16%) and another 4 patients were shown to have subclinical leaks, as demonstrated by endoscopy and/or X-ray. The total incidence of leaks was therefore 32% (8/25). Even when constructed with the autosuture technique a low anastomosis should probably be protected by a proximal enterostomy. There was a general tendency to anastomic narrowing during the initial period but in most patients stenosis disappeared with time after closure of the enterostomy. Frequent endoscopic examinations and dilatation of the anastomosis during the early postoperative period may be advantageous. The immediate functional results were unsatisfactory with increased frequency and varying grades of incontinence. Although these disturbances improved with time the results at six months after surgery were still not satisfactory and for confidence many patients wore a pad.

Aged↗
PubMed1982

Efflux of 3-methylhistidine from the leg in cancer patients who experience weight loss.

An improved method for measurement of 3-methylhistidine in blood samples has been used to assess efflux of 3-methylhistidine from the leg in cancer patients experiencing weight loss. Three control groups were studied: malnourished depleted patients without cancer; comparatively well-nourished but acutely ill patients; and well-nourished controls, hospitalized for elective surgery, who showed no symptoms of metabolic disease. Well-nourished controls and acutely ill patients had a statistically significant release of 3-methylhistidine [1.92 +/- 0.40 (S.E.) nmol/min/100 g leg tissue and 0.93 +/- 0.32 nmol/min/100 g, respectively], but cancer patients and malnourished noncancer patients had insignificant efflux. When nutritional support was provided, noncancer patients abolished their previously negative tyrosine balance and increased the efflux of 3-methylhistidine; however, cancer patients as a group continued to show a negative tyrosine balance, and the efflux of 3-methylhistidine continued to decrease further in them. The results in this study demonstrate that weight loss in clinical cancer is not dependent on increased skeletal muscle protein degradation, not even at an early stage of the disease. It seems likely that decreased protein synthesis is a more important factor.

Body Weight↗