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Biomedical subjects

H Freund

Publications and source records attributed to H Freund.

At least 73 records · Page 4Linked to original sources
PubMed1982

Infusion of branched-chain enriched amino acid solution in patients with hepatic encephalopathy.

Hospitalized patients with hepatic insufficiency often suffer from severe catabolic states and are in urgent need of nutritional support during their acute illness. Protein intolerence, however, remains a significant problem with respect to the provision of adequate nutrition, either enterally or parenterally. The following report is an anecdotal series of 63 consecutive patients in a large urban hospital treated prospectively with nutritional support using a prototype high branched-chain amino acid solution (FO80) given by technique of total parenteral nutrition by the subclavian or internal jugular route with hypertonic dextrose. Sixty-three patients, of which 42 had chronic liver disease (cirrhosis) with acute decompensation and 17 with acute hepatic injury as well as four with hepatorenal syndrome, are the subject of this report. All required intravenous nutritional support and were either intolerant to commercially available parenteral nutrition solutions or were in hepatic encephalopathy at the time they were initially seen. The cirrhotic patients had been hospitalized for a mean of 14.5 +/- 1.9 days before therapy, had a mean bilirubin of 13 mg/100 ml, and had been in coma for 4.8 +/- 0.7 days despite standard therapy. Patients with acute hepatitis had been in the hospital for 16.2 +/- 4.1 days before therapy, had a mean bilirubin of 25 mg/100 ml, and had been in coma 5.2 +/- 1.6 days before therapy. Routine tests of liver function, blood chemistries, amino acids, EEGs, and complex neurological testing including Reitan trailmaking tests were used in the evaluation of these patients. Up to 120 grams of synthetic amino acid solution with hypertonic dextrose was tolerated in these patients with improvement noted in encephalopathy of at least one grade in 87% of the patients with cirrhosis and 75% of the patients with hepatitis. Nitrogen balance was achieved when 75 to 80 grams of synthetic amino acids were administered. Survival was 45% in the cirrhotic group and 47% in the acute hepatitis group. Encephalopathy appeared to correlate with individual amino acids differentially in the various groups and with the ratio between the aromatic and the branched-chain amino acids. Ammonia did not correlate with either the degree of encephalopathy or improvement therefrom. In 24 Patients therapy for hepatic encephalopathy was limited to infusion of the branched-chain enriched amino acid solution only, with wake-up in 66% of this group. The results strongly suggest that in protein intolerant patients requiring nutritional support, infusion with branchedchain enriched amino acid solutions is well tolerated with either no worsening of or improvement in hepatic encephalopathy coincident with the achievement of nitrogen equilibrium and adequate nutritional support.

2-Hydroxyphenethylamine↗
PubMed1982

Surgical correction of ectropion of the anal mucosa.

A method to correct an ectropion of the anal mucosa, using the triangular flap technique, has been described. The operation is simple and physiologically sound, with special attention being paid to skin tension lines. The results are excellent, and the patient is relieved of discomfort, bleeding tenesmus and pruritus which accompany ectropion of the anal mucosa.

Anal Canal↗
PubMed1981

Lactate after exercise in man: I. Evolution kinetics in arterial blood.

Arterial and venous blood lactate concentrations were measured at 10 or 30 s time intervals before, during, and after several types of muscular exercise on an ergocycle in a sitting or supine position. Arterial blood lactate concentration curves over the recovery period were found to fit a biexponential time function including a rapidly increasing and a slowly decreasing component, even during active recovery at approximately 40% VO2 max exercise. The velocity constants were dependent on the exercise load. They were also linearly related to each other. The time of lactate disappearance during recovery increased with the work load.

Arm↗
PubMed1981

Lactate after exercise in Man: II. Mathematical model.

A mathematical model of lactate kinetics after exercise has been constructed from the application of the mass conservation law and the following assumptions: 1. The total lactate distribution space is composed of two compartments, i.e., (M) the previously working muscles and (S) the remaining lactate space; 2. The rates of lactate release and utilization in (M) and (S) are proportional to the lactate contents of these compartments; 3. The post-exercise lactate production rates in (M) and (S) are constants; 4. Arterial lactate concentration can represent the average lactate concentration in (S). Consideration of experimental facts reported in the literature shows these assumptions to be reasonable. The relationships obtained express the compatibility of parameters and time functions concerning lactate concentrations, as well as rates of production, uptake, release, and utilization. They open the way to various applications, especially those involving numerical fits to observed time courses of lactate concentrations.

Humans↗
PubMed1981

Lactate after exercise in man: III. Properties of the compartment model.

Lactate movements during recovery following muscular exercise in man were studied by means of a two-compartment model. Mathematical discussion of the literal expressions obtained allows one to represent parameters concerning lactate exchange, utilization, and production in the previously working muscles and in the remaining lactate distribution space. It also shows that bi-exponential time courses predicted for muscular and blood lactate concentrations as well as for rates of lactate uptake, release, and utilization can denote several morphologies. All of the time evolutions for muscular and blood lactate concentrations found in the literature are consistent with these theoretical possibilities in the model. A numerical application confirms this concordance. Thus, this simple model, for which the basic assumption were previously justified, appears to be qualitatively able to describe lactate exchanges and disappearance after exercise. A practical algorithm is put forward to display its possibilities and to test further its quantitative validity.

Humans↗
PubMed1981

Lactate after exercise in man: IV. Physiological observations and model predictions.

Following earlier papers that established the mathematical form of the time dependence of lactate concentrations during recovery from several types of exercise, and that set up a two-compartment model predicting the same time dependences, the present work applies the model to obtain parameters of specific physiological processes. Satisfactory agreement between predictions of the model and our experiment and literature data is obtained in the cases were comparisons can be made, as in the muscular lactate time evolution measured from biopsy samples, in blood flows through the active muscle at the end of exercise or at rest and their evolution during recovery, as well as in the volume of the active muscle compartment. The model prediction that lactate efflux from the muscles to the blood can reduce to zero during recovery is verified experimentally.

Arteries↗
PubMed1981

Choledochoduodenostomy in the treatment of benign biliary tract disease.

During the 15 year period 1965 through 1979, sixty patients underwent choledochoduodenostomy for benign obstructive lesions of the biliary tract. Patients with traumatic and iatrogenic common duct strictures were excluded. Eighty-two percent of the patients were in the seventh to ninth decades of life. Twenty-seven patients (45 percent) had undergone a total of 40 previous biliary tract surgical interventions. Thirty-three patients (55 percent) in the older age group (average age 75 years) were subjected to choledochoduodenostomy as a primary procedure during the first surgical intervention on the biliary system. Cholangitis recurred in only one patient (in whom the sump syndrome was the culprit), while all other patients have been free of abdominal complaints, cholangitis and pancreatitis during follow-up of 1 to 15 years. There was no operative mortality; morbidity was 26 percent. Hospital stay averaged 15 days. These favorable results mark choledochoduodenostomy as a safe, simple and effective procedure in the treatment of benign biliary tract disease, particularly in aged and high risk patients.

Adolescent↗
PubMed1981

An increase in vasoactive intestinal peptide levels in canine endotoxin shock.

Some of the many metabolic and cardiovascular activities and effects of vasoactive intestinal peptide are quite similar to the changes observed in endotoxin shock. The changes occurring in plasma vasoactive intestinal peptide levels during canine endotoxin shock were studied. Vasoactive intestinal peptide levels were markedly and significantly elevated following the administration of endotoxin, corresponding well with the drop in systemic blood pressure. In the dogs surviving the experiment, plasma vasoactive intestinal peptide levels returned to normal levels after 24 hours, corresponding well with the restoration of normal hemodynamic values. Surviving dogs exhibited significantly lower vasoactive intestinal peptide levels than did nonsurvivors. Many of the biologic activities of vasoactive intestinal peptide make it suitable for counteracting endotoxemia, thus acting as the defense of the body against endotoxin. However, the lower vasoactive intestinal peptide levels in the surviving dogs rather points to vasoactive intestinal peptide as a causative factor in canine endotoxemia.

Animals↗
PubMed1980

Protecting the high-risk rectal anastomosis.

Anastomotic leakage is a serious complication of colonic surgery, and contributes significantly to morbidity and mortality. A new technique has been developed to reduce the danger from such leaks, which involves exteriorizing a loop of transverse colon without opeining it. Should a leak develop, this loop can be transformed into a colostomy; otherwise, it can be easily remimplanted into the abdomen once the bowel is healed.

Colon↗
PubMed1980

Induction of pituitary tumours and hyperprolactinemia in female rats by estrogens. The effect of apomorphine, reserpine and L-dopa.

Prolonged estrogen treatment induced an enlargement of the anterior pituitary gland and finally resulted in irreversible pituitary tumours. Using continuous estrogen delivery [subcutaneous (s.c.) cholesterol-estrogen implants], the effects of ethinyl estradiol and the likewise synthetic estrogens STS 153 and STS 456 have been studied with or without concomitant administration of a progestogen without anti-estrogenic activities (STS 557). There was a dose-dependent prolactin cell-stimulating effect of all these estrogens. Ethinyl estradiol (EE2) had the most marked effect followed by STS 456 which coincides with the relative uterotrophic activity found in rats and mice. The elevated serum prolactin levels in rats with an EE2 implant for 6 months could be reduced slightly but not significantly by apomorphine and reserpine at a daily dose of 100 micrograms/animal and 5 micrograms/animal, respectively. Daily administration of 300 micrograms L-dopa led to a slight but insignificant increase of serum prolactin. The high pituitary weight and serum prolactin levels induced by long-term EE2 treatment were partially reversible after implant withdrawal.

Animals↗
PubMed1980

Blood pyruvate recovery curves after short heavy submaximal exercise in man.

Arterial pyruvate and lactate concentrations were measured after short heavy submaximal exercise on a bicycle ergometer, at 10 or 30 s time intervals, on six male subjects. During most of the first 2 min of recovery pyruvate concentration decreased. Thereafter, it increased and reached its maximum within the 5th to 9th min of recovery. Finally, it decreased gradually as a function of time. Recovery curves could be accurately described after a short delay time following the end of the exercise, by a sum of three exponential terms according to the equation: (Formula: see text), where the time origin (to) is fixed at about 1-1.5 min(delay time) after the end of exercise, t is the time after to, Y(O) and Y(t) are the concentrations of pyruvate respectively at times zero and T, and Ai and zi are constants. The velocity constant of the final arterial blood pyruvate decrease was similar to that of the simultaneously measured lactate, indicating that the rate of lactate removal is closely related to that of pyruvate. This is consistent with the fact that pyruvate is a necessary intermediate in the lactate metabolism.

Adult↗
PubMed1980

Does intravenous fat spare nitrogen in the injured rat?

The role of glucose versus fat as a source of energy in parenteral nutrition is controversial, particularly when administered after trauma, injury or in sepsis. In the present series of experiments, rats undergoing laparotomy and jugular vein cannulation were infused with hypertonic glucose or Intralipid with and without amino acids. The results demonstrate that the combination of amino acids and glucose has a better nitrogen-conserving ability than amino acids and fat, lasting at least 4 days after injury. However, when infused without amino acids, fat had the same nitrogen-conserving quality as glucose. The authors attribute the improved nitrogen-conserving quality of amino acids and glucose to the specific carbohydrate influence on amino acid metabolism, an action which is specific in both protein-free and protein-containing meals but has only very limited effect in the absence of simultaneously infused or fed amino acids. In the moderately to severely injured rat, a glucose calorie is significantly more effective in sparing nitrogen than a fat calorie.

Amino Acids↗
PubMed1980

Plasma amino acid analysis in the differential diagnosis of jaundice.

Distinguishing between obstructive (surgical) and hepatocellular (medical) jaundice is sometimes impossible using the relatively simple diagnostic means of history, physical examination and liver function tests. In an attempt to reduce the number of jaundiced patients in need of complex and expensive diagnostic procedures, we investigated the use of the plasma amino acid pattern in the diagnosis of jaundice. Jaundiced rats with galactosamine-induced hepatitis and seven patients with acute onset hepatitis presented a plasma amino acid pattern in which most all amino acid levels were elevated except for arginine in the rat and branched chain amino acids in the patients. Rats jaundiced due to common bile duct ligation and seven patients with obstructive jaundice proved at surgery exhibited a near-normal amino acid pattern. These experimental and clinical data demonstrate very clear qualitative and quantitative differences in plasma amino acid patterns of hepatocellular and obstructive jaundice, with the latter exhibiting an almost-normal pattern. We suggest the use of the plasma amino acid pattern as a useful adjunct in the differential diagnosis of medical and surgical jaundice.

Adult↗
PubMed1980

Effect of STS 557 on semen composition, fertility and sexual behaviour of male rabbits.

Fertility control of male rabbits was achieved by daily oral administration of STS 557 (17 alpha-cyanomethyl-17 beta-hydroxy-estra-4.9(10)-diene-3-one) over a period of 8 weeks. In doses of 10 and 20 mg STS 557 per animal per day, fertility inhibition was accompanied by a decrease of mean number of mounts and ejaculations. Furthermore, semen volume, number of sperm per ejaculate, and sperm motility were reduced. At a dose of 5 mg STS 557 per day, male sterility was associated with reduction of sperm motility and semen fructose content. Libido, semen volume, sperm number, and sialic acid content in semen remained unaffected. Development of male contraceptives on the basis of chronic progestin treatment without concomitant androgen supplement may thus be possible.

Animals↗
PubMed1980

Comparative study of parenteral nutrition in renal failure using essential and nonessential amino acid containing solutions.

One of the controversies in the nutritional therapy of patients with renal failure is the respective role of either the essential amino acids alone or both essential and nonessential amino acids in the treatment of these patients. During a period when essential amino acids were unavailable, a large number of patients with acute renal failure was treated with a modified solution consisting of both essential and nonessential amino acids. The solution consisted of 3.8 grams of nitrogen in 46 per cent dextrose in units of 750 milliliters. A mean of 2,322 +/- 151 calories was administered to this group of patients. Over-all, the survival rate was 9 per cent as opposed to 75 per cent in the previous group treated with essential amino acids only and hypertonic dextrose, 40 per cent, in the group of historical controls treated with hypertonic dextrose. The groups are not strictly comparable because the group treated with both essential and nonessential amino acids may not have been strictly comparable, particularly with a slightly longer duration of renal failure, higher initial blood urea nitrogen level and lower urine volume than either of the other two groups previously treated. While adequate stabilization, but not a decrease in the blood urea nitrogen level, may be achieved from the use of both essential and nonessential amino acids, the excessive mortality seen may be related to differential effects of essential amino acids in supporting host resistance, while nonessential amino acids do not. The results of this study suggest that, until the safety and efficacy of a mixture of essential and nonessential amino acids in renal failure can be demonstrated, essential amino acids remain the treatment of choice as the nutritional support of patients with acute tubular necrosis.

Acute Kidney Injury↗